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Background: The organization and operation of clinical trials have become increasingly complex requiring the coordination of a well-trained workforce to ensure that complicated protocols yield valid results that will advance human health. We hypothesized that formal education in clinical research is equivalent to a number of years of work experience as a clinical research professional in terms of self-perceived clinical research competence. Methods: Using REDCap, we conducted a survey of students and recent graduates from academic programs in clinical research in the USA using the CICRP index that consists of 20 clinical research core competencies. We compared the responses of recent graduates to CRCs wording in the USA and Canada in various research settings who responded to a similar survey conducted by the Joint Task Force and to experienced CRCs working at research-intensive CTSA hubs and their affiliated hospitals who were surveyed as part of the NIH funded DIAMOND project. Results: We found that the degree of self-perceived competence to perform advanced core competencies such as those related to regulatory affairs among new graduates of formal academic programs without research experience to be equivalent to as many as five years of on-the-job-training in a research-intensive CTSA setting and more than ten years of experience in less research-intensive community settings. Conclusions: These findings suggest that scores on both forms of the CICRP differentiate CRCs according to formal education in clinical research, years of experience as a CRC and type of research setting in which they work. Further, the self-perceived competency assessed by CICRP acquired by completing an academic program in clinical research is equivalent to years of work experience. [ABSTRACT FROM AUTHOR]

Background: Depression has been linked to immune function and mortality in patients with chronic illnesses. Factors such as poorer spiritual well-being has been linked to increased risk for depression and other mood disorders in patients with HIV.Objective: We sought to determine how specific dimensions of religion, spirituality, and other factors relate to depressive symptoms in a contemporary, multi-center cohort of patients with HIV/AIDS.Design: Patients were recruited from 4 medical centers in 3 cities in 2002 to 2003, and trained interviewers administered the questionnaires. The level of depressive symptoms was measured with the 10-item Center for Epidemiologic Studies Depression (CESD-10) Scale. Independent variables included socio-demographics, clinical information, 8 dimensions of health status and concerns, symptoms, social support, risk attitudes, self-esteem, spirituality, religious affiliation, religiosity, and religious coping. We examined the bivariate and multivariable associations of religiosity, spirituality, and depressive symptoms.Measurements and Main Results: We collected data from 450 subjects. Their mean (SD) age was 43.8 (8.4) years; 387 (86.0%) were male; 204 (45.3%) were white; and their mean CD4 count was 420.5 (301.0). Two hundred forty-one (53.6%) fit the criteria for significant depressive symptoms (CESD-10 score > or = 10). In multivariable analyses, having greater health worries, less comfort with how one contracted HIV, more HIV-related symptoms, less social support, and lower spiritual well-being was associated with significant depressive symptoms (P<.05).Conclusion: A majority of patients with HIV reported having significant depressive symptoms. Poorer health status and perceptions, less social support, and lower spiritual well-being were related to significant depressive symptoms, while personal religiosity and having a religious affiliation was not associated when controlling for other factors. Helping to address the spiritual needs of patients in the medical or community setting may be one way to decrease depressive symptoms in patients with HIV/AIDS. [ABSTRACT FROM AUTHOR]

The article explores the challenges on three dimensional (3D) content creation and display despite the surge of stereoscopic movies and advances in the industry in the U.S. It focuses mainly on the profound issue on the control and modification of the stereoscopic profundity of live-action content of production tools. It discusses and provides an overview on the existing technologies for stereoscopic editing, its challenges, and novel solutions to digital problems.

The following set of essays consists of revised versions of contributions read at, or prepared for, a roundtable discussion at the 2009 convention of the American Studies Association in Washington, DC. The short contributions by the individual authors reflect on the boundaries, the perspectives, and the transdisciplinary dynamics of the field imaginary of transnational American Studies and the specific political role of new notions of citizenship and the parameters of a new cosmopolitanism beyond the limits of the Western tradition. [ABSTRACT FROM AUTHOR]

Objective: The Paducah Gaseous Diffusion Plant (PGDP) became operational in 1952; it is located in the western part of Kentucky. We conducted a mortality study for adverse health effects that workers may have suffered while working at the plant, including exposures to chemicals. Materials and Methods: We studied a cohort of 6820 workers at the PGDP for the period 1953 to 2003; there were a total of 1672 deaths to cohort members. Trichloroethylene (TCE) is a specific concern for this workforce; exposure to TCE occurred primarily in departments that clean the process equipment. The Life Table Analysis System (LTAS) program developed by NIOSH was used to calculate the standardized mortality ratios for the worker cohort and standardized rate ratio relative to exposure to TCE (the U.S. population is the referent for ageadjustment). LTAS calculated a significantly low overall SMR for these workers of 0.76 (95% CI: 0.72-0.79). A further review of three major cancers of interest to Kentucky produced significantly low SMR for trachea, bronchus, lung cancer (0.75, 95% CI: 0.72-0.79) and high SMR for Non-Hodgkin's lymphoma (NHL) (1.49, 95% CI: 1.02-2.10). Results: No significant SMR was observed for leukemia and no significant SRRs were observed for any disease. Both the leukemia and lung cancer results were examined and determined to reflect regional mortality patterns. However, the Non-Hodgkin's Lymphoma finding suggests a curious amplification when living cases are included with the mortality experience. Conclusions: Further examination is recommended of this recurrent finding from all three U.S. Gaseous Diffusion plants. [ABSTRACT FROM AUTHOR]

Research in the USA has demonstrated numerous associations between adult attention-deficit/hyperactivity disorder (ADHD) and smoking behaviour; however, no specific work on this topic has been done in Switzerland. The aim of the study was to gain knowledge about the association between ADHD and tobacco consumption in a Swiss sample of adult ADHD patients. The study subjects were recruited from patients with a DSM-IV diagnosis of ADHD consecutively presenting to the ADHD consultation service at the Centre for Addiction Disorders, an outpatient facility of the Zurich University Hospital, between September 2000 and January 2006. Complete data could be obtained from 100 of 134 patients presenting to the service. The number of current smokers in the ADHD sample was significantly elevated compared to the Swiss general population (55 vs 31%). Additionally, daily smokers in the ADHD sample smoked significantly more cigarettes per day, reported higher levels of nicotine dependence and started to smoke regularly at a significantly younger age. The motivation to quit smoking was high. The results of this Swiss study are consistent with previous research in the USA. The fact that many adults with ADHD are motivated to quit smoking and that they actually make use of support in quitting is crucial for secondary tobacco prevention. [ABSTRACT FROM AUTHOR]

An interview is presented with German professor Alfred Hornung. When asked about his interest in American studies, he discusses U.S. literature and applying for a scholarship. When asked about the international aspects of American studies, he discussed the global advancement of the field and the influence of U.S. society. Other topics include the 2008 U.S. election, life writing, and editorial work.

Background: Excess mortality from lymphohematopoietic malignancies, in particular myeloid leukemia, and brain cancer has been found in surveys of anatomists, pathologists, and funeral industry workers, all of whom may have worked with formaldehyde. We investigated the relation of mortality to work practices and formaldehyde exposure levels among these professionals to address cancer risk in the funeral industry. [ABSTRACT FROM PUBLISHER]

Background: Susceptibility to lead toxicity is often assumed to be greatest during early childhood (e.g., 2 years of age), but recent studies suggest that blood lead concentrations (BPb) taken at 5-7 years of age are more strongly associated with IQ. Objective: We aimed to determine the age of greatest susceptibility to lead exposure using an innovative statistical approach that avoids the problem of correlated serial BPb measurements. Methods: We analyzed two cohorts of children that were followed from infancy to 6 years of age in Rochester, New York (n = 211), and Cincinnati, Ohio (n = 251). Serial BPb levels were measured and IQ tests were done when children were 6 years of age. After adjustment for relevant covariates, the ratio of 6-year BPb to 2-year BPb was added to the multiple regression model to test whether the pattern of BPb profiles during childhood had additional effect on IQ. Results: The ratio of BPb at 6 years to the BPb at 2 years showed a strong effect on IQ (p < 0.001) when added to the multiple regression model that included the average childhood BPb. IQ decreased by 7.0 points for children whose BPb at 6 years of age was 50% greater than that at 2 years compared with children whose 6-year BPb was 50% less than their 2-year BPb. Similarly, criminal arrest rates were a factor of 3.35 higher for those subjects whose 6-year BPb was 50% higher than their 2-year BPb. Conclusions: We conclude that 6-year BPb is more strongly associated with cognitive and behavioral development than is BPb measured in early childhood. [ABSTRACT FROM AUTHOR]

We investigated the effects of urban environments on the chemical properties of forest soils in the metropolitan areas of Baltimore, New York, and Budapest. We hypothesized that soils in forest patches in each city will exhibit changes in chemistry corresponding to urbanization gradients, but more strongly with various urban metrics than distance to the urban core. Moreover, differences in parent material and development patterns would differentially affect the soil chemical response in each metropolitan area. Results showed that soil chemical properties varied with measures of urban land use in all three cities, including distance to the urban core, which was an unexpected result. Moreover, the results showed that the spatial extent and amount of change was greater in New York than in Baltimore and Budapest for those elements that showed a relationship to the urbanization gradient (Pb, Cu, and to a lesser extent Ca). The spatial relationship of the soil chemical properties to distance varied from city to city. In New York, concentrations of Pb, Cu, and Ca decreased to approximately background concentrations at 75 km from the urban core. By contrast, concentrations of these elements decreased closer to the urban core in Baltimore and Budapest. Moreover, a threshold was reached at about 75% urban land use above which concentrations of Pb and Cu increased by more than twofold relative to concentrations below this threshold. Results of this study suggest that forest soils are responding to urbanization gradients in all three cities, though characteristics of each city (spatial pattern of development, parent material, and pollution sources) influenced the soil chemical response. [ABSTRACT FROM AUTHOR]

Puya, a large genus mostly from South America, has been taxonomically divided into two subgenera: Puyopsis and Puya. The latter includes only eight species distributed mainly in Chile, extending to Argentina, Bolivia, and Peru. The species of subgenus Puya are recognized by the presence of a sterile apex of the inflorescence branches, whereas those of subgenus Puyopsis have fertile flowers all along the branches. The objectives of this article were to determine whether this diagnostic character was synapomorphic for subgenus Puya, and to explore the relationships between its species. Parsimony analyses were performed for 43 taxa and 93 morphological characters, 87 of which were discrete and six continuous. In the analysis that included all characters, a single most parsimonious tree was found that supported subgenus Puya by two synapomorphic character states, including the diagnostic character of a sterile inflorescence branch apex and a blooming pattern in which flowers open gradually from base to apex. The trees were better supported when the continuous characters were included. Further studies are suggested to resolve the infrageneric classification of Puya and the relationships of the species belonging to subgenus Puya. © 2008 The Linnean Society of London, Botanical Journal of the Linnean Society, 2008, 156, 93–110. [ABSTRACT FROM AUTHOR]

The article presents the author's views regarding the comments made by other researchers on the evaluation of the case study regarding the reregistration of phosphine by the U.S. Environmental Protection Agency. According to the author, the case study passed through a thorough peer review and was handled properly in all aspects, which is contrary to the accusations of the researchers that the author improperly used his status in the publication where the study was published. The author reveals that there are legitimate scientific concerns that require resolution but was neglected in the study.

Background Failure to recruit a sufficient number of eligible subjects in a timely manner represents a major impediment to the success of clinical trials. Physician participation is vital to trial recruitment but is often limited. Methods After 12 months of traditional recruitment to a clinical trial, we activated our electronic health record (EHR)–based clinical trial alert (CTA) system in selected outpatient clinics of a large, US academic health care system. When a patient’s EHR data met selected trial criteria during the subsequent 4-month intervention period, the CTA prompted physician consideration of the patient’s eligibility and facilitated secure messaging to the trial’s coordinator. Subjects were the 114 physicians practicing at selected EHR-equipped clinics throughout our study. We compared differences in the number of physicians participating in recruitment and their recruitment rates before and after CTA activation. Results The CTA intervention was associated with significant increases in the number of physicians generating referrals (5 before and 42 after; P < .001) and enrollments (5 before and 11 after; P = .03), a 10-fold increase in those physicians’ referral rate (5.7/mo before and 59.5/mo after; rate ratio, 10.44; 95% confidence interval, 7.98-13.68; P<.001), and a doubling of their enrollment rate (2.9/mo before and 6.0/mo after; rate ratio, 2.06; 95% confidence interval, 1.22-3.46; P = .007). Conclusions Use of an EHR-based CTA led to significant increases in physicians’ participation in and recruitment rates to an ongoing clinical trial. Given the trend toward the EHR implementation in health care centers engaged in clinical research, this approach may represent a much-needed solution to the common problem of inadequate trial recruitment. [ABSTRACT FROM AUTHOR]

We used the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994, to investigate the relationship between environmental tobacco smoke (ETS) exposure and cognitive abilities among U.S. children and adolescents 6–16 years of age. Serum cotinine was used as a biomarker of ETS exposure. Children were included in the sample if their serum cotinine levels were ⩽ 15 ng/mL, a level consistent with ETS exposure, and if they denied using any tobacco products in the previous 5 days. Cognitive and academic abilities were assessed using the reading and math subtests of the Wide Range Achievement Test-Revised and the block design and digit span subtests of the Wechsler Intelligence Scale for Children-III. Analyses were conducted using SUDAAN software. Of the 5,365 6- to 16-year-olds included in NHANES III, 4,399 (82%) were included in this analysis. The geometric mean serum cotinine level was 0.23 ng/mL (range, 0.035–15 ng/mL); 80% of subjects had levels < 1 ng/mL. After adjustment for sex, race, region, poverty, parent education and marital status, ferritin, and blood lead concentration, there was a significant inverse relationship between serum cotinine and scores on reading (β = -2.69, p = 0.001), math (β = -1.93, p = 0.01), and block design (β = -0.55, p < 0.001) but not digit span (β = -0.08, p = 0.52). The estimated ETS-associated decrement in cognitive test scores was greater at lower cotinine levels. A log-linear analysis was selected as the best fit to characterize the increased slope in cognitive deficits at lower levels of exposure. These data, which indicate an inverse association between ETS exposure and cognitive deficits among children even at extremely low levels of exposure, support policy to further restrict children's exposure. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between the use and type of primary care and visits to the emergency department (ED) in early infancy by healthy infants who are Medicaid recipients. Design: A population-based cohort study using a database linking birth certificate data to Medicaid claims. Participants: A total of 151 464 full-term infants born in Ohio to mothers receiving Medicaid from July 1, 1991, through June 30, 1998. Main Outcome Measures: The primary outcome of interest was the occurrence of an ED visit within 91 days of the neonate's birth. Bivariate and multivariate analyses were performed to determine the effect of early linkage with primary care (within 21 days of birth) on ED use in early infancy. Results: Only 53% of the infants had a documented primary care visit within 21 days of birth. Twenty-eight percent of infants had at least 1 ED visit within 91 days of birth and 9% had more than 1 visit. The mean age of the neonate at the first ED visit was 39.7 days. Fifteen percent of primary care visits within 21 days of birth occurred at a hospital-based primary care clinic. After adjusting for maternal, infant, and residency characteristics and temporal differences, early primary care linkage was associated with a 16% increase in the likelihood of ED use. When the primary care visit occurred in a hospital-based primary care clinic, it was associated with a 27% increase in the likelihood of ED use. Conclusion: Contrary to our expectations, early primary care linkage did not result in a decreased risk of ED use. [ABSTRACT FROM AUTHOR]

In response to growing complaints and safety concerns most states and the federal government have now enacted legislation to guarantee a more reasonable postpartum length of stay. The Ohio law required health maintenance organizations, health insurers, public employers and the state's Medicaid program to provide a minimum of 48 hours of impatient care following a normal vaginal delivery and a minimum of 96 hours or inpatient care following a cesartan delivery. This study examined, in a single region in southwestern Ohio, whether the state legislative mandate was applied in a manner that equally affected decisions made for Medicaid and commercially insured infants and their Families. The study population consisted of 30035 healthy full-term, single-birth infants born in of hospital in southwestern Ohio between April 1, 1996, and December 31, 1998 and discharged to home. Patients were stratified by insurance type; 25747 had commercial insurance and 4288 had Mediclaid coverage. Self-pay patients were excluded. Changes over time in the proportions of newborns with a "short-stay" delivery were examined for commercially insured infants and those with Mediclaid coverage.

Background: Halo scalp ring is an uncommonly reported alopecia of the scalp that arises perinatally. Objectives: To describe 5 new cases of halo scalp ring, and to review the literature. Setting: An outpatient dermatology clinic in an urban area; patients diagnosed in a 2-year period were included in the study. Results: Halo scalp ring is most commonly a temporary, nonscarring alopecia that occurs in patients born to primigravidas. Conclusions: Halo scalp ring is a distinctive form of alopecia attributed to caput succedaneum. It is underreported and generally has a good prognosis. However, scarring may occur. [ABSTRACT FROM AUTHOR]

Los servicios educativos que se brindan a niños no acompañados en alojamientos financiados por el gobierno en Estados Unidos deben analizarse desde una perspectiva más crítica para cumplir mejor con las diferentes necesidades de los niños y con las normas federales de la educación pública. [ABSTRACT FROM AUTHOR]

Given the scientific consensus that exposure to radon decay productscauses lung cancer, most recent studies have focused on the nature of the exposure--response relationship. Since residential radon exposure is now a primary public health issue, a better understanding of the effects of low levels of radon as well as factors modifying risk estimates has become very important. Several factors are shown to affect risk estimates in the latest update of the vital status follow-up (through 1990) and smoking history for the cohort of under ground uranium miners in the Colorado Plateau. This analysis confirms earlier results indicating a strong dependence of relative risk estimates upon attained age. Quantitative estimates of relative risk as a function of cumulative exposure to radon decay products (WLM) are provided for three age strata. The non-linearity often reported in the Colorado Plateau data is shown to be at least partially due to an inverse exposure-rate effect, i.e., low exposure rates for long periods are more hazardous than equivalent cumulative exposure received at higher rates for shorter periods of time. However, this effect is shown to diminish at lower exposure rates and cumulative exposures. In addition, use of the new smoking data indicates that the radon/smoking interaction is sub multiplicative and may depend upon attained age. [ABSTRACT FROM AUTHOR]

A growing number of families immigrating to the United States from Central America are being separated at the border, including parents of children who are under age 6. We explore what happens to these children once they are separated from their families by examining the nature of the services and programs provided while they are in transitional foster care. We then draw preliminary conclusions about the emerging impact of family separation on outcomes for these children. [ABSTRACT FROM AUTHOR]

The article presents a survey study on the level of awareness, training and attitude about psychocutaneous disorders among psychiatrists in the U.S. The survey respondents were asked several questions including demographic variables, the degree of comfort in managing psychodermatological disorders and the interest in continuing medical education on psychocutaneous disorders. It also presents the results and the conclusions of the survey.

Importance: The ability to predict sudden cardiac death (SCD) in children and adolescents with hypertrophic cardiomyopathy (HCM) is currently inadequate. Late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) imaging is associated with SCD events in adults with HCM., Objective: To examine the prognostic significance of LGE in patients with HCM who are younger than 21 years., Design, Setting, and Participants: This multicenter, retrospective cohort study was conducted from April 8, 2015, to September 12, 2022, in patients with HCM who were younger than 21 years and had undergone CMR imaging across multiple sites in the US, Europe, and South America. Observers of CMR studies were masked toward outcomes and demographic characteristics., Exposure: Natural history of HCM., Main Outcome and Measures: The primary outcome was SCD and surrogate events, including resuscitated cardiac arrest and appropriate discharges from an implantable defibrillator. Continuous and categorical data are expressed as mean (SD), median (IQR), or number (percentage), respectively. Survivor curves comparing patients with and without LGE were constructed by the Kaplan-Meier method, and likelihood of subsequent clinical events was further evaluated using univariate and multivariable Cox proportional hazards models., Results: Among 700 patients from 37 international centers, median (IQR) age was 14.8 (11.9-17.4) years, and 518 participants (74.0%) were male. During a median (IQR) [range] follow-up period of 1.9 (0.5-4.1) [0.1-14.8] years, 35 patients (5.0%) experienced SCD or equivalent events. LGE was present in 230 patients (32.9%), which constituted an mean (SD) burden of 5.9% (7.3%) of left ventricular myocardium. The LGE amount was higher in older patients and those with greater left ventricular mass and maximal wall thickness; patients with LGE had lower left ventricular ejection fractions and larger left atrial diameters. The presence and burden of LGE was associated with SCD, even after correcting for existing risk stratification tools. Patients with 10% or more LGE, relative to total myocardium, had a higher risk of SCD (unadjusted hazard ratio [HR], 2.19; 95% CI, 1.59-3.02; P < .001). Furthermore, the addition of LGE burden improved the performance of the HCM Risk-Kids score (before LGE addition: 0.66; 95% CI, 0.58-0.75; after LGE addition: 0.73; 95% CI, 0.66-0.81) and Precision Medicine in Cardiomyopathy score (before LGE addition: 0.68; 95% CI, 0.49-0.77; after LGE addition: 0.73; 95% CI, 0.64-0.82) SCD predictive models., Conclusions and Relevance: In this retrospective cohort study, quantitative LGE was a risk factor for SCD in patients younger than 21 years with HCM and improved risk stratification.