Search

This study examined several early childhood education and care (ECEC) factors and their relation to children's salivary cortisol slope and hair cortisol concentration (HCC). The study is part of the cross-sectional DAGIS study, conducted in 2015–2016, examining 66 preschools and 677 children aged 3–6 years in Finland. Two saliva samples from one childcare day and a hair sample were collected from the children. Educators' education level, perceived stress, and occupational well-being factors, group size, child-adult ratio, and amount of childcare per week were assessed by questionnaires filled in by educators and guardians. Higher educators' education level was associated with a higher likelihood of children having a declining salivary cortisol slope. Educators with higher perceived stress were associated with a lower likelihood of children having a declining cortisol slope, but the result was attenuated in the adjusted model. Child-adult ratio was negatively associated with HCC. The results indicate that educators' higher education level and possibly lower stress associate with a favourable cortisol profile in children, suggesting less stress. These factors should receive attention when considering children's stress at childcare. [ABSTRACT FROM AUTHOR]

Weeds are undesirable plants that can interfere with human activities and can hamper crop production and practices. The competition among ornamentals and weeds for space, nutrition, light, and moisture within a restricted area, such as in container production, can be intense and destructive. In response to increasing concerns regarding herbicide injuries and the effects of pesticide use on the environment, many growers are extremely interested in non-chemical pest-management approaches. There are various non-chemical strategies to control weeds in containers, which include scouting, sanitation practices, hand weeding, mulching, irrigation management, substrate stratification, mulch discs or geo discs, lid bags, and fertilizer placement. In a restricted growth environment, weeds have been shown to reduce crop growth significantly. Limited information is available on the effects of weed densities and container sizes on ornament–weed competition within containerized production and how the concepts of fertilizer placement can be used efficiently to control weeds in containers without using any herbicides on the ornamentals. There is an immediate need to evaluate the interference and competitive effects of pernicious weed species in container-grown ornamentals in the North Central United States and to develop effective non-chemical weed control strategies by altering fertilizer placement in container production. [ABSTRACT FROM AUTHOR]

Background: Switchgrass (Panicum virgatum L.) is a warm-season perennial (C4) grass identified as an important biofuel crop in the United States. It is well adapted to the marginal environment where heat and moisture stresses predominantly affect crop growth. However, the underlying molecular mechanisms associated with heat and drought stress tolerance still need to be fully understood in switchgrass. The methylation of H3K4 is often associated with transcriptional activation of genes, including stress-responsive. Therefore, this study aimed to analyze genome-wide histone H3K4-tri-methylation in switchgrass under heat, drought, and combined stress. Results: In total, ~ 1.3 million H3K4me3 peaks were identified in this study using SICER. Among them, 7,342; 6,510; and 8,536 peaks responded under drought (DT), drought and heat (DTHT), and heat (HT) stresses, respectively. Most DT and DTHT peaks spanned 0 to + 2000 bases from the transcription start site [TSS]. By comparing differentially marked peaks with RNA-Seq data, we identified peaks associated with genes: 155 DT-responsive peaks with 118 DT-responsive genes, 121 DTHT-responsive peaks with 110 DTHT-responsive genes, and 175 HT-responsive peaks with 136 HT-responsive genes. We have identified various transcription factors involved in DT, DTHT, and HT stresses. Gene Ontology analysis using the AgriGO revealed that most genes belonged to biological processes. Most annotated peaks belonged to metabolite interconversion, RNA metabolism, transporter, protein modifying, defense/immunity, membrane traffic protein, transmembrane signal receptor, and transcriptional regulator protein families. Further, we identified significant peaks associated with TFs, hormones, signaling, fatty acid and carbohydrate metabolism, and secondary metabolites. qRT-PCR analysis revealed the relative expressions of six abiotic stress-responsive genes (transketolase, chromatin remodeling factor-CDH3, fatty-acid desaturase A, transmembrane protein 14C, beta-amylase 1, and integrase-type DNA binding protein genes) that were significantly (P < 0.05) marked during drought, heat, and combined stresses by comparing stress-induced against un-stressed and input controls. Conclusion: Our study provides a comprehensive and reproducible epigenomic analysis of drought, heat, and combined stress responses in switchgrass. Significant enrichment of H3K4me3 peaks downstream of the TSS of protein-coding genes was observed. In addition, the cost-effective experimental design, modified ChIP-Seq approach, and analyses presented here can serve as a prototype for other non-model plant species for conducting stress studies. [ABSTRACT FROM AUTHOR]

Background: Integrating stress-reduction interventions into the workplace may improve the health and well-being of employees, and there is an opportunity to leverage ubiquitous everyday work technologies to understand dynamic work contexts and facilitate stress reduction wherever work happens. Sensing-powered just-in-time adaptive intervention (JITAI) systems have the potential to adapt and deliver tailored interventions, but such adaptation requires a comprehensive analysis of contextual and individual-level variables that may influence intervention outcomes and be leveraged to drive the system's decision-making. Objective: This study aims to identify key tailoring variables that influence momentary engagement in digital stress reduction microinterventions to inform the design of similar JITAI systems. Methods: To inform the design of such dynamic adaptation, we analyzed data from the implementation and deployment of a system that incorporates passively sensed data across everyday work devices to send just-in-time stress reduction microinterventions in the workplace to 43 participants during a 4-week deployment. We evaluated 27 trait-based factors (ie, individual characteristics), state-based factors (ie, workplace contextual and behavioral signals and momentary stress), and intervention-related factors (ie, location and function) across 1585 system-initiated interventions. We built logistical regression models to identify the factors contributing to momentary engagement, the choice of interventions, the engagement given an intervention choice, the user rating of interventions engaged, and the stress reduction from the engagement. Results: We found that women (odds ratio [OR] 0.41, 95% CI 0.21-0.77; P=.03), those with higher neuroticism (OR 0.57, 95% CI 0.39-0.81; P=.01), those with higher cognitive reappraisal skills (OR 0.69, 95% CI 0.52-0.91; P=.04), and those that chose calm interventions (OR 0.43, 95% CI 0.23-0.78; P=.03) were significantly less likely to experience stress reduction, while those with higher agreeableness (OR 1.73, 95% CI 1.10-2.76; P=.06) and those that chose prompt-based (OR 6.65, 95% CI 1.53-36.45; P=.06) or video-based (OR 5.62, 95% CI 1.12-34.10; P=.12) interventions were substantially more likely to experience stress reduction. We also found that work-related contextual signals such as higher meeting counts (OR 0.62, 95% CI 0.49-0.78; P<.001) and higher engagement skewness (OR 0.64, 95% CI 0.51-0.79; P<.001) were associated with a lower likelihood of engagement, indicating that state-based contextual factors such as being in a meeting or the time of the day may matter more for engagement than efficacy. In addition, a just-in-time intervention that was explicitly rescheduled to a later time was more likely to be engaged with (OR 1.77, 95% CI 1.32-2.38; P<.001). Conclusions: JITAI systems have the potential to integrate timely support into the workplace. On the basis of our findings, we recommend that individual, contextual, and content-based factors be incorporated into the system for tailoring as well as for monitoring ineffective engagements across subgroups and contexts. [ABSTRACT FROM AUTHOR]

Objective: The objective is to update recommendations for prevention and treatment of glucocorticoid‐induced osteoporosis (GIOP) for patients with rheumatic or nonrheumatic conditions receiving >3 months treatment with glucocorticoids (GCs) ≥2.5 mg daily. Methods: An updated systematic literature review was performed for clinical questions on nonpharmacologic, pharmacologic treatments, discontinuation of medications, and sequential therapy. Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the certainty of evidence. A Voting Panel achieved ≥70% consensus on the direction (for or against) and strength (strong or conditional) of recommendations. Results: For adults beginning or continuing >3 months of GC treatment, we strongly recommend as soon as possible after initiation of GCs, initial assessment of fracture risks with clinical fracture assessment, bone mineral density with vertebral fracture assessment or spinal x‐ray, and Fracture Risk Assessment Tool if ≥40 years old. For adults at medium, high, or very high fracture risk, we strongly recommend pharmacologic treatment. Choice of oral or intravenous bisphosphonates, denosumab, or parathyroid hormone analogs should be made by shared decision‐making. Anabolic agents are conditionally recommended as initial therapy for those with high and very high fracture risk. Recommendations are made for special populations, including children, people with organ transplants, people who may become pregnant, and people receiving very high‐dose GC treatment. New recommendations for both discontinuation of osteoporosis therapy and sequential therapies are included. Conclusion: This guideline provides direction for clinicians and patients making treatment decisions for management of GIOP. These recommendations should not be used to limit or deny access to therapies. [ABSTRACT FROM AUTHOR]

Cyanobacteria are infamous producers of toxins. While the toxic potential of planktonic cyanobacterial blooms is well documented, the ecosystem level effects of toxigenic benthic and epiphytic cyanobacteria are an understudied threat. The freshwater epiphytic cyanobacterium Aetokthonos hydrillicola has recently been shown to produce the "eagle killer" neurotoxin aetokthonotoxin (AETX) causing the fatal neurological disease vacuolar myelinopathy. The disease affects a wide array of wildlife in the southeastern United States, most notably waterfowl and birds of prey, including the bald eagle. In an assay for cytotoxicity, we found the crude extract of the cyanobacterium to be much more potent than pure AETX, prompting further investigation. Here, we describe the isolation and structure elucidation of the aetokthonostatins (AESTs), linear peptides belonging to the dolastatin compound family, featuring a unique modification of the C-terminal phenylalanine-derived moiety. Using immunofluorescence microscopy and molecular modeling, we confirmed that AEST potently impacts microtubule dynamics and can bind to tubulin in a similar matter as dolastatin 10. We also show that AEST inhibits reproduction of the nematode Caenorhabditis elegans. Bioinformatic analysis revealed the AEST biosynthetic gene cluster encoding a nonribosomal peptide synthetase/polyketide synthase accompanied by a unique tailoring machinery. The biosynthetic activity of a specific N-terminal methyltransferase was confirmed by in vitro biochemical studies, establishing a mechanistic link between the gene cluster and its product. [ABSTRACT FROM AUTHOR]

Claims that education research is flawed and that it has little or no impact on school practices have been circulating for at least 75 years, and this chorus of criticism has intensified in the past three decades. Yet the validity of such claims has not been investigated, write Biddle and Saha. The authors interviewed 120 school principals (81 in the United States and 39 in Australia) to find out whether these educators value and use education research. Their findings indicated that most principals held positive opinions about education research, were actively interested in research that was relevant to their professional needs, were at least minimally familiar with important education research topics, learned about education research from a wide variety of sources, and applied research knowledge in their schools. The authors recommend that educators work to dispel the myth that education research has no impact--but at the same time, that schools enhance educators' ability to apply research through improved professional training. (Contains 1 figure.)

This paper examines the symmetric and asymmetric effects of house price changes and a few other macroeconomic variables on durable and non-durable consumption separately. The study considers the nonlinear panel Autoregressive Distributed Lag (ARDL) approach (Pooled Mean Group (PMG) estimation (Pesaran, 1997; Pesaran et al., 1999)) for cointegration and error-correction modeling, and uses annual data from fifty states of the U.S. The results show that changes in house prices have asymmetric effects on both durable and non-durable consumption in the long run. To dig deeper into the relationship between house price and consumption, I divide the fifty U.S. states into three categories: high-, middle- and low-income states. This helps to examine how the responsiveness of durable and non-durable consumption varies across these three categories. The findings show that the low-income states are affected more by changes in house prices than that of the high- and middle-income states. [ABSTRACT FROM AUTHOR]

Background: Fitness technologies such as wearables and sit-stand desks are increasingly being used to fight sedentary lifestyles by encouraging physical activity. However, adherence to such technologies decreases over time because of apathy and increased dismissal of behavioral nudges. Objective: To address this problem, we introduced shared autonomy in the context of sit-stand desks, where user input is integrated with robot autonomy to control the desk and reduce sedentary behavior and investigated user reactions and preferences for levels of automation with a sit-stand desk. As demographics affect user acceptance of robotic technology, we also studied how perceptions of nonvolitional behavior change differ across cultures (United States and India), sex, familiarity, dispositional factors, and health priming messages. Methods: We conducted a web-based vignette study in the United States and India where a total of 279 participants watched video vignettes of a person interacting with sit-stand desks of various levels of automation and answered questions about their perceptions of the desks such as ranking of the different levels of automation. Results: Participants generally preferred either manual or semiautonomous desks over the fully autonomous option (P<.001). However, participants in India were generally more amenable to the idea of nonvolitional interventions from the desk than participants in the United States (P<.001). Male participants had a stronger desire for having control over the desk than female participants (P=.01). Participants who were more familiar with sit-stand desks were more likely to adopt autonomous sit-stand desks (P=.001). No effects of health priming messages were observed. We estimated the projected health outcome by combining ranking data and hazard ratios from previous work and found that the semiautonomous desk led to the highest projected health outcome. Conclusions: These results suggest that the shared autonomy desk is the optimal level of automation in terms of both user preferences and estimated projected health outcomes. Demographics such as culture and sex had significant effects on how receptive users were to autonomous intervention. As familiarity improves the likelihood of adoption, we propose a gradual behavior change intervention to increase acceptance and adherence, especially for populations with a high desire for control. [ABSTRACT FROM AUTHOR]

Research is needed to support culturally informed interventions for diverse groups of survivors of intimate partner violence (IPV), such as immigrant women. Researchers, however, often face numerous barriers in recruiting and retaining immigrant survivors of IPV in intervention research. This qualitative study explored strategies to enhance recruitment and retention of immigrant survivors of IPV in intervention research from the perspective of immigrant survivors of IPV and providers serving immigrant women. Forty-six in-depth interviews were conducted with diverse groups of immigrant women (Africans, Asians, and Latinas) and 17 key informant interviews were conducted with providers serving immigrant women. The interviews focused on perceived facilitators and barriers to recruitment and retention including strategies to form partnerships with domestic violence organizations. Data were analyzed using systematic inductive thematic analysis. Participants identified barriers to recruitment such as fear of being judged, lack of familiarity with the recruiter, normalcy of abuse in some cultures, undocumented status, and fear related to legal implications of reporting IPV. Barriers to study retention included lack of motivation, time burden related to study participation, and emotional strain with recounting abuse experience. Participants also shared strategies to facilitate recruitment and retention such as engaging with the community, forming partnerships with domestic violence organizations, using recruiters with similar background and experiences as potential participants, using snowball sampling strategies, recruiting in locations frequently visited by immigrant survivors, providing adequate incentives, ensuring confidentiality, educating survivors about IPV, and conducting periodic check-ins throughout the study period. Findings can be useful for researchers conducting intervention studies with immigrant survivors of IPV. [ABSTRACT FROM AUTHOR]

Neurons in the brainstem preBötzinger complex (preBötC) generate the rhythm and rudimentary motor pattern for inspiratory breathing movements. We performed whole-cell patch-clamp recordings from inspiratory neurons in the preBötC of neonatal mouse slices that retain breathing-related rhythmicity in vitro. We classified neurons based on their electrophysiological properties and genetic background, and then aspirated their cellular contents for single-cell RNA sequencing (scRNA-seq). This data set provides the raw nucleotide sequences (FASTQ files) and annotated files of nucleotide sequences mapped to the mouse genome (mm10 from Ensembl), which includes the fragment counts, gene lengths, and fragments per kilobase of transcript per million mapped reads (FPKM). These data reflect the transcriptomes of the neurons that generate the rhythm and pattern for inspiratory breathing movements. Measurement(s) nucleotide sequences Technology Type(s) Illumina Sequencing Factor Type(s) genotype: Dbx1-derived vs. non-Dbx1-derived neurons in the mouse preBötzinger complex • electrophysiological properties: Type-1 vs. Type-2 inspiratory preBötzinger complex neurons Sample Characteristic - Organism Mus musculus Sample Characteristic - Environment laboratory environment Sample Characteristic - Location contiguous United States of America [ABSTRACT FROM AUTHOR]

Ehrlichiosis has been infrequently described as transmissible through organ transplantation. Two donor-derived clusters of ehrlichiosis are described here. During the summer of 2020, 2 cases of ehrlichiosis were reported to the Organ Procurement and Transplantation Network (OPTN) and the Centers for Disease Control and Prevention (CDC) for investigation. Additional transplant centers were contacted to investigate similar illness in other recipients and samples were sent to the CDC. Two kidney recipients from a common donor developed fatal ehrlichiosis-induced hemophagocytic lymphocytic histiocytosis. Two kidney recipients and a liver recipient from another common donor developed ehrlichiosis. All 3 were successfully treated. Clinicians should consider donor-derived ehrlichiosis when evaluating recipients with fever early after transplantation after more common causes are ruled out, especially if the donor has epidemiological risk factors for infection. Suspected cases should be reported to the organ procurement organization and the OPTN for further investigation by public health authorities. [ABSTRACT FROM AUTHOR]

Tall fescue (Festuca arundinacea Schreb.) is one of the most important cool-season perennial obligatory outcrossing forage grasses in the United States. The production and persistence of tall fescue is significantly affected by drought in the south-central United States. Shoot-specific endophyte (Epichloë coenophiala)-infected tall fescue showed superior performance under both biotic and abiotic stress conditions. We performed a genome-wide association analysis using clonal pairs of novel endophyte AR584-positive (EP) and endophyte-free (EF) tall fescue populations consisting of 205 genotypes to identify marker-trait associations (MTAs) that contribute to drought tolerance. The experiment was performed through November 2014 to June 2018 in the field, and phenotypic data were taken on plant height, plant spread, plant vigor, and dry biomass weight under natural summer conditions of sporadic drought. Genotyping-by-sequencing of the population generated 3,597 high quality single nucleotide polymorphisms (SNPs) for further analysis. We identified 26 putative drought responsive MTAs (17 specific to EP, eight specific to EF, and one in both EP and EF populations) and nine of them (i.e., V.ep_10, S.ef_12, V.ep_27, HSV.ef_31, S.ep_30, SV.ef_32, V.ep_68, V.ef_56, and H.ef_57) were identified within 0.5 Mb region in the tall fescue genome (44.5–44.7, 75.3–75.8, 77.5–77.9 and 143.7–144.2 Mb). Using 26 MTAs, 11 tall fescue genotypes were selected for subsequent study to develop EP and EF drought tolerant tall fescue populations. Ten orthologous genes (six for EP and four for EF population) were identified in Brachypodium genome as potential candidates for drought tolerance in tall fescue, which were also earlier reported for their involvement in abiotic stress tolerance. The MTAs and candidate genes identified in this study will be useful for marker-assisted selection in improving drought tolerance of tall fescue as well opening avenue for further drought study in tall fescue. [ABSTRACT FROM AUTHOR]

• Proposed a novel reverse logistics network for LIB recycling under uncertainty. • Developed a two-stage stochastic model to facilitate strategic decision-making. • Applied simple average approximation to solve the model. • Quantified the impact of uncertainty on recycling operation and government policy. Recycling waste LIBs can be a promising option to tackle the increasing demand of Li-ion batteries (LIBs) in the United States due to the electric vehicle boom and transition towards clean energy. However, the recycling infrastructure is in its infancy in the United States, and there are inherent uncertainties in the collection volume of waste LIBs and the recovered material value that may hinder the path toward sustainable operations. The goal of this study is to maximize the recycling profit of a reverse logistics supply chain network developed considering uncertainties in feedstock volume and sales price as well as other economic challenges unique to the US market. In this study, a two-stage stochastic model is proposed to facilitate strategic decision-making. Additionally, this study quantifies the impact of uncertainties on recycling operations and government policies adopted to promote large-scale recycling of waste LIB materials in the US. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: While year-round exposure to pollen is linked to a large burden of allergic diseases, location-specific risk information on pollen types and allergy outcomes are limited. We characterize the relationship between acute exposure to tree, grass and weed pollen taxa and two allergy outcomes (allergic rhinitis physician visit and prescription allergy medication fill) across 28 metropolitan statistical areas (MSA) in the United States.Methods: We obtained daily pollen data from National Allergy Bureau (NAB) monitors at these 28 MSAs for 2008-2015. We revised the NAB guidelines to classify taxa-specific pollen severity each day. Daily information on allergic rhinitis and prescribed allergy medications for individuals with employer-based health insurance from the IBM MarketScan Research database for these MSAs. We combined the daily pollen and health data for each MSA into a longitudinal dataset. We conducted a MSA-specific conditional quasi-Poisson regression analysis to assess how different levels of pollen concentration impact the health outcomes, controlling for local air pollution, meteorology and Influenza-like illness (ILI). We used a random effects meta-analysis to produce an overall risk estimate for each pollen type and health outcome.Results: The seasonal distribution of pollen taxa and associated health impacts varied across the MSAs. Relative risk of allergic rhinitis visits increased as concentrations increased for all pollen types; relative risk of medication fills increased for tree and weed pollen only. We observed an increase in health risk even on days with moderate levels of pollen concentration. 7-day average concentration of pollen had stronger association with the health outcomes compared to the same-day measure. Controlling for air pollution and ILI had little impact on effect estimates.Conclusion: This analysis expands the catalogue of associations between different pollen taxa and allergy-related outcomes across multiple MSAs. The effect estimates we present can be used to project the burden of allergic disease in specific locations in the future as well inform patients with allergies on impending pollen exposure. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a significant national and global public health concern, with COVID-19 pandemic increasing IPV and associated health issues. Immigrant women may be disproportionately vulnerable to IPV-related health risks during the pandemic. Using qualitative in-depth interviews, we explored the perspectives of service providers (n = 17) and immigrant survivors of IPV(n = 45) on the impact of COVID-19 on immigrant women, existing services for survivors and strategies needed needed to enhance women's health and safety. Participants reported issues such as increased IPV and suggested strategies (e.g. strengthening virtual platforms). The findings could be informative for providers in national and international settings. [ABSTRACT FROM AUTHOR]

Switchgrass (Panicum virgatum L.) has been identified as a potential feedstock for cellulosic ethanol production in United States for its high biomass yield and adaptation to marginal lands. Composition of the cell wall plays an important role in bioethanol conversion. A total of 209 pseudo‐F1 testcross progenies obtained from a biparental cross, AP13 × VS16, were grown at three locations from 2008 to 2011. Near‐infrared spectroscopy was used to estimate cell wall composition from biomass harvested at maturity. A linkage map of the pseudo‐F1 testcross was constructed with 8,757 SNPs developed by genotyping‐by‐sequencing. Quantitative trait loci (QTL) analysis was performed on eight lignocellulosic traits, namely, klason lignin, sugar, glucose, xylose, hexose, ethanol, hexosoic ethanol, and cell wall ethanol conversion percentage. A total of 327 QTL were recorded for the eight lignocellulosic traits. We have identified 111 major regions in the switchgrass genome that underlie these lignocellulosic traits. Scanning of the genome sequence for genes flanking the QTL peaks, we identified 45 important genes that are involved in lignin biosynthesis, carbohydrate and sugar metabolism, and other biological and cellular functions. Identification of valuable genes associated with QTL along with pleotropic effects of the significant number of QTL suggests that simultaneous selection and genetic improvement of these traits are possible using marker‐assisted selection. [ABSTRACT FROM AUTHOR]

Approaches that root national climate strategies in local actions will be essential for all countries as they develop new nationally determined contributions under the Paris Agreement. The potential impact of climate action from non-national actors in delivering higher global ambition is significant. Sub-national action in the United States provides a test for how such actions can accelerate emissions reductions. We aggregated U.S. state, city, and business commitments within an integrated assessment model to assess how a national climate strategy can be built upon non-state actions. We find that existing commitments alone could reduce emissions 25% below 2005 levels by 2030, and that enhancing actions by these actors could reduce emissions up to 37%. We show how these actions can provide a stepped-up basis for additional federal action to reduce emissions by 49%—consistent with 1.5 °C. Our analysis demonstrates sub-national actions can lead to substantial reductions and support increased national action. Climate action from local actors is vital in achieving nationally determined contributions under the Paris Agreement. Here the authors show that existing commitments from U.S. states, cities and business could reduce emissions 25% below 2005 levels by 2030, with expanded subnational action reducing emissions by 37% and federal action by up to 49%. [ABSTRACT FROM AUTHOR]

The US Food and Drug Administration is one of several US and global agencies making strides to incorporate patient preference information (PPI) into its decision making. PPI has been included in 5 completed medical device marketing decisions to date. Its usage is not more widespread because of uncertainty about how to design "fit-for-purpose" patient preference studies and a lack of standards for the choice of preference elicitation methods, among other reasons. To advance the application of PPI to decision making about medical devices, the Food and Drug Administration has published a guidance document, "Patient Preference Information-Voluntary Submission, Review in Premarket Approval Applications, Humanitarian Device Exemption Applications, and De Novo Requests, and Inclusion in Decision Summaries and Device Labeling." This article discusses key concepts in the guidance document, in addition to providing lessons learned from the use of PPI for medical device regulatory applications to date and identifying new opportunities to leverage PPI to elevate the patient voice in the medical device product life cycle. [ABSTRACT FROM AUTHOR]

Contends that as long as the structural location of schooling in less developed societies is related to the effects of foreign penetration, the educational achievement process whereby this learning is improved will differ from that found in the developed societies. (BRR)

Objective: To describe how access to primary and specialty care differs for Medicaid patients relative to commercially insured patients, and how these differences vary across rural and urban counties, using comprehensive claims data from Oregon.Design: Cross-sectional study of risk-adjusted access rates for two types of primary care providers (physicians; nurse practitioners (NPs) and physician assistants (PAs)); four types of mental health providers (psychiatrists, psychologists, advanced practice NPs or PAs specializing in mental health care, behavioral specialists); and four physician specialties (obstetrics and gynecology, general surgery, gastroenterology, dermatology).Participants: 420,947 Medicaid and 638,980 commercially insured adults in Oregon, October 2014-September 2015.Outcome: Presence of any visit with each provider type, risk-adjusted for sex, age, and health conditions.Results: Relative to commercially insured individuals, Medicaid enrollees had lower rates of access to primary care physicians (- 11.82%; CI - 12.01 to - 11.63%) and to some specialists (e.g., obstetrics and gynecology, dermatology), but had equivalent or higher rates of access to NPs and PAs providing primary care (4.33%; CI 4.15 to 4.52%) and a variety of mental health providers (including psychiatrists, NPs and PAs, and other behavioral specialists). Across all providers, the largest gaps in Medicaid-commercial access rates were observed in rural counties. The Medicaid-commercial patient mix was evenly distributed across primary care physicians, suggesting that access for Medicaid patients was not limited to a small subset of primary care providers.Conclusions: This cross-sectional study found lower rates of access to primary care physicians for Medicaid enrollees, but Medicaid-commercial differences in access rates were not present across all provider types and displayed substantial variability across counties. Policies that address rural-urban differences as well as Medicaid-commercial differences-such as expansions of telemedicine or changes in the workforce mix-may have the largest impact on improving access to care across a wide range of populations. [ABSTRACT FROM AUTHOR]

Purpose: Despite advances in biologic therapy, approximately 10–15% of ulcerative colitis (UC) patients require surgery. We aimed to (1) examine the rates of emergent colectomy and elective ileal pouch anal anastomosis (IPAA) over time among UC patients in the USA and (2) investigate disparities in surgery rates by patient demographics. Methods: Data from the Nationwide Inpatient Sample (NIS) from 2000 to 2014 were analyzed. Inclusion criteria were admissions with a primary UC ICD-9-CM diagnosis code and age > 18. Emergent cases were defined as those admitted through the emergency room with an outcome ICD-9-CM code for subtotal colectomy. Elective IPAA cases were defined with an outcome ICD-9-CM code for IPAA, used as a surrogate measure of colectomy. Patient and hospital-level demographics were analyzed. Temporal trends of colectomy were analyzed utilizing joinpoint-regression analysis with calculation of annual percentage change (APC). Results: A total of 470,708 admissions were included over the 14-year period. Emergent colectomy rate significantly declined (APC − 7.35%, p = 0.0002), while the rate of elective IPAA remained stable (APC − 0.21%, p = 0.8). Emergent colectomy rates declined similarly across all demographics, though not as marked among patients age 50 and older and Medicare patients. Elective IPAA rates were significantly lower among blacks and patients with public insurance. Conclusions: There has been a significant decline in emergent UC colectomy rates in the USA; however, the overall need for surgery appears unchanged given stable IPAA rates. This suggests a limited impact on overall surgery rates with a shift from emergent to elective procedures. [ABSTRACT FROM AUTHOR]

Motor vehicle crashes remain a leading cause of accidental death in the United States, and weather is frequently cited as a contributing factor in fatal crashes. Previous studies have investigated the link between these crashes and precipitation typically using station-based observations that, while providing a good estimate of the prevailing conditions on a given day or hour, often fail to capture the conditions present at the actual time and location of a crash. Using a multiyear, high-resolution radar reanalysis and information on 125,012 fatal crashes spanning the entire continental United States over a 6-yr period, we find that the overall risk of a fatal crash increases by approximately 34% during active precipitation. The risk is significant in all regions of the continental United States, and it is highest during the morning rush hour and during the winter months. [ABSTRACT FROM AUTHOR]

A new design of a compact ultra-wide band (UWB) monopole antenna with triple-band, triple-sense circular polarisation (CP) is presented here. It is composed of a compact quad-circular monopole, a fractal parasitic ring resonator, a triangular ring resonator, rectangular ring resonator, and modified 'T' and 'I' shaped slots on the ground plane along with a rectangular stub with 'E'-shaped slot on the right side of the monopole. The proposed antenna radiates left-hand circularly polarised (LHCP) wave at lower and mid-frequency bands, while right-hand circularly polarised (RHCP) wave at upper frequency band. The results show that the antenna covers an ultra-wide bandwidth from 3.1 to 11 GHz (112%). Moreover, the proposed antenna achieves good CP characteristics at Citizens Broadband Radio Services in USA (3.55-3.72 GHz), artificial magnetic conductors and WLAN upper frequency spectrum (4.81-5.61 GHz), VSAT services & Satellite Communication and Ground Surveillance RADAR (9.29-10.95 GHz), respectively. Novelty of this article lies in designing a compact printed UWB monopole antenna with combined triple band CP characteristics controllable by adjusting the antenna design parameters. The simulated and measured results of the antenna have been compared and seen to be in reasonable agreement. [ABSTRACT FROM AUTHOR]

Background: Endoscopy-related musculoskeletal injuries are increasingly recognized among gastroenterologists. While injury rates and risk factors have been studied among practicing gastroenterologists, little is known about rates among trainees during fellowship.Aims: This study analyzes the prevalence of endoscopy-related overuse injuries and risk factors for injuries among a national sample of gastroenterology (GI) fellows. We also surveyed GI fellowship program directors and fellows about perceptions of overuse injuries during GI training.Methods: We distributed a 29-item electronic survey to GI fellows at accredited programs in the USA in April 2016. Survey items included demographic information, questions pertaining to injuries, and level of agreement on the importance of ergonomics training in GI fellowship. Additionally, we distributed a 7-item electronic survey to fellowship program directors evaluating perception of overuse injuries and prevention during fellowship training. Fisher's exact test determined factors associated with sustaining an injury.Results: An estimated 1509 fellows received the survey. Eleven percent (n = 165) of gastroenterology fellows completed the survey. Twenty percent reported having a musculoskeletal injury. Female gender was the only factor associated with a higher rate of reported injury (p < 0.01). The most common injuries reported were thumb and other hand-related pain (n = 28 [64%]).Conclusions: Musculoskeletal injuries may affect up to 20% of GI fellows. Female fellows more frequently report injuries and may be at particularly high risk which has not been found in previously reported surveys of practicing gastroenterologists. Standardized curricula on ergonomic considerations and injury prevention are needed to enhance GI fellowship training and reduce injury rates. [ABSTRACT FROM AUTHOR]

A second-generation chlorin-based photosensitizer, 2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide-a (HPPH) has shown tremendous therapeutic potential in clinical trials in the treatment of esophageal cancer. Herein, we have developed and validated a bioanalytical method for estimation of HPPH in rat plasma using High Performance Liquid Chromatography (HPLC) with a photo diode array (PDA) detector. The method was applied for carrying out pharmacokinetic study of HPPH. Further pharmacokinetic modeling was carried out to understand the compartment kinetics of HPPH. The developed method was fully validated as per the United States Food and Drug Administration (US-FDA) guidelines for bioanalytical method validation. The linearity of the method was in the range of 250–8000 ng mL−1, and the plasma recovery was found to be 70%. Pharmacokinetic parameters were evaluated and compared via non-compartment analysis and compartment modeling after the intravenous (i.v.) bolus administration in rats using Phoenix WinNonlin 8.0 (Certara™, USA). From the obtained results, we hypothesize that the HPPH complies with two compartmental pharmacokinetic model. Furthermore, it was observed that HPPH has the rapid distribution from the central compartment to peripheral compartment along with slow elimination from peripheral compartment. [ABSTRACT FROM AUTHOR]

Background: Although lower-complexity cardiac malformations constitute the majority of adult congenital heart disease (ACHD), the long-term risks of adverse cardiovascular events and relationship with conventional risk factors in this population are poorly understood. We aimed to quantify the risk of adverse cardiovascular events associated with lower-complexity ACHD that is unmeasured by conventional risk factors.Methods: A multitiered classification algorithm was used to select individuals with lower-complexity ACHD and individuals without ACHD for comparison among >500 000 British adults in the UK Biobank. ACHD diagnoses were subclassified as isolated aortic valve and noncomplex defects. Time-to-event analyses were conducted for the primary end points of fatal or nonfatal acute coronary syndrome, ischemic stroke, heart failure, and atrial fibrillation and a secondary combined end point for major adverse cardiovascular events. Maximum follow-up time for the study period was 22 years with retrospectively and prospectively collected data from the UK Biobank.Results: We identified 2006 individuals with lower-complexity ACHD and 497 983 unexposed individuals in the UK Biobank (median age at enrollment, 58 [interquartile range, 51-63] years). Of the ACHD-exposed group, 59% were male, 51% were current or former smokers, 30% were obese, and 69%, 41%, and 7% were diagnosed or treated for hypertension, hyperlipidemia, and diabetes mellitus, respectively. After adjustment for 12 measured cardiovascular risk factors, ACHD remained strongly associated with the primary end points, with hazard ratios ranging from 2.0 (95% CI, 1.5-2.8; P<0.001) for acute coronary syndrome to 13.0 (95% CI, 9.4-18.1; P<0.001) for heart failure. ACHD-exposed individuals with ≤2 cardiovascular risk factors had a 29% age-adjusted incidence rate of major adverse cardiovascular events, in contrast to 13% in individuals without ACHD with ≥5 risk factors.Conclusions: Individuals with lower-complexity ACHD had a higher burden of adverse cardiovascular events relative to the general population that was unaccounted for by conventional cardiovascular risk factors. These findings highlight the need for closer surveillance of patients with mild to moderate ACHD and further investigation into management and mechanisms of cardiovascular risk unique to this growing population of high-risk adults. [ABSTRACT FROM AUTHOR]

Childhood hypertension has become a significant health concern. There have been a slew of important new findings in this field over the last decade. This has led to an update by the American Academy of Pediatrics of the original recommendation of United States Fourth Working Group on blood pressure. We herein describe the important changes in the guideline, which include an updated normative data, change in blood pressure classification, strong endorsement of ambulatory blood pressure measurement and the reduction in the blood pressure target for both chronic kidney disease and non-chronic kidney disease hypertensive children. [ABSTRACT FROM AUTHOR]

Wyoming's Interstate 80 has one of the highest truck crash rates in the United States. This is due to a variety of reasons, including high percentage of truck traffic, adverse weather conditions and mountainous terrain. These factors have caused the Wyoming Highway Patrol (WHP) to spend extensive resources on inspecting commercial vehicles and enforcement of traffic laws in this corridor. This study estimated the correlation between traffic citations and truck crashes. In addition, the paper evaluated the increased risk of truck crashes in adverse weather and road conditions. The explanatory variables included geometric features, weather condition, traffic volume and types of citations. This research concluded that speeding related citations and truck crashes are negatively correlated, and the risk of truck crashes is significantly higher when weather is not clear, and the road is not dry. [ABSTRACT FROM AUTHOR]

Major changes to the operation of local newsrooms--ownership restructuring, layoffs, and a reorientation away from print advertising--have become commonplace in the last few decades. However, there have been few systematic attempts to characterize the impact of these changes on the types of reporting that local newsrooms produce. In this paper, we propose a method to measure the investigative content of news articles based on article text and influence on subsequent articles. We use our method to examine over-time and cross-sectional patterns in news production by local newspapers in the United States over the past decade. We find surprising stability in the quantity of investigative articles produced over most of the time period examined, but a notable decline in the last 2 y of the decade, corresponding to a recent wave of newsroom layoffs. [ABSTRACT FROM AUTHOR]

Achieving net zero largely depends on the stability of the domestic renewable energy generation firms. Steady investment attracted by these firms can ensure their sustenance. Price fluctuations of these firms can affect their risk profiles, and subsequently, the investments coming toward those firms. The fluctuating stance of the United States of America (USA) in tacking climatic shift has made the policy environment inconducive of the domestic renewable energy generation firms. The disruptions in the financial market caused by the Russia-Ukraine Conflict have worsened the situation. Moreover, the trade restrictions on critical minerals and restrictive trade flows in the post-conflict period are expected to hamper the operational efficiency of these firms. Given this background, the present study attempts to develop a policy framework for the USA to internalize the impacts of conflict and stabilize the price returns of the renewable energy generation firms in the USA. The study is done from January 5, 2021, to March 31, 2023, and by comparing the pre- and post-conflict scenarios after dividing the sample. This study has used the multivariate quantile-on-quantile regression (m-QQR) framework. Results of the study have provided with significant insights into the price response of the renewable energy generation firms in the USA to the Russia-Ukraine Conflict. These insights are utilized to develop a policy framework to achieve net zero in the USA. • Price fluctuations of renewable energy generation firms affect their investments. • Study is done for the USA from January 5, 2021, to March 31, 2023. • Russia-Ukraine Conflict's impact on clean energy generation firm prices is shown. • Multivariate quantile-on-quantile regression is introduced. • Results are used to develop a policy framework to achieve net-zero in the USA. [ABSTRACT FROM AUTHOR]

Cat-scratch disease (CSD) is mostly preventable. More information about the epidemiology and extent of CSD would help direct prevention efforts to those at highest risk. To gain such information, we reviewed the 2005-2013 MarketScan national health insurance claims databases and identified patients <65 years of age with an inpatient admission or outpatient visit that included a CSD code from the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence of CSD was highest among those who lived in the southern United States (6.4 cases/100,000 population) and among children 5-9 years of age (9.4 cases/100,000 population). Inpatients were significantly more likely than outpatients to be male and 50-64 years of age. We estimate that each year, 12,000 outpatients are given a CSD diagnosis and 500 inpatients are hospitalized for CSD. Prevention measures (e.g., flea control for cats) are particularly helpful in southern states and in households with children. [ABSTRACT FROM AUTHOR]

Objectives: To present current, nationally representative US findings on the past-year and lifetime prevalences, sociodemographic correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 posttraumatic stress disorder (PTSD).Methods: Face-to-face interviews with 36,309 adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. PTSD, alcohol and drug use disorders, and selected mood, anxiety, and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5.Results: Past-year and lifetime prevalences were 4.7 and 6.1 %, higher for female, white, Native American, younger, and previously married respondents, those with Conclusions: DSM-5 PTSD is prevalent, highly comorbid, disabling, and associated with delayed help seeking. Additional research is needed to elucidate relationships identified herein, estimate PTSD-related costs, investigate hypotheses regarding etiology, course, and treatment, and support decisions about resource allocation to service delivery and research. Initiatives are needed to destigmatize PTSD, educate the public about its treatment, and encourage affected individuals to seek help. [ABSTRACT FROM AUTHOR]

We used qualitative methods (semi-structured interviews with healthcare providers) to explore: 1) the role of narratives as a vehicle for raising awareness and engaging providers about the issue of healthcare disparities and 2) the extent to which different ways of framing issues of race within narratives might lead to message acceptance for providers' whose preexisting beliefs about causal attributions might predispose them to resist communication about racial healthcare disparities. Individual interviews were conducted with 53 providers who had completed a prior survey assessing beliefs about disparities. Participants were stratified by the degree to which they believed providers contributed to healthcare inequality: low provider attribution (LPA) versus high provider attribution (HPA). Each participant read and discussed two differently framed narratives about race in healthcare. All participants accepted the "Provider Success" narratives, in which interpersonal barriers involving a patient of color were successfully resolved by the provider narrator, through patient-centered communication. By contrast, "Persistent Racism" narratives, in which problems faced by the patient of color were more explicitly linked to racism and remained unresolved, were very polarizing, eliciting acceptance from HPA participants and resistance from LPA participants. This study provides a foundation for and raises questions about how to develop effective narrative communication strategies to engage providers in efforts to reduce healthcare disparities. [ABSTRACT FROM AUTHOR]

Abstract The Manual on Uniform Traffic Control Devices (MUTCD) for Streets and Highways recommends hill signs be placed in advance of downgrade descent of mountain passes. Mountain passes increase the risk of a runaway, or out of control trucks and so the advance warning signs inform the driver to take special precautions such as reducing speed or using lower gears during the descent. The Wyoming Department of Transportation has installed steep grade advance warning systems on Wyoming mountain passes. However, concerns for out of control trucks on the mountain passes persist. The objective of this study is to evaluate the safety effectiveness of steep grade advance warning signs for trucks on Wyoming mountain passes. The safety evaluation was carried out by implementing a zero-inflated negative binomial modeling technique for predicting truck crashes on mountain passes. The outcome was two models that showed the risk of runaway truck accidents were high at locations where either the grades were steep and long or the grades were long with multiple vertical curves. The analysis showed the current advance warning systems were not significantly impacting truck crash risks at the high risk locations. The study, therefore, recommends some improvements to the current advanced warning signs or implementing an improved Federal Highway Administration Grade Severity Rating System based warning system that will significantly improve truck safety at the hazardous locations. The study informs policy makers on the safety issues on Wyoming Mountain passes with regards to runaway trucks and makes recommendations for reducing the risk of runaway truck crashes on mountain passes. [ABSTRACT FROM AUTHOR]

Background: Endoscopic retrograde cholangiopancreatography (ERCP) can be challenging in patients with decompensated cirrhosis (DC) due to increased risk of adverse events related to liver dysfunction. Limited data exist regarding its national utilization in patients with DC. We aim to determine the trends in utilization and outcomes of ERCP among patients with DC in US hospitalizations.Methods: We identified hospitalizations undergoing ERCP (diagnostic and therapeutic) between 2000 and 2013 from the National Inpatient Sample (NIS) database and used validated ICD9-CM codes to identify DC hospitalizations. We utilized Cochrane-Armitage test to identify changes in trends and multivariable survey regression modeling for adjusted odds ratios (aOR) for adverse outcomes and mortality predictors.Results: There were 43782 cases of ERCPs performed in DC patients during the study period. Absolute number of ERCPs performed in this population from 2000 to 2013 showed an upward trend; however, the proportion of DC patients undergoing ERCP remained stable. We noted significant decrease in utilization of diagnostic ERCP and an increase of therapeutic ERCPs (P < 0.01). There was a significant decrease in the mean length of stay for DC patients undergoing ERCP from 8.2 days in 2000 to 7.2 days in 2013 (P < 0.01) with an increase in the mean cost of hospitalization from $17053 to $19825 (P < 0.001). Mortality rates showed a downward trend from 2000 to 2013 from 13.6 to 9.6% (P < 0.01). Increasing age, Hispanic race, diagnosis of hypertension and diabetes mellitus, and private insurance were related to adverse discharges(P < 0.01). Increasing age, presence of hepatic encephalopathy, and sepsis were associated with higher mortality (P < 0.01).Conclusions: There is an increasing trend in therapeutic ERCP utilization in DC hospitalizations nationally. There is an overall decrease in mortality in DC hospitalizations undergoing ERCP. This improvement in mortality suggests improvement in both procedural technique and peri-procedural care as well as overall decreasing mortality in cirrhosis. [ABSTRACT FROM AUTHOR]

Background Rounding checklists are an increasingly common quality improvement tool in the intensive care unit (ICU). However, effectiveness studies have shown conflicting results. We sought to understand ICU providers' perceptions of checklists, as well as barriers and facilitators to effective utilisation of checklists during daily rounds. Objectives To understand how ICU providers perceive rounding checklists and develop a framework for more effective rounding checklist implementation. Methods We performed a qualitative study in 32 ICUs within 14 hospitals in a large integrated health system in the USA. We used two complementary data collection methods: direct observation of daily rounds and semistructured interviews with ICU clinicians. Observations and interviews were thematically coded and primary themes were identified using a combined inductive and deductive approach. Results We conducted 89 interviews and performed 114 hours of observation. Among study ICUs, 12 used checklists and 20 did not. Participants described the purpose of rounding checklists as a daily reminder for evidence-based practices, a tool for increasing shared understanding of patient care across care providers and a way to increase the efficiency of rounds. Checklists were perceived as not helpful when viewed as overstandardising care and when they are not relevant to a particular ICU's needs. Strategies to improve checklist implementation include attention to the brevity and relevance of the checklist to the particular ICU, consistent use over time, and integration with daily work flow. Conclusion Our results provide potential insights about why ICU rounding checklists frequently fail to improve outcomes and offer a framework for effective checklist implementation through greater feedback and accountability. [ABSTRACT FROM AUTHOR]

The article explores the need of the U.S. to lead on nuclear energy to maintain its national security. It attributes the scenario to the deterioration of nuclear nonproliferation and security standards around the world. The importance of protocols promoting nuclear security, deterring nuclear theft and preventing weapons development is explained. Also discussed is the role of the Nuclear Suppliers Group (NSG) in coordinating national export policies regarding nuclear technology and materials and in promoting standards from the International Atomic Energy Agency (IAEA).

Importance: No US national data are available on the prevalence and correlates of DSM-5-defined major depressive disorder (MDD) or on MDD specifiers as defined in DSM-5.Objective: To present current nationally representative findings on the prevalence, correlates, psychiatric comorbidity, functioning, and treatment of DSM-5 MDD and initial information on the prevalence, severity, and treatment of DSM-5 MDD severity, anxious/distressed specifier, and mixed-features specifier, as well as cases that would have been characterized as bereavement in DSM-IV.Design, Setting, and Participants: In-person interviews with a representative sample of US noninstitutionalized civilian adults (≥18 years) (n = 36 309) who participated in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). Data were collected from April 2012 to June 2013 and were analyzed in 2016-2017.Main Outcomes and Measures: Prevalence of DSM-5 MDD and the DSM-5 specifiers. Odds ratios (ORs), adjusted ORs (aORs), and 95% CIs indicated associations with demographic characteristics and other psychiatric disorders.Results: Of the 36 309 adult participants in NESARC-III, 12-month and lifetime prevalences of MDD were 10.4% and 20.6%, respectively. Odds of 12-month MDD were significantly lower in men (OR, 0.5; 95% CI, 0.46-0.55) and in African American (OR, 0.6; 95% CI, 0.54-0.68), Asian/Pacific Islander (OR, 0.6; 95% CI, 0.45-0.67), and Hispanic (OR, 0.7; 95% CI, 0.62-0.78) adults than in white adults and were higher in younger adults (age range, 18-29 years; OR, 3.0; 95% CI, 2.48-3.55) and those with low incomes ($19 999 or less; OR, 1.7; 95% CI, 1.49-2.04). Associations of MDD with psychiatric disorders ranged from an aOR of 2.1 (95% CI, 1.84-2.35) for specific phobia to an aOR of 5.7 (95% CI, 4.98-6.50) for generalized anxiety disorder. Associations of MDD with substance use disorders ranged from an aOR of 1.8 (95% CI, 1.63-2.01) for alcohol to an aOR of 3.0 (95% CI, 2.57-3.55) for any drug. Most lifetime MDD cases were moderate (39.7%) or severe (49.5%). Almost 70% with lifetime MDD had some type of treatment. Functioning among those with severe MDD was approximately 1 SD below the national mean. Among 12.9% of those with lifetime MDD, all episodes occurred just after the death of someone close and lasted less than 2 months. The anxious/distressed specifier characterized 74.6% of MDD cases, and the mixed-features specifier characterized 15.5%. Controlling for severity, both specifiers were associated with early onset, poor course and functioning, and suicidality.Conclusions and Relevance: Among US adults, DSM-5 MDD is highly prevalent, comorbid, and disabling. While most cases received some treatment, a substantial minority did not. Much remains to be learned about the DSM-5 MDD specifiers in the general population. [ABSTRACT FROM AUTHOR]

This study presents a GIS-based model developed for urban site-specific bioenergy production potential on marginal land parcels. The model is applied on a metropolitan region level, encompassing 101 cities and towns surrounding Boston in the northeastern United States. The ‘marginal’ land use category includes vacant and abandoned lands, portions of public and private lots, and degraded lands, with poor soil quality. Four different energy crops—miscanthus, switchgrass, poplar, and willow—were considered as biomass feedstocks for bioenergy production. A total marginal land area of 71,200 ha (712 km 2 ) was identified that can be suitably used for bioenergy production, representing 20% of the total land area of the region. Spatial analysis revealed greatest marginal land densities close to the urban core. Statistical analysis found a weak positive correlation between population density and marginal land availability. Short-rotation hybrid poplar was identified as the highest yielding bioenergy crop for this region. Bioenergy potential calculations revealed that poplar can potentially yield up to 22 PJ (HHV) of yearly primary energy for this region that can be used for heat, conversion to transportation fuels, and/or electricity production. This is equivalent to >50% of current biomass primary energy use in Massachusetts and could potentially fulfill all of the core city of Boston’s heating demand. Hauling of biomass from the periphery to the urban core would add an estimated maximum of $7.20 per ton delivered. While the results reflect a maximum utilization scenario for marginal land, several logistical and social considerations are discussed that would impact practical implementation. [ABSTRACT FROM AUTHOR]

This study explores the relationship between tourism development and economic growth in a high tourist arrival country such as the US by adopting the wavelet transform approach using monthly data over the period 1996M01–2015M08. Three innovative techniques that are continuous wavelet, wavelet coherence power spectrum, and wavelet-based Granger causality that consider the decomposition of time series of different time frequencies are utilized to conduct the study. The results of autoregressive distributed lag and combine cointegration tests show that there is a significant long-run relationship occurring between tourism development and economic growth in the US. Furthermore, the results indicate that there is a unidirectional causal influence of economic growth on tourism development in the short run whereas in the long run the opposite causal relationship is evident in the US. Thus, it can be recommended that government needs to increase and promote tourism demand and further provide and nurture the expansion of tourism supply with the advancement of economic growth. [ABSTRACT FROM AUTHOR]

A slew of gruesome executions by terrorist groups in 2014–2015 renewed interest in the public relations strategies of terrorists. As a case in point, the Islamic State group’s escalating brutality reflects their efforts as a relatively nascent extremist group to ensure a high and sustained volume of media coverage, especially among Western outlets. But what characteristics of events actually prompt coverage from major U.S. news media? Using a rich data set of terrorist incidents and coverage from six major broadcast and cable U.S. networks, we model coverage of terrorist incidents as a function of event proximity from U.S. soil, target country affinity with the United States, number of total and U.S. casualties, and the characteristics of the terrorist group. Our findings largely corroborate expectations set forth by the literature on norms and routines of journalism and economics of news. When it comes to terrorism, coverage by U.S. major media outlets is largely dependent on proximity to and affinity with the United States, weapons of mass destruction, and the number of global and U.S. casualties. [ABSTRACT FROM PUBLISHER]

Introduction: This study presents nationally representative data on the prevalence, correlates, psychiatric comorbidity and treatment (including pharmacological and nonpharmacological) among electronic nicotine delivery system (ENDS) users.Methods: Face-to-face interviews in the National Epidemiologic Survey on Alcohol and Related Conditions-III.Results: Prevalences of 12-month and lifetime ENDS use were 3.8% (SE=0.14) and 5.4% (SE=0.17). Odds of ENDS use were greater among men than women, regardless of timeframe. Rates were lower among Blacks, Hispanics and Asians/Pacific Islanders relative to Whites. Odds of 12-month and lifetime ENDS use was also higher among younger (<65years) than older (≥65years) individuals and higher among individuals with high school education relative to these with some college education. Odds of 12-month and lifetime ENDS use was also higher among individuals with incomes <$70,000.00 compared with those with incomes≥$70,000.00 and higher among the previously married relative to those who were currently married. Associations between 12-month ENDS use and severe nicotine use disorder were strong, whereas associations with other substance use disorders and borderline and antisocial personality disorders were modest (AORs=1.3-2.6). Rates of treatment seeking to cut down or quit tobacco or nicotine use (12-month, 25.0% (SE=1.6); lifetime, 24.4% (SE=1.4)) were low.Conclusions: ENDS use is substantially comorbid, especially with nicotine use disorder. Virtually all ENDS users smoked cigarettes. Research is needed to understand their role in smoking cessation, adverse effects on bodily systems and their potential for addiction and comorbidity. [ABSTRACT FROM AUTHOR]

Importance: Lack of current and comprehensive trend data derived from a uniform, reliable, and valid source on alcohol use, high-risk drinking, and DSM-IV alcohol use disorder (AUD) represents a major gap in public health information.Objective: To present nationally representative data on changes in the prevalences of 12-month alcohol use, 12-month high-risk drinking, 12-month DSM-IV AUD, 12-month DSM-IV AUD among 12-month alcohol users, and 12-month DSM-IV AUD among 12-month high-risk drinkers between 2001-2002 and 2012-2013.Design, Setting, and Participants: The study data were derived from face-to-face interviews conducted in 2 nationally representative surveys of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions, with data collected from April 2001 to June 2002, and the National Epidemiologic Survey on Alcohol and Related Conditions III, with data collected from April 2012 to June 2013. Data were analyzed in November and December 2016.Main Outcomes and Measures: Twelve-month alcohol use, high-risk drinking, and DSM-IV AUD.Results: The study sample included 43 093 participants in the National Epidemiologic Survey on Alcohol and Related Conditions and 36 309 participants in the National Epidemiologic Survey on Alcohol and Related Conditions III. Between 2001-2002 and 2012-2013, 12-month alcohol use, high-risk drinking, and DSM-IV AUD increased by 11.2%, 29.9%, and 49.4%, respectively, with alcohol use increasing from 65.4% (95% CI, 64.3%-66.6%) to 72.7% (95% CI, 71.4%-73.9%), high-risk drinking increasing from 9.7% (95% CI, 9.3%-10.2%) to 12.6% (95% CI, 12.0%-13.2%), and DSM-IV AUD increasing from 8.5% (95% CI, 8.0%-8.9%) to 12.7% (95% CI, 12.1%-13.3%). With few exceptions, increases in alcohol use, high-risk drinking, and DSM-IV AUD between 2001-2002 and 2012-2013 were also statistically significant across sociodemographic subgroups. Increases in all of these outcomes were greatest among women, older adults, racial/ethnic minorities, and individuals with lower educational level and family income. Increases were also seen for the total sample and most sociodemographic subgroups for the prevalences of 12-month DSM-IV AUD among 12-month alcohol users from 12.9% (95% CI, 12.3%-17.5%) to 17.5% (95% CI, 16.7%-18.3%) and 12-month DSM-IV AUD among 12-month high-risk drinkers from 46.5% (95% CI, 44.3%-48.7%) to 54.5% (95% CI, 52.7%-56.4%).Conclusions and Relevance: Increases in alcohol use, high-risk drinking, and DSM-IV AUD in the US population and among subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis. Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role. [ABSTRACT FROM AUTHOR]

Objectives To examine how medical complexity modifies the relationship between enrollment in Department of Veterans Affairs ( VA) home-based primary care ( HBPC) and hospitalization for ambulatory care-sensitive conditions ( ACSC) for veterans with diabetes mellitus and whether the effect of HBPC on hospitalizations varies according to clinical condition. Design Retrospective cohort study. Setting VA and non- VA hospitals. Participants VA beneficiaries aged 67 and older with diabetes mellitus and enrolled in Medicare (N = 364,972). Measurements Instrumental variables regression models were used to estimate the effect of HBPC enrollment on hospitalization for ACSCs (defined according to the Agency for Healthcare Research and Quality Prevention Quality Indicators) overall and in subgroups stratified according to medical complexity. Models were also estimated for each ACSC to determine which conditions were most sensitive to HBPC. Distance from the veteran's residence to the nearest HBPC site was used as the instrumental variable. Results HBPC was associated with fewer ACSC hospitalizations (odds ratio ( OR) = 0.35 per person-month, 95% confidence interval ( CI) = 0.30-0.42). For veterans in the highest quartile of medical complexity, HBPC enrollment was associated with fewer ACSC hospitalizations ( OR = 0.43, 95% CI = 0.19-0.93), whereas for those in the lowest quartile, HBPC was associated with more ACSC hospitalizations ( OR = 33.2, 95% CI = 4.6-240.1). HBPC enrollment was associated with fewer hospitalizations for a range of ACSCs. Conclusion HBPC enrollment was associated with fewer hospitalizations for a range of ACSCs in veterans with diabetes mellitus but only in the most medically complex individuals. This demonstrates the importance of appropriate targeting and suggests that the effect of HBPC is attributable to its comprehensive approach rather than condition-specific interventions. [ABSTRACT FROM AUTHOR]

Objective: To develop recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP).Methods: We conducted a systematic review to synthesize the evidence for the benefits and harms of GIOP prevention and treatment options. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence. We used a group consensus process to determine the final recommendations and grade their strength. The guideline addresses initial assessment and reassessment in patients beginning or continuing long-term (≥3 months) glucocorticoid (GC) treatment, as well as the relative benefits and harms of lifestyle modification and of calcium, vitamin D, bisphosphonate, raloxifene, teriparatide, and denosumab treatment in the general adult population receiving long-term GC treatment, as well as in special populations of long-term GC users.Results: Because of limited evidence regarding the benefits and harms of interventions in GC users, most recommendations in this guideline are conditional (uncertain balance between benefits and harms). Recommendations include treating only with calcium and vitamin D in adults at low fracture risk, treating with calcium and vitamin D plus an additional osteoporosis medication (oral bisphosphonate preferred) in adults at moderate-to-high fracture risk, continuing calcium plus vitamin D but switching from an oral bisphosphonate to another antifracture medication in adults in whom oral bisphosphonate treatment is not appropriate, and continuing oral bisphosphonate treatment or switching to another antifracture medication in adults who complete a planned oral bisphosphonate regimen but continue to receive GC treatment. Recommendations for special populations, including children, people with organ transplants, women of childbearing potential, and people receiving very high-dose GC treatment, are also made.Conclusion: This guideline provides direction for clinicians and patients making treatment decisions. Clinicians and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies. [ABSTRACT FROM AUTHOR]