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Background: Engaging patients and community members in healthcare implementation, research and evaluation has become more popular over the past two decades. Despite the growing interest in patient engagement, there is scant evidence of its impact and importance. Boot Camp Translation (BCT) is one evidence-based method of engaging communities in research. The purpose of this report is to describe the uptake by primary care practices of cardiovascular disease prevention materials produced through four different local community engagement efforts using BCT. Methods: EvidenceNOW Southwest (ENSW) was a randomized trial to increase cardiovascular disease (CVD) prevention in primary care practices. Because of its study design, Four BCTs were conducted, and the materials created were made available to participating practices in the "enhanced" study arm. As a result, ENSW offered one of the first opportunities to explore the impact of the BCT method by describing the uptake by primary care practices of health messages and materials created locally using the BCT process. Analysis compared uptake of locally translated BCT products vs. all other products among practices based on geography, type of practice, and local BCT. Results: Within the enhanced arm of the study that included BCT, 69 urban and 13 rural practices participated with 9 being federally qualified community health centers, 14 hospital owned and 59 clinician owned. Sixty-three practices had 5 or fewer clinicians. Two hundred and ten separate orders for materials were placed by 43 of the 82 practices. While practices ordered a wide variety of BCT products, they were more likely to order materials developed by their local BCT. Conclusions: In this study, patients and community members generated common and unique messages and materials for cardiovascular disease prevention relevant to their regional and community culture. Primary care practices preferred the materials created in their region. The greater uptake of locally created materials over non-local materials supports the use of patient engagement methods such as BCT to increase the implementation and delivery of guideline-based care. Yes, patient and community engagement matters. Trial registration and IRB: Trial registration was prospectively registered on July 31, 2015 at ClinicalTrials.gov (NCT02515578, protocol identifier 15–0403). The project was approved by the Colorado Multiple Institutional Review Board and the University of New Mexico Human Research Protections Office. [ABSTRACT FROM AUTHOR]

E-Verify laws, which have been adopted by 23 states, require employers to verify whether new employees are eligible to legally work prior to employment. This study explores the impact of state E-Verify laws on crime. Using data from the 2004–2015 National Incident Based Reporting System, the authors find that the enactment of E-Verify is associated with a 7% reduction in property crime incidents involving Hispanic arrestees. This finding was strongest for universal E-Verify mandates that extend to private employers and its external validity bolstered by evidence from the Uniform Crime Reports. Supplemental analyses from the Current Population Survey suggest two mechanisms to explain this result: E-Verify-induced increases in the employment of low-skilled natives of Hispanic descent and out-migration of younger Hispanics. Findings show no evidence that arrests were displaced to nearby jurisdictions without E-Verify or that violent crime or arrests of African Americans were affected by E-Verify laws. The magnitudes of the estimates suggest that E-Verify laws averted $491 million in property crime costs to the United States. [ABSTRACT FROM AUTHOR]

As of 2023, the use of prescribed fire to manage ecosystems accounts for more than 50% of area burned annually across the United States. Prescribed fire is carried out when meteorological conditions, including temperature, humidity, and wind speed are appropriate for its safe and effective application. However, changes in these meteorological variables associated with future climate change may impact future opportunities to conduct prescribed fire. In this study, we combine climate projections with information on prescribed burning windows for ecoregions across the contiguous United States (CONUS) to compute the number of days when meteorological conditions allow for the safe and effective application of prescribed fire under present-day (2006–2015) and future climate (2051–2060) conditions. The resulting projections, which cover 57% of all vegetated area across the CONUS, indicate fewer days with conditions suitable for prescribed burning across ecoregions of the eastern United States due to rising maximum daily temperatures, but opportunities increase in the northern and northwestern United States, driven primarily by rising minimum temperatures and declining wind speeds. [ABSTRACT FROM AUTHOR]

Across much of the eastern United States, oak forests are undergoing mesophication as shade‐tolerant competitors become more abundant and suppress oak regeneration. Given the historical role of anthropogenic surface fires in promoting oak dominance, prescribed fire has become important in efforts to reverse mesophication and sustain oaks. In 2000 we established the Ohio Hills Fire and Fire Surrogate (FFS) study to examine whether repeated prescribed fire (Fire), mechanical partial harvest (Mech), and their combined application (Mech + Fire) reduced the dominance of subcanopy mesophytic competitors, increased the abundance of large oak–hickory advance regeneration, created a more diverse and productive ground‐layer flora, and produced fuel beds more conducive to prescribed fire, reducing the risk of high‐severity wildfire. Here we report on the ~20‐year effects of treatments on vegetation and fuels and examine the support for interactive effects across a topographic‐moisture and energy gradient. In general, we found that Fire and Mech + Fire treatments tended to reverse mesophication while the Mech‐only treatment did not. The moderate and occasionally high‐intensity fires resulted in effects that were ultimately very similar between the two fire treatments but were modulated by topography with increasing fire severity on drier sites. In particular, we found support for an interaction effect between treatment and topography on forest structure and tree regeneration responses. Fire generally reduced mesophytic tree density in the midstory and sapling strata across all site conditions, while leading to substantial gains in the abundance of large oak–hickory advance regeneration on dry and intermediate landscape positions. Fire also promoted ground‐layer diversity and created compositionally distinct communities across all site conditions, primarily through the increased richness of native perennial herbs. However, the fire had limited effects on fine surface fuel loading and increased the loading of large woody fuels, potentially increasing the risk of high‐severity wildfire during drought conditions. We conclude that two decades of repeated fires, with and without mechanical density reduction, significantly shifted the trajectory of mesophication across most of the landscape, particularly on dry and intermediate sites, highlighting the capacity of a periodic fire regime to sustain eastern oak forests and promote plant diversity but modulated by topography. [ABSTRACT FROM AUTHOR]

Forty-five years ago, the first author of this paper surveyed the US medical schools to determine their offerings on EOL (End-of-Life) issues. The results showed limited exposure for medical school students to learn about dying and death, thus their "learning" was apparently on-the-job training. The EOL offerings were so limited that the American Association of Medical Colleges (AAMC), following the 1975 publication from the survey, contacted the first author to inquire about death and dying in the curricula of their medical schools. Apparently, it was so insignificant that the AAMC did not have such information. Palliative medicine, geriatric medicine, and hospice were then in the "birthing" process, a mere blur on the horizon. Today, as in 1975, it is likely that most medical students have personally had minimal experience with death and that for many entering students, other than on television, the cadaver is their first sight of a dead person. The objective of this research is a longitudinal study at five-year intervals since 1975 reporting on EOL education in US medical schools. The total number of medical schools has increased from 113 in 1975 to 150 in 2020. The current study surveyed medical schools electronically and via postal services with a response rate of 37%. Findings from the survey over time revealed significant inclusion of death and dying and palliative medicine as well as geriatrics and hospice. Gross anatomy has evolved from strictly hands-on to integrating 3D/virtual models, a change not without controversy. A noticeable difference in emphasis is obvious as care now plays a more significant role in medical training than previously, thus making modern medicine not only about cure, but more about care than was previously emphasized. Communication with dying patients and families, analgesics for chronic pain, and advance directives all are covered in over 90% of schools today. The current emphasis on EOL care, not just disease management, is increasing and puts more of a human face on modern medicine. [ABSTRACT FROM AUTHOR]

Background: Health insurance coverage type differs significantly by socioeconomic status and racial group in the United States. The aim of this study was to determine whether publicly insured children and young adults with type 1 diabetes were more likely to experience adverse outcomes compared with privately insured patients with acute coronavirus disease 2019 (COVID-19) infections. Methods: Data from 619 patients with previously established type 1 diabetes who were <24 years of age with acute COVID-19 infections were analyzed from the T1D Exchange COVID-19 surveillance registry. Data for the registry was collected from 52 endocrinology clinics across the United States using an online survey tool. Each site completed the survey using electronic health record data between April 2020 and December 2021. Results: Of the 619 patients included in this study, 257 had public insurance and 362 had private insurance. Of the 257 publicly insured patients with COVID-19, 57 reported severe adverse outcomes (22%), defined as diabetic ketoacidosis (DKA) or severe hypoglycemia. In comparison, there were 25 reported adverse outcomes (7%) among the 362 privately insured patients. Conclusion: Our data reveal high rates of hospitalization and DKA among publicly insured racial/ethnic minority children and young adults with type 1 diabetes and COVID-19. [ABSTRACT FROM AUTHOR]

Opioid use disorder (OUD) represents a public health crisis in the United States. Medication for opioid use disorder (MOUD) with buprenorphine in primary care is a proven OUD treatment strategy. MOUD induction is when patients begin withdrawal and receive the first doses of buprenorphine. Differences between induction methods might influence short-term stabilization, long-term maintenance, and quality of life. This paper describes the protocol for a study designed to: (1) compare short-term stabilization and long-term maintenance treatment engagement in MOUD in patients receiving office, home, or telehealth induction and (2) identify clinically-relevant practice and patient characteristics associated with successful long-term treatment. The study design is a randomized, parallel group, pragmatic comparative effectiveness trial of three care models of MOUD induction in 100 primary care practices in the United States. Eligible patients are at least 16 years old, have been identified by their clinician as having opioid dependence and would benefit from MOUD. Patients will be randomized to one of three induction comparators: office, home, or telehealth induction. Primary outcomes are buprenorphine medication-taking and illicit opioid use at 30, 90, and 270 days post-induction. Secondary outcomes include quality of life and potential mediators of treatment maintenance (intentions, planning, automaticity). Potential moderators include social determinants of health, substance use history and appeal, and executive function. An intent to treat analysis will assess effects of the interventions on long-term treatment, using general/generalized linear mixed models, adjusted for covariates, for the outcomes analysis. Analysis includes practice- and patient-level random effects for hierarchical/longitudinal data. No large-scale, randomized comparative effectiveness research has compared home induction to office or telehealth MOUD induction on long-term outcomes for patients with OUD seen in primary care settings. The results of this study will offer primary care providers evidence and guidance in selecting the most beneficial induction method(s) for specific patients. [ABSTRACT FROM AUTHOR]

The rarity of primary hyperoxaluria (PH) challenges our understanding of the disease. The purpose of our study was to describe the course of clinical care in a United States cohort of PH pediatric patients, highlighting health service utilization. We performed a retrospective cohort study of PH patients < 18 years old in the PEDSnet clinical research network from 2009 to 2021. Outcomes queried included diagnostic imaging and testing related to known organ involvement of PH, surgical and medical interventions specific to PH-related renal disease, and select PH-related hospital service utilization. Outcomes were evaluated relative to cohort entrance date (CED), defined as date of first PH-related diagnostic code. Thirty-three patients were identified: 23 with PH type 1; 4 with PH type 2; 6 with PH type 3. Median age at CED was 5.0 years (IQR 1.4, 9.3 years) with the majority being non-Hispanic white (73%) males (70%). Median follow-up between CED and most recent encounter was 5.1 years (IQR 1.2, 6.8). Nephrology and Urology were the most common specialties involved in care, with low utilization of other sub-specialties (12%-36%). Most patients (82%) had diagnostic imaging used to evaluate kidney stones; 11 (33%) had studies of extra-renal involvement. Stone surgery was performed in 15 (46%) patients. Four patients (12%) required dialysis, begun in all prior to CED; four patients required renal or renal/liver transplant. Conclusion: In this large cohort of U.S. PH children, patients required heavy health care utilization with room for improvement in involving multi-disciplinary specialists. What is Known: • Primary hyperoxaluria (PH) is rare with significant implications on patient health. Typical involvement includes the kidneys; however, extra-renal manifestations occur. • Most large population studies describe clinical manifestations and involve registries. What is New: • We report the clinical journey, particularly related to diagnostic studies, interventions, multispecialty involvement, and hospital utilization, of a large cohort of PH pediatric patients in the PEDSnet clinical research network. • There are missed opportunities, particularly in that of specialty care, that could help in the diagnosis, treatment, and even prevention of known clinical manifestations. [ABSTRACT FROM AUTHOR]

Background: Dementia Care Navigators (DCNs) are professionals without clinical training, who provide individualised emotional and practical support to people living with dementia, working alongside clinical services. Navigator services have been implemented but the service offered vary without a consistent overview provided. The aim of this narrative systematic review was to describe and compare existing service formats, and to synthesise evidence regarding their implementation and impacts. Methods: The review was registered on PROSPERO [CRD42021292518]. Three electronic databases were searched and included studies reported on a DCN service, defined as a service in which non‐clinically trained workers provide personalised advice and support to people with dementia and/or carers in the community. Two independent reviewers screened abstracts and titles and read through full papers for inclusion. Risk of bias was assessed using the Standard Quality Assessment QualSyst. Results: We included 14 papers reporting on six studies. All services were US‐based and only varied by integration and training provided. Studies reported different degrees of impact on service utilisation and on symptoms and mental well‐being of people with dementia and their carers, with too little evidence to draw substantial/meaningful conclusions and studies employing different outcome measures. One study evidenced greater impacts on people with more advanced dementia compared to earlier stages. Conclusions: DCN services have the potential to effectively provide non‐clinical support to people with dementia and carers from the point of diagnosis. Further research from countries other than the USA, focusing on the impact on social care and social support service access and utilisation, and utilising similar established outcome measures are required. Key points: Evidence on the impact of Dementia Care Navigators (DCNs) is limited but shows promising benefits for people living with dementia and their carers.More research needs to be conducted in countries other than the US, where all evidence was reported, and with similar outcome measures to allow comparison.DCNs are a highly useful professional group without medical training, who can navigate people living with dementia and their carers to support and provide support themselves. [ABSTRACT FROM AUTHOR]

Simple Summary: Parrots (Order: Psittaciformes) are an ancient arboreal lineage with a long history as companion animals for humans. Since at least the 1960s, released parrots have become established in non-native ranges globally. The method of their introduction is almost certainly a direct result of the pet trade through either accidental or intentional releases. Within the continental United States there are currently seventy-three naturalized parrot species that have been observed as of May 2023. Of these, close to half have established breeding populations. The propensity for a parrot species to become established appears to be phylogenetically driven. Notably, parrots in the family Cacatuidae and Neotropical Pyrrhua are less successful at establishing themselves in the United States once released. We posit that what makes parrots such successful naturalized species are their charismatic nature paired with considerable intelligence and behavioral flexibility. Parrots (Order: Psittaciformes) represent one of the most striking and ecomorphologically diverse avian clades, spanning more than two orders of magnitude in body size with populations occupying six continents. The worldwide diaspora of parrots is largely due to the pet trade, driven by human desire for bright, colorful, and intelligent animals as companions. Some introduced species have aptly inserted themselves into the local ecosystem and established successful breeding colonies all around the globe. Notably, the United States is home to several thriving populations of introduced species including red-masked parakeets (Psittacara erythrogenys), monk parakeets (Myiopsitta monachus), nanday conures (Aratinga nenday), and red-crowned amazons (Amazona viridigenalis). Their incredible success globally begs the question as to how these birds adapt so readily to novel environments. In this commentary, we trace parrots through evolutionary history, contextualize existent naturalized parrot populations within the contiguous United States, and provide a phylogenetic regression analysis of body mass and brain size based on success in establishing breeding populations. The propensity for a parrot species to become established appears to be phylogenetically driven. Notably, parrots in the family Cacatuidae and Neotropical Pyrrhua appear to be poor at establishing themselves in the United States once released. Although brain size among Psittaciformes did not show a significant impact on successful breeding in the continental United States, we propose that the success of parrots can be attributed to their charismatic nature, significant intelligence relative to other avian lineages, and behavioral flexibility. [ABSTRACT FROM AUTHOR]

Because use of high-resolution hydrologic models is becoming more widespread and estimates are made over large domains, there is a pressing need for systematic evaluation of their performance. Most evaluation efforts to date have focused on smaller basins that have been relatively undisturbed by human activity, but there is also a need to benchmark model performance more comprehensively, including basins impacted by human activities. This study benchmarks the long-term performance of two process-oriented, high-resolution, continental-scale hydrologic models that have been developed to assess water availability and risks in the United States (US): the National Water Model v2.1 application of WRF-Hydro (NWMv2.1) and the National Hydrologic Model v1.0 application of the Precipitation–Runoff Modeling System (NHMv1.0). The evaluation is performed on 5390 streamflow gages from 1983 to 2016 (∼ 33 years) at a daily time step, including both natural and human-impacted catchments, representing one of the most comprehensive evaluations over the contiguous US. Using the Kling–Gupta efficiency as the main evaluation metric, the models are compared against a climatological benchmark that accounts for seasonality. Overall, the model applications show similar performance, with better performance in minimally disturbed basins than in those impacted by human activities. Relative regional differences are also similar: the best performance is found in the Northeast, followed by the Southeast, and generally worse performance is found in the Central and West areas. For both models, about 80 % of the sites exceed the seasonal climatological benchmark. Basins that do not exceed the climatological benchmark are further scrutinized to provide model diagnostics for each application. Using the underperforming subset, both models tend to overestimate streamflow volumes in the West, which could be attributed to not accounting for human activities, such as active management. Both models underestimate flow variability, especially the highest flows; this was more pronounced for NHMv1.0. Low flows tended to be overestimated by NWMv2.1, whereas there were both over and underestimations for NHMv1.0, but they were less severe. Although this study focused on model diagnostics for underperforming sites based on the seasonal climatological benchmark, metrics for all sites for both model applications are openly available online. [ABSTRACT FROM AUTHOR]

A professional outlet in most children's hospitals for seriously-ill children is the child life specialist. Our objective in this study was to determine the extent that dying and death is emphasized in child life programs in the United States. Therefore, we surveyed via snail mail the 35 child life programs on the website of the Child Life Council. A response rate of 74% revealed that all programs offer something on this topic and over two-thirds have a separate course for the topic of dying and death, with an average of 33 course content hours of instruction per program. The lecture mode is the most frequent teaching method, and the child life specialist is most often the instructor.

Medical and nursing schools in the United States have traditionally had a limited emphasis on end-of-life care. The present study is a comparison of these 2 professional programs' current offerings on death education. Data were gathered via a mailed survey from the 122 medical schools in 2005 and the 580 baccalaureate nursing programs in 2006. Return rates of 81% and 71%, respectively, were received. All medical schools and 99% of nursing schools reported offering something on death and dying, with over 90% of students in these programs participating. The average number of hours offered in both professional programs is less than 15. Over 87% in both programs have offerings in palliative care. Whereas nursing programs rely almost solely on nurses for end-of-life course provisions, medical schools are more interdisciplinary by faculty. End-of-life issues are presented in both medical and nursing curricula, though on a limited basis. This emphasis exposes students to the issues, though not in an in-depth way. (Contains 5 tables.)

We describe the perceptions of mental health clinicians practicing in the United States about the effects of the COVID-19 pandemic on the presentation and treatment course of active clients with anxiety. Clinician participants reported on client symptomology at the beginning of treatment, just before (prior to March 2020), and at a mid-pandemic timepoint (December 2020/January 2021). An initial sample of 70 clinicians responded to a survey assessing their clients' overall anxiety severity, anxiety sensitivity, pathological uncertainty, family accommodation, and avoidance levels. Of these, 54 clinician responses were included in study analyses, providing detailed clinical information on 81 clients. Findings suggest that the COVID-19 pandemic was associated with increases in anxiety severity in the majority of clients; overall, clinicians reported that 53% of clients had symptoms worsen due to COVID-19 and that only 16% experienced improvement of symptoms during treatment. Those who had lower levels of avoidance pre-pandemic and those who increased their frequency of treatment were more likely to experience increases in anxiety severity by the mid-pandemic timepoint. Further research is needed to understand the extended effects of the COVID-19 pandemic on anxiety symptomology and treatment. [ABSTRACT FROM AUTHOR]

Many adults with diabetes do not reach optimal glycemic targets, and, despite advances in diabetes management, diabetes technology use remains significantly lower in racial/ethnic minority groups. This study aimed to identify factors associated with achieving the recommended A1C target of <7% using data on 12,035 adults with type 1 diabetes from 15 centers participating in the T1D Exchange Quality Improvement Collaborative. Individuals attaining the target A1C were more likely to be older, White, have private health insurance, and use diabetes technology and less likely to report depressive symptoms or episodes of severe hypoglycemia or diabetic ketoacidosis than those with higher A1C levels. These findings highlight the importance of overcoming inequities in diabetes care. [ABSTRACT FROM AUTHOR]

With an annual budget of nearly fifty million dollars and over five billion views on social media, PragerU is a central node in the production of misinformation and radicalization in the United States today. Despite this, it has received little-to-no attention in contemporary scholarship. This paper begins to correct this dangerous oversight by introducing PragerU to an academic audience as a powerful far-right institution. We build on Rebecca Lewis's concept of the Alternative Influence Network to show that PragerU is a unique and sinister institution with the ability to draw together disparate parts of the American right, using immense financial resources and advertising reach to do so. At its core, we contend that PragerU functions as a legitimizing hub for the US far right. It creates for itself a veneer of legitimacy as a seemingly moderate, centrist educational organization, even appropriating the term 'university'. PragerU then shares that legitimacy, serving as a hub that unites the right, bringing together Reaganite neoliberals, Bush-era neoconservatives, Tea Partiers, Trumpists and the contemporary alt-right under PragerU branding. Combined with its staggering reach and the structural features of social media platforms ('suggested videos', recommendations), PragerU acts as a gateway to the extreme right, and the first steps on the path to radicalization. As a result, we argue that it can no longer be ignored by scholars seeking to understand the far right in the United States, and should be treated as an essential area of study into right-wing radicalization and the spread of misinformation on social media today. [ABSTRACT FROM AUTHOR]

Online platforms have completely transformed American social lije. They have democratized publication, overthrown old gatekeepers, and given ordinary Americans a fresh voice in politics. But the system is beginning to.falter. Control over online speech lies in the hands of a selectfew-Facebook. Googte. and Twitter-who moderate content.for the entire nation. It is an impossible task. Americans cannot even agree among themselves what speech should be permitted. And, more importantly, platforms have their own interests at staker Fringe theories and ugly name-calling drive away users. Moderation is good jk}r business. But platform beautification has consequences.fur society's unpopular members, whose unsightly voices are silenced in the process. With control over online speech so centralized, online outcasts are left with fiw avenues for expression. Concentrated private control over important resources is an old problem. Last century, for example, saw the rise of railroads and telephone networks. To ensure access, such entities are treated as common carriers and required to provide equal service to all corners. Perhaps the same should be true jbr social media. This Essay responds to recent calls jrom Congress, the Supreme Court, and academia arguing that, like common carriers, online platfurms should be required to carry all lawful content. The Essay studies users' and platforms competing expressive interests, analyzes problematic trends in platforms censorship practices, and explores the c'osts of common-carrier regulation before ultimatelyproposingmarket expansion and segmentation as an alternate pathway to avoid the economic and social costs of common-carrier regulation. [ABSTRACT FROM AUTHOR]

Previous studies have identified a recent increase in wildfire activity in the western United States (WUS). However, the extent to which this trend is due to weather pattern changes dominated by natural variability versus anthropogenic warming has been unclear. Using an ensemble constructed flow analogue approach, we have employed observations to estimate vapor pressure deficit (VPD), the leading meteorological variable that controls wildfires, associated with different atmospheric circulation patterns. Our results show that for the period 1979 to 2020, variation in the atmospheric circulation explains, on average, only 32% of the observed VPD trend of 0.48 6 0.25 hPa/decade (95% CI) over the WUS during the warm season (May to September). The remaining 68% of the upward VPD trend is likely due to anthropogenic warming. The ensemble simulations of climate models participating in the sixth phase of the Coupled Model Intercomparison Project suggest that anthropogenic forcing explains an even larger fraction of the observed VPD trend (88%) for the same period and region. These models and observational estimates likely provide a lower and an upper bound on the true impact of anthropogenic warming on the VPD trend over the WUS. During August 2020, when the August Complex "Gigafire" occurred in the WUS, anthropogenic warming likely explains 50% of the unprecedented high VPD anomalies. [ABSTRACT FROM AUTHOR]

Background Lifestyle interventions are the first-line treatment for obesity, but participant weight loss is typically low. Objectives We evaluated the efficacy of an alternative lifestyle intervention [Healthy Weight for Living (HWL)] compared with a modified Diabetes Prevention Program (m-DPP). HWL was based on a revised health behavior change model emphasizing hunger management and the development of healthy food preferences. m-DPP was a standard Diabetes Prevention Program implemented with counselor time matched to HWL. Participants were adult dependents of military personnel and had overweight or obesity. Methods Participants were randomly assigned to HWL (n  = 121) or m-DPP (n  = 117), delivered primarily by group videoconference with additional midweek emails. The primary outcome was 12-mo weight change. Secondary outcomes included 6-mo changes in cardiometabolic risk factors and diet. Intention-to-treat (ITT) and complete case (CC) analyses were performed using linear mixed models. Results Retention did not differ between groups (72% and 66% for HWL and m-DPP at 12 mo, respectively; P  = 0.30). Mean ± SE adjusted 12-mo weight loss in the ITT cohort was 7.46 ± 0.85 kg for HWL and 7.32 ± 0.87 kg for m-DPP (P  = 0.91); in the CC cohort, it was 7.83 ± 0.82 kg for HWL and 6.86 ± 0.88 kg for m-DPP (P  = 0.43). Thirty-eight percent of HWL and 30% of m-DPP completers achieved ≥10% weight loss (P  = 0.32). Improvements in systolic blood pressure, LDL cholesterol, triglycerides, fasting glucose, general health, sleep, and mood were similar across groups; improvements in diastolic blood pressure were greater in m-DPP. Adjusted group mean reductions in energy intake were not significantly different between groups, but HWL participants were more adherent to their dietary prescription for lower glycemic index and high fiber and protein (P  = 0.05 to <0.001 for ITT). Conclusions HWL and m-DPP showed equivalent and clinically impactful mean weight loss with cardiometabolic benefits. These results identify an alternative approach for behavioral treatment of overweight and obesity. This trial was registered at clinicaltrials.gov as NCT02348853. [ABSTRACT FROM AUTHOR]

Extreme precipitation across multiple time scales is a natural hazard that creates a significant risk to life, with a commensurately large cost through property loss. We devise a method to create 14-day extreme-event windows that characterize precipitation events in the contiguous United States (CONUS) for the years 1915–2018. Our algorithm imposes thresholds for both total precipitation and the duration of the precipitation to identify events with sufficient length to accentuate the synoptic and longer time scale contribution to the precipitation event. Kernel density estimation is employed to create extreme-event polygons that are formed into a database spanning from 1915 through 2018. Using the developed database, we clustered events into regions using a k-means algorithm. We define the "hybrid index," a weighted composite of silhouette score and number of clustered events, to show that the optimal number of clusters is 15. We also show that 14-day extreme precipitation events are increasing in the CONUS, specifically in the Dakotas and much of New England. The algorithm presented in this work is designed to be sufficiently flexible to be extended to any desired number of days on the subseasonal-to-seasonal (S2S) time scale (e.g., 30 days). Additional databases generated using this framework are available for download from our GitHub. Consequently, these S2S databases can be analyzed in future works to determine the climatology of S2S extreme precipitation events and be used for predictability studies for identified events. [ABSTRACT FROM AUTHOR]

In 2019, a 42-year-old African man who works as an Ebola virus disease (EVD) researcher traveled from the Democratic Republic of Congo (DRC), near an ongoing EVD epidemic, to Philadelphia and presented to the Hospital of the University of Pennsylvania Emergency Department with altered mental status, vomiting, diarrhea, and fever. He was classified as a "wet" person under investigation for EVD, and his arrival activated our hospital emergency management command center and bioresponse teams. He was found to be in septic shock with multisystem organ dysfunction, including circulatory dysfunction, encephalopathy, metabolic lactic acidosis, acute kidney injury, acute liver injury, and diffuse intravascular coagulation. Critical care was delivered within high-risk pathogen isolation in the ED and in our Special Treatment Unit until a diagnosis of severe cerebral malaria was confirmed and EVD was definitively excluded. This report discusses our experience activating a longitudinal preparedness program designed for rare, resource-intensive events at hospitals physically remote from any active epidemic but serving a high-volume international air travel port-of-entry. [ABSTRACT FROM AUTHOR]

The Common Core State Standards (CCSS) initiative for K-12 education has been adopted by 45 states and will have a broad impact on American education al institutions, including libraries. The CCSS focus on close reading of informational texts, inquiry learning, and college and career readiness with an emphasis on assessment and accountability. This research study used a focusgroup approach to provide a framework for asking school librarians from two states about the future of teaching and learning and th e types of challenges they envision for the future. The datacollected were then aligned with CCSS to better understand the p otential impact for patrons of all types of libraries. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Coaching is emerging as a form of facilitation in health professions education. Most studies focus on one-on-one coaching rather than team coaching. We assessed the experiences of interprofessional teams coached to simultaneously improve primary care residency training and interprofessional practice. Methods: This three-year exploratory mixed methods study included transformational assistance from 9 interprofessional coaches, one assigned to each of 9 interprofessional primary care teams that included family medicine, internal medicine, pediatrics, nursing, pharmacy and behavioral health. Coaches interacted with teams during 2 in-person training sessions, an in-person site visit, and then as requested by their teams. Surveys administered at 1 year and end study assessed the coaching relationship and process. Results: The majority of participants (82% at end of Year 1 and 76.6% at end study) agreed or strongly agreed that their coach developed a positive working relationship with their team. Participants indicated coaches helped them: (1) develop as teams, (2) stay on task, and (3) respond to local context issues, with between 54.3% and 69.2% agreeing or strongly agreeing that their coaches were helpful in these areas. Cronbach's alpha for the 15 coaching survey items was 0.965. Challenges included aligning the coach's expertise with the team's needs. Conclusions: While team coaching was well received by interprofessional teams of primary care professionals undertaking educational and clinical redesign, the 3 primary care disciplines have much to learn from each other regarding how to improve inter- and intra-professional collaborative practice among clinicians and staff as well as with interprofessional learners rotating through their outpatient clinics. [ABSTRACT FROM AUTHOR]

Scholars have long debated whether and how international law impacts governmental behavior, even in the absence of coercive sanction. But this literature does not sufficiently address the possible impact of international law in the area of national security policymaking. Yet, policies that the executive branch purports to adopt as a wholly discretionary matter may still be heavily influenced by international legal norms, regardless of whether or not those norms are formally recognized as legally binding. And those policies can be surprisingly resilient, even in subsequent administrations. Moreover, because they are only seen as discretionary policies, they may be more easily adopted than formal legal interpretations. For all of these reasons, the impact of international law on national security policymaking is a crucial unexplored area in the debate about the efficacy of international law. This Article describes how the norms and values embedded in international human rights law can sometimes be adopted, if not as a matter of formal law at the international level, then as a matter of official policy and practice. In addition, it surveys the advantages and disadvantages of such an approach, using two different Obama administration counterterrorism policies and Trump administration successor policies as case studies. Ultimately, I argue that the emergence and persistence of such policies is evidence of international law's constraining impact. International law, it turns out, casts a long shadow as its paradigms get translated into policy. I also analyze the attributes of these policies, including their "legalistic" character and the consequences of creating policies of this type. This analysis suggests that importing international law paradigms into national security policymaking can be a pragmatic and effective alternative to formal international lawmaking, though it also may side-step the process of creating robust new international law rules. Therefore, it is a practice that executive branch officials from the United States and other countries, human rights organizations, and administrative, constitutional, and international law scholars should at least consider, while weighing both the pros and cons. In addition, the stickiness of such policymaking, even across administrations, illustrates the importance of institutional path dependence, the role of lawyers, the constraint of interoperability with key U.S. allies in multilateral military actions, and the way norms get embedded in government organizations. [ABSTRACT FROM AUTHOR]

The long, fallacious history of attributing racial disparities in public health outcomes to biological inferiority or poor decision making persists in contemporary conversations about the COVID-19 pandemic. Given the disproportionate impacts of this pandemic on communities of color, it is essential for scholars, practitioners, and policymakers to focus on how structural racism drives these disparate outcomes. In May and June 2020, we conducted a 6-state online survey to examine racial/ethnic differences in exposure to COVID-19, risk mitigation behaviors, risk perceptions, and COVID-19 impacts. Results show that Black and Hispanic individuals were more likely than White respondents to experience factors associated with structural racism (eg, living in larger households, going to work in person, using public transportation) that, by their very nature, increase the likelihood of exposure to COVID-19. Controlling for other demographic and socioeconomic characteristics, non-White respondents were equally or more likely than White respondents to take protective actions against COVID-19, including keeping distance from others and wearing masks. Black and Hispanic respondents also perceived higher risks of dying of the disease and of running out of money due to the pandemic, and 40% of Black respondents reported knowing someone who had died of COVID-19 at a time when the US death toll had just surpassed 100,000 people. To manage the current pandemic and prepare to combat future health crises in an effective, equitable, and antiracist manner, it is imperative to understand the structural factors perpetuating racial inequalities in the COVID-19 experience. [ABSTRACT FROM AUTHOR]

Background: Child life specialists play a crucial role with children and their families when the child has a life-threatening illness and is hospitalized by trying to establish some degree of normalcy in a situation void of such. Programs designed to train child life specialists have expanded over the last 10 years. Objective: This is a follow-up of our previous study a decade ago to determine if offerings on end of life issues have changed in US child life programs since 2009. Method: We surveyed the 48 child life academic programs in the U.S. in 2019 and compared these findings with the earlier survey in 2009. We also analyzed the websites of all 48 programs to obtain a better understanding of current death and dying offerings in U.S. child life programs. Results: All child life programs now include content on death, dying, and bereavement. Child life programs continue to emphasize end-of-life issues, with child life specialists being the primary deliverers of such information. Communication with patients with life-threatening illnesses, communication with family members of such patients, and grief and bereavement were the three most covered topics in both 2009 and 2019. Conclusions: U.S. child life specialist programs have increased in numbers over the decade and continue to prepare child life specialists to relate to children with life-threatening illnesses and their families, thus playing a pivotal role in the lives of these individuals. [ABSTRACT FROM AUTHOR]

Compassionate release (CR) is touted as an ethical and cost-effective mechanism for releasing older adults or individuals with life-limiting illness from prison and reducing prison overcrowding. However, little is known regarding the monitoring practices and the numbers of persons eligible, applying for, and being released under CR policies. The current study sought to describe CR monitoring practices, and access and use of CR for each U.S. state between 2013 and 2015 using data obtained via public records requests. Roughly 80% of responding states monitored the number of persons released under CR policies (n = 39), though only 65% of responding states captured records of those who applied for release (n = 32). Fewer monitored CR eligibility (35% n = 17). Between 2013 and 2015, 5,932 persons were eligible for CR. However, less than half of these persons applied for CR during the study period (46.4%; n = 2,751), and less than 30% of those who applied were discharged under CR during the study period (n = 802). The importance of monitoring and reporting numbers of persons eligible, applying, and released under CR policies is discussed. [ABSTRACT FROM AUTHOR]

In Spring/Summer 2020, most individuals living in the United States experienced several months of social distancing and stay-at-home orders because of the coronavirus (COVID-19) pandemic. Clinicians, restaurant cooks, cashiers, transit operators, and other essential workers (EWs), however, continued to work outside the home during this time in order to keep others alive and maintain a functioning society. In the United States, EWs are often low-income persons of color who are more likely to face socioeconomic vulnerabilities, systemic racism, and health inequities. To assess the various impacts of COVID-19 on EWs, an online survey was distributed to a representative sample of individuals residing in six states during May/June 2020. The sample included 990 individuals who identified as EWs and 736 nonessential workers (NWs). We assessed differences between EW and NW respondents according to three categories related to health equity and social determinants of health: (1) demographics (e.g. race/ethnicity); (2) COVID-19 exposure risk pathways (e.g. ability to social distance); and (3) COVID-19 risk perceptions (e.g. perceived risk of contracting COVID-19). EWs were more likely to be Black or Hispanic than NWs and also had lower incomes and education levels on average. Unsurprisingly, EWs were substantially more likely to report working outside the home and less likely to report social distancing and wearing masks indoors as compared to NWs. EWs also perceived a slightly greater risk of contracting COVID-19. These findings, which we discuss in the context of persistent structural inequalities, systemic racism, and health inequities within the United States, highlight ways in which COVID-19 exacerbates existing socioeconomic vulnerabilities faced by EWs. [ABSTRACT FROM AUTHOR]

Large and increasing numbers of inmates with chronic and terminal illnesses are serving time, and dying, in U.S. prisons. The restriction of men and women to die in prisons has many ethical and fiscal concerns, as it deprives incarcerated persons of their autonomy and requires comprehensive and costly health-care services. To ameliorate these concerns, compassionate release policies, which allow inmates the ability to die in their own communities, have been adopted in federal and state prison systems. However, little is known about the content of compassionate release policies within U.S. states' department of corrections, despite recent calls to release incarcerated persons who meet eligibility criteria into the community. The current study provides an overview of compassionate release policies in the United States, which vary widely across the compassionate release process. Specific policy recommendations are made to assure the timely access and utilization of compassionate release among eligible incarcerated individuals. [ABSTRACT FROM AUTHOR]

The Distance Library Services Conference was founded in 1982 by the librarians of the Off-Campus Library Services department at Central Michigan University. From its inception through its 18th conference in 2018, Central Michigan University planned and administered this conference for the benefit of librarians serving distance learners and faculty at their institutions. This article discusses the founding of the Distance Library Services Conference and its role as the library profession's preeminent forum for the exchange of ideas on the topic of distance librarianship. [ABSTRACT FROM AUTHOR]

Few studies have investigated pricing and promotional practices used by the indoor tanning industry, despite their potential to promote indoor UV tanning-a well-established risk factor for melanoma skin cancer. Posing as potential customers, we telephoned 94 indoor tanning businesses in six United States (U.S.) cities and requested pricing information. The price of a single tanning session ranged from $0 to $23, and was lower at facilities that offered indoor tanning as a secondary service (mean $4.82 and free in 35%) than at tanning salons (mean $16.45). Session prices in salons could be as low as $1.50 with daily use of an unlimited monthly plan. Free indoor tanning, monthly packages, and memberships encourage increased use. Policies that limit free indoor tanning or that restrict pricing and advertising for indoor tanning exist in several places in the U.S. and Europe. Future research should evaluate whether those policies are effective in reducing indoor tanning. [ABSTRACT FROM AUTHOR]

The home enjoys a special place in American constitutional law. A doctrinal thread runs across the first five amendments that demarcates the home as a realm in which rights enjoy elevated protection. That thread covers rights involving smut, guns, soldiers, searches, and selfincrimination, hut inexplicably does not extend to takings. This stark dichotomy between the solicitude of the home for most rights and the opposite for takings produces a deep puzzle. This Article contends that the answer to this fundamental puzzle is that the Court's takings doctrine, unlike the home-centric doctrines in the Bill of Rights, is infected with/wV-Lochner v. New York judicial deference to economic regulation. This has influenced the Court's aversion to a special protections doctrine to homes under the Takings Clause. This Article argues that, as a matter of constitutional coherence theory, which prizes doctrinal symmetry and harmony, the Court should, in limited circumstances, extend the home-centric thread to protect homes in takings that expropriate title to or impact the economic value of homes. This Article also grapples with several broader methodological, doctrinal, and theoretical implications. First, the Court consistently applies atextual methods of interpretation of the home. Second, this atextual interpretive pattern of influence supports this Article's proposition that the home-centric doctrinal thread should extend to takings. Finally, a congruent home-centric Bill of Rights that extends to takings aligns neatly with constitutional coherence theory. [ABSTRACT FROM AUTHOR]

Purpose: EvidenceNOW Southwest is a cluster-randomized trial evaluating the differential impact on cardiovascular disease (CVD) care of engaging patients and communities in practice transformation in addition to standard practice facilitation support. The trial included development of locally tailored CVD patient engagement materials through Boot Camp Translation (BCT), a community engagement process that occurred before practice recruitment but after cluster randomization.Methods: We introduce a cluster randomization method performed before recruitment of small to medium-size primary care practices in Colorado and New Mexico, which allowed for balanced study arms while minimizing contamination. Engagement materials for the enhanced study arm were developed by means of BCT, which included community members, practice members, and public health professionals from (1) metropolitan Denver, (2) rural northeast Colorado, (3) Albuquerque, and (4) rural southeast New Mexico. Outcome measures were messages and materials from BCTs and population characteristics of study arms after using geographic-based covariate constrained randomization.Results: The 4 BCTs' messages and materials developed by the BCT groups uniquely reflected each community and ranged from family or spiritual values to early prevention or adding relevance to CVD risk. The geographic-based covariate of a cluster randomization method constrained randomization-assigned regions to study arms, allowing BCTs to precede practice recruitment, reduce contamination, and balance populations.Conclusions: Cluster-randomized trials with community-based interventions present study design and implementation challenges. The BCTs elicited unique contextual messages and materials, suggesting that interventions designed to help primary care practices decrease CVD risk may not be one size fits all. [ABSTRACT FROM AUTHOR]

Stephen Krashen believes that schools can counter the effects of poverty in at least one area: access to books. However, little research has been done to determine whether students living in poverty have access to school library services comparable to those attending schools with low concentrations of students living in poverty. We examined the school library access gap; namely, the differences in school library characteristics (staffing, books added to collection, schedule, and number of days closed) in schools with various concentrations of students living in poverty. Alarmingly, we found that the students in most need--those attending schools with the highest concentrations of students living in poverty--had the fewest school library resources to draw on. Findings suggest that if we hope to close achievement gaps between high and low socioeconomic groups, we must attend to the access gap in school libraries in high- and low-poverty schools. [ABSTRACT FROM AUTHOR]

Background: Despite the increased risk for nodal disease, definitive endoscopic resection is being increasingly offered for lesions invasive into the submucosa based on the success with intramucosal tumors. The aim of this study was to evaluate survival after esophagectomy alone for confirmed submucosal tumors after endoscopic resection.Methods: Patients from seven centers in the USA who underwent esophagectomy for submucosal tumors removed with endoscopic resection were analyzed. Nodal involvement was correlated with recurrence and survival.Results: We identified 23 patients with submucosal esophageal adenocarcinoma. Esophagectomy was performed at a median of 2 months (Interquartile range 1-3) after the endoscopic resection. There was no postoperative mortality. Positive nodal disease was seen in 26 % of patients on final pathology. At a median of 37 months (Interquartile range 25-55), 91 % of patients were alive and free of disease. The disease-specific 5-year survival was 88 %. Disease-specific 5-year survival was 67 % in patients with positive nodal metastases and 100 % in those without (p = 0.159).Conclusions: Esophagectomy is curative in the majority of patients with submucosal tumors even in the presence of nodal metastases. These data serve as a benchmark for comparison when considering extending the indications for therapeutic endoscopic resection for submucosal tumors in the future. [ABSTRACT FROM AUTHOR]

Introduction: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care. The majority of patients with chronic non-malignant pain (CNMP) are managed by their general practitioner (GP). Recent qualitative studies have examined the issue of opioid prescribing for CNMP from a GP viewpoint. The aim of this study is to identify and synthesise the qualitative literature describing the factors influencing the nature and extent of opioid prescribing by GPs for patients with CNMP in primary care. Methods: MEDLINE, Embase, PsycINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986 to February 2018. The full text of included articles was reviewed using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researchers and themes organised using Thematic Network Analysis. Themes were constructed in a hierarchical manner, basic themes informed organising themes which informed global themes. A theoretical model was derived using global themes to explain the interplay between factors influencing opioid prescribing decisions. Results: From 7020 records, 21 full text papers were assessed, and 13 studies included in the synthesis; 9 were from the United States, 3 from the United Kingdom and 1 from Canada. Four global themes emerged: suspicion, risk, agreement and encompassing systems level factors. These global themes are inter-related and capture the complex decision-making processes underlying opioid prescribing whereby the physician both consciously and unconsciously quantifies the risk–benefit relationship associated with initiating or continuing an opioid prescription. Conclusion: Recognising the inherent complexity of opioid prescribing and the limitations of healthcare systems is crucial to developing opioid stewardship strategies to combat the rise in opioid prescription morbidity and mortality. [ABSTRACT FROM AUTHOR]

The purpose of this research is to determine the status of dying, death and bereavement within the curricula of veterinary medicine schools in the United States and the United Kingdom. Data were obtained via a mailed questionnaire (80% US and 86% UK return rates). Results revealed that over 96% of schools have offerings related to end-of-life (eol) issues, with nearly 100% of students exposed to these offerings. The average number of hours spent on eol issues is 7 (US) and 21 (UK). Topics covered most often are 'euthanasia', 'analgesics for chronic pain', and 'communication with owners of dying animals'. Veterinary schools overwhelmingly note that dying, death and bereavement are important topics. It might be helpful to veterinary medicine students if their own feelings regarding dying and death were addressed early in the curriculum and throughout class activities and clinical work. [ABSTRACT FROM AUTHOR]

Background and Objectives: Family medicine is continuously advanced by a reinforcing research enterprise. In the United States, each national family medicine organization contributes to the discipline's research foundations. We sought to map the unique and interorganizational roles of the eight US family medicine professional organizations participating in Family Medicine for America's Health (FMAHealth) in supporting family medicine research.Methods: We interviewed leaders and reviewed supporting materials from organizations participating in FMAHealth. We explored existing activities, capacity, and collaboration. We identified areas of strength and opportunities for growth and synergy with respect to how the family of family medicine nurtures family medicine research.Results: The FMAHealth organizations support certain aspects of the family medicine research infrastructure. Six domains were identified through this work: showcasing scholarship, communication and dissemination, workforce development, data-driven initiatives, performing primary research, and advocacy for family medicine research. Each organization's areas of emphasis differ, but we found substantial collaboration on initiatives across organizations, possibly attributable to the fact that many members belong to more than one organization.Conclusions: Deliberate contributions to each of the six domains identified herein will be important for the future success of family medicine research. Key opportunity areas described here include coordinated and strategic advocacy for increased funding for family medicine research, dedicated investment in training opportunities, protected effort to grow the next generation of family medicine researchers, pilot funding to build a research base for future high-impact research, and infrastructure to facilitate cross-institutional collaboration and data sharing. [ABSTRACT FROM AUTHOR]

The article discusses the two modes of conformity in the sports aspect and in the changing culture of America. The two modes of conformity are inner-directed and other-directed and are considered to influence the American social content and structure. Sports are observed as a popular culture, a primary and sometimes secondary group and as a sub-culture. The modes of conformity are part of the absolute culture and they are not values or behaviors that could be easily described by the individual. An analysis of the modes of conformity and its consequences are also presented.

The authors examine the histories of four business-to-business relationships in the United States: advertising agencies and clients, textile agents and mills, the Pullman Car Company and railroads, and independent department stores and their resident buying offices. The authors' goals are to gain perspective on how marketing relationships evolve over time and identify those factors that foster closer relationships and those that attenuate relationships. The results show that economic growth, information asymmetry partially prompted by geographic dispersion, entry barriers in one or both industries, dependence asymmetry, and economies of scale are important environmental forces that impinge on relationship development in all four cases. [ABSTRACT FROM AUTHOR]

This paper provides the first estimates of the net impact of CETA participation on the components of CETA participants' post-program earnings. Employing a sample of 1975 CETA enrollees and comparison groups drawn from the March 1978 CPS using a nearest-neighbor matching technique, the authors estimate statistically significant negative effects on men's earnings and statistically significant positive effects on women's earnings. These results stem partly from the impact of CETA participation on the likelihood of being employed after leaving the program (negative for men, positive for women), but also from a negative impact on hours worked during the year and hourly wage rate for men and a large positive impact on hours worked per week and weeks worked per year for women. [ABSTRACT FROM AUTHOR]

The author discusses the problems faced in the United States by small retailers with higher proportional spending on advertising than larger competitors caused by the Robinson-Patman Act. Typically, such companies charge higher retail prices for goods in exchange for providing higher levels of customer service and spend a greater proportion of their revenues on advertising. Although the Act was intended to protect small businesses, through 1967, the largest group of charges filed by the U.S. Federal Trade Commission (FTC) been against small businesses.

The author discusses the business implications the Robinson-Patman Act has had upon nonfood retailers. The United States Congress passed the legislation in 1936 as a way to protect small businesses and consumers against the bargaining power of larger food retail companies who could reduce their purchase costs because of the amount of products they bought. However, the Act was poorly written and compliance is difficult. The author found that most large retailers do not centralize their purchasing departments in an effort to avoid government persecution under the Act by the Federal Trade Commission (FTC).