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Introduction: While prior research has identified racial disparities in prehospital analgesia for traumatic pain, little is known about non-traumatic pain. Using a national prehospital dataset, we sought to evaluate for racial and ethnic disparities in analgesia given by EMS for non-traumatic pain. Methods: We analyzed the 2018 and 2019 data from the ESO Data Collaborative, a collection of de-identified prehospital electronic health records from nearly 1,300 participating EMS agencies in the US. We included all transported, adult, non-traumatic encounters with a primary or secondary impression of a pain complaint, and we stratified encounters based on race and ethnicity as recorded by the EMS clinicians. We performed a mixed model analysis, modeling EMS agency as a random intercept and adjusting for age, sex, pain location, level of service, location of incident, and highest pain score. With non-Hispanic White patients as the reference group, we then evaluated the association between race/ethnicity and receiving any pain medication (acetaminophen, non-steroidal anti-inflammatories, or opioids), receiving opioid pain medication, and receiving pain medication within 20 minutes of EMS arrival. Results: We included 1,035,486 patients; 67.5% non-Hispanic White, 26.8% Black, 4.9% Hispanic, 0.5% Asian, 0.1% Native Hawaiian or Other Pacific Islander, and 0.2% American Indian or Alaska Native patients. 4.7% of patients received pain medications. Compared to White patients (5.1%), Black patients were less likely to receive pain medication (3.3%, aOR 0.7; 95% CI 0.7-0.7) and Hispanics were more likely to receive pain medication (7.6%, aOR 1.5; 95% CI 1.4-1.6). Black patients were also less likely to receive opioids (1.8% for Black v 3.0% for White, aOR 0.7; 95% CI 0.6-0.7), while Hispanic patients were more likely to receive opioids (4.9%, aOR 1.4; 95% CI 1.3-1.5). The odds of receiving pain medication within 20 minutes was lower for Black patients (aOR 0.9; 95% CI 0.8-0.95) but no different for Hispanic patients (aOR 1.0; 95% CI 0.9-1.1), when compared to White patients. Conclusion: Pain medication administration is uncommon for non-traumatic pain complaints. While Black patients were less likely than White patients to receive pain medications and receive pain medication within 20 minutes, Hispanics were more likely to receive pain medications. [ABSTRACT FROM AUTHOR]

Objective. One major theory of environmental inequality is that firms follow a political path of least resistance when locating polluting facilities in low-income and minority communities. Such communities, this theory suggests, lack the social capital that allows others to keep such facilities at bay. We will test this argument. Methods. We investigate whether communities across the United States are located further from stationary sources of airborne toxins depending on their levels of social capital. Results. At some scales, we found that communities with more of some types of social capital do indeed tend to be located further from such facilities, though the differences are slight. We also found that, by some measures, minority communities possess no less social capital than others, and that controlling for differences in social capital barely attenuates the associations between demographics and proximity. Conclusion. The theory that differences in social capital explain environmental inequality is not supported. [ABSTRACT FROM AUTHOR]

The article offers information on the Smack-A-Mole game launched by the Dermatology Nurses' Association at its 2010 annual meeting. The game aims to raise funds for the association as well as a teaching tool to entice audiences to play while learning the ABCDE warning signs of melanoma and the need to adopt prevention behavior. It describes how the game was created and illustrates how it can be effectively used in one-on-one patient education sessions, health fairs and wellness events.

The article discusses issues concerning public health and clinical issues associated with expedited partner therapy in the U.S.

Despite data gaps and information shortfalls, government agencies in the United States are expected to produce timely and defensible decisions to regulate pesticide use under the Federal Insecticide, Fungicide, and Rodenticide Act and in compliance with the Endangered Species Act. The decision to register a pesticide is predicated on a conclusion that no unreasonable effects will accrue to the environment, including threatened and endangered species. We recognize that the definition of acceptable risk is a policy judgment stemming from legislative language and judicial interpretation. However, a common risk assessment approach with similar technical underpinnings and a high degree of transparency used by all the agencies would be cost effective and more likely to achieve consensus among interested parties. Quantitative probabilistic risk assessment (PRA) methods can be used to develop risk estimates and to describe the level of confidence in these estimates. PRA methods can also differentiate among the contributions of natural stochasticity, measurement variability, and lack of knowledge. Because this approach enhances transparency and increases understanding of the implications of limited data sets and associated assumptions, we encourage the appropriate agencies to implement PRA methods as a means of reaching common ground when assessing risks of pesticides to listed species. [ABSTRACT FROM AUTHOR]

The study objective was to examine quality oversight efforts by Medicaid managed care organizations (MCOs) for children in a sample of ambulatory care institutions and private practices in New York City. This was a cross-sectional study of quality assurance priorities and strategies of MCOs and their impact date in institutions in New York City. Data were from structured interviews administered in 1997 to medical directors in the eight largest MCOs; and medical directors, heads of ambulatory pediatrics, and institutional pediatricians in a random sample of 15 institutions and 20 private office-based providers. Medical directors in MCOs reported that their main priority areas were the preventive care measures (e.g., immunization and lead screening) that they must report to the state. Knowledge of these MCO priority areas and monitoring activities was high for medical directors in the random sample, but decreased from these medical directors to heads of ambulatory pediatrics to institutional pediatricians, with the differences between the medical directors and institutional pediatricians significant (P < .05). However, 96% of the institutional pediatricians reported knowing their own institution's priorities and monitoring activities. In contrast, most private pediatricians reported they knew MCO priorities and monitoring activities (80%). Less than 33% of any group reported activities as "very effective" or felt any incentive to improve performance. There was a high level of overlap in provider networks, with institutions and private providers having children in many MCOs, and MCOs having children in many sites. Conclusions. The current model of quality oversight is producing reports for the state, but is not translating into effective strategies at the provider level. The need to work through the leadership in institutions to influence quality is highlighted. The level of overlap in provider networks suggests the need for collaboration among MCOs in quality monitoring. [ABSTRACT FROM AUTHOR]

The article discusses the factors that may be responsible for the pervasive pattern of higher mortality and inferior health in the U.S. Topics covered include the major health disadvantages between the U.S. and 16 high-income per countries, the sharp difference in social spending between the U.S. and peer countries, and the need to address the leading causes of morbidity and mortality.

Abstract: Previous research has argued that income inequality reduces people’s trust in other people, and that declining social trust in the United States in recent decades has been due to rising levels of income inequality. Using multilevel models fitted to data from the General Social Survey, this paper substantially qualifies these arguments. We show that while people are less trusting in US states with higher income inequality, this association holds only cross-sectionally, not longitudinally; since the 1970s, states experiencing larger increases in inequality have not suffered systematically larger declines in trust. For counties, there is no statistically significant relationship either cross-sectionally or longitudinally. There is therefore only limited empirical support for the argument that inequality influences generalized social trust; and the declining trust of recent decades certainly cannot be attributed to rising inequality. [Copyright &y& Elsevier]

Wildlife toxicity reference values (TRVs) are routinely used during screening level and baseline ecological risk assessments (ERAs). Risk assessment professionals often adopt TRVs from published sources to expedite risk analyses. The US Environmental Protection Agency (USEPA) developed ecological soil screening levels (Eco-SSLs) to provide a source of TRVs that would improve consistency among risk assessments. We conducted a survey and evaluated more than 50 publicly available, large-scale ERAs published in the last decade to evaluate if USEPA's goal of uniformity in the use of wildlife TRVs has been met. In addition, these ERAs were reviewed to understand current practices for wildlife TRV use and development within the risk assessment community. The use of no observed and lowest observed adverse effect levels culled from published compendia was common practice among the majority of ERAs reviewed. We found increasing use over time of TRVs established in the Eco-SSL documents; however, Eco-SSL TRV values were not used in the majority of recent ERAs and there continues to be wide variation in TRVs for commonly studied contaminants (e.g., metals, pesticides, PAHs, and PCBs). Variability in the toxicity values was driven by differences in the key studies selected, dose estimation methods, and use of uncertainty factors. These differences result in TRVs that span multiple orders of magnitude for many of the chemicals examined. This lack of consistency in TRV development leads to highly variable results in ecological risk assessments conducted throughout the United States. Integr Environ Assess Manag 2013; 9: 114-123. © 2012 SETAC [ABSTRACT FROM AUTHOR]

OBJECTIVES: The objective of this study was to determine both practice and child characteristics and practice strategies associated with receipt of influenza vaccine in young children during the 2004-2005 influenza season, the first season for the universal influenza vaccination recommendation for all children who are aged 6 to 23 months. METHODS: Clinical and demographic data from randomly selected children who were aged 6 to 23 months were obtained by chart review from a community-based cohort study in 3 US counties. The proportion of children who were vaccinated by April 5, 2005, in each practice was obtained. For assessment of practice characteristics and strategies, sampled practices received a self-administered practice survey. Practice and child characteristics that predicted complete influenza vaccination were determined by using multinomial logistic regression. RESULTS: Forty-six (88%) of 52 sampled practices completed the survey and permitted chart reviews. Of 2384 children who were aged 6 to 23 months and were studied, 27% were completely vaccinated. The proportion of children who were completely vaccinated varied widely among practices (0%-71%). Most (87%) practices implemented ⩾1 vaccination strategy. Complete influenza vaccination was associated with 3 practice characteristics: suburban location, lower patient volume, and vaccination strategies of evening/weekend vaccine clinics; with child characteristics of younger age, existing high-risk conditions, ⩾6 well visits to the practice by 3 years of age, and any practice visit from October through January. CONCLUSIONS: Modifiable factors that were associated with increased influenza vaccination coverage included October to January practice visits and evening/weekend vaccine clinics. [ABSTRACT FROM AUTHOR]

Abstract: This study determined direct medical costs for influenza-associated hospitalizations and emergency department (ED) visits. For 3 influenza seasons, children <5 years of age with laboratory-confirmed influenza were identified through population-based surveillance. The mean direct cost per hospitalized child was $5402, with annual cost burden estimated at $44 to $163 million. Factors associated with high-cost hospitalizations included intensive care unit (ICU) admission and having an underlying high-risk condition. The mean medical cost per ED visit was $512, with annual ED cost burden estimated at $62 to $279 million. Implementation of the current vaccination policies will likely reduce the cost burden. [Copyright &y& Elsevier]

Children with private health insurance are more than six and a half times as likely to lose coverage in the three months after one or both of their parents loses a job, compared to children whose parents remain employed. In the current economic environment, this finding is especially troubling. We estimate that for every 1,000 jobs lost, 311 privately insured children lose coverage and more than 45 percent of the poorest and most vulnerable of privately insured children became uninsured. Much more effort is needed to quickly enroll children in public health insurance programs when their parents suffer a job loss. [ABSTRACT FROM AUTHOR]

Age-related changes in times of elite swimmers have indicated marked slowing at about age 70 - suggesting a discontinuity in aging processes related to physical performance. Overrepresentation of younger swimmers in United States Masters Swimming (USMS) data may also explain this shift. This study determined if age representation in USMS All-American records influenced predicted swimming times for older ages in 1500-m freestyle. Results indicated no influence. Thus, age-related changes in swimming times were predicted accurately using data from either all swimmers or just older swimmers, suggesting that different rates of slowing before and after age 70 represent biological or behavioral factors affecting physical performance and not simply a problem related to disproportionate sampling across age groups. [ABSTRACT FROM AUTHOR]

EPA recognized that metals present unique risk assessment issues, and saw the need to develop a framework document that puts forth key scientific principles for metals risk assessments to help ensure consistency in metals assessments across EPA programs and regional offices. This framework, called the “Framework for Metals Risk Assessment,” is a science-based document that describes basic principles that address the special attributes and behaviors of metals and metal compounds to be considered when assessing their human health and ecological risks. The Risk Assessment Forum oversaw the development of this document, including input from stakeholders and experts throughout the Agency, and obtained through several expert workshops, followed by peer review by the EPA Science Advisory Board (SAB). The Framework for Metals Risk Assessment document is intended to serve as a guide for all EPA programs and regional offices to supplement or update the policies, practices and guidance they currently use in their respective metals assessments. This framework document is not a prescriptive guide on how any particular type of assessment should be conducted within an EPA program office. Rather, it outlines key metal principles and describes how they should be considered in conducting human health and ecological risk assessments to advance our understanding of metals impact and foster consistency across EPA programs and regions. Although the audience for the framework is primarily intended to be Agency risk assessors, it also will communicate principles and recommendations for metals risk assessment to stakeholders and the public. This framework will be used in conjunction with guidance developed by the programs and regions for site-specific risk assessment, criteria derivation, ranking or categorization and other similar Agency activities related to metals. The Framework for Metals Risk Assessment document is intended to serve as a guide for all EPA programs and regional offices to supplement or update the policies, practices and guidance they currently use in their respective metals assessments. EPA assessments can vary in level of detail from simple, screening analyses to complex, definitive assessments. More complex scientific tools and metal specific methods should be applied as the complexity of the hazard assessment or risk assessment increases. [Copyright &y& Elsevier]

Genomics information has great potential to enhance assessment of risks to human health and the environment. Although understanding genomic responses with respect to adverse ecological and human health outcomes is not, as yet, established, it is important to consider the likely future impacts of genomics technologies on risk assessment and decision-making. Four areas are identified as those likely to be influenced by the generation of genomics information within, and the submission of such information to, the U.S. Environmental Protection Agency (USEPA): risk assessment, prioritization of contaminants and contaminated sites, monitoring, and reporting provisions. For each of these risk assessment and regulatory applications, representative activities are presented to illustrate the application. Three major challenges for the USEPA associated with genomics are also identified in the areas of research, technical development, and capacity. The USEPA's initial activities to address these challenges are discussed. The Agency recognizes it must be prepared to use genomics information, and that many scientific, policy, ethical, and legal concerns will need to be addressed. The USEPA also recognizes it is essential to continue to collaborate with other federal agencies, academia, the regulated community, and other stakeholders in order to benefit from ongoing advances in genomics in the wider scientific and regulatory communities. [ABSTRACT FROM AUTHOR]

Teachers are frequently expected to support children psychologically in the aftermath of mass casualty events, yet they generally have not been trained to do so. This study of a small private school in New York City reports the reactions, needs, and interests in preparedness training among teachers in response to the September 11, 2001, terrorist attacks. By and large, teachers coped by talking to others and/or a health professional, but felt ill-equipped to intervene with students and expressed substantial need for assistance. [ABSTRACT FROM AUTHOR]

This article reviews the literature on the psychological impact of terrorism on children and families in the United States. It includes studies of the 1993 World Trade Center bombing in New York City and the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, as well as the September 11 attacks. These studies explore the impact of various forms and degrees of exposure to terrorism on children across the development spectrum and on the relationships 4 between parental and child reactions. The article concludes with a framework for future research on children's adaptation following mass trauma. [ABSTRACT FROM AUTHOR]

As a way of saving Medicaid dollars, many states are reintroducing administrative hurdles into the enrollment process to deter people from enrolling. This study finds that administrative tasks associated with enrollment absorb sizable amounts of funds. We estimate that it costs approximately $280 to enroll a child in Medicaid or the State Children's Health Insurance Program (SCHIP) in the New York City area. This amount could be reduced by approximately 40 percent if documentation requirements were simplified. In an era of scarce resources, the case for simplification is more compelling than ever. [ABSTRACT FROM AUTHOR]

The article focuses on organizing model of trade unionism. The organizing model of trade unionism, developed in the United States since the early 1990s, has been subject to a good deal of scrutiny. This paper reiterates the need to examine why, despite the claims of the efficacy of new methods associated with the organizing model, revitalization has occurred in only a minority of unions and locals. Having established the features that appear to be necessary in specific locations, the chapter examines the more general conditions in the U.S. that have encouraged the limited development of these features. This examination provides the basis for the substantive contribution, a comparative analysis of the situation in Britain, allowing an evaluation of the likely success of the attempt of the Trade Union Congress to transplant the organizing model. American unionism has long been characterized as narrow business unionism and its decline has been even longer and more decisive than that experienced recently in other countries, including Britain. While British unionism reached its peak density in 1979, this was achieved in the U.S. by a surge of trade union organizing in 1946, with 40% of the factory labor force unionized. From this base of activity, decline has been unionized.

Explores the extent to which community health centers in the U.S. are able to manage their uninsured patient caseloads. Provision of primary care, medications and medical supplies; Limit in the ability to provide diagnostic, specialty and behavioral health services; Organizational characteristics of community health centers.

Investigates the seasonal variation in morphology of continuously stocked white clover, Trifolium repens, grown in the United States. Factors which influence the growth of the white clover; Identification of countries in which white clover is grown.

Objectives: This study examined the association between participation in Medicaid managed care and up-to-date coverage for childhood immunizations and screenings among private practice physicians serving New York City's poorest neighborhoods. Method: A random sample of 2174 children 3–35 months of age was drawn from 60 physician practices in 1995, and a cross-sectional analysis was used to compare up-to-date status for immunizations, and lead and anemia screening tests, for children cared for by managed care and nonmanaged care physicians. In 1996, an independent sample of 2380 children from the same practices was used to compare up-to-date status for individual children enrolled in Medicaid managed care and children predominantly enrolled in traditional fee-for-service Medicaid. Information from physician interviews augmented chart review data. Chi-square analysis and logistic regression were used. Results: Physicians who participate in Medicaid managed care and those who do not had equal up-to-date coverage for immunizations (41.0 vs. 36.9%, p = .527), and lead (46.8 vs. 38.7%, p = .199) and anemia screening (63.2 vs. 56.5%, p = .272). Measures of the process of care were also similar for the two groups of physicians. Children themselves enrolled in Medicaid managed care appeared significantly more likely to be up-to-date than their nonmanaged care counterparts for immunizations (OR = 1.53, p = .027) and anemia screening (OR = 2.95, p = .000). Conclusions: Participation in managed care does not seem to change physicians' overall preventive care practice behavior. Available data did not reveal major differences in demographics or health status between individual children enrolled in managed care and those not enrolled. That children enrolled in managed care were better immunized and screened than those in fee-for-service Medicaid suggests that physicians receiving compensation under two payment systems may treat children differently depending on each child's mode of reimbursement. [ABSTRACT FROM AUTHOR]

Examines levels for immunization, missed opportunities to immunize, and extent of lead and tuberculosis screening in inner-city storefront physician offices. Relation of child, visit and physician characteristics to missed opportunities; Problems with quality of care; Involvement of storefront physicians in managed care plans.

The US has experienced a substantial decline in social trust in recent decades. Surprisingly few studies analyze whether individual-level explanations can account for this decrease. We use three-wave panel data from the General Social Survey (2006–2014) to study the effects of four possible individual-level sources of changes in social trust: job loss, social ties, income, and confidence in political institutions. Findings from fixed-effects linear regression models suggest that all but social ties matter. We then use 1973–2018 GSS data to predict trust based on observed values for unemployment, confidence in institutions, and satisfaction with income, versus an alternative counterfactual scenario in which the values of those three predictors are held constant at their mean levels in the early 1970s. Predicted values from these two scenarios differ substantially, suggesting that decreasing confidence in institutions and increasing unemployment scarring may explain about half of the observed decline in US social trust. • There is a scarring effect of unemployment on social trust. • Changes in confidence in political institutions predict changes in social trust. • Dissatisfaction with income predicts social trust. • In the US, individual-level factors explain half of the 1973–2018 decline in trust. [ABSTRACT FROM AUTHOR]

The article focuses on the developments of the Dermatology Nurses' Association (DNA) in the U.S. According to the author, the association recently held its 26th annual convention in Las Vegas, Nevada where the theme was "Champions of Health Care." She mentions that the DNA is committed to fostering continued opportunities to expand education for all members. She believes that members need to work together and continue to be engaged in events such as the cross country bike tour "Ride4Melanoma."

Reducing early elective deliveries has become a priority for Medicaid medical directors and their state partners. Such deliveries lead to poor health outcomes for newborns and their mothers and generate additional costs for patients, providers, and Medicaid, which pays for up to 48 percent of all births in the United States each year. Early elective deliveries are non-medically indicated labor inductions or cesarean deliveries of infants with a confirmed gestational age of less than thirty-nine weeks. This retrospective descriptive study reports the results of a perinatal project, led by the state Medicaid medical directors, that sought to coordinate quality improvement efforts related to early elective deliveries for the Medicaid population. Twenty-two states participated in the project and provided data on elective deliveries in the period 2010-12. We found that 75,131 (8.9 percent) of 839,688 Medicaid singleton births were early elective deliveries. Thus, we estimate that there are 160,000 early elective Medicaid deliveries nationwide each year. In twelve states, early-term elective deliveries declined 32 percent between 2007 and 2011. Our study offers additional evidence and new tools for policy makers pursuing strategies to further reduce the number of such deliveries. [ABSTRACT FROM AUTHOR]

Reducing hospital readmissions is a way to improve care and reduce avoidable costs. However, there have been few studies of readmissions in the Medicaid population. We sought to characterize acute care hospital admissions and thirty-day readmissions in the Medicaid population through a retrospective analysis in nineteen states. We found that Medicaid readmissions were both prevalent (9.4 percent of all admissions) and costly ($77 million per state) and that they represented 12.5 percent of Medicaid payments for all hospitalizations. Five diagnostic groups appeared to drive Medicaid readmissions, accounting for 57 percent of readmissions and 49 percent of hospital payments for readmissions. The most prevalent diagnostic categories were mental and behavioral disorders and diagnoses related to pregnancy, childbirth, and their complications, which together accounted for 31.2 percent of readmissions. This analysis, conducted through the Medicaid Medical Directors Learning Network, allows Medicaid medical directors to better understand the nature and prevalence of hospital use in the Medicaid population and provides a baseline for measuring improvement. [ABSTRACT FROM AUTHOR]

OBJECTIVES. Routine vaccination of US infants against rotavirus was implemented in 2006, prompting the Centers for Disease Control and Prevention New Vaccine Surveillance Network to begin population-based acute gastroenteritis surveillance among US children <3 years of age. This surveillance system establishes baseline estimates of rotavirus disease burden and allows for the prospective monitoring of rotavirus vaccination impact. METHODS. Eligible children with acute gastroenteritis (⩾3 episodes of diarrhea and/or any vomiting in a 24-hour period) who were hospitalized, were seen in emergency departments, or visited selected outpatient clinics in 3 US counties during the period of January through June 2006 were enrolled. Epidemiological and clinical information was obtained through parental interview and medical chart review, and stool specimens were tested for rotavirus with enzyme immunoassays. Rotavirus-positive specimens were genotyped by using reverse transcription-polymerase chain reaction assays. RESULTS. Stool specimens were collected from 516 of the 739 enrolled children with acute gastroenteritis (181 inpatient, 201 emergency department, and 134 outpatient) and 44% tested positive for rotavirus (227 of 516 specimens). The most common strain was P[8]G1 (84%), followed by P[41G2 (5%) and P[6]G12 (4%). None of the 516 children had received rotavirus vaccine. The rotavirus detection rate was 50% for hospitalized acute gastroenteritis cases, 50% for emergency department visits, and 27% for outpatient visits. Rotavirus-related acute gastroenteritis cases were more likely than non-rotavirus-related acute gastroenteritis cases to present with vomiting, diarrhea, fever, and lethargy. Directly calculated, population-based rates for rotavirus hospitalizations and emergency department visits were 22.5 hospitalizations and 301.0 emergency department visits per 10 000 children <3 years of age, respectively. A sentinel outpatient clinic visit rate of 311.9 outpatient visits per 10 000 children <3 years of age was observed. CONCLUSIONS. Population-based, laboratory-confirmed rotavirus surveillance in the final rotavirus season before implementation of the US rotavirus vaccine program indicated a considerable burden of disease on the US health care system. [ABSTRACT FROM AUTHOR]

OBJECTIVE. The goal was to estimate the influenza disease burden among children with asthma and among healthy children by using active, laboratory-confirmed, population-based surveillance. METHODS. Children 6 to 59 months of age residing in 3 US counties who were hospitalized with acute respiratory illnesses or fever were enrolled prospectively from 2000 through 2004. Similar children who presented to clinics and emergency departments during 2 of the influenza seasons (2002-2004) were enrolled. Rates of influenza-attributable outpatient visits and hospitalizations for children with asthma and for healthy children were estimated. History of asthma and receipt of influenza vaccine for the study children were determined through parental report. The prevalence of asthma in the surveillance population was assumed to be 6.2% for children 6 to 23 months of age and 12.3% for children 24 to 59 months of age. RESULTS. Of 81 children 6 to 59 months of age with influenza-confirmed hospitalizations in 2000 to 2004, 19 (23%) had asthma. Average annual influenza-attributable hospitalization rates were significantly higher among children with asthma than among healthy children 6 to 23 months of age (2.8 vs 0.6 cases per 1000 children) but not children 24 to 59 months of age (0.6 vs 0.2 case per 1000 children). Of 249 children 6 to 59 months of age with influenza-confirmed outpatient visits in 2002 to 2004, 38 (15%) had asthma. Estimated outpatient influenza-attributable visit rates were higher among children with asthma than among healthy children 6 to 23 months of age (316 vs 152 cases per 1000 children) and 24 to 59 months of age (188 vs 102 cases per 1000 children) in 2003 to 2004. Few parents reported that their children had been vaccinated, including <30% of children with asthma. CONCLUSION. Influenza-attributable health care utilization is high among children with asthma and is generally higher than among healthy children. [ABSTRACT FROM AUTHOR]

• We sequenced 592 Staphylococcus pseudintermedius , the largest collection reported. • Genomics data predicted antimicrobial resistance with 98.4 % accuracy. • Nearly one third of isolates had mecA , a gene that confers methicillin resistance. • Isolates usually had resistance genes for either 0–2 or 5–7 antibiotic classes. Whole-genome sequencing (WGS) has changed our understanding of bacterial pathogens, aiding outbreak investigations and advancing our knowledge of their genetic features. However, there has been limited use of genomics to understand antimicrobial resistance of veterinary pathogens, which would help identify emerging resistance mechanisms and track their spread. The objectives of this study were to evaluate the correlation between resistance genotypes and phenotypes for Staphylococcus pseudintermedius, a major pathogen of companion animals, by comparing broth microdilution antimicrobial susceptibility testing and WGS. From 2017–2019, we conducted antimicrobial susceptibility testing and WGS on S. pseudintermedius isolates collected from dogs in the United States as a part of the Veterinary Laboratory Investigation and Response Network (Vet-LIRN) antimicrobial resistance monitoring program. Across thirteen antimicrobials in nine classes, resistance genotypes correlated with clinical resistance phenotypes 98.4 % of the time among a collection of 592 isolates. Our findings represent isolates from diverse lineages based on phylogenetic analyses, and these strong correlations are comparable to those from studies of several human pathogens such as Staphylococcus aureus and Salmonella enterica. We uncovered some important findings, including that 32.3 % of isolates had the mecA gene, which correlated with oxacillin resistance 97.0 % of the time. We also identified a novel rpoB mutation likely encoding rifampin resistance. These results show the value in using WGS to assess antimicrobial resistance in veterinary pathogens and to reveal putative new mechanisms of resistance. [ABSTRACT FROM AUTHOR]

The U.S. has a long history of legislation to protect wildlife, beginning with the Lacey Act of 1900. There are now over 170 Federal laws that regulate environmental activities which may affect wildlife. Two important laws are the Pittman-Robertson Act enacted in 1937 that authorizes a tax for wildlife management and the Fish and Wildlife Coordination Act passed in 1958 whose primary purpose is conservation of fish and wildlife, both of which continue to provide significant funding for wildlife management. Modern environmental regulations began by passage of the National Environmental Policy Act in 1969, followed by the Clean Water Act, Superfund, and other laws to regulate pesticides and toxics and clean up contaminated sites. International conventions regulate sale, use and disposal of toxics and ocean dumping. These laws and conventions should protect wildlife from unintended consequences of global industrialization.

Manufactured nanomaterials entered the marketplace of consumer goods in the mid-1990s. With the exception of pending reporting requirements in Canada, no new regulatory requirements have been imposed on the manufacture or use of nanomaterials or their commercial products, although in the past three years governments, industry, and nongovernmental organizations have questioned the need for new regulatory approaches. The debate hinges on whether current scientific information is sufficient for making risk-based decisions, if nanomaterial effects differ from macroscale products, and how much knowledge about potential risk governments should require before products are brought to market. The debate over when and how to regulate manufactured nanomaterials opens the door for a renewed discussion on regulatory environmental policy and suggests that the public may be demanding increased precaution and assurances from government. How government, in concert with industry and the open market, responds will set the bar for future regulations of emerging technologies.