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American Indian and Alaska Native (AI/AN) people in the United States face elevated childbirth-related risks when compared with non-Hispanic white people. Access to health care is a treaty right of many AI/AN people, often facilitated through the Indian Health Service (IHS), but many AI/AN people do not qualify for or cannot access IHS care and rely on health insurance coverage to access care in other facilities. Our goal was to describe health insurance coverage and access to IHS care before, during, and after childbirth for AI/AN birthing people in the United States. We analyzed 2016 to 2020 Pregnancy Risk Assessment Monitoring System data (44 states and two other jurisdictions) for 102,860 postpartum individuals (12,920 AI/AN and 89,940 non-Hispanic white). We calculated weighted percentages, adjusted predicted probabilities, and percentage point differences for health care coverage (insurance type and IHS care) before, during, and after childbirth. Approximately 75% of AI/AN birthing people did not have IHS care around the time of childbirth. AI/AN people had greater variability in insurance coverage and more insurance churn (changes in type of insurance, including between coverage and no coverage) during the perinatal period, compared with non-Hispanic white people. Health care coverage differed for rural and urban AI/AN people, with rural AI/AN residents having the lowest prevalence of continuous insurance (60%). AI/AN birthing people experience insurance churning and limited access to IHS care during the perinatal period. Efforts to improve care for AI/AN birthing people should engage federal, state, and tribal entities to ensure fulfillment of the trust responsibility of the United States and to address health inequities. [ABSTRACT FROM AUTHOR]

Purpose: Intimate partner violence (IPV) is elevated among rural residents and contributes to maternal morbidity and mortality. Postpartum health insurance expansion efforts could address multiple causes of maternal morbidity and mortality, including IPV. The objective of this study was to describe the relationship between perinatal health insurance, IPV, and postpartum abuse screening among rural US residents. Methods: Using 2016‐2020 data on rural residents from the Pregnancy Risk Assessment Monitoring System, we assessed self‐report of experiencing physical violence by an intimate partner and rates of abuse screening at postpartum visits. Health insurance at childbirth and postpartum was categorized as private, Medicaid, or uninsured. We also measured insurance transitions from childbirth to postpartum (continuous private, continuous Medicaid, Medicaid to private, and Medicaid to uninsured). Findings: IPV rates varied by health insurance status at childbirth, with the highest rates among Medicaid beneficiaries (7.7%), compared to those who were uninsured (1.6%) or privately insured (1.6%). When measured by insurance transitions, the highest IPV rates were reported by those with continuous Medicaid coverage (8.6%), followed by those who transitioned from Medicaid at childbirth to private insurance (5.3%) or no insurance (5.9%) postpartum. Nearly half (48.1%) of rural residents lacked postpartum abuse screening, with the highest proportion among rural residents who were uninsured at childbirth (66.1%) or postpartum (52.1%). Conclusion: Rural residents who are insured by Medicaid before or after childbirth are at elevated risk for IPV. Medicaid policy efforts to improve maternal health should focus on improving detection and screening for IPV among rural residents. [ABSTRACT FROM AUTHOR]

The National Collegiate Athletic Association and Department of Defense (NCAA-DoD) Mind Matters Challenge created "useful and feasible" consensus recommendations to improve concussion care-seeking behavior in collegiate athletes and military cadets. Given athletic trainers' (ATs') role as providers of concussion education and medical care, it is important to understand if they agree with the expert panel that the recommendations are useful and feasible. To describe and compare the perceptions of ATs in the secondary school (SS) and collegiate settings of the utility and feasibility of the NCAA-DoD Mind Matters Challenge recommendations on improving concussion education. Cross-sectional study. Electronic survey. Five hundred fifteen (515) ATs (age = 40.7 ± 12.4 years, 53.1% female gender) practicing in the SS (60.6%) or collegiate (38.4%) setting. An online survey asked participants about their awareness of the statement followed by 17 pairs of Likert-item questions regarding each recommendation's utility and feasibility with responses ranging from no (1) to yes (9). Mimicking the consensus process, we defined consensus as a mean rating of ≥7.00. We compared utility and feasibility rating responses between SS and collegiate setting participants using Mann-Whitney U tests with α =.05. Two-thirds (66.6%) of participants were unaware of the consensus statement. Participants felt all recommendations were useful (all means ≥ 7.0); however, 4 recommendations related to collaborating with stakeholders did not meet the feasibility cutoff (mean range = 6.66–6.84). Secondary school ATs rated lower feasibility related to educational content (P value range =.001–.014), providing patient education throughout recovery (P =.002), and promoting peer intervention (P =.019) but higher utility (P =.007) and feasibility (P =.002) for providing parent education than collegiate ATs. The NCAA-DoD Mind Matters Challenge recommendations require further dissemination. Athletic trainers rated collaboration with stakeholders as a feasibility barrier. Secondary school ATs require more resources for educational content, messaging, and promoting peer intervention but find educating athletes' parents more useful and feasible than collegiate ATs. [ABSTRACT FROM AUTHOR]

Purpose. Recently, the association between ATRX and a more aggressive sarcoma phenotype has been shown. We performed a retrospective study of sarcomas from an individual institution to evaluate ATRX as a prognosticator in soft tissue sarcoma. Experimental Design. 128 sarcomas were collected from a single institution and stained for ATRX. The prognostic significance of these markers was evaluated in a smaller cohort of primary soft tissue sarcomas (n = 68). Kaplan–Meier curves were created for univariate analysis, and Cox regression was utilized for multivariate analysis. Results. High expression of ATRX was found to be a positive prognostic indicator for overall survival and metastasis-free survival in our group of soft tissue sarcomas both in univariate analysis and multivariate analysis (HR: 0.38 (0.17–0.85), P = 0.02 and HR: 0.49 (0.24–0.99), P = 0.05 , respectively). Conclusions. High expression of ATRX is a positive prognostic indicator of overall survival and metastasis-free survival in patients with STS. This is consistent with studies in osteosarcoma, which indicate possible mechanisms through which loss of ATRX leads to more aggressive phenotypes. Future prospective clinical studies are required to validate the prognostic significance of these findings. [ABSTRACT FROM AUTHOR]

African American/Black persons belong to the second largest racial/ethnic minority group in the United States. This group evinces significant disparities related to cannabis use problems. Social determinants of health may be potentially relevant to better understand cannabis use problems among African American/Black adults. As such, the current study sought to provide an initial test of the role of financial strain, a prominent social determinant of health, in cannabis use problems and perceived barriers for cannabis cessation among African American/Black adults. Participants were 76 (32.9% female, Mage = 38.64, SD = 10.82) African American/Black adult, current cannabis users. Hierarchical regression results indicated that greater financial strain was associated with more cannabis use problems and greater perceived barriers for cannabis cessation; such effects were evident above and beyond the variance explained by a range of relevant covariates, including age, sex, income, education, and depressive symptoms. These findings suggest addressing financial strain (e.g., financial planning, psychoeducation about the handling financial stress) may be a useful therapeutic tactic in the larger landscape of treatment programming when targeting cannabis use behaviors and beliefs among African American/Black adult cannabis users. [ABSTRACT FROM AUTHOR]

Objective: To describe rates and predictors of perinatal intimate partner violence (IPV) and rates and predictors of not being screened for abuse among rural and urban IPV victims who gave birth. Data Sources and Study Setting: This analysis utilized 2016–2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 45 states and three jurisdictions. Study Design: This is a retrospective, cross‐sectional study using multistate survey data. Data Collection/Extraction Methods: This analysis included 201,413 survey respondents who gave birth in 2016–2020 (n = 42,193 rural and 159,220 urban respondents). We used survey‐weighted multivariable logistic regression models, stratified by rural/urban residence, to estimate adjusted predicted probabilities and 95% confidence intervals (CIs) for two outcomes: (1) self‐reported experiences of IPV (physical violence by a current or former intimate partner) and (2) not receiving abuse screening at health care visits before, during, or after pregnancy. Principal Findings: Rural residents had a higher prevalence of perinatal IPV (4.6%) than urban residents (3.2%). Rural respondents who were Medicaid beneficiaries, 18–35 years old, non‐Hispanic white, Hispanic (English‐speaking), or American Indian/Alaska Native had significantly higher predicted probabilities of experiencing perinatal IPV compared with their urban counterparts. Among respondents who experienced perinatal IPV, predicted probabilities of not receiving abuse screening were 21.3% for rural and 16.5% for urban residents. Predicted probabilities of not being screened for abuse were elevated for rural IPV victims who were Medicaid beneficiaries, 18–24 years old, or unmarried, compared to urban IPV victims with those same characteristics. Conclusions: IPV is more common among rural birthing people, and rural IPV victims are at higher risk of not being screened for abuse compared with their urban peers. IPV prevention and support interventions are needed in rural communities and should focus on universal abuse screening during health care visits and targeted support for those at greatest risk of perinatal IPV. [ABSTRACT FROM AUTHOR]

Gestational and pregestational diabetes during pregnancy are substantial and growing public health issues. Low-income individuals and individuals who identify as racial and ethnic minorities are disproportionately affected. Food security, which is defined as the degree to which individuals have capacity to access and obtain food, is at the center of nutritional resources and decisions for individuals with diabetes. While increasingly recognized as an important mediator of health disparities in the United States, food insecurity is understudied during pregnancy and specifically among pregnant individuals with diabetes, for whom the impact of food-related resources may be even greater. Previous research has suggested that food insecurity is associated with type 2 diabetes mellitus diagnoses and disease exacerbation in the general adult population. An emerging body of research has suggested that food insecurity during pregnancy is associated with gestational diabetes mellitus diagnoses and adverse diabetes-related outcomes. Additionally, food insecurity during pregnancy may be associated with adverse maternal and neonatal outcomes. Future research and clinical work should aim to further examine these relationships and subsequently develop evidence-based interventions to improve diabetes-related outcomes among pregnant individuals with food insecurity. The purpose of this article is to offer a working definition of food security, briefly review issues of food insecurity and diabetes, summarize research on food insecurity and diabetes-related pregnancy health, and discuss clinical recommendations and areas for future investigation. Key Points Research on food insecurity and diabetes-related health is limited. The impact of food security on diabetes management and obstetric outcomes is likely significant. Future work to evaluate perinatal food security screening is warranted. [ABSTRACT FROM AUTHOR]

Objectives. To measure rates of intimate partner violence (IPV) screening during the perinatal period among people experiencing physical violence in the United States. Methods. We used 2016–2019 Pregnancy Risk Assessment Monitoring System data (n = 158 338) to describe the incidence of physical IPV before or during pregnancy. We then assessed the prevalence of IPV screening before, during, or after pregnancy and predictors of receiving screening among those reporting violence. Results. Among the 3.5% (n = 6259) of respondents experiencing violence, 58.7%, 26.9%, and 48.3% were not screened before, during, or after pregnancy, respectively. Those reporting Medicaid or no insurance at birth, American Indian/Alaska Native people, and Spanish-speaking Hispanic people faced increased risk of not having a health care visit during which screening might occur. Among those attending a health care visit, privately insured people, rural residents, and non-Hispanic White respondents faced increased risk of not being screened. Conclusions. Among birthing people reporting physical IPV, nearly half were not screened for IPV before or after pregnancy. Public health efforts to improve maternal health must address both access to care and universal screening for IPV. (Am J Public Health. 2023;113(3):297–305. https://doi.org/10.2105/10.2105/AJPH.2022.307195) [ABSTRACT FROM AUTHOR]

Difficulties with emotion regulation and distress tolerance are related to more cannabis problems, yet little research has identified why this is the case. Cannabis-related protective behavioral strategies (PBS; behaviors used to mitigate cannabis related problems) are related to less cannabis consumption and related problems. Potentially, these individuals may use cannabis to alleviate the distress and/or in an attempt to regulate their emotions. Thus, the present study aimed to examine the mediational role of PBS on the relations of emotion dysregulation and distress intolerance with cannabis problems. Undergraduate students who endorsed past-month cannabis use (N = 339, M age = 19.33, SD age = 1.37; 77.9 % female) at a southern United States university completed a survey online via Qualtrics. More emotion dysregulation and less distress tolerance predicted less PBS use and more cannabis problems, but not cannabis use frequency. After statistically controlling for sex, the relation of each transdiagnostic factor with cannabis problems occurred indirectly via the relations of less PBS use and greater cannabis use frequency The present study supports previous claims that emotion dysregulation and distress intolerance are related to more cannabis problems. Additionally, results suggest that individuals with high levels of these problems underutilize PBS which, in turn, is associated with more frequent cannabis use and use-related problems. Clinical implications are discussed. • Emotion dysregulation (ED) predicted less protective behavioral strategies (PBS) and more cannabis problems • Lower distress tolerance (DT) predicted less PBS and more cannabis problems • ED and low DT were related to cannabis problems indirectly via the serial effects of less PBS and more frequent cannabis use [ABSTRACT FROM AUTHOR]

Objective: Half of maternal deaths occur during the postpartum year, with data suggesting greater risks among Black, Indigenous, and people of color (BIPOC) and rural residents. Being insured after childbirth improves postpartum health-related outcomes, and recent policy efforts focus on extending postpartum Medicaid coverage from 60 days to 1 year postpartum. The purpose of this study is to describe postpartum health insurance coverage for rural and urban U.S. residents who are BIPOC compared to those who are white. Materials and Methods: Using data from the 2016–2019 Pregnancy Risk Assessment Monitoring System (n = 150,273), we describe health insurance coverage categorized as Medicaid, commercial, or uninsured at the time of childbirth and postpartum. We measured continuity of insurance coverage across these periods, focusing on postpartum Medicaid disruptions. Analyses were conducted among white and BIPOC residents from rural and urban U.S. counties. Results: Three-quarters (75.3%) of rural white people and 85.3% of urban white people were continuously insured from childbirth to postpartum, compared to 60.5% of rural BIPOC people and 65.6% of urban BIPOC people. Postpartum insurance disruptions were frequent among people with Medicaid coverage at childbirth, particularly among BIPOC individuals, compared to those with private insurance; 17.0% of rural BIPOC residents had Medicaid at birth and became uninsured postpartum compared with 3.4% of urban white people. Conclusions: Health insurance coverage at childbirth, postpartum, and across these timepoints varies by race/ethnicity and rural compared with urban residents. Policy efforts to extend postpartum Medicaid coverage may reduce inequities at the intersection of racial/ethnic identity and rural geography. [ABSTRACT FROM AUTHOR]

American black bears (Ursus americanus) commonly habituate to human resources in regions of urban‐wildland interface, which frequently leads to human‐wildlife conflict. Monitoring bear densities is important to inform management, yet traditional density estimation methods may not be practical in such areas. Minimally or noninvasive genetic tools offer a potential solution, but the most common sampling method employs barbed‐wire hair snares and scented lure, which can pose dangers to people and pets. Fecal DNA, which is less invasive, has been used successfully for many species, but has not been commonly used for ursids in the United States. We conducted a pilot study from July–September 2018 to assess the feasibility of using fecal DNA in a spatial capture‐recapture analysis to estimate black bear density in the Lake Tahoe Basin in California, a region of high‐human density compared to other urban‐wildland interface localities in the United States, where bears pose significant nuisance problems. The use of fecal DNA allowed us to sample in both urban and wildland areas with minimal disturbance to the surrounding community. Based on 142 genotyped samples from 101 distinct individuals, we estimated an abundance of 0.84 bears/km2 (95% CI = 0.58–1.21 bears/km2), which was similar to a previous capture‐recapture estimate in the study area and represents one of the highest densities reported for black bears. More generally, our findings indicated that fecal DNA capture‐recapture approaches provide a feasible means of estimating black bear densities in areas where hair sampling may be impractical. [ABSTRACT FROM AUTHOR]

Background: The Coronavirus disease 2019 (COVID-19) pandemic has contributed to over 2 million deaths and hospitalization of many individuals worldwide. Although preliminary evidence suggests that cannabis use has increased during the pandemic, there has been little research on the impact of cannabis use on COVID-related psychological outcomes. Cannabis use among college students is associated with problematic psychosocial outcomes; thus, it follows that cannabis users during the pandemic may experience more functional impairment problems with daily living as a result of increased psychological distress from the pandemic and difficulty with regulating that distress. Methods: The current study tested whether cannabis use status was related to functional impairment in daily activities and whether this was due to difficulty with emotion regulation and COVID-related distress. The sample comprised of 727 (184 current cannabis users) young adults in Louisiana, a state that had some of the highest rates of COVID-19 deaths and infections in the U.S. Results: Cannabis use was related to greater functional impairment in daily activities and this relation was mediated by the sequential effects of difficulty with emotion regulation and COVID-related distress. Conclusions: Results indicated that cannabis users during the COVID-19 pandemic are experiencing problematic psychosocial outcomes further highlighting the need for the development of interventions to help target COVID-related distress and improve psychosocial functioning during the pandemic. [ABSTRACT FROM AUTHOR]

Background: Electronic cigarette (e-cigarette) use has risen dramatically in the United States among young adults; however, little is understood about potential factors that are related to e-cigarette use and maintenance among this population. Fatigue severity is one promising individual difference factor, as past work indicates that it is related to greater withdrawal symptoms and greater dependence on e-cigarettes, and more barriers to quitting. In addition, anxiety sensitivity and severe fatigue are both uniquely related to poor e-cigarette use outcomes; yet, no known studies have examined whether these individual difference factors are related to e-cigarette outcomes among young adults. Method: The current study sought to examine the unique and interactive effects of anxiety sensitivity and fatigue severity in predicting a variety of e-cigarette outcomes among 685 (69.1% female; Mage = 19.61 years, SD = 1.44) young adult e-cigarette users. Results: Results indicated that anxiety sensitivity was significantly associated with greater barriers for cessation (β =.63, p <.001) and e-cigarette cravings (β =.67, p =.001), but not dependence. Fatigue severity was significantly associated with greater e-cigarette dependence (β =.58, p <.001), barriers to cessation (β = 1.56, p <.001), and e-cigarette cravings (β = 3.34, p <.001). The interactive effects of anxiety sensitivity and fatigue severity did not significantly predict the outcomes. Discussion: Results suggest that anxiety sensitivity and fatigue severity independently predict greater e-cigarette maintenance factors among young adults. The current investigation highlights the importance of targeting anxiety sensitivity and fatigue severity among young adult e-cigarette users. [ABSTRACT FROM AUTHOR]

Background: Rural hospitals are closing obstetric units, and limited information is available about local emergency obstetric preparedness and capacity in rural communities where hospitals do not routinely provide this care. Objective: To describe emergency obstetric capacity at rural US hospitals that do not routinely offer childbirth services. Methods: Data from the 2018 American Hospital Association Annual Survey were used to identify a random sample of rural hospitals that did not offer obstetric services. A survey was developed based on World Health Organization criteria for obstetric emergencies. With data collected from 69 rural hospital emergency departments (48% response rate), we analyzed local capacity to support childbirth. Results: Most responding hospitals (65%) were located 30 or more miles away from a hospital with obstetric services. Some reported having emergency room births in the past year (28%), an unanticipated adverse birth outcome (32%), and/or a delay in urgent transport for a pregnant patient (22%). More than 90% of responding hospitals had capacity for blood transfusion, intravenous antibiotics or anticonvulsants, and basic neonatal resuscitation. However, less than one‐fifth had capacity to perform surgery (16%), remove retained products of delivery (17%), or had a policy for emergency cesarean (18%). Almost all respondents (80%) reported the need for additional training or resources to handle emergency obstetric situations. Conclusion: Many rural hospitals do not have basic capacity to provide emergency obstetric services. Programs and policies to improve this may focus on surgical care, clinician and staff training, transportation, and coordination with nearby hospitals that provide obstetric services. [ABSTRACT FROM AUTHOR]

The opioid epidemic is a significant public health concern in the United States, particularly among adults with chronic pain. Considerable research suggests that people with mental health problems, including anxiety and depression, may experience more opioid-related problems in the context of chronic pain. Yet, little work has examined potential mechanisms underyling these relations. Emotion dysregulation is one mechanistic factor that may link anxiety and depression and opioid-related problems among persons with chronic pain. Therefore, the current study examined the explanatory role of emotion dysregulation in the cross-sectional relationship between anxiety and depression problems and current opioid misuse and severity of opioid dependence among 431 adults with chronic pain who reported currently using opioid medications (74% female, Mage=38.32 years, SD = 11.11). Results indicated that emotion dysregulation explained, in part, the relationship between anxiety and depression symptoms and opioid-related problems. These findings highlight the need to further consider the role of emotion dysregulation among adults with chronic pain who use prescription opioids and experience symptoms of anxiety or depression. Future prospective research will be needed to further establish emotion dysregulation as a mechanism in anxiety/depression-opioid misuse/dependence processes. [ABSTRACT FROM AUTHOR]

Background: Historically, amputation was the primary surgical treatment for osteosarcoma of the extremities; however, with advancements in surgical techniques and chemotherapies limb salvage has replaced amputation as the dominant treatment paradigm. This study assessed the type of surgical resection chosen for osteosarcoma patients in the twenty-first century.Methods: Utilizing the largest registry of primary osteosarcoma, the National Cancer Database (NCDB), we retrospectively analyzed patients with high grade osteosarcoma of the extremities from 2004 through 2015. Differences between patients undergoing amputation and patients undergoing limb salvage are described. Unadjusted five-year overall survival between patients who received limb salvage and amputation was assessed utilizing Kaplan Meier curves. A multivariate Cox proportional hazard model and propensity matched analysis was used to determine the variables independently correlated with survival.Results: From a total of 2442 patients, 1855 underwent limb salvage and 587 underwent amputation. Patients undergoing amputation were more likely to be older, male, uninsured, and live in zip codes associated with lower income. Patients undergoing amputation were also more likely to have larger tumors, more comorbid conditions, and metastatic disease at presentation. After controlling for confounders, limb salvage was associated with a significant survival benefit over amputation (HR: 0.70; p < 0.001). Although this may well reflect underlying biases impacting choice of treatment, this survival benefit remained significant after propensity matched analysis of all significantly different independent variables (HR: 0.71; p < 0.01).Conclusion: Among patients in the NCDB, amputation for osteosarcoma is associated with advanced age, advanced stage, larger tumors, greater comorbidities, and lower income. Limb salvage is associated with a significant survival benefit, even when controlling for significant confounding variables and differences between cohorts. [ABSTRACT FROM AUTHOR]

Objective: To describe delivery-related severe maternal morbidity and mortality among indigenous women compared with non-Hispanic white (white) women, distinguishing rural and urban residents.Methods: We used 2012-2015 maternal hospital discharge data from the National Inpatient Sample to conduct a pooled, cross-sectional analysis of indigenous and white patients who gave birth. We used weighted multivariable logistic regression and predictive population margins to measure health conditions and severe maternal morbidity and mortality (identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes) among indigenous and white patients, to test for differences across both groups, and to test for differences between rural and urban residents within each racial category.Results: We identified an estimated 7,561,729 (unweighted n=1,417,500) childbirth hospitalizations that were included in the analyses. Of those, an estimated 101,493 (unweighted n=19,080) were among indigenous women, and an estimated 7,460,236 (unweighted n=1,398,420) were among white women. The incidence of severe maternal morbidity and mortality was greater among indigenous women compared with white women (2.0% vs 1.1%, respectively; relative risk [RR] 1.8, 95% CI 1.6-2.0). Within each group, incidence was higher among rural compared with urban residents (2.3% for rural indigenous women vs 1.8% for urban indigenous women [RR 1.3, 95% CI 1.0-1.6]; 1.3% for rural white women vs 1.2% for urban white women [RR 1.1, 95% CI 1.1-1.2]).Conclusion: Severe maternal morbidity and mortality is elevated among indigenous women compared with white women. Incidence is highest among rural indigenous residents. Efforts to improve maternal health should focus on populations at greatest risk, including rural indigenous populations. [ABSTRACT FROM AUTHOR]

In the United States, severe maternal morbidity and mortality is climbing--a reality that is especially challenging for rural communities, which face declining access to obstetric services. Severe maternal morbidity refers to potentially life-threatening complications or the need to undergo a lifesaving procedure during or immediately following childbirth. Using data for 2007-15 from the National Inpatient Sample, we analyzed severe maternal morbidity and mortality during childbirth hospitalizations among rural and urban residents. We found that severe maternal morbidity and mortality increased among both rural and urban residents in the study period, from 109 per 10,000 childbirth hospitalizations in 2007 to 152 per 10,000 in 2015. When we controlled for sociodemographic factors and clinical conditions, we found that rural residents had a 9 percent greater probability of severe maternal morbidity and mortality, compared with urban residents. Attention to the challenges faced by rural patients and health care facilities is crucial to the success of efforts to reduce maternal morbidity and mortality in rural areas. These challenges include both clinical factors (workforce shortages, low patient volume, and the opioid epidemic) and social determinants of health (transportation, housing, poverty, food security, racism, violence, and trauma). [ABSTRACT FROM AUTHOR]

Mainstream policy discussions take as given that the United States will and must pay its debts in full and on time, and that restructuring is legally and politically impossible. In our judgment, this assumption is unwarranted. Far from being unthinkable, under some circumstances restructuring the debt of the United States would merit serious consideration, and these circumstances may well be fast approaching. We diverge from the standard wisdom for two reasons. First, we doubt that payments on treasury obligations will necessarily take precedence over what the electorate sees as more pressing needs, including national security and price stability. In particular, we suspect voters may balk if told that holders of United States debt securities have ironclad priority over Social Security claimants and others with well-settled expectations of government benefits. Second, we think it wrong to equate restructuring with catastrophe. While we do not dismiss out of hand the dangers of not paying creditors in full and on time, we believe that--perhaps counterintuitively--the American constitutional framework could prove an asset rather than a liability when it comes to handling severe financial stress. Our conclusion on this point follows from the insight that the very dispersals of power that can fuel gridlock can also serve to enable the United States to offer credible assurances that its new financial structure will be stable going forward. [ABSTRACT FROM AUTHOR]

Between 1990 and 2013, maternal mortality nearly doubled in the United States and rural residents experienced decreasing access to obstetric care. To improve maternal health, many states have established maternal mortality and morbidity review committees (MMRCs). We assessed the extent of rural representation in state policy efforts related to MMRCs. We reviewed publicly available information on MMRCs (websites, statutes, bills, media) in all 50 states and the District of Columbia, separately identifying highly rural states (with >30% of the population being rural residents). We assessed whether each state 1) had established an MMRC, 2) had passed legislation requiring an MMRC, 3) had considered, but not passed, legislation requiring an MMRC, 4) mentioned rural populations in MMRC legislation, 5) required representation on the MMRC from any particular groups, and 6) required rural representation on the MMRC. As of December 2018, MMRCs were established in 45 states and the District of Columbia, an increase from 23 in 2010. Legislation was in place in 27 states, up from 6 in 2010. Only three states specifically mentioned rurality in legislation (including one highly rural state), and only two states required rural representation among their MMRC members (neither of which were highly rural states). Recent growth in MMRCs has had a limited focus on rural residents, despite their worse health outcomes and more limited access to health care, including obstetric services. Lack of rural representation may hamper geographically tailored efforts to reverse rising rates of maternal morbidity and mortality nationally. [ABSTRACT FROM AUTHOR]

Objectives. To describe characteristics of rural hospitals in the United States by whether they provide labor and delivery (obstetric) care for pregnant patients. Methods. We used the 2017 American Hospital Association Annual Survey to identify rural hospitals and describe their characteristics based on the lack or provision of obstetric services. Results. Among the 2019 rural hospitals in the United States, 51% (n = 1032) of rural hospitals did not provide obstetric care. These hospitals were more often located in rural noncore counties (counties with no town of more than 10 000 residents). Rural hospitals without obstetrics also had lower average daily censuses, were more likely to be government owned or for profit compared with nonprofit ownership, and were more likely to not have an emergency department compared with hospitals providing obstetric care (P for all comparisons <.001). Conclusions. Rural US hospitals that do not provide obstetric care are located in more sparsely populated rural locations and are smaller than hospitals providing obstetric care. Public Health Implications. Understanding the characteristics of rural hospitals by lack or provision of obstetric services is important to clinical and policy efforts to ensure safe maternity care for rural residents. [ABSTRACT FROM AUTHOR]

This study describes hospital-based obstetric service losses in rural US counties between 2014 and 2018 overall and by county population and urban adjacency. [ABSTRACT FROM AUTHOR]

Background: Specific events such as Mardi Gras (MG) and St. Patrick's Day (SPD) have been identified as high-risk events for cannabis use. Further, some campuses may have traditions that are associated with more event-specific cannabis use. Objectives: Campus A has specific traditions regarding MG whereas Campus B has specific traditions regarding SPD and these campuses are differentially related to event-specific cannabis use (Buckner, Henslee, & Jeffries, 2015). Yet, little work has identified individual difference variables related to high-risk cannabis use events. Methods: Current cannabis using undergraduates (N = 154) at two campuses completed an online survey of event-specific cannabis use motives, cannabis use, and cannabis-related problems. Results: Campus A endorsed more MG-specific social and enhancement motives than Campus B. Campus A reported more socially, enhancement, coping, conformity, and expansion motivated cannabis use on MG than on SPD, whereas Campus B reported more socially and enhancement motivated cannabis use on SPD than on MG. Campus A was indirectly related to more MG-specific cannabis use through MG-specific social and enhancement motives. Conclusions/Importance: Event-specific cannabis motives are differentially related to specific high-risk cannabis use events and may be important therapeutic targets. [ABSTRACT FROM AUTHOR]

Background: Counseling for appropriate medication use and folic acid consumption are elements of preconception care critical for improving pregnancy outcomes. Hispanic women receive less preconception care than women of other race/ethnic groups. The objective of this analysis is to describe differences in these two elements of preconception care among Hispanic subsegments. Materials and Methods: Porter Novelli's 2013 Estilos survey was sent to 2,609 U.S. Hispanic adults of the Offerwise QueOpinas Panel. Surveys were completed by 1,000 individuals (calculated response rate 42%), and results were weighted to the 2012 U.S. Census Hispanic proportions for sex, age, income, household size, education, region, country of origin, and acculturation. Responses were analyzed with weighted descriptive statistics, linear regression, and Rao-Scott chi-square tests. Results: Of the 499 female respondents, 248 had a child under the age of 18 years and were asked about healthcare provider discussions concerning medication use before or during their last pregnancy. Timing of discussions varied by maternal age, marital status, income, youngest child's country of birth, and acculturation. Discussions before pregnancy were reported by 47% of the female respondents; high acculturated women more often reported never having such discussions. Among female respondents, 320 were of reproductive age, and 27% of those reported daily multivitamin use. Multivitamin use varied by pregnancy intention and youngest child's country of birth, but did not vary significantly by acculturation. Conclusions: Differences in discussions concerning medication use in pregnancy and multivitamin use exist among Hispanic subsegments based on pregnancy intention, marital status, income, youngest child's country of birth, and level of acculturation. [ABSTRACT FROM AUTHOR]

The article examines the importance in doctor of philosophy (PhD) degree as student's preparation for an academic position in the job market in the U.S. Challenges and goals of PhD training to ensure the quality and return on investment of degree programs, are highlighted. Also emphasized is the major role of higher education in evaluation the quality and results of the programs.

Background: Childhood maltreatment is a known risk factor for cannabis initiation and problem use, but the extent to which this association is attributable to shared familial influences is unknown. We estimate the magnitude of associations between childhood maltreatment, timing of cannabis initiation, and cannabis-related problems, in European-American (EA) and African-American (AA) women, and parse the relative influence of additive genetic (A), shared environmental (C), and individual-specific environmental (E) factors on these constructs and their covariation.Methods: Data were from diagnostic telephone interviews conducted with 3786 participants (14.6% AA) in a population-based study of female twins. Logistic regression analyses and twin modeling were used to test for associations, and estimate the relative contributions of genetic and environmental influences to childhood maltreatment and cannabis outcomes and their covariation.Results: Maltreatment was significantly associated with increased likelihood of cannabis initiation before age 15 among EAs (OR=6.33) and AAs (OR=3.93), but with increased likelihood of later initiation among EAs only (OR=1.68). Maltreatment was associated with cannabis problems among both groups (EA OR=2.32; AA OR=2.03). Among EA women, the covariation between maltreatment and cannabis outcomes was primarily attributable to familial environment (rC=0.67-0.70); among AAs, only individual-specific environment contributed (rE=0.37-0.40).Conclusion: Childhood maltreatment is a major contributor to early initiation of cannabis as well as progression to cannabis problems in both AA and EA women. Distinctions by race/ethnicity are not in the relative contribution of genetic factors, but rather in the type of environmental influences that contribute to stages of cannabis involvement. [ABSTRACT FROM AUTHOR]

Heavy college drinking is associated with risky sexual behavior. It is therefore important to identify groups that are especially vulnerable to alcohol-influenced sexual risk (e.g., unplanned/unexpected sex). Undergraduates with elevated social anxiety represent one such vulnerable group given that social anxiety is associated with fear of intimacy and heavier drinking in intimate situations and situations with expected negative affect. Drinking to cope with negative affect induced by fear of intimacy might render socially anxious undergraduates vulnerable to risky sexual behavior, yet no known studies have examined this relationship. The current study tested whether social anxiety was related to alcohol-related sexual behaviors among current (past-month) drinking undergraduates (88.1% female; 77.6% non-Hispanic Caucasian) with higher (i.e., clinically elevated) social anxiety (HSA;n = 40) or lower (more normative) social anxiety (LSA;n = 94). Coping motives were examined as a moderator of the social anxiety-risky sexual behavior relationship. Gender was a covariate. HSA students reported more frequent alcohol-influenced sexual risk including regretted sexual situations, unprotected sex, sex with unwanted partners, unwanted sex, pressured/forced to have sex, and pressured someone to have sex. Coping motives significantly interacted with social anxiety group in the prediction of risky sexual behaviors except regretted sexual situations, such that HSA students with greater coping motives experienced more frequent sexual risk when drinking. Findings indicate that HSA students may be particularly vulnerable to risky sexual behaviors and suggest that coping motivated drinking may be an important target for therapeutic interventions geared toward reducing risky sexual behaviors among this high-risk population. [ABSTRACT FROM PUBLISHER]

Background and Objectives: Cannabis is the most widely used illicit substance among young adults. Anxiety sensitivity (AS; ie, fear of anxiety-related symptoms) is positively related to coping motives for cannabis use (which are robustly positively linked to cannabis-related problems). However, AS is unrelated to cannabis use-related problems. Yet, extant studies have been conducted on primarily White samples. It may be that among Black students, AS-physical concerns (ie, fear of physical anxiety-related sensations) are related to cannabis problems given that Black individuals are more likely than White individuals to report experiencing greater and more intense somatic symptoms when experiencing anxiety. Black individuals may rely on cannabis to cope with fear of these somatic symptoms, continuing to use despite cannabis-related problems.Methods: The current study tested whether race moderated the relation between AS-physical concerns and cannabis problems among 102 (85.3% female) current cannabis using undergraduates who were either non-Hispanic Black (n = 51) or non-Hispanic White (n = 51).Results: After controlling for frequency of cannabis use, income, and gender, race significantly moderated the relation between AS-physical concerns and cannabis use-related problems such that AS-physical concerns significantly predicted cannabis-related problems among Black and not White individuals.Discussion and Conclusions: Findings highlight the importance of considering race in identifying psychosocial predictors of cannabis-related problems.Scientific Significance: Intervention strategies for Black cannabis users may benefit from examining and targeting AS-physical concerns. (Am J Addict 2017;26:209-214). [ABSTRACT FROM AUTHOR]

The author argues that the United States has an exceptional welfare safety net when compared to peer countries as of the early 21st century via services such as government-provided health care insurance, Social Security, and public education expenditures, though could be even more exceptional in renewing the economic prospects for poorer citizens by restructuring the finances of the U.S. government and better harnessing the capabilities of access to health care.

Background and aims Substance use has been implicated in the onset and maintenance of risky sexual behaviors, which have particularly devastating consequences in young women. This study examined whether (i) adolescent onset of cannabis use is associated with repeated voluntary unprotected sex in women and (ii) whether this association persists after accounting for correlated familial influences. Design General population sample of female twins. Setting Midwestern United States. Participants A total of 2784 sexually active twin women (15.5% African American) aged 18-27 years (assessed 2002-05), including 119 dizygotic (DZ) and 115 monozygotic (MZ) discordant pairs. Measurements Self-report interview data on cannabis use that first occurred prior to age 17 (27.1%) and repeated voluntary unprotected sex (27.2%). Key covariates included early onset of regular drinking, regular smoking, sexual debut and menstruation as well as conduct disorder symptoms and childhood sexual abuse. Findings Compared with never users and those who started using cannabis at a later age, adolescent cannabis users were more likely to report repeated voluntary unprotected sex [odds ratio (OR) = 2.69; 95% confidence interval (CI) = 2.24-3.22]. Genetic ( rg = 0.57, 95% CI = 0.38-0.87) and non-shared environmental ( re = 0.21, 95% CI = 0.02-0.38) factors contributed to the association. After accounting for correlated familial factors, there was a consistent elevation in the likelihood of repeated voluntary unprotected sex in the exposed twin relative to her genetically identical never/late-onset user co-twin (unadjusted OR = 2.25, 95% CI = 1.14-4.44), even after adjustment for covariates (adjusted OR = 2.27, 95% CI = 1.08-4.80). Conclusions Women who start using cannabis during adolescence appear to be more likely to report voluntary engagement in repeated unprotected sex than women who never use cannabis or who initiate cannabis use after adolescence. The results appear to be independent of shared genetic influences. [ABSTRACT FROM AUTHOR]

Background: Distinctions in the relative contributions of genetic and environmental factors to initiation of cigarette smoking may explain, in part, the differences between African Americans and European Americans in the prevalence of smoking. The current investigation is the first to compare heritable and environmental influences on smoking initiation between African-American and European-American women.Methods: Data were drawn from Missouri Adolescent Female Twin Study participants and female Missouri Family Study participants (n=4498; 21% African-American, the remainder European-American). Mean ages at first and last assessments were 17.0 (SD=3.5) and 24.0 (SD=3.2), respectively. Twin-sibling modeling was conducted to estimate the proportion of variance in smoking initiation (i.e., ever trying a cigarette) attributable to additive genetic, shared environmental, special twin environmental, and unique environmental factors.Results: Additive genetic influences accounted for approximately half of the variance in smoking initiation in both African-American and European-American women. In the African-American subsample, the remaining variance was attributable primarily to unique environmental factors (46%; 95% CI: 28-71%). In the European-American subsample, only 12% (95% CI: 8-16%) of the variance was attributable to unique environmental factors, with the remainder accounted for by shared environmental (13%; 95% CI: 0-41%) and special twin environmental (24%; 95% CI: 0-52%) factors.Conclusions: The estimated heritability of smoking initiation is substantial and nearly identical for African-American and European-American women, but the type of environmental factors that contribute to risk differ by race/ethnicity. Whereas the primary environmental influences on European-American women's smoking initiation are at the family level, those that impact African-American women's smoking initiation are primarily individual-specific. [ABSTRACT FROM AUTHOR]

Rationale: The etiology of recurrent tuberculosis is typically presumed to be reactivation of residual Mycobacterium tuberculosis infection, but reinfection may account for a greater proportion of recurrent tuberculosis than previously recognized.Objective: To use M. tuberculosis genotyping to characterize the etiology of recurrent tuberculosis occurring 12 months or more after treatment completion.Methods: The study population for this national population-based cohort was drawn from the estimated 3,039 persons reported to the National Tuberculosis Surveillance System with two episodes of tuberculosis in the United States during 1993-2011, 194 of whom had genotyping results from both the initial and subsequent episode. We analyzed the proportion of recurrent tuberculosis attributable to and risk factors associated with reinfection.Measurements and Main Results: Among 136 recurrences meeting inclusion criteria, genotypes between episodes were the same for 116 (85%) recurrences during 1996-2011; the 20 (15%) with differing genotypes were categorized as reinfections. Using exact logistic regression, factors associated with reinfection included Mexican birth with both TB episodes diagnosed in the United States within 12 years of immigration (adjusted odds ratio, 10.7; 95% confidence interval, 1.7-86.3) and exclusive use of directly observed therapy for treatment of the first episode (adjusted odds ratio, 4.5; 95% confidence interval, 1.0-29.2).Conclusions: Reinfection was the cause of 15% of late recurrent tuberculosis cases in this U.S. cohort. The proportion caused by reinfection increased to 60% in certain subpopulations, such as recent immigrants from Mexico, suggesting that, despite successful treatment for tuberculosis during their first episode, these individuals remain in a social environment where they are reexposed to M. tuberculosis. Public health interventions to prevent novel reinfection might require a broader focus in these communities. [ABSTRACT FROM AUTHOR]

The article discusses the U.S. Internal Revenue Service's (IRS') enforcement of a prohibition on political activity under Section 510(c)(3) of America's Internal Revenue Code, focusing on tax penalties and the revocation of an organization's tax-exempt status by the IRS. Punishment for the public condemnation of a political figure is mentioned, along with the legal rights of tax-exempt charities, churches, and educational institutions. The U.S. Congress and lobbying laws are examined.

Background: Pharmacists as the most accessible health professionals can serve as an important resource on medication safety for breastfeeding women. Previous research suggests that a barrier to pharmacists providing optimal pharmaceutical care for this population is a lack of knowledge.Objective: To evaluate pharmacist perceptions and barriers related to medication management of patients who are breastfeeding.Methods: A 25-question electronic survey was distributed via e-mail list servers to members of state pharmacy organizations. Pharmacists were queried on the importance of breastfeeding, barriers to pharmaceutical care, comfort level in making pharmacotherapy recommendations, adequacy of pharmacy school's curriculum, breastfeeding resources used, and need for continuing pharmacy education regarding medication use during breastfeeding.Results: Pharmacists from all geographic regions of the United States and diverse practice settings agreed to participate in the survey (N = 197). Most pharmacists reported feeling somewhat or extremely comfortable making recommendations and counseling breastfeeding patients on over-the-counter (102 of 187, 55%) and prescription medications (110 of 187, 59%). In contrast, 66% (123 of 187) reported feeling somewhat or extremely uncomfortable making recommendations and counseling on the use of herbal supplements in breastfeeding. Notably, 95% of pharmacists (171 of 180) responded that there is an unmet need for continuing pharmacy education on medication use in lactation.Conclusion: Pharmacists are generally uncomfortable when making recommendations and counseling breastfeeding patients on herbal and other supplements. Most pharmacists agree that there is a lack of available continuing pharmacy education on breastfeeding. [ABSTRACT FROM AUTHOR]

Simple Summary: This study looked at the reasons why people sought help for their dog's behavior, where those dogs were acquired by the owner, and which breeds of dogs were seen most often. All dogs in this study presented to a veterinary college specialty hospital in the United States. For dogs presenting to the behavioral medicine service, the types of behavior problems and sources of dogs from 1923 cases over twenty years (1997 to 2017) were evaluated. The breeds of dogs presenting for behavior (822) compared to those presenting to the rest of the hospital for non-behavioral reasons (51,052) were compared over ten years (2007 to 2016). The most common behavioral issue was aggression (72.2% of cases). Dogs obtained from breeders decreased and dogs adopted from shelters increased over twenty years. Dogs from the herding and terrier groups presented more often to the behavioral medicine service compared to the rest of the hospital. While these findings are specific to this population, these results could be helpful in making choices about the allocation of resources for the prevention of behavioral problems, such as genetics research or educational support to shelters. Finally, we found that the variations in terminology and available data made comparisons of behavior problems challenging. The purpose of this retrospective case study was to evaluate trends over time in case distribution, sources, and breeds of dogs presenting to the behavioral medicine service at a veterinary college referral hospital in the United States. For case distribution and sources, the available records from the behavior service (n = 1923) from 1997 to 2017 were evaluated. Breeds of dogs presenting to all services (n = 51,052) were compared to behavior cases (n = 822) from 2007 to 2016. Over twenty years, 72.2% of dogs presented for aggression, 20.1% for anxieties/fears/phobias, and 7.4% for miscellaneous behavioral problems. Dogs acquired from breeders decreased and dogs from shelters, rescues, or adopted as a stray increased over twenty years (p < 0.0001). The Herding (p = 0.0124) and Terrier (p < 0.0001) groups were overrepresented for behavior problems as compared to all other services over ten years. Variations in terminology and diagnostic approach made comparisons with earlier studies difficult, which underscores a need for a more consistent methodology in veterinary behavioral medicine. Understanding trends in sources of dogs could direct resources aimed at guiding owners when acquiring a pet dog and preventing behavioral problems. Findings related to breeds could help guide research focused on the genetic contributions to behavior. [ABSTRACT FROM AUTHOR]

Objectives. Our aim was to determine if the decrease in drug use disorders with age is attributable to changes in persistence, as implied by the notion of maturing out. Also, we examined the association between role transitions and persistence, recurrence, and new onset of drug use disorders. Methods. We performed secondary analysis of the 2 waves of the National Epidemiologic Survey on Alcohol and Related Conditions data (baseline assessment 2001-2002, follow-up conducted 2004-2005). We conducted logistic regressions and multinomial logistic regression to determine the effect of age on wave 2 diagnosis status, as well as the interaction between age and role transitions. Results. Rates of persistence were stable over the life span, whereas rates of new onset and recurrence decreased with age. Changes in parenthood, marital, and employment status were associated with persistence, new onset, and recurrence. We found an interaction between marital status and age. Conclusions. Our findings challenge commonly held notions that the age-related decrease in drug use disorders is attributable to an increase in persistence, and that the effects of role transitions are stronger during young, compared with middle and older, adulthood. [ABSTRACT FROM AUTHOR]

Liver diseases, such as hepatitis C virus (HCV) infection, are "broken spirit" diseases. The prevalence of HCV infection for American Indian/Alaskan Native (AI/AN) in the United States and Canadian Aboriginals varies; nonetheless, incidence rates of newly diagnosed HCV infection are typically higher relative to non-indigenous people. For AI/AN and Aboriginal peoples risk factors for the diagnosis of HCV infection can reflect that of the general population: predominately male, a history of injection drug use, in midlife years, with a connection with urban centers. However, the face of the indigenous HCV infected individual is becoming increasingly female and younger compared to non-indigenous counterparts. Epidemiology studies indicate that more effective clearance of acute HCV infection can occur for select Aboriginal populations, a phenomenon which may be linked to unique immune characteristics. For individuals progressing to chronic HCV infection treatment outcomes are comparable to other racial cohorts. Disease progression, however, is propelled by elevated rates of co-morbidities including type 2 diabetes and alcohol use, along with human immunodeficiency virus (HIV) co-infection relative to non-indigenous patients. Historical and personal trauma has a major role in the participation of high risk behaviors and associated diseases. Although emerging treatments provide hope, combating HCV-related morbidity and mortality will require interventions that address the etiology of broken spirit diseases. [ABSTRACT FROM AUTHOR]

Background: Although there is a long tradition in alcoholism research of using family history ratings, the interpretability of family history reports of alcoholism from general community samples has yet to be established. Methods: Telephone interview data obtained from a large cohort of female like-sex twins ( N = 3,787, median age 22) and their biological parents ( N = 2,928, assessed at twins' median age 15) were analyzed to determine agreement between parent self-report, parent ratings of coparent, and twin narrow (alcohol problems) and broad (problem or excessive drinking) ratings of each parent. Results: In European ancestry ( EA) families, high tetrachoric correlations were observed between twin and cotwin ratings of parental alcohol problems, between twin and parent ratings of coparent alcohol problems using symptom-based and single-item assessments, as well as moderately high correlations between twin and both mother and father self-reports. In African American ( AA) families, inter-rater agreement was substantially lower than for EA families, with no cases where father ratings of maternal alcohol problems agreed with either twin ratings or mother self-report, and both cotwin agreement and mother-twin agreement were reduced. Differences between EA and AA families were not explained by differences in years of cohabitation with father or mother's education; however, underreporting of problems by AA parents may have contributed. Conclusions: Results support the use of family history ratings of parental alcoholism in general community surveys for EA families, but suggest that family history assessment in AA families requires improved methods. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To estimate ethnic differences in three components of alcohol use disorder and alcohol dependence course (onset, persistence and recurrence) in a developmental framework. Design Longitudinal data from The National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), collected using face-to-face interviews. Setting Civilian non-institutionalized US population aged 18 years and older, with oversampling of Hispanics, blacks and those aged 18-24 years. Participants Individuals who completed both NESARC assessments, were not life-long abstainers and were either white ( n = 17 458), black ( n = 4995), US-born Hispanic ( n = 2810) or Hispanic-born outside the United States ( n = 2389). Measurements Alcohol dependence (AD) and alcohol use disorder (AUD; abuse or dependence) onset, persistence and recurrence were examined using the Alcohol Use Disorders and Associated Disabilities Interview Schedule, DSM-IV version. Findings Among men: relative to whites aged 18-29, AUD onset and persistence were elevated only in US-born Hispanics aged 40 years and older; odds were reduced for all non-US-born Hispanics, older whites, most blacks and US-born Hispanics aged 30-39. For AD, onset risk was elevated for all younger minority men and only reduced among non-US-born aged Hispanics 40 or older. For women: compared to young whites, non-US-born Hispanics were at decreased AUD and AD onset risk; AUD and AD onset and persistence were increased for older blacks and US-born Hispanics. Conclusions In the United States, ethnic differences in alcohol disorder transitions (onset, persistence, and recurrence) vary across age, gender and whether a broad (alcohol use disorder) or narrow (alcohol dependence) alcohol definition is used. Evidence of increased risk for some transitions in minority groups suggests that attention should be paid to the course of alcohol use disorders, and that differences in prevalence should not be assumed to reflect differences in specific transitions. [ABSTRACT FROM AUTHOR]

Genetic differences in immune regulators influence disease resistance and susceptibility patterns. There are major health discrepancies in immune-mediated diseases between Caucasians and Canadian Aboriginal people, as well as with other indigenous people of the Americas. Environmental factors offer a limited explanation as Aboriginal people also demonstrate a rare resistance to chronic hepatitis C virus infection. Killer immunoglobulin-like receptors (KIRs) are known modulators of viral responses and autoimmune diseases. The possibility that variation in KIR cluster profiles contribute to the health outcomes of Aboriginal people was evaluated with Canadian Caucasian (n=93, population controls) and Aboriginal (n=86) individuals. Relative to Caucasians, the Aboriginal KIR cluster displayed a greater immune activating phenotype associated with genes of the B haplotype situated within the telomeric region. In conjunction, there was a decrease in the genes of the B haplotype from the centromeric region. Caucasian and Aboriginal cohorts further demonstrated distinct genotype and haplotype relationships enforcing the disconnect between the B haplotype centromeric and telomeric regions within the Aboriginal population. Moreover, Caucasian KIR cluster patterns reflected studies of Caucasians globally, as well as Asians. In contrast, the unique pattern of the Canadian Aboriginal cohort mirrored the phenotype of other indigenous peoples of the Americas, but not that of Caucasians or Asians. Taken together, these data suggest that historically indigenous peoples of the Americas were subject to immune selection processes that could be influencing the current disease resistance and susceptibility patterns of their descendents. [ABSTRACT FROM AUTHOR]

Agricultural runoff is a major non-point source pollutant and is the leading impairment of streams and rivers in the USA. This study examined the effects of agricultural, forest and urban land cover on water quality at the watershed level. Forty-three catchments ranging from 12 to 50 km were selected based on a land cover gradient within Lower Kaskaskia River Watershed in Illinois. Grab samples were collected and analyzed for nutrients, bacteria, and total suspended solids (TSS). Forest land cover was included in six of the ten regression models produced. Four of these regression models were for base flow conditions, suggesting that forest land cover had a significant impact on base flow water quality. Urban land cover was also included in six of the regression models. However, the majority were during storm flow conditions implying urban land cover had a greater impact on storm flow conditions. Watersheds were further categorized into agriculture, village, and urban watersheds. During base flow conditions agriculture watersheds had significantly higher TSS concentrations and urban watersheds had significantly higher ortho-P concentrations. In all watersheds, ortho-P concentrations were above the statewide 95th percentile for Illinois streams. Escherichia coli levels during storm conditions exceeded the national US EPA criteria. [ABSTRACT FROM AUTHOR]

Despite decades of research on the importance of engagement and interaction in learning experiences, programs produced for planetarium audiences are primarily passive in nature. Planetarium professionals were interviewed with regard to their goals and beliefs for planetarium experiences, specifically focusing on goals for children, and their interest with regard to a program format that integrates segments of live interaction with automated content (N=36). Planetarium professionals' goals most frequently reflect increasing content knowledge and motivating audiences to continue learning. To meet these goals, they often cite live interaction as a key strategy for elementary-aged audiences. Further, planetarium professionals often combine live interaction with prerendered automation. These results suggest that the planetarium community's goals and beliefs are at odds with the current model of passive planetarium production and that the frontline professionals would support opportunities that support their ability to actively engage their audiences. [ABSTRACT FROM AUTHOR]

Abstract: We assessed whether, after controlling for genetic and shared environmental influences, early cannabis use remains a significant predictor of other drug use, abuse, and dependence, and whether the risk for early-users is greater than that for later cannabis users. Data from a 1992 telephone diagnostic interview of 8169 male twins (M =42.0 years at interview) who served in the U.S. military during the Vietnam-era were used to identify a subsample of 293 monozygotic (MZ) and dizygotic (DZ) twin pairs discordant for early cannabis use (before age 18). Using cotwin-control analyses, outcomes assessed were: lifetime illegal drug use (stimulant/cocaine, sedative, opiate, and hallucinogen/PCP), lifetime DSM-III-R illegal drug abuse/dependence, and lifetime DSM-III-R alcohol dependence. After controlling for covariates, early cannabis users were at greater risk than their later/never-using cotwins for 8 of 9 substance-related comparisons, including: using other illegal drugs (ORs: 2.71–4.09), having illegal drug abuse/dependence (ORs: 2.02–2.13), and developing alcohol dependence (OR=2.36). When analyses were limited to pairs in which the cotwin used cannabis later, early and later-users only differed significantly on sedative, opiate, and hallucinogen use. After familial influences on early cannabis use were controlled for, cannabis use—regardless of the age of initiation—still conferred increased risk of other illegal drug use, drug abuse/dependence, and alcohol dependence. In contrast to previous research, there is limited evidence for increased risk associated with early-onset use in this sample of Vietnam-era veterans. [Copyright &y& Elsevier]

The US National Science Education Standards and the Benchmarks for Science Literacy recommend that students understand the apparent patterns of motion of the Sun, Moon, and stars by the end of early elementary school, yet no research has specifically examined these concepts from an Earth-based perspective with this age group. This study examines children's understanding of the patterns of apparent celestial motion among first-grade, third-grade, and eighth-grade students, and investigates the extent to which these concepts develop from elementary to middle school in students without targeted instruction. Twenty students at each grade level (total n = 60) were interviewed using a novel interview setting: a small dome representing the sky, which allowed students to demonstrate their ideas. Analysis reveals that elementary and middle school students hold a variety of non-scientific ideas about all aspects of apparent celestial motion. While the eighth-grade students' understanding of the apparent motion of the Sun shows a greater level of accuracy compared with the third-grade students, across the majority of topics of apparent celestial motion, the overall level of accuracy shows little change from third grade to eighth grade. Just as prior research has demonstrated the need for instruction to improve children's understanding of the nature of celestial objects and their actual motions, these results support the need for research on instructional strategies that improve students' understanding of celestial motion as seen from their own perspective. [ABSTRACT FROM AUTHOR]

Objective: We conducted a systematic review and meta-analysis to comprehensively compare cardiometabolic and reproductive health risk between Hispanic and White women with polycystic ovary syndrome in the United States in response to the call by the international guideline for polycystic ovary syndrome to delineate health disparities.Data Sources: Databases of MEDLINE, Web of Science, and Scopus were initially searched through October 25, 2020, and confirmed on February 1, 2021.Study Eligibility Criteria: Observational studies comparing glucoregulatory, lipid profile, anthropometric, blood pressure, androgen, ovarian morphology, oligoanovulation, and infertility status between Hispanic and White women with polycystic ovary syndrome were included. The primary outcome was metabolic syndrome risk. Furthermore, major cardiovascular events (stroke, coronary heart disease, and heart failure) and mortality rate (cardiovascular death and total mortality) data were evaluated. Studies on adolescents (<2 years after menarche), pregnant, or menopausal-aged women (>50 years) were excluded.Methods: Data were pooled by random-effects models and expressed as mean differences and 95% confidence intervals. Risk of bias was assessed by the Newcastle-Ottawa Scale.Results: A total of 11 studies (n=2267; 589 Hispanic and 1678 White women) were eligible. All studies, including both White and Hispanic women, had high-quality assessment (Newcastle-Ottawa Scale score of ≥8). Hispanic women exhibited comparable metabolic syndrome prevalence (7% [95% confidence interval, -1 to 14]; P=.06; I2=0%); however, Hispanic women exhibited higher modified Ferriman-Gallwey score (0.60 [95% confidence interval, -0.01 to 1.21]; P=.05; I2=0%), fasting insulin (5.48 μIU/mL [95% confidence interval, 3.11-7.85]; P≤.01; I2=40.0%), and homeostatic model assessment of insulin resistance (1.20 [95% confidence interval, 0.50-1.89]; P≤.01; I2=43.0%) than White women. The 2 groups had comparable glucose, lipid profile, waist circumference, blood pressure, and androgen status (all P≥.08). Findings about group differences in certain reproductive outcomes (ie, ovarian dysmorphology and infertility) were contradictory and described only narratively as inclusion in the meta-analyses was not possible. No study reported on cardiovascular events or mortality.Conclusion: Hispanic women with polycystic ovary syndrome exhibited greater impairments in glucoregulatory status than White women. Disparities in reproductive risks could not be concluded. The degree to which glucoregulatory aberrations translate into patient-pressing diseases (diabetes mellitus and infertility) remains a major roadblock given the paucity of available evidence. Our observations have supported the consideration of these disparities in the diagnostic, monitoring, and management practices for polycystic ovary syndrome and reinforced the need to elucidate mechanisms that account for the observed disparities to foster equity in polycystic ovary syndrome care. [ABSTRACT FROM AUTHOR]

Abstract: This paper identifies the overarching patterns of immigrant health in the US. Most studies indicate that foreign-born individuals are in better health than native-born Americans, including individuals of the same race/ethnicity. They tend to have lower mortality rates and are less likely to suffer from circulatory diseases, overweight/obesity, and some cancers. However, many foreign-born groups have higher rates of diabetes, some infections, and occupational injuries. There is heterogeneity in health among immigrants, whose health increasingly resembles that of natives with duration of US residence. Prospective studies are needed to better understand migrant health and inform interventions for migrant health maintenance. [Copyright &y& Elsevier]

The article looks into the jurisprudence related to the power of eminent domain in the case of Kelo v. New London in the U.S. It explains the grounds despite the case's serious doctrinal weaknesses, the homeowners were denied their claims. The author predicts on the judiciary pressure on declaring eminent domain unconstitutional as incited by the Kelo case. Implications of continued judicial involvement and the benefits of multiple vetoes over exercises of the eminent domain power are discussed.