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Background: Patients with overactive bladder (OAB) experience sudden, intense urges to urinate, which may include urge urinary incontinence and nocturia. Pharmacotherapy includes β3-adrenergic receptor agonists such as mirabegron; however, mirabegron contains a label warning for cytochrome P450 (CYP) 2D6 inhibition, making coadministration with CYP2D6 substrates require monitoring and dose adjustment to avoid unintended increases in substrate concentration. Objective: To understand the codispensing patterns of mirabegron among patients using ten predefined CYP2D6 substrates with and before mirabegron dispensing. Methods: This retrospective claims database analysis used the IQVIA PharMetrics® Plus Database to assess codispensing of mirabegron with ten predefined CYP2D6 substrate groups identified on the basis of medications most frequently prescribed in the United States, those with high susceptibility to CYP2D6 inhibition, and those with evidence for exposure-related toxicity. Patients had to be ≥ 18 years old before initiation of the CYP2D6 substrate episode that overlapped with mirabegron. The cohort entry period was November 2012 to September 2019, and the overall study period was 1 January 2011 to 30 September 2019. Comparisons of patient profiles at dispensing were made between time periods with and before mirabegron use in the same patient. Descriptive statistics were used to assess the number of exposure episodes, total duration of exposure, and median duration of exposure of CYP2D6 substrate dispensing with and before mirabegron. Results: CYP2D6 substrate exposure periods totaling ≥ 9000 person-months were available before overlapping exposure to mirabegron for all ten CYP2D6 substrate cohorts. Median codispensing duration for chronically administered CYP2D6 substrates was 62 (interquartile range [IQR] 91) days for citalopram/escitalopram, 71 (105) days for duloxetine/venlafaxine, and 75 (115) days for metoprolol/carvedilol; median codispensing duration for acutely administered CYP2D6 substrates was 15 (33) days for tramadol and 9 (18) days for hydrocodone. Conclusions: In this claims database analysis, the dispensing patterns of CYP2D6 substrates with mirabegron displayed frequent overlapping of exposure. Thus, a need exists to better understand the outcomes experienced by patients with OAB who are at increased risk for drug‒drug interactions when taking multiple CYP2D6 substrates concurrently with a CYP2D6 inhibitor. [ABSTRACT FROM AUTHOR]

Background: Overactive bladder (OAB) is characterized by the presence of bothersome urinary symptoms. Pharmacologic treatment options for OAB include anticholinergics and β3-adrenergic agonists. Use of β3-adrenergic agonists may result in similar treatment efficacy with a decreased side effect profile compared with anticholinergics because high anticholinergic burden is associated with cardiovascular and neurologic side effects. However, the β3-adrenergic agonist mirabegron, one of two approved drugs within this class, is a moderate cytochrome P450 (CYP) 2D6 inhibitor, and coadministration of drugs that are CYP2D6 substrates with mirabegron may lead to adverse drug effects. Objective: The aim of this study was to quantify how often CYP2D6 substrates were dispensed in patients receiving mirabegron among adults of any age and among those ≥ 65 years of age. Methods: In this retrospective descriptive analysis, a deidentified administrative claims database in the United States, IQVIA PharMetrics® Plus, was used to identify dispensing claims for CYP2D6 substrates and mirabegron from November 2012 to September 2019. Prevalence of CYP2D6 substrate dispensing was assessed in patients dispensed mirabegron among all adults ≥ 18 years old and additionally among a cohort of those ≥ 65 years old. Patient baseline profiles at the time of mirabegron and CYP2D6 substrate codispensing and at the time of mirabegron dispensing were compared. CYP2D6 substrates were categorized as those with the potential for increased risk of QT prolongation, with anticholinergic properties, with narrow therapeutic index (NTI), contraindicated or having a black box warning when used with CYP2D6 inhibitors, or used for depression or other psychiatric disease. Dispensing data and patient profiles were summarized descriptively. Results: Overall, 68.5% of adults ≥ 18 years old dispensed mirabegron had overlapping dispensings for one or more CYP2D6 substrate; 60.6% and 53.6% had overlapping dispensings for CYP2D6 substrates with anticholinergic properties or risk of QT prolongation, respectively. CYP2D6 substrates with NTI, contraindicated with CYP2D6 inhibitors, or for psychiatric use were codispensed in 17.7%, 16.6%, and 38.0% of adult mirabegron users, respectively. Mirabegron users receiving one or more concurrent CYP2D6 substrate were more likely to be older, have more comorbidities and baseline polypharmacy, and have increased healthcare resource utilization compared with those without concurrent CYP2D6 substrates. Commonly codispensed CYP2D6 substrates included hydrocodone, oxycodone, tramadol, metoprolol, and tamsulosin. Findings were similar for patients in the older cohort (≥ 65 years old), with 72.1% receiving overlapping CYP2D6 substrates. Conclusions: Codispensing of CYP2D6 substrates, especially those with anticholinergic properties or risk of QT prolongation, was common among adults and older adults receiving mirabegron. Results highlight the need for improved awareness of CYP2D6 substrate prescribing among patients receiving pharmacologic treatment for OAB that inhibits the CYP2D6 pathway. [ABSTRACT FROM AUTHOR]

Objective: To report the first case series of ureterorenoscopy in North America using the High Power Super Pulse Thulium Fiber Laser for the treatment of upper urinary tract stones.Methods: After Institutional Review Board approval, a multicentric retrospective chart review of patients treated with the High Power Super Pulse Thulium Fiber Laser from October 2019 to March 2020 was conducted. Basic demographic information, pre-operative, and peri-operative data were recorded.Results: Seventy-six patients were included with a mean age of 60.9 ± 13.3 years. 118 stones were treated including 32 within the ureter, 49 in the lower pole, 37 in mid or upper poles. Dusting technique was commonly used (67.1%) with pulse frequencies up to 2400 Hz. Mean operative time was 59.4 ± 31.5 minutes. Mean laser time and total laser energy were 10.8 ± 14.1 minutes and 12.5 ± 19.1 KJ, respectively. Intraoperative complications were limited to 7 grade 1, 3 grade 2, and 1 grade 3 ureteral injuries and one case of renal collecting system bleeding that was adequately managed with laser coagulation settings (1J-20Hz).Conclusion: This initial case series in North America of the High Power Super Pulse Thulium Fiber Laser is promising for the treatment of urolithiasis. Sub-200 μm fibers and dusting settings up to 2400 Hz were utilized successfully. No specific complications related to use of the laser were seen. [ABSTRACT FROM AUTHOR]

Background: Since 1995, 14 states have passed laws encouraging or mandating influenza vaccination for hospital workers. Although the Centers for Disease Control and Prevention recommends vaccinating health care workers to reduce disease transmission and patient risk, the effect of these laws on pneumonia and influenza mortality is unknown.Objective: To measure the effect of state-level hospital worker influenza vaccination laws on pneumonia and influenza mortality.Design: Quasi-experimental observational study.Setting: United States.Participants: Population of all states from 1995 to 2017.Intervention: State adoption of a law promoting influenza vaccination for hospital workers.Measurements: Pneumonia and influenza mortality per 100 000 persons by state and by month, both population-wide and separately by age group, obtained from restricted-access National Vital Statistics System files. Linear and log-linear models were used to compare changes in mortality rates for adopting versus nonadopting states.Results: Implementation of state laws requiring hospitals to offer influenza vaccination to their employees was associated with a 2.5% reduction in the monthly pneumonia and influenza mortality rate (-0.16 deaths per 100 000 persons [95% CI, -0.29 to -0.02]; P = 0.022) during the years when the vaccine was well matched to the circulating strains. The largest effects occurred among elderly persons and during peak influenza months.Limitation: Utilization of large-scale national data precluded analysis of more specific outcomes, such as laboratory-confirmed or hospital-acquired influenza.Conclusion: State laws promoting hospital worker vaccination against influenza may be effective in preventing pneumonia- and influenza-related deaths, particularly among elderly persons. Vaccinating hospital workers may substantially reduce the spread of influenza and protect the most vulnerable populations.Primary Funding Source: None. [ABSTRACT FROM AUTHOR]

Recently, empathic concern was separated into the components of sympathy and tenderness (Lishner et al. 2011). So far, these two emotional experiences have been assessed as episodic emotional responses, as the existent dispositional measures remain blind to such distinction. The aim of the present research is to develop and validate a dispositional measure that captures the personal disposition to feel sympathy, tenderness, and personal distress. This new scale is called Sympathy, Tenderness and Distress Dispositional Scale (SyTeD). In Study 1, we developed and tested the internal consistency and factor structure of the English version of the scale in the United States. In Study 2, we translated the scale into Spanish and tested its content and criterion validity in Spain. In Study 3, we tested the predictive validity of the sympathy-tenderness distinction within a helping vs. a care-based scenario in the United Kingdom (SyTeD-English version). In Study 4, we tested the predictive validity of the sympathy-tenderness distinction in a real helping situation in Spain (SyTeD-Spanish version). The results across these four studies suggest that the SyTeD is a useful measure of dispositional sympathy and tenderness that allows studying further different types of prosocial behavior (i.e., help vs. care). [ABSTRACT FROM AUTHOR]

We draw on social capital theory to examine the relationship between audit committee (AC) members’ social capital and financial reporting quality. Using US data for the period 2001–2010, our results suggest that non-AC directors’ social capital does not appear to be relevant to financial reporting quality. As far as AC members are concerned, our findings show a negative relationship between their social capital and financial reporting quality, suggesting a ‘dark side’ to social capital. Specifically, we find that sitting in multiple ACs (centrality) has a negative impact on reporting quality only for those AC members designated as financial experts. When other proxies for social capital are considered (connectedness, brokerage position and strong ties), our results show that the quality of financial reporting significantly decreases with the social capital of non-financial experts sitting in the AC. We contribute to prior research by: (i) relying on social capital theory, which is widely neglected in accounting research, (ii) using multiple metrics to capture the complex dimensions of social capital, and (iii) discriminating between the effects of financial and non-financial experts’ social capital on reporting quality. Our results suggest policy-makers might wish to limit financial experts’ multiple directorships as well as assess the actual contribution of non-financial experts to AC effectiveness. [ABSTRACT FROM AUTHOR]

There are three species of Neotropical cats whose northernmost distribution reaches the USA-Mexico border region: the jaguar Panthera onca , ocelot Leopardus pardalis and jaguarundi Herpailurus yagouaroundi . To ensure the long-term viability of Neotropical cat populations in this region it is imperative to identify current distribution and status in the northern limits of their range to conserve important populations effectively. The purpose of this study was to construct a blueprint of priority conservation areas for each species in the border region. This was done by (1) compiling reliable sightings for each species from the early 1900s to 2003, (2) conducting field surveys to ascertain species presence, and (3) conducting a geographical information system based habitat mapping workshop in which 29 scientists and conservationists provided information on the distribution and status of each species. Participants were asked to delineate and describe specific areas in the border region where historical and recent sightings of Neotropical cats have occurred, resulting in a compilation of 864 felid sightings of which 283 where reliable and had physical evidence. Twenty-one Cat Conservation Units and seven Cat Conservation Corridors were identified as areas in which to concentrate efforts for protecting felids. Only 8.9% of these Corridors and 1.1% of the Units currently have any protection. An additional 12 Corridors and 12 Units were identified as areas requiring further study. [ABSTRACT FROM AUTHOR]

Urban growth and development depends on both the local hydrologic conditions and how water resources are procured and managed. The objective of this study was to assess the water security of large urban areas based on their physical hydrology, existing water supply infrastructure, and water management institutions. This study examined 108 large cities (>750,000 people) in the United States ( n = 50) and Africa ( n = 58), encompassing a broad range of hydrologic and socio-economic conditions, including degrees of institutional complexity. Urban water availability was estimated as the volume of water available from local, natural water sources, as well as water captured via infrastructure such as reservoirs, wellfields, or water transfers. Urban institutional complexity was assessed based on ability to provide, regulate and maintain urban water supplies. Over half of the cities in this study rely on captured water to meet urban demands and maintain high levels of institutional complexity in doing so. Cities able to adequately supply water from local natural sources (37 %) maintain significantly lower institutional complexity than cities using water captured from non-local sources. Cities categorized as water insecure (7 %) had minimal access to either local or captured water resources and operated using the simplest water institutions. Results suggest that low local availability drives the urban response for capturing additional water supplies, and is both the cause and product of more complex institutional frameworks. Efforts to address urban water insecurity should focus more attention on meeting not only the physical but managerial needs of a city. [ABSTRACT FROM AUTHOR]

Based on Markus and Kitayama's (1991) theory, this study was conducted to examine whether the association between emotional suppression and interpersonal harmony would be moderated by cultural group (i.e., Chinese and European Americans) and an Asian cultural value (i.e., emotional self-control). A total of 451 college students (205 Chinese and 246 European Americans) participated in this study. As expected, results indicated that the association between emotional suppression and interpersonal harmony was significantly positive for Chinese but not significant for European Americans. Similarly, when emotional self-control was examined as a moderator, the results still confirmed our hypotheses. That is, the association between emotional suppression and interpersonal harmony was significantly positive for those with stronger endorsement of emotional self-control but not for those with weaker endorsement of emotional self-control. Furthermore, we examined whether the above results could be replicated when forbearance (a construct similar to suppression) and distress disclosure (a construct opposite to suppression) were examined. The results showed the same pattern for forbearance and distress disclosure when cultural group or emotional self-control served as the moderator. The convergence of findings increased the robustness of our results. Finally, our data suggest that individuals from Eastern, interdependent cultures (e.g., Chinese) tend to value emotional suppression to preserve interpersonal harmony; individuals from Western, independent cultures may or may not necessarily suppress their emotions for this purpose. A comprehensive understanding of the different meanings of a specific strategy (i.e., emotional suppression) in different cultural contexts is important to promote effective cross-cultural counseling. [ABSTRACT FROM AUTHOR]

The emergence of concerns about 'peak oil,' the fallout from the Iraq War in terms of renewed calls for 'energy security,' and the development of new technology to gain access to fossil fuels and gas long off-limits because of economic and environmental concerns has led to a boom of multiple kinds of energy development in and around rural communities in the United States. This article uses the lens of treadmill-of-production and growth-machine literature to understand these developments in south central Illinois, an area with rich farmland and a history of underground coal extraction. While this analysis finds the expected support from community elites for renewed coal extraction, despite health and environmental risks, we find that the farm community, concerned about damage to land critical for producing corn and beans, profitable at historical levels in part because of the biofuel boom, formed a strong opposition movement. In short, we find evidence of colliding treadmills of energy production. The findings have implications for the analysis of rural energy production in the United States and beyond. [ABSTRACT FROM AUTHOR]

El artículo examina el papel de la Unión Europea, a los 10 años del ataque terrorista en Nueva York el 11 de septiembre de 2011. Pocos días después el Consejo Europeo extraordinario de Brusela declaró que la lucha antiterrorista era una prioridad de la Unión. Se mencionan varios tratados internacionales, como el Maastricht, que dotó a la Unión de competencias.

This article explores the construction and deconstruction of male friendship in Richard Ford's novel The Sportswriter. The first part offers an overview of classic fictions of male bonding in U.S. literature, while the second contrasts such idyllic representations with the available empirical evidence on men's friendships, which emphasizes their scarcity and precariousness. So as to reconcile the 'reality' and the 'fiction' of male friendship, part three analyzes Richard Ford's 1986 novel The Sportswriter as a contemporary literary revision of the classic myth of male friendship in U.S. literature. More specifically, the novel will be used to illustrate the effects on male friendship of traditional masculinity, which tends to undermine intimacy between men by dissociating them from emotions and, especially, by promoting male homophobia. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the satisfaction of medical students in the U.S. with their career choice. The study analyzed data from a national survey of U.S. medical students in order to determine the factors associated with the medical students' satisfaction. Medical students in 16 medical schools in the country were required to complete 3 questionnaires during their medical training. The demographic characteristics that affect the satisfaction of medical students in choosing to become a physician are also examined.

Background: Studies have examined factors affecting medical students' specialty choice, but little research exists on stability of these specialty interests.Objective: To describe patterns of change in specialty interests during medical school and examine associations between specialty change patterns and gender, desire for a high-prestige career, and interest in prevention.Design: Medical students (Class of 2003) at 15 representative US schools were invited to complete surveys during freshman orientation, entry to wards, and senior year.Participants: This analysis used data from 942 students who completed all 3 surveys.Measurements: In addition to a number of other items, students were asked to choose the 1 specialty they were most interested in pursuing.Results: The most common specialty choices among freshman students were pediatrics (20%) and surgery (18%); least common choices were psychiatry and preventive medicine (1% each). General internal medicine was the initial specialty choice for 8%. Most students changed their specialty choices, regardless of initial interest. Only 30% of those initially interested in primary care (PC) remained interested at all 3 time points, compared to 68% of those initially interested in non-PC. Female versus male students were more commonly interested in PC at all 3 time points. Senior students interested in non-PC specialties were more likely to desire a high-prestige career (48%) than those interested in PC (31%).Conclusions: Medical students may benefit from more intensive introduction to some specialties earlier in pre-medical and medical education. In addition, increasing the prestige of PC fields may shape the physician workforce. [ABSTRACT FROM AUTHOR]

The American literary hero has often been portrayed as a self-willed orphan, an individualistic character who breaks with his origins and begins a new life by himself, alone and unencumbered by the responsibilities of family life. Moreover, American literary fathers, when/if present, tend to be represented as authoritarian and repressive figures. Nevertheless, the aim of this paper will be twofold. On the one hand, it will explore, and re-assess, several theoretical explanations that may help account for such dichotomous representation of fatherhood as an absent or repressive institution in U.S literature. On the other hand, it will posit both the feasibility and the desirability of moving beyond traditional binary conceptions of American fatherhood, illustrating the plurality as well as the irreducible complexity of fathers in American literary history. [ABSTRACT FROM AUTHOR]

During the 2004 North American Monsoon Experiment (NAME) field campaign, an extensive set of enhanced atmospheric soundings was gathered over the southwest United States and Mexico. Most of these soundings were assimilated into the NCEP operational global and regional data assimilation systems in real time. This presents a unique opportunity to carry out a series of data assimilation experiments to examine their influence on the NCEP analyses and short-range forecasts. To quantify these impacts, several data-withholding experiments were carried out using the global Climate Data Assimilation System (CDAS), the Regional Climate Data Assimilation System (RCDAS), and the three-dimensional variational data assimilation (3DVAR) Eta Model Data Assimilation System (EDAS) for the NAME 2004 enhanced observation period (EOP). The impacts of soundings vary between the assimilation systems examined in this study. Overall, the influence of the enhanced soundings is concentrated over the core monsoon area. While differences at upper levels are small, the differences at lower levels are more substantial. The coarse-resolution CDAS does not properly resolve the Gulf of California (GoC), so the assimilation system is not able to exploit the additional soundings to improve characteristics of the Gulf of California low-level jet (GCLLJ) and the associated moisture transport in the GoC region. In contrast, the GCLLJ produced by RCDAS is conspicuously stronger than the observations, though the problem is somewhat alleviated with additional special NAME soundings. For EDAS, soundings improve the intensity and position of the Great Plains low-level jet (GPLLJ). The soundings in general improve the analyses over the areas where the assimilation system has the largest uncertainties and errors. However, the differences in regional analyses owing to the soundings are smaller than the differences between the two regional data assimilation systems. [ABSTRACT FROM AUTHOR]

BACKGROUND: There have been no prior studies of the political self-characterization of U.S. physicians-in-training, and little is known about physicians' political leanings or the critical relationship between medical issues and political orientations of physicians and physicians-in-training. METHODS: All medical students in the class of 2003 at 16 nationally representative U.S. schools were eligible to complete three questionnaire administrations (at freshman orientation, entrance to wards, and senior year). RESULTS: Among these medical students, 5% self-characterized as politically very conservative, 21% conservative, 33% moderate, 31% liberal, and 9% as very liberal." Being male, white, Protestant, intending to specialize in Surgery or anesthesiology/pathology/radiology, or currently or previously being married significantly (P ≤ .001) increased the likelihood that a student self-identified as very conservative or conservative. Disagreement or strong disagreement with the statements, "I'm glad I chose to become a physician" and "Access to care is a fundamental human right," were also both associated with being very conservative or conservative. Being more liberal was reported by blacks arid Hispanics; those intending to become ob-gyns, psychiatrists, and pediatric subspecialists; and atheists, Jews, and adherents of eastern religions. CONCLUSIONS: U.S. medical students are considerably more likely to be liberal than conservative and are more likely to be liberal than are other young U.S. adults. Future U.S. physicians may be more receptive to liberal messages than conservative ones, and their political orientation may profoundly affect their health system attitudes. [ABSTRACT FROM AUTHOR]

Abstract: Objective. : To understand predictors of medical students'' prevention counseling practices. Methods. : We surveyed medical students (n =2316 individuals) in the Class of 2003 at freshman orientation, and again at entrance to wards and senior year in a nationally representative sample of 16 US medical schools (response rate=80.3%). Main outcome measures. : Perceived relevance of prevention counseling and seniors'' frequency of prevention counseling. Results. : Healthier personal practices (p <0.0001), intention to become a primary care practitioner (p =0.0007), and attending a medical school that encouraged healthy personal practices (p =0.002) significantly predicted the frequency with which seniors reported currently counseling patients about preventive interventions (using a validated measure). Perceived counseling relevance was also significantly predicted by intention to become a primary care practitioner (p <0.0001), attending a school that encouraged healthy personal practices (p =0.0007), being earlier in one''s training (p <0.0001), more interested in prevention (p <0.0001), female (p <0.0001), non-White (p =0.007), and by having healthy personal practices (p =0.008). Conclusions. : Several of the variables predicting physician counseling also predict US medical students'' reporting counseling (especially personal health practices and specialty type). In addition, the avidity with which medical schools encourage students to be healthy significantly influences their reported patient counseling. These findings can give a fresh, evidence-based direction to help create physicians who counsel patients about prevention. [Copyright &y& Elsevier]

Background: There has never been a nationally representative survey of medical students’ personal health-related practices, although they are inherently of interest and may affect students’ patient-counseling practices. Methods: To determine basic health practices and status, a survey was conducted of medical students (n =2316 individuals responding to ≥1 survey) in the Class of 2003 at freshman orientation, entrance to wards, and senior year in a nationally representative sample of 16 medical schools (response rate=80.3%). Results: Most medical students (84%) reported never having smoked cigarettes, and both genders typically drank two drinks per drinking episode (with bingeing more common among men). Students exercised a median of at least 4 hours per week, and preferred strenuous exercise. Medical students across all years and both genders reported a median of 7 hours of sleep per night. Nearly all (97%) reported their health to be at least good, typically with 1 or fewer days of poor physical or mental health in the past month. Both genders (particularly women) were unlikely to be overweight or obese. Reported rates of any chronic condition were ≤2% except for hypertension among men, and obesity, dyslipidemia, and depression in both genders. Unlike their other relatively positive behaviors compared with their peers, medical students had variable rates of preventive screening. Conclusions: Medical students in the United States were healthy, and reported many good health behaviors when compared with other young U.S. adults. However, for some, health behaviors and personal health practices either did not meet national goals or placed students at risk. [Copyright &y& Elsevier]

The large-scale atmospheric hydrologic cycle over the United States and Mexico derived from the 23-yr NCEP regional reanalysis (RR) was evaluated by comparing the RR products with satellite estimates, independent sounding data, and the operational Eta Model three-dimensional variational data assimilation (3DVAR) system (EDAS). In general, the winter atmospheric transport and precipitation are realistic. The climatology and interannual variability of the Pacific, subtropical jet streams, and low-tropospheric moisture transport are well captured. During the summer season, the basic features and the evolution of the North American monsoon (NAM) revealed by the RR compare favorably with observations. The RR also captures the out-of-phase relationship of precipitation as well as the moisture flux convergence between the central United States and the Southwest. The RR is able to capture the zonal easterly Caribbean low-level jet (CALLJ) and the meridional southerly Great Plains low-level jet (GPLLJ). Together, they transport copious moisture from the Caribbean to the Gulf of Mexico and from the Gulf of Mexico to the Great Plains, respectively. The RR systematically overestimates the meridional southerly Gulf of California low-level jet (GCLLJ). A comparison with observations suggests that the meridional winds from the RR are too strong, with the largest differences centered over the northern Gulf of California. The strongest winds over the Gulf in the RR extend above 700 hPa, while the operational EDAS and station soundings indicate that the GCLLJ is confined to the boundary layer. [ABSTRACT FROM AUTHOR]

Discusses the effort towards maintaining security within the borders of European Union (EU) member countries. Practices implementing the Schengen borders regime; Establishment of EU policy ensuring the right of data protection; Call on the need to consider the fundamental rights and freedoms of every human being in the creation, adoption and implementation of security initiatives.

Cocaine addiction continues to be a major health and social problem in the United States and other countries. Currently used pharmacological agents for treating cocaine abuse have proved inadequate, leaving few treatment options. An alternative is to use protein-based therapeutics that can eliminate the load of cocaine, thereby attenuating its effects. This approach is especially attractive because the therapeutic agents exert no pharmacodynamic action of their own and therefore have little potential for side effects. The effectiveness of these agents, however, is limited by their inability to act directly within the CNS. Bacteriophage have the capacity to penetrate the CNS when administered intranasally. Here, a method is presented for engineering filamentous bacteriophage to display cocaine-binding proteins on its surface that sequester cocaine in the brain. These antibody-displaying constructs were examined by using a locomotor activity rodent model to assess the ability of the phage-displayed proteins to block the psychoactive effects of cocaine. Results presented demonstrate a strategy in the continuing efforts to find effective treatments for cocaine addiction and suggest the application of this protein-based treatment for other drug abuse syndromes. [ABSTRACT FROM AUTHOR]

• We model bait-box vaccination as a control for mouse-tick Lyme disease transmission. • We perform cost analysis on a dynamical system transmission model. • In areas with high human risk, mouse vaccination is cost-effective. Lyme disease is one of the most prevalent and fastest growing vector-borne bacterial illnesses in the United States, with over 25,000 new confirmed cases every year. Humans contract the bacterium Borrelia burgdorferi through the bite of the tick Ixodes scapularis. The tick can receive the bacterium from a variety of small mammal and bird species, but the white-footed mouse Peromyscus leucopus is the primary reservoir in the northeastern United States, especially near human settlement. The tick's life cycle and behavior depend greatly on the season, with different stages of tick biting at different times. Reducing the infection in the tick-mouse cycle may greatly lower human Lyme incidence in some areas. However, research on the effects of various mouse-targeted interventions is limited. One particularly promising method involves administering vaccine pellets to white-footed mice through special bait boxes. In this study, we develop and analyze a mathematical model consisting of a system of nonlinear difference equations to understand the complex transmission dynamics and vector demographics in both tick and mice populations. We evaluate to what extent vaccination of white-footed mice can affect Lyme incidence in I. scapularis , and under which conditions this method saves money in preventing Lyme disease. We find that, in areas with high human risk, vaccination can eliminate mouse-tick transmission of B. burgdorferi while saving money. [ABSTRACT FROM AUTHOR]

Background: Prompt and accurate identification of stroke victims is essential to reduce time from symptom onset to adequate treatment and to improve neurological outcomes. Most neurologists evaluate the extent of neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), but the use of this scale by paramedics, the first healthcare providers to usually take care of stroke victims, has proven unreliable. This might be, at least in part, due to the teaching method. The video used to teach NIHSS lacks interactivity, while more engaging electronic learning (e-learning) methods might improve knowledge acquisition.Objective: This study was designed to evaluate whether a highly interactive e-learning module could enhance NIHSS knowledge acquisition in paramedics.Methods: A randomized controlled trial comparing a specially designed e-learning module with the original NIHSS video was performed with paramedics working in Geneva, Switzerland. A registration number was not required as our study does not come into the scope of the Swiss federal law on human research. The protocol was nevertheless submitted to the local ethics committee (Project ID 2017-00847), which issued a "Declaration of no objection." Paramedics were excluded if they had prior knowledge of or previous training in the NIHSS, or if they had worked in a neurology or neurosurgery ward. The primary outcome was overall performance in the study quiz, which contained 50 questions. Secondary outcomes were performance by NIHSS item, time to course and quiz completion, user satisfaction regarding the learning method, user perception of the course duration, and probability the user would recommend the course to a colleague.Results: The study was completed by 39 paramedics. There was a better overall median score (36/50 vs 33/50, P=.04) and a higher degree of satisfaction regarding the learning method in the e-learning group (90% vs 37%, P=.002). Users who had followed the e-learning module were more likely to recommend the course to a colleague (95% vs 63%, P=.02). Paramedics in the e-learning group took more time to complete the course (93 vs 59 minutes, P<.001), but considered the duration to be more adequate (75% vs 32%, P=.01). Time to quiz completion was similar between groups (25 vs 38 minutes, P=.12).Conclusions: Use of an e-learning module shows promising results in teaching the NIHSS to paramedics. [ABSTRACT FROM AUTHOR]

Objective To determine medical students' perceptions of having been harassed or belittled and their correlates, for the purposes of reducing such abuses. Design Longitudinal survey. Setting 16 nationally representative US medical schools. Participants 2884 students from class of 2003. Main outcome measures Experiences of harassment and belittlement at freshman orientation, at entry to wards, and in senior year by other students, by residents or fellows, by preclinical professors, by clinical professors or attendings, or by patients. Results 2316 students provided data (response rate 80.3%). Among seniors, 42% (581/1387) reported having experienced harassment and 84% (1166/1393) belittlement during medical school. These types of abuse were caused by other students (11% (158/1389) and 32% (443/1390) of students experienced such harassment or belittlement, respectively). Harassment and belittlement was also caused by residents (27% (374/1387) and 71% (993/1393)), preclinical professors (9% (131/1386) and 29% (398/1385)), clinical professors (21% (285/1386) and 63% (878/1390)), and patients (25% (352/1387) and 43% (592/1388)). Only 13% (181/1385) of students classified any of these experiences as severe. Medical students who reported having been harassed or belittled did not differ significantly from those not reporting such experiences by sex, ethnicity, political orientation, or religion. They did differ significantly by chosen specialty and were significantly more likely to be stressed, depressed, and suicidal, to drink alcohol or to binge drink, and to state that their faculty did not care about medical students. They were also significantly less likely to be glad they trained to become a doctor. Conclusion Most medical students in the United States report having been harassed or belittled during their training. Although few students characterised the harassment or belittlement as severe, poor mental health and low career satisfaction were significantly correlated [ABSTRACT FROM AUTHOR]

Reports on Community Sex Information Inc.'s (CSI) provision of sex information and counseling by making use of trained volunteers and interested professionals in New York City. Offer of a telephone sex information service that give sex information in a caring, open and nonjudgmental way; Training design for the volunteer telephone workers at CSI.

In this article we examine the ways in which institutional stratification and academic labor segmentation contribute to shaping faculty collaborative activities. We draw on interviews from science and engineering faculty at two institutions in the United States to highlight how collaboration, as an essential form of academic labor, is shaped by institutional factors like resource stress and isomorphic pressures to fit the ideal of the "world-class" research-intensive university. The findings suggest that a university's relative position in the institutional status hierarchy has a significant impact on the types of resources faculty seeking to establish collaborations can access and mobilize, thus reinforcing existing patterns of institutional stratification where "striving" institutions can never catch up to their more prestigious peers. At the same time, the pressure to maximize institutional prestige can create paradoxical interinstitutional dynamics where seemingly successful "Mode 2" units that rely almost exclusively on external resources and partnerships with industry are expected to mold themselves more closely to the activity streams of traditional academic units. [ABSTRACT FROM AUTHOR]

Invasive Asian earthworms are increasingly common in the eastern USA where they are a major cause of terrestrial ecosystem disturbance. Among these, Amynthas agrestis (Crazy Worm, Alabama Jumper, and other common names) has been shown to alter above-and belowground food webs. Life-history traits of these earthworms are largely unknown, particularly in their invaded range. Here, we sought to answer questions about temperature effects on hatching success for cocoons of this species, using specimens collected from the southern Appalachian Mountains. We conducted 2 experiments investigating the effects of incubation temperature and the effect of varying the duration of cold temperature on hatching success. Of the temperatures tested, we found that cocoons hatched with greatest success at 10 °C, but our tests indicate a long duration at that temperature may be needed to result in an increase in hatching success. These results indicate that temperature and the duration of temperature exposure affect hatching success in this species. While our results contribute to the growing body of knowledge about the life-history traits of invasive Asian earthworms in the eastern US, more research is needed to provide a finer-resolution understanding of the optimum level and duration of temperatures for hatching success of A. agrestis. [ABSTRACT FROM AUTHOR]

The article presents the review of Food and Drug Administration (FDA) in clinical trial revealing a higher frequency of cancer diagnoses in the lorcaserin group than in the placebo group. Topics include obesity increasing the risk of life-threatening diseases like type 2 diabetes, cardiovascular disease, and cancer; and weight reduction being associated with improvements in cardiovascular and metabolic parameters such as blood pressure, lipid levels, and sensitivity.

The circulation of the South-east Asian/American (AS/AM) dengue 2 virus (DENV-2) genotype in the Americas has been associated with a high rate of severe disease. From 1993, the year DENV was reintroduced in Panama, until 2011 there were 29 dengue-associated deaths, 17 of which occurred in 2011, the most severe outbreak with a case fatality rate (CFR) of 44% (17 deaths out of 38 severe dengue cases). During this outbreak DENV-2 was reintroduced into the country, whereas over the prior five years DENV-1 and −3 were predominant. Herein, we describe the 2011 Panama outbreak and genetically characterize the Panamanian DENV-2 strains, which were associated with severe dengue disease in Panama. Our results suggest that the DENV-2 isolates from this outbreak belonged to the AS/AM genotype sub-clade 2BI and were genetically close to viruses described in the outbreaks in Nicaragua, Honduras, Guatemala and Mexico from 2006-2011. Sub-clade 2BI has previously been associated with severe disease in Nicaragua during outbreaks from 2005-2007. [ABSTRACT FROM AUTHOR]

The article presents a study which determines the personal physical activity (PA) levels and counselling practices of medical students in the U.S. The researchers conducted a prospective survey of a representative sample of medical students to determine health-related attitudes and practices using a Godin exercise questionnaire. The results indicate that personal PA levels in medical students are correlated with frequency of PA counseling of their patients. It is suggested that adequate PA habits during medical education may be an essential step to improve the PA preventive counselling that future clinicians offer.

Introduction: Vibegron is a selective β 3 -adrenergic receptor agonist that was approved by the US Food and Drug Administration in December 2020 for the treatment of overactive bladder in adults. This retrospective study assessed US pharmacy claims data to evaluate the real-world adherence and persistence of vibegron compared with mirabegron and with anticholinergics., Materials and Methods: This analysis used the Optum Research Database to identify adults with ≥1 pharmacy claim for vibegron, mirabegron, or an anticholinergic from April 1, 2021, to August 31, 2022. Patients had ≥ 90 days of continuous commercial or Medicare medical and pharmacy coverage preindex and ≥ 60 days of continuous pharmacy coverage postindex. Two independent propensity-score models matched patients treated with (1) vibegron versus mirabegron and (2) vibegron versus anticholinergics on key variables such as demographics and clinical characteristics, index copay, days' supply, and time of entry into analysis (index quarter). Adherence was measured by proportion of days covered (PDC) from index to the end of follow-up and was defined as PDC ≥ 80%. Persistence was defined as days to discontinuation of index medication (first 30-day gap) or end of follow-up., Results: The matched vibegron and mirabegron cohorts included 4921 and 9842 patients, respectively, and the matched vibegron and anticholinergic cohorts included 4676 and 9352 patients, respectively. Patients receiving vibegron had greater mean PDC versus patients receiving mirabegron (0.67 vs. 0.64, respectively; p < 0.001) or anticholinergics (0.67 vs. 0.58; p < 0.001). A greater percentage of patients receiving vibegron were adherent versus those receiving mirabegron (49.0% vs. 45.1%, respectively; p < 0.001) or anticholinergics (49.1% vs. 38.5%; p < 0.001). Persistence was longer with vibegron compared with both mirabegron (median [95% CI], 171 [159-182] vs. 128 [122-137] days, respectively; p < 0.001) and anticholinergics (172 [159-183] vs. 91 [91] days; p < 0.001)., Conclusion: In this retrospective analysis of pharmacy claims data, patients receiving vibegron exhibited significantly higher adherence and demonstrated longer persistence in comparison to matched patient cohorts receiving either mirabegron or anticholinergics., (© 2024 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Introduction: Vibegron is a β 3 -adrenergic receptor agonist approved for overactive bladder (OAB). This analysis assessed real-world adherence and persistence with vibegron in patients with OAB, along with demographics and clinical characteristics associated with adherence and persistence., Methods: This retrospective study used the Optum Research Database to identify patients treated with vibegron from April 2021 to August 2022 (identification period). Patients had ≥ 60 days of continuous pharmacy coverage in a commercial or Medicare Advantage plan following the index fill (follow-up). Adherence was assessed as proportion of days covered (PDC) from index to end of follow-up and was defined as PDC ≥ 80%. Persistence was measured as days to discontinuation of therapy (30-day gap) or end of follow-up. Data for adherence and persistence are presented descriptively. Characteristics associated with adherence and persistence were analyzed using multivariable models among patients with medical and pharmacy benefits during the 90 days before index (baseline)., Results: Overall, 9992 patients had a vibegron claim during the identification period; 9712 had ≥ 2 months of follow-up. Mean (SD) age was 74.2 (10.7) years; 68.2% were female. Mean (SD) PDC was 0.64 (0.34). Median (95% confidence interval) persistence was 142 (132-153) days. Of the 5073 patients who were ≥ 18 years old with continuous baseline pharmacy and medical benefits ≥ 90 days before index, 2497 (49.2%) were adherent. Patients were more likely to be adherent and persistent if they received a greater days' supply for the index fill and had baseline medication count ≥ 6. Patients were more likely to discontinue if their index copay was > $45., Conclusion: Nearly half of the patients initiating vibegron were adherent. Factors associated with adherence and persistence were more likely to be related to prescribing practices than patient characteristics. These results suggest it may be best to follow up with patients approximately 4 to 5 months after initiating treatment with vibegron., (© 2024. The Author(s).)