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Diet-related metabolic syndrome is the largest contributor to adverse health in the United States. However, the study of gene-environment interactions and their epigenomic and transcriptomic integration is complicated by the lack of environmental and genetic control in humans that is possible in mouse models. Here we exposed three mouse strains, C57BL/6J (BL6), A/J, and NOD/ShiLtJ (NOD), to a high-fat, high-carbohydrate diet, leading to varying degrees of metabolic syndrome. We then performed transcriptomic and genome-wide DNA methylation analyses for each strain and found overlapping but also highly divergent changes in gene expression and methylation upstream of the discordant metabolic phenotypes. Strain-specific pathway analysis of dietary effects revealed a dysregulation of cholesterol biosynthesis common to all three strains but distinct regulatory networks driving this dysregulation. This suggests a strategy for strain-specific targeted pharmacologic intervention of these upstream regulators informed by epigenetic and transcriptional regulation. As a pilot study, we administered the drug GW4064 to target one of these genotype-dependent networks, the Farnesoid X receptor pathway, and found that GW4064 exerts strain-specific protection against dietary effects in BL6, as predicted by our transcriptomic analysis. Furthermore, GW4064 treatment induced inflammatory-related gene expression changes in NOD, indicating a strain-specific effect in its associated toxicities as well as its therapeutic efficacy. This pilot study demonstrates the potential efficacy of precision therapeutics for genotype-informed dietary metabolic intervention and a mouse platform for guiding this approach. Author summary: Metabolic syndrome is a major contributor to worldwide morbidity and mortality. This disorder is influenced by both genetics and environmental exposures, particularly diet. Such an effect, known as a "gene-by-diet" interaction, suggests that optimal dietary recommendations and therapeutic interventions for treating metabolic syndrome may differ dramatically between genetic sub-populations. Here, we have analyzed genetically distinct mouse strains which exhibit varying degrees of metabolic syndrome in response to a high-fat, high-carbohydrate American diet. While similar biological processes were affected by the change in diet in all three strains, we observed a strain-unique disruption of epigenetic and transcriptional regulation of certain molecular pathways, allowing for a strain-specific therapeutic platform aimed to re-establish normal functionality of one of these disrupted molecular pathways. Indeed, application of the chosen drug significantly decreased the observed metabolic effects of the American diet in only the predicted strain while the other tested strain exhibited increased activity of inflammatory response genes, demonstrating the strain-specificity of this drug's efficacy as well as its associated toxicities. This pilot study highlights the value of precision therapeutics in the treatment of metabolic syndrome and underscores the advantage of using multiple genetically distinct strains of mice in preclinical drug trials to help identify genetic dependencies in efficacy and toxicity. [ABSTRACT FROM AUTHOR]

Background: Identifying and eliminating racial health care disparities is a public health priority. However, data evaluating race differences in emergency department (ED) chest pain care are limited. Methods: We conducted a secondary analysis of the High‐Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification (STOP‐CP) cohort, which prospectively enrolled adults with symptoms suggestive of acute coronary syndrome without ST‐elevation from eight EDs in the United States from 2017 to 2018. Race was self‐reported by patients and abstracted from health records. Rates of 30‐day noninvasive testing (NIT), cardiac catheterization, revascularization, and adjudicated cardiac death or myocardial infarction (MI) were determined. Logistic regression was used to evaluate the association between race and 30‐day outcomes with and without adjustment for potential confounders. Results: Among 1454 participants, 42.3% (615/1454) were non‐White. At 30 days NIT occurred in 31.4% (457/1454), cardiac catheterization in 13.5% (197/1454), revascularization in 6.0% (87/1454), and cardiac death or MI in 13.1% (190/1454). Among Whites versus non‐Whites, NIT occurred in 33.8% (284/839) versus 28.1% (173/615; odds ratio [OR] 0.76, 95% confidence interval [CI] 0.61–0.96) and catheterization in 15.9% (133/839) versus 10.4% (64/615; OR 0.62, 95% CI 0.45–0.84). After covariates were adjusted for, non‐White race remained associated with decreased 30‐day NIT (adjusted OR [aOR] 0.71, 95% CI 0.56–0.90) and cardiac catheterization (aOR 0.62, 95% CI 0.43–0.88). Revascularization occurred in 6.9% (58/839) of Whites versus 4.7% (29/615) of non‐Whites (OR 0.67, 95% CI 0.42–1.04). Cardiac death or MI at 30 days occurred in 14.2% of Whites (119/839) versus 11.5% (71/615) of non‐Whites (OR 0.79 95% CI 0.57–1.08). After adjustment there was still no association between race and 30‐day revascularization (aOR 0.74, 95% CI 0.45–1.20) or cardiac death or MI (aOR 0.74, 95% CI 0.50–1.09). Conclusions: In this U.S. cohort, non‐White patients were less likely to receive NIT and cardiac catheterization compared to Whites but had similar rates of revascularization and cardiac death or MI. [ABSTRACT FROM AUTHOR]

Cardiac arrest guidelines recommend epinephrine every 3–5 minutes during cardiac arrest resuscitation. However, it is unclear if multiple epinephrine doses are associated with improved outcomes. The objective of this study was to determine if a single-dose epinephrine protocol was associated with improved survival compared to traditional multidose protocols. We conducted a pre-post study across five North Carolina EMS agencies from 11/1/2016 to 10/29/2019. Patients ≥18 years old with attempted resuscitation for non-traumatic prehospital cardiac arrest were included. Data were collected 1 year before and after implementation of the single-dose epinephrine protocol. Prior to implementation, all agencies used a multidose epinephrine protocol. The Cardiac Arrest Registry to Enhance Survival (CARES) was used to obtain patient outcomes. Study outcomes were survival to hospital discharge (primary) and return of spontaneous circulation (ROSC). Analysis was by intention to treat. Outcomes were compared pre- vs. post-implementation using generalized estimating equations to account for clustering within EMS agencies. Adjusted analyses included age, sex, race, shockable vs. non-shockable rhythm, witnessed arrest, automatic external defibrillator availability, EMS response interval, and bystander cardiopulmonary resuscitation. During the study period there were 1,690 encounters (899 pre- and 791 post-implementation). The population was 74.7% white, 61.1% male, and had a median age of 65 (IQR 53–76) years. Survival to hospital discharge was similar pre- vs. post-implementation [13.6% (122/899) vs. 15.4% (122/791); OR 1.19, 95%CI 0.89–1.59]. However, ROSC was more common post-implementation [42.3% (380/899) vs. 32.5% (257/791); OR 0.66, 95%CI 0.54–0.81]. After adjusting for covariates, the single-dose protocol was associated with similar survival to discharge rates (aOR 0.88, 95%CI 0.77–1.29), but with decreased ROSC rates (aOR 0.58, 95%CI 0.47–0.72). A prehospital single-dose epinephrine protocol was associated with similar survival to hospital discharge, but decreased ROSC rates compared to the traditional multidose epinephrine protocol. [ABSTRACT FROM AUTHOR]

Rural patients with ST-elevation myocardial infarction (STEMI) may be less likely to receive prompt reperfusion therapy. This study's primary objective was to compare rural versus urban time intervals among a national cohort of prehospital patients with STEMI. The ESO Data Collaborative (Austin, TX), containing records from 1,366 emergency medical services agencies, was queried for adult 9-1-1 responses with suspected STEMI from 1/1/2018-12/31/2019. The scene address for each encounter was classified as either urban or rural using the 2010 US Census Urban Area Zip Code Tabulation Area relationship. The primary outcome was total EMS interval (9-1-1 call to hospital arrival); a key secondary outcome was the proportion of responses that had EMS intervals under 60 minutes. Generalized estimating equations were used to determine whether rural versus urban differences in interval outcomes occurred when adjusting for loaded mileage (distance from scene to hospital) and patient and clinical encounter characteristics. Of 15,915,027 adult 9-1-1 transports, 23,655 records with suspected STEMI were included in the analysis. Most responses (91.6%, n = 21,661) occurred in urban settings. Median EMS interval was 37.6 minutes (IQR 30.0-48.0) in urban settings compared to 57.0 minutes (IQR 46.5-70.7) in rural settings (p < 0.01). Urban responses more frequently had EMS intervals <60 minutes (89.5%, n = 19,130), compared to rural responses (55.5%, n = 1,100, p < 0.01). After adjusting for loaded mileage, age, sex, race/ethnicity, abnormal vital signs, pain assessment, aspirin administration, and IV/IO attempt, rural location was associated with a 5.8 (95%CI 4.2-7.4) minute longer EMS interval than urban, and rural location was associated with a reduced chance of achieving EMS interval < 60 minutes (OR 0.40; 95%CI 0.33-0.49) as compared to urban location. In this large national sample, rural location was associated with significantly longer EMS interval for patients with suspected STEMI, even after accounting for loaded mileage. [ABSTRACT FROM AUTHOR]

To examine the relationship between COVID-19-related distress and mental health among first-year college students. Data for this longitudinal study (n = 727) were collected before the school year (August 2019), end of fall semester (December 2019), and soon after the university suspended in-person instruction (April 2020). We used multivariable log-linear and logistic regressions to examine continuous and dichotomous outcomes on the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale. The most consistent predictor of during-pandemic mental health was feeling extremely isolated (versus not at all), which was associated with increased symptom severity of depression (proportional change[95% CI] = 2.43[1.87, 3.15]) and anxiety (2.02[1.50, 2.73]) and greater odds of new moderate depression (OR[95% CI] = 14.83[3.00, 73.41]) and anxiety (24.74[2.91, 210.00]). Greater COVID-19-related concern was also related to increased mental health symptoms. Results highlight the need for mental health services during crises that lead to social isolation. [ABSTRACT FROM AUTHOR]

Simple Summary: Surgical treatment of pelvic sarcoma involving the bone is the standard of care but is associated with several treatment sequelae and reduced functional quality of life. Treatment with photon and proton radiotherapy is associated with relapse. Carbon ion radiotherapy may reduce both relapse rates and treatment sequelae. The PROSPER study is a tricontinental, nonrandomized, prospective, three-arm, pragmatic trial evaluating carbon ion radiotherapy, proton therapy, and the surgical treatment of pelvic sarcoma involving the bone. We describe the rationale and design of this clinical trial currently open to enrollment. Surgical treatment of pelvic sarcoma involving the bone is the standard of care but is associated with several sequelae and reduced functional quality of life (QOL). Treatment with photon and proton radiotherapy is associated with relapse. Carbon ion radiotherapy (CIRT) may reduce both relapse rates and treatment sequelae. The PROSPER study is a tricontinental, nonrandomized, prospective, three-arm, pragmatic trial evaluating treatments of pelvic sarcoma involving the bone. Patients aged at least 15 years are eligible for inclusion. Participants must have an Eastern Cooperative Oncology Group Performance Status score of two or less, newly diagnosed disease, and histopathologic confirmation of pelvic chordoma, chondrosarcoma, osteosarcoma, Ewing sarcoma with bone involvement, rhabdomyosarcoma (RMS) with bone involvement, or non-RMS soft tissue sarcoma with bone involvement. Treatment arms include (1) CIRT (n = 30) delivered in Europe and Asia, (2) surgical treatment with or without adjuvant radiotherapy (n = 30), and (3) proton therapy (n = 30). Arms two and three will be conducted at Mayo Clinic campuses in Arizona, Florida, and Minnesota. The primary end point is to compare the 1-year change in functional QOL between CIRT and surgical treatment. Additional comparisons among the three arms will be made between treatment sequelae, local control, and other QOL measures. [ABSTRACT FROM AUTHOR]

Sexual minority women (i.e., women minoritized for their sexualities) are identified as high risk for mental health and substance use problems; however, there is no consensus on the criteria by which women are categorized as sexual minority. Though there is some evidence suggesting that certain subgroups of women are at higher risk than others based on sexual orientation, different categorization schemes for sexual orientation have yet to be compared within the same sample. Using data from the National Epidemiologic Survey of Alcohol and Related Conditions–III (N = 19,528), we examined how multiple categorization schemes (i.e., identity, behavior, recency of sexual behavior) for categorizing women who have sex with women (WSW) yield different estimates of prevalence of mental health and substance use issues. We used chi-square and logistic regression to analyze the link between sexual orientation categorization schemes and health, categorizing by 1) self-identification only, 2) behavior only, and 3) the combination of self-identification and behavior (recent vs. past). We discovered high prevalence rates of health problems among heterosexual-identified WSW who reported no recent sexual activity with women (i.e., previously had sex with women but not within the past 12 months); this category of women comprised 35% of all WSW. Step by step, we found more detailed information about these women's experiences by moving to the complex categorization scheme (the combination of self-identification and behavior). Heterosexual-identified women who have had sex with women in their past (though not recently) presented as a large group with high prevalence rates of substance use and mental disorders. These women remain invisible to researchers who categorize sexual orientation only by sexual identity or by behavior and ignore the role of behavior change over time—imprecisely categorizing such women as heterosexual or as women who have sex with men. They thus are underserved by health research and represent a significant population for further study and intervention. [ABSTRACT FROM AUTHOR]

• Young adults have created unique self-narratives while in foster care. • Foster youth navigate relational instability, ambiguity, and hope. • Foster care shapes the self-narrative and identity processes of youth. Foster care involvement is often marked by being in a frequent state of disruption, resilience, disempowerment, and self-protection (e.g., Mitchell, 2016). Although over 400,000 children are in foster care at any given time in the U.S. (Children's Bureau, 2021), foster youth are a relatively understudied population, especially regarding their own meaning-making and the development of their sense of self. The purpose of the present study was to understand the psychological experiences that shape the construction of self-narratives in young adults who have been in foster care. The sample included nine young adults (18–24 years old) who had been in foster care at some point in their childhood; all participants identified as women. The sample was diverse in terms of racial and ethnic identities. Participants completed brief surveys and an interview regarding their background, foster care experiences, and hopes for the future. Data were analyzed using reflexive thematic analysis. Study findings highlighted how foster youth navigated uncertainty, instability, and isolation in their interpersonal relationships, as well as ambiguity in understanding their past, present, and future. Findings further highlighted the process of managing dialectics throughout development, especially regarding adverse experiences, and how youth are shaped by their past to create their future. While these themes were not exhaustive of the complete process of self-narrative development, they did provide a starting point for understanding and empowering foster youth to own their stories. The primary implication of this study is that the unique developmental context of foster care shapes the self-narrative processes and meaning-making experiences of youth. [ABSTRACT FROM AUTHOR]

Introduction: Cannabis use in the United States is increasingly accepted and legal. Rise in use among childbearing aged adults is potentially concerning, as the impacts of parental cannabis use on children are largely unknown, especially for young children. This study examined whether cannabis use is associated with increased risk for negative parenting and child emotional and behavioral problems among the parents of young children. Methods: We conducted a cross-sectional survey of parents and child behavior, recruited through five primary care practices in three states. Parents of children aged 1.5–5 years reported on family demographics, last 6-months cannabis use, negative parenting, parent mental health, parents' adverse childhood experiences (ACEs), and child emotional/behavioral problems. We conducted hierarchical regressions to determine if parental cannabis use predicts negative parenting and/or child emotional/behavioral problems when controlling for other risk factors. Results: Of 266 responding parents, 34 (13%) reported cannabis use in the last 6 months. Parents who endorsed cannabis use reported significantly more negative parenting, ACEs, anxiety, depression, and child emotional/behavioral problems. Adjusting for the effects of other risk factors, cannabis use significantly predicted more negative parenting, but was not uniquely and significantly associated with child emotional/behavioral problems. Conclusion: Parental cannabis predicted negative parenting, which in turn predicted early childhood emotional/behavioral problems; however, parental cannabis use did not predict child emotional/behavioral problems when other risk factors were considered. Further research is needed to elucidate the nature and direction of relationships between parent cannabis use, negative parenting, child psychological outcomes, and other risk factors. [ABSTRACT FROM AUTHOR]

The composition of land use/land cover (LULC) in coastal watersheds has many implications for estuarine system ecological function. Land use/land cover can influence allochthonous inputs and can enhance or degrade the physical characteristics of estuaries, which in turn affects estuaries' ability to support local biota. However, these implications for estuaries are often poorly considered when assessing the value of lands for conservation. The focus of research regarding terrestrial and estuarine interfaces often evaluates how LULC may stress estuarine ecosystems, but in this study we sought to understand how LULC may both positively and negatively affect estuaries using measures of observed biotic richness as proxies for estuarine function. We investigated the influence of LULC on estuarine biotic richness with Bayesian hierarchical models using multiple geospatial data sets from 33 estuaries and their associated watersheds along the Gulf of Mexico coastal region of the United States. We designed the hierarchical models with observed species richness of three functional groups (FGs) (i.e., pelagic fishes, forage fishes, and shrimp) from fishery‐independent trawl surveys as response variables. We then set salinity and water temperature as trawl‐specific covariates and measures of influence from six LULC classes as estuary‐specific covariates and allowed the models to vary by estuary, trawl program, salinity, and temperature. The model results indicated that the observed richness of each FG was both positively and negatively associated with different LULC classes, with estuarine wetlands and forested lands demonstrating the strongest positive influences on each FG. The results are generally consistent with past studies, and the modeling framework provides a promising way to systematically quantify LULC linkages with the biotic health of estuaries for the purposes of potentially valuing the estuarine implications of land conservation. [ABSTRACT FROM AUTHOR]

Background: The HEART Pathway is a validated protocol for risk stratifying emergency department (ED) patients with possible acute coronary syndrome (ACS). Its performance in different age groups is unknown. The objective of this study is to evaluate its safety and effectiveness among older adults. Methods: A pre‐planned subgroup analysis of the HEART Pathway implementation study was conducted. This prospective interrupted time series accrued adult ED patients with possible ACS who were without ST‐elevation across three US sites from 11/2013–01/2016. After implementation, providers prospectively used the HEART Pathway to stratify patients as low‐risk or non‐low‐risk. Patients were classified as older adults (≥65 years), middle‐aged (46–64 years), and young (21–45 years). Primary safety and effectiveness outcomes were 30‐day death or MI and hospitalization at 30 days, determined from health records, insurance claims, and death index data. Fisher's exact test compared low‐risk proportions between groups. Sensitivity for 30‐day death or MI and adjusted odds ratios (aORs) for hospitalization and objective cardiac testing were calculated. Results: The HEART Pathway implementation study accrued 8474 patients, of which 26.9% (2281/8474) were older adults, 45.5% (3862/8474) middle‐aged, and 27.5% (2331/8474) were young. The HEART Pathway identified 7.4% (97/1303) of older adults, 32.0% (683/2131) of middle‐aged, and 51.4% (681/1326) of young patients as low‐risk (p < 0.001). The HEART Pathway was 98.8% (95% CI 97.1–100) sensitive for 30‐day death or MI among older adults. Following implementation, the rate of 30‐day hospitalization was similar among older adults (aOR 1.25, 95% CI 1.00–1.55) and cardiac testing increased (aOR 1.25, 95% CI 1.04–1.51). Conclusion: The HEART Pathway identified fewer older adults as low‐risk and did not decrease hospitalizations in this age group. [ABSTRACT FROM AUTHOR]

This qualitative study examined adolescent and caregiver perspectives on identification and early response in emerging eating disorders. Fifteen female-identified adolescents with an eating disorder diagnosis (M age = 15.20 years; 93% White; 20% Hispanic) and 12 caregivers (all biological parents: 1 father, 11 mothers; M age = 51.56 years) participated in semi-structured interviews about their experience identifying and responding to the eating disorder, eventually seeking treatment. Participants were recruited from three eating disorder treatment centers in the United States. Interview responses were coded by three raters using inductive consensual qualitative methods. Results found that parents were typically the first to notice and confront the eating disorder, and weight loss and thinness usually were the earliest symptoms identified. The most common adolescent response to detection was mixed (e.g., relief and anger), and common parental reactions included seeking professional consultation and creating limitations on disordered behaviors (e.g., encouraging eating). Barriers to earlier detection were highlighted (e.g., parental hesitancy to act on suspicions), suggesting that parents need greater support for swift and confident responding. To combat this, parents recommended increasing knowledge of eating disorder symptoms. Parents and adolescents both recommended parent-led monitoring of eating and exercise behaviors to increase the chance of noticing changes and responding quickly with aggressive and supportive action. These experiences provide a framework for early identification and the role of caregiver response, highlighting the need for assertive yet compassionate efforts to combat emerging eating disorders. [ABSTRACT FROM AUTHOR]

Background: Of the nearly 50,000 women in the United States who undergo treatment for ductal carcinoma in situ (DCIS) annually, many may not benefit from treatment. To better understand the impact of a DCIS diagnosis, patients self‐identified as having had DCIS were engaged regarding their experience. Methods: In July 2014, a web‐based survey was administered through the Susan Love Army of Women breast cancer listserv. The survey included open‐ended questions designed to assess patients' perspectives about DCIS diagnosis and treatment. Deductive and inductive codes were applied to the responses; common themes were summarized. Results: Among the 1832 women included in the analytic sample, the median age at diagnosis was 60 years. Four primary themes were identified: 1) uncertainty surrounding a DCIS diagnosis, 2) uncertainty about DCIS treatment, 3) concern about treatment side effects, and 4) concern about recurrence and/or developing invasive breast cancer. When diagnosed, participants were often uncertain about whether they had cancer or not and whether they should be considered a "survivor." Uncertainty about treatment manifested as questioning the appropriateness of the amount of treatment received. Participants expressed concern about the "cancer spreading" or becoming invasive and that they were not necessarily "doing enough" to prevent recurrence. Conclusions: In a large, national sample, participants with a history of DCIS reported confusion and concern about the diagnosis and treatment, which caused worry and significant uncertainty. Developing strategies to improve patient and provider communications regarding the nature of DCIS and acknowledging gaps in the current knowledge of management options should be a priority. Ductal carcinoma in situ (DCIS) survivors often report feelings of uncertainty and concern about their diagnosis and treatment. Developing strategies to improve communication regarding the nature of DCIS as well as the potential benefits and harms of different DCIS management options should be a priority. [ABSTRACT FROM AUTHOR]

Background: Most older adults visit the emergency department (ED) near the end of life without advance care planning (ACP) and thus are at risk of receiving care that does not align with their wishes and values. ED GOAL is a behavioral intervention administered by ED clinicians, which is designed to engage seriously ill older adults in serious illness conversations in the ED. Seriously ill older adults found it acceptable in the ED. However, its potential to be used by nurses remains unclear. Objective: The aim of this study is to identify refinements to adapt an ED-based ACP intervention by eliciting the perspectives of nurses. Design: This is a qualitative study using semistructured interviews. Data were analyzed using axial coding methods. Setting/Subjects: We recruited a purposeful sample of ED nurses in one urban academic ED and one urban community ED in the northeastern region of the United States. Results: Twenty-five nurses were interviewed (mean age 46 years, 84% female, and mean clinical experience of 16 years). Emerging themes were identified within six domains: (1) nurses' prior experience with serious illness conversations, (2) overall impression of ED GOAL, (3) refinements to ED GOAL, (4) implementation of ED GOAL by ED nurses, (5) specially trained nursing model, and (6) use of telehealth with ED GOAL. Conclusions: ED nurses were generally supportive of using ED GOAL and provided insight into how to best adapt and implement it in their clinical practice. Empirical evidence for adapting ED GOAL to the nursing practice remains to be seen. [ABSTRACT FROM AUTHOR]

Agricultural fields in drylands are challenged globally by limited freshwater resources for irrigation and also by elevated soil salinity and sodicity. It is well known that pedogenic carbonate is less soluble than evaporate salts and commonly forms in natural drylands. However, few studies have evaluated how irrigation loads dissolved calcium and bicarbonate to agricultural fields, accelerating formation rates of secondary calcite and simultaneously releasing abiotic CO2 to the atmosphere. This study reports one of the first geochemical and isotopic studies of such "anthropogenic" pedogenic carbonates and CO2 from irrigated drylands of southwestern United States. A pecan orchard and an alfalfa field, where flood-irrigation using the Rio Grande river is a common practice, were compared to a nearby natural dryland site. Strontium and carbon isotope ratios show that bulk pedogenic carbonates in irrigated soils at the pecan orchard primarily formed due to flood-irrigation, and that approximately 20–50% of soil CO2 in these irrigated soils is calcite-derived abiotic CO2 instead of soil-respired or atmospheric origins. Multiple variables that control the salt buildup in this region are identified and impact the crop production and soil sustainability regionally and globally. Irrigation intensity and water chemistry (irrigation water quantity and quality) dictate salt loading, and soil texture governs water infiltration and salt leaching. In the study area, agricultural soils have accumulated up to 10 wt% of calcite after just about 100 years of cultivation. These rates will likely increase in the future due to the combined effects of climate variability (reduced rainfall and more intense evaporation), use of more brackish groundwater for irrigation, and reduced porosity in soils. The enhanced accumulation rates of pedogenic carbonate are accompanied by release of large amounts of abiotic CO2 from irrigated drylands to atmosphere. Extensive field studies and modelling approaches are needed to further quantify these effluxes at local, regional and global scales. [ABSTRACT FROM AUTHOR]

Agricultural fields in drylands are challenged globally by limited freshwater resources for irrigation and also by elevated soil salinity and sodicity. It is well known that pedogenic carbonate is less soluble than evaporate salts and commonly forms in natural drylands. However, few studies have evaluated how irrigation loads dissolved calcium and bicarbonate to agricultural fields, accelerating formation rates of secondary calcite and simultaneously releasing abiotic CO2 to the atmosphere. This study reports one of the first geochemical and isotopic studies of such "anthropogenic" pedogenic carbonates and CO2 from irrigated drylands of southwestern United States. A pecan orchard and an alfalfa field, where flood-irrigation using the Rio Grande river is a common practice, were compared to a nearby natural dryland site. Strontium and carbon isotope ratios show that bulk pedogenic carbonates in irrigated soils at the pecan orchard primarily formed due to flood-irrigation, and that approximately 20–50% of soil CO2 in these irrigated soils is calcite-derived abiotic CO2 instead of soil-respired or atmospheric origins. Multiple variables that control the salt buildup in this region are identified and impact the crop production and soil sustainability regionally and globally. Irrigation intensity and water chemistry (irrigation water quantity and quality) dictate salt loading, and soil texture governs water infiltration and salt leaching. In the study area, agricultural soils have accumulated up to 10 wt% of calcite after just about 100 years of cultivation. These rates will likely increase in the future due to the combined effects of climate variability (reduced rainfall and more intense evaporation), use of more brackish groundwater for irrigation, and reduced porosity in soils. The enhanced accumulation rates of pedogenic carbonate are accompanied by release of large amounts of abiotic CO2 from irrigated drylands to atmosphere. Extensive field studies and modelling approaches are needed to further quantify these effluxes at local, regional and global scales. [ABSTRACT FROM AUTHOR]

Purpose: Dental implants have become a common treatment option for the replacement of missing teeth. The purpose of this study was to identify the curriculum content used for teaching dental implant maintenance within entry-level dental hygiene programs in the United States. Methods: An electronic questionnaire was distributed via five mailings in March and April of 2020 to accredited entry-level dental hygiene program directors (n=329) in the United States. The survey instrument evaluated curriculum content related to dental implant maintenance within dental hygiene programs at both the associate and baccalaureate levels. Results were analyzed using descriptive statistics and Chi square tests of association (p=0.01). Results: A total of 86 responses were received for a response rate of 26.1%. Most programs (98.80%, n=82) provide didactic instruction on dental implant maintenance, while less than half (45.8%, n=38) include laboratory instruction in maintenance therapy. On average, students worked with 3.41 implant patients during their clinical education (range = 0-20). Most respondents indicated that clinical competencies are not required for implant maintenance. There were no statistically significant differences found in the curriculum content for teaching dental implant maintenance between associate degree/certificate and baccalaureate entry-level programs. Conclusions: Varied approaches in the assessment and maintenance of peri-implant health were identified among the dental hygiene programs surveyed. These findings may provide an opportunity for program directors to assess their curriculum and create protocols and competencies related to dental implant maintenance. Future research is needed to investigate the curriculum content and evaluate whether programs are implementing maintenance approaches that promote implant health. [ABSTRACT FROM AUTHOR]

Expanded access is a treatment use of investigational drugs, biologicals or medical devices outside of clinical trials. The purpose of our study was to assess self‐reported conflicts of interest (COIs) in oncology expanded access studies. One hundred fifty‐eight oncology expanded access studies published from 2013 through 2020 were included. The pharmaceutical industry funded either completely or in part 94 studies (59.49%). The authors disclosed mostly financial COIs, while the number of the reported nonfinancial conflicts was relatively small (3528 and 57 COIs, respectively). The number of articles in which at least one author had a financial COI was 118 (74.68%). The most common financial COI types included advisory board membership/consulting (1471 COIs; 41.7%), followed by honoraria (570 COIs; 16.16%) and research funding (441 COIs; 12.5%). Logistic regression was performed to identify predictors of disclosing financial COIs and positive study's conclusions. On univariate analysis, financial COIs were more likely to occur in studies with at least one center located in the United States (odds ratio [OR], 5.62; 95% confidence interval [CI], 1.57‐35.98; P =.02). We also found that positive conclusions about the studied treatments were less likely in studies without industry funding (OR, 0.26; CI, 0.08‐0.77; P =.01). Most of the research on COIs in oncology performed to date focused on other types of studies, especially clinical trials. To our knowledge, our study is the first to evaluate COIs in oncology expanded access studies. [ABSTRACT FROM AUTHOR]

Background: Supportive care interventions have demonstrated benefits for both informal and/or family cancer caregivers and their patients, but uptake generally is poor. To the authors' knowledge, little is known regarding the availability of supportive care services in community oncology practices, as well as engagement practices to connect caregivers with these services. Methods: Questions from the National Cancer Institute Community Oncology Research Program (NCORP)'s 2017 Landscape Survey examined caregiver engagement practices (ie, caregiver identification, needs assessment, and supportive care service availability). Logistic regression was used to assess the relationship between the caregiver engagement outcomes and practice group characteristics. Results: A total of 204 practice groups responded to each of the primary outcome questions. Only 40.2% of practice groups endorsed having a process with which to systematically identify and document caregivers, although approximately 76% were routinely using assessment tools to identify caregiver needs and approximately 63.7% had supportive care services available to caregivers. Caregiver identification was more common in sites affiliated with a critical access hospital (odds ratio [OR], 2.44; P =.013), and assessments were less common in safety‐net practices (OR, 0.41; P =.013). Supportive care services were more commonly available in the Western region of the United States, in practices with inpatient services (OR, 2.96; P =.012), and in practices affiliated with a critical access hospital (OR, 3.31; P =.010). Conclusions: Although many practice groups provide supportive care services, fewer than one‐half systematically identify and document informal cancer caregivers. Expanding fundamental engagement practices such as caregiver identification, assessment, and service provision will be critical to support recent calls to improve caregivers' well‐being and skills to perform caregiving tasks. Although many community oncology practice groups provide supportive care services, fewer than one‐half systematically identify and document informal cancer caregivers. Expanding fundamental engagement practices such as caregiver identification, assessment, and service provision will be critical to support recent calls to improve caregivers' well‐being and skills to perform caregiving tasks. [ABSTRACT FROM AUTHOR]

The growing availability of genetic testing in the clinical, research, and direct-to-consumer realms has caused people to fear that they will be discriminated against for their genes. In response, Congress passed the Genetic Information Nondiscrimination Act (GINA), which prohibits the use of genetic information in much of health insurance and employment. Importantly, this prohibition does not apply to life, long-term care, and disability insurance. While these lines of insurance are not federally prohibited from using an individual's genetic information, several states do regulate use of genetic information in these insurance lines. This paper presents a comprehensive 50-state survey on regulation of how life, long-term care, and disability insurers can use genetic information. Overall, it shows that the use of genetic information in these lines of insurance is still relatively unregulated and that the divergent strategies adopted across states are both weak and problematic. Consistent and even regulation, whether from the federal government or through model legislation, is needed to adequately protect insurers and families alike. [ABSTRACT FROM AUTHOR]

In the United States, ~1.4 million sporadic human Salmonella enterica infections occur annually, with an estimated 6% attributable to reptile exposure. Detection of Salmonella in reptiles can be challenging given the limitations among detection methods. We evaluated sampling and detection methods for S. enterica in a cross-sectional study of reptilian patients (n = 45) over the course of 13 mo. Two sampling methods (cloacal swabs, electrostatic cloth body-feet samples) and 3 detection methods (enriched culture, lateral flow immunoassay [LFI], real-time PCR) were compared using McNemar and Fisher exact tests. Results varied by species, sample type, and detection method. In total, 14 of 45 (33%) patients were positive by culture, 10 of 45 (22%), and/or 13 of 45 (29%) by rtPCR. Among rtPCR-positive results, cloacal swabs (12 of 45 [27%]) resulted in a higher detection than body-feet wipes (4 of 45 [9%]; p = 0.01). Among culture-positive results, shedding was most commonly detected after additional incubation at room temperature when testing cloacal swabs (9 of 45 [20%]). However, there was significant disagreement between sampling methods (cloacal vs. body-feet; p = 0.03). No samples were positive by LFI. In general, cloacal swabs yielded the highest test-positive rates, irrespective of testing method. Our study highlights the importance of using detection methods optimized for the sample being tested. [ABSTRACT FROM AUTHOR]

The increase in deportations under the Obama administration followed by reduced discretion in arrests in the U.S. interior by the Trump administration has had tangible effects on undocumented immigrants and their communities. The unpredictability of removals, coupled with a sense of foreboding, directly impacts health, limits health seeking behaviors, and instills fear of government institutions. We describe how advocates with the Washtenaw Interfaith Coalition for Immigrant Rights reorganized their urgent response phone line to address an increase in number and complexity of calls, provide a case study of a typical call, and suggest strategies for replication in similar communities. [ABSTRACT FROM AUTHOR]

Objective  To compare labor patterns in pregnancies affected by fetal anomalies to low-risk singletons. Study Design  Labor data from the Consortium on Safe Labor, a multicenter retrospective study from 19 U.S. hospitals, including 98,674 low-risk singletons compared with 6,343 pregnancies with fetal anomalies were analyzed. Repeated-measures analysis constructed mean labor curves by parity, gestational age, and presence of fetal anomaly in women who reached full dilation. Interval-censored regression analysis adjusted for covariables was used to determine the median traverse times for labor progression. Results  Labor curves for all groups indicated slower labor progress for patients with fetal anomalies. The most significant trends in median traverse times were observed in the preterm nulliparous and term multiparous groups. The median traverse times from 4 cm to complete dilation in the preterm nulliparous control versus anomaly groups were 5.0 and 5.4 hours (p  < 0.0001). Conclusion  Labor proceeds at a slower rate in pregnancies affected by anomalies. [ABSTRACT FROM AUTHOR]

Rationale: Critically ill patients in the intensive care unit (ICU) often require the care of specialist physicians for clinical or procedural expertise. The current state of communication between specialist physicians and families and nurses has not been explored. Objectives: To document the receipt of communication by nurses and family members regarding consultations performed on their patient or loved one, and to quantify how this impacts their overall perceptions of the quality of specialty care. Methods: Prospective survey of 60 adult family members and 90 nurses of 189 ICU patients who received a specialist consultation between March and October of 2015 in a single academic medical center in the United States. Surveys measured the prevalence of direct communication—defined as communication conducted in person, via telephone, or via text-page in which the specialist team gathered information about the patient from the nurse/family member and/or shared recommendations for care—and perceived quality of care. Results: In about two-thirds of family surveys (40/60) and one-half of nurse surveys (75/160), respondents had no direct communication with the specialist team that performed the consultation. Compared to nurses who had no direct communication with the specialists, those who did were 1.5 times more likely to rate the consultation as “excellent” (RR 1.48, 95% CI 1.2–1.8, p<0.001). Nearly 40% (22/60) of families knew so little about the consultation that they felt incapable of evaluating it. Conclusions: Most ICU families and nurses have no interaction with specialist providers. Nurses’ frequent exclusion from conversations about specialty care may pose safety risks and increase the likelihood of mixed messages for patients and families, most of whom desire some interaction with specialists. Future research is needed to identify effective mechanisms for information sharing that keep nurses and families aware of consultation requests, delivery, and outcomes without increasing the risk of mixed messages. [ABSTRACT FROM AUTHOR]

Racial/ethnic identity is contingent and arbitrary, yet it is commonly used to evaluate disease risk and treatment response. Drawing on open-ended interviews with patients and clinicians in two US clinics, we explore how racialized risk is conceptualized and how it impacts patient care and experience. We found that racial/ethnic risk was a common but poorly defined construct for both patients and clinicians, who intermingled concepts of genetics, biology, behavior, and culture, while disregarding historical or structural context. We argue that racializing risk embodies social power in marked and unmarked bodies, reinforcing inequality along racial lines and undermining equitable health care. [ABSTRACT FROM AUTHOR]

Today, the United States exports 2.2 million tons of pork and pork products annually, representing just over 26% of U.S. pork production. In order to meet specific demands of a growing export market, pork quality and carcass characteristics are now integrated into breeding objectives. Color and marbling are 2 loin quality traits that influence consumer acceptability of pork and while correlations between early and aged ventral quality have been established, it is unclear if those correlations differ between production objectives (meat quality vs. lean growth). Therefore, the objective of this experiment was to compare correlations among early postmortem ventral loin quality characteristics and aged ventral loin and chop quality characteristics between pigs sired by either Pietrain (lean growth) or Duroc (meat quality) boars. Early postmortem (~1 d) quality traits included: instrumental and visual color, marbling and firmness, and loin pH on the ventral surface of the loin. Loins were aged until 14 d postmortem in vacuum packages. Aged quality traits included traits evaluated early as well as Warner-Bratzler shear force (WBSF) and cook loss. Correlations were compared between Pietrain and Duroc-sired pigs using a Fisher’s z-test. Early instrumental lightness (L*) was moderately correlated with aged ventral L* (Pietrain r = 0.47; Duroc r = 0.65) and aged ventral visual color (Pietrain r = 0.42; Duroc r = 0.58). Early ventral visual color was moderately correlated with aged chop L* (Pietrain r = 0.46; Duroc r = 0.60) and aged chop visual color (Pietrain r = 0.45; Duroc r = 0.57). Early visual marbling was strongly correlated (Pietrain r = 0.68; Duroc r = 0.84) with aged chop visual marbling. Within the Durocsired pigs, early L* was moderately correlated with aged chop L* (r = 0.64) but only weakly correlated (r = 0.35) within the Pietrain-sired pigs and those correlations differed at P ≤0.02. Within the Duroc-sired pigs, early ventral visual color was moderately correlated with aged pH (r = 0.44) and aged ventral L* (r = 0.57) but only weakly correlated (r ≤ 0.29) within the Pietrain-sired pigs and those correlations differed at P ≤0.03. No early postmortem quality traits were correlated (r ≤ 0.34) with WBSF or cook loss for either sire line. In summary, correlations between early and aged postmortem quality traits rarely differed between Duroc- and Pietrain-sired pigs. It is not necessary to account for sire line when relating early and aged quality characteristics. [ABSTRACT FROM AUTHOR]

The article discusses the U.S. Food and Drug Administration's (FDA's) regulation of genetically modified animals, including the use of the genetic technology CRISPR on animals and the altering of animals' genomic DNA. The use of gene editing to treat genetic diseases in animals is discussed.

In the first known longitudinal study of the topic, we examined whether experiencing sexual assault or sexual harassment while in the military was associated with increased risk for subsequent unhealthy alcohol use and smoking among U.S. service members in the Millennium Cohort Study (2001-2012). Adjusted complementary log-log models were fit to estimate the relative risk of (a) smoking relapse among former smokers (men: n = 4,610; women: n = 1,453); (b) initiation of unhealthy alcohol use (problem drinking and/or drinking over recommended limits) among those with no known history of unhealthy alcohol use (men: n = 8,459; women: n = 4,816); and (c) relapse among those previously reporting unhealthy alcohol use (men: n = 3,487; women: n = 1,318). Men who reported experiencing sexual assault while in the military had sixfold higher risk for smoking relapse: relative risk (RR) = 6.62; 95% confidence interval (CI) [2.34, 18.73], than men who did not. Women who reported experiencing sexual assault while in the military had almost twice the risk for alcohol relapse: RR = 1.73; 95% CI [1.06, 2.83]. There were no other significant associations. These findings suggest that men and women may respond differently following sexual trauma, and support future concerted policy efforts by military leadership to prevent, detect, and intervene on sexual assault. [ABSTRACT FROM AUTHOR]

Under the Affordable Care Act, Medicaid Expansion programs are extending Medicaid eligibility and increasing access to care. However, stigma associated with public insurance coverage may importantly affect the nature and content of the health care beneficiaries receive. In this paper, we examine the health care stigma experiences described by a group of low-income public insurance beneficiaries. They perceive stigma as manifest in poor quality care and negative interpersonal interactions in the health care setting. Using an intersectional approach, we found that the stigma of public insurance was compounded with other sources of stigma including socioeconomic status, race, gender, and illness status. Experiences of stigma had important implications for how subjects evaluated the quality of care, their decisions impacting continuity of care, and their reported ability to access health care. We argue that stigma challenges the quality of care provided under public insurance and is thus a public health issue that should be addressed in Medicaid policy. [ABSTRACT FROM AUTHOR]

Food safety-related infrastructure, procedures, and practices at grocery stores play an important role in protecting public health. Thus, as part of a companion study to establish the "true" prevalence of Listeria monocytogenes among ready-to-eat (RTE) foods purchased at retail stores, digital photographs were recorded by data collectors trained to identify potential perceived and actual food safety risk situations. Digital photographs taken between 2010 and 2012 at stores across FoodNet sites in California, Maryland, Connecticut, and Georgia were coded by use of qualitative content analysis techniques. Risk factors for foodborne illnesses, including contaminated equipment resulting in cross-contamination, poor personal hygiene, and improper temperature control, were observed. As examples, photographs captured utensils, such as tongs, placed handle-down in containers of uncovered RTE foods, bare-handed contact of deli meat during slicing, and water dripping from the ceiling onto the deli counter. Also seen were practices where good risk management practices were implemented. These digital photographs provide a set of learning materials that the retail food industry can use as examples of what shoppers may see if they are focused on food safety. Such photographs can also be used as a motivation and as a real-world teaching tool to better inform and engage a positive food safety culture among shoppers and employees at grocery stores. [ABSTRACT FROM AUTHOR]

Background: Hospice provides intensive end-of-life care to patients and their families delivered by an interdisciplinary team of nurses, aides, chaplains, social workers, and physicians. Significant gaps remain about how team members respond to diverse needs of patients and families, especially in the last week of life. Objective: The study objective was to describe the frequency of hospice team provider visits in the last week of life, to examine changes in frequency over time, and to identify patient characteristics that were associated with an increase in visit frequency. Design: This was a retrospective cohort study using electronic medical record data. Setting/subjects: From U.S. not-for-profit hospices, 92,250 records were used of patients who died at home or in a nursing home, with a length of stay of at least seven days. Measurements: Data included basic demographic variables, diagnoses, clinical markers of illness severity, patient functioning, and number of hospice team member visits in the last seven days of life. Results: On average the total number of hospice team member visits in the last week of life was 1.36 visits/day. Most were nurse visits, followed by aides, social workers, and chaplains. Visits increased over each day on average across the last week of life. Greater increase in visits was associated with patients who were younger, male, Caucasian, had a spouse caregiver, and shorter lengths of stay. Conclusions: This study provides important information to help hospices align the interdisciplinary team configuration with the timing of team member visits, to better meet the needs of the patients and families they serve. [ABSTRACT FROM AUTHOR]

Objective. The Institute of Medicine and the draft National Pain Strategy recently called for better training for health care clinicians. This was the first high-level needs assessment for pain psychology services and resources in the United States. Design. Prospective, observational, cross-sectional. Methods. Brief surveys were administered online to six stakeholder groups (psychologists/therapists, individuals with chronic pain, pain physicians, primary care physicians/physician assistants, nurse practitioners, and the directors of graduate and postgraduate psychology training programs). Results. 1,991 responses were received. Results revealed low confidence and low perceived competency to address physical pain among psychologists/ therapists, and high levels of interest and need for pain education. We found broad support for pain psychology across stakeholder groups, and global support for a national initiative to increase pain training and competency in U.S. therapists. Among directors of graduate and postgraduate psychology training programs, we found unanimous interest for a no-cost pain psychology curriculum that could be integrated into existing programs. Primary barriers to pain psychology include lack of a system to identify qualified therapists, paucity of therapists with pain training, limited awareness of the psychological treatment modality, and poor insurance coverage. Conclusions. This report calls for transformation within psychology predoctoral and postdoctoral education and training and psychology continuing education to include and emphasize pain and pain management. A system for certification is needed to facilitate quality control and appropriate reimbursement. There is a need for systems to facilitate identification and access to practicing psychologists and therapists skilled in the treatment of pain. [ABSTRACT FROM AUTHOR]

Background: Trying to lose weight has been associated with alcohol use among college-aged females. Excessive drinking along with purging as a method for weight control has been documented in this population. However, little is known about the relationship between alcohol use and trying to lose weight among high school girls. Objectives: To examine the relationship between trying to lose weight and past 30-day (1) alcohol use and (2) binge drinking (separately). Methods: Using data from the National 2011 YRBS, we examined these relationships among 5,106 girls aged 14–18+ who reported ever using alcohol. Survey-weighted iterative logistic regression models were conducted. Results: 44.0% of girls reported current alcohol use with 27.8% reporting binge drinking. While a significant relationship was not found between trying to lose weight and current alcohol use in the final multivariable model, a significant relationship was found between trying to lose weight and binge drinking (AOR: 1.24, 95% CI: 1.02–1.52). Additional variables that were found to be associated with an increased odds of binge drinking included: being in 11th and 12th grades compared to being in 9th grade, screening positively for depression, and current cigarette use. Variables associated with a decreased odds included: talking to an adult/teacher about a problem, and identifying as Black/African American compared to White. Conclusions/Importance: Understanding the relationship between trying to lose weight and binge drinking among high school students is important, as these behaviors may be a precursor to risk behaviors later in life and need to be more fully examined. [ABSTRACT FROM AUTHOR]

The article discusses the aspects of tax and social justice in the U.S. Topics discussed include role of the author as Brunswick Public Service Fellow at South Brooklyn Legal Services where he spent time with immigrant workers who want to participate in the federal tax system, the American Bar Association's Section of Taxation that has advanced the practice of tax law in the public interest and delivery of holistic legal services in low-income communities.

Recent work has extended the idea of implicit self-theories to the realm of emotion to assess beliefs in the malleability of emotions. The current article expanded on prior measurement of emotion beliefs in a scale development project. Items were tested and revised over rounds of data collection with both students and nonstudent adult online participants. Exploratory and confirmatory factor analyses revealed a three-factor structure. The resulting scale, the Emotion and Regulation Beliefs Scale, assesses beliefs that emotions can hijack self-control, beliefs that emotion regulation is a worthwhile pursuit, and beliefs that emotions can constrain behavior. Preliminary findings suggest that the Emotion and Regulation Beliefs Scale has good internal consistency, is conceptually distinct from measures assessing individuals’ beliefs in their management of emotions and facets of emotional intelligence, and predicts clinically relevant outcomes even after controlling for an existing short measure of beliefs in emotion controllability. [ABSTRACT FROM PUBLISHER]

Diabetes is a serious global public health challenge. The cost for health services for diabetes care has increased 41% over the past 5 years. Despite escalating health expenditure, the United States continues to have higher rates of diabetes than many other developed countries. There is a need for health care reform in the United States not only in reducing health care costs but also in improving the quality of preventative care. This study presents the testing of a multilevel model investigating variables on the individual and state levels to develop a better understanding of the most important contextual pathways that can lead to providing older adults (50+) with type 2 diabetes with the recommended preventative quality care they require. The model was tested using a three-level repeated cross-sectional design with data from various existing data sources, using a national sample of 181,870 individuals aged 50 years and older. Results showed that differences in state health care systems contributed to inequitable access. Specifically, in a state where there was a higher percentage of adults 65 and older coupled with a shortage of health care professionals, the likelihood of receiving the recommended preventative quality care decreased. Also, older adults living in states with a higher percentage of people with diagnosed diabetes but with a lower-than-average annual per capita health care expenditure fared worse in receiving quality preventative care. Last, older adults in wealthy states with higher percentages of uninsured people had the lowest odds of receiving quality preventative care. Health care reform, similar to what is currently promoted by the Patient Protection and Affordable Care Act of 2010, is recommended to improve the performance of all health care systems in all states. [ABSTRACT FROM AUTHOR]

An essay is presented which discusses the career of American sculptor Carl Andre, including his retirement and the Dia Art Foundation's exhibitions of his sculpture. An overview of his relationship with his deceased wife Cuban American artist Ana Mendieta, including her 1985 death resulting from falling from their New York City, New York apartment building and Andre's subsequent murder trial for it, is provided. Feminists' attitudes that he murdered Mendieta are discussed.

The objective of this study was to assess the role of provider coordination on nurse manager and physician perceptions of care quality, while controlling for organizational factors. Findings indicated that nurse-nurse coordination was positively associated with nurse manager perceptions of care quality; neither physician-physician nor physician-nurse coordination was associated with physician perceptions. Organizational factors associated with positive perceptions of care quality included facility support of education for nurses and physicians, and the use of multidisciplinary rounding. [ABSTRACT FROM AUTHOR]

Phytophthora infestans causes late blight of potato and tomato, a disease that has been estimated to cost U.S. potato growers $287.8 million annually. We collected isolates of P. infestans from Wisconsin from 2009 to 2012 and determined distribution of clonal lineages and mating types and sensitivity to the systemic fungicide mefenoxam. We also sought to evaluate the current utility of an analysis of the Glucose- 6- phosphate isomerase ( Gpi) allozyme locus for predicting mefenoxam sensitivity with the aim of delivering timely information to growers. Overall, 143 isolates were collected from 52 locations in 20 Wisconsin counties from 2009 to 2012. Three clonal lineages, US-22, US-23, and US-24, were identified and were novel to Wisconsin and the U.S. US-22 is of the A2 mating type and sensitive to mefenoxam, with Gpi 100/122. US-23 and US-24 are of the A1 mating type and primarily intermediately sensitive to mefenoxam, with Gpi 100/100 and 100/100/111, respectively. Because of this close correlation and the unique Gpi patterns for each lineage present, we were able to predict mefenoxam sensitivity directly from samples using the allozyme assay and quickly deliver management information to growers. Both mating types were present in Wisconsin in 2009 and 2010 but were spatially separated and no evidence of sexual recombination or soil persistence was detected. The presence of new clonal lineages of P. infestans in Wisconsin indicates a need for continued close monitoring of late blight to facilitate generation of timely information for enhanced short-term and long-term late blight management. [ABSTRACT FROM AUTHOR]

The article reports on heat-related deaths after an extreme heat event in four U.S. states in 2012 and the whole of the U.S. from 1999 to 2009. Intense thurnderstorms with high winds on June 29, 2012 caused damage and power outages in Maryland, Ohio, Virginia, and West Virginia. Roughly 3.8 million persons were affected by the power outages. Sixty-nine percent of heat-related deaths were reported most frequently among males.

The article focuses on the increasing obesity in the U.S. It informs that primary cause of obesity is energy imbalance that is a difference in the intake and burning of the calories. It reports that 25 million children are obese or at risk of becoming obese in the U.S. It mentions several strategies to control obesity including school and community interventions, limiting fast food and establishing parks. It also mentions University of California's Cooperative Extension's nutrition programs.

The article discusses the group of anonymous women activist artists named the Guerrilla Girls that formed in New York City in 1985 to address sexual discrimination against women and minorities occurring in the U.S. art industry. The author traces the group's history and relation with prominent art critics, focusing on their protest posters and their lecture/performance art. Topics include the group's changing dynamic amidst their political protest projects, internal divisions based on the racial diversification of the group, and their appearance to protest various art museums, including the Guggenheim Museum in New York City and the Tate Modern in London, England.

Parkinson disease (PD) is a common complex neurodegenerative disorder with an underlying genetic etiology that has been difficult to dissect. Although some PD risk genes have been discovered, most of the underlying genetic etiology remains unknown. To further elucidate the genetic component, we have undertaken a genome-wide linkage screen in an isolated founder population of Amish living in the Midwestern United States. We performed tests for linkage and for association using a marker set of nearly 6000 single-nucleotide polymorphisms. Parametric multipoint linkage analysis generated a logarithm of the odds of linkage (LOD) score of 2.44 on chromosome 6 in the SYNE1 gene, approximately 8 Mbp from the PARK2 gene. In a different region on chromosome 6 (∼67 Mbp from PARK2) an association was found for rs4302647 (p < 4.0 × 10), which is not within 300 kb of any gene. While the association exceeds Bonferroni correction, it may yet represent a false positive due to the small sample size and the low minor allele frequency. The minor allele frequency in affecteds is 0.07 compared to 0.01 in unaffecteds. Taken together, these results support involvement of loci on chromosome 6 in the genetic etiology of PD. [ABSTRACT FROM AUTHOR]

The article discusses the legislative activity during the 111th Congress which focused on the detention of alleged enemy combatants at the U.S. Naval Station in Guantanamo Bay, Cuba, and the potential transfer from the Guantanamo detention facility. Enacted authorizations and appropriations measures is said to impact the treatment of the detainees and restrict the use of federal funds to transfer or release of the individuals into the U.S. The section 14103 of the Supplemental Appropriations Act of 2009 restricts the use of funds appropriated by any prior act for the transfer or release of the detainees into the country. The president's submission of a plan that fullfills specified requirements top Congress 45 days prior to transfer is outlined as an exception to the legislation.

Following the terrorist attacks of 9/11, Congress passed the Authorization to Use Military Force (AUMF), which granted the President the authority "to use all necessary and appropriate force against those … [who] planned, authorized, committed, or aided the terrorist attacks" against the United States. As part of the subsequent "war on terror," many persons captured during military operations in Afghanistan and elsewhere were transferred to the U.S. Naval Station at Guantanamo Bay, Cuba for detention and possible prosecution before military tribunals. Although nearly 800 persons have been transferred to Guantanamo since early 2002, the substantial majority of Guantanamo detainees have ultimately been transferred to a third country for continued detention or release. The 229 detainees who remain fall into three categories: (1) persons placed in non-penal, preventive detention to stop them from rejoining hostilities; (2) persons who have faced or are expected to face criminal charges; and (3) persons who have been cleared for transfer or release, whom the United States continues to detain pending transfer. Although the Supreme Court ruled in Bournediene v. Bush that Guantanamo detainees may seek habeas corpus review of the legality of their detention, several legal issues remain unsettled, including the scope of habeas review available to Guantanamo detainees, the remedy available for those persons found to be unlawfully held by the United States, and the extent to which other constitutional provisions extend to noncitizens held at Guantanamo. On January 22, 2009, President Obama issued an Executive Order requiring the Guantananio detention facility to be closed as soon as practicable, and no later than a year from the date of the Order. Several legislative proposals have been introduced in the 111th Congress concerning the potential closure of the Guantanamo facility. The Supplemental Appropriations Act, 2009 (P.L. 111-32), bars any funds from being used to release any individual detained at Guantanamo into the continental United States, Hawaii, or Alaska, and also requires the President to submit reports to Congress regarding the handling of persons held at Guantanamo. For more information on relevant legislative activity in the 111th Congress, see CRS Report R40419, Analysis of Selected Legislative Proposals Addressing Guantanamo Detainees, by Anna C. Henning. The closure of the Guantanamo detention facility may raise a number of legal issues with respect to the individuals formerly interned there, particularly if those detainees are transferred to the United States for continued detention, prosecution, or release. The nature and scope of constitutional protections owed to detainees within the United States may be different from the protections owed to persons held outside the U.S. This may have implications for the continued detention or prosecution of persons who are transferred to the United States. The transfer of detainees to the United States may also have immigration consequences. Notably, some detainees might qualify for asylum or other protections under immigration law. This report provides an overview of major legal issues likely to arise as a result of executive and legislative action to close the Guantanamo detention facility. It discusses legal issues related to the transfer of Guantanamo detainees (either to a foreign country or into the United States), the continued detention of such persons in the United States, and the possible removal of persons brought into the country. The report also discusses selected constitutional issues that may arise in the criminal prosecution of detainees, emphasizing the procedural and substantive protections that are utilized in different adjudicatory forums (i.e., federal civilian courts, court-martial proceedings, and military commissions). Issues discussed include detainees' right to a speedy trial, the prohibition against prosecution under ex post facto laws, and limitations upon the admissibility of hearsay and secret evidence in criminal cases. [ABSTRACT FROM AUTHOR]

Apologies are rare in the medical world, where health care providers fear that admissions of guilt or expressions of regret could be used by plaintiffs in malpractice lawsuits. Nevertheless, some states are moving toward giving health care providers legal protection so that they feel free to apologize to patients for a medical mistake. Advocates believe that these laws are beneficial for patients and providers. However, our analysis of "apology" and "disclosure" laws in thirty-four states and the District of Columbia finds that most of the laws have major shortcomings. These may actually discourage comprehensive disclosures and apologies and weaken the laws' impact on malpractice suits. Many could be resolved by improved statutory design and communication of new legal requirements and protections. [ABSTRACT FROM AUTHOR]

Type 2 diabetes is increasing rapidly in the United States and Latin America and contributes significantly to the rise in health care spending. Diabetes increases the risk of cardiovascular disease, renal failure and blindness, and leads to other complications. Type 2 diabetes and its complications can be delayed in high-risk individuals through a healthy lifestyle and ongoing medical care. Some research suggests a relationship between diabetes and other underlying metabolic conditions, either as predisposing factors or as adverse outcomes of occupational exposures in farmworkers. UC Cooperative Extension can have a greater impact on the health and safety of California's workforce by filling in research gaps and strengthening collaborations. [ABSTRACT FROM AUTHOR]

For the first time since the judicial impeachments of 1986-1989, the House has impeached a federal judge. On June 19, 2009, the House voted to impeach U.S. District Judge Samuel B. Kent of the U.S. District Court for the Southern District of Texas. The impeachment process provides a mechanism for removal of the President, Vice President, and other federal civil officers found to have engaged in "treason, bribery, or other high crimes and misdemeanors." The Constitution places the responsibility and authority to determine whether to impeach and to draft articles of impeachment in the hands of the House of Representatives. A number of means have been used to trigger the House's investigation, but the ultimate decision in all instances as to whether impeachment is appropriate rests with the House. Should the House vote to impeach and vote articles of impeachment specifying the grounds upon which impeachment is based, the matter is then presented to the Senate for trial. Under the Constitution, the Senate has the unique power to try an impeachment. The decision whether to convict on each of the articles must be made separately. A conviction must be supported by a two-thirds majority of the Senators present. A conviction on any one of the articles of impeachment brought against an individual is sufficient to constitute conviction in the trial of the impeachment. Should a conviction occur, then the Senate must determine what the appropriate judgment is in the case. The Constitution limits the judgment to either removal from office or removal and prohibition against holding any future offices of "honor, Trust or Profit under the United States." The precedents in impeachment suggest that removal may flow automatically from conviction, but that the Senate must vote to prohibit the individual from holding future offices of public trust, if that judgment is also deemed appropriate. A simple majority vote is required on a judgment. Conviction on impeachment does not foreclose the possibility of criminal prosecution arising out of the same factual situation. The Constitution does not permit the President to extend executive clemency to anyone in order to preclude his or her impeachment by the House or trial or conviction by the Senate. [ABSTRACT FROM AUTHOR]