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Children from diverse ethnic groups are at significantly increased risk for dental caries. In particular, American Indian (AI) children have the highest incidence of detal caries of any ethnic group. The COVID-19 pandemic dramatically restricted health care access, including preventive oral health care. Given this context, it is unclear whether or not preventive oral health care for AI children has resumed since lockdown. To address this question, we surveyed adult AI caregivers (N = 152) of children aged 0–5 years, assessing recent (12-month) and pre-COVID (for caregivers of children aged 3–5 years) preventive oral and medical health services. We also examined medical health care access and utilization among caregivers. Among children aged 3–5 years old, both pre-pandemic and past year medical care utilization were generally high (80 and 90%, respectively) as was any oral health care utilization (64 & 78%, respectively). Oral health check-ups were more common over the last year (62%) compared to pre-COVID (44%). Recent health care utilization among children 1–5 years old in this sample were generally comparable to national estimates, except for higher reported preventive medical care (99% vs. 87.6%, respectively) and higher preventive oral care (96% vs. 59.6%, respectively). More caregivers reported delaying or foregoing needed health care due to COVID (28–38%) versus due to cost (8–17%). In this survey of AI caregivers, recent child preventive health care utilization was high, and changes in utilization following the lockdown phases of the pandemic were comparable for oral and medical health care. [ABSTRACT FROM AUTHOR]

Management of colon cancer has changed over the last few decades. We assessed the trends in management and outcomes using the US National Cancer Database (NCDB). A retrospective analysis of all patients with colonic adenocarcinoma between 2005 and 2019 was conducted. The cohort was divided into three equal time periods: Period 1 (2005–2009), Period 2 (2010–2014), and Period 3 (2015–2019) to examine treatment and outcomes trends. The primary outcome was 5‐year overall survival (OS). The study included 923,275 patients. A significant increase in patients with stage IV disease was noted in Period 3 compared to Period 1 (47.9% vs. 27.9%, respectively), whereas a reciprocal reduction was seen in patients with locally advanced disease (stage II: 20.8%–12%; stage III: 14.5%–7.7%). Use of immunotherapy significantly increased from 0.3% to 7.6%. Mean 5‐year OS increased (43.6 vs. 42.1 months) despite the increase in metastatic disease and longer time from diagnosis to definitive surgery (7 vs. 14 days). A reduction in 30‐day readmission (5.1%–4.2%), 30‐ (3.9%–2.8%), and 90‐day mortality (7.1%–5%) was seen. Laparoscopic and robotic surgery increased from 45.8% to 53.1% and 2.9% to 12.7%, respectively. Median postoperative length of hospital stay decreased by 2 days. Rate of positive resection margins (7.2%–6%) and median number of examined lymph nodes (14–16) also improved. Minimally invasive surgery and immunotherapy for colon cancer significantly increased in recent years. Patient outcomes including OS improved over time. [ABSTRACT FROM AUTHOR]

Aim: The benefits and short-term outcomes of transanal total mesorectal excision (taTME) for rectal cancer have been demonstrated previously, but questions remain regarding the oncologic outcomes following this challenging procedure. The purpose of this study was to analyze the oncologic outcomes following taTME at high-volume centers in the USA. Methods: This was a multicenter, retrospective observational study of 8 tertiary care centers. All consecutive taTME cases for primary rectal cancer performed between 2011 and 2020 were included. Clinical, histopathologic, and oncologic data were analyzed. Primary endpoints were rate of local recurrence, distal recurrence, 3-year disease recurrence, and 3-year overall survival. Secondary endpoints included perioperative complications and TME specimen quality. Results: A total of 391 patients were included in the study. The median age was 57 years (IQR: 49, 66), 68% of patients were male, and the median BMI was 27.4 (IQR: 24.1, 31.0). TME specimen was complete or near complete in 94.5% of cases and the rates of positive circumferential radial margin and distal resection margin were 2.0% and 0.3%, respectively. Median follow-up time was 30.7 months as calculated using reverse-KM estimator (CI 28.1–33.8) and there were 9 cases (2.5%) of local recurrence not accounting for competing risk. The 3-year estimated rate of disease recurrence was 19% (CI 15–25%) and the 3-year estimated overall survival was 90% (CI 87–94%). Conclusion: This large multicenter study confirms the oncologic safety and perioperative benefits of taTME for rectal cancer when performed by experienced surgeons at experienced referral centers. [ABSTRACT FROM AUTHOR]

Duponchelia fovealis (Zeller) (Lepidoptera: Crambidae) is a polyphagous pest that feeds on a variety of ornamental and crop plants. At least 47 plant families have been identified as hosts for D. fovealis in literature based on empirical data and observations. This list is surely incomplete based on the broad feeding habits of D. fovealis. We sought to expand the list of known D. fovealis host plants and to identify species that may be less preferred or not fed upon by D. fovealis. We used laboratory feeding assays to measure D. fovealis consumption rate of leaf disks from 32 herbaceous plant species and 32 woody species grown outdoors throughout the Southeastern United States, and 24 tropical species typically grown as house plants. These plants were from 65 genera and 36 families. Between the 3 ornamental plant groups, we tested (herbaceous, woody, and tropical) that, after 24 h, plants in the tropical group were the least consumed by D. fovealis. After 24 h, the average proportion of leaf disks eaten by D. fovealis was 0.80 or higher for 5 herbaceous and 12 woody species. Proportions of leaf disks eaten varied at the family and genus level in many cases. Our research can improve integrated pest management of D. fovealis by informing growers that plants may be at more or less risk of infestation and damage by larvae. [ABSTRACT FROM AUTHOR]

Ureteral injuries (UIs) during surgical procedures can have serious consequences for patients. Although UIs can result in substantial clinical burden, few studies report the impact of these injuries on payer reimbursement and patient cost-sharing. This retrospective study evaluated 30-day, 90-day, and 1-year healthcare resource utilization for patients with UIs and estimated patient and payer costs. Patients aged ≥ 12 years who underwent abdominopelvic surgery from January 2016 to December 2018 were identified in a United States claims database. Patients were followed for 1 year to estimate all-cause healthcare visits and costs for patients and payers. Surgeries resulting in UIs within 30 days from the surgery date were matched to surgeries without UIs to estimate UI-attributable visits and costs. Five hundred and twenty-two patients with UIs were included. Almost a third (29.9%) of patients with UIs had outpatient surgery. Patients with UIs had slightly more healthcare visits and a 15.3% higher 30-day hospital readmission rate than patients without UIs. Patient costs due to UIs were not statistically significant, but annual payer costs attributable to UIs were $38,859 (95% CI = 28,142–49,576), largely driven by inpatient costs. UIs add substantial cost for payers and result in more healthcare visits for patients. These findings highlight the importance of including inpatient and outpatient settings for UI prevention. Although UIs are rare, the associated patient and payer burdens are high; thus, protocols or techniques are needed to recognize and avert UIs as current guideline recommendations are lacking. Though not common, injuries to the ureters, which carry urine from the kidneys to the bladder, can occur during surgeries on the abdomen. Ureter injuries can lead to discomfort, pain, infection, and death. Patients with ureter injuries can also require additional care from doctors, leading to increased costs for both patients and insurance companies. The researchers in this study calculated the costs of ureter injuries at 30-days, 90-days, and 1-year after surgery using anonymous information from insurance claims from patients who received abdominal surgery. Compared with patients who did not have a ureter injury from surgery, a higher percentage of those with ureter injuries had healthcare visits in the year following surgery and a greater chance of being readmitted to the hospital in the 30 days after surgery. Costs for both patients and insurance companies increased in the year after surgery. Insurance companies paid almost $39,000 more on average per patient with ureter injury in the year after surgery compared with costs for patients who did not have ureter injuries. Patients with ureter injuries paid approximately $1,000 more out-of-pocket in the year after surgery compared with patients without ureter injuries. This study showed that ureter injuries increased costs for both patients and insurance companies. Patients with ureter injuries needed more healthcare and the insurance companies for those patients had higher financial costs. Though ureter injuries are uncommon, this study supports efforts to minimize their occurrence to prevent these impacts on patients and the healthcare system. [ABSTRACT FROM AUTHOR]

White bass (Morone chrysops) are a popular sportfish throughout the southern United States, and one parent of the commercially-successful hybrid striped bass (M. chrysops ♂ x M. saxatilis ♀. Currently, white bass are cultured using diets formulated for other carnivorous fish, such as largemouth bass (Micropterus salmoides) or hybrid striped bass and contain a significant percentage of marine fish meal. Since there are no studies regarding the utilization of alternative proteins in this species, we evaluated the global gene expression of white bass fed diets in which fish meal was partially or totally replaced by various combinations of soybean meal, poultry by-product meal, canola meal, soy protein concentrate, wheat gluten, or a commercial protein blend (Pro-Cision™). Six isonitrogenous (40% protein), isolipidic (11%), and isocaloric (17.1 kJ/g) diets were formulated to meet the known nutrient and energy requirements of largemouth bass and hybrid striped bass using nutrient availability data for most of the dietary ingredients. One of the test diets consisted exclusively of plant protein sources. Juvenile white bass (40.2 g initial weight) were stocked into a flow-through aquaculture system (three tanks/diet; 10 fish/tank) and fed the test diets twice daily to satiation for 60 days. RNA sequencing and bioinformatic analyses revealed significant differentially expressed genes between all test diets when compared to fish meal control. A total of 1,260 differentially expressed genes were identified, with major ontology relating to cell cycle and metabolic processes as well as immune gene functions. This data will be useful as a resource for future refinements to moronid diet formulation, as marine fish meal becomes limiting and plant ingredients are increasingly added as a reliable protein source. [ABSTRACT FROM AUTHOR]

The article describes the case of a one-year-old Latino boy who had ten days of cough and nasal congestion followed by two days of fevers, decreased food intake, and diarrhea. Topics discussed include the most common pathogens associated with pediatric necrotizing pneumonia (NP) in the U.S., reason that diagnosis of tuberculosis (TB) in young children can be difficult, and standard treatment for TB.

Background and Aims: Although intravenous thrombolysis (IVT) represents standard-of-care treatment for acute ischemic stroke (AIS) in eligible adult patients, definitive evidence-based guidelines and randomized clinical trial data evaluating its safety and efficacy in the pediatric population remain absent from the literature. We aimed to evaluate the utilization and outcomes of IVT for the treatment of pediatric AIS using a large national registry. Methods: Weighted hospitalizations for pediatric (<18 years of age) AIS patients were identified in the National Inpatient Sample during the period of 2001 to 2019. Complex sample statistical methods were performed to assess unadjusted and adjusted outcomes in patients treated with IVT or other medical management. Results: Among 13,901 pediatric AIS patients, 270 (1.9%) were treated with IVT monotherapy (median age 12.8 years). IVT-treated patients developed any intracranial hemorrhage (ICH) at a rate of 5.6% (n = 15), and 71.9% (n = 194) experienced favorable functional outcomes at discharge (to home or to acute rehabilitation). Following propensity-score adjustment for age, acute stroke severity, infarct location, and etiological/comorbid conditions, IVT was not associated with an increased risk of any ICH (5.6% vs 5.4%, p = 0.931; adjusted odds ratio (aOR) = 1.01, 95% confidence interval (CI) = 0.48–2.14, p = 0.971), nor with favorable functional outcome (71.9% vs 74.5%, p = 0.489; aOR = 0.88, 95% CI = 0.60–1.29, p = 0.511) in comparison with other medical therapy. Conclusions: Twenty years of population-level data in the United States demonstrate that pediatric AIS patients treated with IVT experienced high rates of favorable outcomes without an increased risk of hemorrhagic transformation. [ABSTRACT FROM AUTHOR]

Biomonitoring studies evaluating air quality via airborne element accumulation patterns in lichens typically control variability by focusing on narrow geographic regions and short time windows. Using samples of the widespread "rock‐posy" lichen sampled across the Intermountain Region of the United States, we investigate whether accumulation patterns of generic pollution sources are detectable on broad geographic and temporal scales. We develop a novel Bayesian multivariate receptor modeling (BMRM) approach that sharpens detection and discrimination of candidate pollution sources through (i) regularization of source contributions to each sample and (ii) incorporating estimated lichen secondary chemistry as a factor. Through a simulation study, we demonstrate a distinct advantage in shrinking contributions when they are truly sparse, as would be expected with heterogeneous samples from dispersed collection sites. We contrast analyses employing both standard and sparse BMRMs, and positive matrix factorization (PMF). The sparse model better maintains source identity, as specified though informative prior distributions on elemental profiles. We advocate quantitative profile matching, which reveals that PMF primarily captures variations of the baseline profile for lichen secondary chemistry. Both PMF and BMRM results suggest that the most detectable signatures relate to aeolian dust deposition, while spatial patterns hint at sporadic anthropogenic influence. [ABSTRACT FROM AUTHOR]

Aim: The National Accreditation Program for Rectal Cancer (NAPRC) was developed to improve rectal cancer patient outcomes in the United States. The NAPRC consists of a set of process and outcome measures that hospitals must meet in order to be accredited. We aimed to assess the potential of the NAPRC by determining whether achievement of the process measures correlates with improved survival. Methods: The National Cancer Database was used to identify patients undergoing curative proctectomy for non‐metastatic rectal cancer from 2010 to 2014. NAPRC process measures identified in the National Cancer Database included clinical staging completion, treatment starting <60 days from diagnosis, carcinoembryonic antigen level measured prior to treatment, tumour regression grading and margin assessment. Results: There were 48 669 patients identified with a mean age of 62 ± 12.9 years and 61.3% of patients were men. The process measure completed most often was assessment of proximal and distal margins (98.4%) and the measure completed least often was the serum carcinoembryonic antigen level prior to treatment (63.8%). All six process measures were completed in 23.6% of patients. After controlling for age, gender, comorbidities, annual facility resection volume, race and pathological stage, completion of all process measures was associated with a statistically significant mortality decrease (Cox hazard ratio 0.88, 95% CI 0.81–0.94, P < 0.001). Conclusion: Participating institutions provided complete datasets for all six process measures in less than a quarter of patients. Compliance with all process measures was associated with a significant mortality reduction. Improved adoption of NAPRC process measures could therefore result in improved survival rates for rectal cancer in the United States. [ABSTRACT FROM AUTHOR]

Objectives: Incarcerated persons in the United States have a high burden of hepatitis C virus (HCV) infection. This study assessed the impact of a statewide effort in Vermont to treat HCV in this group. Methods: We performed a retrospective, observational cohort study of all HCV-infected persons who were imprisoned in Vermont during the 19-month study period (December 2018–June 2020). The cascade of care comprised opt-out HCV screening, full access to direct-acting antiviral treatment (without hepatic fibrosis-based treatment restrictions), HCV specialist involvement, and medication-assisted treatment for patients with opioid use disorder. The primary outcome was sustained virologic response at 12 weeks after treatment completion (SVR12). Results: The study included 217 HCV-infected patients; the median age was 35 years (range, 18-73 years), 89% were male, 76% had opioid use disorder, 67% had a psychiatric comorbidity, and 9% had cirrhosis. Of the 217 patients, 98% had a liver fibrosis assessment, 59% started direct-acting antiviral treatment, 55% completed direct-acting antiviral treatment, and 51% achieved documented SVR12. Of the 129 HCV-infected persons who started direct-acting antiviral treatment, 92% completed therapy and 86% achieved documented SVR12. Psychiatric comorbidity was not significantly associated with achieving SVR12 (odds ratio = 0.67; 95% CI, 0.27-1.65; P =.38), nor was receiving medication-assisted treatment for patients with opioid use disorder (odds ratio = 1.45; 95% CI, 0.62-2.56; P =.45). Conclusions: This study reports the highest SVR12 rate achieved in a state incarcerated population to date. HCV treatment in incarcerated populations is a practical and efficacious strategy that should serve a foundational role in HCV elimination. [ABSTRACT FROM AUTHOR]

Within the first couple of years after release from prison in the United States, recidivism rates are highest. Lack of or limited education levels, access to mental health services or substance abuse treatment, and the environment post release are well-documented reasons for recidivism. A grant-funded community-based multidisciplinary post-incarceration pilot program in Southwest Michigan began to assist the returning ex-offenders overcome reintegration barriers to ensure a successful transition to community living. The program design provided wrap around services that included access to counseling, social work navigator services, mentoring, tutoring, and occupational therapy life skills training to selected ex-offenders who chose to enroll. The program provided services for one year. The conclusion of the program occurred at the end of the grant funded period, when at the same time, the COVID-19 pandemic occurred in March 2020, and coincidentally, at the same time the team adjourned due to internal consequences. There are lessons learned in this experience that worked to reduce recidivism and re-incarceration in prison for a one-year period to effectively zero. Programmatically and organizationally, there are also important lessons to share for practice that are universal. [ABSTRACT FROM AUTHOR]

Research has provided compelling evidence that employee referrals result in positive outcomes for organizations and job seekers, but it has been limited on how organizations can increase the likelihood of obtaining employee referrals. Using the theoretical lens of social exchange theory and tenets from expectancy theory, we tested two common assumptions of most employers: A referral bonus motivates employees to refer, and higher bonus amounts incite greater likelihood of referring. We theoretically developed and tested a model integrating the effects of perceived risk in referring and affective commitment and their interactions with the referral bonus to better explain the likelihood of referring. Results largely supported our predictions. Referral bonus presence, referral bonus amount, and affective commitment positively related to likelihood of referring, while perceived risk in referring negatively related to likelihood of referring. The findings also suggest that larger referral bonuses can help offset perceived risk in referring and low affective commitment levels. We contribute to the literature by developing theory, expanding the scope of the current referral literature, and offering a quantitative examination of previously theorized variables in the referring process. We conclude with suggestions to practicing managers on ways to improve the motivating potential of their employee referral programs. [ABSTRACT FROM AUTHOR]

As the opioid crisis re-intensifies,1 the potential for fraudulent, wasteful, or abusive substance use disorder (SUD) treatment practices increases. Moreover, fraud detection algorithms are reactive by nature, and their development relies on past experiences with fraud - there may be other ongoing fraudulent behavior related to SUD treatment that has not yet been detected by the field. In this commentary, we outline the role of claims data-based algorithms in unethical SUD treatment detection, potential algorithm inputs, and limitations in algorithm-based fraud detection, alternate detection strategies, and recommendations for improving fraud detection.

Consumer interest in grass-fed beef has been steadily rising due to consumer perception of its potential benefits. This interest has led to a growing demand for niche market beef, particularly in the western United States. Therefore, the objective of this study was to assess the impact of feeding systems on the change in microbial counts, color, and lipid oxidation of steaks during retail display, and on their sensory attributes. The systems included: conventional grain-fed (CON), 20 months-grass-fed (20GF), 25-months-grass-fed (25GF) and 20-months-grass-fed + 45-day-grain-fed (45GR). The results indicate that steaks in the 20GF group displayed a darker lean and fat color, and a lower oxidation state than those in the 25GF group. However, the feeding system did not have an impact on pH or objective tenderness of beef steaks. In addition, consumers and trained panelist did not detect a difference in taste or flavor between the 20GF or 25GF steaks but expressed a preference for the CON and 45GR steaks, indicating that an increased grazing period may improve the color and oxidative stability of beef, while a short supplementation with grain may improve eating quality. [ABSTRACT FROM AUTHOR]

Agent Orange (AO) was the dominant weaponized herbicide employed by the United States (US) military during the Vietnam war. AO, however, was found to be regularly contaminated by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic dioxin known; furthermore, AO was commonly diluted in the field with other aromatic hydrocarbons to assist with delivery mechanisms. Unbeknownst to the US military and the millions exposed, these events have likely contributed to the development of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) that has affected many veterans. Null studies regarding an association between AO exposure and AML/MDS are limited in their methodology and application. The acknowledgement that the known carcinogen TCDD was a contaminant in AO when paired with a strong biological plausibility for its leukemogenicity and an observed increased risk of AML/MDS in TCDD-exposed individuals should suffice to establish causal association and that veterans to whom this might apply should be awarded appropriate indemnity. [ABSTRACT FROM AUTHOR]

Decomposer fungi play a fundamental role in terrestrial ecosystem dynamics. In the southwestern United States, climate change is causing more frequent and severe droughts, which may alter fungal community composition and activity. Investigating relationships between fungal traits may improve the prediction of fungal responses to drought. In this dual field and laboratory experiment, we examine whether trade‐offs occur between traits associated with drought. Specifically, we test the hypothesis that fungi sort into lifestyles specializing in growth yield, resource acquisition, and drought stress tolerance ("YAS" framework). For the field experiment, we constructed microbial "cages" containing sterilized litter and 1 of 10 fungal isolates. These cages were placed in long‐term drought and control plots in a southern Californian grassland for 6 and 12 months. We measured fungal hyphal length per unit litter mass loss for growth yield, the potential activities of four extracellular enzymes for resource acquisition, and the ability to grow in the drought versus control plots for drought stress tolerance. We compared these results with a laboratory microcosm experiment constructed with the same fungal isolates and that measured the same fungal traits. The field experiment corroborated our laboratory results, in that no trade‐offs were observed between growth yield and resource acquisition traits. However, in contrast to the laboratory experiment, drought tolerance was negatively related to extracellular enzyme activity and growth yield in the field, implying a trade‐off. Despite this observed trade‐off in the field, growth yield was not hindered by drought. We propose a modification to the YAS framework, by combining the growth yield and resource acquisition lifestyles, which may be more appropriate for this arid system. This joint laboratory and field approach contextualizes a theoretical framework in microbial ecology and improves understanding of fungal community response to climate change. [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic sweeps the globe, many veterans with substance use issues have faced the closure of treatment facilities, mandates to shelter in place, and social distancing measures. To better understand their pandemic experiences, substance use changes, and functioning, a survey was nationally administered to a sample of United States veterans reporting substance use issues during the pandemic. The purpose of this cross-sectional online survey for veterans (N = 409) was to report on COVID-19 experiences, safety behaviors, and infection experiences while also investigating the relationship among addictive behaviors, mental and physical health, and COVID-19 impact. Measures also assessed specific substance use concerns, pandemic-related loneliness, and functioning. Though few veterans reported personally receiving a confirmed COVID-19 medical diagnosis (10.5%), the impact of pandemic stressors was evident, with a majority reporting anxiety related to contracting COVID-19 (61.4%) or fear of a family member or close friend contracting COVID-19 (58.7%). Participants reported increased use of alcohol (45.3%), sedatives (36.6%), inhalants (35.7%), tobacco (35.0%), and cannabis (34.9%), attributed specifically to the pandemic. Regression analyses revealed that even when controlling for the contribution of problematic substance use issues, negative pandemic impacts and self-reported COVID-19 related loneliness were related to more impaired physical and mental health functioning during the pandemic. Findings from this sample of veterans with addiction issues add to the growing literature suggesting unique and adverse effects of COVID-19 stressors on functioning while also revealing specific pandemic impacts for this group. [ABSTRACT FROM AUTHOR]

Introduction: Pressure to meet U.S. military weight requirements during service may predispose some service members to develop psychiatric disorders such as eating disorders or unhealthy eating behaviors, which may persist after military discharge. Specifically, research examining U.S. military veterans has found that in weight management programs, veterans with binge-eating behaviors have shown poor treatment outcomes. Overall, previous research suggests that veterans experience considerable and persistent disordered eating problems, and in addition may experience a higher prevalence of disordered eating in comparison to the general U.S. population. Research on Post-9/11 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans is needed as this group frequently presents with high rates of medical and psychiatric disorders. The current study used clinician-administered structured interviews to examine relationships between psychiatric, health, and demographic variables in a sample of Post-9/11 OEF/OIF/OND veterans with binge-eating or overeating behavior or neither.Materials and Methods: This article presents secondary analyses of the baseline phase from data obtained for the Survey of the Experiences of Returning Veterans. Using structured phone interviews, we cross-sectionally examined patterns of medical comorbidities between sociodemographic, health, eating, and psychiatric variables in 846 recently deployed U.S. veterans with binge-eating behaviors (reporting both overeating and loss of control [LOC] eating), overeating behaviors (overeating without LOC), or healthy controls (absence of any disordered eating). Study procedures were approved by the Department of Veterans Affairs (VA) Institutional Review Boards, and informed consent was obtained from the participants. A series of chi-square and analysis of variance tests revealed significant bivariate between-group differences in sociodemographic, health, eating, and psychiatric variables. Variables with significant group differences (P < .05) were entered into a multinomial logistic regression to examine relationships between psychiatric, health, and eating factors and binge-eating severity.Results: Results of the multinomial logistic regression analysis showed that women relative to men were less likely to overeat. When comparing the binge-eating group and controls, higher body mass index was associated with higher odds of binge eating. Furthermore, for the overeating group in comparison to controls, fasting behavior was associated with higher odds of overeating. For the psychiatric variables, the binge-eating and overeating groups were associated with higher rates of compulsive buying when compared to healthy controls. Additionally, the overeating group was associated with higher rates of alcohol dependence. Lastly, binge-eating and overeating behaviors were positively associated with specific psychiatric and health comorbidities.Conclusions: Further research is needed to inform the development of effective treatments for disordered eating problems, as evidenced by an anticipated increase of veterans entering the VA healthcare system and the high rate of binge eating observed in our study and prior research in Post-9/11 veterans. Moreover, our study findings suggest the relevance of screening veterans for compulsive buying. This study was limited by its relatively small sample which only examined disordered eating behaviors. Future studies could simultaneously explore binge-eating behaviors and binge-eating disorder diagnoses in larger samples. Study strengths include a diverse sample of Post-9/11 veterans with sizable female representation. [ABSTRACT FROM AUTHOR]

Soil erosion has been recognized as a significant environmental issue in the United States for over 200 years. Numerous attempts have been made to predict and quantify the phenomenon, yet significant issues remain that hinder the accuracy and effectiveness of such models. This article describes the application of the new generation Unit Stream Power Erosion and Deposition (USPED) model that estimates soil erosion and concomitant sediment deposition at Schofield Barracks, Hawai'i, an active Army training installation. The model accurately placed modeled estimates of soil erosion and sediment deposition in the correct visually determined category 85% the time (51 of 60 randomly assigned points). While not perfect, the USPED model estimates exceeded a predetermined accuracy threshold of 80%, recognizing that model estimates represent long-term estimates while visual estimates are based primarily on relatively recent conditions. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the prevalence of specific comorbid conditions (CCs) and multiple comorbid conditions (MCCs) among adult patients with hyperkalemia and examine the associations between MCCs and healthcare resource utilization (HRU) and costs. Methods: This retrospective observational cohort study was conducted using a large administrative claims database. We identified patients with hyperkalemia (ICD-10-CM: E87.5; or serum potassium >5.0 mEq/L; or NDC codes for either patiromer or sodium polystyrene sulfonate) during the study period (1/1/2016–6/30/2019). The earliest service/claim date with evidence of hyperkalemia was identified as index date. Qualified patients had ≥12 months of enrolment before and after index date, ≥18 years of age. Comorbid conditions were assessed using all data within 12 months prior to the index date. Healthcare resource utilization and costs were estimated using all data within 12 months after the index date. Association rule mining was applied to identify MCCs. Generalized linear models were used to examine the associations between MCCs and HRU and costs. Results: Of 22,154 patients with hyperkalemia, 94% had ≥3 CCs. The most common individual CCs were chronic kidney disease (CKD, 85%), hypertension (HTN, 83%), hyperlipidemia (HLD, 81%), and diabetes mellitus (DM, 47%). The most common dyad combination of CCs was CKD+HTN (71%). The most common triad combination was CKD+HTN+HLD (62%). The most common quartet combination was CKD+HTN+HLD+DM (36%). The increased number of CCs were significantly associated with increased ED visits, length of hospital stays, and total healthcare costs (all p-value < 0.0001). Conclusions: MCCs are very prevalent among patients with hyperkalemia and are strongly associated with HRU and costs. [ABSTRACT FROM AUTHOR]

Existing studies regarding the role of DNA methyltransferase inhibitors (DNMTi) and lenalidomide in refractory anemia with ring sideroblasts (RARS) are limited. Using the surveillance, epidemiology, and end results-medicare database, we assembled a population-based cohort of older adults diagnosed with non-del(5q) lower-risk myelodysplastic syndromes during 2007–2015. Of 2167 patients, 30% had RARS. About 16% of RARS and non- ring sideroblasts (RS) patients received DNMTi. RARS patients were more likely to receive lenalidomide (11.1% vs. 7.1%, p < 0.01). Among patients who were transfusion-dependent at treatment initiation, 55.6% of those treated with DNMTi only and 42.5% treated with lenalidomide only achieved red blood cell transfusion independence (RBC-TI) for a median duration of 21 and 12 weeks, respectively. RS status did not impact rate of RBC-TI. RARS patients had a significantly better survival, and the median survival of RARS patients varied by treatment group. In this population-based study of older RARS patients, DNMTi and lenalidomide were clinically active. [ABSTRACT FROM AUTHOR]

Preventative behavioral interventions aimed at reducing mental problems among refugees are limited. We assessed the effect of a Social and Emotional Wellbeing (SEW) intervention on health-promoting behaviors (coping, social-networking, and conflict-resolution) and health-outcomes (stress, anxiety, and depression) among resettled Bhutanese adults in Western Massachusetts. The study was a community-based SEW intervention with pre-posttest evaluation among 44 Bhutanese adults in Western Massachusetts. The SEW is a culturally tailored 5-week, once-weekly health-education, problem solving, and mind-body exercise program to promote stress management skills. We used validated scales to measure outcomes. Mean scores of mental problems decreased by 5.9 for depression, 9.0 for anxiety, and 5.0 for stress post-intervention (p < 0.01). Mean scores increased by 27.3 for coping, 10.6 for social support, and 20.4 for conflict-resolution. Mean social-network scores increased by 4.6 for family, 4.7 for friends, and 1.8 for community networks (p < 0.01). Our Bhutanese participants reported improvement in their mental health after attending SEW intervention. [ABSTRACT FROM AUTHOR]

Previous research has demonstrated the effectiveness of both extended-release injectable naltrexone (XR-NTX) and buprenorphine/naloxone (BUP-NX) in the treatment of opioid use disorder (OUD). However, studies using real-world samples with multiple medical and psychiatric comorbidities are lacking. The study's primary aims were to: (1) compare clinical presentations in an inclusive sample of OUD-diagnosed US military veterans receiving XR-NTX and BUP-NX, and (2) investigate differences in 90-day treatment outcomes between these two groups. Methods: The medical records of 79 patients receiving medications to treat OUD in a VA hospital's addiction outpatient treatment program were reviewed retrospectively. The analysis included all veterans who initiated medication treatment during the study period. Differences between medication groups on co-occurring diagnoses, treatment retention, and related outcomes were examined. Results: The two groups were similar in medical and psychiatric comorbidity, although the BUP-NX group were more likely to have a pain diagnosis. No statistically significant differences in retention or toxicology results were found between the two groups over the 90-day study period. The rate of positive urine screens for the BUP-NX group was 19.2% for opiates and 13.5% for other illicit substances, and 3.7% and 11.1% respectively for the XR- NTX group. Conclusion: There was no evidence that 90-days outcomes differed for veterans based on medication received, and there were more similarities than differences in clinical characteristics. Additional research is needed, including larger sample size and prospective randomized control trial to evaluate VA patients' treatment outcomes receiving BUP-NX or XR-NTX for OUD. [ABSTRACT FROM AUTHOR]

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Introduction/Objectives: Coaching is emerging as a form of facilitation in health professions education. Most studies focus on one-on-one coaching rather than team coaching. We assessed the experiences of interprofessional teams coached to simultaneously improve primary care residency training and interprofessional practice. Methods: This three-year exploratory mixed methods study included transformational assistance from 9 interprofessional coaches, one assigned to each of 9 interprofessional primary care teams that included family medicine, internal medicine, pediatrics, nursing, pharmacy and behavioral health. Coaches interacted with teams during 2 in-person training sessions, an in-person site visit, and then as requested by their teams. Surveys administered at 1 year and end study assessed the coaching relationship and process. Results: The majority of participants (82% at end of Year 1 and 76.6% at end study) agreed or strongly agreed that their coach developed a positive working relationship with their team. Participants indicated coaches helped them: (1) develop as teams, (2) stay on task, and (3) respond to local context issues, with between 54.3% and 69.2% agreeing or strongly agreeing that their coaches were helpful in these areas. Cronbach's alpha for the 15 coaching survey items was 0.965. Challenges included aligning the coach's expertise with the team's needs. Conclusions: While team coaching was well received by interprofessional teams of primary care professionals undertaking educational and clinical redesign, the 3 primary care disciplines have much to learn from each other regarding how to improve inter- and intra-professional collaborative practice among clinicians and staff as well as with interprofessional learners rotating through their outpatient clinics. [ABSTRACT FROM AUTHOR]

Background: The roles of US otolaryngology residents have changed in response to the coronavirus disease 2019 (COVID‐19) pandemic. As the pandemic peaked in the United States, we characterized resident activities and concerns. Methods: A cross‐sectional study of US otolaryngology residents between April 20, 2020 and May 2, 2020. Results: A total of 219 residents at 65/118 (55%) institutions responded. Thirty (14%) residents had been redeployed. Residents reported greatest concerns regarding education (P <.00001). Assuming adequate protective equipment, 55% desired active participation in high‐risk procedures on COVID‐19‐positive patients. Redeployed residents had greater concern for burnout and reduced in‐hospital well‐being (P <.05). Resident satisfaction correlated with comfort communicating concerns to their department (odds ratio [OR] = 4.9, 95% confidence interval [CI] 1.4‐17.3, P =.01) and inversely correlated with low perceived meaning in work (OR = 3.1, CI 1.1‐9.1, P =.03). Conclusion: Otolaryngology resident concerns have evolved as the pandemic progressed. Residency programs should prioritize resident education, well‐being in redeployed residents, and open communication as they transition toward recovery. [ABSTRACT FROM AUTHOR]

Detailed understanding of longitudinal behavior, response to therapy, and applicable biomarkers for interstitial lung diseases (ILDs) is lacking. There is a need for a large multicenter registry that provides researchers and clinicians access to well-characterized data not limited to patients with idiopathic pulmonary fibrosis. The Pulmonary Fibrosis Foundation Patient Registry (PFF-PR) is a database that collects baseline and longitudinal demographic and clinical information about patients with ILDs in the United States. The objective of this study is to describe the patient population, data collection process, and opportunities for retrospective and prospective research with the PFF-PR. Individuals 18 years or older who had ILD diagnosed and who were seen at PFF-PR centers who provided informed consent were eligible to participate. Baseline and longitudinal demographic, spirometric, radiographic, morbidity, and mortality data are recorded into a secure electronic data capture system. Starting in 2016, the PFF-PR has collected data on 2,003 patients at 42 clinical sites in the United States. At the time of enrollment, the mean age of participants was 68 years old. Most (62%) of participants were male, and 58% had a positive smoking history. The mean forced vital capacity was 69% predicted, and the mean diffusing capacity of the lung for carbon monoxide was 43% predicted. Forty-one percent of patients were using supplemental oxygen, and 39% were on antifibrotic therapy. Reasons for attrition were mostly death or transplant, with low rates of loss to follow-up or withdrawal. The PFF-PR is a large multicenter United States-based registry that provides researchers and clinicians access to well-characterized ILD patient data. [ABSTRACT FROM AUTHOR]

Background: Health care operations managers need to balance scheduling frequent follow-ups for patients with chronic conditions and fitting in patients requiring care for new complaints.Objective: We quantify how frequency of follow-up visits corresponds with access to care for patients receiving care from the Department of Veterans Affairs (VA).Design: We use patient data collected between October 2013 and June 2016 by the Survey of Healthcare Experiences of Patients (SHEP). Our sample is comprised of 94,496 patients. We estimate logistic models with 1-month lagged facility-level predictors.Main Measures: We calculate monthly measures characterizing facility-level service provision, including the average time between successive primary care visits, the average primary care visit length, the percentage of primary care appointments that are overbooked, the percent of visits that are unscheduled (i.e., walk-ins), and the ratio of patients to providers. We control for economic factors that are associated with health care supply and demand, including median household income, veteran priority status, the Zillow Housing Price Index, and veteran unemployment rates. We also control for patient demographics.Patients: We restrict the data to patients with at least one in-person primary care visit who have provided information on their ability to access urgent and routine care.Key Results: We find that shorter average follow-up times are associated with better access for patients needing urgent or routine care. A 1-month increase in the average time between successive primary care visits is associated with 10% (p < 0.001) lower odds of reporting being able to access urgent care within 1 day and 13% (p < 0.001) lower odds of reporting usually or always being able to access routine care when needed.Conclusion: Facilities with higher average follow-up times are more likely to have patients report that they are unable to quickly access urgent or routine primary care. [ABSTRACT FROM AUTHOR]

The story of the winter of 1880/81 in the central United States has been retold in historical fiction, including Laura Ingalls Wilder's The Long Winter, as well as in local histories and folklore. What story does the meteorological data tell, and how does it measure up when compared to the fiction and folklore? What were the contributing factors to the severity of the Long Winter, and has it been or could it be repeated? Examining historical and meteorological data, reconstructions, and reanalysis, including the Accumulated Winter Season Severity Index, the Long Winter emerges as one of the most severe since European-descended settlers arrived to the central United States and began documenting weather. Contributing factors to its severity include an extremely negative North Atlantic Oscillation pattern, a mild to moderate El Niño, and a background climate state that was much colder than the twentieth-century average. The winter began early and was particularly cold and snowy throughout its duration, with a sudden spring melt that caused subsequent record-setting flooding. Historical accounts of the winter, including The Long Winter, prove to be largely accurate in describing its severity, as well as its impacts on transportation, fuel availability, food supplies, and human and livestock health. Being just one of the most severe winters on record, there are others in the modern historical record that do compare in severity, providing opportunity for comparing and contrasting the impacts of similarly severe winters. [ABSTRACT FROM AUTHOR]

Objectives: To review assessments from the Institute for Clinical and Economic Review (ICER) and describe how cost-effectiveness, other benefits or disadvantages, and contextual considerations affect Council members' assessments of value.Methods: Assessments published by the ICER between December 2014 and April 2019 were reviewed. Data on the assessment, intervention, results from cost-effectiveness analyses, and Council members' votes were extracted. Voting data were examined using bar charts and radar plots. Spearman's correlations between the number of votes for other benefits and contextual considerations were estimated. Two case studies (tisagenlecleucel and voretigene neparvovec) explored the relationship between different aspects of value and the vote.Results: Thirty-one ICER assessments were reviewed, which included 51 value votes and 17 votes on other benefits and contextual considerations. On average, interventions with lower cost-effectiveness ratios received a higher proportion of high and intermediate value votes; however, there was heterogeneity across assessments. Of other benefits or disadvantages, having a novel mechanism of action received the most votes (n = 138), and reducing health disparities received the fewest (n = 24). Of contextual considerations, treating a condition that has a severe impact on length and quality of life received the most votes (n = 164). There was a strong positive correlation between votes for reduced caregiver/family burden and improving return to work/productivity (ρ = 0.88, P < .05). Two case studies highlighted that factors beyond cost-effectiveness can lead to lower (tisagenlecleucel) or higher (voretigene neparvovec) assessments of value.Conclusion: Council members' judgments about the value of interventions are influenced by other benefits or disadvantages and contextual considerations but anchored by cost-effectiveness. [ABSTRACT FROM AUTHOR]

The article focuses on brief history of the U.S. House Committees' subpoenas, and the U.S. President Donald Trump Administration's refusal to comply. It explore some of the problems with those reasons, and with the on-off theory of congressional authority and examine the Administration's reasons for noncompliance. It also mentions presidential behavior in future impeachments, and even presidential behavior in mine-run congressional oversight investigations.

Hypomethylating agents (HMA) showed overall survival (OS) benefits in patients with higher-risk myelodysplastic syndromes (HR-MDS) in clinical trials. We conducted a retrospective cohort study of Surveillance, Epidemiology, and End Results (SEER)-Medicare data of patients ≥66 years diagnosed with refractory anemia with excess blasts (RAEB), a proxy for HR-MDS, in 01/2001–04/2004 (pre-period) or 01/2006–12/2011 (post-period). Association between post-period diagnosis and OS was examined using propensity scores (PS)-matched samples. Among 1876 RAEB patients, median OS was 9 months and 30.8% received HMAs (3.6% in pre-period; 43.0% in post-period) with no association between post-period diagnosis and OS. In the top PS quartile, post-period diagnosis was associated with a 74% lower risk of death (Hazard ratio [HR] = 0.26, 95%-CI: 0.10–0.69, p = 0.007), while outcomes were worse in the lowest PS quartile (HR = 2.80, 95%-CI: 1.06–7.36, p = 0.037). HMA lead to a 3-month OS benefit for patients most likely to receive HMA but not for unselected RAEB cohort. [ABSTRACT FROM AUTHOR]

Importance: Antidepressant medication (ADM) maintenance treatment is associated with the prevention of depressive recurrence in patients with major depressive disorder (MDD), but whether cognitive behavioral therapy (CBT) treatment is associated with recurrence prevention remains unclear.Objective: To determine the effects of combining CBT with ADM on the prevention of depressive recurrence when ADMs are withdrawn or maintained after recovery in patients with MDD.Design, Setting, and Participants: A total of 292 adult outpatients with chronic or recurrent MDD who participated in the second phase of a 2-phase trial. Participants had recovered in the first phase of the trial receiving ADM, either alone or in combination with CBT. The trial was conducted in research clinics in 3 university medical centers in the United States. Patients in phase 2 were randomized to receive maintenance of or withdrawal from ADM and were followed up for 3 years. The first and last patients entered phase 2 in August 2003 and October 2009, respectively. The last patient completed phase 2 in August 2012. Data were analyzed from December 2013 to December 2018.Interventions: Maintenance of or withdrawal from treatment with ADM.Main Outcomes and Measures: Recurrence of an MDD episode using longitudinal interval follow-up evaluations; sustained recovery across both phases.Results: A total of 292 participants (171 women, 121 men; mean [SD] age 45.1 [12.9] years) were included in analyses of depressive recurrence. Maintenance ADM yielded lower rates of recurrence compared with ADM withdrawal regardless of whether patients had achieved recovery in phase 1 with ADM alone (48.5% vs 74.8%; z = -3.16; P = .002; number needed to treat [NNT], 2.8; 95% CI, 1.8-7.0) or ADM plus CBT (48.5% vs 76.7%; z = -3.49; P < .001; NNT, 2.7; 95% CI, 1.9-5.9). Sustained recovery rates differed as a function of phase 2 condition, with maintenance ADM superior to ADM withdrawal (z = 2.90; P = .004; OR, 2.54; 95% CI, 1.37-4.84; NNT, 2.3; 95% CI, 1.5-6.4). Phase 1 condition was not associated with differential rates of sustained recovery (ADM alone vs ADM plus CBT; z = 0.22; P = .83; OR, 1.08; 95% CI, 0.52-2.11; NNT, 26.0; 95% CI, number needed to harm 3.2 to NNT 2.8), nor was there a significant interaction of phase 1 condition and phase 2 condition (z = 0.30; P = .77; OR, 1.14; 95% CI, 0.49-2.88).Conclusions and Relevance: Maintenance ADM treatment, but not previous exposure to CBT, was associated with reduced rates of depressive recurrence. In previous studies, when CBT has been provided without ADM, CBT has shown a preventive effect on depressive relapse. Whether CBT also has a preventive effect on depressive recurrence, or if adding ADM interferes with any such preventive effect, remains unclear.Trial Registration: ClinicalTrial.gov identifier: NCT00057577. [ABSTRACT FROM AUTHOR]

Objective: Patiromer is a sodium-free, non-absorbed, potassium (K+) binder approved for the treatment of hyperkalemia (HK). Among US Veterans with HK, this retrospective, observational cohort study evaluated patiromer utilization, RAASi continuation, and K+ concentration change following patiromer initiation.Methods: Using data from the Veterans Affairs Corporate Data Warehouse, Veterans with HK (K+ ≥5.1 mmol/L) were included upon patiromer initiation (index date) during the study period (1/2016-8/2018). All patients had heart failure (HF), diabetes, or chronic kidney disease (CKD). Patients with end-stage renal disease were excluded. The following outcomes were assessed within 6-months post-patiromer initiation: patiromer utilization (using proportion of days covered); K+ concentration change (pre- vs post-initiation); and RAASi continuation.Results: 288 Veterans with HK were included. Baseline characteristics were: median age 70 years, African-American race 24%, diabetes 83%, HF 32%, CKD 95%, and median K+ concentration 5.7 mmol/L. At 1, 3, and 6 months post-index, the median patiromer PDC was 100%, 66%, and 44%, respectively. K+ concentration reductions post-patiromer initiation were, on average, - 1.0 mmol/L (P < 0.001). At 3-6 months, 71% of patiromer initiators had K+ <5.1 mmol/L and 95% had K+ <5.5 mmol/L. RAASi therapy was continued in >80%-90% of patiromer-treated patients.Conclusions: The real-world utilization results suggest patiromer is used for the chronic management of HK. Clinically relevant K+ concentration reductions were observed at all study time points. The successful management of HK may have contributed to the observed high rate of RAASi therapy continuation. Further research is warranted to corroborate and extend these findings. [ABSTRACT FROM AUTHOR]

An insect species' geographic distribution is probably delimited in part by physiological tolerances of environmental temperatures. Gloomy scale (Melanaspis tenebricosa (Comstock)) is a native insect herbivore in eastern U.S. forests. In eastern U.S. cities, where temperatures are warmer than nearby natural areas, M. tenebricosa is a primary pest of red maple (Acer rubrum L.; Sapindales: Sapindaceae) With warming, M. tenebricosa may spread to new cities or become pestilent in forests. To better understand current and future M. tenebricosa distribution boundaries, we examined M. tenebricosa thermal tolerance under laboratory conditions. We selected five hot and five cold experimental temperatures representative of locations in the known M. tenebricosa distribution. We built models to predict scale mortality based on duration of exposure to warm or cold experimental temperatures. We then used these models to estimate upper and lower lethal durations, i.e., temperature exposure durations that result in 50% mortality. We tested the thermal tolerance for M. tenebricosa populations from northern, mid, and southern locations of the species' known distribution. Scales were more heat and cold tolerant of temperatures representative of the midlatitudes of their distribution where their densities are the greatest. Moreover, the scale population from the northern distribution boundary could tolerate cold temperatures from the northern boundary for twice as long as the population collected near the southern boundary. Our results suggest that as the climate warms the M. tenebricosa distribution may expand poleward, but experience a contraction at its southern boundary. [ABSTRACT FROM AUTHOR]

Background: The end‐of‐life period is a crucial time in lung cancer care. To have a better understanding of the racial‐ethnic disparities in health care expenditures, access, and quality, we evaluated these disparities specifically in the end‐of‐life period for patients with lung cancer in the U.S. Materials and Methods: We used the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database to analyze characteristics of lung cancer care among those diagnosed between the years 2000 and 2011. Linear and logistic regression models were constructed to measure racial‐ethnic disparities in end‐of‐life care cost and utilization among non‐Hispanic (NH) Asian, NH black, Hispanic, and NH white patients while controlling for other risk factors such as age, sex, and SEER geographic region. Results: Total costs and hospital utilization were, on average, greater among racial‐ethnic minorities compared with NH white patients in the last month of life. Among patients with NSCLC, the relative total costs were 1.27 (95% confidence interval [CI], 1.21–1.33) for NH black patients, 1.36 (95% CI, 1.25–1.49) for NH Asian patients, and 1.21 (95% CI, 1.07–1.38) for Hispanic patients. Additionally, the odds of being admitted to a hospital for NH black, NH Asian, and Hispanic patients were 1.22 (95% CI, 1.15–1.30), 1.47 (95% CI, 1.32–1.63), and 1.18 (95% CI, 1.01–1.38) times that of NH white patients, respectively. Similar results were found for patients with SCLC. Conclusion: Minority patients with lung cancer have significantly higher end‐of‐life medical expenditures than NH white patients, which may be explained by a greater intensity of care in the end‐of‐life period. Implications for Practice: This study investigated racial‐ethnic disparities in the cost and utilization of medical care among lung cancer patients during the end‐of‐life period. Compared with non‐Hispanic white patients, racial‐ethnic minority patients were more likely to receive intensive care in their final month of life and had statistically significantly higher end‐of‐life care costs. The findings of this study may lead to a better understanding of the racial‐ethnic disparities in end‐of‐life care, which can better inform future end‐of‐life interventions and help health care providers develop less intensive and more equitable care, such as culturally competent advanced care planning programs, for all patients. This article evaluates racial‐ethnic disparities in cancer care for patients with lung cancer in the United States, focusing on cost and utilization of medical care in the end‐of‐life stage. [ABSTRACT FROM AUTHOR]

Gloomy scale, Melanaspis tenebricosa (Comstock), is native to the eastern United States and feeds on deciduous trees. In natural areas, it is a background herbivore that typically remains at low densities. Gloomy scale generally responds positively to warming with greater egg production, size, survival, and abundance. In urban areas, which are warmer than surrounding natural areas, gloomy scale is pestiferous on planted trees, particularly red maple (Acer rubrum L.; Sapindales: Sapindaceae) but other native maples as well. They live on the bark and damage host trees by feeding from plant cells and tissues, which deprives the trees of energy and nutrients, reducing the trees' growth and overall health. Gloomy scales are likely to expand their range beyond the Southeast and become pestilent in new areas with continued climatic warming and urbanization. Here we present a review of the biology, ecology, response to environmental conditions, host range and damage, and management of gloomy scale. [ABSTRACT FROM AUTHOR]

Background: The majority of patients with acute myeloid leukemia (AML) are aged >65 years at the time of diagnosis and are not actively treated. The objective of the current study was to determine the prevalence, temporal trends, and factors associated with no active treatment (NAT) among older patients with AML in the United States.Methods: A retrospective analysis was performed of Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 14,089 patients with AML residing in the United States who were diagnosed with AML at age ≥66 years during 2001 through 2013. NAT was defined as not receiving any chemotherapy, including hypomethylating agents. Multivariable logistic regression models were used to analyze sociodemographic, clinical, and provider characteristics associated with NAT.Results: The percentage of patients with NAT decreased over time from 59.7% among patients diagnosed in 2001 to 42.8% among those diagnosed in 2013. The median overall survival for the entire cohort was 82 days from the time of diagnosis. Patients treated with NAT had worse survival compared with those receiving active treatment. Variables found to be associated with higher odds of NAT included older age, certain sociodemographic characteristics (household income within the lowest quartile, residence outside the Northeast region of the United States, and being unmarried), and clinical factors (≥3 comorbidities, the presence of mental disorders, recent hospitalization, and disability).Conclusions: Greater than one-half of older patients with AML residing in the United States do not receive any active leukemia-directed therapy despite the availability of lower intensity therapies such as hypomethylating agents. Lack of active therapy receipt is associated with inferior survival. Identifying predictors of NAT might improve the quality of care and survival in this patient population, especially as novel therapeutic options with lower toxicity are becoming available. [ABSTRACT FROM AUTHOR]

We examine the degree to which required management courses in U.S.-based MBA programs make reference to the emerging evidence-based management (EBM) movement. More than 800 required management course syllabi from 333 programs were reviewed for either explicit reference to the concept of EBM, or verbiage within course descriptions that was consistent with teaching evidence-based management principles. In addition, instructor, course, and institution-level characteristics were examined as potential correlates of references to EBM. Using a liberal operationalization of EBM (i.e., keywords or phrases that are consistent with evidence-based management principles), results suggest that approximately 25% of core MBA management courses utilize EBM in some form. However, there are substantial differences across categories of course content and depending on whether the instructor has a PhD. Evidence-based management-consistent syllabi are most prevalent at the MBA level in organizational behavior and least in international management and entrepreneurship. Suggestions for future research, as well as an exemplary course description from an EBM syllabus, are offered. [ABSTRACT FROM AUTHOR]

Focuses on the views of epistemologist on sports in the United States. Comments on the belief that success breeds success in relation to sports; Impact of self-confidence in the performance of the player; Mistake in distinguishing between chance and streak shooting.

Background: With improving survival for patients with multiple myeloma (MM), supportive care that is focused on optimizing quality of life and minimizing treatment-related toxicities is increasingly important. The extent to which patients with MM are receiving recommended supportive care is unknown.Methods: This study used the Surveillance, Epidemiology, and End Results-Medicare database to identify older adults (age ≥66 years) diagnosed with MM in 2008-2013 who had received active treatment and survived 1 year or longer after their diagnosis. Outcomes of interest included guideline-recommended supportive care, which was defined as 1) bone-modifying drugs (BMDs) within the 12 months after the diagnosis, 2) influenza vaccination in the first season after the diagnosis, and 3) concomitant use of prophylactic antivirals with proteasome inhibitors. Multivariable logistic regression models were used to evaluate associations between patient/facility-level characteristics and supportive care use.Results: Among 1996 patients receiving MM-directed therapy, 64%, 52%, and 49% received BMDs, an influenza vaccination, and antiviral prophylaxis, respectively. Non-Hispanic black patients (odds ratio [OR] vs white patients, 0.63; 95% confidence interval [CI], 0.46-0.88) and patients with baseline renal impairment (OR, 0.43; 95% CI, 0.34-0.54) had lower odds of BMDs. Non-Hispanic blacks (OR, 0.52; 95% CI, 0.37-0.73) and those with dual Medicaid enrollment (OR, 0.76; 95% CI, 0.58-0.99) had lower odds of influenza vaccination. Treatment in a community-based setting was associated with reduced odds of antiviral prophylaxis (OR, 0.58; 95% CI, 0.46-0.72).Conclusions: Substantial underutilization of guideline-recommended supportive care was observed among older adults with MM in the United States, and this was associated with both patient and facility characteristics. Targeted interventions are needed to improve supportive care for patients with MM. [ABSTRACT FROM AUTHOR]

Cities contain dozens of street tree species each with multiple arthropod pests. Developing and implementing integrated pest management (IPM) tactics, such as scouting protocols and thresholds, for all of them is untenable. A survey of university research and extension personnel and tree care professionals was conducted as a first step in identifying key pests of common street tree genera in the Southern United States. The survey allowed respondents to rate seven pest groups from 0 (not pests) to 3 (very important or damaging) for each of ten tree genera. The categories were sucking insects on bark, sucking insects on leaves, defoliators and leafminers, leaf and stem gall forming arthropods, trunk and twig borers and bark beetles, and mites. Respondents could also identify important pest species within categories. Some tree genera, like Quercus and Acer, have many important pests in multiple categories. Other genera like Liriodendron, Platanus, and Lagerstroemia have only one or two key pests. Bark sucking insects were the highest ranked pests of Acer spp. Defoliators, primarily caterpillars, were ranked highest on Quercus spp. followed closely by leaf and stem gallers, leaf suckers, and bark suckers. All pest groups were rated below '1' on Zelkova spp. Identifying key pests on key tree genera could help researchers prioritize IPM development and help tree care professionals prioritize their training and IPM implementation. Recommendations for future surveys include having more respondents and tree taxa represented and identifying trees to species within large genera, such as Acer and Quercus. [ABSTRACT FROM AUTHOR]

Background: Resilience, or an individual's positive response in managing life's adversities, is of increasing interest in addressing the mental health disparities in refugees. Although the link between stressful life events and poor mental health is established, research on the role of resilience on the mental health of refugees is limited. Aims: This study assessed the association between resilience and anxiety or depression in resettled Bhutanese adults in Western Massachusetts. Methods: A cross-sectional survey was conducted among 225 Bhutanese (men: 113, women: 112) refugees aged 20–65 residing in Massachusetts. Resilience was measured with the 25-item Wagnild and Young's Resilience Scale including two constructs as follows: a 17-item 'personal competence' that measures self-reliance, independence, determination, resourcefulness, mastery and perseverance and an 8-item 'acceptance of self and life' that measures adaptability, flexibility and a balanced perspective of life. Higher total scores indicate greater resilience. The Hopkins Symptom Checklist-25 was used to measure anxiety (10-item) and depression (15-item) with a cutoff mean score of ⩾1.75 for moderate to severe symptoms. Associations of resilience with anxiety or depression scores were assessed using multiple-linear and logistic regression analyses. Results: The proportion of participants with above threshold anxiety and depression were 34.2% and 24%, respectively. Resilience was inversely associated with both anxiety (beta for 1 unit change in resilience scores: β = −0.026; p =.037) and depression (β = −0.036, p =.041). 'Personal competence' resilience was inversely associated with both anxiety (β = −0.041 p =.017) and depression (β = −0.058, p =.019), but 'acceptance of self and life' resilience was not. Participants with the highest tertile of resilience scores had a significantly decreased risk of anxiety (ORs (95% CI): 0.13 (0.04–0.40)) and depression (0.16 (0.04–0.60)). Conclusion: Higher resilience was associated with reduced anxiety and depression among Bhutanese with personal competence resilience accounting for most of the effects. These findings suggest the potential targets for mental-health intervention to improve resilience in refugees. [ABSTRACT FROM AUTHOR]

Background and Objectives: Little research has examined the clinical characteristics of U.S. post-9/11 military veterans coping with alcohol problems. Specifically, we examined psychopathology and hypersexuality among male and female post-9/11 veterans with and without a lifetime history of alcohol-use disorders (AUDs).Methods: Using data from a baseline telephone interview and follow-up web-based survey, we examined frequencies of AUDs, mental health and addictive disorders, sexual behaviors, hypersexuality, and problematic use of pornography in a national convenience sample of 283 U.S. veterans.Results: Many (39.1%) veterans met lifetime criteria for AUDs. Bivariate associations revealed that veterans with lifetime AUDs met clinically significant levels of posttraumatic stress disorder and criteria for drug-use disorders (lifetime). Veterans with lifetime AUDs also attended religious services less often, engaged in more solitary masturbation in the past month, and reported more issues with problematic use of pornography and hypersexuality compared with veterans without AUDs. Results from a logistic regression found that lifetime drug-use disorders (odds ratio [OR] = 4.22) and posttraumatic stress disorder symptoms (OR = 1.98) were significant predictors of veterans with lifetime AUD status.Discussion and Conclusions: We found differences among veterans with lifetime AUDs compared with those without on select measures of psychopathology, sexual behavior, and hypersexuality.Scientific Significance: Further screening for substance-use disorders and hypersexuality in Veterans Affairs is strongly encouraged while veterans are transitioning back into civilian life. (Am J Addict 2019;28:398-404). [ABSTRACT FROM AUTHOR]

Midlife non-Hispanic white mortality in the United States is rising, particularly in small metro and rural counties. This article responds to calls for county-level studies. We examine social determinants of morbidity and mortality among adult non-Hispanic whites in Yavapai County, Arizona, as part of an integrative study. We report overall mortality trends in Yavapai County using CDC Wonder data and then examine social determinants of reported physical health and mental distress in Yavapai County data using 6 years (2011–2016) of the Arizona Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS includes 1,024 non-Hispanic white respondents aged 25–64. We also present data from the recently established Yavapai County Overdose Fatality Review Board (YCOFRB). Mortality trends indicate that suicide and drug and alcohol-related mortality have all increased since 1999. These increases affect all 5-year age groups from 25 to 64 and both men and women. BRFSS data show that low education and unemployment, but not number of children or home ownership, are significantly associated with worse reported health and frequent mental distress in multivariate analyses. The YCOFRB point to the importance of homelessness and mental health. The mortality crisis in Yavapai County is not restricted to midlife or to drug-related deaths. The unemployed and those with low levels of education are particularly at risk. There is a need for integrative approaches that use local data to elucidate social determinants of morbidity and mortality and to reveal structural determinants. [ABSTRACT FROM AUTHOR]

Tree-stem growth is an important metric for evaluating many ecological and silvicultural research questions. However, answering these questions may require monitoring growth on many individual trees that span changing environments and geographies, which can incur significant costs. Recently, citizen science has been successfully employed as a cost-effective approach to collect data for large-scale projects that also increases scientific awareness. Still, citizen-science-led tree-growth monitoring requires the use of tools that are affordable, understandable, and accurate. Here, we compare an inexpensive, easy-to-install dendrometer band to two other bands that are more expensive with more complex installations. We installed a series of three dendrometers on 31 red maples (Acer rubrum) in two urban areas in the eastern United States. We found that the stem-growth measurements reported by these dendrometers were highly correlated and, thus, validate the utility of the inexpensive band. [ABSTRACT FROM AUTHOR]

We present an algorithm for retrieving aerosol layer height (ALH) and aerosol optical depth (AOD) for smoke over vegetated land and water surfaces from measurements of the Earth Polychromatic Imaging Camera (EPIC) onboard the Deep Space Climate Observatory (DSCOVR). The algorithm uses Earth-reflected radiances in six EPIC bands in the visible and near-infrared and incorporates flexible spectral fitting that accounts for the specifics of land and water surface reflectivity. The fitting procedure first determines AOD using EPIC atmospheric window bands (443, 551, 680, and 780 nm), then uses oxygen (O2) A and B bands (688 and 764 nm) to derive ALH, which represents an optical centroid altitude. ALH retrieval over vegetated surface primarily takes advantage of measurements in the O2 B band. We applied the algorithm to EPIC observations of several biomass burning events over the United States and Canada in August 2017. We found that the algorithm can be used to obtain AOD and ALH multiple times daily over water and vegetated land surface. Validation is performed against aerosol extinction profiles detected by the Cloud–Aerosol Lidar with Orthogonal Polarization (CALIOP) and against AOD observed at nine Aerosol Robotic Network (AERONET) sites, showing, on average, an error of 0.58 km and a bias of -0.13 km in retrieved ALH and an error of 0.05 and a bias of 0.03 in retrieved AOD. Additionally, we show that the aerosol height information retrieved by the present algorithm can potentially benefit the retrieval of aerosol properties from EPIC's ultraviolet (UV) bands. [ABSTRACT FROM AUTHOR]

In response to widespread concerns regarding Veterans' access to VA care, Congress enacted the Veterans Access, Choice and Accountability Act of 2014, which required VA to establish the Veterans Choice Program (VCP). Since the inception of VCP, more than two million Veterans have received care from community providers, representing approximately 25% of Veterans enrolled in VA care. However, expanded access to non-VA care has created challenges in care coordination between VA and community health systems. In March 2018, the VA Health Services Research & Development Service hosted a VA State of the Art conference (SOTA) focused on care coordination. The SOTA convened VA researchers, program directors, clinicians, and policy makers to identify knowledge gaps regarding care coordination within the VA and between VA and community systems of care. This article provides a summary and synthesis of relevant literature and provides recommendations generated from the SOTA about how to evaluate cross-system care coordination. Care coordination is typically evaluated using health outcomes including hospital readmissions and death; however, in cross-system evaluations of care coordination, measures such as access, cost, Veteran/patient and provider satisfaction (including with cross-system communication), comparable quality metrics, context (urban vs. rural), and patient complexity (medical and mental health conditions) need to be included to fully evaluate care coordination effectiveness. Future research should examine the role of multiple individuals coordinating VA and non-VA care, and how these coordinators work together to optimize coordination. [ABSTRACT FROM AUTHOR]