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Context.--Existing targeted cystic fibrosis screening assays miss important pathogenic CFTR variants in the ethnically diverse US population. Objective.--To evaluate the analytic performance of a multiplex polymerase chain reaction (PCR)/capillary electropho-resis (CE) CFTR assay panel that simultaneously interrogates primary pathogenic variants of different ethnic/ancestral groups. Design.--Performance characteristic assessment and variant coverage comparison of the panel with a focus on ethnicity-specific CFTR variants were performed. Sample DNA was primarily from whole blood or cell lines. Detection of CFTR carriers was compared across several commercially available CFTR kits and recommended variant sets based on panel content. Results.--The panel interrogated 65 pathogenic CFTR variants representing 92% coverage from a recent genomic sequencing survey of the US population, including 4 variants with top 5 frequency in African or Asian populations not reflected in other targeted panels. In simulation studies, the panel represented 95% of carriers across the global population, resulting in a 6.9% to 19.0% higher carrier detection rate compared with 10 targeted panels or variant sets. Precision and sensitivity/specificity were 100% concordant. Multisite sample-level genotyping accuracy was 99.2%. Across PCR and CE instruments, sample-level genotyping accuracy was 97.1 %, with greater than 99% agreement for all variant-level metrics. Conclusions.--The CFTR assay achieves 92% or higher coverage of CFTR variants in diverse populations and provides improved pan-ethnic coverage of minority subgroups of the US populace. The assay can be completed within 5 hours from DNA sample to genotype, and performance data exceed acceptance criteria for analytic metrics. This assay panel content may help address gaps in ancestry-specific CFTR genotypes while providing a streamlined procedure with rapidly generated results. [ABSTRACT FROM AUTHOR]

Historically Black Colleges and Universities (HBCUs) have made notable social, cultural, and economic contributions to the African Diaspora, particularly since their inception in the United States. Being that HBCU athletic programs account for a small proportion of the intercollegiate athletic industry, these unique entities are often examined in the same vein as their Historically White Institution counterparts without a full account of the intergenerational adverse impacts of systemic racism. Since HBCUs are situated within the distinct context of Blackness, the researchers offer a reconceptualization through the theoretical lens of Black Critical Theory. This manuscript illuminates linkages across extant literature, while also presenting a budding theoretical framework in the study of sport, and sport organizations, that have deeply embedded relationships with communities, for example, HBCUs and the Black community, stickball and lacrosse within Indigenous communities, and the relationship between women and womens' sports leagues. Implications of this work are centered on promoting more critical reconceptualizations of sporting spaces that reflect the full diversity of the societies in which they exist. [ABSTRACT FROM AUTHOR]

Valley Fever (VF), caused by fungi in the genus Coccidioides, is a prevalent disease in southwestern and western parts of the United States that affects both humans and animals, such as dogs. Although the immune responses to infection with Coccidioides spp. are not fully characterized, antibody-detection assays are used in conjunction with clinical presentation and radiologic findings to aid in the diagnosis of VF. These assays often use Complement Fixation (CF) and Tube Precipitin (TP) antigens as the main targets of IgG and IgM reactivity, respectively. Our group previously reported evidence of over 800 genes expressed at the protein level in C. posadasii. However, antibody reactivity to the majority of these proteins has never been explored. Using a new, high-throughput screening technology, the Nucleic Acid Programmable Protein Array (NAPPA), we screened serum specimens from dogs against 708 of these previously identified proteins for IgG reactivity. Serum from three separate groups of dogs was analyzed and revealed a small panel of proteins to be further characterized for immuno-reactivity. In addition to CF/CTS1 antigen, sera from most infected dogs showed antibody reactivity to endo-1,3-betaglucanase, peroxisomal matrix protein, and another novel reactive protein, CPSG_05795. These antigens may provide additional targets to aid in antibody-based diagnostics. [ABSTRACT FROM AUTHOR]

We build a publicly available database that tracks economic activity in the United States at a granular level in real time using anonymized data from private companies. We report weekly statistics on consumer spending, business revenues, job postings, and employment rates disaggregated by county, sector, and income group. Using the publicly available data, we show how the COVID-19 pandemic affected the economy by analyzing heterogeneity in its effects across subgroups. High-income individuals reduced spending sharply in March 2020, particularly in sectors that require in-person interaction. This reduction in spending greatly reduced the revenues of small businesses in affluent, dense areas. Those businesses laid off many of their employees, leading to widespread job losses, especially among low-wage workers in such areas. High-wage workers experienced a V-shaped recession that lasted a few weeks, whereas low-wage workers experienced much larger, more persistent job losses. Even though consumer spending and job postings had recovered fully by December 2021, employment rates in low-wage jobs remained depressed in areas that were initially hard hit, indicating that the temporary fall in labor demand led to a persistent reduction in labor supply. Building on this diagnostic analysis, we evaluate the effects of fiscal stimulus policies designed to stem the downward spiral in economic activity. Cash stimulus payments led to sharp increases in spending early in the pandemic, but much smaller responses later in the pandemic, especially for high-income households. Real-time estimates of marginal propensities to consume provided better forecasts of the impacts of subsequent rounds of stimulus payments than historical estimates. Overall, our findings suggest that fiscal policies can stem secondary declines in consumer spending and job losses, but cannot restore full employment when the initial shock to consumer spending arises from health concerns. More broadly, our analysis demonstrates how public statistics constructed from private sector data can support many research and real-time policy analyses, providing a new tool for empirical macroeconomics. [ABSTRACT FROM AUTHOR]

One prominent, well-debated issue in the American higher education system is whether university officials should remove the names of individuals with racist pasts from campus buildings/structures that bear their namesake. The purpose of this study was to analyze basketball and football facilities at Division I Football Bowl Subdivision institutions to explore the racialized history of the people whom these facilities are named after. Utilizing a collective case study approach, the authors identified 18 facilities that were named after athletic administrators, coaches, and philanthropists who engaged in racist activities or harbored racist views. The authors argue, using critical race theory and systemic racism theory as interpretative lenses, that naming buildings after racist persons legitimizes their legacies, rationalizes systemic racism, and continues to unjustly enrich this particular group. [ABSTRACT FROM AUTHOR]

The number of persons in the United States with Alzheimer disease will approach 14 million by 2060. New anti–amyloid-β infusions have been shown to reduce the volume of amyloid plaques on positron emission tomography scans and slow disease progression for patients with Alzheimer disease–related mild cognitive impairment and mild dementia. This commentary provides guidance to help physicians carefully communicate potential benefits and harms of this therapy. [ABSTRACT FROM AUTHOR]

This study's primary objective was to assess pharmacists' knowledge and beliefs regarding climate change and health. Secondary objectives included assessing perceptions of its relevance to pharmacists and pharmacy practice as well as potential roles in mitigating climate change. An 18-question, anonymous survey was developed using questions adapted from previously published surveys that evaluated the general public's views of international issues and health professionals' perceptions of climate change and health, with additions specific to the Midwestern United States and Ohio. It was sent electronically to a random sample of 500 registered pharmacists living and working in Ohio. Data were analyzed using descriptive and nonparametric statistics. Seventy pharmacists participated in the study. The majority of respondents (78.3%) believed climate change is happening. More respondents recognized climate change to be a great or moderate threat to human health worldwide (72.7%) than to patients in their community (45.4%; P <.001). A little more than half (54.5%) thought climate change was relevant to pharmacy practice. Perceived barriers that reduced willingness to communicate with the public about this topic included lack of time (73.4%) or knowledge (49.2%) and feeling that it would not make a difference (46.1%) or it is too controversial (35.4%). Respondents believed pharmacists could have the greatest impact through increasing sustainability in the health care system (48.5%). Most respondents recognized that climate change is happening, is a threat to human health worldwide, and is relevant to pharmacy. However, many did not recognize its potential impact on their own patients or their role in climate action, showing a need for more education on this topic. As these are the first data collected among pharmacists in the United States, additional studies should be performed in other parts of the country as opinions may vary based on personal experience with or exposure to impacts of climate change. [ABSTRACT FROM AUTHOR]

This study utilized critical race theory (CRT) as an epistemological framework and theoretical tool for understanding African American male student-athletes' perceptions of racism and the potential impact racism might have on their educational experiences and overall development. This qualitative case study included a single focus group and in-depth interviews with four African American male football players in a big-time college sport program at a predominantly White institution (PWI) in the Midwestern United States. These males felt that racism manifested itself in terms of African Americans (1) being denied access to leadership and major decision-making opportunities in college and professional sport, and (2) being treated differently than their White counterparts. These findings point to the need for further studies that are inclusive of the voices of this particular group and other groups of African American student-athletes. Further, these results have implications for administrators, coaches, academic support personnel, and other educators at American universities and colleges with big-time college sport programs.

When dealing with First Amendment free speech issues in the context of public libraries, courts have merely cited the supposition that constitutional public forum analysis leads to the conclusion that the public library is a limited public forum for the purposes of First Amendment analysis. By focusing narrowly on the issue of whether Internet access in libraries constitutes a public forum, and determining that it does not, the U.S. Supreme Court not only misses an opportunity to refine the concept of the public forum in modern-day terms but also somehow implies that public library activities are different from other speech activities and are subject to the managerial authority of the government. This article makes the argument that a redefinition of the public forum doctrine would bring under its ambit the public library, to join the "traditional" public forums such as streets, sidewalks, and parks--a departure from the current designation of the public library as a limited public forum. This article also examines the extent to which the Internet represents an expansion of the forum, whether public or limited. The argument is structured within the framework of the decision in the case of "United States v. American Library Association."

Purpose: This study aimed to develop home care quality indicators (HCQIs) to be used by a variety of audiences including consumers, agencies, regulators, and policy makers to support evidence-based decision making related to the quality of home care services. Design and Methods: Data from 3,041 Canadian and 11,252 U.S. home care clients assessed with the Minimum Data Set--Home Care (MDS-HC) were used to evaluate a series of indicators suggested by international experts and by focus groups conducted in Canada and the United States. Risk adjustment methods were derived and validated using data from Ontario and Michigan. Results: Of the 73 original candidate HCQIs, 22 were retained for the final list of recommended indicators. All but three indicators include risk adjusters based on individual-level covoriates. An agency-level risk adjustment was developed to correct for selection and ascertainment bias. Implications: The HCQIs are new tools providing a first step along the path of quality improvement for home care. These indicators can provide high-quality evidence on performance at the agency level and on a regional basis.

Compares backgrounds and aspirations of teachers in China with teachers in America. Concludes that Chinese teachers generally come from less privileged backgrounds and are less likely to make teaching a lifelong career. Urges both Chinese and American policy makers to revise policies and practices in order to recruit and retain qualified teachers. (Contains 27 references.) (NB)

The 2018 United States Farm Bill has opened the possibility for farmers to increase their profits through hemp cultivation. The literature suggests hemp has the potential to replace soybeans in soybean–wheat double-cropping because hemp shares key attributes of soybeans as a rotation crop (profitability, potential as an energy crop, and maintenance of soil fertility). Nonetheless, due to a short history of hemp cultivation in the USA, it is difficult to predict a time series relationship between hemp, soybean, and wheat through conventional approaches. In this article, we use Bayesian time series models and data from Statistics Canada and the Alberta Agricultural and Rural Development Department to examine a time series relationship between hemp, wheat, and soybean acreage and therefore predict farmers' decision when hemp is a legal alternative agricultural commodity. Our results show evidence of complementary and substitution relationships for hemp–wheat and hemp–soybean, respectively. In addition, the results indicate a potential of hemp monoculture as a positive response to self-positive shock on hemp acreage that lasts for years. [ABSTRACT FROM AUTHOR]

Describe the rate of death over 4 consecutive quarters and determine optimal categorization of residents into risk-of-death categories, expanding the Changes in Health, Endstage Disease, Signs and Symptoms (CHESS) scale. Using secondary analysis design with Minimum Data Set (MDS) data, the CHESS scale provided the base upon which the DeathRisk-NH scale was developed. Baseline and 4 quarterly follow-up analyses of Canadian (n = 109,145) and US (n = 1,075,611) nursing home resident data were completed. Logistic regression analyses identified predictors of death, additive to CHESS, to form the DeathRisk-NH scale. The independent variable set used MDS items, focusing on clinical complexity indicators, diagnostic conditions, and measures of severe clinical distress. Country cohorts had similar percentages of residents with mean activities of daily living hierarchy scores, dependence in mobility, continence, memory, and overall CHESS scores. The percentage of individuals who died increased from 10.5% (3 months) to 30.7% (12 months). The average annual death rate for this cohort was 5.5 times higher than the national annual death rate of approximately 5.6%. The DeathRisk-NH is an effective prediction model to identify residents at risk of death within the first 12 months after admission to the nursing home. The tool may be helpful in patient care planning, resource allocation, and excess death monitoring. [ABSTRACT FROM AUTHOR]

Provides an overview of the issues shaping efforts to reform elementary education in the People's Republic of China. China's school organization and practices invite comparison with aspects of the U.S. system of elementary education. Enduring features of Chinese elementary education are discussed. (Author/BB)

The challenge for financial professionals is to understand more about demographic dynamics in order to work with millennial clients and their baby boomer parents. For example, the information available about millennial clients can help create more emphasis on important life events deferred or delayed because of financial circumstances and how to improve the process of attaining them. This would include helping them with planning for debt reduction rather than asset accumulation alone. [ABSTRACT FROM AUTHOR]

Lyme disease is the most common vector-borne infectious disease in the United States. Post-treatment Lyme disease (PTLD) is a condition affecting 10–20% of patients in which symptoms persist despite antibiotic treatment. Cognitive complaints are common among those with PTLD, suggesting that brain changes are associated with the course of the illness. However, there has been a paucity of evidence to explain the cognitive difficulties expressed by patients with PTLD. This study administered a working memory task to a carefully screened group of 12 patients with well-characterized PTLD and 18 healthy controls while undergoing functional MRI (fMRI). A subset of 12 controls and all 12 PTLD participants also received diffusion tensor imaging (DTI) to measure white matter integrity. Clinical variables were also assessed and correlated with these multimodal MRI findings. On the working memory task, the patients with PTLD responded more slowly, but no less accurately, than did controls. FMRI activations were observed in expected regions by the controls, and to a lesser extent, by the PTLD participants. The PTLD group also hypoactivated several regions relevant to the task. Conversely, novel regions were activated by the PTLD group that were not observed in controls, suggesting a compensatory mechanism. Notably, three activations were located in white matter of the frontal lobe. DTI measures applied to these three regions of interest revealed that higher axial diffusivity correlated with fewer cognitive and neurological symptoms. Whole-brain DTI analyses revealed several frontal lobe regions in which higher axial diffusivity in the patients with PTLD correlated with longer duration of illness. Together, these results show that the brain is altered by PTLD, involving changes to white matter within the frontal lobe. Higher axial diffusivity may reflect white matter repair and healing over time, rather than pathology, and cognition appears to be dynamically affected throughout this repair process. [ABSTRACT FROM AUTHOR]

In the article, the authors present their cross-sectional study to estimate the wasteful spending on aducanumab dispensing for treating Alzheimer's disease in the U.S. Also cited are how the widespread use of the drug could strain Medicare's budget, and the conduct of the study on Medicare beneficiaries with mild dementia or mild cognitive impairment (MCI).

It may be time to reexamine the proposition that insuring a family member for the direct cost of long-term care is the only goal of long-term care insurance (LTCI). Instead, considering LTCI as the first layer of longterm care provides an opportunity to broaden the market and to provide innovative combination products and financial support that would reflect the full spectrum of care needed for both recipient and caregiver. [ABSTRACT FROM AUTHOR]

Recent articles have drawn attention to the evolving challenge of retirement in the twenty-first century. Not all of the experts agree on the financial target. In fact some believe it may be too low for those with even low six-figure incomes, while others recommend a percentage of income saving and investment goal with certain targets and benchmarks based on age. Financial advisors will certainly want to know more about and keep tabs on millennials and their number. [ABSTRACT FROM AUTHOR]

As thousands of baby boomers cross the age 65 and retirement threshold every day, and typically comprise a significant portion of a financial professional's book of business, it's especially important for financial advisors to understand the many demographic and personal dynamics of this huge client base. Despite decades of scrutiny, many myths, stereotypes, and misperceptions remain about baby boomers. The financial professional who understands and appreciates the differing characteristics within this cohort, as well as how individuals can differ in their approaches to the planning process, can create a more satisfying and successful client relationship. [ABSTRACT FROM AUTHOR]

OBJECTIVES: African American (AA) children affected by autism spectrum disorder (ASD) experience delays in diagnosis and obstacles to service access, as well as a disproportionate burden of intellectual disability (ID) as documented in surveillance data recently published by the US Centers for Disease Control and Prevention. Our objective in this study was to analyze data from the largest-available repository of diagnostic and phenotypic information on AA children with ASD, and to explore the wide variation in outcome within the cohort as a function of sociodemographic risk and specific obstacles to service access for the purpose of informing a national approach to resolution of these disparities. METHODS: Parents of 584 AA children with autism consecutively enrolled in the Autism Genetic Resource Exchange across 4 US data collection sites completed event history calendar interviews of the diagnostic odysseys for their children with ASD. These data were examined in relation to developmental outcomes of the children with autism and their unaffected siblings. RESULTS: The average age of ASD diagnosis was 64.9 months (±49.6), on average 42.3 months (±45.1) after parents' first concerns about their children's development. The relationship between timing of diagnosis and ASD severity was complex, and ID comorbidity was not predicted in a straightforward manner by familial factors associated with cognitive variation in the general population. CONCLUSIONS: These findings document significant opportunity to expedite diagnosis, the need to further understand causes of ID comorbidity, and the necessity to identify effective approaches to the resolution of disparities in severity-of-outcome for AA children with autism. [ABSTRACT FROM AUTHOR]

Pedestrian fatalities are becoming a larger percentage of overall fatalities in the United States, therefore better understanding of the expected effects of any interventions/treatments aimed at modifying pedestrian behavior is essential for improving safety. This study used pedestrian safety interventions to assess their effect on respondents' stated crossing behavior. Also, specific demographic data was used to identify behavioral trends regarding street-crossing behavior. Results show that safety interventions are significantly associated with changes in crossing behavior. The effect of interventions was predominantly positive, because the respondents' behavior after the interventions showed improvement relative to comparison group. This study found significant association between demographic variables and the compliance rate. Women were more compliant than men, and respondents age 25 or younger were more compliant after the interventions. Married respondents were more compliant than unmarried ones. Respondents who drive often were more compliant, but having been involved in a car accident as a pedestrian (or knowing someone who was) was not significant in explaining crossing behavior. The findings from this study could serve as a guide of potential factors/variables to be taken into consideration when studying street-crossing behavior and consequently could help to improve pedestrian street-crossing behavior models. [ABSTRACT FROM AUTHOR]

The article discusses historical and archival materials related to the American West in the special collections of the St. Louis Mercantile Library in St. Louis, Missouri. The author notes how the library's geographic location aided the collection of historical materials for the library. The library's collections include personal narratives, and information on Western exploration, trade and railroads.

We develop indices that can be used to measure the susceptibility of a route to human trafficking. The susceptibility is based on data providing a measure of a country's vulnerability for and its government response to human trafficking. The data was normalized and the Pearson correlation coefficient was used to determine the correlation between five types of government response and five types of vulnerability. It was determined that comparing government response values with vulnerability values yielded a negative correlation. Four routes through the Americas to the United States were examined. The indices of two of the measures agree on all four routes. [ABSTRACT FROM AUTHOR]

Introduction: Earlier development of cardiovascular disease risk factors in blacks versus whites may result from differences in maintaining health behaviors. Age-specific racial differences in maintaining health behaviors from ages 18 to 50 years were determined.Methods: In 1985-1986, the population-based Coronary Artery Risk Development in Young Adults study enrolled 5,115 participants aged 18-30 years. In 2017, a total of 2,485 blacks and 2,407 whites with one or more optimal health behaviors at baseline who attended one or more of seven follow-up exams over 25 years (i.e., through 2010-2011) were analyzed. The primary outcome, maintaining four or more optimal health behaviors, included BMI <25; never smoking; ≥150 minutes/week of moderate to vigorous physical activity; no/moderate alcohol intake (women/men: zero to seven/zero to 14 drinks per week); and Dietary Approaches to Stop Hypertension diet adherence score ≥15 (i.e., baseline highest quartile). Hazard ratios comparing blacks with whites for maintaining optimal health behaviors were calculated among participants with each optimal behavior at baseline.Results: From ages 18 to 50 years, 2.6% of blacks and 9.2% of whites maintained four or more optimal health behaviors (for optimal BMI: 16.0% and 30.1%, smoking status: 74.6% and 78.4%, physical activity: 17.7% and 21.4%, alcohol intake: 68.4% and 64.6%, diet adherence: 3.9% and 10.3%, respectively). The multivariable adjusted hazard ratio comparing blacks with whites was 0.63 (95% CI=0.56, 0.72) for maintaining four or more optimal health behaviors (for optimal BMI: 0.82 [95% CI=0.66, 1.01], smoking status: 0.57 [95% CI=0.52, 0.62], physical activity: 0.83 [95% CI=0.75, 0.91], alcohol intake: 1.19 [95% CI=1.03, 1.37], diet adherence: 0.71 [95% CI=0.61, 0.82]).Conclusions: Fewer blacks than whites maintained four or more optimal health behaviors until age 50 years, but maintenance was low among both races. [ABSTRACT FROM AUTHOR]

Background Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CoNS) that is a part of the normal human skin flora. Even though it belongs to CoNS family, it can cause severe and destructive infections in a similar fashion to Staphylococcus aureus. Skin and soft tissue infections (SSTI), bacteremia and endocarditis are amongst the most common clinical presentations. Diagnosis and clinical presentation of infections caused by S. lugdunensis in cancer patients is limited. Materials and Methods We performed a retrospective chart review of 24 patients who had cultures positive for S. lugdunensis. Out of 24 patients, 14 patients were diagnosed with a true infection and 10 other patients were considered to be colonized with this pathogen. We analyzed clinical manifestation, treatment and response to therapy. Results SSTI was the most common presentation in our study patients. All patients diagnosed with SSTI had a prior surgery or an invasive procedure at the affected site. Five urinary tract infections (UTIs), one catheter-associated bloodstream infection, and a deep pelvic abscess were other reported infections in our study. We observed that S. lugdunensis remains susceptible to a variety of antibiotics, with all isolates susceptible to vancomycin and linezolid and most remain susceptible to fluoroquinolone and trimethoprim/ sulfamethoxazole. All 14 patients received antibiotics and improved. Conclusion In our case series, SSTI was common and diagnosed in 50% of the patients with clinically significant isolates for S. lugdunensis. This is consistent with prior studies indicating that S. lugdunensis is a significant pathogen in SSTIs. UTI was the second most common infection type in our patient population. [ABSTRACT FROM AUTHOR]

The article analyzes the Free Trade Agreement signed by the U.S. and Canada on October 4, 1987. The author notes that freer trade leads to more competitive and efficient allocation of resources, whereas bilateral free trade favors the stronger economic unit. Canada has historically sought agreement with the U.S. through multilateral rather than bilateral negotiations because they offset disparities in negotiating power between Canada and its trading partners. The agreement was not considered one of free trade by Canada, who was unable to obtain secure access to the U.S. market and claimed that they had entered into the agreement under false pretenses. Canada was not allowed to invoke the General Agreement on Tariffs and Trade (GATT) due to a stipulation in their initial agreement. Canada's struggle to develop a Canadian cultural industry is discussed.

This paper views deferred income taxes as a summary measurement correction that adjusts the various income statement items to an aggregate net-of-tax valuation. Further, the author observes that the tax effects of revenue timing differences are conceptually distinct from the tax effects of expense timing differences and concludes that the FASB should adopt a combination method of comprehensive interperiod allocation. [ABSTRACT FROM AUTHOR]

Importance: Recent increases in US opioid-related deaths underscore the need to understand drivers of fatal overdose. The initial prescription of opioids represents a critical juncture because it increases the risk of future opioid use disorder and is preventable.Objective: To examine new opioid prescribing patterns in US patients at increased risk of overdose from benzodiazepine use.Design, Setting, and Participants: This study used publicly available data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from January 1, 2005, through December 31, 2015, to identify adults 20 years or older receiving new opioid prescriptions and concurrently using a benzodiazepine.Main Outcomes and Measures: Population-based rates of new opioid prescriptions stratified by use of benzodiazepines.Results: This study analyzed 13 146 visits, representing 214 million visits nationally, with a new opioid prescription. Rates of new opioid prescriptions among adults using a benzodiazepine increased from 189 to 351 per 1000 persons between 2005 and 2010 (rate difference, 162; 95% CI, 29-295; P = .02) and decreased to 172 per 1000 persons by 2015 (rate difference, -179; 95% CI, -310 to -48; P = .008). New opioid prescriptions in the general population not using benzodiazepines increased nonsignificantly from 78 to 93 per 1000 US persons between 2005 and 2010 (rate difference, 15; 95% CI, -3 to 33; P = .10) and decreased nonsignificantly to 79 per 1000 persons by 2015 (rate difference, -14; 95% CI, -38 to 11; P = .28). The likelihood of receiving a new opioid prescription during an ambulatory visit remained higher for patients concurrently using benzodiazepines compared with the general population after adjusting for demographic characteristics, comorbidities, and diagnoses associated with pain (adjusted relative risk, 1.83; 95% CI, 1.56-2.15; P < .001). Naloxone was coprescribed in less than 1% of visits when a patient concurrently used a benzodiazepine.Conclusions and Relevance: In 2010, new opioid prescriptions for US adults stopped increasing and began to decrease among higher-risk patients who used benzodiazepines. These patterns suggest that the recent increase in opioid-related deaths may be associated with factors other than physicians writing new opioid prescriptions. Nevertheless, prescribing among higher-risk patients still occurred at rates higher than rates in the general population, representing an important opportunity to improve quality of care for patients experiencing pain. [ABSTRACT FROM AUTHOR]

Objectives interRAI launched this study to introduce a set of standardized self-report measures through which residents of long-term care facilities (LTCFs) could describe their quality of life and services. This article reports on the international development effort, describing measures relative to privacy, food, security, comfort, autonomy, respect, staff responsiveness, relationships with staff, friendships, and activities. First, we evaluated these items individually and then combined them in summary scales. Second, we examined how the summary scales related to whether the residents did or did not say that the LTCFs in which they lived felt like home. Design Cross-sectional self-report surveys by residents of LTCFs regarding their quality of life and services. Setting/Participants Resident self-report data came from 16,017 individuals who resided in 355 LTCFs. Of this total, 7113 were from the Flanders region of Belgium, 5143 residents were from Canada, and 3358 residents were from the eastern and mid-western United States. Smaller data sets were collected from facilities in Australia (20), the Czech Republic (72), Estonia (103), Poland (118), and South Africa (87). Measurements The interRAI Self-Report Quality of Life Survey for LTCFs was used to assess residents' quality of life and services. It includes 49 items. Each area of inquiry (eg, autonomy) is represented by multiple items; the item sets have been designed to elicit resident responses that could range from highly positive to highly negative. Each item has a 5-item response set that ranges from “never” to “always.” Results Typically, we scored individual items scored based on the 2 most positive categories: “sometimes” and “always.” When these 2 categories were aggregated, among the more positive items were: being alone when wished (83%); decide what clothes to wear (85%); get needed services (87%); and treated with dignity by staff (88%). Areas with a less positive response included: staff knows resident's life story (30%); resident has enjoyable things to do on weekends (32%); resident has people to do things with (33%); and resident has friendly conversation with staff (45%). We identified 5 reliable scales; these scales were positively associated with the resident statement that the LTCF felt like home. Finally, international score standards were established for the items and scales. Conclusions This study establishes a set of standardized, self-report items and scales with which to assess the quality of life and services for residents in LTCFs. The study also demonstrates that these scales are significantly related to resident perception of the home-like quality of the facilities. [ABSTRACT FROM AUTHOR]

The article discusses research which focused on the OurNotes initiative which involves cooperation between physicians and patients in the production of medical notes and outcome reports. Topics explored include the use of secure electronic portals in this initiative, the study participants which consist of primary care physicians, patient advocates, and health information technology professionals, and the possibility of improving patient engagement and communication through this scheme.

Pain is an increasing clinical challenge affecting about half the population, with a substantial number of people suffering daily intense pain. Such suffering can be linked to the dramatic rise in opioid use and associated deaths in the United States. There is a pressing need for new analgesics with limited side effects. Here, we summarize what we know about the genetics of pain and implications for drug development. We make the case that chronic pain is not one but a set of disease states, with peripheral drive a key element in most. We argue that understanding redundancy and plasticity, hallmarks of the nervous system, is critical in developing analgesic drug strategies. We describe the exploitation of monogenic pain syndromes and genetic association studies to define analgesic targets, as well as issues associated with animal models of pain. We appraise present-day screening technologies and describe recent approaches to pain treatment that hold promise. [ABSTRACT FROM AUTHOR]

We critically evaluate arguments in a recent Journal of Law, Medicine & Ethics article by Svoboda, Adler, and Van Howe disputing the 2012 affirmative infant male circumcision policy recommendations of the American Academy of Pediatrics. We provide detailed evidence in explaining why the extensive claims by these opponents are not supported by the current strong scientific evidence. We furthermore show why their legal and ethical arguments are contradicted by a reasonable interpretation of current U.S. and international law and ethics. After all considerations are taken into account it would be logical to conclude that failure to recommend male circumcision early in infancy may be viewed as akin to failure to recommend childhood vaccination to parents. In each case, parental consent is required and the intervention is not compulsory. Our evaluation leads us to dismiss the arguments by Svoboda et al. Instead, based on the evidence, infant male circumcision is both ethical and lawful. [ABSTRACT FROM AUTHOR]

Public housing reform has fostered widespread revitalization in American cities. Courts have been critical to this process, but so far urban scholars have not yet closely analyzed this role. This article illuminates how courts participated in reform, sometimes empowering and at other times disempowering tenants. Looking at litigation filed by tenants to fight demolition, I examine how courts framed disputes in legal terms and how the judicial stance on demolition coevolved with national policy debate. In particular, I emphasize how tenants tapped into the ideological power of rights in American society and show that courts never explicitly rejected the notion that tenants held rights against demolition but instead gradually adopted urban planning sensibilities that implicitly denied rights to tenants. Thus, this article reveals the complicated and paradoxical nature of legal rights in the Right to the City struggles. [ABSTRACT FROM AUTHOR]

Engaging other health care providers in oral health-related activities and interprofessional care (IPC) could increase access to oral health care for underserved populations in the U.S. The aims of this study were to assess dental hygiene, dental, and medical students' intra- and interprofessional and oral and maxillofacial surgery (OMFS)/hospital dentistry-related knowledge/skills, attitudes, and behavior; determine whether first and second year vs. third and fourth year cohorts' responses differed; and explore how intra- and interprofessional knowledge was related to interprofessional education (IPE) and interprofessional attitudes and behavior. Data were collected between April 2014 and May 2015 from 69 dental hygiene, 316 dental, and 187 medical students. Response rates across classes for the dental hygiene students ranged from 85% to 100%; 24% to 100% for the dental students; and 13% to 35% for the medical students. The results showed that the medical students had lower oral health-related and interprofessional knowledge and less positive attitudes about oral health-related behavior, IPE, and interprofessional teamwork than the dental hygiene and dental students. While third- and fourth-year medical students' interprofessional knowledge/skills and behavior were higher than those of first- and second-year students, the two groups' IPE-related and interprofessional attitudes did not differ. The students' knowledge correlated with their IPE and interprofessional communication-related skills and behavior, but not with their interprofessional attitudes. These dental hygiene, dental, and medical students' OMFS/hospital dentistry-related knowledge/skills and behavior increased over the course of their academic programs, while their IPE-related and intra- and interprofessional attitudes, especially for medical students, did not improve over time. OMFS and hospital dentistry units in medical centers offer distinctive opportunities for IPE and IPC. Utilizing these units may be one way to ensure that graduating providers are motivated to engage in IPC in their practice, thus contributing to reducing oral health disparities and increasing access to oral care for underserved populations. [ABSTRACT FROM AUTHOR]

The article discusses the organizational aspects of stamp collecting in relation to the author's views about how classification brings order to the law as of 2017, and it mentions the views of Nobel Prize winner Ronald Coase regarding physics and social science. The history of legal scholarship is addressed, along with legal classification in relation to estates in land and American antitrust law. The U.S. Sherman Act and the relationship between law and science are assessed.

This study presents narrative case study vignettes of three elite African American male football athletes at a major historically White institution of higher education with a big-time athletics department. More specifically, I draw from critical race theory to garner insight into their secondary schooling background, what education means to them, and how racism impacts their holistic development. The focus group and individual interviews revealed each came from urban high schools in close proximity to the university, viewed education as more than classroom learning and obtaining a degree, and perceived racism as alive and well in college sport. [ABSTRACT FROM AUTHOR]

Objectives To evaluate whether the Hospital Admission Risk Profile ( HARP) score is associated with skilled nursing or acute rehabilitation facility discharge after an acute hospitalization. Design Retrospective cohort study. Setting Inpatient unit of a rural academic medical center. Participants Hospitalized individuals aged 70 and older from October 1, 2013 to June 1, 2014. Measurements Participant age at the time of admission, modified Folstein Mini-Mental State Examination score, and self-reported instrumental activities of daily living 2 weeks before admission were used to calculate HARP score. The primary predictor was HARP score, and the primary outcome was discharge disposition (home, facility, deceased). Multivariate analysis was used to evaluate the association between HARP score and discharge disposition, adjusting for age, sex, comorbidities, and length of stay. Results Four hundred twenty-eight individuals admitted from home were screened and their HARP scores were categorized as low (n = 162, 37.8%), intermediate (n = 157, 36.7%), or high (n = 109, 25.5%). Participants with high HARP scores were significantly more likely to be discharged to a facility (55%) than those with low HARP scores (20%) ( P < .001). After adjustment, participants with high HARP scores were more than four times as likely as those with low scores to be discharged to a facility (odds ratio = 4.58, 95% confidence interval = 2.42-8.66). Conclusion In a population of older hospitalized adults, HARP score (using readily available admission information) identifies individuals at greater risk of skilled nursing or acute rehabilitation facility discharge. Early identification for potential facility discharges may allow for targeted interventions to prevent functional decline, improve informed shared decision-making about post-acute care needs, and expedite discharge planning. [ABSTRACT FROM AUTHOR]

Background: The objective of this work was to inform the design of a rapid response program to support evidence-informed decision-making in health policy and practice for the Americas region. Specifically, we focus on the following: (1) What are the best methodological approaches for rapid reviews of the research evidence? (2) What other strategies are needed to facilitate evidence-informed decision-making in health policy and practice? and (3) How best to operationalize a rapid response program?Methods: The evidence used to inform the design of a rapid response program included (i) two rapid reviews of methodological approaches for rapid reviews of the research evidence and strategies to facilitate evidence-informed decision-making, (ii) supplementary literature in relation to the "shortcuts" that could be considered to reduce the time needed to complete rapid reviews, (iii) four case studies, and (iv) supplementary literature to identify additional operational issues for the design of the program.Results: There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting them. Better reporting of rapid review methods is needed. The literature found in relation to shortcuts will be helpful in choosing shortcuts that maximize timeliness while minimizing the impact on quality. Evidence for other strategies that can be used concurrently to facilitate the uptake of research evidence, including evidence drawn from rapid reviews, is presented. Operational issues that need to be considered in designing a rapid response program include the implications of a "user-pays" model, the importance of recruiting staff with the right mix of skills and qualifications, and ensuring that the impact of the model on research use in decision-making is formally evaluated.Conclusions: When designing a new rapid response program, greater attention needs to be given to specifying the rapid review methods and reporting these in sufficient detail to allow a quality assessment. It will also be important to engage in other strategies to facilitate the uptake of the rapid reviews and to evaluate the chosen model in order to make refinements and add to the evidence base for evidence-informed decision-making. [ABSTRACT FROM AUTHOR]