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Introduction: COVID‐19 survivors are at greater risk for new medical conditions. Among older adults, where multimorbidity and functional impairment are common, frailty measurement provides a tool for understanding how infection impacts future health beyond a one‐disease‐at‐a‐time approach. We investigated whether COVID‐19 was associated with change in frailty among older Veterans. Methods: Data were from the Veterans Affairs (VA) COVID‐19 Observational Research Collaboratory, which extracted VA medical record data. We included Veterans who had COVID‐19 from March 1, 2020, to April 30, 2021 and matched uninfected controls. We excluded those <50 years at index or did not survive 12 months after. Frailty was assessed at the index date and 12 months using the VA Frailty Index (VA‐FI). We assessed the number of new VA‐FI deficits over 12 months. Analysis was done by negative binomial regression adjusted for age, gender, race, ethnicity, and BMI. Coefficients are given as the ratio of the mean number of new deficits in COVID‐19 cases versus controls during follow‐up. Results: We identified 91,338 COVID‐19‐infected Veterans and an equal number of matched controls. Median (IQR) age was 68.9 years (60.3–74.2), 5% were female, 71% were White, and baseline VA‐FI was 0.16 (0.10, 0.26). Median (IQR) number of new deficits at 1 year was 1 (0–2) for infected and 0 (0–1) for uninfected controls. After adjustment, those with COVID‐19 accrued 1.54 (95% CI 1.52–1.56) times more deficits than those who did not. The five most common new deficits were fatigue (9.7%), anemia (6.8%), muscle atrophy (6.5%), gait abnormality (6.2%), and arthritis (5.8%). Discussion: We found a greater increase in frailty among older Veterans with COVID‐19 compared with matched uninfected controls, suggesting that COVID‐19 infection has long‐term implications for vulnerability and disability among older adults. Functional impairments such as fatigue, impaired mobility, and joint pain may warrant specific attention in this population. [ABSTRACT FROM AUTHOR]

Authors of few studies have used randomized controlled trials (RCTs) to quantify clinical intervention safety of rehabilitation after sport-related concussion across sport levels. Describe symptom exacerbation and adverse events (AEs) associated with two concussion rehabilitation interventions. Cluster RCT (NCT02988596) Sports medicine clinic and field settings. The RCT enrolled 251 concussed athletes (median age = 20 years; female, n = 48) across 28 sites from New Zealand professional rugby (n = 31), Canadian professional football (n = 52), US/Canadian colleges (n = 128) and US high schools (n = 40). Two medically supervised interventions: (1) enhanced graded exertion (EGE): international return-to-sport strategy and sport-specific activities only (EGE only, n = 119); and (2) multidimensional rehabilitation (MDR) followed by EGE: early symptom-directed exercises once symptoms were stable, followed by EGE after symptoms resolved (MDR + EGE, n = 132). Primary outcomes were intrasession total symptom severity score exacerbation and significant intersession (increase 10+ severity points) sustained total symptom severity exacerbation, each measured with the Postconcussion Symptom Scale (132 total severity points on scale). Reported AEs were also described. Activity-based rehabilitation sessions (n = 1437) were the primary analysis unit. Frequencies, proportions, medians, and interquartile ranges were calculated for outcomes by treatment group. The 251 postinjury participants completed 1437 (MDR + EGE = 819, EGE only = 618) activity-based intervention sessions. A total of 110 and 105 participants contributed data (those missing had no documented session data) to at least 1 activity-based session in the MDR + EGE and EGE-only arms, respectively. Intrasession symptom exacerbations were equivalently low in MDR + EGE and EGE-only arms (MDR + EGE: 16.7%, 95% CI = 14.1%, 19.1%; EGE only: 15.7%, 95% CI = 12.8%, 18.6%). In total, 9/819 MDR + EGE sessions (0.9%) and 1/618 EGE-only sessions (0.2%) resulted in a presession to postsession symptom exacerbation beyond a 10+ severity point increase; 8/9 resolved to <10 points by the next session. Two study-related AEs (1 in each arm) were reported. Participants in MDR + EGE and EGE-only activities reported equivalently low rates of symptom exacerbation. [ABSTRACT FROM AUTHOR]

Background Nirmatrelvir-ritonavir is recommended for persons at risk for severe coronavirus disease 2019 (COVID-19) but remains underutilized. Information on which eligible groups are likely to benefit from treatment is needed. Methods We conducted a target trial emulation study in the Veterans Health Administration comparing nirmatrelvir–ritonavir treated versus matched untreated veterans at risk for severe COVID-19 who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from April 2022 through March 2023. We measured incidence of any hospitalization or all-cause mortality at 30 days. Outcomes were measured for the entire cohort, as well as among subgroups defined by 30-day risk of death or hospitalization, estimated using an ensemble risk prediction model. Results Participants were 87% male with median age 66 years and 16% unvaccinated. Compared with matched untreated participants, those treated with nirmatrelvir-ritonavir (n = 24 205) had a lower 30-day risk for hospitalization (1.80% vs 2.30%; risk difference [RD], −0.50% points [95% confidence interval {CI}: −.69 to −.35]) and death (0.11% vs 0.30%; RD, −0.20 [95% CI: −.24 to −.13]). The greatest reductions in combined hospitalization or death were observed in the highest risk quartile (RD −2.85 [95% CI: −3.94 to −1.76]), immunocompromised persons (RD −1.91 [95% CI: −3.09 to −.74]), and persons aged ≥75 years (RD −1.16 [95% CI: −1.73 to −.59]). No reductions were observed in the 2 lowest risk quartiles or persons younger than 65 years. Conclusions Nirmatrelvir-ritonavir was effective in reducing 30-day hospitalization and death in older veterans, those at highest predicted risk for severe outcomes, and immunocompromised groups. Benefit was not observed in younger veterans or groups at lower predicted risk for hospitalization and death. [ABSTRACT FROM AUTHOR]

Background: Prior research demonstrates that SARS-COV-2 infection can be associated with a broad range of mental health outcomes including depression symptoms. Veterans, in particular, may be at elevated risk of increased depression following SARS-COV-2 infection given their high rates of pre-existing mental and physical health comorbidities. However, few studies have tried to isolate SARS-COV-2 infection associations with long term, patient-reported depression symptoms from other factors (e.g., physical health comorbidities, pandemic-related stress). Objective: To evaluate the association between SARS-COV-2 infection and subsequent depression symptoms among United States Military Veterans. Design: Survey-based non-randomized cohort study with matched comparators. Participants: A matched-dyadic sample from a larger, stratified random sample of participants with and without known to SARS-COV-2 infection were invited to participate in a survey evaluating mental health and wellness 18-months after their index infection date. Sampled participants were stratified by infection severity of the participant infected with SARS-COV-2 (hospitalized or not) and by month of index date. A total of 186 participants in each group agreed to participate in the survey and had sufficient data for inclusion in analyses. Those in the uninfected group who were later infected were excluded from analyses. Main Measures: Participants were administered the Patient Health Questionnaire-9 as part of a phone interview survey. Demographics, physical and mental health comorbidities were extracted from VHA administrative data. Key Results: Veterans infected with SARS-COV-2 had significantly higher depression symptoms scores compared with those uninfected. In particular, psychological symptoms (e.g., low mood, suicidal ideation) scores were elevated relative to the comparator group (MInfected = 3.16, 95%CI: 2.5, 3.8; MUninfected = 1.96, 95%CI: 1.4, 2.5). Findings were similar regardless of history of depression. Conclusion: SARS-COV-2 infection was associated with more depression symptoms among Veterans at 18-months post-infection. Routine evaluation of depression symptoms over time following SARS-COV-2 infection is important to facilitate adequate assessment and treatment. [ABSTRACT FROM AUTHOR]

The novel SARS-CoV-2, or coronavirus, has greatly altered the landscape of college life for students across the United States. The ever-present health concerns and quarantine have been linked to increased anxiety, depression, stress, and post-traumatic stress disorder. To this end, we examined the influence of the COVID-19 pandemic on the psychosocial health of college students. We explored the impact of COVID-19 on levels of stress and distress in college students using a qualitative expressive writing methodology. Results of this study suggested that the college students included in the sample were moderately distressed - their scores on inventories of depression, anxiety, and COVID-19-related stressors suggested moderate distress. [ABSTRACT FROM AUTHOR]

BACKGROUND: Research shows associations between bullying victimization and substance use for teens. However, more research about this relationship for younger adolescents and across race/ethnicity is needed. METHODS: Prevalence and pooled logistic regression analyses of 2019 Middle School Youth Risk Behavior Survey data from 13 states (N = 74,059 students) examined associations between self‐reported bulling victimization (at school, electronically, and both) and having ever tried cigarette smoking, alcohol, or marijuana; used an electronic vapor product; or misused prescription pain medicine. Regression analyses were adjusted by age and sex/race/ethnicity. RESULTS: All 3 measures of bullying victimization were significantly associated (p <.05) with the 5 substance use behaviors examined (adjusted prevalence ratios ranged from 1.29 to 2.32). These associations held across sexes. Significant associations were found within all 7 race/ethnicity categories, with the most associations reported for the non‐Hispanic (NH) white, NH black or African American, Hispanic/Latino, and NH Asian groups. CONCLUSION: The association between bullying and substance use by middle school is a highly relevant issue to consider as students return to classrooms. [ABSTRACT FROM AUTHOR]

Social media is a salient aspect of most people's lives in the United States. Younger generations (e.g., Gen Z) are among some of the most likely to engage with social media and have mental health concerns. Mental health providers are beginning to use social media to engage with prospective clients. However, there is a lack of guidance on how to maximize the utility of social media engagement for couple and family therapists (CFTs). This paper reviews the current literature on therapists' professional presence on social media and younger generations' expectations around social media competency. Recommendations for how CFTs can effectively engage with younger generations through social media are provided. A discussion of professionalism, accessibility, demonstrating aligned values, branding CFT, and gaining a reputation of cost effectiveness are emphasized. Future directions for studying the phenomenon of therapists using social media to engage with an online audience are included. [ABSTRACT FROM AUTHOR]

Clinicians may have to adapt their online marketing and engagement strategies to convey messages regarding COVID-19 and telehealth appointments for current and potential clients. This study reports the results of a linguistic inquiry of ways therapists presented telehealth services, advertised on their professional websites in six cities in the United States, during the COVID-19 global pandemic. Results of the analysis indicated that while MFTs use positive emotional tone in their language, the authenticity scores were poor. Dimensions of Clout and analytical language scored high. This suggests that MFTs use language that is professional, but distant, or inauthentic. Implications are discussed. [ABSTRACT FROM AUTHOR]

Bald eagles (Haliaeetus leucocephalus) are considered a recovery success in the United States after rebounding from near extirpation due to widespread use of the insecticide dichlorodiphenyltrichloroethane (DDT) in the twentieth century. Although abundances of bald eagles have increased since DDT was banned, other contaminants have remained in the environment with unknown influence on eagle population trends. Ingestion of spent lead (Pb) ammunition, the source of Pb most available to eagles and other scavengers in the United States, is known to kill individual eagles, but the influence of the contaminant on overall population dynamics remains unclear, resulting in longstanding controversy over the continued legality of the use of Pb in terrestrial hunting ammunition. We hypothesized that mortalities from the ingestion of Pb reduced the long‐term growth rate and resiliency of bald eagles in the northeast United States over the last 3 decades. We used Holling's definition of resilience (the ability of a system to absorb changes of state variables, driving variables, and parameters and still persist) to quantify how reduction in survival from Pb‐associated mortalities reduced the likelihood of population persistence. We used a population matrix model and necropsy records gathered between 1990 and 2018 from a 7‐state area to compare population dynamics under current versus hypothetical Pb‐reduced and Pb‐free scenarios. Despite a robust increase in eagle abundances in the northeast United States over that period, we estimated that deaths arising from ingestion of Pb was associated with a 4.2% (females) and 6.3% (males) reduction in the asymptotic long‐term growth rate (lambda). Comparison between real (current) and counterfactual (Pb‐reduced and Pb‐free) population dynamics indicated that the deaths from acute Pb poisoning were additive because the mortality events were associated with marked reduction in annual survival performance of hatchlings and reproductive females. These shifts in survival performance were further associated with a reduction in resilience for hatchling (95.4%) and breeding (81.6%) female eagles. Counterintuitively, the current conditions produced an increase in resilience (68.9%) for immature and non‐breeding female eagles over hypothetical Pb‐free conditions, suggesting that the population of eagles in the northeast United States reorganized (in a population dynamics sense) to ensure population expansion despite additive mortalities associated with Pb. This study can be used by state and federal wildlife managers or non‐governmental organizations to inform policy surrounding the use of lead ammunition or to educate hunters on the population‐scale effects of their ammunition choices. [ABSTRACT FROM AUTHOR]

Background: We examined whether key sociodemographic and clinical risk factors for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and mortality changed over time in a population-based cohort study.Methods and Findings: In a cohort of 9,127,673 persons enrolled in the United States Veterans Affairs (VA) healthcare system, we evaluated the independent associations of sociodemographic and clinical characteristics with SARS-CoV-2 infection (n = 216,046), SARS-CoV-2-related mortality (n = 10,230), and case fatality at monthly intervals between February 1, 2020 and March 31, 2021. VA enrollees had a mean age of 61 years (SD 17.7) and were predominantly male (90.9%) and White (64.5%), with 14.6% of Black race and 6.3% of Hispanic ethnicity. Black (versus White) race was strongly associated with SARS-CoV-2 infection (adjusted odds ratio [AOR] 5.10, [95% CI 4.65 to 5.59], p-value <0.001), mortality (AOR 3.85 [95% CI 3.30 to 4.50], p-value < 0.001), and case fatality (AOR 2.56, 95% CI 2.23 to 2.93, p-value < 0.001) in February to March 2020, but these associations were attenuated and not statistically significant by November 2020 for infection (AOR 1.03 [95% CI 1.00 to 1.07] p-value = 0.05) and mortality (AOR 1.08 [95% CI 0.96 to 1.20], p-value = 0.21) and were reversed for case fatality (AOR 0.86, 95% CI 0.78 to 0.95, p-value = 0.005). American Indian/Alaska Native (AI/AN versus White) race was associated with higher risk of SARS-CoV-2 infection in April and May 2020; this association declined over time and reversed by March 2021 (AOR 0.66 [95% CI 0.51 to 0.85] p-value = 0.004). Hispanic (versus non-Hispanic) ethnicity was associated with higher risk of SARS-CoV-2 infection and mortality during almost every time period, with no evidence of attenuation over time. Urban (versus rural) residence was associated with higher risk of infection (AOR 2.02, [95% CI 1.83 to 2.22], p-value < 0.001), mortality (AOR 2.48 [95% CI 2.08 to 2.96], p-value < 0.001), and case fatality (AOR 2.24, 95% CI 1.93 to 2.60, p-value < 0.001) in February to April 2020, but these associations attenuated over time and reversed by September 2020 (AOR 0.85, 95% CI 0.81 to 0.89, p-value < 0.001 for infection, AOR 0.72, 95% CI 0.62 to 0.83, p-value < 0.001 for mortality and AOR 0.81, 95% CI 0.71 to 0.93, p-value = 0.006 for case fatality). Throughout the observation period, high comorbidity burden, younger age, and obesity were consistently associated with infection, while high comorbidity burden, older age, and male sex were consistently associated with mortality. Limitations of the study include that changes over time in the associations of some risk factors may be affected by changes in the likelihood of testing for SARS-CoV-2 according to those risk factors; also, study results apply directly to VA enrollees who are predominantly male and have comprehensive healthcare and need to be confirmed in other populations.Conclusions: In this study, we found that strongly positive associations of Black and AI/AN (versus White) race and urban (versus rural) residence with SARS-CoV-2 infection, mortality, and case fatality observed early in the pandemic were ameliorated or reversed by March 2021. [ABSTRACT FROM AUTHOR]

When individuals are arrested or indicted for a crime, governments have legitimate interests in assuring that those individuals show up for future legal proceedings and also do not cause more social harm in the meanwhile. To serve those legitimate interests, governments may restrain the personal liberty of those presumptively innocent individuals--traditionally accomplished either by incarceration or by release subject to certain sureties and conditions. The choice, in short, is between jail and bail. Currently, governments skew that choice by subsidizing the costs of jail but not bail. The result--wholly predictable given the size and asymmetric nature of the subsidy--is that the United States maintains an inefficiently large jail population that both costs taxpayers too much and excessively limits the liberty of too many. Prior commentators and reformers have correctly identified the overuse of pretrial detention in jails as a major public policy crisis and have urged substantial reforms to current bail processes up to and including the abolition of state constitutional rights to bail (as one state has recently done). We believe that the hostility toward bail overlooks the root cause of the problem, which is the asymmetric subsidization of jail over bail. We propose a balanced subsidization system that can preserve the beneficial aspects of a traditional bail surety system while (i) reducing unnecessary and inefficient restraints on individual liberty, (ii) addressing the distributional inequities of current practices, and (iii) saving taxpayers billions of dollars per year. [ABSTRACT FROM AUTHOR]

National restrictions on trade and immigration are the most salient illustrations of the current protectionist moment, but cities have played their part too, taxing foreign investors in local real estate and imposing second or vacant home taxes that indirectly burden foreign investment. We call these taxes "protectionist property taxes." Although these taxes are new, they draw from an old well of suspicion about foreign ownership. We provide economic and historical context for the recent wave of protectionist property taxes and evaluate their legality under U.S. law. We conclude that taxes on second or vacant homes would likely survive constitutional challenge but facially protectionist property taxes generally would not. We then assess the policy merits of these taxes using an economic framework that highlights how law affects housing risk. We show that foreign real estate investment can reduce the riskiness of local housing markets so that even if a city can get away with enacting a protectionist property tax, it is not typically a good idea. Government spending can better achieve policy goals such as affordable housing and neighborhood stability without running afoul of constitutional prohibitions. [ABSTRACT FROM AUTHOR]

Examines the use of evidence in arms negotiations. Demonstrates how evidence is systematically processed to match prior beliefs. Shows public debate to be an exercise not likely to contribute much to new arms settlements. (MS)

The Maker Movement inspires people to express their creativity by making things in a self-directed and, often, collaborative learning endeavor. The excitement of the movement has spurred the development of various types of Makerspaces across the United States and the World to further enable people to make and innovate. The education community has recognized the potential for Makerspaces as learning environments that can foster interdisciplinary collaboration and self-directed learning. As such, there is much excitement to create Makerspaces within K-12 schools, libraries, colleges and universities. However, contrary to the formal design process used to build many school facilities, successful grass-roots makerspaces are most often created when those with like-minded interests come together and adapt the building around them to fit their needs. The research in this paper focuses on the design of such spaces by applying the environmental preferences predictors psychology construct. The study surveyed 276 students from art and design, engineering, and liberal arts majors to better understand their preferences as related to images of eight different Makerspaces. The results are broken down by the four predictors of preference, major, and gender. The results highlight differences among the images along with design considerations for creating spaces that welcome a broader audience. [ABSTRACT FROM AUTHOR]

Category: Trauma; Ankle Introduction/Purpose: The traditional surgical treatment for distal fibula fractures is open reduction and plate fixation (PF). However, intramedullary fixation (IMF) has been shown to provide advantages over plate fixation, particularly in patients and injuries with higher risks of soft tissue complications. Current evidence comparing the two fixation types remains scarce and is limited by modest sample sizes. Using a large national database, this retrospective cohort study aims to examine differences in use rates, associated fracture patterns, patient characteristics (e.g. age, gender, comorbidities, Elixhauser Comorbidity Index (ECI)), and complication rates between fibular IMF and PF within the United States. Methods: Patients (age≥18) with lower leg or ankle fractures treated with fibular IMF or PF between October 2015 and October 2021 were identified using a United States insurance claims database. The monthly ratio of IMF-treated patients to PF-treated patients was tracked over time to compare use rates. Fracture patterns were determined using fracture diagnoses within one month preceding surgery. Further analyses of patient characteristics and complication rates only included fibula fracture patients with 12 months of post-operative follow-up, and patients with concomitant upper tibia or tibia shaft fractures were excluded. To compare complication rates, a 1:4 (IMF:PF) matched comparison was performed, controlling for age, gender, high-energy (i.e. pilon, lower tibia, and trimalleolar) fractures, diabetes, tobacco use, obesity, and chronic kidney disease (CKD). Comparisons were conducted using chi-squared tests for categorical variables and t-tests for means. Ordinary least squares regression was used to visualize the trend in monthly relative use rates. Results: In total, 39329 patients (2294 IMF, 37035 PF) were identified. IMF use trended upwards relative to PF use over time (Figure 1). Tibia and fibula shaft fractures were the most common fractures in IMF patients versus trimalleolar and bimalleolar fractures in PF patients. A higher proportion of IMF patients had open fractures (p < 0.01). 627 IMF and 29703 PF patients were included for further analysis of patient characteristics and complications. The IMF cohort was younger, with higher mean ECI, fewer females, and higher rates of CKD (ps < 0.01). No significant differences in diabetes, tobacco use, or obesity rates were identified. Among 316 IMF and 1254 PF matched patients, no significant differences in infection, nonunion, malunion, revision, hardware removal, pulmonary embolism, and deep vein thrombosis rates were found. Conclusion: The upward trend in the ratio of IMF-treated to PF-treated patients suggests that the popularity of IMF is steadily rising. The higher rate of concomitant tibia shaft fractures and open fractures seen among IMF-treated patients in this study is consistent with the use of fibular IMF in cases involving higher-energy trauma and soft-tissue disruption. Higher ECI scores and rates of CKD in IMF patients also suggest that IMF is used more frequently in medically complex patients with impaired wound healing. Lastly, fibular IMF appears to be a viable alternative to PF when used in similar populations. [ABSTRACT FROM AUTHOR]

Background: Multipurpose prevention technologies (MPTs) are being developed to simultaneously protect women from unintended pregnancy and sexually transmitted infections (STIs) or human immunodeficiency virus. This study aims to determine MPT characteristics desired by young women in the United States (U.S.). Materials and Methods: This is a cross-sectional national survey administered online by MTurk. Eligibility criteria included female sex, age 18–29 years, U.S. residence, and sexual activity with a male partner in the past 3 months. MPT characteristics were rated for importance. Odds ratios were generated to explore associations between demographics, sexual behaviors, and prior contraceptive use and likelihood of using various MPT formulations. Results: Of 835 women, the largest proportion reported being likely to use MPTs in the form of injectables (45.6%), followed by vaginal gels (33.7%), vaginal rings (26.3%) and diaphragms (17.3%). Women with prior experience using a specific method of contraception appeared more likely to try an MPT of the same form. Women concerned about STIs and unwanted pregnancy, or with a history of such undesirable outcomes, expressed higher likelihood of use for a broad range of products. Women indicated that safety and efficacy at preventing pregnancy were the most important product characteristics when choosing an MPT. Conclusions: MPTs in the form of injectables are most highly desired, but many women would use vaginal methods, highlighting the importance of developing different delivery methods. Women desire safety and emphasize contraceptive efficacy over infection prevention. MPT preferences must be considered during product development to promote future acceptance among young women in the U.S. [ABSTRACT FROM AUTHOR]

This perspective paper seeks to lay out an efficient approach for health care providers, researchers, and other stakeholders involved in interventions aimed at improving care coordination to partner in locating and using applicable care coordination theory. The objective is to learn from relevant theory-based literature about fit between intervention options and coordination needs, thereby bringing insights from theory to enhance intervention design, implementation, and troubleshooting. To take this idea from an abstract notion to tangible application, our workgroup on models and measures from the Veterans Health Administration (VA) State of the Art (SOTA) conference on care coordination first summarizes our distillation of care coordination theoretical frameworks (models) into three common conceptual domains-context of an intervention, locus in which an intervention is applied, and specific design features of the intervention. Then we apply these three conceptual domains to four cases of care coordination interventions ("use cases") chosen to represent various scopes and stages of interventions to improve care coordination for veterans. Taken together, these examples make theory more accessible and practical by demonstrating how it can be applied to specific cases. Drawing from theory offers one method to anticipate which intervention options match a particular coordination situation. [ABSTRACT FROM AUTHOR]

Background: Care coordination is crucial to avoid potential risks of care fragmentation in people with complex care needs. While there are many empirical and conceptual approaches to measuring and improving care coordination, use of theory is limited by its complexity and the wide variability of available frameworks. We systematically identified and categorized existing care coordination theoretical frameworks in new ways to make the theory-to-practice link more accessible.Methods: To identify relevant frameworks, we searched MEDLINE®, Cochrane, CINAHL, PsycINFO, and SocINDEX from 2010 to May 2018, and various other nonbibliographic sources. We summarized framework characteristics and organized them using categories from the Sustainable intEgrated chronic care modeLs for multi-morbidity: delivery, FInancing, and performancE (SELFIE) framework. Based on expert input, we then categorized available frameworks on consideration of whether they addressed contextual factors, what locus they addressed, and their design elements. We used predefined criteria for study selection and data abstraction.Results: Among 4389 citations, we identified 37 widely diverse frameworks, including 16 recent frameworks unidentified by previous reviews. Few led to development of measures (39%) or initiatives (6%). We identified 5 that are most relevant to primary care. The 2018 framework by Weaver et al., describing relationships between a wide range of primary care-specific domains, may be the most useful to those investigating the effectiveness of primary care coordination approaches. We also identified 3 frameworks focused on locus and design features of implementation that could prove especially useful to those responsible for implementing care coordination.Discussion: This review identified the most comprehensive frameworks and their main emphases for several general practice-relevant applications. Greater application of these frameworks in the design and evaluation of coordination approaches may increase their consistent implementation and measurement. Future research should emphasize implementation-focused frameworks that better identify factors and mechanisms through which an initiative achieves impact. [ABSTRACT FROM AUTHOR]

Objective: Examine the impact of the 2011 shortage of the drug cytarabine on patient receipt and timeliness of induction treatment for Acute Myeloid Leukemia (AML).Study Design: A retrospective cohort was utilized to examine odds of receipt of inpatient induction chemotherapy and time to first dose across major (N = 105) and moderate (N = 316) shortage time periods as compared to a nonshortage baseline (N = 1,147).Data Collection/extraction Methods: De-identified patient data from 2008 to 2011 Surveillance, Epidemiology, and End Results (SEER) were linked to 2007-2013 Medicare claims and 2007-2013 Hospital Characteristics.Principal Findings: Compared to prior nonshortage time period, patients diagnosed during a major drug shortage were 47 percent less likely (p < .05) to receive inpatient chemotherapy within 14 days of diagnosis. Patients who were younger, had a lower Charlson Comorbidity score, and for whom AML was a first primary cancer were prioritized across all periods.Conclusions: Period of major shortage of a generic oncolytic, without an equivalent therapeutic substitute, reduced timely receipt of induction chemotherapy treatment. More favorable economic and regulatory policies for generic drug suppliers might result in greater availability of essential, older generic drug products that face prolonged or chronic shortage. [ABSTRACT FROM AUTHOR]

The article discusses credit report accuracy in relation to the author's views about the U.S. Federal Trade Commission (FTC), litigation involving the nation's Equal Employment Opportunity Commission (EEOC), and the regulation of credit reports and the credit reporting industry in America as of 2017. Credit reporting reform measures and standard tort theory in the U.S. are examined, as well as the social costs of mistakes, legal liability in America, and the country's Fair Credit Reporting Act.

The article offers information on improving care coordination for Veterans Within Veterans' Health Administration (VA) and healthcare system. It mentions coordinating care is essential for improving patients' clinical outcomes, enhancing patients' experiences of care, increasing provider satisfaction, and decreasing costs; and also mentions in the patient-centered medical home (PCMH) model, primary care is the locus for coordinating care.

For more than a century, the commercial law of intellectual property has generated intense controversy with ever-growing stakes. The central fulcrum in the area--the "first sale" or "exhaustion" doctrine--has produced four recent Supreme Court cases, a host of lower court decisions, and a mountain of scholarly criticism. Scholars who otherwise agree on little unite in excoriating the doctrine as a "per se, " "hamhanded," "sterile" rule that is "frustratingly under-theorized" and grounded in "a set of arid technicalities of no particular value. " Champions of intellectual property dislike the doctrine because they want infringement suits to enforce contractual restrictions on goods embodying intellectual property. Skeptics of intellectual property want a stronger doctrine that would sweep away all contractual restrictions and encumbrances on such goods. We argue that both camps wrongly assume that the doctrine was created through common law reasoning in pursuit of substantive policies such as fostering an unencumbered flow of goods in commerce. This Article demonstrates that, in both its historical origins and its current application, the law in this area is based on statutory interpretation and is directed toward the more nuanced goal of limiting the domain of intellectual property statutes to avoid displacing other areas of law. This thesis explains why the foundational cases reject intellectual property infringement claims but are agnostic as to whether the unsuccessful plaintiffs could achieve their goals under contract or property law theories. The century-long development of law in this area also provides useful insights for statutory interpretation theory by illustrating precisely how courts limit a statute's domain so that one area of law appropriately yields to another. [ABSTRACT FROM AUTHOR]

Background: The largest-ever outbreak of Ebola virus disease (EVD), ongoing in West Africa since late 2013, has led to export of cases to Europe and North America. Clinicians encountering ill travelers arriving from countries with widespread Ebola virus transmission must be aware of alternate diagnoses associated with fever and other nonspecific symptoms. Objective: To define the spectrum of illness observed in persons returning from areas of West Africa where EVD transmission has been widespread. Design: Descriptive, using GeoSentinel records. Setting: 57 travel or tropical medicine clinics in 25 countries. Patients: 805 ill returned travelers and new immigrants from Sierra Leone, Liberia, or Guinea seen between September 2009 and August 2014. Measurements: Frequencies of demographic and travel-related characteristics and illnesses reported. Results: The most common specific diagnosis among 770 nonimmigrant travelers was malaria (n = 310 [40.3%]), with Plasmodium falciparum or severe malaria in 267 (86%) and non-P. falciparum malaria in 43 (14%). Acute diarrhea was the second most common diagnosis among nonimmigrant travelers (n = 95 [12.3%]). Such common diagnoses as upper respiratory tract infection, urinary tract infection, and influenza-like illness occurred in only 26, 9, and 7 returning travelers, respectively. Few instances of typhoid fever (n = 8), acute HIV infection (n = 5), and dengue (n = 2) were encountered. Limitation: Surveillance data collected by specialist clinics may not be representative of all ill returned travelers. Conclusion: Although EVD may currently drive clinical evaluation of ill travelers arriving from Sierra Leone, Liberia, and Guinea, clinicians must be aware of other more common, potentially fatal diseases. Malaria remains a common diagnosis among travelers seen at GeoSentinel sites. Prompt exclusion of malaria and other life-threatening conditions is critical to limiting morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objective: Routine screening for prostate cancer is controversial because of frequent false-positive results, the potential for slow, non-life-threatening growth of untreated cancer, the uncertainty regarding whether treatment can extend life, and the potential for treatment complications. This study examines how information about prostate-specific antigen (PSA) testing and the uncertain benefits of treating prostate cancer affects patients' desire for PSA testing.Design: An educational videotape designed to inform men about the uncertainty surrounding PSA screening and the treatment of early-stage prostate cancer was presented to two groups of male patients 50 years of age or older.Setting: Dartmouth-Hitchcock Medical Center.Patients/participants: For study 1, men seeking a free prostate cancer screening were preassigned to view the educational videotape (N = 184) or another videotape (N = 185). For study 2, men scheduled to visit a general internal medicine clinic viewed either the educational videotape (N = 103) or no videotape (N = 93).Measurements and Main Results: The men's information and preferences about prostate cancer screening and treatment and actual choice of PSA test at the next test opportunity were measured. Men who viewed the educational videotape were: better informed about PSA tests, prostate cancer, and its treatment; preferred no active treatment if cancer were found; and preferred not to be screened (all significant at p < or = .002 in both studies). Men viewing the educational video were less likely to have a PSA test (p = .041, study 2). This tendency was not significant at the free-PSA clinic (p = .079).Conclusions: Preference regarding cancer screening and treatment is greatly affected by information about medical uncertainties. Because informed patient choices vary. PSA screening decisions should incorporate individual preferences. [ABSTRACT FROM AUTHOR]

Recent large municipal bankruptcies raise legal and moral questions of the priority in payment of the municipality's pension obligations. Focusing on existing law, we describe the bases on which pension obligations might have priority in bankruptcy. Priority under existing bankruptcy law requires that these obligations be supported by property rights effective outside bankruptcy. Part I identifies and rejects arguments that pension priority can be granted without property rights as part of Chapter 9 reorganization. Part II describes the requirement that pension priority be supported by property rights, identifies how statutory liens or trusts in favor of pensions can create priority, and describes the barriers to using these devices. A conclusion briefly describes revisions to the Bankruptcy Code that would allow pension priority, with or without property rights. [ABSTRACT FROM AUTHOR]

While much of Europe grants recreational users a right to access private land, American landowners enjoy a robust right to exclude. To fully exercise this right, landowners must provide notice by posting their property. In most states, the public has an implied license to use unposted land for recreation, and other states sharply increase the sanction for trespass if the land is posted. Today, posting means physically marking property with signs or paint, but this article suggests that states should soon allow landowners to post their property by making a notation in existing property records. If current technology becomes more available, centralized posting would both reduce the landowners' costs and provide better notice to the public. Centralized posting would also enhance the government's ability to serve as an intermediary between landowners and recreational users, furthering the efficient use of land regardless of whether the law begins with a right of access or a right to exclude. [ABSTRACT FROM AUTHOR]

The article focuses on anti-takeover protections for corporations and internal revenue law in the U.S. Topics include the government's pecuniary returns on taxation, the choice of corporate governance, and the private benefits of taxation control. Information is provided on corrective action, tax distortions, and what is considered 'good governance.'

Study Objective To determine whether the hemoglobin level at which health care providers prescribed erythropoiesis-stimulating agent ( ESA) therapy (trigger hemoglobin level) for their patients receiving chemotherapy was lower after the United States Food and Drug Administration ( FDA) mandated a black-box warning in March 2007. Design Retrospective analysis. Data Source U.S. Department of Veterans Affairs Healthcare System ( VA) national databases. Patients A total of 7450 patients who were diagnosed with cancer between 2002 and 2009, were undergoing chemotherapy, and who received an ESA within 12 months after their cancer diagnosis. Measurements and Main Results Data were collected on patients' demographic, clinical, environmental, and treatment-related factors. After controlling for these factors, multivariable regression analyses were used to compare the trigger hemoglobin level before and after the FDA-mandated labeling change. The average trigger hemoglobin level was 0.73 g/dl lower after the labeling change (95% confidence interval [ CI] −0.84 to −0.63). Moreover, the decline in trigger hemoglobin levels began in mid-2006, when the average trigger hemoglobin level fell from 10.50 g/dl in early 2006 (95% CI 10.36-10.63) to 9.30 g/dl by late 2009 (95% CI 9.10-9.49). Conclusion Even before the 2007 FDA-mandated changes in ESA product labeling, hemoglobin levels that triggered ESA treatment began declining for patients receiving cancer care within the VA. This highlights the critical importance of dissemination of postmarketing safety data to impact shifts in ESA use for anemia management. [ABSTRACT FROM AUTHOR]

An insolvent state does not need bankruptcy if sovereign immunity would protect it from lawsuits and other collection efforts. To the extent that a state is not judgment-proof and needs bankruptcy, we may not need to modify the Federal Bankruptcy Code to allow it to file. First, a substantial share of state spending flows through their municipalities, and these municipalities have substantial obligations of their own. Unlike states, municipalities can file for bankruptcy under current law, and a state could substantially reduce the cost of accomplishing its own fiscal goals by forcing its municipalities to file. Second, states may be able to create their own synthetic "bankruptcy" mechanisms, or bankruptcy without the federal code. State obligations are creatures of state law; states do not need a federal bankruptcy discharge. Federal law would not preempt a state composition mechanism used to adjust these debts, and any adjustment that would have been confirmed by a bankruptcy court would likely survive a Contract Clause challenge as well. Even if a state does not enact a composition mechanism, it could capture most of the benefits of federal bankruptcy by directly altering the rights of its creditors. A synthetic bankruptcy mechanism created by a state would not precisely replicate a federal bankruptcy chapter for states. Perhaps the best argument for federal bankruptcy is that it could operate with significantly lower transactions costs. In a world without omniscient judges, however, transactions costs can actually increase welfare by enhancing the ability of a state to make credible commitments. [ABSTRACT FROM AUTHOR]

Conditions that facilitate sustained dengue transmission exist in the United States, and outbreaks have occurred during the past decade in Texas, Hawaii, and Florida. More outbreaks can also be expected in years to come. To combat dengue, medical and public health practitioners in areas with mosquito vectors that are competent to transmit the virus must be aware of the threat of reemergent dengue, and the need for early reporting and control to reduce the impact of dengue outbreaks. Comprehensive dengue control includes human and vector surveillance, vector management programs, and community engagement efforts. Public health, medical, and vector-control communities must collaborate to prevent and control disease spread. Policy makers should understand the role of mosquito abatement and community engagement in the prevention and control of the disease. [ABSTRACT FROM AUTHOR]

Economic theory suggests that payday lending can either increase or decrease consumer welfare. Consumers can use payday loans to cushion the effects of financial shocks, but payday loans may also increase the chance that consumers will succumb to temptation or cognitive errors and seek instant gratification. Both supporters and critics of payday lending have alleged that the welfare effects of the industry can be substantial and that the legalization of payday lending can even have measurable effects on proxies for financial distress, such as bankruptcy, foreclosure, and property crime. Critics further allege that payday lenders target minority and military communities, making these groups especially vulnerable. If the critics of payday lending are correct, we should see an increase (decrease) in signs of financial distress after the legalization (prohibition) of payday lending, and these changes should be more pronounced in areas with large military or minority populations. This Article uses county-level data to test this theory. The results, like those of the existing literature, are mixed. Bankruptcy filings do not increase after states legalize payday lending, and filings tend to fall in counties with large military communities. This result supports the beneficial view of payday lending, but it may be due to states' incentives in enacting laws. This Article tests the effect of a change in federal law that should have had a disparate impact according to the prior choice of state law. This second test does not offer clear support for either the beneficial or detrimental view of payday lending. [ABSTRACT FROM AUTHOR]

Researchers continue to question fathers' willingness to report their biological children in surveys and the ability of surveys to adequately represent fathers. To address these concerns, this study evaluates the quality of men's fertility data in the 1979 and 1997 cohorts of the National Longitudinal Survey of Youth (NLSY79 and NLSY97) and in the 2002 National Survey of Family Growth (NSFG). Comparing fertility rates in each survey with population rates based on data from Vital Statistics and the U.S. Census Bureau, we document how the incomplete reporting of births in different surveys varies according to men's characteristics, including their age, race, marital status, and birth cohort. In addition, we use Monte Carlo simulations based on the NSFG data to demonstrate how birth underreporting biases associations between early parenthood and its antecedents. We find that in the NSFG, roughly four out of five early births were reported; but in the NLSY79 and NLSY97, almost nine-tenths of early births were reported. In all three surveys, incomplete reporting was especially pronounced for nonmarital births. Our results suggest that the quality of male fertility data is strongly linked to survey design and that it has implications for models of early male fertility. [ABSTRACT FROM AUTHOR]

There is considerable interest in identifying ways to close the Black-White achievement gap. This study examines race differences in children's participation in after-school programs, an out-of- school time experience that may influence children's achievement. Using nationally representative data spanning 1995-2005, the authors find that African American children ages 6-12 are twice as likely to attend after-school programs as White children, and the gap in program use is growing. Race differences in family and neighborhood characteristics explain only a small portion of the gap in program use, leaving much of the difference unexplained. The authors discuss the implications of the findings for research and policy. [ABSTRACT FROM AUTHOR]

An essay is presented on how the environment may be deemed as an invisible casualty of war and the U.S. military's role in pollution and use of natural resources. The severe impact of war preparedness and war activities on the health of the environment is examined. Several studies reveal the environment's degradation due to military contaminants such as perchlorate, the herbicide Agent Orange, and dioxin. Food chain pollution resulting from chemicals used in former U.S. bases is also addressed.

Unlike most other countries, the United States uses different procedures to resolve insolvent banks and nonbank firms. The Bankruptcy Code divides control over nonbank firms among the various claimants, and a judge supervises the resolution process. By contrast, the FDIC acts as the receiver for an insolvent bank and has almost complete control. Other claimants can sue the FDIC, but they cannot obtain injunctive relief, and their damages are limited to the amount that they would have received in liquidation. The FDIC has acted as the receiver of insolvent banks since the Great Depression, and the concentration of power in the FDIC is traditionally justified by two arguments: (i) FDIC control speeds the disposition of the bank's assets which maintains the liquidity of deposits and encourages faith in the banking system, and (ii) the FDIC's role as the largest creditor gives it an incentive to maximize recovery. We ask whether they still (or ever did) justify FDIC control. The first argument fails because it conflates the need for a timely satisfaction of the claims of insured depositors by the FDIC with the need to quickly dispose of the failed bank's assets. As stated, the second argument fails to justify FDIC control as the largest creditor can take selfinterested actions harmful to other claimants. However, the FDIC is not merely the largest creditor. A detailed survey of the capital structure of failed banks reveals that the FDIC is usually the only major creditor and that the value of the FDIC's claim nearly always exceeds the value of a failed bank's assets. The FDIC is the residual claimant and has the incentive to make the right decisions in disposing of the bank's assets. We question whether this principle can justify recent legislation that extends FDIC control over the resolution of large bank holding companies. We further consider four limits on our argument for FDIC control: (i) capital structure is endogenous-the absence of claims junior to the FDIC may reflect the lack of voice given to these claimants in a bank resolution process, (ii) agency costs internal to the FDIC may prevent the FDIC from maximizing the recovery from the failed bank's assets, (iii) the FDIC may not be the residual claimant of extremely large banks with complex liability structures, and (iv) debt conversion schemes which allow for automatic financial restructuring of a failed bank may render bank resolution procedures less necessary. This Article argues that these limits do not justify removing the FDIC from control in resolving most bank failures. [ABSTRACT FROM AUTHOR]

In this paper we tested three hypotheses: (a) the transition to fatherhood is associated with an increase in work effort; (b) the positive association (if any) between the transition to fatherhood and work effort is greater for fathers who are married at the time of the transition; and (c) the association (if any) is greater for men who make the transition at younger ages. The data are from the National Longitudinal Survey of Youth 1979 Cohort. The transition to fatherhood was associated with an increase in work effort among young unmarried men, but not for married men. Among married men who were on-time fathers, work effort decreased. Among childless men, the marriage transition was associated with increased work effort. [ABSTRACT FROM AUTHOR]

The United States is a federal union with separate state jurisdictions. In part owing to the sometimes heated debate about public support for human embryonic stem-cell (ESC) research, there has been restricted federal support and little central regulation of this research to date. Instead, guidelines developed by scientific organizations have set principles for oversight and good practice for this research. These guidelines are functioning well, have influenced developing state regulations and, one hopes, will affect any future federal regulation. [ABSTRACT FROM AUTHOR]

The Solar Terrestrial Relations Observatory (STEREO) is the third mission in NASA’s Solar Terrestrial Probes program. The mission is managed by the Goddard Space Flight Center (GSFC) and implemented by The Johns Hopkins University Applied Physics Laboratory (JHU/APL). This two-year mission provides a unique and revolutionary view of the Sun–Earth system. Consisting of two nearly identical observatories, one ahead of Earth in its orbit around the Sun and the other trailing behind the Earth, the spacecraft trace the flow of energy and matter from the Sun to Earth and reveal the three-dimensional structure of coronal mass ejections (CMEs) to help explain their genesis and propagation. From its unique side-viewing vantage point, STEREO also provides alerts for Earth-directed solar ejections. These alerts are broadcast at all times and received either by NASA’s Deep Space Network (DSN) or by various space-weather partners. [ABSTRACT FROM AUTHOR]

The article discusses the impact of technological innovations towards special education and teacher preparation in the U.S. The author stated that technology has the potential to level the playing field for students with disabilities since the new word processing platforms have built-in voice software, combined with the introduction of National Instructional Materials Accessibility Standards (NIMAS). In addition, the virtual teaching environment aims to positively impact teacher recruitment, preparation and retention in education by allowing teachers to hone their skills with virtual children.

This study provides systematic information about the prevalence of early male fertility and the relationship between family background characteristics and early parenthood across three widely used data sources: the 1979 and 1997 National Longitudinal Surveys of Youth and the 2002 National Survey of Family Growth. We provide descriptive statistics on early fertility by age, sex, race, cohort, and data set. Because each data set includes birth cohorts with varying early fertility rates, prevalence estimates for early male fertility are relatively similar across data sets. Associations between background characteristics and early fertility in regression models are less consistent across data sets. We discuss the implications of these findings for scholars doing research on early male fertility. [ABSTRACT FROM AUTHOR]

This study presents findings that investigated the effects of block scheduling (90-120 minute periods) on sixth-to-twelfth grade students attending secondary physical education classes located in the northeast and west-coast United States. Quantitative methods of data collection were utilized. Results found students spent more time "waiting" and in "management" and less time in "activity. " Furthermore, although the proportion of appropriate to inappropriate responses to tasks was in the right range, the number of opportunities to respond was low. Therefore, even though it seems there are advantages in adopting block scheduling, including the provision of a larger block of time to carry out state and national learning standards, this study, also raises several questions concerning it's effectiveness. Consequently, suggestions that will help improve teaching strategies of teachers, including how to keep the students involved in active learning activities throughout the 90-minute class period, are discussed. [ABSTRACT FROM AUTHOR]

The German cockroach is the most common pest of urban, low-income housing in the United States and is associated with high pesticide use by residents. Cockroach allergen is implicated in asthma exacerbation and initiation and in the growing social and medical aspects of the disease. A safe and secure home environment is an environmental justice issue, and environmentally sound and effective models of cockroach control are needed in public and low-income multifamily housing. One model that offers potential is the integrated pest management (IPM) peer educator model (IPM Educator) in public housing as a component of IPM. A pre-post-analysis of an IPM Educator pilot programme in Boston public housing was undertaken. Thirty-four moderate- to high-infested units received baseline assessment and three applications of gel baits and IPM treatment by a pest control operator. Before the first pest control application, residents received written notice to prepare their units for treatment, a standard procedure. Before the second and third pest control treatments, an IPM Educator instructed residents in basic pest biology and habits, preparation for treatment, and the role of sanitation in pest control. Results showed a significant improvement in rate of preparation for pest control treatment after the IPM Educator intervention when compared with the preparation rate before the education intervention, and a significant reduction in cockroach populations by the third visit in units that were prepared and had improved sanitation, when compared with unprepared units and unclean units. The IPM peer educator is a promising, low-cost model of educating and engaging residents of urban, low-income, multifamily housing in environmentally sound pest control, thereby giving them some power and control over their living environment. It is also a potential source of professional training and jobs for public housing and other low-income housing residents. [ABSTRACT FROM AUTHOR]

The United States can significantly reduce the likelihood of a nuclear terrorist attack if it pursues a vigorous, multilayered approach. Such an approach involves controlling nuclear technology and materials, manipulating the black market, and monitoring the behavior of aspiring nuclear actors. After analyzing each of these components, this article outlines the broad contours of a national preventative strategy that should give the nonproliferation community some cause for optimism. [ABSTRACT FROM AUTHOR]

Background: Patient race in the Department of Veterans Affairs (VA) information system was previously recorded based on an administrative or clinical employee's observation. Since 2003, the VA started to collect self-reported race in compliance with a new federal guideline. We investigated the implications of this transition for using race/ethnicity data in multi-year trends in the VA and in other healthcare data systems that make the transition. Methods: All unique users of VA healthcare services with self-reported race/ethnicity data in 2004 were compared with their prior observer-recorded race/ethnicity data from 1997 - 2002 (N = 988,277). Results: In 2004, only about 39% of all VA healthcare users reported race/ethnicity values other than "unknown" or "declined." Females reported race/ethnicity at a lower rate than males (27% vs. 40%; p < 0.001). Over 95% of observer-recorded data agreed with self-reported data. Compared with the patient self-reported data, the observer-recorded White and African American races were accurate for 98% (kappa = 0.89) and 94% (kappa = 0.93) individuals, respectively. Accuracy of observer-recorded races was much worse for other minority groups with kappa coefficients ranging between 0.38 for American Indian or Alaskan Natives and 0.79 for Hispanic Whites. When observer-recorded race/ethnicity values were reclassified into non-African American groups, they agreed with the self-reported data for 98% of all individuals (kappa = 0.93). Conclusion: For overall VA healthcare users, the agreement between observer-recorded and self-reported race/ethnicity was excellent and observer-recorded and self-reported data can be used together for multi-year trends without creating serious bias. However, this study also showed that observation was not a reliable method of race/ethnicity data collection for non-African American minorities and racial disparity might be underestimated if observer-recorded data are used due to systematic patterns of inaccurate race/ethnicity assignments. [ABSTRACT FROM AUTHOR]