Search

Summary: Review of medical records from 173 women with osteoporosis who received abaloparatide treatment revealed that 96.0% had at least one visit for osteoporosis management and 55.5% had medication support group access. The most common reasons for discontinuing treatment were financial (31.2%) and tolerability (22.8%). Most patients (64.8%) completed treatment as prescribed. Purpose: Abaloparatide is approved for the treatment of women with postmenopausal osteoporosis at high risk for fracture. This study evaluated real-world treatment patterns for patients new to abaloparatide, regardless of osteoporosis treatment history. Methods: Data for patients with ≥ 1 prescription for abaloparatide were collected retrospectively from six academic and clinical practice settings across the US. Results: A total of 173 patients were enrolled (mean [SD] age, 69.8 [7.4] years). At the time of abaloparatide treatment initiation, 78.6% had received other osteoporosis medications. Mean (SD) time from discontinuation of osteoporosis medications prior to initiation of abaloparatide was 1.7 (3.2) years. Twenty-four months of follow-up data from the initiation date of abaloparatide was collected from 94.0% of patients and 6.0% of patients had 12–24 months of follow-up. During the follow-up period, 96.0% of patients had at least one visit for osteoporosis management and 55.5% had access to a medication support program. The median duration of therapy was 18.6 months and 105/162 (64.8%) completed abaloparatide treatment as prescribed. The most common reasons for treatment discontinuation were financial (31.2%) and tolerability (22.8%). Following completion of a course of treatment with abaloparatide, 82/162 (50.6%) patients transitioned to another osteoporosis medication. The median time between abaloparatide treatment course completion and the initiation of follow-on medication was 21 days. Conclusion: Most patients completed treatment with abaloparatide as prescribed, and over half continued with an antiresorptive agent. This favorable conduct may be the result of regular follow-up visits and accessibility to both medication and patient support services. [ABSTRACT FROM AUTHOR]

Background and Purpose: People with Parkinson's disease (PD) are at risk for stigma. The stigma theory suggests four stigma types: public stigma, self-stigma, stigma by association, and structural stigma. The purposes of this study were to understand how people with PD and caregivers perceived and experienced stigma, review the literature and scan social media for evidence of stigma and PD, and examine the interrelationships between stigma types. Methods: This was a multicase, qualitative, descriptive research study. Cases included interviews with people with PD and caregivers, a literature review, and a scan of social media posts for evidence of stigma. Literature and social media were searched; seven people with PD and five caregivers completed the interviews. The stigma theory guided the analysis. Methods to ensure trustworthiness were employed. Results: Public stigma, self-stigma, stigma by association, and structural stigma were evident in the literature and described by caregivers. Public stigma, self-stigma, and structural stigma were described by people with PD. Public stigma was represented in social media posts. Interrelationships between public and self-stigma, public stigma and stigma by association, and self-stigma and structural stigma were identified. Implications for Practice: All stigma types were experienced and negatively affected people with PD and caregivers. Lack of knowledge and awareness caused stigma and should be addressed on multiple levels. Stigma experienced by people with PD was a global phenomenon; therefore, nurses internationally must be aware of their perceptions of and behavior toward people with PD. Engaging the public with people with PD will demystify PD and reduce stigma. Greater understanding of structural stigma and diverse populations and public perceptions is needed. [ABSTRACT FROM AUTHOR]

The article discusses research which examined the change in Internet use during the COVID-19 pandemic for people with Medicare aged 65 and older in the U.S. Cited are the method used to calculate for the proportion of people with Medicare who reported ever using the Internet at home in each year, overall and by person-level characteristics, and the reasons why racially or ethnically minoritized people with Medicare may be less likely to have access to telemedicine.

The passing of the Tax Cuts and Jobs Act ("TCJA") in December 2017 made significant changes that affect both domestic and international businesses income taxes. One of the most notable changes involves the Internal Revenue Code ("IRC") section 965 transition tax on foreign earnings of foreign subsidiaries of U.S. companies, which deems those earnings to be repatriated. Effectively, this transition tax disregards the realization element thought by some to be a U.S. Constitutional requirement. As such, questions have arisen in the courts regarding the constitutionality of these laws. The most noteworthy case of Moore v. United States has found its way to the steps of the U.S. Supreme Court. Petitioners are asking the U.S. Supreme Court to overturn the Ninth Circuit holding that income realization is not a requirement when upholding the transition tax. The outcome of this case could redefine the term "income" and thus disrupt the entire U.S. income tax code. The ruling from Moore will greatly affect not only current tax regimes such as Subpart F, GILTI, passthrough tax treatment, but also may have large implications on proposed tax laws such as the mark-to-market tax. Eliminating the realization requirement in the definition of income would effectively eliminate all possibility of the mark-to-market tax, otherwise known as the wealth tax, and quite possibly change all of tax law as we know it. [ABSTRACT FROM AUTHOR]

This article discusses the findings of an ethnographic study that explored the perceptions of ESL graduate students toward non-native English-Speaker Teachers (NNESTs) in the United States, a little researched topic. Analysis of classroom observations and interviews with 12 ESL graduate students from various countries showed that international ESL graduate students were active agents capable of exercising their agencies in evaluations of NNESTs. Overall, students enjoyed having a non-native speaker as their ESL teacher, which suggests that NNESTs have the cultural capital necessary for teaching ESL center courses. The students also reported initial disappointment about the constraints of NNESTs and about their changed attitudes, which seemed to be connected to changes in their teachers' confidence and effectiveness in classroom management. Suggestions for further research and practice are made.

Background: Hospitals may provide less positive patient experiences for older than younger patients. Methods: We used 2019 HCAHPS data from 4358 hospitals to compare patient‐mix adjusted HCAHPS Survey scores for 19 experience of care items for patients ages 75+ versus 55–74 years and tested for interactions of age group with patient and hospital characteristics. We contrasted the age patterns observed for inpatient experiences with those among respondents to the 2019 Medicare CAHPS (MCAHPS) Survey of overall experience. Results: Patients 75+ years (31% of all HCAHPS respondents) reported less‐positive experiences than those 55–74 (46% of respondents) for 18 of 19 substantive HCAHPS items (mean difference −3.3% points). Age differences in HCAHPS top‐box scores were large (>5 points) for 1 of 3 Nurse Communication items, 1 of 3 Doctor Communication, 2 of 2 Communication about Medication items, 1 of 2 Discharge Information items, and 2 of 3 Care Transition items. In contrast, for MCAHPS, those 75+ reported similar experiences to younger adults. The magnitude of age differences varied considerably across hospitals; some hospitals had very large age disparities for older patients (age 75+ vs. ages 55–74), while others had none. These age differences were generally smaller for patients in government and non‐profit than in for‐profit hospitals, and in the Pacific region than in other parts of the United States. This variation in age disparities across hospitals may help to identify best practices. Conclusions: Patients ages 75+ reported less‐positive experiences than patients ages 55–74, especially for measures of communication. These differences may be specific to inpatient care. Further study should investigate the effectiveness of hospital staffs' communication with older patients. Hospital protocols designed for younger patients may need to be adjusted to meet the needs of older patients. There may also be opportunities to learn from outpatient interactions with older patients. See related editorial by Aanand D. Naik in this issue. [ABSTRACT FROM AUTHOR]

When Michael Jackson died unexpectedly in Los Angeles, California, on June 25, 2009, his career and earnings were nearing an all-time low. Plagued by past sexual abuse allegations, scandals, and questionable health, Michael Jackson's personal finances were purported to be in complete disarray. However, following his unexpected death, the value of his estate, which was reported to be near to nothing, swelled as the world remembered his beloved contributions to the world and began to purchase accordingly. Sales of Michael Jackson's music began to soar high. The estate's value soared even higher as it signed licensing agreements and released new feature films and theatrical material of Michael Jackson. Not surprisingly, the Internal Revenue Service ("IRS") and the estate disagreed over the amount of estate tax owed. The IRS also remembered how beloved Michael Jackson had been and decided to take issue with the valuation used on the estate's tax return. There were three primary points of valuation disagreement, all of which involve intellectual property rights: (1) the estate's image and likeness rights; (2) the estate's share of the Sony/ATV music catalog; and (3) the estate's interest in Mijac Music, a music publishing catalog owning copyrights to many compositions written by Michael Jackson and other artists. With neither side willing to budge on its valuations, the dispute was to be settled in the U.S. Tax Court of Judge Mark Holmes. One would think that with the outcome of such a high-profile case resting almost exclusively on the testimony of valuation experts, the IRS would take great care with any experts selected to testify since any error on the part of an expert would have a damning effect on the entire case. However, one would be disappointed. The IRS's sole expert witness perjured himself in court testimony. In its opinion, the court reasoned that the expert's creditability "suffered greatly at trial" and his lack of creditability "affected our factfinding throughout [the case]." The article discusses: (1) the rise and fall of Michael Jackson during his life; (2) the details of the valuation battle with the IRS that took place after his death over various intellectual property; and (3) Judge Holmes' reasoning for his conclusion, including the perjury committed by the IRS' expert. [ABSTRACT FROM AUTHOR]

Healthcare workers (HCWs) need to be vaccinated against COVID-19 because they care for vulnerable patients. Hesitation to receiving the COVID-19 vaccine stems from the argument of bodily autonomy, novel mRNA vaccine technology, and conspiracy theories. However, vaccinations may prevent thousands of hospitalizations and deaths. HCWs have previously complied with other required vaccinations to care for children, elderly, and immunocompromised patients. Yet, COVID-19 vaccination mandates in the healthcare setting have been faced with resistance and subsequent staffing shortages. As HCWs display their hesitation to the vaccine, the community loses trust in its efficacy and safety. Speculation on pharmaceutical profiteering has also contributed to vaccine mistrust. As the pandemic continues, the healthcare field must decide on a course of action: adhere to vaccination mandates and cope with decreased staffing, repeal vaccination mandates to recover staff, rely on personal protective equipment (PPE) alone for protection, or do nothing and expect survival through herd immunity. To date, the United States has chosen to mandate COVID-19 vaccinations for any healthcare worker employed by Medicare and/or Medicaid-accepting facilities, allowing allergy and religious exemptions. This COVID-19 vaccination mandate for HCWs ethically protects the vulnerable people who HCWs vow to care for. [ABSTRACT FROM AUTHOR]

The article presents a study which asked whether there is evidence of improvement a few years after enrollment in healthcare access, care experiences, or quality of care as people gain experience with the Medicare program. Topics discussed include comparison of enrollees aged 66 to somewhat older counterparts in two ways, case-mix adjusted scores for seven Consumer Assessment of Healthcare Providers & Systems (CAHPS) measures, and assurance that Medicare's onboarding process is effective.

Objective: To evaluate how the addition of concurrent chemotherapy to radiation therapy (RT) affects outcomes for Asian American patients with nasopharyngeal carcinoma. Methods: Using the California Cancer Registry – a population‐based, state‐sponsored database – Asian American patients with newly‐diagnosed, locally advanced nasopharyngeal carcinoma diagnosed between 1998 and 2010 were identified. The Kaplan–Meier method was used to analyze overall survival and cancer‐specific survival. Cox proportional hazards models were constructed to investigate the association with chemotherapy. Propensity score methods were used to control for measure confounders. Results: A total of 812 Asian Americans were included; 91 (11.2%) underwent RT alone, and 721 (88.8%) underwent RT with chemotherapy. The overall survival at 5 years was 65% with RT alone versus 72% with RT plus chemotherapy (p = 0.31). The corresponding rates of cancer‐specific survival were 70% and 78% (p = 0.35). Cox regression analysis confirmed a trend toward reduced mortality (HR 0.88, 95% CI 0.62–1.25, p = 0.37) in patients receiving RT and chemotherapy. Conclusion: Consistent with other studies that have been published, the addition of chemotherapy to RT was associated with improved clinical outcomes. Although this improvement did not reach statistical significance, the use of concurrent chemoradiation seems reasonable for Asian Americans with nasopharyngeal carcinoma. [ABSTRACT FROM AUTHOR]

Stress is a significant part of daily life, and systemic social inequities, such as racism and discrimination, are well-established contributors of chronic stress for African Americans. Added exposure to the stress of caregiving may exacerbate adverse health outcomes. This secondary analysis describes subjective and objective stress in African American family caregivers, and relationships of subjective and objective stress to health outcomes. Baseline data from 142 African American dementia family caregivers from the "Great Village" study were described using means and frequencies; regression models and Pearson's correlation were used to examine associations between demographics, social determinants of health, and health outcomes. Mixed models were used to examine change and change variation in cortisol. Most caregivers had moderate degrees of stress. Stress was associated with sleep disruption and depressive symptoms, and discrimination appeared to be an independent contributor to depressive symptoms. This work provides a foundation for interpreting subjective and objective indicators of stress to tailor existing multicomponent interventions. [ABSTRACT FROM AUTHOR]

Imprisonment has deleterious effects on prisoners' mental, physical, social, and economic well-being. These harms are long lasting and affect prisoners' partners and children. In the United States and elsewhere, imprisonment disproportionately inflicts these harms on people of color and people living in poverty. Although imprisonment is regarded as a reasonable and effective means of protecting the public, it is not, when compared with nonconfinement alternatives, an effective way to achieve public safety. Two broad sets of policy reforms would be better: retroactive and prospective sentencing reforms that reduce reliance on confinement for all types of offenses, including violent crimes, and broad initiatives that reduce reliance on prison and jails while also investing in housing, education, treatment, health, and communities. Researchers and policy analysts need to engage in problem-solving research that examines not only incarceration's effects but alternative ongoing efforts to achieve public safety and justice. [ABSTRACT FROM AUTHOR]

Despite the availability of various osteoporosis treatments, adherence remains suboptimal. One contributing factor may be patient experience with therapy. This US, multicenter, combined retrospective chart review and patient questionnaire study included postmenopausal women at high risk for fracture and is the first study to describe real‐world patient experience with abaloparatide (ABL) injection. Eight geographically diverse secondary care sites in the United States participated (n = 193). Mean ± SD age was 67.4 ±8.62 years. Most patients (86%) were satisfied with the ABL regimen, especially with ease of preparation (82%), ease of storage (87%), and storage convenience (89%), an attribute 83% of the patients thought was important. The majority of patients reported complete satisfaction with the ABL regimen allowing for their ability to conduct daily activities (85%) and convenience to fit into their daily schedule (84%). All reported taking ABL as directed, by injection in the lower abdomen, and 83% of patients reported medium or high adherence. Patients were satisfied with the needle size (76% completely satisfied), and 93% reported never deliberately missing a dose. Although injecting medication (18%) and higher out‐of‐pocket costs (17%) were deemed the most bothersome attributes, the majority (69%) noted their healthcare team understands how osteoporosis impacts their lives. In multivariable analyses, ease of preparation (OR = 2.62; 95% CI, 1.01–6.81; p = 0.048) and fracture history (OR = 1.72; 95% CI, 1.03–2.86; p = 0.037) were significantly associated with overall satisfaction. Ease of preparation was a predictor of higher satisfaction with treatment convenience (coefficient = 13.60; 95% CI, 8.08–19.12; p = 0.00). Remembering to take the medication was a significant predictor of self‐reported adherence (OR = 16.66; 95% CI, 3.30–84.24; p = 0.001). In conclusion, the majority of patients were satisfied with ABL and found it convenient/easy to prepare and store. High self‐reported adherence may be associated with positive patient experience including ease of use and adequate support from healthcare providers. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

Introduction: Although HIV pre-exposure prophylaxis (PrEP) is available at no cost to personnel in the United States (U.S.) military, uptake has been lower than expected. An online survey was conducted assessing current knowledge, perceptions, and attitudes of primary care providers in the U.S. Navy.Materials and Methods: A cross-sectional anonymous online survey was conducted among U.S. Navy healthcare providers in active service. Providers' demographics, medical practice and PrEP experience, and attitudes regarding PrEP were assessed by self-rated PrEP knowledge.Results: Greater than half of respondents reported being knowledgeable about PrEP and a majority (78%) supported the provision of PrEP in the military health system. However, only 19% had ever prescribed PrEP. Self-reports of having been questioned by a patient about PrEP, having high levels of comfort discussing sexual risk behaviors, and being in a specialty of infectious disease, occupational health, or preventive medicine were associated with increased knowledge about PrEP. The more knowledgeable a provider was about PrEP, the more likely they were to prescribe it (29% vs. 6%).Conclusions: Although Navy providers were supportive of the provision of PrEP by the military, knowledge gaps remain. Training to address the knowledge deficit as well as improving sexual history taking are potential areas to target in implementing PrEP in primary care specialties. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to compare the incidence of venous thromboembolism between obese and non-obese hospitalized patients who received United States Food and Drug Administration-approved prophylactic enoxaparin doses and to describe enoxaparin dosing strategies used in obese patients. Methods: This was a retrospective cohort study including patients who were admitted to Parkview Regional Medical Center, Parkview Hospital, or Parkview Orthopedic Hospital between September 2011 and August 2012 and received at least one dose of enoxaparin 30 mg twice daily or enoxaparin 40 mg once daily for venous thromboembolism prophylaxis. Patients classified based on their body mass index into three groups, Group 1 (non-obese: body mass index < 25 kg/m2), Group 2 (overweight: body mass index ≥ 25 kg/m2 but < 30 kg/m2), and Group 3 (obese: body mass index ≥ 30 kg/m2). The primary endpoint was venous thromboembolism occurrence within 90 days, considering day 1 of hospitalization as day 1. Results: Of the 428 patients included, 8 cases of venous thromboembolism (1.9%) were identified; 3 in the non-obese group, 2 in the overweight group, and 3 in the obese group, no statistically significant differences were found between the three groups, p = 0.81. When venous thromboembolism incidence was adjusted for age and sex, no statistically significant differences were found between overweight (OR = 0.685; 95% CI 0.115–4.095), obese (OR = 0.797; 95% CI 0.353–1.796), and combined overweight and obese (OR = 0.656; 95% CI 0.154–2.799) groups compared to patients with normal body weight. Conclusion: This study did not find a statistically significant difference in venous thromboembolism incidence between obese, overweight, and non-obese hospitalized patients receiving approved enoxaparin prophylaxis doses. [ABSTRACT FROM AUTHOR]

Objective: Spanish-preferring Medicare beneficiaries are underrepresented in national patient experience surveys. We test a method for improving their representation via higher response rates.Data Sources/study Setting: 2009-2010 Medicare CAHPS surveys; Medicare population.Study Design: We used surname and address to predict Spanish-language preference for a national sample of 177 139 beneficiaries. We randomized half of the 10 000 non-Puerto Rico beneficiaries with the highest predicted probabilities of Spanish preference (>10 percent) to bilingual mailings (intervention) and half to standard English-only mailings (control).Data Collection: Medicare CAHPS Survey data were collected through mail surveys with telephone follow-up of nonrespondents.Principal Findings: Mail response rate was higher for intervention (28.7 percent) than control (23.9 percent) (P < 0.0001); phone response rates among mail nonrespondents were similar in intervention and control arms (15.8 percent vs 15.7 percent, P = 0.90). Targeted bilingual mailings induced 6.5 percent of those who would not have responded to respond by mail and 54.0 percent of those who would have responded in English to respond in Spanish. Beneficiaries with greater Spanish probabilities showed greater increases in response rates, a higher proportion of responses in Spanish, and lower control response rates among.Conclusions: Targeted bilingual mailing of mixed-mode surveys using commonly available surname and address information can efficiently increase representation of this underrepresented group. [ABSTRACT FROM AUTHOR]

The article discusses U.S. waterborne commerce on the Great Lakes System in the 1940's. The Great Lakes System consists of the Michigan, Huron, Erie, Superior, and Ontario lakes, along with their connecting channels. The area is considered an integral part of the world's grain producing regions. Wheat is the leading grain carried on the lakes. The lakes also serve as links in the transportation of iron ore resources from mine to smeltery. Experts say the trade in the lakes system is a classic example of the comparative advantage doctrine.

Although the wisdom of mass incarceration is now widely questioned, incarceration rates have fallen far less than what would be predicted on the basis of crime trends. Informed by institutional studies of path dependence, sociolegal scholarship on legal discretion, and research suggesting that "late mass incarceration" is characterized by a moderated response to nonviolent crime but even stronger penalties for violent offenses, this article analyzes recent sentencing‐related reforms and case processing outcomes. Although the legislative findings reveal widespread willingness to moderate penalties for nonviolent crimes, the results also reveal a notably heightened system response to both violent and nonviolent crimes at the level of case processing. These findings help explain why the decline in incarceration rates has been notably smaller than the drop in crime rates and are consistent with the literature on path dependence, which emphasizes that massive institutional developments enhance the capacity and motivation of institutional actors to preserve jobs, resources, and authorities. The findings also underscore the importance of analyzing on‐the‐ground case processing outcomes as well as formal law when assessing the state and fate of complex institutional developments such as mass incarceration. [ABSTRACT FROM AUTHOR]

Background. "The ongoing opioid crisis lies at the intersection of two substantial public health challenges- reducing the burden of suffering from pain and containing the rising toll of the harms that can result from the use of opioid medications" [1]. Improved pain education for health care providers is an essential component of the multidimensional response to both still-unmet challenges [2,3]. Despite the importance of licensing examinations in assuring competency in health care providers, there has been no prior appraisal of pain and related content within the United States Medical Licensing Examination (USMLE). Methods. An expert panel developed a novel methodology for characterizing USMLE questions based on pain core competencies and topical and public health relevance. Results. Under secure conditions, raters used this methodology to score 1,506 questions, with 28.7% (432) identified as including the word "pain." Of these, 232 questions (15.4% of the 1,506 USMLE questions reviewed) were assessed as being fully or partially related to pain, rather than just mentioning pain but not testing knowledge of its mechanisms and their implications for treatment. The large majority of questions related to pain (88%) focused on assessment rather than safe and effective pain management, or the context of pain. Conclusions. This emphasis on assessment misses other important aspects of safe and effective pain management, including those specific to opioid safety. Our findings inform ways to improve the long-term education of our medical and other graduates, thereby improving the health care of the populations they serve. [ABSTRACT FROM AUTHOR]

Objectives To use items from the Medicare Health Outcomes Survey ( HOS) to adapt or validate a simple method for identifying community-dwelling older adults at greater risk of death and to extend the method to identify a very high-risk group. Design Analysis of longitudinal data. Setting National sample of beneficiaries from Medicare Advantage plans with 500 or more enrollees. Participants Medicare beneficiaries aged 65 and older responding to 2009 baseline and 2011 follow-up HOS (N = 238,687). Measurements Bivariate and multivariate analyses of the HOS; adaptation and validation of a previously validated Vulnerable Elders Survey-13 ( VES-13) scoring system that uses age and self-reported function to predict mortality. Results A modified predictive model, that uses substitutes for several items in the previously validated VES-13, predicted 2-year mortality; 10.6% of those scoring 3 or more, and 2.4% of those scoring less than 3 died within 2 years (relative risk of death 4.4, similar to 4.2 for the original VES-13 sample), and 15.5% of those scoring 7 or more died within 2 years (relative risk of death (relative to scores <3) of 6.5). Sixteen percent of HOS beneficiaries were missing some data; 2-year mortality for those with missing items was 9.5%, versus 7.1% for those with no missing items ( P < .001). Imputation of median values for missing VES-13 items results in valid predictions of mortality for those with partially missing data. Conclusion The VES-13 algorithm is robust to substitution of functional items and can be used to identify very high-risk older adults. Multiple imputation of missing items reduces loss-to-follow-up bias and increases sample size. [ABSTRACT FROM AUTHOR]

Seattle deploys several mechanisms by which individuals' presence in particular spaces can constitute a crime. Through a range of means, police in Seattle are given wide authority to question and arrest those who appear as human manifestations of the 'disorder' that is of concern to many. Importantly, these programs accentuate the power of criminal law by mobilizing other forms of law, most notably civil law and administrative law. This legally-hybrid structure works to accentuate the police's power notably. Yet increased police power does not actually work to reduce 'disorder' to any appreciable extent. For this reason, and others, we suggest that different approaches to addressing social marginality represent more promising avenues for cities like Seattle to explore. [ABSTRACT FROM AUTHOR]

The article discusses the state of trade in Alaska at the time of publication. The author presents the history of the United States' acquisition of Alaska from Russia in 1867. A profile of Alaska's exploited natural resources is given, including the mining of iron, silver, platinum and gold, fur trade, fishing and canning industries, and petroleum production. The author notes the limited system of road and rail transportation that exists in the region and highlights the use of air travel to reach remote areas.

The article reports on the statistical analysis of reciprocal foreign trade agreements. The author explains that the United States' trade with foreign countries is correlated between trade agreement countries and non-trade agreement countries. A chart is presented which tracks the changes in value of foreign trade between 1934-1939 for both agreement countries and non-agreement countries. Another chart evaluates the amount of imports between the United States and foreign countries depending if they are agreement or non-agreement countries.

Given the high costs of collecting survey data, adding supplemental questions to large, ongoing survey data collection efforts potentially offers a cost-effective way to collect additional information customized to the specific needs of users of a general survey. The Medicare Advantage Consumer Assessment of Healthcare Providers and Systems (MA CAHPS) Surveys use mail with telephone follow-up to survey Medicare beneficiaries about their experiences with health plans. These surveys are administered by trained survey vendors, who were allowed to add any number of supplementary survey items to the core survey in 2012, as long as the items met content requirements. Vendors and health plans create these supplemental items for internal quality improvement efforts. Because the results of the core items from the surveys are publicly reported and used to calculate Medicare Quality Bonus Payments to health plans under the Affordable Care Act, concern arose that an excessive number of supplementary items might adversely affect response rates and the reliability of plan-level estimates. To estimate the effect of supplemental items on response rates, we used logistic regression, controlling for survey vendor and characteristics of beneficiaries and plans. Response rates were lower in both telephone and mail modes with more supplemental items (p < 0.001). The use of 12 supplemental items was associated with response rates 2.5 percentage points lower, compared with surveys with no supplemental items. These results were used to develop new guidelines suggesting that supplemental items be limited to a maximum of 12. [ABSTRACT FROM AUTHOR]

Objective. Hepatitis B virus (HBV) infection continues to be a public health threat in the United States. As many as 2.2 million people are infected, approximately 70% of whom are foreign-born, and fewer than one-third are aware of their infection. We launched an HBV testing and linkage-to-care initiative among foreign-born people. Methods. As part of the Hepatitis Testing and Linkage to Care (HepTLC) initiative, which promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites, nine U.S. programs in seven states conducted HBV screening from October 2012 to September 2014. The nine programs partnered with health-care centers and community-based organizations to recruit foreign-born people recommended for HBV testing. We assessed patient characteristics, region of origin, risk factors, hepatitis B surface antigen (HBsAg) status, and referral to medical care. Results. Of 23,144 participants tested for HBV, 1,317 (5.7%) were HBsAg positive. Of these, the median age was 47 years, 1,205 (91%) had at least one risk factor for HBV infection, 1,117 (85%) received posttest counseling, 1,098 (83%) were referred to care, and 606 (46%) attended a first medical appointment. The proportion of HBsAg-positive participants by region of origin included Africa (10%, 206/2,129), Western Pacific (6%, 616/9,673), Eastern Mediterranean (5%, 174/3,337), Southeast Asia (5%, 191/3,891), South America (2%, 6/252), Eastern Europe (2%, 6/262), and North America (1%, 17/1,936). Conclusion. Community-based HBV testing initiatives can identify substantial numbers of people with chronic HBV infection, inform them of their infection status, and provide posttest counseling and linkage to care. However, strategies are needed to improve linkage to HBV-directed medical care for foreign-born individuals living with chronic HBV infection. [ABSTRACT FROM AUTHOR]

Background: Seniors who live alone are a large, growing population with poorer health outcomes. We examine the little-studied health care experiences and immunizations of older adults who live alone.Methods: We use regression-based case-mix adjustment to compare immunizations and health care experiences of 325,649 adults aged 65 and older who lived alone to those who did not, overall and by gender and health status, using nationally representative data from the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) surveys. Outcomes were five global care ratings (health plan, drug plan, doctor, specialists, all care), six composite care measures (getting needed care, getting care quickly, doctor communication, customer service, getting needed drugs, getting information from drug plan), and two immunization measures (influenza, pneumonia).Results: About 30.3% of respondents lived alone. Women, older beneficiaries, and low income (Medicaid eligible) beneficiaries reported living alone at substantially higher rates than their counterparts. Care experiences for 8 of the 13 measures were significantly worse for those who lived alone than for others. The association differed significantly in magnitude by gender for 10 measures, with larger average differences for men. The largest disadvantages for those living alone were for immunization measures (eg, influenza -6 percentage points, for men living alone vs other men). The disadvantages of living alone were not consistently greater for those in worse health.Conclusions: Living alone is associated with worse care experiences and immunization, especially for men. Health plans should target quality improvement and outreach efforts to beneficiaries who live alone, especially men. [ABSTRACT FROM AUTHOR]

Like many businesses, companies in the financial services industry can generally benefit from the flexible coverage available through captive insurance company arrangements. Financial services companies may have an especially high degree of exposure because of the large amounts of assets they have under management, and the perception that they have "deep pockets." Moreover, financial service companies face various risks for which coverage may be commercially unavailable, or unattractive due to prohibitively high premiums. Available commercial policies may have large coverage gaps. Among other benefits, captive insurance companies offer the flexibility to underwrite these and other commercially reasonable risks. Although in the past the IRS aggressively resisted captive insurance companies, both the IRS and the courts now respect captive insurance as a legitimate risk management arrangement--as long as it meets all legal requirements. [ABSTRACT FROM AUTHOR]

Front-of-package nutrition symbols (FOPs) are presumably readily noticeable and require minimal prior nutrition knowledge to use. Although there is evidence to support this notion, few studies have focused on Facts Up Front type symbols which are used in the US. Participants with varying levels of prior knowledge were asked to view two products and decide which was more healthful. FOPs on packages were manipulated so that one product was more healthful, allowing us to assess accuracy. Attention to nutrition information was assessed via eye tracking to determine what if any FOP information was used to make their decisions. Results showed that accuracy was below chance on half of the comparisons despite consulting FOPs. Negative correlations between attention to calories, fat, and sodium and accuracy indicated that consumers over-relied on these nutrients. Although relatively little attention was allocated to fiber and sugar, associations between attention and accuracy were positive. Attention to vitamin D showed no association to accuracy, indicating confusion surrounding what constitutes a meaningful change across products. Greater nutrition knowledge was associated with greater accuracy, even when less attention was paid. Individuals, particularly those with less knowledge, are misled by calorie, sodium, and fat information on FOPs. [ABSTRACT FROM AUTHOR]

Objectives. We examined HCV exposure prevalence and predictors among persons in the United States born during 1945-1965. Methods. With data from the 1999-2008 National Health and Nutrition Examination Survey, we calculated the proportion of persons born during 1945-1965 who tested positive for HCV antibody (anti-HCV) and analyzed the prevalence by sociodemographic and behavioral risk factors. Results. Anti-HCV prevalence in the 1945-1965 birth cohort was 3.2% (95% confidence interval [CI] = 2.8%, 3.8%), substantially higher than among other adults (0.9%). Within the cohort, anti-HCV prevalence was higher among non- Hispanic Blacks (6.4%; 95% CI = 5.3%, 7.7%), persons with injection drug use histories (56.8%; 95% CI = 48.4%, 64.8%), and persons with elevated alanine aminotransferase levels (12.7%; 95% CI = 10.7%, 15.1%). Injection drug use (adjusted odds ratio = 98.4; 95% CI = 58.8, 164.5) was the strongest anti-HCV prevalence predictor. Among anti-HCV-positive persons, 57.8% reported having 2 or more alcoholic drinks daily. Conclusions. With the high prevalence of HCV among persons born during 1945-1965, the increasing morbidity and mortality associated with HCV, and reductions in liver cancer and HCV-related mortality when HCV is eradicated, it is critically important to identify persons with HCV and link them to appropriate care. [ABSTRACT FROM AUTHOR]

Background: During the last decade, there has been a movement in the United States toward utilizing size-appropriate radiation doses for pediatric body CT, with smaller doses given to smaller patients. Objective: This study assesses community adoption of size-appropriate pediatric CT techniques. Size-specific dose estimates (SSDE) in pediatric body scans are compared between community facilities and a university children's hospital that tailors CT protocols to patient size as advocated by Image Gently. Materials and methods: We compared 164 pediatric body scans done at community facilities (group X) with 466 children's hospital scans. Children's hospital scans were divided into two groups: A, 250 performed with established pediatric weight-based protocols and filtered back projection; B, 216 performed with addition of iterative reconstruction technique and a 60% reduction in volume CT dose index (CTDI). SSDE was calculated and differences among groups were compared by regression analysis. Results: Mean SSDE was 1.6 and 3.9 times higher in group X than in groups A and B and 2.5 times higher for group A than group B. A model adjusting for confounders confirmed significant differences between group pairs. Conclusions: Regional community hospitals and imaging centers have not universally adopted child-sized pediatric CT practices. More education and accountability may be necessary to achieve widespread implementation. Since even lower radiation doses are possible with iterative reconstruction technique than with filtered back projection alone, further exploration of the former is encouraged. [ABSTRACT FROM AUTHOR]

Objectives To compare reports about care experiences of individuals who died within 1 year of survey with reports of those who did not. Design Medicare Advantage ( MA) Consumer Assessment of Healthcare Providers and Systems ( CAHPS) surveys asked about care experiences. Survey completion dates were linked to Social Security Administration death records to identify enrollees dying within 1 year of survey completion. Propensity-score weighting combined with regression-based case-mix adjustment was used to compare these individuals' experiences with experiences of those who were alive 1 year later. Setting Nationally representative sample of MA enrollees. Participants Four hundred two thousand five hundred ninety-three MA enrollees responding to 2008 and 2009 CAHPS Surveys. Measurements Outcomes were five care ratings (plan, prescription drug coverage, doctor, specialists, care) and five composite measures of care (getting needed care, getting care quickly, doctor communication, getting drugs, getting drug information). Analyses were adjusted for age, sex, race and ethnicity, education, Medicaid status, geographic region, and several health status measures. Results Twelve thousand one hundred two enrollees (3%) died within 1 year of survey completion (near-end-of-life group). Those enrollees reported slightly better experiences than other enrollees with respect to getting care quickly (+2%, P < .001) and gave slightly higher ratings for their plans (+1%, P = .02) and prescription drug coverage (+1%, P < .001). There were no measures of participant experience for which the near-end-of-life group reported worse experiences than other enrollees. Conclusion Contrary to analyses based on retrospective reports from surviving relatives after an individual's death, MA enrollees' reports about care within 1 year of death were as good as or better than reports of other MA enrollees. Future research might investigate whether results are similar in other Medicare populations. [ABSTRACT FROM AUTHOR]

An essay is presented about an article on the prevalence of racial disparities in the U.S. drug law enforcement system, by Engel and colleagues, published within the issue. The article concluded that there is a high degree of geographic and racial congruity between drug-related 911 calls and drug arrests. The author argues against the article's claim that reforming deployment and arrest patterns will be unjust.

This article presents a study which identified sex-specific trends in annual Northern Saw-whet Owl movement during autumn migration across eastern North America. Using DNA analysis, the researchers determined the accuracy of the morphometric methods used by banders to sex the owls reported in the archives compiled by the U.S. Geological Survey's Bird Banding Laboratory. The study concluded that the sex-specific migration hypothesis is supported by the low variation in measurements between captures and the high congruence between genetic and morphometric sexing methods.

Abstract: Vaccination with plasmid DNA against infectious pathogens including dengue is an active area of investigation. By design, DNA vaccines are able to elicit both antibody responses and cellular immune responses capable of mediating long-term protection. Great technical improvements have been made in dengue DNA vaccine constructs and trials are underway to study these in the clinic. The scope of this review is to highlight the rich history of this vaccine platform and the work in dengue DNA vaccines accomplished by scientists at the Naval Medical Research Center. This work resulted in the only dengue DNA vaccine tested in a clinical trial to date. Additional advancements paving the road ahead in dengue DNA vaccine development are also discussed. [Copyright &y& Elsevier]

We used information compiled by the U.S. Geological Survey's Bird Banding Laboratory and geographic information systems (GIS) analysis to identify trends in annual Northern Saw-whet Owl (Aegolius acadicus) movement across eastern North America. Analysis of 81,584 Northern Saw-whet Owl banding events revealed a southbound annual fall migration front with peak banding activity occurring progressively later in the season as latitude decreases. Northbound owls comprised <9% of owls banded and recaptured elsewhere in the same season, and <5% were recaptured northbound > 100 km from banding location. There was no relationship between banding latitude and adult-to-juvenile ratio. However, the proportion of adults versus juveniles banded was not uniform among banding stations, suggesting age-differentiated migration patterns may exist. Information from multiyear foreign recaptures revealed that 72% of owls banded and subsequently recaptured at the same latitude in different years were recaptured < 100 km from banding location. A similar trend was found in the Appalachian Mountains, the Great Lakes Basin, and the Atlantic seaboard. This indicates that Northern Saw-whet Owls may exhibit high migration route fidelity. These findings expand the Northern Saw-whet Owl information portfolio and illustrate the versatility of aggregate data sets as a tool for answering large-scale questions regarding migration. [ABSTRACT FROM AUTHOR]

This article explores the impact of the imposition of legal financial obligations (LFOs) as supplements to other criminal penalties in the U.S. According to the article, LFOs include fees, fines and restitution orders. It discusses a proposal that offenders should pay for the cost of punishing their misdeeds. It also comments on the absence of a persuasive penological rationale for the practice.

Recent research suggests that the use of monetary sanctions as a supplementary penalty in state and federal criminal courts is expanding, and that their imposition creates substantial and deleterious legal debt. Little is known, however, about the factors that influence the discretionary imposition of these penalties. This study offers a comprehensive account of the role socio-cultural factors, especially race and ethnicity, have in this institutional sanctioning process. We rely on multilevel statistical analysis of the imposition of monetary sanctions in Washington State courts to test our theory. The theoretical framework emphasizes the need to treat race and ethnicity as complex cultural categories, the meaning and institutional effects of which may vary across time and space. Findings indicate that racialized crime scripts, such as the association of Latinos with drugs, affect defendants whose wrong-doing is stereotype congruent. Moreover, all individuals accused of committing racially and ethnically stigmatized offenses in racialized contexts may experience the courtesy stigma that flows from racialization. We find that race and ethnicity are not just individual attributes but cultural categories that shape the distribution of stigma and the institutional consequences that flow from it. [ABSTRACT FROM PUBLISHER]

The article focuses on the judicial battle of the U.S. on offshore banking. Information is offered on the U.S. v. UBS AG case wherein the U.S. Department of Justice filed a suit against the Union Bank of Switzerland (UBS) to reveal the names of American customers, suggesting that UBS and its clients made use of offshore accounts to evade taxes. The 2003 changes in the U.S.-Switzerland Tax Information Exchange Agreement (TIEA) is discussed wherein it clarified what constituted "tax fraud."

Background: The National Institutes of Health has called for expansion of practice-based research to improve the clinical research enterprise. Methods: This paper presents a model for the reorganization of clinical research to foster long-term participation by community clinicians. Based on the literature and interviews with clinicians and other stakeholders, we posited a model, conducted further interviews to test the viability of the model, and further adapted it. Results: We propose a three-dimensional system of checks and balances to support community clinicians using research support organizations, community outreach, a web-based registry of clinicians and studies, web-based training services, quality audits, and a feedback mechanism for clinicians engaged in research. Conclusions: The proposed model is designed to offer a systemic mechanism to address current barriers that prevent clinicians from participation in research. Transparent mechanisms to guarantee the safety of patients and the integrity of the research enterprise paired with efficiencies and economies of scale are maintained by centralizing some of the functions. Assigning other responsibilities to more local levels assures flexibility with respect to the size of the clinician networks and the changing needs of researchers. [ABSTRACT FROM AUTHOR]

Background: Translating the extraordinary scientific and technological advances occurring in medical research laboratories into care for patients in communities throughout the country has been a major challenge. One contributing factor has been the relative absence of community practitioners from the US biomedical research enterprise. Identifying and addressing the barriers that prevent their participation in research should help bridge the gap between basic research and practice to improve quality of care for all Americans. Methods: We interviewed over 200 clinicians and other healthcare stakeholders from 2004 through 2005 to develop a conceptual framework and set of strategies for engaging a stable cadre of community clinicians in a clinical research program. Results: Lack of engagement of community practitioners, lack of necessary infrastructure, and the current misalignment of financial incentives and research participation emerged as the three primary barriers to community clinician research participation. Although every effort was made to learn key motivators for engagement in clinical research from interviewees, we did not observe their behavior and self-report by clinicians does not always track with their behavior. Conclusions: A paradigm shift involving acknowledgement of the value of clinicians in the context of community research, establishment of a stable infrastructure to support a cohort of clinicians across time and research studies, and realignment of incentives to encourage participation in clinical research is required. [ABSTRACT FROM AUTHOR]

The article it discusses the capital control effects of tax enforcement, gold regulation and retirement reform in the U.S. It states that the Hiring Incentives to Restore Employment (HIRE) Act created a tougher regulatory environment especially for foreign financial institutions that have bank or investment accounts for taxpayers. The article also mentions the Dodd-Frank Act in relation to the supply of gold to the market.