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BACKGROUND AND OBJECTIVES: Children hospitalized with a mental health crisis often receive pharmacologic restraint for management of acute agitation. We examined associations between pharmacologic restraint use and race and ethnicity among children admitted for mental health conditions to acute care nonpsychiatric children's hospitals. METHODS: We performed a retrospective cohort study of children (aged 5-≤18 years) admitted for a primary mental health condition from 2018 to 2022 at 41 US children's hospitals. Pharmacologic restraint use was defined as parenteral administration of medications for acute agitation. The association of race and ethnicity and pharmacologic restraint was assessed using generalized linear multivariable mixed models adjusted for clinical and demographic factors. Stratified analyses were performed based on significant interaction analyses between covariates and race and ethnicity. RESULTS: The cohort included 61 503 hospitalizations. Compared with non-Hispanic Black children, children of non-Hispanic White (adjusted odds ratio [aOR], 0.81; 95% confidence interval [CI], 0.72-0.92), Asian (aOR, 0.82; 95% CI, 0.68-0.99), or other race and ethnicity (aOR, 0.68; 95% CI, 0.57-0.82) were less likely to receive pharmacologic restraint. There was no significant difference with Hispanic children. When stratified by sex, racial/ethnic differences were magnified in males (aORs, 0.49-0.68), except for Hispanic males, and not found in females (aORs, 0.83-0.93). Sensitivity analysis revealed amplified disparities for all racial/ethnic groups, including Hispanic youth (aOR, 0.65; 95% CI, 0.47-0.91). CONCLUSIONS: Non-Hispanic Black children were significantly more likely to receive pharmacologic restraint. More research is needed to understand reasons for these disparities, which may be secondary to implicit bias and systemic and interpersonal racism. [ABSTRACT FROM AUTHOR]

We evaluate the determinants of officer support for their agency participating in the 1033 Program: a program that facilitates the flow of military hardware to local law enforcement agencies. In doing so, we provide insight into why officers demand such equipment, which, in turn, may partially explain patterns of program participation and equipment usage. We utilize a series of random forest models to examine survey data collected from officers in a large police department, finding that being White and exhibiting animus toward minority communities are highly predictive of officer support across models. Our findings validate long‐held public concerns regarding the distributional patterns and consequences of 1033 transfers: concerns that have led to a number of proposed policy changes at the state and federal levels meant to restrict program usage (e.g., EO‐13688, HR‐1694, MO HB‐330). Policy makers should consider how out‐group animus may drive distributional patterns and usage when considering policy reform. [ABSTRACT FROM AUTHOR]

Barberry (Berberis thunbergii) is a widely established invasive shrub in temperate forests of the northeastern United States with the potential to alter soil arthropod communities through changes to soil nutrient cycling and acidity.We compared soil arthropod taxa and functional feeding groups between invaded and nearby control areas in a paired observational survey.Community ordination analysis suggested minimal differences between barberry and control samples. In contrast, pairwise differences revealed elevated densities of multiple taxa in barberry‐invaded soils.Among taxa that were able to be defined by functional feeding group and were collected at higher densities under barberry, all were detritivores. For example, barberry‐invaded soils harboured an average of 40% more Isopoda and more than twice as many Diplopoda per unit dry compared with control samples. Differences we observed between barberry and control samples despite the limited study spatiotemporal scope demonstrate the potential for invasions to restructure soil arthropod communities.Observed patterns potentially reflects elevated leaf litter decomposition rates associated with the invasion and results also highlight the need to integrate site‐specific environmental attributes when assessing the impact of invading plants on soil ecosystems. [ABSTRACT FROM AUTHOR]

Using item response theory, we examined the psychometric properties of scores on the Trauma-Informed Practice Scales – Supervision Version (TIPS-SV) – a unidimensional measure of supervisees' perceptions of their supervisors' adherence to trauma-informed supervision – in a sample of 312 supervisees. Implications for research and supervision practice are discussed. [ABSTRACT FROM AUTHOR]

Many professional chaplaincy organizations in the United States have board certified healthcare chaplains since the 1920s and documented how they have adapted their process as the profession has grown. In 2019, the Association of Professional Chaplains and the National Association of Catholic Chaplains sought the perspectives of key stakeholders about professional chaplaincy board certification. This study reports the results from 50 semi-structured interviews with certification candidates, certification committee members, and chaplaincy managers in the United States. Participants discussed the preparation of the certification application, the certification interview, the ease and difficulty of certification competencies, and the evolving workforce. This study demonstrated divergent views on many aspects of board certification, but participants predominately respected and valued the process. Chaplains with varying levels of experience discussed how board certification strengthens multidisciplinary respect and collaboration. Participants reported difficulties with competencies that required translating between theory and practice. [ABSTRACT FROM AUTHOR]

This investigatory study sought to explore the range and variation of well-being initiatives on a select cross-section of college campuses across the United States and in Canada. This whitepaper seeks to highlight innovative practices that may inspire institutions to consider new ways of promoting well-being for both students and employees. In this whitepaper, we report findings from 10 participating higher education institutions across three major categories: student-serving programs, employee-serving programs, and hybrid programs. The qualitative data collected from key stakeholder interviews and focus groups were analyzed for trends between and across institutions. Importantly, the results of this study are intended to be hypothesis-generating as opposed to hypothesis-testing. In an effort to describe the state of the field with respect to both common and innovative practices the findings have generated additional questions for further research. Several themes emerged from this study: (1) Campuses have not adopted a universally-accepted definition of well-being; (2) While many institutions are using iterations of the wellness wheel and its various dimensions (e.g. physical, emotional, intellectual, social, spiritual, financial) to guide their efforts, there is not a dominant model for structuring or measuring well-being initiatives on campus; (3) There appears to be a systematic shift from use of the term "wellness" to "well-being"; (4) While many institutions are still utilizing traditional health education practices, there appears to be a movement toward more systemic, environmental approaches to well- being, including structural, organizational, and financial strategies, in addition to a range of policy initiatives; (5) There is a range of engagement in well-being initiatives, with significant variance based on institutional philosophy; and (6) Many institutions are designing well-being initiatives that address health disparities—particularly among underrepresented or marginalized populations. [ABSTRACT FROM AUTHOR]

This article explores the ways in which gendered processes play out through the professionalization of chaplains in healthcare settings. It describes how gender manifests within organizations, how literature addresses the role of gender in professionalization, and considerations for professional chaplaincy. Fifty interviews with U.S. chaplains were analyzed to explore the relationship between the professionalization of chaplaincy and male and female positionality. Although gender theory moves beyond binary conceptualizations of gender, all participants in this study self‐identified as male or female and our data were analyzed accordingly. The language and professionalization efforts used by male and female chaplains mirror the gendered cultural expectations associated with these groups. This article notes how the patriarchal structures of both religious and healthcare institutions are inextricably embedded in the chaplaincy profession; thus, female chaplains have found it necessary to challenge these systems from the beginning. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To characterize patterns of surgery among pediatric patients during terminal hospitalizations in children's hospitals. METHODS: We reviewed patients ≤20 years of age who died among 4 424 886 hospitalizations from January 2013-December 2019 within 49 US children's hospitals in the Pediatric Health Information System database. Surgical procedures, identified by International Classification of Diseases procedure codes, were classified by type and purpose. Descriptive statistics characterized procedures, and hypothesis testing determined if undergoing surgery varied by patient age, race and ethnicity, or the presence of chronic complex conditions (CCCs). RESULTS: Among 33 693 terminal hospitalizations, the majority (n = 30 440, 90.3%) of children were admitted for nontraumatic causes. Of these children, 15 142 (49.7%) underwent surgery during the hospitalization, with the percentage declining over time (P < .001). When surgical procedures were classified according to likely purpose, the most common were to insert or address hardware or catheters (31%), explore or aid in diagnosis (14%), attempt to rescue patient from mortality (13%), or obtain a biopsy (13%). Specific CCC types were associated with undergoing surgery. Surgery during terminal hospitalization was less likely among Hispanic children (47.8%; P < .001), increasingly less likely as patient age increased, and more so for Black, Asian American, and Hispanic patients compared with white patients (P < .001). CONCLUSIONS: Nearly half of children undergo surgery during their terminal hospitalization, and accordingly, pediatric surgical care is an important aspect of end-of-life care in hospital settings. Differences observed across race and ethnicity categories of patients may reflect different preferences for and access to nonhospital-based palliative, hospice, and end-of-life care. [ABSTRACT FROM AUTHOR]

The use of genetic markers, specifically Short Tandem Repeats (STRs), has been a valuable tool for identifying persons of interest. However, the ability to analyze additional markers including Single Nucleotide Polymorphisms (SNPs) and Insertion/Deletion (INDELs) polymorphisms allows laboratories to explore other investigative leads. INDELs were chosen in this study because large panels can be differentiated by size, allowing them to be genotyped by capillary electrophoresis. Moreover, these markers do not produce stutter and are smaller in size than STRs, facilitating the recovery of genetic information from degraded samples. The INDEL Ancestry Informative Markers (AIMs) in this study were selected from the 1000 Genomes Project based on a fixation index (FST) greater than 0.50, high allele frequency divergence, and genetic distance. A total of 25 INDEL-AIMs were optimized and validated according to SWGDAM guidelines in a five-dye multiplex. To validate the panel, genotyping was performed on 155 unrelated individuals from four ancestral groups (Caucasian, African, Hispanic, and East Asian). Bayesian clustering and principal component analysis (PCA) were performed revealing clear separation among three groups, with some observed overlap within the Hispanic group. Additionally, the PCA results were compared against a training set of 793 samples from the 1000 Genomes Project, demonstrating consistent results. Validation studies showed the assay to be reproducible, tolerant to common inhibitors, robust with challenging casework type samples, and sensitive down to 125 pg. In conclusion, our results demonstrated the robustness and effectiveness of a 25 loci INDEL system for ancestry inference of four ancestries commonly found in the United States. [ABSTRACT FROM AUTHOR]

We evaluated the psychometric properties of the Trauma Informed Practice Scales – School Counseling Programs Version scores using item response theory with a sample of 270 school counselors. Participants ranged in age from 24 to 69 years (M = 42.82, SD = 9.96). Participants identified as female (81.5%), male (14.1%) or unreported (4.4%,). Participants' racial and ethnic backgrounds were: White (79.3%), African American or Black (5.6%), Multiracial (5.2%), Latino/Hispanic/Spanish (4.8%), American Indian/Alaskan Native (0.4%), Other (0.4%), or unreported (4.4%). Participants from 14 states completed an online survey, which included demographics questions and the TIPS-SCP. After removing the poorly performing items, partial credit model estimates explained 58.63% of the variance in participant responses. We found psychometric evidence to support its ability to capture trauma informed practices in schools and school counseling programs. The TIPS-SCP is a brief instrument to provide school counselors with a self-assessment of their trauma informed practices. The TIPS-SCP can aid school counselors in making data-informed decisions about immediate and future incorporations of integrating trauma informed practices into their schools and school counseling programs. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding the initiation of antipsychotic medications across individual cholinesterase inhibitors (ChEIs) to manage the behavioral symptoms of dementia is lacking. Objectives: This study compared the risk of initiation of antipsychotic medications among older adults with dementia treated with the ChEIs donepezil, rivastigmine, or galantamine. Methods: This retrospective cohort study used multiyear (2013–2015) Medicare claims data involving Parts A, B, and D. The study sample included community-dwelling older adults (aged ≥ 65 years) with a diagnosis of dementia. The study identified new users of ChEIs and followed them for up to 180 days for antipsychotic initiation. The ChEIs included donepezil, rivastigmine, and galantamine, whereas antipsychotics included typical and atypical agents. Donepezil was used as the reference category as it is the most commonly used ChEI and only acts on acetylcholinesterase, whereas both rivastigmine and galantamine have dual mechanisms of action. Multivariable Cox proportional hazards regression compared the risk of and time to antipsychotic initiation among the three ChEIs, adjusting for other risk factors. Results: The study cohort consisted of 178,441 older adults with dementia who were new users of ChEIs. A total of 23,433 (15.14%) donepezil users, 4114 (19.04%) rivastigmine users, and 324 (15.77%) galantamine users initiated antipsychotics. The mean time to antipsychotic initiation among patients who received antipsychotics was 109.29 ± 69.72 days for donepezil users, 96.70 ± 71.60 days for rivastigmine users, and 104.15 ± 72.53 days for galantamine users. The Cox regression analysis showed that rivastigmine (adjusted hazard ratio [aHR] = 1.27; 95% confidence interval [CI], 1.20–1.34) was significantly associated with antipsychotic initiation compared with donepezil, whereas no significant difference was observed between galantamine and donepezil (aHR = 0.98; 95% CI, 0.81–1.20). Conclusion: The study found a 27% increased risk of antipsychotic initiation among users of rivastigmine compared with donepezil users. There was no difference between galantamine and donepezil for antipsychotic initiation. Although the limitations of the study should be considered, the results suggest that donepezil or galantamine may be more appropriate treatments for older patients with dementia, to minimize antipsychotic use. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated possible differences in glioblastoma (GBM) survival attributable to ethnicity. The goal of this study was to quantify oncogenic differences and evaluate the overall survival (OS) and progression-free survival (PFS) differences in GBM patients across race/ethnicity using both population-based surveillance and institutional data sets from the United States (US) and Mexico. Retrospective cohort study comprising the Texas Cancer Registry (TCR, n = 4134) and referral institutions located in US (n = 254) and Mexico (n = 47) were evaluated. Primary outcomes include OS and PFS. Oncogenic differences attributable to ethnicity were assessed. IDH1/IDH2 status was evaluated by sequencing in US and Mexico samples. Kaplan-Meier and Cox proportional hazards regression for survival analysis. A total of 4134 GBM patients were identified from the TCR data set, ethnicity comparison demonstrated that Hispanic patients were diagnosed at a significantly younger age compared to non-Hispanic white patients (NHW) (median: 58 vs. 62, P < 0.001) and had improved OS (hazard ratio: 0.82, P < 0.001). In the oncogenic analysis, we observed a significant enrichment of IDH1/IDH2 mutations in Mexican Hispanic patients compared to US Hispanic patients (29.8% vs. 7.9%, P = 0.012); IDH2 mutations drove this difference. Post-progression survival was significantly shorter in patients from Mexico than US (3.0 vs. 11.4 months; P < 0.001), while OS remained similar. IDH2 mutations are more prevalent in Mexican Hispanic individuals compared to US individuals and may be a crucial contributor to the previously reported survival benefit of Hispanic individuals in large population databases. These findings are critical for both screening of IDH2 mutations and targeted interventions in GBM. [ABSTRACT FROM AUTHOR]

Volatile nitrogen oxides (N2O, NO, NO2, HONO, ...) can negatively impact climate, air quality, and human health. Using soils collected from temperate forests across the eastern United States, we show microbial communities involved in nitrogen (N) cycling are structured, in large part, by the composition of overstory trees, leading to predictable N‐cycling syndromes, with consequences for emissions of volatile nitrogen oxides to air. Trees associating with arbuscular mycorrhizal (AM) fungi promote soil microbial communities with higher N‐cycle potential and activity, relative to microbial communities in soils dominated by trees associating with ectomycorrhizal (ECM) fungi. Metagenomic analysis and gene expression studies reveal a 5 and 3.5 times greater estimated N‐cycle gene and transcript copy numbers, respectively, in AM relative to ECM soil. Furthermore, we observe a 60% linear decrease in volatile reactive nitrogen gas flux (NOy ≡ NO, NO2, HONO) as ECM tree abundance increases. Compared to oxic conditions, gas flux potential of N2O and NO increase significantly under anoxic conditions for AM soil (30‐ and 120‐fold increase), but not ECM soil—likely owing to small concentrations of available substrate (NO3‐) in ECM soil. Linear mixed effects modeling shows that ECM tree abundance, microbial process rates, and geographic location are primarily responsible for variation in peak potential NOy flux. Given that nearly all tree species associate with either AM or ECM fungi, our results indicate that the consequences of tree species shifts associated with global change may have predictable consequences for soil N cycling. [ABSTRACT FROM AUTHOR]

Steadily increasing ethnic and cultural diversity in the United States has led employers to see intercultural competence as a valuable and necessary trait for those entering the workforce, including students studying psychology. One high-impact practice that may increase students' multicultural awareness is study abroad. The current research examined the effectiveness of a cultural scavenger hunt offered during two short-term study abroad programs to increase participants' intercultural competencies. Cultural competence was assessed in Study 1 (N = 10) using the Miville-Guzman Universality-Diversity Scale–Short Form. Results indicated a statistically significant increase across all subscales. In Study 2 (N = 16), the Cross-Cultural Adaptability Inventory was utilized. Results from Study 2 demonstrated statistically significant improvements in the Emotional Resilience subscale. These findings suggest that a cultural scavenger hunt may assist participants in actively engaging in the local culture and facilitate the initial development of intercultural competencies. [ABSTRACT FROM AUTHOR]

Suicide-related behaviors are over-represented among youth with autism spectrum disorder (ASD). A more thorough understanding of the connections between ASD and suicide-related behaviors may help to identify potential avenues for prevention efforts and can inform clinical care for youth with ASD. This manuscript presents a conceptualization of suicide risk among youth with ASD based on the Interpersonal Theory of Suicide, in order to spur discussion and future research. This manuscript also provides preliminary clinical recommendations for improving suicide prevention efforts among youth with ASD based on hypothesized risk and protective factors. [ABSTRACT FROM AUTHOR]

This study proposes a method for calculating the annual incidence rate of sibling bereavement among US youth using national epidemiological data. The proposed model combines data on family household size with national death statistics to calculate the number of siblings affected by the death of a child annually. From 2012 to 2015, an average of 61,389 children per year experienced the death of a sibling, resulting in an estimate of 0.0832% of children bereaved by the death of a sibling annually. Data indicate a need for greater awareness and dialog concerning the frequency with which children experience the death of a sibling. [ABSTRACT FROM AUTHOR]

Several US states have expanded Medicaid under the Patient Protection and Affordable Care Act (ACA), extending Medicaid coverage to millions of previously uninsured low-income individuals[2] including those with non-dialysis-dependent kidney disease.[3] The goal of this study was to determine whether Medicaid expansion was associated with changes in Medicaid coverage for pre-emptive living-donor KT (LDKT) and deceased-donor KT (DDKT) in the US. After Medicaid expansion, Medicaid-covered pre-emptive KT recipients from expansion states were more likely to be minorities and to be employed than those from non-expansion states (Table 1). To account for different calendar dates of Medicaid expansion, results are presented as the number of quarters before and after a standardized Medicaid expansion date, where the date of Medicaid expansion is set to equal zero. [Extracted from the article]

Rationale: Stable isotope analysis is used to understand the foraging habits and movements of a diverse set of organisms. Variability in stable isotope ratios among tissues derived from the same animal makes it difficult to compare data among study results in which different tissue types are evaluated. Isotopic relationships between two green turtle (Chelonia mydas) tissue types, skin and unhatched egg contents are unknown. Similarly, few data exist to evaluate the influence of time elapsed after oviposition (as a proxy for decomposition) on isotopic variability among unhatched eggs within the same nest. Methods: Skin and unhatched egg contents were collected from 69 adult female green turtles and associated nests at the Archie Carr National Wildlife Refuge in Florida, USA. Values of δ13C, δ15N, and δ34S were measured for both tissue types using a continuous flow isotope ratio mass spectrometer. Standardized major‐axis (SMA) regression was used to generate conversion equations of carbon, nitrogen, and sulfur isotope ratios between the two tissue types. Model selection frameworks consisting of single‐factor linear models were employed per isotope ratio to assess how egg time‐in‐nest affected intraclutch isotopic variability. Results: Conversion equations for all three isotope ratios indicated significant relationships between skin and unhatched egg values, although model fits were lower than found in some studies examining similar patterns in other marine turtle species. The probability of increased intraclutch variability was significantly higher among eggs collected at longer intervals after deposition. Conclusions: This study reports the first‐ever δ13C and δ15N conversion equations between skin and unhatched eggs for green turtles, and the first δ34S conversion equation for any marine turtle species. SMA regression was used to directly convert tissue values bidirectionally, unlike equations generated using ordinary least‐squares regression. Issues with increased intraclutch variability at later excavation dates highlight the importance of collecting unhatched eggs as soon as possible after hatchling emergence. [ABSTRACT FROM AUTHOR]

Conversational agents (CAs) are an integral component of many personal and business interactions. Many recent advancements in CA technology have attempted to make these interactions more natural and human-like. However, it is currently unclear how human-like traits in a CA impact the way users respond to questions from the CA. In some applications where CAs may be used, detecting deception is important. Design elements that make CA interactions more human-like may induce undesired strategic behaviors from human deceivers to mask their deception. To better understand this interaction, this research investigates the effect of conversational skill—that is, the ability of the CA to mimic human conversation—from CAs on behavioral indicators of deception. Our results show that cues of deception vary depending on CA conversational skill, and that increased conversational skill leads to users engaging in strategic behaviors that are detrimental to deception detection. This finding suggests that for applications in which it is desirable to detect when individuals are lying, the pursuit of more human-like interactions may be counter-productive. • People type differently when conversing with conversational agents that have more human-like conversational skill. • People show strategic behavior to conceal their deception when conversing with a more human-like conversational agent. • Conversational agents that indicate understanding affect behavior more than agents that merely have variety in responses. [ABSTRACT FROM AUTHOR]

The article discusses the author's claim that the U.S. Supreme Court should repudiate the nation's constitutional avoidance and severability statutory interpretation legal doctrines, and it mentions the case Erie Railroad Co. v. Tompkins which deals with U.S. common law and legal positivism. The U.S. Patient Protection and Affordable Care Act cases National Federation of Independent Business v. Sebelius and King v. Burwell are assessed, along with a textualism legal interpretation doctrine.

Background: Repetitive head impacts in young athletes are potentially detrimental to later life (e.g., age 50 + years) neurological function; however, it is unknown what the short-term effects (e.g., age 20 years) are in collegiate student-athletes.Objective: The purpose of this study was to determine the effect of the estimated age of first exposure to American tackle football participation on neurocognitive performance and symptom severity scores in collegiate student-athletes.Methods: We used a cohort study in which neurocognitive performance was assessed using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test in 4376 male athletes (age 19.3 ± 1.5 years, mass 96.3 ± 20.3 kg, height 185.0 ± 7.4 cm). Athletes were grouped by sport participation [American football (n = 3462) or non-contact (n = 914)] and estimated age of first exposure [< 12 years (n = 3022) or ≥ 12 years (n = 1354)]. The outcome measures were the four primary cognitive scores and the symptom severity score from ImPACT. We assessed primary outcomes across groups, controlling for age, learning accommodations, and concussion history.Results: Neurocognitive performance was not associated with the estimated age of first exposure-by-group interaction.Conclusion: Our findings indicate that participation in American tackle football before age 12 years does not result in neurocognitive deficits in college. Therefore, we suggest the following: the consequences of early exposure to repetitive head impacts do not manifest by college, the ImPACT test was not sensitive enough to identify the effects of an earlier estimated age of first exposure, or there is no association between an earlier estimated age of first exposure and neurocognitive functioning. Future longitudinal studies are warranted. [ABSTRACT FROM AUTHOR]

Introduction: The opioid epidemic in the United States is an ongoing public health crisis that is in part fueled by excessive prescribing by physicians. Percutaneous nephrolithotomy (PCNL) is a procedure that conventionally involves opioid prescriptions for adequate post-operative pain control. We aimed to evaluate the feasibility of a non-opioid pain regimen by evaluating post-operative outcomes in PCNL patients discharged without opioids. Materials and methods: As a quality improvement measure to reduce opioid consumption our department began routinely prescribing oral ketorolac instead of oxycodone–acetaminophen for pain control after PCNL. We retrospectively compared patients undergoing PCNL who had received ketorolac prescriptions (NSAID) to those who received oxycodone–acetaminophen prescriptions (NARC). Demographic, operative, and post-operative factors were obtained and compared in both groups. Peri-operative factors and demographics were compared using either Chi-squared tests, Mann–Whitney U tests. Surgical outcomes were compared between the two groups using Chi-squared tests and Fisher's exact tests. Multivariate logistic regression analysis was performed to determine whether ketorolac use was an independent predictor of post-surgical pain-related encounters. Primary outcome was unplanned pain-related healthcare encounters inclusive of office phone calls, unscheduled office visits, and emergency department (ED) visits. Secondary outcome measures were non-pain-related healthcare encounters, hospital readmissions, pain-related rescue medications prescribed, and post-op complications. Results: There were similar demographics and peri-operative characteristics amongst patients in both cohorts. There was no significant difference identified between NSAID and NARC regarding unplanned pain-related encounters (8/70, 11.4% vs. 10/70, 14.3%, p = 0.614). However, NARC experienced more unplanned phone calls (42, 60% vs. 24, 34.3%, p = 0.004). Multivariate analysis revealed only prior stone surgery was predictive of pain-related encounters after PCNL (p = 0.035). Conclusion: Our results show that there were no significant differences in pain-related encounters between those who received ketorolac and oxycodone–acetaminophen following PCNL. A non-opioid pathway may mitigate the potential risk associated with opioid prescription without compromising analgesia. Prospective comparative studies are warranted to confirm feasibility. [ABSTRACT FROM AUTHOR]

Health insurance and health systems literacy needs are evolving with changes to the U.S. healthcare system. Following the implementation of the Affordable Care Act, many residents in West Louisville, Kentucky, a predominantly African American community, gained health insurance coverage for the first time. A qualitative study was conducted to assess residents’ health insurance and health systems needs and to identify ways of assisting residents with navigating the healthcare system and utilizing their health insurance coverage. Twelve focus groups were conducted with a total of eighty-seven residents. Round one explored participants’ experiences with health insurance, and round two examined their health information delivery preferences. An inductive thematic analysis was performed. Participants revealed the complexity of the health insurance system, many citing difficulty understanding health insurance concepts and finding suitable healthcare providers. High costs, mistrust in the healthcare system, and perceived public-private disparities were barriers to effective health insurance utilization. Health insurance materials in their current form have limited value in translating health insurance and health systems information to the West Louisville population. Alternative forms of information delivery, such as locally accessible and culturally competent community health workers may be better received and more successfully utilized by the community. [ABSTRACT FROM AUTHOR]

There is an increasing movement throughout the United States and abroad to develop cost-effective and evidence-based strategies that enhance public safety, decrease recidivism, and reduce the number of inmates held in correctional facilities. One such recent approach to achieve these goals is the use of justice reinvestment strategies, which promote the reallocation of funds initially designated for imprisonment into other community-based alternatives. Although the available research generally indicates many of the reinvestment initiatives undertaken so far are effective in achieving these goals, much less empirical attention focuses on what aspects of these programs are effective. In response, this study fills a critical gap in this literature by evaluating how different treatment services and offender risk levels influence the recidivism of youth involved in a justice reinvestment program in Ohio. The findings of this study indicate youth who were incarcerated were nearly two times as likely to recidivate during a one-year follow-up compared to similarly matched youth who participated in the justice reinvestment programming. This study also found that the effectiveness of treatment was also moderated to a large extent by treatment modality and offender risk level. The policy implications of these findings and recommendations for future research are also discussed. [ABSTRACT FROM AUTHOR]

The article offers information on using critical theory to investigate the imbalance of power and systems of inequality in the U.S. Topics discussed include educational goal of encouraging critical thinking; adoption of the C3 Framework and the development of the Inquiry Design Model for implementing a critical social studies pedagogy; and asking questions on oppression and power.

Importance: Recent reports have described the increasing use of nonsteroidal selective androgen receptor modulators, which have not been approved by the US Food and Drug Administration (FDA), to enhance appearance and performance. The composition and purity of such products is not known.Objective: To determine the chemical identity and the amounts of ingredients in dietary supplements and products marketed and sold through the internet as selective androgen receptor modulators and compare the analyzed contents with product labels.Design and Setting: Web-based searches were performed from February 18, 2016, to March 25, 2016, using the Google search engine on the Chrome and Internet Explorer web browsers to identify suppliers selling selective androgen receptor modulators. The products were purchased and the identities of the compounds and their amounts were determined from April to August 2016 using chain-of-custody and World Anti-Doping Association-approved analytical procedures. Analytical findings were compared against the label information.Exposures: Products marketed and sold as selective androgen receptor modulators.Main Outcomes and Measures: Chemical identities and the amount of ingredients in each product marketed and sold as selective androgen receptor modulators.Results: Among 44 products marketed and sold as selective androgen receptor modulators, only 23 (52%) contained 1 or more selective androgen receptor modulators (Ostarine, LGD-4033, or Andarine). An additional 17 products (39%) contained another unapproved drug, including the growth hormone secretagogue ibutamoren, the peroxisome proliferator-activated receptor-δ agonist GW501516, and the Rev-ErbA agonist SR9009. Of the 44 tested products, no active compound was detected in 4 (9%) and substances not listed on the label were contained in 11 (25%). In only 18 of the 44 products (41%), the amount of active compound in the product matched that listed on the label. The amount of the compounds listed on the label differed substantially from that found by analysis in 26 of 44 products (59%).Conclusions and Relevance: In this limited investigation involving chemical analyses of 44 products marketed as selective androgen receptor modulators and sold via the internet, most products contained unapproved drugs and substances. Only 52% contained selective androgen receptor modulators and many were inaccurately labeled. [ABSTRACT FROM AUTHOR]

Introduction: Despite increasing rates of opioid misuse and hospitalizations, rates of treatment for those with opioid use disorder (OUD) are very low. This study examined the impact of the Patient Protection and Affordable Care Act's (ACA) insurance expansion on improving rates of insurance, health care access, and treatment for those with OUD.Methods: Data on individuals ages 18-64 with OUD come from the 2008-2014 National Survey on Drug Use and Health (N=4100). Multivariable logistic regression analyses were performed to estimate the trends of health care insurance, treatment and barriers to care across the stages of ACA implementation: pre-ACA (2008-2009), partial-ACA (2010-2013), and national implementation (2014). All models were adjusted for predisposing, enabling, and need factors.Results: In both adjusted and unadjusted comparisons, national implementation of the ACA was associated with significant improvements in outcome measures for those with OUD. Multivariable analyses indicate that, after national implementation, those with OUD were significantly less likely to be uninsured and were less likely to report financial barriers as a reason for not receiving substance use treatment, relative to the pre-ACA period. Individuals were also more likely to receive substance use treatment and were more likely to report that insurance paid for treatment after national implementation of the ACA relative to the pre-ACA period. These results persisted when national implementation was compared relative to partial-implementation.Conclusions: National implementation of the ACA has helped to reduce rates of uninsurance, barriers to care, and improve rates of substance use treatment for those with OUD. [ABSTRACT FROM AUTHOR]

The article discusses the role of equality and the rule of law to the collapse of egalitarianism. It cites that the U.S. is the only nation to be founded on the principle of human equality. The article also discusses on the explicit or implicit framework for every revolution including antislavery, women's rights, and civil rights movements in the U.S.

Justice reinvestment strategies have been proposed to allow financial resources originally allocated for imprisonment to be reinvested into community-based alternatives. According to this perspective, the government has the responsibility to fund strategies that reduce crime, and previous studies have questioned the effectiveness of prison as one solution. Furthermore, empirical support for community-based alternatives underscores the importance of delivering interventions in offenders’ natural environments. This study explores one state’s attempt to fund strategies that reduce crime and delinquency. Through the Targeted Reasoned and Equitable Community and Local Alternatives to the Incarceration of Minors (RECLAIM) initiative, the State of Ohio attempted to reduce the risk of recidivism by serving more youth locally, instead of in secure facilities in the six most populous counties throughout the state. Specifically, the findings suggest that the Targeted RECLAIM initiative was successful in reducing the risk of recidivism of participating youth. [ABSTRACT FROM AUTHOR]

This critical case study investigated the experiences of six White preservice teachers as they learned about race and racism during the first semester of an urban-focused teacher preparation program. The author identified two broad themes oftransgressive White racial knowledgeandnegotiated White racial knowledgeto capture the participants’ engagement with the topic of race. By detailing the complexities of the racial knowledge of a group of race-conscious White teachers, the project helps to de-homogenize conceptualizations of White teachers’ racial identities. The transgressive knowledge displayed by the participants largely occurred in their intellectual understandings of issues related to urban education. When the participants discussed their antiracist practice and their own complicity in racism, their negotiations with critical understandings of race emerged. These findings suggest that educators working with race-conscious White teachers should emphasize the messiness inherent in enacting an antiracist practice and think differently about the subtle distancing strategies White teachers often deploy to release themselves from complicity in racism. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) is a range of pathologies arising from fat accumulation in the liver in the absence of excess alcohol use or other causes of liver disease. Its complications include cirrhosis and liver failure, hepatocellular carcinoma, and eventual death. NAFLD is the most common cause of liver disease globally and is estimated to affect nearly one-third of individuals in the United States. Despite knowledge that the incidence and prevalence of NAFLD are increasing, the pathophysiology of the disease and its progression to cirrhosis remain insufficiently understood. The molecular pathogenesis of NAFLD involves insulin resistance, inflammation, oxidative stress, and endoplasmic reticulum stress. Better insight into these molecular pathways would allow for therapies that target specific stages of NAFLD. Preclinical animal models have aided in defining these mechanisms and have served as platforms for screening and testing of potential therapeutic approaches. In this review, we will discuss the cellular and molecular mechanisms thought to contribute to NAFLD, with a focus on the role of animal models in elucidating these mechanisms and in developing therapies. [ABSTRACT FROM AUTHOR]

Established doctrine holds that customary international law ("GIL") arises from general and consistent state practice that is backed by a sense of legal obligation. Contemporary litigation requires federal courts to apply this doctrine to identify the contours of CIL in a diverse collection of cases ranging from civil actions under the Alien Tort Statute to criminal prosecutions under the Maritime Drug Law Enforcement Act. This Article provides an in-depth look at how federal judges carry out this task. Conducting a citation analysis of opinions published since the U.S. Supreme Court's 2004 decision in Sosa v. Alvarez-Machain, this Article analyzes the form, quality, and geographical origins of the authorities that tend to serve as evidence of custom; explores the implications of recent citation patterns; and offers ideas to help courts grapple more effectively with the challenge of finding custom. [ABSTRACT FROM AUTHOR]

Background: Research has documented significant associations between life stress, especially interpersonal stress, and suicidal ideation in adolescents. Little is known about variables that explain the association between interpersonal stress and suicidal ideation.Methods: The present study evaluated a conceptual model in which interpersonal stress (chronic and episodic) predicted suicidal ideation indirectly via thwarted belongingness and perceived burdensomeness among 180 inpatients (65.0% girls) ages 12-17 years (M=14.72, SD=1.49). Non-interpersonal stress was also examined to determine whether the model was specific to interpersonal stress or common to stress in general.Results: Structural equation modeling identified a significant indirect effect of chronic interpersonal stress on suicidal ideation via perceived burdensomeness. Episodic interpersonal stress was significantly correlated with thwarted belongingness and suicidal ideation, but was not a significant predictor of suicidal ideation in a model that controlled for depressive and anxious symptoms. No significant associations were found between non-interpersonal stress and suicidal ideation.Limitations: Adolescents were the sole informant source, data on psychiatric diagnoses were not available, and the optimal time interval for examining stress remains unclear. The cross-sectional study design prevents conclusions regarding directionality.Conclusions: These findings highlight the role of chronic interpersonal stress in suicidal ideation in adolescents, as well as the potential promise of perceived burdensomeness as a target for programs designed to prevent or reduce suicidal ideation. [ABSTRACT FROM AUTHOR]

Canine rabies virus variant has been eliminated in the United States and multiple other countries. Globally, however, dogs remain the principal source for human rabies infections. The World Health Organization recommends that when dogs cross international borders, national importing authorities should require an international veterinary certificate attesting that the animal did not show signs of rabies at the time of shipment, was permanently identified, vaccinated, or revaccinated, and had been subjected to a serologic test for rabies before shipment. On June 8, 2015, an adult female dog that had recently been picked up from the streets of Cairo, Egypt, and shipped by a U.S. animal rescue organization to the United States was confirmed to have rabies by the Virginia Department of General Services Division of Consolidated Laboratory Services (DCLS). This dog was part of a large shipment of dogs and cats from Egypt that rescue organizations had distributed to multiple states for adoption. During the investigation, public health officials learned that the rabies vaccination certificate used for entry of the rabid dog into the United States had intentionally been falsified to avoid exclusion of the dog from entry under CDC's current dog importation regulations. This report underscores the ongoing risk posed by U.S. importation of domestic animals that have not been adequately vaccinated against rabies. [ABSTRACT FROM AUTHOR]

Recent archaeological investigations indicate that coastal Fort Walton cultures in the St. Joseph Bay region of northwest Florida emphasized marine and estuarine foraging. These late prehistoric, Mississippi-period (A.D. 1000–1500) peoples collected fish, shellfish, and other aquatic resources. At the Richardson's Hammock site (8Gu10), radiocarbon-dated to about A.D. 1300, large, predatory gastropods were a major subsistence component. This adaptation is in sharp contrast with that of contemporaneous inland Fort Walton societies, who relied on maize agriculture, and raises the question whether coastal groups were separate hunter–gatherer–fisher populations or migrated seasonally from inland farming villages. We perform stable oxygen and carbon isotope sclerochronology on lightning whelks ( Busycon sinistrum ) to determine the seasonality of Fort Walton foraging and to compare the environment of prehistoric St. Joseph Bay with that of the modern bay. Oxygen isotope profiles suggest that shellfish collecting was relegated primarily to the summer months, producing a scheduling conflict with the primary growing season for maize in northwest Florida. Thus, coastal and inland Fort Walton sites probably represent separate culture groups. The relationship between δ 18 O shell and δ 13 C shell indicates similar environmental and climatic conditions between prehistoric St. Joseph Bay and today. However, modern whelks are depleted in 13 C compared to Fort Walton whelks, which reflects both twentieth century CO 2 emissions and years of dredging and wastewater pollution entering the bay. [ABSTRACT FROM AUTHOR]

Several empirical studies have estimated a negative relationship between the share of an area's elderly population and per-pupil education spending. These findings have often been interpreted as evidence that an aging population has hindered the growth in per-pupil expenditures. We offer a reinterpretation of these oft-cited estimates and demonstrate that the population has aged in a way not reflected in these earlier studies’ empirical designs. After fully accounting for actual U.S. population trends, we demonstrate that a rise in the elderly share of the population has resulted in a rise in per-pupil education spending, not a decline. [ABSTRACT FROM AUTHOR]

The article looks at the U.S. Religious Land Use and Institutionalized Persons Act of 2000 and discusses its application to local land use decisions in the country. Topic discussed include the U.S. Supreme Court ruling in the Court's holding in "Employment Division, Department of Human Resources of Oregon v. Smith" involving laws related to free exercise of religion; and opinion of the U.S. Court of Appeals for the first district in "Roman Catholic Bishop v. City of Springfield" case.

The article discusses the legal aspects of emergency contraceptives and "abortion-inducing" drugs in America as of 2014, focusing on the apparent efforts to empower women to make informed decisions about issues such as abortion, pregnancy, and abortifacients. Employer-mandated health insurance coverage for certain contraceptive drugs and devices is addressed in relation to the U.S. Patient Protection and Affordable Care Act. U.S. abortion laws and drug-related religious objections are examined.

In 1975, Congress amended the Securities Exchange Act of 1934, incorporating section 13(f) on Periodic Reporting requirements of institutional investment managers. The law mandates that institutional investors file a holdings report, known as Form 13F, with the Securities and Exchange Commission for public distribution. The law provides filers with confidential treatment when in the public interest. This Note argues that the SEC has not implemented section 13(f) in a way that achieves Congress's professed goal of providing more egalitarian access to information about the financial and security markets, both by neglecting to effectively administer the program and failing to promulgate a meaningful standard for exemption. It also argues that this failure is detrimental to the efficiency of the securities markets. It makes the case that the SEC should more deliberately balance the competitive interest of institutional investment managers with the public interest in transparent and efficient markets when administering the regulation. By harmonizing section 13(f) with existing securities regulation doctrine, this Note ultimately arrives at suggestions for improvement, namely that the law be deployed as a mechanism for sharing gains with the market and that confidential treatment be granted only when necessary to avoid inflicting losses on an institution, as opposed to protecting future potential gain. This Note also makes corollary suggestions that modernize the administration of the law and provide for more rigorous enforcement policies. [ABSTRACT FROM AUTHOR]

The article discusses a study that evaluates the success of the Effective Practices in Community Supervision model in targeting and changing antisocial attitudes in the U.S. Study participants came from one of four regional parole departments in one large Midwestern state. Data was gathered by University of Cincinnati Corrections Institute staff. A table is shown that outlines demographic attributes of participants by officer training status.

A traditional view in legal scholarship holds that the U.S. Constitution assigns the president exclusive power to carry on official diplomatic communications with foreign governments. But in fact, Congress and its members routinely engage in communications of their own. Congress, for example, receives heads of state and maintains official contacts with foreign parliaments. And individual members of the House and Senate frequently travel overseas on congressional delegations ("CODELs") to confer with foreign leaders, investigate problems that arise, promote the interests of the United States and constituents, and even represent the president. Moreover, many of these activities have occurred ever since the Founding. Together, they comprise an understudied field of legislative diplomacy. This Article has two purposes: The first is to use State Department cables from WikiLeaks, a recent compilation of public reports, and original historical sources to provide a uniquely detailed, descriptive account of legislative diplomacy. The second is to develop theories about the practice's constitutionality. Text, original meaning, and customary practice suggest that the separation of diplomacy powers is more complicated than commonly assumed and that those powers do not belong exclusively to the president. The analysis undermines the "sole organ" metaphor, serves as a counterpoint to the widely held view that authority over foreign affairs belongs overwhelmingly to the executive, and carries practical implications for the execution of U.S. foreign relations. [ABSTRACT FROM AUTHOR]

The author utilized Critical Race Theory (CRT) to examine the passage of the US Voting Rights Act (VRA) of 1965 in an effort to disrupt the simplistic, uncritical understandings of the US Civil Rights Movement common to school texts while also arguing for the ongoing importance of the VRA in a time when voting rights for people of color are under attack. The author identified four points of interest convergence in the passage of the VRA and contends that a critical revisionist narrative of the VRA – along with other events and individuals Civil Rights Movement – is necessary to help students and teachers understand the persistence of racism and the limitations of liberalism in addressing racial inequality. [ABSTRACT FROM PUBLISHER]

The article discusses alcoholism among soldiers at Fort Hays in Kansas in the mid-to-late nineteenth century. It comments for reasons for alcoholism, including boredom and loneliness. The author considers ways in which soldiers obtained alcohol, including on base and at saloons. He reflects on consequences of drunkenness, including absence, desertion, and violence, and examines punishments, including court-martial, solitary confinement, and forced labor. Alcoholism among regimental band members is also addressed.

Abstract: Context: Debates persist about the relevance of “dignity” as an ethical concept in U.S. health care, especially in end-of-life care. Objectives: To describe the attitudes and beliefs regarding the usefulness and meaning of the concept of dignity and to examine judgments about a clinical scenario in which dignity might be relevant. Methods: Two thousand practicing U.S. physicians, from all specialties, were mailed a survey. Main measures included physicians'' judgments about an end-of-life clinical scenario (criterion variable), attitudes about the concept of dignity (predictors), and their religious characteristics (predictors). Results: Responses were received from 1032 eligible physicians (54%). Nine (90%) of 10 physicians reported that dignity was relevant to their practice. After controlling for age, gender, region, and specialty, physicians who judged that the case patient had either some dignity or full dignity, and who agreed that dignity is given by a creator, were all positively associated with believing that the patient''s life was worth living (odds ratio [OR] 10.2, 95% confidence interval [CI] 5.8–17.8, OR 20.5, 95% CI 11.4–36.8, OR 4.7, 95% CI 3.1–7.0, respectively). Respondents who strongly agreed that “all living humans have the same amount of dignity” were also more likely to believe that the patient''s life was worth living (OR 1.8, 95% CI 1.2–2.7). Religious characteristics also were associated with believing that the case patient''s life was worth living (OR 4.1, 95% CI 2.4–7.2, OR 3.2, 95% CI 1.6–6.3, OR 9.2, 95% CI 4.3–19.5, respectively). Conclusion: U.S. physicians view the concept of dignity as useful. Those views are associated with their judgments about common end-of-life scenarios in which dignity concepts may be relevant. [Copyright &y& Elsevier]

Osteoarthritis is a common indication for hip and knee arthroplasty. An accurate assessment of current trends in healthcare utilization as they relate to arthroplasty may predict the needs of a growing elderly population in the United States. First, incidence data was queried from the United States Nationwide Inpatient Sample from 1993 to 2009. Patients undergoing total knee and hip arthroplasty were identified. Then, the United States Census Bureau was queried for population data fromthe same study period as well as to provide future projections. Arthroplasty followed linear regression models with the population group >64 years in both hip and knee groups. Projections for procedure incidence in the year 2050 based on these models were calculated to be 1,859,553 cases (hip) and 4,174,554 cases (knee). The need for hip and knee arthroplasty is expected to grow significantly in the upcoming years, given population growth predictions. [ABSTRACT FROM AUTHOR]

The article focuses on forensic science in criminal justice administration in the U.S. The author discusses how stronger state level oversight of forensic science regulation would prevent errors and describes how states use forensic regulation measures within the federal framework. It is noted that state regulation is necessary despite efforts to increase the federal government's role in forensic regulation.