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Introduction: Severe trauma-induced blood loss can lead to metabolic acidosis, shock, and death. Identification of abnormalities in the bicarbonate and serum markers may be seen before frank changes in vital signs in the hemorrhaging trauma patient, allowing for earlier lifesaving interventions. In this study the author aimed to evaluate the usefulness of serum bicarbonate and other lab markers as predictors of mortality in trauma patients within 30 days after injury. Methods: This retrospective, propensity-matched cohort study used the TriNetX database, covering approximately 92 million patients from 55 healthcare organizations in the United States, including 3.8 million trauma patients in the last two decades. Trauma patients were included if they had lab measurements available the day of the event. The analysis focused on mortality within 30 days post-trauma in comparison to measured lab markers. Cohorts were formed based on ranges of bicarbonate, lactate, and base excess levels. Results: Before propensity score matching, a total of 1,275,363 trauma patients with same-day bicarbonate, lactate, or base excess labs were identified. A significant difference in mortality was found across various serum bicarbonate lab ranges compared to the standard range of 21-27 milliequivalents per liter (mEq/L), post-propensity score matching. The relative risk of death was 6.806 for bicarbonate ≤5 mEq/L; 8.651 for 6-10; 6.746 for 11-15; 2.822 for 16-20; and 1.015 for bicarbonate ≥28. Serum lactate also displayed significant mortality outcomes when compared to a normal level of ≤2 millimoles per liter. Base excess showed similar significant correlation at different values compared to a normal base excess of-2 to 2 mEq/L. Conclusion: This study, approximately 100 times larger than prior studies, associated lower bicarbonate levels with increased mortality in the trauma patient. While lactate and base excess offer prognostic value, lower bicarbonate values have a higher relative risk of death. The greater predictive value of bicarbonate and accessibility during resuscitations suggests that it may be the superior prognostic marker in trauma. [ABSTRACT FROM AUTHOR]

The first comprehensive national survey of all academic libraries in the United States which were conducting chat reference service was carried out to determine: what practices were being used to prepare personnel for chat reference service, what competencies were being taught, how and why training practices may have changed over time, and what modifications to current training practices were anticipated in the future.

Objective: Treat‐to‐target (T2T) and shared decision‐making are valued features of current guidelines for rheumatoid arthritis (RA) management. Although T2T has demonstrated value for improving RA outcomes, implementation remains inconsistent and lacks standardization and procedures for including patient input. We sought to better understand the impact of shared decisions on T2T and how treatment goal discussions between patients and providers impact RA treatment improvement and satisfaction. Methods: An anonymous, web‐based questionnaire was presented to United States residents aged 18 years or older with a self‐reported diagnosis of RA by a medical professional with 28 questions regarding socio‐demographics, RA disease activity (DA), diagnosis, treatments, outcomes, and goals. Analyses included descriptive statistics with χ2 and rank sum tests for comparisons. Results: The questionnaire was completed by 907 people (mean age of 58 years; mean 11 years since diagnosis; 90% female). The majority (571; 63%) did not discuss RA treatment goals with providers. Patients engaging in treatment goal discussions with their providers were three times more likely to be satisfied with their treatment plans. Patients discussing treatment goals with their providers were more likely to have improved DA levels and 68% more likely to reach remission. Conclusion: A majority of patients with RA report having no treatment goal discussion with their providers; however, these discussions are associated with greater DA improvement and treatment satisfaction. Further research should seek understanding of how shared treatment goal discussions relate to successful RA management and explore the development of practical tools to implement them in regular clinic practice as part of a T2T regimen. [ABSTRACT FROM AUTHOR]

Objective: Effectiveness of antipsychotic drugs is inferred from relatively small randomized clinical trials conducted with carefully selected and monitored participants. This evidence is not necessarily generalizable to individuals treated in daily clinical practice. The authors compared the clinical effectiveness between all oral and long-acting injectable (LAI) antipsychotic medications used in the treatment of schizophrenia in the U.S. Department of Veterans Affairs (VA) health care system.Methods: This was an observational study utilizing VA pharmacy data from 37,368 outpatient veterans with schizophrenia. Outcome measures were all-cause antipsychotic discontinuation and psychiatric hospitalizations. Oral olanzapine was used as the reference group.Results: In multivariable analysis, clozapine (hazard ratio=0.43), aripiprazole long-acting injectable (LAI) (hazard ratio=0.71), paliperidone LAI (hazard ratio=0.76), antipsychotic polypharmacy (hazard ratio=0.77), and risperidone LAI (hazard ratio=0.91) were associated with reduced hazard of discontinuation compared with oral olanzapine. Oral first-generation antipsychotics (hazard ratio=1.16), oral risperidone (hazard ratio=1.15), oral aripiprazole (hazard ratio=1.14), oral ziprasidone (hazard ratio=1.13), and oral quetiapine (hazard ratio=1.11) were significantly associated with an increased risk of discontinuation compared with oral olanzapine. No treatment showed reduced risk of psychiatric hospitalization compared with oral olanzapine; quetiapine was associated with a 36% worse outcome in terms of hospitalizations compared with olanzapine.Conclusions: In a national sample of veterans with schizophrenia, those treated with clozapine, two of the LAI second-generation antipsychotics, and antipsychotic polypharmacy continued the same antipsychotic therapy for a longer period of time compared with the reference drug. This may reflect greater overall acceptability of these medications in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of psoriatic arthritis (PsA) in a US population and describe trends in incidence and mortality over 5 decades. Methods: The previously identified population‐based cohort that included Olmsted County, Minnesota residents ≥18 years of age who fulfilled PsA criteria during 1970–1999 was extended to include patients with incident PsA during 2000–2017. Age‐ and sex‐specific incidence rates and point prevalence, adjusted to the 2010 US White population, were reported. Results: There were 164 incident cases of PsA in 2000–2017 (mean ± SD age 46.4 ± 12.0 years; 47% female). The overall age‐ and sex‐adjusted annual incidence of PsA per 100,000 population was 8.5 (95% confidence interval [95% CI] 7.2–9.8) and was higher in men (9.3 [95% CI 7.4–11.3]) than women (7.7 [95% CI 5.9–9.4]) in 2000–2017. Overall incidence was highest in the 40–59 years age group. The incidence rate was relatively stable during 2000–2017, with no evidence of an overall increase or an increase in men only (but a modest increase of 3% per year in women), compared to 1970–1999 when a 4%‐per‐year increase in incidence was observed. Point prevalence was 181.8 per 100,000 population (95% CI 156.5–207.1) in 2015. The percentage of women among those with PsA increased from 39% in 1970–1999 and 41% in 2000–2009 to 54% in 2010–2017 (P = 0.08). Overall survival in PsA did not differ from the general population (standardized mortality ratio 0.85 [95% CI 0.61–1.15]). Conclusion: The incidence of PsA in this predominantly White US population was stable in 2000–2017, in contrast to previous years. However, an increasing proportion of women with PsA was found in this study. [ABSTRACT FROM AUTHOR]

Purpose: To assess psychological effects of the initial peak phase of the COVID-19 pandemic on United States (US) medical students in clinical training to anticipate sequelae and prepare for future outbreaks. Methods: Authors emailed a cross-sectional survey in April-May, 2020 to students in clinical training years at six US medical schools which included validated General Anxiety Disorder (GAD-7) and Primary Care-PTSD (PC-PTSD-5) screening tools, and asked students about pandemic-related stress and specific concerns. Authors used quantitative and thematic analysis to present results. Results: Of 2511 eligible students, 741 responded (29.5%). Most students (84.1%) reported at least "somewhat" increased levels of stress and anxiety related to the pandemic. On the GAD-7, 34.3% showed mild, 16.1% moderate, and 9.5% severe anxiety symptoms, with 39.6% demonstrating no/minimal symptoms. One quarter (25.4%) screened positive for PTSD risk symptoms. Top concerns of students chosen from a pre-populated list included inadequate COVID-19 testing, undiagnosed or asymptomatic spread and racial or other disparities in the pandemic. In thematic analysis, students' reactions to removal from clinical learning included: understanding the need to conserve PPE (32.2%), a desire to help (27.7%), worry over infectious risk to others (25.4%) and self (21.2%), and lost learning opportunities (22.5%). Female students were significantly more likely to report anxiety and PTSD risk symptoms. Asian students had a greater risk of moderate anxiety and those underrepresented in medicine (UIM) had greater risk of moderate and severe anxiety symptoms compared to white students. Conclusions: During the initial peak phase of COVID-19, over 60% of US medical students screened positive for pandemic-related anxiety and one quarter were at risk for PTSD. Female and UIM students were significantly more affected. Medical schools should consider broad support of students, and targeted outreach to female and UIM students. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic disrupted the United States (US) medical education system with the necessary, yet unprecedented Association of American Medical Colleges (AAMC) national recommendation to pause all student clinical rotations with in-person patient care. This study is a quantitative analysis investigating the educational and psychological effects of the pandemic on US medical students and their reactions to the AAMC recommendation in order to inform medical education policy. Methods: The authors sent a cross-sectional survey via email to medical students in their clinical training years at six medical schools during the initial peak phase of the COVID-19 pandemic. Survey questions aimed to evaluate students' perceptions of COVID-19's impact on medical education; ethical obligations during a pandemic; infection risk; anxiety and burnout; willingness and needed preparations to return to clinical rotations. Results: Seven hundred forty-one (29.5%) students responded. Nearly all students (93.7%) were not involved in clinical rotations with in-person patient contact at the time the study was conducted. Reactions to being removed were mixed, with 75.8% feeling this was appropriate, 34.7% guilty, 33.5% disappointed, and 27.0% relieved. Most students (74.7%) agreed the pandemic had significantly disrupted their medical education, and believed they should continue with normal clinical rotations during this pandemic (61.3%). When asked if they would accept the risk of infection with COVID-19 if they returned to the clinical setting, 83.4% agreed. Students reported the pandemic had moderate effects on their stress and anxiety levels with 84.1% of respondents feeling at least somewhat anxious. Adequate personal protective equipment (PPE) (53.5%) was the most important factor to feel safe returning to clinical rotations, followed by adequate testing for infection (19.3%) and antibody testing (16.2%). Conclusions: The COVID-19 pandemic disrupted the education of US medical students in their clinical training years. The majority of students wanted to return to clinical rotations and were willing to accept the risk of COVID-19 infection. Students were most concerned with having enough PPE if allowed to return to clinical activities. [ABSTRACT FROM AUTHOR]

We report the results of a survey on HIV pre-exposure prophylaxis (PrEP) perceptions, capacity, and barriers at federally qualified health centers (FQHCs) in high–HIV burden jurisdictions in the United States. Health care workers at FQHCs identified multiple barriers to, and strategies for, improving PrEP implementation. [ABSTRACT FROM AUTHOR]

Objectives: To examine trends in the incidence of rheumatoid arthritis (RA) from 2005 to 2014 overall and by serological status as compared with 1995-2004 and 1985-1994.Methods: We evaluated RA incidence trends in a population-based inception cohort of individuals aged ≥18 years who first fulfilled the 1987 American College of Rheumatology (ACR) criteria for RA between 1 January 1985 and 31 December 2014. Incidence rates were estimated and were age-adjusted and sex-adjusted to the white population in the USA in 2010. Trends in incidence were examined using Poisson regression methods.Results: The 2005-2014 incidence cohort comprised 427 patients: mean age 55.4 years, 68% female, 51% rheumatoid factor (RF) positive and 50% anti-cyclic citrullinated peptide antibody positive. The overall age-adjusted and sex-adjusted annual RA incidence in 2005-2014 was 41/100 000 population (age-adjusted incidence: 53/100 000 in women and 29/100 000 in men). While these estimates were similar to the 1995-2004 decade, there was a decline in the incidence of RF-positive RA in 2005-2014 compared with the previous two decades (p=0.004), with a corresponding increase in RF-negative cases (p<0.001). Smoking rates declined and obesity rates increased from earlier decades to more recent years.Conclusions: Significant increase in incidence of RF-negative RA and decrease in RF-positive RA in 2005-2014 compared with previous decades was found using 1987 ACR criteria. The incidence of RA overall during this period remained similar to the previous decade. The changing prevalence of environmental factors, such as smoking, obesity and others, may have contributed to these trends. Whether these trends represent a changing serological profile of RA requires further investigation. [ABSTRACT FROM AUTHOR]

In the United States, “seed fund” programs in biomedical fields have been reported to enhance faculty success in securing federal awards. Seed funds are relatively small internal grants that are allocated by universities to their faculty to invigorate research, in anticipation that they will lead to larger benefits—these benefits could be the creation of stronger teams that lead to larger external grants and/or more impactful publications. We hypothesized that a seed funding approach for research on natural resources and agricultural systems, including forest systems, may have similar benefits. Here, we report that seed funding supported faculty development in numerous ways, including leveraging to generate external competitive awards. For each dollar of institutional investment in each of the three seed funding programs, faculty acquired $6, >$50, and $4.50, respectively, in external funding that was leveraged within three years of the seed fund award date. Notably, the majority of the leveraged funding was from federal granting agencies through competitive programs. Federal competitive awards are important elements of tenure and promotion dossiers, as they reflect success in acquiring grants that are difficult to obtain, thus providing evidence of research excellence. We speculate that the seed fund proposal review process prepared faculty for competitive awards. Finally, we suggest best management practices for the implementation of seed funding to support teams of faculty. [ABSTRACT FROM AUTHOR]

Background: Pre-exposure prophylaxis (PrEP) for HIV is effective, yet many providers continue to lack knowledge and comfort in providing this intervention. It remains unclear whether internal medicine (IM) residents receive appropriate training in PrEP care and if this affects their future practices.Objective: We sought to evaluate the relationship between current IM residents' prior PrEP training and knowledge, comfort, and practice regarding the provision of PrEP.Design and Participants: We created an online survey to assess IM residents' knowledge, attitudes, and behaviors related to PrEP. The survey was distributed among five IM programs across the USA.Key Results: We had a 35% response rate. Of 229 respondents, 96% (n = 220) had heard of PrEP but only 25% (n = 51) had received prior training and 11% (n = 24) had prescribed PrEP. Compared with those without, those with prior training reported good to excellent knowledge scores regarding PrEP (80% versus 33%, p < 0.001), more frequent prescribing (28% versus 7%, p = 0.001), and higher comfort levels with evaluating risk for HIV, educating patients, and monitoring aspects of PrEP (75% versus 26%, 56% versus 16%, and 47% versus 8%, respectively; all p values < 0.0001). While only 25% (n = 51) had received prior training, 75% (n = 103) of respondents reported that training all providers at their continuity clinic sites would improve implementation.Conclusions: We found that prior training was associated with higher levels of self-reported PrEP knowledge, comfort, and prescribing behaviors. Given the significant need for PrEP, IM residents should be trained to achieve adequate knowledge and comfort levels to prescribe it. This study demonstrates that providing appropriate PrEP training for IM residents may lead to an increase in the pool of graduating IM residents prescribing PrEP. [ABSTRACT FROM AUTHOR]

Background: In May 2012, the US Preventive Services Task Force issued a grade D recommendation against PSA-based prostate cancer screening. Epidemiologists have concerns that an unintended consequence is a problematic increase in high-risk disease and subsequent prostate cancer-specific mortality.Materials and methods: To assess the effect of decreased PSA screening on the presentation of high-risk prostate cancer post-radical prostatectomy (RP). Nine high-volume referral centers throughout the United States (n = 19,602) from October 2008 through September 2016 were assessed and absolute number of men presenting with GS ≥ 8, seminal vesicle and lymph node invasion were compared with propensity score matching.Results: Compared to the 4-year average pre-(Oct. 2008-Sept. 2012) versus post-(Oct. 2012-Sept. 2016) recommendation, a 22.6% reduction in surgical volume and increases in median PSA (5.1-5.8 ng/mL) and mean age (60.8-62.0 years) were observed. The proportion of low-grade GS 3 + 3 cancers decreased significantly (30.2-17.1%) while high-grade GS 8 + cancers increased (8.4-13.5%). There was a 24% increase in absolute numbers of GS 8+ cancers. One-year biochemical recurrence rose from 6.2 to 17.5%. To discern whether increases in high-risk disease were due to referral patterns, propensity score matching was performed. Forest plots of odds ratios adjusted for age and PSA showed significant increases in pathologic stage, grade, and lymph node involvement.Conclusions: All centers experienced consistent decreases of low-grade disease and absolute increases in intermediate and high-risk cancer. For any given age and PSA, propensity matching demonstrates more aggressive disease in the post-recommendation era. [ABSTRACT FROM AUTHOR]

The article discusses the common ground concept involving community-owned land in relation to an effort to promote equitable and sustainable development as of 2017, and it mentions community land trusts (CLTs) in places such as the U.S. Community development and affordable housing in America are assessed, along with neighborhood revitalization, the economic aspects of land reform, and the social aspects of power. Property-related laws and covenants are examined.

Existing research identifies partisan differences in taxing choices made by state governments. Research has also found that, even when controlling for intrastate characteristics such as party, jurisdictions respond to the taxing decisions of their neighbours, particularly when citizens can easily cross-border shop. These studies treat political and competitive factors as independent influences on taxes. We suggest they are more likely to interact in taxing decisions. We argue that the political costs of cross-border shopping are higher for Republicans, and the threat of it should have a greater negative impact on taxes when that party controls major state policy-making institutions. Our analyses of state cigarette taxes between 1980 and 2011 confirm that a higher threat of cross-border shopping has a larger negative impact on taxes under Republican governors. We conclude that, by missing the interaction between partisanship and the threat of fiscal mobility, previous work misestimates key influences on tax competition. [ABSTRACT FROM AUTHOR]

Opioid prescriptions have seen an increase across the USA, Canada, Europe, and the UK. In the USA, they have quadrupled from 1999 to 2010. Opioid use among patients with rheumatoid arthritis (RA) over time is not well described. This study examined trends of opioid use in patients with RA. Retrospective prescription data was examined from 2005 to 2014 in a population-based incidence cohort of patients with RA by 1987 ACR criteria and comparable non-RA subjects. Differences in opioid use were examined with Poisson models. A total of 501 patients with RA (71 % female) and 532 non-RA subjects (70 % female) were included in the study. Total and chronic opioid use in 2014 was substantial in both cohorts 40 % RA vs 24 % non-RA and 12 % RA vs. 4 % non-RA, respectively. Opioid use increased by 19 % per year in both cohorts during the study period (95 % confidence interval [CI] 1.15, 1.25). Relative risk (RR) of chronic opiate use for RA patients compared to non-RA subjects was highest in adults aged 50-64 years (RR 2.82; 95 % CI 1.43-6.23). RA disease characteristics, biologic use at index, treated depression/fibromyalgia, education, and smoking status were not significantly associated with chronic opiate use. Over a third of patients with RA use opioids in some form, and in more than a tenth use is chronic. Use has increased in recent years. Patients aged 50-64 with RA use substantially more opioids than their non-RA counterparts. [ABSTRACT FROM AUTHOR]

The educational impacts of mandated assessment in U.S. colleges is part of a growing research agenda focused on how methodologies of program evaluation best enable educators to improve teaching and learning. Accordingly, research has tried to identify the key aspects of evaluation/assessment 'capacity' in college language departments (i.e., environmental conditions and personnel factors) that seem most associated with meaningful reform and evaluation use. This article reports on a provisional framework of evaluation/assessment capacity for university foreign language (FL) programs. Factor analysis was performed on questionnaire data from 204 university language educators reporting on their program assessment activities. Results suggested a set of program-level and institutional capacity elements grouped into 7 categories: (a) institutional support (funding, training, expertise, etc.), (b) institutional governance and leadership, (c) facilitative infrastructures (e.g., curricular maps, assessment plans), (d) program-level support (financial, personnel resources), (e) a prevailing program ethos conducive to educational innovation, (f) pro-assessment attitudes, and (g) high-quality assessment activities and abilities (i.e., dimensions of assessment practice at advanced levels of skill and experience). The framework delineates a provisional set of theory-based, empirically supported program factors linked to assessment usefulness in postsecondary FL education and provides educators a set of guidelines to develop their assessment capabilities. [ABSTRACT FROM AUTHOR]

Gig economy compensation policy initiatives, such as California Prop 22, are increasing the number of US workers receiving piece rate pay (PRP) and other forms of insecure income. However, there is limited evidence about how this trend affects people's health. Using data from the 2008-19 IPUMS Medical Expenditure Panel Survey (MEPS), we examined associations between insecure compensation and US adults' self-reported overall health as well as psychological distress. We report significant associations with three types of insecure income — PRP, hourly, and daily pay — on overall health and psychological distress. These effects were robust to adjustment for suspected confounders, but point estimates suggested that the effect of each type of non-salary compensation differed by sex, level of education, income level, and health insurance coverage. These findings warrant policy makers' consideration as they balance the purported benefits of gig economy non-salary compensated work with implications for workers' health. • Insecure income is a growing concern in the United States and globally. • IPUMS-MEPS is a US-national survey containing important work and health questions. • Three of the most common insecure compensation methods are piece rate, hourly, and daily pay. • We found 50%+ increases in poor physical and mental health with insecure income. • These associations were moderated by education, health insurance, poverty, and sex. [ABSTRACT FROM AUTHOR]

Laurel wilt, caused by the fungus Raffaelea lauricola, is an exotic disease that affects members of the Lauraceae plant family in the southeastern United States. The disease is spreading rapidly in native forests and is now found in commercial avocado groves in south Florida, where an accurate diagnostic method would improve disease management. A polymerase chain reaction (PCR) method based on amplifying the ribosomal small-subunit DNA, with a detection limit of 0.0001 ng, was found to be suitable for some quantitative PCR applications; however, it was not taxon specific. Genomic sequencing of R. lauricola was used to identify and develop primers to amplify two taxon-specific simple-sequence repeat (SSR) loci, which did not amplify from related taxa or host DNA. The new SSR loci PCR assay has a detection limit of 0.1 ng of R. lauricola DNA, is compatible with traditional and real-time PCR, was tested in four labs to confirm consistency, and reduces diagnostic time from 1 week to 1 day. Our work illustrates pitfalls to designing taxon-specific assays for new pathogens and that undescribed fungi can limit specificity. [ABSTRACT FROM AUTHOR]

Within a response to intervention model, educators increasingly use progress monitoring (PM) to support medium- to high-stakes decisions for individual students. For PM to serve these more demanding decisions requires more careful consideration of measurement error. That error should be calculated within a fixed linear regression model rather than a classical test theory model, which has been more common. Seven practical skills are described for improving the use of PM data for medium- to high-stakes decisions: (a) estimating a static performance level in PM, (b) fitting a level of confidence to an educational decision, (c) expressing an estimated score (Yhat) with its measurement error, (d) judging reliable improvement from one time to a later time, (e) properly using slope versus trendedness, (f) expressing “rate of improvement” (slope) with error, and (g) controlling autocorrelation. An example data set and PM graphs are used to illustrate each. [ABSTRACT FROM PUBLISHER]

The majority of incidence and prevalence studies on childhood behavioral problems report the occurrence of mental health disorders under diagnostic categories. A few studies report prevalence of specific behavior problems identified through direct observation, teacher surveys, or analyses of office discipline referrals. However, each possesses limitations that may be informed by data that report the occurrence of specific behavior problems at the classroom level. The rapidly increasing use of multitiered models of prevention and intervention will benefit from data of prevalence of problem behaviors. The purpose of this study was to identify the “most common” problem behaviors in classrooms in the United States as reported by teachers on a broadband rating scale with a demographically representative sample of 3,600 children and adolescents. Results indicate 17 common problem behaviors of children and adolescents, each in four behavioral domains. Interesting findings include behaviors associated with anxiety, learning problems, and distractibility as the most commonly addressed by teachers in the classroom as opposed to the most frequently addressed by administrators, such as aggression. Implications are discussed for policy makers, teacher educators, administrators, and teachers. [ABSTRACT FROM AUTHOR]

HCV incidence from 1996-2008 among HIV-infected men in U.S. HIV therapeutic trials was 0.51 per 100 person-years. Incident HCV occurred primarily through non-parenteral means; 75% of seroconverters reported no drug injection. At-risk HIV-infected persons should have access to HCV surveillanceBackground. Outbreaks of sexually transmitted hepatitis C virus (HCV) infection have been reported among human immunodeficiency virus (HIV)–infected men who have sex with men in Europe, Australia, and New York. Whether this is occurring across the United States is unknown.Methods. We determined incidence of HCV infection during 1996–2008 among male participants of the AIDS Clinical Trial Group Longitudinal Linked Randomized Trials cohort, a long-term study of HIV-infected persons randomized into selected US-based clinical trials. We evaluated associations with self-reported injection drug use (IDU), time-varying CD4+ cell count, and HIV RNA level with use of multivariate Poisson regression. No sexual or non-IDU risk factor data was available.Results. A total of 1830 men had an initial negative HCV antibody test result and at least 1 subsequent HCV antibody test result, contributing >7000 person-years. At the time of the initial negative HCV antibody test result, 94% of men were receiving highly active antiretroviral therapy (HAART) and 6% reported current or prior IDU. Thirty-six seroconverted, with overall incidence of .51 cases per 100 person-years (95% confidence interval, .36–.70). Mean age at seroconversion was 46 years. Seroconversion was associated with IDU (25% of seroconverters reported IDU history vs 5% of nonseroconverters; P < .001), whereas 75% (n = 27) of seroconverters reported no IDU (incidence, 2.67 cases per 100 person-years among IDUs, .40 cases per 100 person-years among non-IDUs). Seroconversion was associated with HIV RNA level >400 copies/mL (44% at time of antibody positivity vs 21% at time of last negative antibody test result; P = .02) but not with CD4+ cell count.Conclusions. Incident HCV infection occurs in HIV-infected men involved in US HIV therapeutic trials, primarily through nonparenteral means, despite engagement in care and HAART. HCV antibody development was not related to immune status but was associated with inadequate HIV suppression. At-risk HIV-infected persons should have access to HCV surveillance. [ABSTRACT FROM AUTHOR]

The Daily Behavior Report Card is an intervention showing promise in various formats and in multiple settings. A meta-analysis evaluated the size of effects obtained from Daily Behavior Report Card interventions within single case research designs, investigating six potential moderators of treatment effects: student age, target behavior, home/school collaboration, breadth of use, scale construction, and reliability measure. Effect sizes are based on the improvement rate difference, a new overlap-based summary. Overall, data yielded 48 separate effect sizes from 17 studies. The mean improvement rate difference for all studies was 0.61 with a range of -0.15 to 0.97. This wide range of scores highlights the need to consider specific aspects of implementation to improve outcomes. High levels of home involvement and broad use throughout the day are associated with stronger intervention outcomes. [ABSTRACT FROM AUTHOR]

At the 2008 annual meeting of the American College of Neuropsychopharmacology (ACNP), a symposium was devoted to the following question: 'what have we learned about the design of pragmatic clinical trials (PCTs) from the recent costly long-term, large-scale trials of psychiatric treatments?' in order to inform the design of future trials. In all, 10 recommendations were generated placing emphasis on (1) appropriate conduct of pragmatic trials; (2) clinical, rather than, merely statistical significance; (3) sampling from the population clinicians are called upon to treat; (4) clinical outcomes of patients, rather than, on outcome measures; (5) use of stratification, controlling, or adjusting when necessary and not otherwise; (6) appropriate consideration of site differences in multisite studies; (7) encouragement of 'post hoc' exploration to generate (not test) hypotheses; (8) precise articulation of the treatment strategy to be tested and use of the corresponding appropriate design; (9) expanded opportunity for training of researchers and reviewers in RCT principles; and (10) greater emphasis on data sharing. [ABSTRACT FROM AUTHOR]

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To measure the time and subjective quality of individual steps of robot-assisted radical prostatectomy (RARP), as RARP performed by trainees has recently become the most common technique of RP in the USA, and although outcomes from expert surgeons are reported, limited data are available to document training experiences. PATIENTS AND METHODS The patients studied were from a prospective cohort of 178 participants (124 with training data). Transperitoneal RARP was performed by one faculty surgeon and one assistant from a rotation of four urological oncology fellows and three residents. RARP was divided into 11 steps, and staff times were recorded for each step. Trainee times and quality scores were recorded for each step, the later defined as grade A equal to staff (A+, no verbal coaching); B, minor corrections; and C, major corrections. Short-term outcomes were recorded to assess the safety of the training. RESULTS The mean (range) console time/case of trainees was 40 (10–123) min. The median console time for a complete case by faculty and by trainees (pooled group) was 128 and 231 min, respectively, an increase in 81%. Individual trainee-performed steps increased in time (compared to staff) by a median range of 50–177%, and the incidence of quality grades < A of 9–100%. Trainee quality grades for basic tissue-dissection steps were higher than for advanced tissue dissection and suturing. There was no downgrading for a major correction. Analysis of short-term outcomes suggested acceptable results in a training environment. The study is limited by no available validated training measurement tools, and a low frequency of beginner trainees advancing to more difficult steps during the rotation. CONCLUSIONS During the initial exposure of trainees to RARP of <40 cases, we measured time and subjective quality grading of basic steps, and introduction to advanced steps. Training requires more procedure time, but does not appear to diminish expected outcomes. [ABSTRACT FROM AUTHOR]

The article reviews the developments of international anti-corruption enforcement in the U.S. in 2009. It notes that the Foreign Corrupt Practices Act (FCPA) among U.S. agencies have used specialized investigation and prosecution units. However, other countries like Great Britain has seriously fought corruption with three FCPA trials that ended in convictions.

The problem of securing and protecting European Union (EU) employee data and meeting EU privacy guidelines is growing as U.S. corporations continue to hire employees overseas. This article examines the ability of a multinational U.S. corporation to meet data privacy and security guidelines for EU data being transferred to the United States. By examining Safe Harbor regulation, this article simplifies the process by which a corporation can meet privacy regulatory constraints over EU data. Participation in Safe Harbor is voluntary for U.S. companies. The U.S. Federal Trade Commission reviews referrals from privacy self-regulatory organizations and EU member states that allege noncompliance to determine if unfair or deceptive practices have been committed. This article can be used to provide an operational framework of subjects to include in a corporation's policy and program to comply with Safe Harbor and to expedite that process. [ABSTRACT FROM AUTHOR]

Background: Depression during pregnancy has adverse consequences for both mother and child. Although common in western countries, depression appears to be virtually absent in countries with high seafood intake. We test the hypothesis that low seafood intake during pregnancy is associated with increased prevalence of depressive symptoms.Methods: This study used data prospectively collected from women participating in the Avon Longitudinal Study of Parents and Children in the period 1991-1992. At 32 weeks' gestation, the mother completed a questionnaire that included symptoms of depression and a food frequency questionnaire from which the amount of omega-3 fatty acids from fish was calculated. Statistical analysis took social and lifestyle factors into account.Results: Unadjusted and adjusted analyses showed lower maternal intake of omega-3 from seafood was associated with high levels of depressive symptoms. Compared with women consuming more than 1.5 g omega-3 from seafood per week, those consuming none were more likely to have high levels of depressive symptoms at 32 weeks' gestation (adjusted odds ratios = 1.54; 95% confidence interval = 1.25-1.89).Conclusions: These observational data support an association between low omega-3 intake from seafood and increased risk of high levels of depressive symptoms during pregnancy. Eating seafood during pregnancy may have beneficial effects on mental well-being. [ABSTRACT FROM AUTHOR]

The article discusses the history of foreign relations between the United States and Poland from the end of World War II to the fall of Communism in 1989, with an emphasis after 1960 on the author's experiences as a U.S. foreign service officer in Poland. Topics discussed include Soviet domination of Poland in the postwar era, the rise of the Solidarność (Solidarity) trade union movement, the role of the Polish-born Pope John Paul II, and the Polish Round Table Agreement of 1989 that cleared the way for democratic elections.

The New York State Attorney General's Environmental Protection Bureau undertook an effort to publicize fish consumption advisories regarding fish found in the waters around New York City. With informational brochures in English, Spanish, Chinese, Creole, and Russian, we reached out to minority and ethnic women who select and prepare family meals. To enhance the utility of the brochures, we illustrated the New York State Department of Health (NYSDOH) consumption advisories with pictures of the fish and maps of relevant locations. Follow-up questionnaires indicated that the brochures were generally well understood and readers were likely to change their meal selection and preparation practices as a result of reading the brochures. We accomplished this outreach at minimal expense and with no special funding. [ABSTRACT FROM AUTHOR]

A literary criticism of the book "A Connecticut Yankee in King Arthur's Court," by Mark Twain is presented. It analyzes the main character Hank Morgan as an archetypal cowboy. An overview of the story is also given. The author also examines Twain's use of reverse multiple symbolism in the novel, as well as the allusion of Morgan's last stand to historic U.S. battles.

Abstract: Two alternative procedures for estimating landslide hazards were evaluated using data on topographic digital elevation models (DEMs) and bedrock lithologies in an area adjacent to the Missouri River in Atchison County, Kansas, USA. The two procedures are based on the likelihood ratio model but utilize different assumptions. The empirical likelihood ratio model is based on non-parametric empirical univariate frequency distribution functions under an assumption of conditional independence while the multivariate logistic discriminant model assumes that likelihood ratios can be expressed in terms of logistic functions. The relative hazards of occurrence of landslides were estimated by an empirical likelihood ratio model and by multivariate logistic discriminant analysis. Predictor variables consisted of grids containing topographic elevations, slope angles, and slope aspects calculated from a 30-m DEM. An integer grid of coded bedrock lithologies taken from digitized geologic maps was also used as a predictor variable. Both statistical models yield relative estimates in the form of the proportion of total map area predicted to already contain or to be the site of future landslides. The stabilities of estimates were checked by cross-validation of results from random subsamples, using each of the two procedures. Cell-by-cell comparisons of hazard maps made by the two models show that the two sets of estimates are virtually identical. This suggests that the empirical likelihood ratio and the logistic discriminant analysis models are robust with respect to the conditional independent assumption and the logistic function assumption, respectively, and that either model can be used successfully to evaluate landslide hazards. [Copyright &y& Elsevier]

With the support of a Preparing Tomorrow's Teachers to Teach Technology (PT3) grant from the U.S. Department of Education, the authors—faculty members in a diverse urban state university—successfully used a training-of-trainers model to motivate and train its faculty to infuse technology into their methods classes. The model facilitated the collaborative efforts of faculty to produce technology-based lessons, implement them in their classes, and produce CD-ROMs that are case studies and tutorials for others. [ABSTRACT FROM AUTHOR]

Discusses the implications of preventive wars for collective security in the U.S. Reasons behind President George W. Bush administration's shift in military policy; Examples of operational use of preventive wars in history; Features of the Bush doctrine of preventive war enclosed in the National Security Strategy of the United States of America.

Reports the arguments on prescribing antipsychotic medications for treating schizophrenia in the U.S. Controversy on efficacy of antipsychotics; Evidence on the safety of ziprasidone; Concern on the reaction of patients treated with antipsychotic medications. INSETS: Antipsychotic treatment evaluated for prodromal schizophrenia.;FDA issues 'approvable letter' for aripiprazole..

The majority of mainstream economists believe that globalization and trade liberalization have had a minor role in increasing U.S. wage inequality. A minority argues that capital mobility and outsourcing indicate a larger effect. This paper first surveys these views, and then argues that how we understand the policy consequences of trade liberalization helps determine the character our analysis of the issue itself. Thus, a shift in policy perspective, to consider the "equity costs" of trade liberalization in terms of eroded U.S. labor market institutions, produces a larger framework for analyzing the consequences of globalization and trade liberalization than is available in traditional comparative advantage efficiency reasoning. From this wider perspective, trade liberalization has likely had a greater impact on U.S. wage inequality than even the minority mainstream position allows. [ABSTRACT FROM AUTHOR]

Addresses the law and policy issues raised by searches of lawyer's offices and the impact of such searches upon the attorney-client relationship and the legal system in the United States. Dangers of law office searches; Advantages of search warrants and subpoenas; Inconsistent adjudications of various courts; Alternatives to the current legal regime.

Focuses on the concepts related to the performing arts in the U.S. Definition of the readers theater; Study of the theory of Noh drama; Comparison of certain common aesthetic goals between Noh drama and readers theater.

The article cites a study which evaluates the maladaptive social behavior of mentally retarded workers in vocational training classrooms in the U.S. Vocational educators have described the maladaptive social behavior of mentally retarded workers. In this study, their patterns of language behavior were analyzed. The study recommended that these workers should be assigned to jobs in accordance with their communication skills.

Illustrates the effects of design of a workers' compensation system on farmers' costs of participation and incentives to protect farmworkers from safety hazards. Benefits provided by workers' compensation systems in the United States; Concern about the rising worker compensation costs.

Models three regulatory incentive systems used in the United States to protect farm workers from pesticide-related harm. Tort liability and administrative agency regulation as a relatively insignificant incentive; Compensation system as more effective; Penalties as too small to have much influence on farmer's compliance decisions.