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Background: The imperative for social justice in education means that pre-service teachers should learn how to teach for and about social justice, including pedagogical and content knowledge. Understanding how physical education (PE) pre-service teachers and teacher educators construct and develop their knowledge of social justice pedagogies and critical content, intertwined with values based on social justice and equity, is needed to best support future teachers. Purpose: The focus of this paper is how physical education teacher educators and PE and sport pedagogy university faculty have developed their knowledge of teaching for and about social justice: where their knowledge came from and how they draw upon it in their teaching and programme design. Method: Seventy-two faculty from seven countries engaged in an in-depth interview about their conceptualisation of social justice, their knowledge, practices, institutions, and policy contexts and completed a demographic survey on their social identity and professional experiences. Using a social justice pedagogical and content knowledge (SJPACK) model, thematic analysis generated formal educational study, workplace experience, and personal or social identity bases of social justice knowledge. Findings: Many of those who expressed a commitment to teaching about and for social justice had personal and professional experiences that had provided 'eye-opening' moments. For instance, some had encountered marginalisation and discrimination based on their identity. If social justice issues were not a part of a participant's lived experience, but they had professional experience in the field, they were struck by what they did not know and subsequently sought out postgraduate or professional development. Professional experiences in the field were much more likely than formal education experiences to provide recognition that participants needed to learn more about social justice. Social justice is both knowledge and an ideological stance, so learning about social justice is as much about values and disposition as about content. Social justice must be important enough for teacher educators to embed in their belief system so that it becomes part of their pedagogical practice. Conclusion: This study prompts consideration of the professional development needs of teacher educators concerning social justice that goes beyond acknowledging the existence of sociocultural issues by moving towards changes in pedagogical practices in PETE and PESP programmes. We advocate collaborative and reflective professional development for educators if SJPACK is to be woven throughout teacher education programmes and not just incumbent on educators with personal experience of social justice issues.

Background: Chronic pain affects over 100 million Americans, with a disproportionately high number being Veterans. Chronic pain is often difficult to treat and responds variably to medications, with many providing minimal relief or having adverse side effects that preclude use. Cannabidiol (CBD) has emerged as a potential treatment for chronic pain, yet research in this area remains limited, with few studies examining CBD's analgesic potential. Because Veterans have a high need for improved pain care, we designed a clinical trial to investigate CBD's effectiveness in managing chronic pain symptoms among Veterans. We aim to determine whether CBD oral solution compared to placebo study medication is associated with greater improvement in the Patient Global Impression of Change (PGIC). Methods: We designed a randomized, double-blind, placebo-controlled, pragmatic clinical trial with 468 participants. Participants will be randomly assigned in a 1:1 ratio to receive either placebo or a CBD oral solution over a 4-week period. The trial is remote via a smartphone app and by shipping study materials, including study medication, to participants. We will compare the difference in PGIC between the CBD and placebo group after four weeks and impacts on secondary outcomes (e.g., pain severity, pain interference, anxiety, suicide ideation, and sleep disturbance). Discussion: Once complete, this trial will be among the largest to date investigating the efficacy of CBD for chronic pain. Findings from this clinical trial will contribute to a greater knowledge of CBD's analgesic potential and guide further research. Given the relative availability of CBD, our findings will help elucidate the potential of an accessible option for helping to manage chronic pain among Veterans. Trial registration: This protocol is registered at clinicaltrials.gov under study number NCT06213233. [ABSTRACT FROM AUTHOR]

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

Introduction In December 2019, the minimum legal sales age (MLSA) for tobacco products in the United States was raised from 18 to 21 years as a measure of preventing smoking initiation. Smoking during pregnancy, which causes maternal, fetal, and infant morbidity and mortality, is a major public health concern. We first study the effects of purchase restrictions on smoking during different stages of pregnancy covering the entire United States and using the records of all live births during 2014–2018 by birthing people aged 18–21 years. Aims and Methods Our identification strategy utilizes the variation in the MLSA of tobacco products over time and across counties in the United States during 2014–2018 using a two-way fixed effects model, modified to accommodate a partially observable treatment indicator. Results The results show that 37.4% of potential smokers in our study population would have been prevented from smoking before pregnancy, 50.5% during the first trimester, 53.4% during the second trimester, and 14.8% during the third trimester if the law prevented selling tobacco products to them in the locality they live. A purchase restriction is estimated to cause the smoking intensity of those who smoke, the intensive margin, to drop by 5.4% before pregnancy, 10.4% during the first trimester, 14.8% during the second trimester, and 5.2% during the third trimester. Conclusions Our results show that purchase restrictions are highly effective in preventing smoking among birthing people in the 18–21 years age group. The effect on smoking prevalence during the first and second trimesters is more pronounced. Implications Many countries around the world have recently tightened age-based purchase restriction policies as a tobacco control measure. We first study the effects of purchase restrictions on smoking during different stages of pregnancy using the birth records of all pregnancies in the United States by birthing people aged 18–21 years during 2014–2018. The study utilizes the variation in the MLSA of tobacco products over time and across counties during that period. Our results show that purchase restrictions are highly effective in preventing smoking among birthing people in the 18–21 years age group. [ABSTRACT FROM AUTHOR]

Background and Aims: This study aimed to (1) describe trends in stimulant‐alone and stimulant and other substance use overdose deaths from 2012 to 2018 and (2) measure patient and service use characteristics across stimulant‐related overdose death profiles. Design Retrospective cohort study of patients who died from stimulant‐involved overdose between annual years 2012 and 2018. Setting: United States Veterans Health Administration (VHA). A total of 3631 patients died from stimulant‐involved overdose, as identified through the National Death Index. Measurements Stimulant‐involved overdose deaths were categorized by stimulant type (cocaine or methamphetamine/other) and other substance co‐involvement. Cause of death data were linked to patient characteristics, including demographic and treatment use preceding overdose from VHA administrative data. We examined trends over time and compared treatment use factors between the following mutually exclusive overdose profiles: cocaine alone, methamphetamine alone, cocaine + opioid, methamphetamine + opioid, any stimulant + other substance and cocaine + methamphetamine. Findings The rate of overdose death was 3.06 times higher in 2018 than 2012, with increases across all toxicology profiles. Compared with cocaine‐involved overdoses, methamphetamine‐involved overdoses were less likely in people who were older [adjusted odds ratio (aOR) = 0.22, 95% confidence interval (CI) = 0.06–0.87 aged 65+ versus 18–29] and more likely among those who lived in rural areas (aOR = 2.73, 95% CI = 1.43–5.23). People who died from stimulant + opioid overdoses had lower odds of a stimulant use disorder diagnosis compared with stimulant alone deaths (cocaine: aOR = 0.55, 95% CI = 0.41–0.75, methamphetamine: aOR = 0.44, 95% CI = 0.29–0.68). Conclusions: The rate of deaths among US Veterans from stimulant‐related overdose was three times higher in 2018 than 2012. Key differences in characteristics of patients across overdose toxicology profiles, such as geographic location and health‐care use, point to distinct treatment needs based on stimulant use type. [ABSTRACT FROM AUTHOR]

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

Aims: To understand the role of comorbid substance use disorders (SUDs), or polysubstance use, in the treatment of opioid use disorder (OUD), this study compared patients with OUD only to those with additional SUDs and examined association with OUD treatment receipt. Design, setting and participants: Retrospective national cohort study of Veterans diagnosed with OUD (n = 65 741) receiving care from the US Veterans Health Administration (VHA) in fiscal year (FY) 2017. Measurements: Patient characteristics were compared among those diagnosed with OUD only versus those with one other SUD (OUD + 1 SUD) and with multiple SUDs (OUD + ≥ 2 SUDs). The study examined the relationship between comorbid SUDs and receipt of buprenorphine, methadone and SUD outpatient treatment during 1‐year follow‐up, adjusting for patient demographic characteristics and clinical conditions. Findings Among the 65 741 Veterans with OUD in FY 2017, 41.2% had OUD only, 22.9% had OUD + 1 SUD and 35.9% had OUD + ≥ 2 SUDs. Common comorbid SUDs included alcohol use disorder (41.3%), cocaine/stimulant use disorder (30.0%) and cannabis use disorder (22.4%). Adjusting for patient characteristics, patients with OUD + 1 SUD [adjusted odds ratio (aOR) = 0.87, 95% confidence interval (CI) = 0.82–0.93] and patients with OUD +≥ 2 SUDs (aOR = 0.65, 95% CI = 0.61–0.69) had lower odds of receiving buprenorphine compared with OUD only patients. There were also lower odds of receiving methadone for patients with OUD + 1 SUD (aOR = 0.91, 95% CI = 0.86–0.97)and for those with OUD + ≥2 SUDs (aOR = 0.79, 95% CI = 0.74–0.84). Patients with OUD + 1 SUD (aOR = 1.85, 95% CI = 1.77–1.93) and patients with OUD + ≥2 SUDs (aOR = 3.25, 95% CI = 3.103.41) were much more likely to have a SUD clinic visit. Conclusions: The majority of Veterans in the US Veterans Health Administration diagnosed with opioid use disorder appeared to have at least one comorbid substance use disorder and many have multiple substance use disorders. Despite the higher likelihood of a substance use disorder clinic visit, having a non‐opioid substance use disorder is associated with lower likelihood of buprenorphine treatment, suggesting the importance of addressing polysubstance use within efforts to expand treatment for opioid use disorder. [ABSTRACT FROM AUTHOR]

We aimed to assess the probability and factors associated with the presence of hepatitis C virus (HCV) antibody among HCV seronegative kidney transplant recipients receiving HCV-infected (nucleic acid testing positive) donor kidneys. This is a retrospective review examining HCV antibody seroconversion of all kidney transplant recipients receiving an organ from an HCV-infected donor between 1 March 2018 and 2 December 2019 at a high-volume kidney transplant center in the southeast United States. Of 97 patients receiving HCV-infected kidneys, the final cohort consisted of 85 recipients with 5 (5.9%) recipients noted to have HCV antibody seroconversion in the setting of HCV viremia. The HCV RNA level at closest time of antibody measurement was higher in the seroconverted patients versus the ones who never converted [median and (interquartile range): 1,091,500 (345,000–8,360,000) vs 71,500 (73–313,000), p = 0.02]. No other significant differences including type of immunosuppression were noted between the HCV antibody positive group and HCV antibody negative group. Donor donation after cardiac death status [Odds Ratio (OR) and 95% Confidence Interval (CI) was: 8.22 (1.14–59.14)], donor age [OR (95% CI) (+5 years) was: 3.19 (1.39–7.29)] and Kidney Donor Profile Index [OR (95% CI) (+1) was:1.07 (1.01–1.15)] showed a statistically significant association with HCV seroconversion. HCV antibody should not be considered routine screening for presence of infection in previously HCV naïve kidney transplant recipients receiving kidneys from HCV-infected donors, as only a modest percentage have antibody despite active viremia. The assessment of HCV viral load should be routine in all transplant recipients receiving organs from public health service increased risk donors. [ABSTRACT FROM AUTHOR]

Water consumption for crop irrigation is the largest single use of water in the U.S. but is poorly quantified because of limitations in data and the inherent challenges in measuring water consumption. In this study, water consumption for irrigated agriculture was estimated across the U.S. to improve understanding of water budgets in different regions. Published data on cropping patterns and water application were used in conjunction with a national-scale analysis to estimate water application and crop water consumption using the SWAT (Soil and Water Assessment Tool) watershed model. Crop water consumption estimates were based on evapotranspiration, with supporting information on the diversity of crops, irrigated area, water quantity and source, and local weather conditions. Quantification of water consumption supports broader analyses of the food-energy-water nexus and allows evaluation of the efficiency of irrigation water use at different spatial scales. Focusing on 2005 data, it is estimated that 60% of water reported as withdrawn from various sources is applied to fields, indicating a potentially large and poorly understood conveyance loss that occurs in a small number of states. Of the field-applied irrigation water, roughly 65% is directly used by crops or is lost in the field, with large regional variations. This may be compared to consumption estimates in prior studies that ranged from 16% to 90%. Areas that dominate the national aggregate estimate of crop water consumption include California's Central and Imperial Valleys, areas overlying the Ogallala Aquifer in the central U.S., the Lower Colorado Basin, and the eastern part of the Pacific Northwest Basin. [ABSTRACT FROM AUTHOR]

Individuals with advanced HIV infection are prone to other infections called opportunistic infections (OIs). This study determines the prevalence of OIs among HIV infected patients. Five hundred and ninety-six (596) HIV positive Anti-Retroviral Therapy (ART) naive subjects referred to the Microbiology and Biotechnology Department, National Institute for Pharmaceutical Research and Development (NIPRD), Abuja, Nigeria for diagnosis were recruited into the study. The socio-demographic and OIs isolated from patient's data were collected and analysed by Statistical Product and Service Solution (SPSS) software (version 17.0, SPSS, Chicago, USA). ANOVA was used to compare the groups and (p ≤ 0.05) was set to be statistically significant. 203 (34.1%) patients presented with OIs. Isolated sputum bacterial pathogens included Mycobacterium tuberculosis (4.9%), Streptococcus pneumonia (7.4%), Staphylococcus aureus (10.0%), Pseudomonas aeruginosa (2.5%). Urinary tract infection pathogens are Eschericha coli (19.7%), Klebsiella aerogenes (9.9%), Proteus vulguria (2.5%). Stool pathogens are: Salmonella typhi (8.9%), Shigella spp (7.9%). High vaginal swab (HVS) pathogens are Candida albicans (7.4%), Staphylococcus aureus (1.0%) and Streptococcus faecalis (1.5%). The presence of each pathogen in the various anatomical sites was statistically significant (p≤ 0.05). The study established OIs among HIV/AIDS patients and the need to have treatment options apart from the use of ART. [ABSTRACT FROM AUTHOR]

The article looks at the findings of studies on executive salaries in the U.S. using individual executive reward and top management group as variables. The author seeks to determine whether executive salaries are more closely correlated with a firm's scale of operations than its profitability. The studies discussed are those of McGuire et al., and of Lewellen and Huntsman. Both McGuire and Lewellen-Huntsman employed individual executive compensation as the dependent variable. While McGuire found a significant correlation between corporate sales and chief executive compensation, Lewellen and Huntsman did not.

Objectives. To quantify deaths in the United States from 2010 through 2018 that were reported with an underlying cause of death as a psychiatric diagnosis, which do not indicate a clear mechanism of death, and that may be misclassified suicide and overdose deaths. Methods. We used national vital statistics data to identify rates and circumstances of deaths by specific underlying cause of death categories in the US population. Results. There were 115 442 deaths attributed to psychiatric diagnoses and 834 763 deaths attributed to suicide or overdose. The population rate of deaths attributed to psychiatric diagnoses increased from 3.26 to 4.96 per 100 000 US persons between 2010 and 2018. Conclusions. Psychiatric diagnoses may represent a fairly substantial number of misclassified overdose and suicide deaths. Improving mortality surveillance requires improving the accuracy of diagnoses reported on death certificates. [ABSTRACT FROM AUTHOR]

The conceptual framework of industrial symbiosis (IS) is gaining recognition for ensuring the conservation of natural resources and resilience of socio-ecological surroundings. Significant scholastic strides have been made for explaining the conceptual paradigm of IS. The current study relied upon the Bibliometric mapping technique to decipher the contemporary orientations in the recent publications (2007-2017). The findings revealed that China, UK and the USA are the pivot for promoting research interests in the field. The loci of IS research was observed more skewed in favour of economically developed and industrialized countries. The findings of this study also acknowledge a growing propensity towards research collaboration between and among nations. [ABSTRACT FROM AUTHOR]

Agriculture in the United States must respond to escalating demands for productivity and efficiency, as well as pressures to improve its stewardship of natural resources. Growing global population and changing diets, combined with a greater societal awareness of agriculture's role in delivering ecosystem services beyond food, feed, fiber, and energy production, require a comprehensive perspective on where and how US agriculture can be sustainably intensified, that is, made more productive without exacerbating local and off-site environmental concerns. The USDA's Long-Term Agroecosystem Research (LTAR) network is composed of 18 locations distributed across the contiguous United States working together to integrate national and local agricultural priorities and advance the sustainable intensification of US agriculture. We explore here the concept of sustainable intensification as a framework for defining strategies to enhance production, environmental, and rural prosperity outcomes from agricultural systems. We also elucidate the diversity of factors that have shaped the past and present conditions of cropland, rangeland, and pastureland agroecosystems represented by the LTAR network and identify priorities for research in the areas of production, resource conservation and environmental quality, and rural prosperity. Ultimately, integrated long-term research on sustainable intensification at the national scale is critical to developing practices and programs that can anticipate and address challenges before they become crises. [ABSTRACT FROM AUTHOR]

Summary: Introduction: This manuscript describes the prevalence and attributes of community programmes and policies (CPPs) to address childhood obesity documented as occurring in 130 diverse US communities. Methods: Key informant interviews (N = 1420) and document abstraction were used to identify and characterize CPPs to promote physical activity and healthy nutrition occurring during a 10‐year retrospective study period. Data were collected in 2013–2015 and analysed in 2016. Results: Across all 130 communities, 9681 distinct CPPs were reported as occurring by key informants. Of these, 5574 (58%) focused on increasing physical activity, 2596 (27%) on improving nutrition and 1511 (16%) on both behaviours. The mean number of CPPs per community was 74.0, with a range of 25 to 295 across all communities. Most CPPs occurred more than once (63%) and on average lasted 6.1 years. The greatest number of reported CPPs occurred in school settings (44%). Conclusions: Communities showed a wide range of investment in the amount of CPPs occurring in settings that affect opportunities for children to engage in physical activity and healthy nutrition. The pattern of implementation of CPPs showed variation over time, with an increase in more recent years. This observational study provides new and valuable information about what US communities are doing to prevent childhood obesity. What is already known about this subject? With increases in childhood obesity, agenda‐setting organizations and federal initiatives have called for comprehensive approaches involving multiple community programs and policies.Community efforts to address childhood obesity have included programs, policies, and environmental changes to promote physical activity and healthy nutrition.Little is known about the amount and kind of community programs and policies actually being implemented in communities throughout the U.S. What this study adds? This study provides data on the observed prevalence of community programs and policies addressing childhood obesity in a diverse sample of 130 U.S./ communities.It shows that the observed number of community programs and policies increased in more recent years, with more marked increases seen after 2009.It shows that the observed length of community programs/ policies and types of behavioral objectives targeted varied substantively across communities; while other variables, such as reach or target, were more similar across programs and policies. This article is part of the supplement: The Healthy Communities Study: Examining Community Programs, Policies and Other Characteristics in Relation to Child Weight, Diet, and Physical Activity [ABSTRACT FROM AUTHOR]

Summary: Background: Little is known about whether characteristics of communities are associated with differential implementation of community programmes and policies to promote physical activity and healthy eating. This study examines associations between community characteristics (e.g. region and race/ethnicity) and the intensity of community programmes and policies implemented to prevent childhood obesity. It explores whether community characteristics moderate the intensity of community efforts to prevent childhood obesity. Objective: The objective of this study is to investigate associations between community characteristics and the intensity of community policies and programmes to prevent childhood obesity documented in the Healthy Communities Study that engaged a diverse sample of US communities. Method: Programmes and policies were documented in 130 communities across the USA, reporting over 9000 different community programmes and policies to prevent obesity among children ages 4–15. We examined associations between community characteristics and the intensity of community programmes and policies implemented (i.e. their amount and reach, duration and strength of change strategy). Conclusion: Community characteristics explain 25% of the variability in the intensity of community programmes and policies implemented in communities. Particular characteristics – urbanicity, region, being a large county and the per cent of African–Americans in a community – contributed to more (over 18% of the 25%) of the observed variability. What is already known about this subject? Childhood obesity is a critical public health challenge facing communities in the United States. Community characteristics are associated with community health outcomes.Previous community‐level interventions to reduce children's BMI have yielded modest and inconsistent outcomes. What this study adds? This study adds to our understanding of whether and how community characteristics are associated with differential implementation of community programmes and policies to address childhood obesity.Measurement of the intensity of community‐level programmes and policies in a large and diverse sample of U.S. communities with different community characteristics. This article is part of the supplement: The Healthy Communities Study: Examining Community Programs, Policies and Other Characteristics in Relation to Child Weight, Diet, and Physical Activity [ABSTRACT FROM AUTHOR]

Summary: Introduction: Efforts to address the critical public health problem of childhood obesity are occurring across the USA; however, little is known about how to characterize the intensity of these efforts. Objectives: The purposes of this study are to describe the intensity of community programs and policies (CPPs) to address childhood obesity in 130 US communities and to examine the extent to which observed CPPs targeted multiple behaviours and employed a comprehensive array of strategies. Methods: To document CPPs occurring over a 10‐year period, key informants were interviewed using a semi‐structured interview protocol. Staff coded CPPs for key characteristics related to intensity, including reach, duration and strategy. Three types of CPP scores were calculated for intensity of CPPs, targeting of CPPs towards multiple behaviours and strategies used. Results: Nine thousand six hundred eighty‐one CPPs were identified. On average, communities had 74 different CPPs in place (standard deviation 30), with variation in documented CPPs (range 25–295). Most communities experienced a steady, modest increase in intensity scores over 10 years. CPP targeting scores suggested that communities expanded the focus of their efforts over time to include more behaviours and strategies. Conclusions: Findings of this large‐scale study indicate that great variation exists across communities in the intensity and focus of community interventions being implemented to address childhood obesity. What is already known about this subject? Communities are implementing programs and policies to address childhood obesity.Little is known about how these programs and policies vary in intensity.Similarly, little is understood about how communities are focusing their efforts by targeting key behaviours or strategies. What this study adds? This study describes the creation of three types of indices for understanding how community programs and policies may contribute to prevention of childhood obesity.Across 130 communities in the USA, implementation of community programs and policies has varied considerably.Findings suggest that, over the last 10 years, intensity and the targeting of specific behaviours and strategies have grown steadily. This article is part of the supplement: The Healthy Communities Study: Examining Community Programs, Policies and Other Characteristics in Relation to Child Weight, Diet, and Physical Activity [ABSTRACT FROM AUTHOR]

The long-term reactions, experiences and reflections of simulation educators have not been explored. In a semistructured, exploratory interview study, the experiences of simulation educators in either Advanced Life Support (ALS) or Crisis Resource Management (CRM) courses in Denmark, Norway and the USA were analyzed. Three overarching themes were identified: (1) general reflections on simulation-based teaching, (2) transfer of knowledge and skills from the simulation setting to clinical settings and (3) more overarching transformations in simulation educators, simulation participants, and the healthcare system. Where ALS was deemed as high on the efficiency dimension of learning, CRM courses were described as high on the innovation dimension. General reflections, transfer and transformations described were related to differences in course principles. The results are relevant for career planning, faculty development and understanding simulation as social practice. [ABSTRACT FROM AUTHOR]

Summary: Lyme disease (LD) is the most common vector‐borne disease in Maryland and the United States. Surveillance for LD is valuable for understanding the burden of the disease, particularly to assess whether the disease is spreading and to appreciate who is affected. However, not all cases of LD in Maryland are reported, and surveillance practices vary across each of Maryland's 24 local health departments (LHDs). To better understand this variability and to systematically characterize the surveillance process, we surveyed Maryland's LHDs regarding LD surveillance. The Maryland Local Health Department Lyme Disease Surveillance Survey has been administered annually since 2011. Questions asked each year included whether all LD reports are investigated or only a subset, and how many reports are not entered into the surveillance database. Since 2011, Maryland has lost surveillance personnel for LD. Each year from 2009 to 2012, a median 3598 (range 2462 to 5722) reports were not entered into the surveillance database and hence not investigated. These reports represent 43–55% of all reports received for the year. Over time, more LHDs chose to streamline their LD investigation approach by investigating only those reports that met the criteria for laboratory evidence of infection: in 2008, 5 (21%) LHDs investigated only a subset of LD reports; by 2013, this increased to 15 (63%). There is wide variability across LHDs in how LD investigations are conducted. Maryland LHDs have experienced a loss of LD surveillance personnel with a concomitant increase in the number of LHDs adopting a streamlined approach to investigating cases. These findings underscore the tremendous burden of LD on the public health agencies and highlight the need for alternative approaches that can both reduce burden and preserve surveillance data quality. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effects of obesity on specialty-specific surgical outcomes in children.Materials and Methods: Retrospective cohort study using the National Surgical Quality Improvement Program, Pediatric, 2012-2014. Patients included those aged 2-17 years who underwent a surgical procedure in one of six specialties. Obesity was the primary patient variable of interest. Outcomes of interest were postoperative complications and operative times. Odds ratios for development of postoperative complications were calculated using stepwise multivariate regression analysis.Results: Obesity was associated with a significantly greater risk of wound complications (OR 1.24, 95% CI 1.13-1.36), but decreased risk of non-wound complications (OR 0.68, 95% CI 0.63-0.73) and morbidity (OR 0.79, 95% CI 0.75-0.84). Obesity was not a significant factor in predicting postoperative complications in patients undergoing otolaryngology or plastic surgery procedures. Anesthesia times and operative times were significantly longer for obese patients undergoing most types of pediatric surgical procedures.Conclusion: Obesity confers an increased risk of wound complications in some pediatric surgical specialties and is associated with overall decreased non-wound complications and morbidity. These findings suggest that the relationship between obesity and postoperative complications is complex and may be more dependent on underlying procedure- or specialty-related factors than previously suspected. [ABSTRACT FROM AUTHOR]

Aims To examine efficacy of drug brief interventions (BIs) among adults presenting to a low-income urban emergency department (ED). Design Randomized controlled trial on drug use outcomes at 3, 6 and 12 months. Participants were assigned to (1) computer-delivered BI (Computer BI), (2) therapist-delivered, computer-guided BI (Therapist BI) or (3) enhanced usual care (EUC-ED) for drug-using adults. Participants were re-randomized after the 3-month assessment to either adapted motivational enhancement therapy (AMET) booster or enhanced usual care booster (EUC-B). Setting Patients recruited from low-income urban emergency departments (ED) in Flint, Michigan, USA. Participants A total of 780 ED patients reporting recent drug use, 44% males, mean age = 31 years. Interventions Computer BI consisted of an interactive program guided by a virtual health counselor. Therapist BI included computer guidance. The EUC-ED conditions included review of community health and HIV prevention resources. The BIs and boosters were based on motivational interviewing, focusing on reduction of drug use and HIV risk behaviors. Measurements Primary outcome was past 90 days using drugs at 6 and 12 months and secondary outcomes were weighted drug-days and days of marijuana use. Findings Percentage changes in mean days used any drug from baseline to 12 months were: Computer BI + EUC-B: -10.9%, P = 0.0844; Therapist BI + EUC-B: -26.7%, P = 0.0041, for EUC-ED + EUC-B: -20.9, P = 0.0011. In adjusted analyses, there was no significant interaction between ED intervention and booster AMET for primary and secondary outcomes. Compared with EUC-ED, Therapist BI reduced number of days using any drug [95% confidence interval (CI) = −0.41, −0.07, P = 0.0422] and weighted drug-days (95% CI = -0.41, −0.08, P = 0.0283). Both Therapist and Computer BI had significantly fewer number of days using marijuana compared to EUC-ED (Therapist BI: 95% CI = -0.42, −0.06, P = 0.0104, Computer BI: 95% CI = -0.34, −0.01, P = 0.0406). Booster effects were not significant. Conclusions An emergency department-based motivational brief intervention, delivered by a therapist and guided by computer, appears to reduce drug use among adults seeking emergency department care compared with enhanced usual care. [ABSTRACT FROM AUTHOR]

Since the year 1970, US milk production per cow has more than doubled, in part because of large increases in feed intake. It is well established that increasing feed intake reduces diet digestibility in dairy cattle. Our objective was to determine whether the digestive efficiency of US dairy cows had also changed. We assembled a data set consisting of diet digestibility measured either by total collection of feces or by use of indigestible neutral detergent fiber (NDF) in lactating dairy cow studies published in the Journal of Dairy Science from July 1970 to July 2014. The data set contained 575 treatment means from 154 individual research trials conducted at 26 US institutions. Based on regression analysis, mean milk yield and dry matter intake (DMI) between 1970 and 2014 increased by 19.7 and 10.3 kg/d, respectively. Temporal effects on digestibility [dry matter (DM), crude protein (CP), and NDF] were determined using the regression model Yi = YEAR1970i + CPi + NDFi + ei, where YEAR1970i is the publication year minus 1970, CPi and NDFi are diet constituents (% of diet DM) that were included to account for their known effects on digestibility, and ei is the residual error. Dry matter digestibility decreased 0.07 percentage units/yr for a total reduction of 3.08 percentage units since 1970. Furthermore, CP and NDF digestibilities decreased 0.04 and 0.17 percentage units/yr, respectively. To account for the potential effect of feed intake on digestibility, DMI as a percentage of body weight was added to the regression model. With DMI as a percentage of body weight in the model, temporal changes in DM, CP, and NDF digestibilities were no longer significant. This suggested that the apparent decline in DM digestibility could be mostly accounted for by simultaneous increases in level of feed intake. Despite lower apparent digestive efficiency, the modern dairy cow has greater production efficiency than the 1970s dairy cow because she produces more milk per unit of feed consumed and digested. [ABSTRACT FROM AUTHOR]

Recent U.S. Geological Survey water-use report suggests that increasing water-use efficiency could mitigate the supply-and-demand imbalance arising from changing climate and growing population. However, this rich data have neither analyzed to understand the underlying patterns, nor have been investigated to identify the factors contributing to this increased efficiency. A national-scale synthesis of public supply withdrawals ('withdrawals') reveals a strong North-south gradient in public supply water use with the increasing population in the South contributing to increased withdrawal. Contrastingly, a reverse South-north gradient exists in per capita withdrawals ('efficiency'), with northern states consistently improving the efficiency, while the southern states' efficiency declined. Our analyses of spatial patterns of per capita withdrawals further demonstrate that urban counties exhibit improved efficiency over rural counties. Improved efficiency is also demonstrated over high-income and well-educated counties. Given the potential implications of the findings in developing long-term water conservation measures (i.e., increasing block rates), we argue the need for frequent updates, perhaps monthly to annual, of water-use data for identifying effective strategies that control the water-use efficiency in various geographic settings under a changing climate. [ABSTRACT FROM AUTHOR]

The Veterans Health Administration (VHA) designed the Opioid Safety Initiative (OSI) to help decrease opioid prescribing practices associated with adverse outcomes. Key components included disseminating a dashboard tool that aggregates electronic medical record data to audit real-time opioid-related prescribing and identifying a clinical leader at each facility to implement the tool and promote safer prescribing. This study examines changes associated with OSI implementation in October 2013 among all adult VHA patients who filled outpatient opioid prescriptions. Interrupted time series analyses controlled for baseline trends and examined data from October 2012 to September 2014 to determine the changes after OSI implementation in prescribing of high-dosage opioid regimens (total daily dosages >100 morphine equivalents [MEQ] and >200 MEQ) and concurrent benzodiazepines. Across VHA facilities nationwide, there was a decreasing trend in high-dosage opioid prescribing with 55,722 patients receiving daily opioid dosages >100 MEQ in October 2012, which decreased to 46,780 in September 2014 (16% reduction). The OSI was associated with an additional decrease, compared to pre-OSI trends, of 331 patients per month (95% confidence interval [CI] -378 to -284) receiving opioids >100 MEQ, a decrease of 164 patients per month (95% CI -186 to -142) receiving opioids >200 MEQ, and a decrease of 781 patients per month (95% CI -969 to -593) receiving concurrent benzodiazepines. Implementation of a national health care system-wide initiative was associated with reductions in outpatient prescribing of risky opioid regimens. These findings provide evidence for the potential utility of large-scale interventions to promote safer opioid prescribing. [ABSTRACT FROM AUTHOR]

Delayed planting is recommended to reduce damage from sunflower insect pests in the United States, including the sunflower moth, Homoeosoma electellum (Hulst) and banded sunflower moth, Cochylis hospes Walsingham. However, in some locations, planting earlier or growing later-maturing hybrids could improve yield or oil content of sunflowers which would partially offset any added costs from insect pests or their management. Because the abundance and distribution of some sunflower insects have changed since recommendations for delayed planting were developed, experimental plots were grown in 2012 and 2013 at sites in North Dakota, Nebraska, Iowa, and Illinois. Sunflowers were planted two to four weeks earlier than normal, including hybrids that flower two to three weeks later than elite commercial hybrids. The sum of seed damaged by sunflower moth, banded sunflower moth, and red sunflower seed weevil, Smicronyx fulvus LeConte, (i. e., total percentage) was influenced by location, but not the relative maturity of tested entries. However, when damage attributed solely to the red sunflower seed weevil was analyzed, more damaged seed were found for late-maturing entries in North Dakota and Nebraska. In addition to the trial data, current pest populations are lower than when delayed planting was first recommended and insecticide use during sunflower bloom is both common and effective. Together, these observations suggest factoring insect pests into planting time decisions may be unnecessary, except for areas with a history of problems with severe pests that cannot be managed using insecticides (e. g., sunflower midge, Contarinia schulzi Gagné). [ABSTRACT FROM AUTHOR]

Chronic pain is associated with increased risk of suicide, and opioids are commonly used to treat moderate to severe pain. However, the association between opioid dose and suicide mortality has not been examined closely. This retrospective data analysis described the risk of suicide associated with differing prescribed opioid doses. Data were from Veterans Affairs health care system treatment records and the National Death Index. Records analyzed were those of Veterans Affairs patients with chronic pain receiving opioids in fiscal years 2004 to 2005 (N = 123,946). Primary predictors were maximum prescribed morphine-equivalent daily opioid dose and opioid fill type. The main outcome measured was suicide death, by any mechanism, and intentional overdose death during 2004 to 2009. Controlling for demographic and clinical characteristics, higher prescribed opioid doses were associated with elevated suicide risk. Compared with those receiving ≤20 milligrams/day (mg/d), hazard ratios were 1.48 (95% confidence intervals [CI], 1.25-1.75) for 20 to <50 mg/d, 1.69 (95% CI, 1.33-2.14) for 50 to <100 mg/d, and 2.15 (95% CI, 1.64-2.81) for 100+ mg/d. The magnitude of association between opioid dose and suicide by intentional overdose was not substantially different from that observed for the overall measure of suicide mortality. Risk of suicide mortality was greater among individuals receiving higher doses of opioids, and treatment providers may want to view high opioid dose as a marker of elevated risk for suicide. Additional research is needed on opioid use, pain treatment, and suicide. [ABSTRACT FROM AUTHOR]

Purpose: Low social support and small social network size have been associated with a variety of negative mental health outcomes, while their impact on mental health services use is less clear. To date, few studies have examined these associations in National Guard service members, where frequency of mental health problems is high, social support may come from military as well as other sources, and services use may be suboptimal.Methods: Surveys were administered to 1448 recently returned National Guard members. Multivariable regression models assessed the associations between social support characteristics, probable mental health conditions, and service utilization.Results: In bivariate analyses, large social network size, high social network diversity, high perceived social support, and high military unit support were each associated with lower likelihood of having a probable mental health condition (p < .001). In adjusted analyses, high perceived social support (OR .90, CI .88-.92) and high unit support (OR .96, CI .94-.97) continued to be significantly associated with lower likelihood of mental health conditions. Two social support measures were associated with lower likelihood of receiving mental health services in bivariate analyses, but were not significant in adjusted models.Conclusions: General social support and military-specific support were robustly associated with reduced mental health symptoms in National Guard members. Policy makers, military leaders, and clinicians should attend to service members' level of support from both the community and their units and continue efforts to bolster these supports. Other strategies, such as focused outreach, may be needed to bring National Guard members with need into mental health care. [ABSTRACT FROM AUTHOR]

Background The relationships between environmental correlates of adolescent obesity are complex and not yet well defined by current research, especially when considering age and gender. Objective The purpose of this study was to test a model of proximal (home) and distal (neighbourhood) environmental correlates of obesity for adolescent age and gender groups. Methods This was a descriptive, cross-sectional study, using the 2007 National Survey of Children's Health of 39 542 children ages 11-17 years. Results The model fit the data well for early adolescents (ages 11-14 years) (root mean square standard error of approximation [ RMSEA] 0.040, 90% confidence interval [ CI]: 0.039-0.041; comparative fit index [ CFI] 0.947; Tucker- Lewis index [ TLI] 0.929) and middle adolescents (ages 15-17 years) ( RMSEA 0.037, 90% CI: 0.036-0.038; CFI 0.052; TLI 0.937). The model also fit the data well for boy adolescents ( RMSEA 0.038, 90% CI: 0.037-0.039; CFI 0.951; TLI 0.935) and girl adolescents ( RMSEA 0.038, 90% CI: 0.037-0.040; CFI 0.949; TLI 0.932). Conclusions All models provide loadings of the environmental correlates of adolescent obesity for specific age and gender groups that can be used for early identification of risks and targeted interventions. [ABSTRACT FROM AUTHOR]

In the early 1960s, the US federal government deemed poverty to be a national crisis, and actively intervened to solve this problem. My question for this article is how did preschool education become a key site to remedy this crisis? Government interventions were a combination of poverty research, racialized politics, and child development. I show how the discipline of early childhood education cohered around the term 'disadvantaged child', in turn influencing the War on Poverty policies, including the basis of Head Start preschool education. During this same decade proponents of Sesame Street-with private funding, along with extensive testing mechanisms by consultants-argued that the television could reach more children, therefore be more cost effective. This paper investigates how surplus populations became determined and demarcated, as early as three years old. I question how televised preschool taught 'affective skills' and proper social relations during times of political crisis. [ABSTRACT FROM AUTHOR]

Animal feeding operations (AFOs) satisfy the demand for meat, dairy, and eggs; however, they may negatively impact air quality. In this study, the concentrations of PM2.5 and PM10 were simultaneously monitored at four ambient locations in the vicinity of a commercial egg production farm for over two years. Overall, concentrations and temporal patterns were similar to other rural sites in the southeast U.S. Concentrations near the farm property line did not exceed the 24 h National Ambient Air Quality Standards (NAAQS) for PM2.5 (35 µg m-3) or PM10 (150 µg m-3). Daily average ambient PM concentrations were best described by a lognormal distribution. Downwind concentrations were statistically significantly higher than upwind concentrations, but differences were <1.0 µg m³ for PM2.5 and <5.0 µg m³ for PM10. Relationships between ambient PM concentrations and rates of PM emission from the poultry houses were statistically significant; however, the strength of the linear relationships (Pearson correlation) was relatively weak (r = 0.15 for PMW and r = 0.33 for PM2.5). On a diurnal time scale, variability was consistent with expected patterns of mobile source emissions, with observed higher concentrations of PM10 on weekdays attributed to on-farm vehicle activity. The observation of higher ambient PM concentrations during summer months was attributed primarily to seasonal variability in non-local primary PM emissions, as well as regional secondary PM precursor emissions and formation mechanisms. Results of this study provide helpful information for understanding the influence of emissions from egg laying facilities on local PM concentrations. [ABSTRACT FROM AUTHOR]

To assess public attitudes and interest in pharmacogenetic (PGx) testing, we conducted a random-digit-dial telephone survey of US adults, achieving a response rate of 42% (n=1139). Most respondents expressed interest in PGx testing to predict mild or serious side effects (73±3.29 and 85±2.91%, respectively), guide dosing (91%) and assist with drug selection (92%). Younger individuals (aged 18-34 years) were more likely to be interested in PGx testing to predict serious side effects (vs aged 55+ years), as well as Whites, those with a college degree, and who had experienced side effects from medications. However, most respondents (78±3.14%) were not likely to have a PGx test if there was a risk that their DNA sample or test result could be shared without their permission. Given differences in interest among some groups, providers should clearly discuss the purpose of testing, alternative testing options (if available) and policies to protect patient privacy and confidentiality. [ABSTRACT FROM AUTHOR]

Background A nationwide survey of family members of people with intellectual and developmental disabilities ranging in age from birth through adulthood was conducted to replicate a similar effort by Wehmeyer and update the knowledge base concerning technology use by people with intellectual and developmental disabilities. Method Survey responses provided information about use of technology for mobility, hearing and vision, communication, independent living, and in the area of computer use. In addition, survey items queried the use of electronic and information technology devices such as use of email, mobile telephones and digital cameras. Results Survey results showed that although the use of computers for individuals with intellectual and developmental disabilities is more prevalent, other technology use frequency is much the same as in the late 1990s. However, technology needs did vary among school-age individuals over time. Conclusion Implications of results for technology use of people with disabilities are discussed through the lens of frequency of use and needs for individuals with disabilities. [ABSTRACT FROM AUTHOR]

Objectives. We sought to examine rates of suicide among individuals receiving health care services in Veterans Health Administration (VHA) facilities over an 8-year period. Methods. We included annual cohorts of all individuals who received VHA health care services from fiscal year (FY) 2000 through FY 2007 (October 1, 1999-September 30, 2007; N = 8 855 655). Vital status and cause of death were obtained from the National Death Index. Results. Suicide was more common among VHA patients than members of the general US population. The overall rates of suicide among VHA patients decreased slightly but significantly from 2000 to 2007 (P < .001). Male veterans between the ages of 30 and 64 years were at the highest risk of suicide. Conclusions. VHA health care system patients are at elevated risk for suicide and are appropriate for suicide reduction services, although the rate of suicide has decreased in recent years for this group. Comprehensive approaches to suicide prevention in the VHA focus not only on recent returnees from Iraq and Afghanistan but also on middle-aged and older Veterans. [ABSTRACT FROM AUTHOR]

Objective: This study sought to compare patterns of alcohol use between male veterans and nonveterans. Methods: Data came from the 2004 Behavioral Risk Factor Surveillance System, a U.S. national telephone survey using stratified random sampling. Outcomes were 30-day alcohol use, binge drinking (5+ drinks on one occasion), and heavy drinking (2+ drinks per day). Age-stratified weighted regression analyses compared men who were veterans (n = 36,874) to those who were not (n = 77,056), and veterans who used Veterans Health Administration (VHA) services in the past year (17 = 7,606) to veterans who did not, adjusting for potential confounders. Results: Veterans aged 41 to 60 were less likely to binge drink (adjusted odds ratio [AOR] = 0.8) and veterans aged 61 to 70 were more likely to drink heavily compared to same-age men without military experience (AOR = 1.7). There were no significant differences in binge or heavy drinking for other age groups. Among veterans aged 51 to 60, those who used VHA services were more likely to report binge drinking than those who did not (AOR = 1.4). Conclusions: Male veterans generally have similar patterns of alcohol use as men without a history of military service, but the elevated alcohol use of specific groups of veterans merits concern. [ABSTRACT FROM AUTHOR]

Due to concerns about the negative environmental impacts of ammonia (NH3), the EPA may soon regulate NH3 emissions from livestock operations, including waste piles. This would require knowledge of NH3 emission rates, but there are very few field-scale studies on emission measurement from broiler waste stockpiles. This is the first study in which short-term NH3 fluxes from broiler cake stockpiled in a shed were measured, taking into account both forced and natural convection. Acid scrubbers were used to measure NH3 concentrations, while the integrated horizontal flux (JHF) method and Fick's law of diffusion were used to determine NH3 emissions due to forced and natural convection, respectively. Average daily air temperature and wind speed 0.75 m above the stockpile were 24.9°C and 0.65 m s-1 in summer and 8.5 °C and 1.02 m s-1 in winter. Natural convection accounted for <0.01% of total emission, but not isolating gas concentrations during forced convection conditions generally led to over estimation of emission. In summer (7 d), NH3-N emission factors were 17 g m-2 d-1 (stockpile surface area), 30 g m-3 d-1 (stockpile volume), 1.8 g kg-1 Nd-1 (initial cake N content), and 11 gAU-1 d-1 (where AU = 500 kg live weight marketed). During the first 7 d of the winter study, the emission factors were 27 g m-2 d-1, 43 gm-3 d-1, 2.1 g kg-1 N d-1, and 18 g AU-1 d-1, respectively. For the 15 d study, the emission factors changed very little. Higher emissions in winter were due to higher wind speeds, broiler cake total Kjeldahl N (TKN), and pH. While air temperature also affected emissions, stockpile temperatures (not measured) due to microbial activity were probably more important. Care should be taken in extrapolating this study's results to other stockpiles due to differences in stockpile dimensions, chemical properties, and environmental conditions. [ABSTRACT FROM AUTHOR]

We present the results of a deep 300 ks Chandra High Energy Transmission Grating (HETG) observation of the highly variable narrow-line Seyfert Type 1 galaxy NGC 4051. The HETG spectrum reveals 28 significant soft X-ray ionized lines in either emission or absorption; primarily originating from H-like and He-like K-shell transitions of O, Ne, Mg and Si (including higher order lines and strong forbidden emission lines from O and Ne ) plus high-ionization L-shell transitions from Fe to Fe and lower ionization inner-shell lines (e.g. O ). Modelling the data with requires four distinct ionization zones for the gas, all outflowing with velocities 1000 km s. A selection of the strongest emission/absorption lines appear to be resolved with full width at half-maximum (FWHM) of 600 km s. We also present the results from a quasi-simultaneous 350 ks Suzaku observation of NGC 4051 where the X-ray Imaging Spectrometer (XIS) spectrum reveals strong evidence for blueshifted absorption lines at 6.8 and 7.1 keV, consistent with previous findings. Modelling with suggests that this is the signature of a highly ionized, high-velocity outflow (log ; ) which potentially may have a significant effect on the host galaxy environment via feedback. Finally, we also simultaneously model the broad-band 2008 XIS+HXD (Hard X-ray Detector) Suzaku data with archival Suzaku data from 2005 when the source was observed to have entered an extended period of low flux in an attempt to analyse the cause of the long-term spectral variability. We find that we can account for this by allowing for large variations in the normalization of the intrinsic power-law component which may be interpreted as being due to significant changes in the covering fraction of a Compton-thick partial-coverer obscuring the central continuum emission. [ABSTRACT FROM AUTHOR]

The article analyzes the U.S. Centers for Disease Control data from the National Notifiable Diseases Surveillance System (NNDSS) for the period January 2001-February 2011 in order to characterize imported measles cases reported in the first two months of 2011 in U.S. travelers aged 6-23 months. Results indicate a total of 13 cases were reported in U.S. residents for January-February 2011 and 159 for the period 2001-2010. The Advisory Committee for Immunization Practices advises U.S. children who travel abroad should be vaccinated at an earlier age.

The article present the results of a survey conducted by the U.S. Centers for Disease Control and Prevention to assess the provision of various reversible contraceptive methods by family planning providers in the U.S. Office-based physicians and federally funded Title X clinics were surveyed for their contraceptive provisions. The mailed survey was conducted from December 2009 to March 2010. Questions on contraceptive method availability are included in the survey.

Objective: Most veterans who use Department of Veterans Affairs (VA) health care are not employed. This study evaluated the association between mental disorders and labor force status among VA health care users. Methods: Multinomial logistic regression analyses modeled the relationship between mental disorders and employment among patients aged 18 to 64 who completed the 2005 Survey of Healthcare Experiences of Patients. Results: Of the 98,867 patients who met eligibility criteria, 36% were disabled, 35% were employed, 20% were retired, and 7% were unemployed. Those with bipolar disorder, depression, post- traumatic stress disorder, schizophrenia, or a substance use disorder were more likely to be unemployed, disabled, or retired than employed. Conclusions: This study confirmed a negative relationship between having a mental disorder and being employed. Future studies of barriers associated with veterans' employment could help policy makers target mental health treatments and supportive employment services to the unique needs of veterans. [ABSTRACT FROM AUTHOR]

Two experiments were conducted to evaluate effects of ractopamine (RAC) and steroidal implant treatments on performance, carcass traits, blood metabolites, and lipogenic enzyme activity in feedlot cattle. In Exp. 1, yearling steers (n = 486; initial BW = 305 kg) were used in a 3 × 3 factorial arrangement of RAG doses of 0 (R0), 100 (R100), or 200 (R200) mg.·steer-1·d-1 fed for 28 d and implant regimens (implant-reimplant) of no implant-no reimplant (NI-NI), 120 mg of trenbolone acetate (TBA) and 24 mg of estradiol-17β (E17B)-no implant (RS-NI), or 80 mg of TBA and 16 mg of E17B followed by 120 mg of TBA and 24 mg of E17β (RI-RS). Except for KPH and skeletal maturity score, no RAG × implant interactions were noted (P > 0.10). Garcasses from R200 were 6.3 kg (P = 0.042) heavier than those from R0. Marbling, calculated empty body fat (EBF), and USDA quality grade did not differ (P > 0.10) among RAG treatments. The RI-RS steers had 12.6 kg (P = 0.001) and 41.1 kg (P < 0.001) greater HGW than RS-NI and NI-NI, respectively. Despite no difference (P > 0.10) in EBF, marbling score was decreased for RI-RS (P < 0.00 1) and RS-NI (P = 0.001) relative to NI-NI, resulting in 14.6 and 11.4 percentage unit fewer USDA Prime and Choice carcasses with RI-RS (P = 0.008) and RS-NI (P = 0.039) than with NI-NI. In Exp. 2, heifers (n = 48; initial BW = 347 kg) were used in a 3 × 2 factorial arrangement of RAG doses of 0 (R0) or 250 (R250) mg·heifer-1·d-1 and implant regimens of none (NI), 200 mg of TBA (TO), or 200 mg of TBA and 20 mg of E17B (TE). Blood samples were collected at various times during the feeding period, and subcutaneous adipose samples were collected on d 119. For growth and carcass measurements, no RAG × implant interactions (P > 0.10) were detected. The RAG-supplemented heifers had greater HGW (P < 0.10) with no difference in marbling score. For implant regimens, TE heifers had greater HGW than the NI (P = 0.001) and TO (P = 0.037) heifers. Although EBF did not differ among implant treatments (P > 0.10), TE (P = 0.021) and TO (P = 0.039) had fewer Ghoice carcasses than NI. Heifers with implants had decreased cortisol and increased IGF-1 and NEFA (P < 0.10) compared with NI heifers. An implant × RAG interaction was detected (P = 0.001) for serum urea nitrogen (SUN), with TE and RAG-supplemented heifers having decreased SUN. These data suggest that the effects of implant and RAG on growth and carcass traits are independent and that USDA quality grade and marbling score can differ significantly among carcasses with similar calculated EBF values. [ABSTRACT FROM AUTHOR]

Study design:Post hoc analysis from a randomized controlled cellular therapy trial in acute, complete spinal cord injury (SCI).Objectives:Description and quantitative review of study logistics, referral patterns, current practice patterns and subject demographics.Setting:Subjects were recruited to one of six international study centers.Methods:Data are presented from 1816 patients pre-screened, 75 participants screened and 50 randomized.Results:Of the 1816 patients pre-screened, 53.7% did not meet initial study criteria, primarily due to an injury outside the time window (14 days) or failure to meet neurological criteria (complete SCI between C5 motor/C4 sensory and T11). MRIs were obtained on 339 patients; 51.0% were ineligible based on imaging criteria. Of the 75 participants enrolled, 25 failed screening (SF), leaving 50 randomized. The primary reason for SF was based on the neurological exam (51.9%), followed by failure to meet MRI criteria (22.2%). Of the 50 randomized subjects, there were no significant differences in demographics in the active versus control arms. In those participants for whom data was available, 93.8% (45 of 48) of randomized participants received steroids before study entry, whereas 94.0% (47 of 50) had spine surgery before study enrollment.Conclusion:The 'funnel effect' (large numbers of potentially eligible participants with a small number enrolled) impacts all trials, but was particularly challenging in this trial due to eligibility criteria and logistics. Data collected may provide information on current practice patterns and the issues encountered and addressed may facilitate design of future trials. [ABSTRACT FROM AUTHOR]