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This study describes and analyzes measurements of 119 non-polar organic compounds in PM2.5 samples from three urban sites in the Southeastern Aerosol Research and Characterization (SEARCH) network: Jefferson Street in Atlanta, Georgia (JST), Birmingham, Alabama (BHM), and Hinton, Texas (HIN). Daily 24-h PM2.5 samples were collected on quartz-fiber filters from January 2006 through 2007 at HIN and from March 2006 through 2010 at JST and BHM. PM2.5 sampling at BHM and JST is ongoing. The measured species are associated with directly emitted particles and potentially serve as tracers of specific types of emissions. PM2.5 organic measurements include 28 n-alkanes (C15-C42), 18 iso-/anteiso-alkanes (C29-C37), 2 methyl alkanes, 3 branched alkanes, 5 cycloalkanes, 32 PAH compounds, 18 hopanes, 12 steranes, and 1 alkene, many of which are constituents of motor-vehicle exhaust and other anthropogenic PM2.5 emissions. Predominantly anthropogenic origins of the measured compounds are indicated by weekly and seasonal cycles that are identified with known emission patterns, especially for motor vehicle usage. Annual mean concentrations of each class of compounds declined by 60-90% from 2006 through 2009, then increased in 2010 to concentrations comparable to 2008. These changes are similar to 40% reductions of on-road and non-road motor-vehicle exhaust PM2.5 emissions between 2006 and 2010. Year-to-year variations in OC correlated with year-to-year variations in measured non-polar compound concentrations. Regression of OC against the sums of measured n-alkanes, iso-/anteiso-alkanes, PAHs, hopanes, and steranes indicates that 32 ± 7% of OC at BHM and 35 ± 4% of OC at JST derived from sources emitting the measured non-polar compounds. The reductions in measured concentrations of EC, OC, and non-polar OC species represent an important improvement in air quality in the southeastern U.S. that can be attributed by the long-term measurement program to PM2.5 emission reductions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Value-based care is an opportunity for medication optimization services to improve medication management and reduce health care spending. The reach of these services may be extended through telehealth. However, as health care systems and payers grapple with the long-term financing of telehealth, real-world assessments are needed to evaluate the potential economic impact of pharmacy-driven telehealth services. OBJECTIVE: To evaluate the impact of a scalable pharmacist-driven telehealth intervention to improve medication management on health care spending for clinically complex patients who were enrolled in a Medicare Next Generation Accountable Care Organization. METHODS: Data for this pretest-posttest nonequivalent group design study came from Medicare claims from 2015 to 2020 and linked pharmacist care activity data derived from the electronic medical record. Patients in the intervention group were identified as those who received the telehealth medication management service. Patients in the control group were offered the service and refused or could not be contacted. The primary outcome was total medical spending over a 6-month period, and impact was assessed using a covariate-adjusted difference-in-difference model. RESULTS: There were 581 patients who received the intervention and 1,765 who served as controls. The telehealth intervention reduced total medical spending by $2,331.85 per patient over the first 6 months of the service ($388.50 per month; P = 0.0261). Across a range of estimates for the cost of service delivery, we find a return on investment of 3.6:1 to 5.2:1. CONCLUSIONS: The $388.50 monthly savings found in this study represent a substantial reduction in health care spending and emphasize the opportunity for telehealth delivery of medication management services to improve value as a part of alternative payment models. DISCLOSURES: This study was funded by the UNC Health Care Department of Pharmacy. Dr Urick has received personal fees from Pharmacy Quality Solutions and Cardinal Health. Drs Peters, Vest, Colmenares, Foushee, and DeFalco are employees of UNC Health Care Department of Pharmacy. Mr Easter received a Co-PI grant from NACDS Foundation to implement Community-based Value Care Initiative (CVCI) in a community pharmacy setting. He also received a grant to Eshelman School of Pharmacy. He has an individual consulting agreement with digital health company Truentity Health to provide go to market strategy for medication management services. He also has stock options from Truentity Health as a component of the consulting agreement. Dr Foushee has a leadership or fiduciary role at Member-At-Large and the Ambulatory Care Academy of the North Carolina Association of Pharmacists. At the time this work was conducted, Dr Urick, Dr Pathak, and Dr Blanchard were all employees of the UNC Eshelman School of Pharmacy.

Objective: To estimate the association between state-level abortion legislation and all-cause mortality among all females of reproductive age and maternal, fetal, and infant mortality., Methods: We conducted a retrospective cohort study using the Centers for Disease Control and Prevention's WONDER (Wide-ranging ONline Data for Epidemiologic Research) database. Generalized estimating equations were used to estimate the association between supportive, moderate, and restrictive state abortion regulations and all-cause mortality in reproductive-aged females. Secondary outcomes included maternal, fetal, and infant mortality. The association of the number and type of laws on mortality were estimated., Results: Moderate and supportive states were not associated with a significant decrease in all-cause mortality compared with restrictive states. Maternal mortality (per 100,000 live births) was significantly lower in moderate (-5.79, 95% CI -9.88 to -1.70) compared with restrictive states, but not supportive states (-2.51, 95% CI -6.75 to 1.72). Infant mortality (per 1,000 live births) was significantly lower in both moderate (-0.56, 95% CI -1.09 to -0.04) and supportive (-1.10, 95% CI -1.56 to -0.64) states. Fetal mortality was lower in moderate states (-0.69, 95% CI -1.18 to -0.20) but not in supportive states (-0.64, 95% CI -1.14 to 0.13). Each additional abortion regulation was associated with an increase in maternal mortality (1.09/100,000 live births, 95% CI 0.36-1.82) and infant mortality (0.20/1,000 live births, 95% CI 0.12-0.26)., Conclusion: Moderate state abortion legislation was associated with lower rates of maternal, fetal, and infant mortality but not lower all-cause mortality in reproductive-aged females compared with restrictive laws. An increasing number of laws restricting abortion was associated with increased maternal and infant mortality., Competing Interests: Financial Disclosure Torri D. Metz served on a medical advisory board and was a site PI for a Pfizer SARS-CoV-2 vaccination in pregnancy trial, and is the site PI for a Pfizer RSV vaccination in pregnancy trial. She was the site PI for a Gestvision trial of a point-of-care test for preeclampsia. She receives royalties from UpToDate for two topics related to trial of labor after cesarean. The other authors did not report any potential conflicts of interest., (Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Rates of severe maternal morbidity and maternal mortality (SMM/MM) in the United States are rising. Disparities in SMM/MM persist by race, ethnicity and geography, and could partially be attributed to social determinants of health., Purpose: Utilizing data from the largest, statewide referral hospital in Alabama, we investigated the relationship between residence in disadvantaged neighborhoods and SMM/MM., Methods: Data on all pregnancies between 2010 and 2020 were included; SMM/MM cases were identified using CDC definitions. Area deprivation index (ADI) available at the census-block group was geographically linked to individual records and categorized using quintile cutoffs; higher ADI score indicated higher socioeconomic disadvantage. Generalized estimating equation models were used to adjust for spatial autocorrelation and ORs were computed to evaluate the relationship between ADI and SMM/MM, adjusted for covariates including age, race, insurance, residence in medically underserved areas/population (MUAP), and urban/rural residence., Results: Overall, 32,909 live-birth deliveries were identified, with a prevalence of 9.8% deliveries with SMM/MM with blood transfusion and 5.3% without blood transfusion, respectively. Increased levels of ADI were associated with increased odds of SMM/MM. Compared to women in the lowest quintile, the adjusted OR for SMM/MM among women in highest quintile was 1.78 (95%CI, 1.22-2.59, P=.0027); increasing age, non-Hispanic Black, government insurance and residence in MUAP were also significantly associated with increased odds of SMM/MM., Conclusion: Our results suggest that residence within disadvantaged neighborhoods may contribute to SMM/MM even after adjusting for patient-level factors. Measures such as ADI can help identify the most vulnerable populations and provide points to intervene., Competing Interests: Competing Interests: None declared., (Copyright © 2022, Ethnicity & Disease, Inc.)

Background: An expanding body of literature shows that pharmacists' interventions improve health outcomes and are cost-saving. However, diverse state regulations of pharmacists' scope of practice create a discrepancy between what pharmacists are trained to do and what they legally can do. This study investigated how stakeholders utilized research evidence when developing expanded scope of practice policies in their respective states., Methods: Using autonomous pharmacist prescriptive authority as a surrogate for general pharmacist scope of practice, a general policy document analysis was performed to understand the scope of practice landscape for pharmacists across the United States. Next, semi-structured interviews with policy-makers and pharmacy advocates were conducted to explore how the identified states in the policy document analysis utilized evidence during the policy-making process. Investigators analysed findings from the transcribed interviews through application of the SPIRIT Action Framework. Resulting codes were summarized across themes, and recommendations to researchers about increasing utilization of research evidence were crafted., Results: Sixteen states with 27 autonomous pharmacist prescriptive authority policies were identified. Public health need and safety considerations motivated evidence engagement, while key considerations dictating utilization of research included perceptions of research, access to resources and experts, and the successful implementation of similar policy. Research evidence helped to advocate for and set terms for pharmacist prescribing. Barriers to research utilization include stakeholder opposition to pharmacist prescribing, inability to interpret research, and a lack of relevant evidence. Recommendations for researchers include investigating specific metrics to evaluate scope of practice policy, developing relationships between policy-makers and researchers, and leveraging pharmacy practice stakeholders., Conclusions: Overall, alignment of researcher goals and legislative priorities, coupled with timely communication, may help to increase research evidence engagement in pharmacist scope of practice policy. By addressing these factors regarding research engagement identified in this study, researchers can increase evidence-based scope of practice, which can help to improve patient outcomes, contain costs, and provide pharmacists with the legal infrastructure to practise at the top of their license., (© 2021. The Author(s).)

Objective: Using a novel isotemporal substitution paradigm, this study aimed to estimate the cross-sectional associations of objectively measured sedentary behaviour and physical activity (PA) with cardiovascular risk factors among patients with SLE., Methods: This was a cross-sectional study of adult SLE patients without documented cardiovascular disease (CVD). Cardiovascular risk factors were measured, including BMI, blood pressure, fasting glucose and lipid profile. Ten-year CVD risk was estimated using the American College of Cardiology/American Heart Association risk assessment tool. Time in sedentary behaviour, light PA, and moderate-vigorous PA (MVPA) was measured by accelerometry. We used three linear regression models-single-activity models, partition models, and isotemporal substitution models-to evaluate the associations of time spent at each movement intensity with each CVD risk variable., Results: There were 100 SLE patients [92% female; mean (s.d.) age 52.4 (14.4) years]. Only 11 participants adhered to current PA recommendations (⩾150 MVPA min/week in ⩾10-min bouts). In isotemporal substitution, reallocating 10 min from sedentary behaviour to MVPA was associated with lower systolic (β = -2.15 mmHg; P = 0.01) and diastolic blood pressure (β = -1.56 mmHg; P = 0.01), as well as lower estimated 10-year CVD risk (RR 0.81, 95% CI 0.70, 0.93). Time reallocation from light PA to MVPA was associated with lower diastolic blood pressure (β = -1.45 mmHg; P = 0.01) and lower 10-year CVD risk estimates (RR 0.80, 95% CI 0.69, 0.94)., Conclusion: Given that reallocating time from other movement intensities to MVPA is associated favourably with lower cardiovascular risk, PA interventions are needed to address suboptimal MVPA levels among SLE patients., (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The objective of this study was to examine, across 22 countries, the association between community size and individual sport, team sport, and exercise participation. Hierarchal non-linear Bernoulli modeling is used to examine the association between community size (100,000-10,000; <10,000) and (a) individual sport, (b) team sport, and (c) exercise participation. After controlling for country-level clustering and demographic variables, those residing a community with between 100,000 and 10,000 residents are more likely to participate in individual sport [odds ratio (OR) = 1.14; 95% confidence interval (CI) = 1.05-1.23] while residing in a community with less than 10,000 residents is unrelated (OR = 1.06; 95% CI = 0.96-1.19). Those residing in communities with between 100,000 and 10,000 residents were more likely to participate in team sport (OR = 1.21; 95% CI = 1.01-1.45) while residing in a community with less than 10,000 residents is unrelated (OR = 1.02; 95% CI = 0.88-1.18). Residing in a community with between 100,000 and 10,000 residents is unrelated to exercise participation (OR = 0.97; 95% CI = 0.89-1.7), while residing in a community with less than 10,000 residents is negatively related to exercise participation (OR = 0.86; 95% CI = 0.79-0.93). These findings provide novel evidence that communities between 100,000 and 10,000 residents are related to increased sport participation, particularly team sport participation., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: There is no "gold standard" for assessing disease activity in patients with eosinophilic esophagitis (EoE). We aimed to compare physicians' judgment of EoE activity with patients' judgment of symptom severity. We also aimed to examine the relative contribution of symptoms as well as endoscopic and histologic findings in shaping physicians' judgment of EoE activity., Methods: Six gastroenterologists (all EoE experts) assessed EoE-associated symptoms in adult patients. Patients completed a symptom instrument and provided global assessment of EoE symptom severity (PatGA) (Likert scale: 0 (inactive) to 10 (most active)). Following esophagogastroduodenoscopy with biopsy sampling, gastroenterologists provided a global assessment of EoE activity (PhysGA) (Likert scale from 0 to 10) based on patient history and endoscopic and histologic findings. Linear regression and analysis of variance was used to quantify the extent to which variations in severity of EoE symptoms and endoscopic and histologic findings explain variations in PhysGA., Results: A total of 149 EoE patients were prospectively included (71.8% male, median age at inclusion 38 years, 71.8% with concomitant allergies). A moderate positive correlation between PhysGA and PatGA (rho=0.442, P<0.001) was observed and the mean difference in the Bland-Altman plot was 1.77. Variations in severity of endoscopic findings, symptoms, and histologic findings alone explained 53%, 49%, and 30%, of the variability in PhysGA, respectively. Together, these findings explained 75% of variability in PhysGA., Conclusions: Gastroenterologists rate EoE activity mainly on the basis of endoscopic findings and symptoms and, to a lesser extent, on histologic findings.

Community health promotion interventions, targeted at marginalised populations and focusing on addressing the social determinants of health (SDH) to reduce health inequalities and addressing the processes of exclusion, are an important strategy to prevent and control non-communicable diseases (NCDs) and promote the health of underprivileged and under-resourced groups. This article builds on key lessons learnt from a learning exchange between Communities for Health in England and the Racial and Ethnic Approaches to Community Health across the US (REACH US) communities that are tackling health inequities. It presents a qualitative analysis further capturing information about specific community interventions involved in the exchange and identifying lessons learnt. This exchange was led by a partnership between the US Centers for Disease Control and Prevention, the International Union for Health Promotion and Education, the Department of Health of England, Health Action Partnership International, and Learning for Public Health West Midlands. These efforts provide interesting insights for further research, priority areas of action for policy and practice to address the SDH and to promote and sustain equity and social justice globally. The article highlights some key lessons about the use of data, assets-based community interventions and the importance of good leadership in times of crisis and adversity. Whilst complex and time-consuming to arrange, such programmes have the potential to offer other countries including the global south new insights and perspectives that will in turn contribute to the SDH field and provide concrete strategies and actions that effectively reduce inequities and promote the health of our societies. The key learnings have the potential to contribute to the global community and growing documentation on evidence of effective efforts in the reduction of health inequities.

It is estimated that as many as 80% of adult cancer patients use at least one form of Complementary and Alternative Medicine (CAM) during or after conventional treatment. Studies of physician-patient communication about the use of CAM have concluded that patients frequently do not tell their oncologists about their use of CAM and physicians consistently underestimate the numbers of their patients using CAM. The purpose of this multi-site study was to assess newly diagnosed cancer patients' and oncologists' communication practices with regard to complementary therapies. Patients (106 breast and 82 prostate) indicated which of 45 complementary therapies they were using while physicians at their institutions indicated which they supported. It is noted that, although we use the popular acronym "CAM" all patients surveyed were receiving conventional medical treatment. Thus, the survey addressed complementary therapies only. A large majority (84%) indicated they were using at least one therapy with the most popular being exercise, vitamins, prayer, and nutritional supplements. Surprisingly, the oncologists surveyed were generally enthusiastic and supportive of patients' use of complementary therapies. In addition to those therapies popular with patients, at least half the physicians supported massage, journal writing, support groups, acupuncture, biofeedback, and art therapy. However, discussions of CAM are relatively rare and most likely to be initiated by patients. When the topic is discussed, both patients and doctors say it usually enhances their relationship. Implications for CAM program development and oncology professionals' roles in patient education regarding complementary therapies are presented.

Background: In an attempt to address the informational needs of female breast cancer survivors, the American Cancer Society (ACS) develops and distributes written documents. Although this educational effort has been well received, little attention has been given to the suitability of the materials themselves., Methods: A random sample of 812 survivors was derived from callers to the ACS National Cancer Information Center (NCIC) from July to December of 2000. The participants then rated the three most commonly distributed breast cancer information documents on five dimensions 1). presentation, 2). satisfaction, 3). understanding, 4). anxiety, and 5). impact., Results: . Participants responded favorably to four of the five rating categories. Conclusions. The evidence suggests that the three materials had positive health outcomes and were well received by the survivors.

The form of the primary National Ambient Air Quality Standard (NAAQS) for ozone has been a matter of some concern in recent years. The Environmental Protection Agency is reviewing the ozone NAAQS and has proposed a set of alternative standards that address some deficiencies. However, the proposed alternatives are all based upon the ozone concentrations occurring at the peak monitor, which may not be representative of the air quality and population exposure throughout a nonattainment area. Representativeness could be improved by converting the form of the standard from an exceedance-based metric (with x allowable exceedances per year, on average) to one based upon exposure. Three approaches to defining an exposure-based standard are developed here. Data from the San Francisco Bay area are used to illustrate the proposed standards.

Effects of a psychosocial intervention program on spouses of cancer patients, and on the cancer patients themselves, will be described. A six session intervention program, which included support, problem-solving and coping skills, was designed to help spouses to cope with the stress of caring for their partner. Forty male and forty female spouses of cancer patients of a regional oncology center were randomly assigned to intervention or usual treatment conditions. Spouses and patients were interviewed prior to intervention, and within two weeks after intervention on a battery of assessment instruments including: (1) demographic variables; (2) psychological variables; (3) health status; (4) social supports; (5) assessment of pressing problems; (6) coping skills; (7) burden levels; and (8) marital satisfaction. Participants were found to be more psychologically distressed than the general population but were not as distressed as psychiatric outpatients. Differences were also found in marital satisfaction and coping activities, when compared to the general population. No significant differences between the conditions were found on any of the measures. Caregivers' level of caregiving activities proved to be low. It is suggested that this may account for why the intervention only appeared effective for a distressed subsample of the caregivers in the study. The implications of these findings is discussed. Recommendations are also made for future research on cancer caregivers.

Six properties appear desirable for any set of ozone attainment criteria: (1) sufficient stringency to protect public health, (2) simplicity and understandability, (3) sensitivity to real changes in air quality, (4) stability against meteorological fluctuations, (5) use of as much data as possible, and (6) equivalence between the stringency the criteria appear to mandate, and what they actually mandate. We consider how the federal attainment criteria might be improved with respect to Properties 4 through 6 while being equally strong on 1 through 3. Whether the federal standard meets Property 1 has been the subject of debate, but our analysis would apply also to a modified standard. We show that there are subtleties in how improvements might be made. In particular, basing the attainment status on a statistic with low variance may not lead to a more stable criterion, and although it is easy to find a criterion that makes it hard for a district with bad air to reach attainment, or a district with good air to get out of attainment, it is hard to find a criterion that does both. This suggests using different criteria for districts that are out of attainment from districts that are in attainment. Initially the burden of proof would be on the district to prove that its air is of attainment quality. However, once the district has achieved attainment the burden of proof would shift; the district would remain in attainment unless there was strong evidence to the contrary.(ABSTRACT TRUNCATED AT 250 WORDS)