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Objectives In view of the growing number of older incarcerated persons in the United States, cognitive impairment represents one of the most challenging and costly health care issues facing the U.S. correctional system. This study examined the prevalence and correlates of this growing public health issue in the nation's largest prison system. Methods In this study of a random sample of 143 older (≥55 years) adults incarcerated in the Texas prison system, we assessed—using the Montreal Cognitive Assessment (MoCA)—the percentage of inmates who met the MoCA thresholds for mild cognitive impairment (MCI; <23) and dementia (<18). Due to sample size limitations, our multivariable analysis assessed the binary outcome, MoCA <23. Results Overall, 35.0% of our random sample of incarcerated older adults in Texas met the threshold for MCI and 9.1% met the threshold for dementia. After adjusting for covariates, study participants who were Black (odds ratio [OR] = 4.12, 95% confidence interval [CI] = 1.57–10.82), Hispanic (OR = 4.34, 95% CI = 1.46–12.93), and those with a diagnosis of major depressive disorder (8.56, 95% CI = 1.21–60.72) all had higher prevalence of a positive screen for MCI or dementia. Dementia was underdiagnosed in our study sample of incarcerated adults, with 15.4% of MoCA-diagnosed dementia patients having a dementia diagnosis documented in their medical records. Discussion Future studies of cognitive impairment in prisons and jails can inform health care planning and resource allocation, such as expansion of access to palliative care, advance care planning, and targeted cognitive screening in older age groups. [ABSTRACT FROM AUTHOR]

Background Although most adults infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) fully recover, a proportion have ongoing symptoms, or post-COVID conditions (PCC), after infection. The objective of this analysis was to estimate the number of United States (US) adults with activity-limiting PCC on 1 November 2021. Methods We modeled the prevalence of PCC using reported infections occurring from 1 February 2020 to 30 September 2021, and population-based, household survey data on new activity-limiting symptoms ≥1 month following SARS-CoV-2 infection. From these data sources, we estimated the number and proportion of US adults with activity-limiting PCC on 1 November 2021 as 95% uncertainty intervals, stratified by sex and age. Sensitivity analyses adjusted for underascertainment of infections and uncertainty about symptom duration. Results On 1 November 2021, at least 3.0–5.0 million US adults, or 1.2%–1.9% of the US adult population, were estimated to have activity-limiting PCC of ≥1 month's duration. Population prevalence was higher in females (1.4%–2.2%) than males. The estimated prevalence after adjusting for underascertainment of infections was 1.7%–3.8%. Conclusions Millions of US adults were estimated to have activity-limiting PCC. These estimates can support future efforts to address the impact of PCC on the US population. [ABSTRACT FROM AUTHOR]

Objective: Accurate assessment of gestational age (GA) is critical to paediatric care, but is limited in developing countries without access to ultrasound. Our objectives were to assess the accuracy of prediction of GA at birth and preterm birth classification using routinely collected anthropometry measures.Design: Prospective cohort study.Setting: United States.Population or Sample: A total of 2334 non-obese and 468 obese pregnant women.Methods: Enrolment GA was determined based on last menstrual period, confirmed by first-trimester ultrasound. Maternal anthropometry and fundal height (FH) were measured by a standardised protocol at study visits; FH alone was additionally abstracted from medical charts. Neonatal anthropometry measurements were obtained at birth. To estimate GA at delivery, we developed three predictor models using longitudinal FH alone and with maternal and neonatal anthropometry. For all predictors, we repeatedly sampled observations to construct training (60%) and test (40%) sets. Linear mixed models incorporated longitudinal maternal anthropometry and a shared parameter model incorporated neonatal anthropometry. We assessed models' accuracy under varied scenarios.Main Outcome Measures: Estimated GA at delivery.Results: Prediction error for various combinations of anthropometric measures ranged between 13.9 and 14.9 days. Longitudinal FH alone predicted GA within 14.9 days with relatively stable prediction errors across individual race/ethnicities [whites (13.9 days), blacks (15.1 days), Hispanics (15.5 days) and Asians (13.1 days)], and correctly identified 75% of preterm births. The model was robust to additional scenarios.Conclusions: In low-risk, non-obese women, longitudinal FH measures alone can provide a reasonably accurate assessment of GA when ultrasound measures are not available.Tweetable Abstract: Longitudinal fundal height alone predicts gestational age at birth when ultrasound measures are unavailable. [ABSTRACT FROM AUTHOR]

Background: Because of advancements in care, there has been a decline in mortality from congenital heart defects (CHDs) over the past several decades. However, there are no current empirical data documenting the number of people living with CHDs in the United States. Our aim was to estimate the CHD prevalence across all age groups in the United States in the year 2010.Methods: The age-, sex-, and severity-specific observed prevalence of CHDs in Québec, Canada, in the year 2010 was assumed to equal the CHD prevalence in the non-Hispanic white population in the United States in 2010. A race-ethnicity adjustment factor, reflecting differential survival between racial-ethnic groups through 5 years of age for individuals with a CHD and that in the general US population, was applied to the estimated non-Hispanic white rates to derive CHD prevalence estimates among US non-Hispanic blacks and Hispanics. Confidence intervals for the estimated CHD prevalence rates and case counts were derived from a combination of Taylor series approximations and Monte Carlo simulation.Results: We estimated that ≈2.4 million people (1.4 million adults, 1 million children) were living with CHDs in the United States in 2010. Nearly 300 000 of these individuals had severe CHDs.Conclusions: Our estimates highlight the need for 2 important efforts: planning for health services delivery to meet the needs of the growing population of adults with CHD and the development of surveillance data across the life span to provide empirical estimates of the prevalence of CHD across all age groups in the United States. [ABSTRACT FROM AUTHOR]

Objective: To assess a continuum of cervical length (CL) cut-offs for the efficacy of ultrasound-indicated cerclage in women with previous spontaneous preterm birth (PTB).Methods: This was a planned secondary analysis of a multicenter randomized clinical trial of ultrasound-indicated cerclage for the prevention of PTB in high-risk women. The efficacy of cerclage for preventing recurrent PTB < 35, < 32 and < 24 weeks' gestation was assessed using multivariable logistic regression analysis. Odds ratios (ORs) and CIs were estimated for a range of CL cut-offs using bootstrap regression. The 2.5(th) and 97.5(th) percentiles of bootstrapped ORs determined the CIs. Results were illustrated using smoothed curves superimposed on estimated ORs by CL cut-off.Results: Of 301 women with a CL < 25 mm, 142 underwent ultrasound-indicated cerclage and 159 did not have cerclage placement. The few cases with CL < 10 mm limited the evaluation to CL cut-offs between < 10 mm and < 25 mm. For PTB < 35 weeks, ORs in women with a cerclage and CL < 25 mm were statistically significantly lower than in those without cerclage, and efficacy was maintained at smaller CL cut-offs. Results were similar for PTB < 32 weeks. For PTB < 24 weeks, results differed, with ORs increasing toward unity (no benefit), with wide CIs, for CL cut-offs between < 10 mm and < 15 mm, attributed to the small number of births < 24 weeks.Conclusions: The efficacy of ultrasound-indicated cerclage in women with previous spontaneous PTB varies by action point CL cut-off and by PTB gestational age of interest. Cerclage significantly reduces the risk of PTB < 35 and < 32 weeks, at CL cut-offs between < 10 mm and < 25 mm, with the greatest reduction at shorter CL, affirming that women with prior spontaneous PTB and a short CL are appropriate candidates for ultrasound-indicated cerclage. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Dermacentor andersoni (Ixodida: Ixodidae) Stiles, also known as the Rocky Mountain Wood Tick ( RMWT), is found throughout the western United States and transmits pathogens of importance to human and animal health. The distributions and activity patterns of RMWTs are shaped by regional climatic variation. However, it is unknown if responses to climatic variation differ across the tick's geographical range. The objective of this narrow study was to test the hypothesis that the responses of RMWTs to abiotic conditions [e.g. temperature and RH (relative humidity)] vary among populations. We collected RMWTs from ecologically distinct field sites in the states of Montana and Oregon ( USA). In the laboratory, we tracked weekly survival of tick larvae under four combinations of RH (75% and 98%) and temperature (26 and 32 °C) that reflected the range of conditions observed in the source habitats during spring-summer. For both populations, larval survival time decreased at the higher ambient temperature (50% mortality 1-2 weeks earlier). Differences in RH did not affect the survival time of larvae from Oregon. By contrast, the survival time of larvae from Montana decreased at the lower RH (50% mortality 1 week earlier). These data suggest that the tolerance limits for water stress may differ among populations of D. andersoni. [ABSTRACT FROM AUTHOR]

Prenatal exposures often are assessed using retrospective interviews. Time from exposure to interview may influence data accuracy. We investigated the association of time to interview (TTI) with aspects of interview responses in the National Birth Defects Prevention Study, a population-based case-control study of birth defects in 10 US states. Mothers completed a computer-assisted telephone interview 1.5–24 months after their estimated date of delivery. Proxy metrics for interview quality were whether certain exposures were reported, whether the start month of reported medication use or illness was reported, or whether responses were missing. Interaction by case status was assessed. Interviews were completed with 30,542 mothers (22,366 cases and 8,176 controls) who gave birth between 1997 and 2007. Mothers of cases were interviewed later than were mothers of controls (11.7 months vs. 9.5 months, respectively). In adjusted analyses, having a TTI that was greater than 6 months was associated with only a few aspects of interview responses (e.g., start month of pseudoephedrine use). Interaction by case-control status was observed for some exposures; mothers of controls had a greater reduction in interview quality with increased TTI in these instances (e.g., report of morning sickness, start month of acetaminophen use and ibuprofen use). The results suggest that TTI might impact interview responses; however, the impact may be minimal and specific to the type of exposure. [ABSTRACT FROM PUBLISHER]

Background The potential for sexual health services to influence the sexual health and behaviour of school-aged young people is only likely to be realised if these services are accessed. This review and synthesis seeks to explore children and adolescents' views and experiences of school-based and school-linked sexual health services to identify barriers to and facilitators of service use. Methods The study design is a systematic review of studies focusing on the views of children and adolescents (11–18 years) about relevant services. Sixteen databases were searched, titles and abstracts were screened against the inclusion criteria, data extraction and quality assessment of included studies were performed and thematic synthesis was undertaken. Results Nineteen relevant studies were identified, but only studies from the USA and the UK satisfied the inclusion criteria. The principal themes to emerge from the analysis were awareness and need, confidentiality and disclosure, perceptions of staff, service location, physical environment, costs and types of services on offer. These findings were consistent across country and type of service. Conclusions In the view of young people, school-linked sexual health services need to guarantee and promote the ideas of privacy, confidentiality and approachability if they are to be accessed and have an impact on behaviour. [ABSTRACT FROM PUBLISHER]

Objective: A number of legal, social, and political factors over the past 40 years have led to the current epidemic of psychiatric disorders in the U.S. prison system. Although numerous investigations have reported substantially elevated rates of psychiatric disorders among prison inmates compared with the general population', it is unclear whether mental illness is a risk factor for multiple episodes of incarceration. The authors examined this association in a retrospective cohort study of the nation's largest state prison system. Method: The study population included 79,211 inmates who began serving a sentence between September 1, 2006, and August 31, 2007. Data on psychiatric disorders, demographic characteristics, and history of incarceration for the preceding 6-year period were obtained from statewide medical information systems and analyzed. Results: Inmates with major psychiatric disorders (major depressive disorder, bipolar disorders, schizophrenia, and nonschizophrenic psychotic disorders) had substantially increased risks of multiple incarcerations over the 6-year study period. The greatest increase in risk was observed among inmates with bipolar disorders, who were 3.3 times more likely to have had four or more previous incarcerations compared with inmates who had no major psychiatric disorder. Conclusions: Prison inmates with major psychiatric disorders are more likely than those without to have had previous incarcerations. The authors recommend expanding interventions to reduce recidivism among mentally ill inmates. They discuss the potential benefits of continuity of care reentry programs to help mentally ill inmates connect with community-based mental health programs at the time of their release, as well as a greater role for mental health courts and other diversion strategies. [ABSTRACT FROM AUTHOR]

This article examines the responses of over 1000 tourists to an exit survey at Laura Plantation, a tourist museum site located outside of New Orleans, Louisiana. Using Critical Race Theory, we evaluate visitor interest in slavery at the plantation compared to other, more dominant narratives commonly associated with promoting plantation history throughout the U.S. South. By separating the respondents on the basis of race and country of origin, we examined the relative importance of different narratives between these various socio-demographic groups. Findings from some white visitors were not surprising; they outranked other visitors groups in their interest in dominant narratives other than slaves. However, the responses from sub-groups of black and foreign born visitors were surprising in that the foreign born group was most interested in slavery at the plantation, even over that of some blacks. [ABSTRACT FROM AUTHOR]

The prevailing view of both the US. Supreme Court and liberal theory in America is that liberal principles are neither essentially religious nor essentially secular, but somehow foundationally neutral, or in the words of the Court neutral between ‘religion and nonreligion.’ This essay challenges the cogency of this view through a comparative examination of two strong defenders of religious freedom from the American revolutionary era: Thomas Jefferson and Isaac Backus. Jefferson, the Enlightenment rationalist, and Backus, the Calvinist-Baptist, may initially seem tailor-made for this foundational neutrality, but closer examination reveals that religious freedom for them was not only an extension of their radically opposed views on religion but also an instrument for the promotion of those views throughout society. The ambiguity of America's founding principles is best understood, not through the notion of neutrality, but as the product of a yet unsettled struggle between devout religion and secular Enlightenment. [ABSTRACT FROM AUTHOR]

Objective: To assess factors associated with residents' decisions to pursue or forego fellowship training in maternal-fetal medicine (MFM).Methods: A survey utilizing multiple-choice, Likert, ordinal and categorical scale questions was distributed to all (n = 2337) postgraduate year (PGY) 3 and 4 obstetrics and gynecology residents in accredited US training programs during the 2001-02 academic year. The 18-question survey sought demographic and residency training details, quality of interactions with the MFM faculty and fellows, and information about 13 specific factors that might influence a resident's decision to pursue MFM training.Results: Surveys were returned by 642 (27%) residents, equally divided between PGY 3 and 4. Only 90 (14%) residents reported either ongoing consideration of, or having already applied for, MFM training (MFM group), while 278 (43%) had considered MFM training, but chose to either stay in general practice or pursue another fellowship (neutral group). The remaining 274 (43%) reported never having considered MFM (never group). The three groups were similar with regard to demographic characteristics and residency training; however, the MFM group ranked the quality of teaching by the MFM faculty significantly higher than the neutral and never groups. Encouragement by the MFM faculty, salary during fellowship and the 3-year (as opposed to 2-year) duration were reported to be the strongest influencing factors and were significantly different from ten other factors considered in the survey (p < 0.05).Conclusion: Major positive factors influencing the pursuit of MFM training are the quality of educational experiences and encouragement from the MFM faculty. Conversely, the duration and the perceived financial burden of the 3-year training program appear to be significant deterrents. [ABSTRACT FROM AUTHOR]

Investigates the effectiveness of nitrate removal of a riparian buffer along an agricultural stream in western Oregon. Installation of a series of nested piezometers; Composition of noncultivated riparian zone; Performance of Darcy's law-based estimates of shallow ground water.

Presents updates to the 1993 guidelines for selecting laboratory tests for Chlamydia trachomatis and Neisseria gonorrhoeae infections with emphasis on screening men and women in the U.S. Economic perspective of testing; Detection of infection.

Offers an overview of memorial practices and representations of the Civil Rights movement found at United States' major memorial landscapes. Role of women in organizing and leading the civil rights movement; Historical-spatial representations embodied in and through the memorial landscape; Visions of the past, present and future authorized at the sites of memory.

Focuses on the transformation of hog farming in eastern North Carolina between 1992 and 1997. Examination of the implosion of hog production; Questions raised about the environmental and social sustainability of industrial hog farming; Speculation about the impact of corporate farming on rural communities.

Analyzes citizen attitudes toward a locally based farmland protection program for Mecklenburg County, North Carolina. Association between public attitudes and individual socioeconomic and personal characteristics; Attitudes toward agricultural land preservation policies and strategies; Factors affecting attitudes toward farmland preservation; Public support for zoning and purchase of development rights approaches.

Discusses the definition and measurement of the quality of life as it applies to planning directors in urban and rural North Carolina. Development of policies; Implementation of quality of life planning; Concerns for basic human needs; Suggestions and recommendations.

This article examines the contention of economist Betsy Buttrill White that a multiperiod life cycle model cannot generate values of aggregate savings as large as in fact observed. Author argue that her results reflect an entirely arbitrary choice of parameters and that for other equally plausible values of these parameters, the life cycle model generates saving similar to or greater than that actually observed. Hence, the model cannot be rejected, as White proposes, on the basis of such a simple test of plausibility. It should be noted at the outset that the argument of this paper is distinct from that of Lars Söderstrom, who accepts White's basic result, and then shows that if the structure is generalized, the result is not robust. The article argues that White's contention is incorrect, when examined on its own terms. White employs a constant proportional risk-aversion utility function to derive the individual desired consumption profile. She then makes assumptions about the present cross section of labor income, and future path of individual labor income to derive the level of saving for a representative individual in each age group.

This article discusses the numerical analysis of the theoretical models related to tax policy, the interest elasticity of saving, and capital accumulation. The purpose of the study is to analyze in a theoretical simulation context, the impact on saving and wealth of an increase in the after tax rate of return to saving, generated by a cut in the tax rate on income from capital. This paper suggests that such simulation analysis, while instructive as to the behavior of the class of models examined, and as to the critical channels of influence, does not yield a theoretical presumption in favor of cutting taxes on income from capital as a means of stimulating capital formation. In the first part of the study, the theoretical structure of a zero bequest life cycle model is outlined, and several numerical simulations of this model are presented. These simulations highlight interesting and nontrivial interactions of theoretical parameters, and also demonstrate the difficulty involved in attempts to develop robust aggregate implications from such a framework.

This article focuses on the peace developments during the Second World War, and the role of U.S. citizens in that crisis situation. During the world war the allied forces only worked on how to be victorious, but they didn't realize that they owe a duty to the country they represent as well as to the peoples of the other countries too, a duty to secure international order and peace. For two hundred and fifty years political philosophers have pointed out the ineffectiveness of treaties and leagues as peace-keeping devices. Order in a town, a city, a nation, is conditioned on law, that law cannot exist without government, and that the failure of any league of nations, necessarily results from the lack of law binding the peoples of the nations. The most that is said in opposition to an effort to attain international law as a function of international government is that this cannot be accomplished so long as so-called national sovereignty remains. The U.S. now has the initiative in world affairs. No advance in world law founded on world government is likely to occur if their citizens do not lead. The principles involved are not difficult of apprehension. The democratic way is to abide the decision of the majority. But the necessary premise of the proposition is that majority decision shall be made with full knowledge of the facts.

A loosely coupled suite of physics-based geotechnical, geospatial, hydrogeologic, and thermal simulations are integrated into a virtual testing facility aimed at resolving terrain-related warfighter problems. This article describes the key aspects of the research conducted by the US Institute for Maneuverability and Terrain Physics Simulation and provides two examples of the virtual testing facility applied to subsurface threat detection. [ABSTRACT FROM PUBLISHER]

Neotraditional planning is an increasingly discussed strategy for building neighborhoods in the United States. To its proponents this urban design-based planning model corrects the flaws inherent in the conventional low density suburban planning that has dominated land use in the United States in the post-World War II era. Neotraditional planning proposes to foster neighborliness and community life through there-creation of idealized small towns from the early twentieth century. Borrowing design and site planning standards, pedestrianism is encouraged and automobile travel discouraged. This paper presents an assessment of the neotraditional planning model and its effectiveness increating functioning neighborhoods. The analysis finds serious deficiencies with the community building capacity of this planning paradigm. The progressive rhetoric of neotraditionalism does not match empirical application of the approach. Reasons for this failure are presented. [ABSTRACT FROM AUTHOR]

Purpose: To assess the contribution of multiple risk factors for two congenital heart defects-hypoplastic left heart syndrome (HLHS) and tetralogy of Fallot (TOF).Methods: We used data from the National Birth Defects Prevention Study (1997-2011) to estimate average adjusted population attributable fractions for several recognized risk factors, including maternal prepregnancy overweight-obesity, pregestational diabetes, age, and infant sex.Results: There were 594 cases of isolated simple HLHS, 971 cases of isolated simple TOF, and 11,829 controls in the analysis. Overall, 57.0% of HLHS cases and 37.0% of TOF cases were estimated to be attributable to risk factors included in our model. Among modifiable HLHS risk factors, maternal prepregnancy overweight-obesity accounted for the largest proportion of cases (6.5%). Among modifiable TOF risk factors, maternal prepregnancy overweight-obesity and maternal age of 35 years or older accounted for the largest proportions of cases (8.3% and 4.3%, respectively).Conclusions: Approximately half of HLHS cases and one-third of TOF cases were estimated to be attributable to risk factors included in our models. Interventions targeting factors that can be modified may help reduce the risk of HLHS and TOF development. Additional research into the etiology of HLHS and TOF may reveal other modifiable risk factors that might contribute to primary prevention efforts. [ABSTRACT FROM AUTHOR]