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Background Tularemia, a potentially fatal zoonosis caused by Francisella tularensis , has been reported from nearly all US states. Information on relative effectiveness of various antimicrobials for treatment of tularemia is limited, particularly for newer classes such as fluoroquinolones. Methods Data on clinical manifestations, antimicrobial treatment, and illness outcome of patients with tularemia are provided voluntarily through case report forms to the US Centers for Disease Control and Prevention by state and local health departments. We summarized available demographic and clinical information submitted during 2006–2021 and evaluated survival according to antimicrobial treatment. We grouped administered antimicrobials into those considered effective for treatment of tularemia (aminoglycosides, fluoroquinolones, and tetracyclines) and those with limited efficacy. Logistic regression models with a bias-reduced estimation method were used to evaluate associations between antimicrobial treatment and survival. Results Case report forms were available for 1163 US patients with tularemia. Francisella tularensis was cultured from a clinical specimen (eg, blood, pleural fluid) in approximately half of patients (592; 50.9%). Nearly three-quarters (853; 73.3%) of patients were treated with a high-efficacy antimicrobial. A total of 27 patients (2.3%) died. After controlling for positive culture as a proxy for illness severity, use of aminoglycosides, fluoroquinolones, and tetracyclines was independently associated with increased odds of survival. Conclusions Most US patients with tularemia received high-efficacy antimicrobials; their use was associated with improved odds of survival regardless of antimicrobial class. Our findings provide supportive evidence that fluoroquinolones are an effective option for treatment of tularemia. [ABSTRACT FROM AUTHOR]

Background Francisella tularensis , the causative agent of tularemia, is endemic throughout the Northern Hemisphere and requires as few as 10 organisms to cause disease, making this potential bioterrorism agent one of the most infectious bacterial pathogens known. Aminoglycosides, tetracyclines, and, more recently, fluoroquinolones are used for treatment of tularemia; however, data on the relative effectiveness of these and other antimicrobial classes are limited. Methods Nine databases, including Medline, Global Health, and Embase, were systematically searched for articles containing terms related to tularemia. Articles with case-level data on tularemia diagnosis, antimicrobial treatment, and patient outcome were included. Patient demographics, clinical findings, antimicrobial administration, and outcome (eg, intubation, fatality) were abstracted using a standardized form. Results Of the 8878 publications identified and screened, 410 articles describing 870 cases from 1993 to 2023 met inclusion criteria. Cases were reported from 35 countries; more than half were from the United States, Turkey, or Spain. The most common clinical forms were ulceroglandular, oropharyngeal, glandular, and pneumonic disease. Among patients treated with aminoglycosides (n = 452 [52%]), fluoroquinolones (n = 339 [39%]), or tetracyclines (n = 419 [48%]), the fatality rate was 0.7%, 0.9%, and 1.2%, respectively. Patients with pneumonic disease who received ciprofloxacin had no fatalities and the lowest rates of thoracentesis/pleural effusion drainage and intubation compared to those who received aminoglycosides and tetracyclines. Conclusions Aminoglycosides, fluoroquinolones, and tetracyclines are effective antimicrobials for treatment of tularemia, regardless of clinical manifestation. For pneumonic disease specifically, ciprofloxacin may have slight advantages compared to other antimicrobials. [ABSTRACT FROM AUTHOR]

The three-tiered School-Wide Positive Behavioral Interventions and Supports (SWPBIS) model is now being implemented in more than 13,000 schools in the United States (Horner, Sugai, & Anderson, 2010). One core feature of Tier One of the SWPBIS model is the identification of social expectations and behavior indicators across all school settings. This study examined the types and frequency of schools' social expectations and behavioral indicators as they were written into their behavior matrices. Participants from 155 schools located in 12 regionally representative states provided a sample of their behavioral matrix. Analyses of the matrices showed that three social expectations (respect, responsibility, and safety) occurred in more than 60% of behavior matrices. In addition, behavior indicators (e.g., walk to the right, quiet voices, hands to self) were identified for the four most frequent social expectations. Regional and state comparisons of social expectation frequency indicate homogeneity of categories across the country. Based on the findings, implications and suggestions for future research and practice are discussed. (Contains 3 tables and 1 figure.)

Background: Cancer survival has improved for the most common cancers. However, less improvement and lower survival has been observed in some groups perhaps due to differential access to cancer care including prevention, screening, diagnosis, and treatment. Methods: To further understand contemporary relative cancer survival (one- and five- year), we used survival data from CDC's National Program of Cancer Registries (NPCR) for cancers diagnosed during 2007–2016. We examined overall relative cancer survival by sex, race and ethnicity, age, and county-level metropolitan and non-metropolitan status. Relative cancer survival by metropolitan and non-metropolitan status was further examined by sex, race and ethnicity, age, and cancer type. Results: Among persons with cancer diagnosed during 2007–2016 the overall one-year and five-year relative survival was 80.6% and 67.4%, respectively. One-year relative survival for persons living in metropolitan counties was 81.1% and 77.8% among persons living in non-metropolitan counties. We found that persons who lived in non-metropolitan counties had lower survival than those who lived in metropolitan counties, and this difference persisted across sex, race and ethnicity, age, and most cancer types. Conclusion: Further examination of the differences in cancer survival by cancer type or other characteristics might be helpful for identifying potential interventions, such as programs that target screening and early detection or strategies to improve access to high quality cancer treatment and follow-up care, that could improve long-term outcomes. Impact: This analysis provided a high-level overview of contemporary cancer survival in the United States. [ABSTRACT FROM AUTHOR]

The article informs that breast cancer accounts for 30% of all cancers diagnosed in women. During 1999–2018, breast cancer incidence among women aged ≥20 years decreased an average of 0.3% per year, decreasing 2.1% per year during 1999–2004 and increasing 0.3% per year during 2004–2018. It is noted that the U.S. Preventive Services Task Force currently recommends biennial mammography screening for women aged 50–74 years.

Arthroplasty procedures are commonly performed and contribute to healthcare expenditures seen in the United States. Surgical team members may make selections among implants and materials without always knowing their relative cost. The current study reports on a survey aimed to investigate the perceptions of an academic group about the relative cost and value of commonly used operating room implants and materials related to joint arthroplasty cases using 10 matched pairs of items. Of the 124 persons eligible to take the survey, 102 responded (response rate of 82.3%) including attendings, fellows, residents, physician assistants (PAs), advanced practice registered nurses (APRNs) and registered nurses (RNs). On average for the ten pairs of items, the more expensive items were correctly selected by 90.2+/-13.9% (mean+/- standard deviation) of respondents with a range from 54.9% to 100%. Of note, the cost differences were significantly overestimated for 8/10 item pairs. The majority of respondents perceived the more expensive item as the item with the higher clinical value for 9/10 item pairs. Most arthroplasty attendings (91.3%) indicated willingness to use the less expensive item of two similar items. Nonetheless, 17.9% of fellows, residents, PAs, APRNs and RNs indicated that they would not feel comfortable suggesting using the less expensive item. Although attending arthroplasty surgeons stated a desire to consider costs, a knowledge deficit with regards to identifying the extent of cost differences was identified, and a significant portion of the surgical support team reported being hesitant to suggest less expensive options. [ABSTRACT FROM AUTHOR]

Plasma cell myeloma (also called multiple myeloma), solitary plasmacytoma, and extramedullary plasmacytoma are primarily diseases of the elderly. Evidence suggests an association between excess body weight and multiple myeloma. Few population‐based studies have examined incidence and mortality of each site in one study. We analyzed incidence and death rates by site (solitary plasmacytoma, extramedullary plasmacytoma, and multiple myeloma) by gender, age, race/ethnicity, and rural‐urban status among adult males and females (aged 20 years or older) in the United States during 2003‐2016. Trends were characterized as average annual percentage change (AAPC) in rates. During 2003‐2016, overall incidence rates among adults were 0.45 for solitary plasmacytoma, 0.09 for extramedullary plasmacytoma, and 8.47 for multiple myeloma per 100,000 persons. Incidence rates for multiple myeloma increased during 2003‐2016 among non‐Hispanic whites (AAPC = 1.78%) and non‐Hispanic blacks (2.98%) 20‐49 years of age; non‐Hispanic whites (1.17%) and non‐Hispanic blacks (1.24%) 50‐59 years of age; and whites non‐Hispanic (0.91%), and non‐Hispanic blacks (0.96%). During 2003‐2016 overall myeloma (extramedullary plasmacytoma and multiple myeloma) death rates among adults was 4.77 per 100,00 persons. Myeloma death rates decreased during 2003‐2016 among non‐Hispanic white (AAPC = −1.23%) and Hispanic (−1.34%) women; and non‐Hispanic white (−0.74%), non‐Hispanic American Indian/Alaska Native (−3.05%) men. The US population is projected to become older and will have a larger proportion of persons who have had an earlier and longer exposure to excess body weight. The potential impact of these population changes on myeloma incidence and mortality can be monitored with high‐quality cancer surveillance data. [ABSTRACT FROM AUTHOR]

Two new species, Fomitopsis mounceae and F. schrenkii (Polyporales, Basidiomycota) in the F. pinicola species complex in North America, are described and illustrated. Previous molecular phylogenetic analyses identified three well-delimited lineages that represent F. mounceae and F. ochracea from Canada, the Appalachian Mountains, and the northern United States and F. schrenkii from western and southwestern regions of the United States. Fomitopsis pinicola sensu stricto is restricted to Eurasia and does not occur in North America. Morphological descriptions of basidiocarps and cultures for F. mounceae, F. schrenkii, and F. ochracea are presented. The three species are readily differentiated by nuc rDNA internal transcribed spacer (ITS1-5.8S-ITS2 = ITS) sequence, geographic distribution, and basidiospore size. Polyporus ponderosus H. Schrenk is an earlier illegitimate synonym of F. schrenkii. Both F. mounceae and F. schrenkii have a heterothallic multiallelic incompatibility system. [ABSTRACT FROM AUTHOR]

The practice of voluntary tipping continues to be the most common compensation method for restaurant front-of-house service staff in the United States. Many previous studies have aimed to understand the outcome of the service exchange relationship, the tip, using only customer evaluations of salient variables. This approach marginalizes the role of the service provider to merely a measure of service quality and not an economic agent who is equally invested in the outcome of the relationship. This study sought to include the customer and the server's perspectives using a game-theoretic model to conceptualize the service exchange relationship more holistically. This study aimed to determine the salient factors in the server and customer's relationship that led to a favorable outcome in the form of a tip for the server. Convenience sampling was used to collect data from restaurant customers and servers. A game-theoretic model was created using customer evaluations of salient variables grounded by server-generated cut-off values. AIC model selection was used to determine the model that balanced information loss with information gain. Finally, logistic regression was used to map the utility-maximizing optimal strategy for a server in the game-theoretic model. Results show that the outcome will be desirable when service quality is perceived as good, the customer is a regular and dines with fewer than seven people. • This study employs a sequential moves style game to model the interactions between a customer and server. • The game-theoretic model was created using customer evaluations of salient variables grounded by server-generated cut-off values which allowed the server's perspective to be layered into the game. • AIC model selection was used to determine the best model and logistic regression to map the utility-maximizing course of play. [ABSTRACT FROM AUTHOR]

Background Context: The prevalence of dialysis-dependent patients in the United States is growing. Prior studies evaluating the risk of perioperative adverse events for dialysis-dependent patients are either institutional cohort studies limited by patient numbers or administrative database studies limited to inpatient data.Purpose: The present study uses a large, national sample with 30-day follow-up to investigate dialysis as risk factor for perioperative complications independent of patient demographics or comorbidities.Study Design/setting: This is a retrospective cohort study.Patient Sample: Patients undergoing elective spine surgery with or without dialysis from the 2005-2015 National Surgical Quality Improvement Program (NSQIP) database were included in the study.Outcome Measures: Postoperative complications within 30 days and binomial reoperation, readmission, and mortality within 30 days were determined.Methods: The 2005-2015 NSQIP databases were queried for adult dialysis-dependent and dialysis-independent patients undergoing elective spinal surgery. Differences in 30-day outcomes were compared using risk-adjusted multivariate regression and coarsened exact matching analysis for adverse events, unplanned readmission, reoperation, and mortality. The percentage of complications occurring before versus after hospital discharge was also assessed. The authors have no financial disclosures related to the present study.Results: A total of 467 dialysis and 173,311 non-dialysis patients met the inclusion criteria. Controlling for age, gender, body mass index, functional status, and American Society of Anesthesiologists (ASA) class, dialysis patients were found to be at significantly greater odds of any adverse event (odds ratio [OR]=2.52 before, 2.17 after matching, p=<.001), major adverse event (OR=2.90 before, 2.52 after matching, p=<.001), and minor adverse event (OR=1.50 before matching, p=<.025, but not significantly different after matching). Further, dialysis patients were significantly more likely to return to the operating room (OR=2.77 before, 2.50 after matching, p=<.001), have unplanned readmissions (OR=2.73 before, 2.37 after matching, p=<.001), and die within 30 days (OR=3.77 before, 2.71 after matching, p=<.001). Adverse events occurred after discharge for 51.78% of non-dialysis patients and for 43.80% of dialysis patients.Conclusions: Dialysis patients undergoing elective spine surgery are at significantly higher risk of aggregated adverse outcomes, return to the operating room, readmission, and death than non-dialysis patients, even after controlling for patient demographics and overall health (as indicated by ASA class). These differences need to be considered when determining treatment options. Additionally, with bundled payments expected in spine surgery, physicians and hospitals need to account for increased costs and liabilities when working with dialysis patients. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective cohort study of prospectively collected data. Objective. The aim of this study was to investigate the influence of changes in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database over the years on the calculation of the modified Frailty Index (mFI) and the modified Charlson Comorbidity Index (mCCI) for posterior lumbar fusion studies. Summary of Background Data. Multiple studies have utilized the mFI and/or mCCI and showed them to be predictors of adverse postoperative outcomes. However, changes in the NSQIP database have resulted in definition changes and/or missing data for many of the variables included in these indices. No studies have assessed the influence of different methods of treating missing values when calculating these indices on such studies. Methods. Elective posterior lumbar fusions were identified in NSQIP from 2005 to 2014. The mFI was calculated for each patient using three methods: treating conditions for which data was missing as not present, dropping patients with missing values, and normalizing by dividing the raw score by the number of variables collected. The mCCI was calculated by the first two of these methods. Mean American Society of Anesthesiologists (ASA) scores used for comparison. Results. In total, 19,755 patients were identified. Mean ASA score increased between 2005 and 2014 from 2.27 to 2.50 (+10.1%). For each of the methods of data handling noted above, mean mFI over the years studied increased by 33.3%, could not be calculated, and increased by 183.3%, respectively. Mean mCCI increased by 31.2% and could not be calculated respectively. Conclusion. Systematic changes in the NSQIP database have resulted in missing data for many of the variables included in the mFI and the mCCI and may affect studies utilizing these indices. These changes can be understood in the context of ASA trends, and raise questions regarding the use of these indices with data available in later NSQIP years. [ABSTRACT FROM AUTHOR]

Wine sales continue to climb in both offline and online settings in the U.S. market. With online sales having a great impact on offline sales, it is important to look at all sales modes in understanding how to better market to consumers across spectrums. What this study aims to do is to utilize a stimulus–organism–response model to better understand wine sales, when it comes to online impulse buying. This study is anticipated to add knowledge to the understanding of impulse buying of wine and is a first step at gaining a better understanding of impulse buying of wine in online settings. [ABSTRACT FROM AUTHOR]

Sudden unexplained infant death is responsible for 14% of Indiana’s infant mortality. The purpose of this qualitative research study was to describe mothers’ experiences when death of an infant occurred suddenly and unexpectedly. Field deputies or social workers interviewed mothers from central Indiana during the child-death team investigations. The Thematic Analysis Program from the Joanna Briggs Institute was used to analyze interview data. Sixteen de-identified interview cases were extracted, and a meta-aggregate method was conducted. The three synthesized themes were Extreme Emotional Shock, We Feel Like We’re to Blame, and Working Toward Moving On. Understanding these phenomena from mothers’ experience may assist in eliminating risks associated with infant deaths and inform nursing practice and policy. [ABSTRACT FROM AUTHOR]

Many health professions include written examinations among their licensing procedures, and constructing these examinations poses special difficulties. For physician licensure the central dilemma is manifested by the longstanding tradition of undifferentiated licensure contrasting with the strong specialty orientation of contemporary physician training. This article details the authors' response to this problem and describes the resulting design of a new physician licensure examination. Using a combination of empirical data and expert judgment, descriptions of selected clinical encounters have been assembled as a practice model of a physician licensed for the delivery of general health care of patients. Application of an explicitly situational framework to the design of a physician licensure examination is unusual, and the approach is advocated for use with other health professions. [ABSTRACT FROM AUTHOR]

Estuarine saltmarshes are widely recognized as highly productive and biologically diverse systems. The Indian River Lagoon (IRL) is a 250 km long 'Estuary of National Significance' along Florida's east coast and is known as one of North America's most diverse estuaries. Like most North American estuaries, the IRL is facing a number of problems, among them loss of emergent wetlands. Between 75 and 90% of the original mangrove and saltmarsh acreage historically bordering the IRL has been lost or impacted, either through direct filling for development or impoundment for mosquito control. This loss has affected IRL water quality and fisheries, since these habitats are now removed from the estuarine system. Active programs are now underway to restore mosquito impoundments by reconnection with culverts or removal of dikes, but restoration of dredge spoil is more problematic, as many of these sites have been developed. However, where undeveloped spoil is found on public lands, restoration is a possibility. One such site, Pine Island Conservation Area (PICA), jointly owned by the Brevard County Environmentally Endangered Lands Program and the St. Johns River Water Management District, contained 25.4 ha of dredge spoil, originating from 1969, when the property was owned by a development company. Following public acquisition in 1996, plans were developed to remove the spoil and restore the site to historic saltmarsh elevation. Between 2003 and 2006 all of the material was removed and the restoration of normal hydrology has resulted in 'volunteer' recruitment by appropriate marsh vegetation, without a need for any plantings. [ABSTRACT FROM AUTHOR]

Residues at sites where stationary feeders were used to provide hay as supplemental forage for cattle during the winter are developmental substrates for immature stable flies, Stomoxys calcitrans (L.), in the central United States. Spatial patterns in physical (substrate depth, temperature, water content), chemical (pH, electrical conductivity [EClab], total nitrogen [N] and carbon [C], ammoniacal nitrogen [NH4-N], extractable phosphorus [P]), and biological (microbial respiration rate) substrate properties for two feeding sites were estimated and the correlations between these properties and adult emergence were characterized. Hay feeding sites had a circular footprint with residues extending ≈7 m from the feeder. With the exception of extractable P and total N, all substrate properties exhibited spatial patterns centered on the feeder location. Adult stable fly emergence densities were significantly correlated with substrate microbial respiration rate, NH4-N concentration, EClab, total C concentration, pH, and moisture content. Logistic regression indicated that EC best predicted the probability of stable flies emerging from a substrate and that the other properties did not provide additional information. A better understanding of the physical, chemical, and biological conditions needed for stable fly larval development may help in identifying previously unrecognized developmental habitats and management of this pest. Targeted implementation of management practices such as sanitation and chemical treatments can be applied to smaller areas reducing labor and improving cost effectiveness. [ABSTRACT FROM AUTHOR]

Hay mixed with manure and urine residues at sites where hay has been provided as supplemental winter feed for cattle provide an excellent substrate for the development of immature stable flies, Stomoxys calcitrans (L.). Such sites are primary sources of early summer stable flies in the central United States and no effective measures are currently available to control fly development in them. A single application of granular cyromazine in May provided 97% reduction in the number of adult stable flies emerging from hay feeding sites. Stable fly control did not decline during the 12 wk season. A small decline in control was observed relative to anthomyiid, sarcophagid, and syrphid flies developing in the hay feeding sites. However, none of those flies are considered to be pests and ≥50% control of those flies was maintained for 65 d after application. Cyromazine offers a safe and affordable option for the control of immature stable flies developing in winter hay feeding sites. Controlling those flies should reduce the estimated $2 billion per year of lost production in U.S. cattle industries attributable to stable flies. [ABSTRACT FROM AUTHOR]

The objectives of the Environmental Monitoring and Assessment Program for Great River Ecosystems (EMAP-GRE) are to (1) develop and demonstrate, in collaboration with states, an assessment program yielding spatially unbiased estimates of the condition of mid-continent great rivers; (2) evaluate environmental indicators for assessing great rivers; and (3) assess the current condition of selected great river resources. The purpose of this paper is to describe EMAP-GRE using examples based on data collected in 2004–2006 with emphasis on an approach to determining reference conditions. EMAP-GRE includes the Upper Mississippi River, the Missouri River, and the Ohio River. Indicators include biotic assemblages (fish, macroinvertebrates, plankton, algae), water chemistry, and aquatic and riparian physical habitat. Reference strata (river reaches for which a single reference expectation is appropriate) were determined by ordination of the fish assemblage and examination of spatial variation in environmental variables. Least disturbed condition of fish assemblages for reference strata was determined by empirical modeling in which we related fish assemblage metrics to a multimetric stressor gradient. We inferred least disturbed condition from the y-intercept, the predicted condition when stress was least. Thresholds for dividing the resource into management-relevant condition classes for biotic indicators were derived using predicted least disturbed condition to set the upper bound on the least disturbed condition class. Also discussed are the outputs of EMAP-GRE, including the assessment document, multimetric indices of condition, and unbiased data supporting state and tribal Clean Water Act reporting, adaptive management, and river restoration. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) exceeds infection and cancer as the leading cause of death. In the USA alone, approximately a million individuals suffer an acute myocardial infarction (AMI) annually. As the prevalence of CVD risk factors (e.g. hypertension, obesity and type 2 diabetes) rises, CVD is increasing in younger individuals. Fortunately, existing therapies have improved post-AMI mortality, but in turn have increased the prevalence of post-AMI heart failure (HF). Approximately half-a-million new HF cases are diagnosed each year in the USA. In the next 25 years, up to 15% of the population over the age of 65 in the USA is projected to have HF. Therapeutic interventions that prevent/reverse atherosclerosis, prevent post-AMI HF and halt the progressive functional deterioration once HF occurs are all needed. Cell therapy – either via exogenous delivery or by endogenous mobilization of cells – may be able to do so, in part, by improving the body’s capacity for repair. To date, primarily bone marrow- or blood-derived cells have been utilized after AMI to prevent left ventricular dysfunction, and skeletal myoblasts have been transplanted into failing myocardium. Preclinical studies are directed at prevention/reversal of atherosclerosis with bone marrow precursors, and ultimately at replacing failing heart with a cell-based bioartificial construct. [ABSTRACT FROM AUTHOR]

Abstract Sm–Nd garnet-whole rock geochronology, phase equilibria, and thermobarometry results from Garnet Ledge, south-eastern Alaska, provide the first precisely constrained P–T–t path for garnet zone contact metamorphism. Garnet cores from two crystals and associated whole rocks yield a four point isochron age for initial garnet growth of 89.9 ± 3.6 Ma. Garnet rims and matrix minerals from the same samples yield a five point isochron age for final garnet growth of 89 ± 1 Ma. Six size fractions of zircon from the adjacent pluton yield a concordant U–Pb age of 91.6 ± 0.5 Ma. The garnet core and rim, and zircon ages are compatible with single-stage garnet growth during and/or after pluton emplacement. All garnet core–whole rock and garnet rim-matrix data from the two samples constrain garnet growth duration to ≤5.5 my. A garnet mid-point and the associated matrix from one of the two garnet crystals yield an age of 90.0 ± 1.0 Ma. This mid-point result is logically younger than the 90.7 ± 5.6 Ma core–whole rock age and older than the 88.4 ± 2.5 Ma rim-matrix age for this sample. A MnNaCaKFMASH phase diagram (P–T pseudosection) and the garnet core composition are used to predict that cores of garnet crystals grew at 610 ± 20 °C and 5 ± 1 kbar. This exceeds the temperature of the garnet-in reaction by c. 50 °C and is compatible with overstepping of the garnet growth reaction during contact metamorphism. Intersection of three reactions involving garnet-biotite-sillimanite-plagioclase-quartz calculated by THERMOCALC in average P–T mode, and exchange thermobarometry were used to estimate peak metamorphic conditions of 678 ± 58 °C at 6.1 ± 0.9 kbar and 685 ± 50 °C at 6.3 ± 1 kbar, respectively. Integration of pressure, temperature, and age estimates yields a pressure-temperature-time path compatible with near isobaric garnet... [ABSTRACT FROM AUTHOR]

Focuses on the significance of the transfer of development rights (TDR) to the preservation of traditional values and landscapes in several communities in New Mexico. Details of the TDR program in La Cienega; Identification of landscapes to preserve; Factors to consider in landscape zoning.

The incidence of human Campylobacter jejuni and C. coli infections has increased markedly in many parts of the world in the last decade as has the number of quinolone-resistant and, to a lesser extent, macrolide-resistant Campylobacter strains causing infections. We review macrolide and quinolone resistance in Campylobacter and track resistance trends in human clinical isolates in relation to use of these agents in food animals. Susceptibility data suggest that erythromycin and other macrolides should remain the drugs of choice in most regions, with systematic surveillance and control measures maintained, but fluoroquinolones may now be of limited use in the empiric treatment of Campylobacter infections in many regions. [ABSTRACT FROM AUTHOR]

Context: In the mid-1980s, states expanded their initiatives of scholarships, loan repayment programs, and similar incentives to recruit primary care practitioners into underserved areas. With no national coordination or mandate to publicize these efforts, little is known about these state programs and their recent growth.Objectives: To identify and describe state programs that provide financial support to physicians and midlevel practitioners in exchange for a period of service in underserved areas, and to begin to assess the magnitude of the contributions of these programs to the US health care safety net.Design: Cross-sectional, descriptive study of data collected by telephone, mail questionnaires, and through other available documents, (eg, program brochures, Web sites).Setting and Participants: All state programs operating in 1996 that provided financial support in exchange for service in defined underserved areas to student, resident, and practicing physicians; nurse practitioners; physician assistants; and nurse midwives. We excluded local community initiatives and programs that received federal support, including that from the National Health Service Corps.Main Outcome Measures: Number and types of state support-for-service programs in 1996; trends in program types and numbers since 1990; distribution of programs across states; numbers of participating physicians and other practitioners in 1996; numbers in state programs relative to federal programs; and basic features of state programs.Results: In 1996, there were 82 eligible programs operating in 41 states, including 29 loan repayment programs, 29 scholarship programs, 11 loan programs, 8 direct financial incentive programs, and 5 resident support programs. Programs more than doubled in number between 1990 (n = 39) and 1996 (n = 82). In 1996, an estimated 1306 physicians and 370 midlevel practitioners were serving obligations to these state programs, a number comparable with those in federal programs. Common features of state programs were a mission to influence the distribution of the health care workforce within their states' borders, an emphasis on primary care, and reliance on annual state appropriations and other public funding mechanisms.Conclusions: In 1996, states fielded an obligated primary care workforce comparable in size to the better-known federal programs. These state programs constitute a major portion of the US health care safety net, and their activities should be monitored, coordinated, and evaluated. State programs should not be omitted from listings of safety-net initiatives or overlooked in future plans to further improve health care access. JAMA. 2000;284:2084-2092. [ABSTRACT FROM AUTHOR]

Focuses on students who have left the public schools in Rockford, Illinois, in their search for educational equity. Implementation of the controlled choice desegregation plan; Mechanics of controlled choice; Dissatisfaction with education quality evident among parents; Reasons for leaving.

Examines the implementation of Controlled Choice student assignment plan in Rockford School District in Rockford, Illinois. Subdivision of elementary schools into three attendance zones; Establishment of Parent Information Center; Services offered in the Parent Information Center; Parents' priorities in school selection.

Particulate exposures were assessed among construction workers engaged in hot processes in four jobs (boilermakers, ironworkers, pipefitters and welder-fitters) at nine sites in the U.S. After being trained by occupational hygienists, the workers obtained shift-long personal samples at each site for total particulates (TP). Selected samples were also assayed for manganese (Mn), nickel (Ni), and chromium (Cr). Workers provided information about process- and task-related covariates that were present on the days of monitoring. Data were investigated with mixed-model regression analyses that designated the jobs and covariates as fixed effects and the worker and error terms as random effects. Results indicated that the within-worker variance components, but not the between-worker variance components, could be pooled among jobs. Mean air levels for a given agent varied by roughly six to 100 fold among the jobs, with boilermakers and ironworkers experiencing much higher levels of TP and Mn than pipefitters and welder-fitters. Limited data also suggested that welder-fitters were exposed to greater levels of Ni and Cr than pipefitters. Sufficient sample sizes were available to evaluate the effects of covariates upon exposures to TP and Mn. As expected, processes involving more than 50% hot work led to substantially higher levels of TP and Mn than those involving shorter durations of hot work. Local-exhaust or mechanical ventilation reduced exposure to TP (but not Mn) by as much as 44%, and shielded or manual arc welding increased exposure to Mn (but not TP) by about 80%. Parameters estimated with these mixed models were used to calculate probabilities that workers were exposed at levels above U.S. occupational exposure limits (OELs). Regarding TP and Mn, these calculations suggested that 26–95% of exposures to boilermakers and pipefitters and 2–13% of exposures to pipefitters and welder-fitters exceeded the current Threshold Limit Values. Among welder-fitters, limited data also pointed to probabilities of 2–50% for exceeding particular OELs for Ni and Cr. Using the significance of the estimated random-worker effects as a gauge for the uniformity of exposure within a job, administrative or engineering changes appear appropriate for reducing exposures to boilermakers and ironworkers, while individual personal environments should be investigated for pipefitters and welder-fitters. [ABSTRACT FROM PUBLISHER]

Effective discharge planning should serve to reduce length of stay (LOS) and lower readmission rates. A com bined prospective/retrospective study was undertaken to assess the effectiveness of anticipated discharge order forms in decreasing LOS for staff pediatric patients. Resident physicians provided advance notice of the planned discharge date to nursing staff and patient fam ily members. Patient selection was random, and the data were collected prospectively. These subjects were matched with patients for whom the order form was not used, and the data was collected retrospectively. Matching variables included: diagnosis, age, gender, race, and method of payment. There were 103 matched pairs. LOS was collapsed into low and high categories. There was a significant difference when comparing subject groups (χ2 = 8.5; P = 0.005). Whereas only 14% of experimental patients were categorized as high LOS, 32% of control patients were classified as such. Physician prediction of discharge date helped decrease patient LOS. [ABSTRACT FROM PUBLISHER]

The article reports that racial minorities, poor, the less educated and the young are groups least likely to be registered and most likely to be under-represented in voting in Chicago, Illinois. An analysis prepared for the Chicago Urban League by social scientist specifies areas in need of expanded registration efforts, the type of problems likely to be encountered, and the mobilizing tactics most likely to be successful.

This study introduces a social indicator of access to medical care--the symptoms-response ratio-- that reflects the difference between the number of visits in response to symptoms that actually occur and the number that a panel of physicians indicate is appropriate for these same symptoms. Findings on the index fro a national sample of the United States population affirm differentials in access that are generally thought to exist in terms of other access indicators (conventional use measures, insurance coverage, etc.). Nonwhites, rural farm people, the poor, and those who have no usual place to go for medical care were found to have less access to care than would be judged appropriate, based on the symptoms-response index. The index also suggests possible "over-utilization" among certain groups such as children and people who see specialists as their regular source of care. [ABSTRACT FROM AUTHOR]

Focuses on the Data Envelopment Analysis, the best-practice analysis of a sample of various natural gas distribution companies in the U.S. Operational dimension of the American Gas Association; Result of the benchmarking effort of the association; Recommendation for change; Adjustment to competitive market positions.

Focuses on discovering how consumers in the United States perceive nutritional labels on food products. Objectives of the research; Information on the perception, understanding and use of labels in 1972; Effect of varying levels of promotional activity.

During the summers of 1980 and 1981 Campylobacter jejuni was isolated from 23% and Giardia lamblia was isolated from 8% of persons with diarrheal disease acquired in the area of Grand Teton National Park, Wyoming. Campylobacter enteritis occurred most frequently in young adults who had been hiking in wilderness areas and was significantly associated with drinking untreated surface water in the week before illness (p less than 0.02 in 1980; p less than 0.005 in 1981). Penner serotype 4 was the commonest serotype isolated from humans and the only serotype isolated from an implicated mountain stream. These studies show that backcountry surface water can be an important source of C. jejuni and that infection with Campylobacter, as well as G. lamblia, should be considered as a cause of diarrhea in those who have recently returned from wilderness areas. [ABSTRACT FROM AUTHOR]

Highlights the sixth international automated cartography symposium in Ottawa, Ontario. Theme of the symposium; Number of registrants attended from different countries; Organization of the symposium by a steering committee chaired by D. R. F. Taylor of Carleton University.

Focuses on the proposed reduction of provisions for end-of-life care as a means for decreasing health care expenditures. Role of the preferences of patients and their families; Difficulties in judging the value of end-of-life care in individual cases; Role of health insurance in providing payment for end-of-life care.

Objectives: Approximately 70% of the military personnel experience chronic sleep insufficiency, which negatively impacts military readiness and health. Military sleep health does not appear to be improving despite targeted programs to optimize sleep. The present quasi-experimental study aims to evaluate a single-session sleep intervention in United States Air Force (USAF) Technical Training., Method: A group-based Brief Sleep Intervention (BSI) was developed for the target population. Participants included 321 technical school students (Mean age = 21; 82% male; 67% White) who were assigned to the BSI ( n  = 203) or a control group ( n  = 118). Propensity-score-weighted multivariable logistic regression was employed to compare outcomes., Results: At the 2-week follow-up, students in the BSI were significantly more likely to report sleeping 6 or more hours on weekdays (OR = 1.49, p  < .001) and "Good/Very Good" sleep quality (OR = 1.50, p  = .032) than those in the control group. In addition, 69.2% of the students in BSI reported having engaged in the self-selected "Action Step" chosen during the intervention., Conclusions: To our knowledge, this is the first study to test a preventative sleep intervention in USAF Technical Training. Results suggest that a single-session group intervention can promote behavioral changes and improve sleep health.

Background: Lyme disease (LD), the most common vector-borne disease in the United States, typically presents with a localised erythema migrans rash (EM). Left untreated, infection can disseminate to cause severe heart, joint or nervous system manifestations. Summaries of LD surveillance data have been published previously but did not include the frequency, demographic or clinical characteristics of LD cases during pregnancy., Methods: We summarised confirmed and probable LD cases by pregnancy status as reported to the U.S. Centers for Disease Control and Prevention during 1992-2019. We defined an LD case during pregnancy as one with (1) female sex, (2) age 14-49 years and (3) positive pregnancy indication. We evaluated the frequency, seasonality, age distribution, race and ethnicity, geographic distribution and clinical manifestations of LD cases during pregnancy and cases among non-pregnant females. We compared proportions using chi-squared tests., Results: Among 698,876 reported LD cases, 112,002 (16%) were confirmed or probable cases among females aged 14-49 years; 32,301 (29%) were specifically reported as non-pregnant and 643 (0.6%) (568 confirmed and 75 probable cases) reported as pregnant. Illness onset peaked in June among LD cases during pregnancy, but in July for cases among non-pregnant females. A higher proportion of confirmed LD cases during pregnancy had only EM rash than did cases among non-pregnant females (66% vs. 60%, p = 0.019)., Conclusions: LD cases during pregnancy are rare. Compared to non-pregnant females, cases among pregnant females more commonly involve early clinical manifestations. These patterns could suggest earlier detection or more complete reporting of LD cases during pregnancy than their non-pregnant counterparts. Earlier detection could be due to frequent contact with healthcare or increased self-advocacy during pregnancy. Prompt antimicrobial treatment is critical for preventing severe disease and reducing risk of adverse pregnancy or birth outcomes., (Published 2024. This article is a U.S. Government work and is in the public domain in the USA.)

Rabies is one of the oldest viral diseases and it has been present on every continent except Antarctica. Within the U.S. human rabies cases are quite rare. In the eastern USA, raccoons are the main reservoir hosts and pet vaccination serves as an important barrier against human rabies exposure. In this paper, we develop a compartmental model for rabies transmission amongst raccoons and domestic pets. We find the disease-free equilibria, reproduction numbers for the raccoons and domestic pets. We also determine the vaccination coverage/rates, both for raccoons and pets, needed to achieve the elimination of rabies., Competing Interests: Declaration of competing interest There is no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Differences in tumor biology and genetic predisposition have been suggested as factors influencing overall survival and increased mortality in Black breast and ovarian cancer patients. Therefore, it is key to evaluate genetic susceptibilities in Afro-Caribbean patients because the black population in the US is not homogeneous. Identifying a high incidence of hereditary breast and ovarian cancer (HBOC) in Afro-Caribbean countries can lead to understanding the pattern of inherited traits in US-Caribbean immigrants and their subsequent generations. The paucity of projects studying the genetic landscape in these populations makes it difficult to design studies aimed at optimizing screening and prophylaxis strategies, which in turn, improve survival and mortality rates. This scoping review identifies and categorizes current research on the genetic paradigm of HBOC in the Afro-Caribbean population. We performed an evaluation of the evidence and generated a summary of findings according to preferred reporting items for systematic review and meta-analysis (PRISMA) Extension for Scoping Reviews guidelines. We included articles that assessed the incidence and prevalence of pathologic germline mutations and experience/barriers for genetic testing in Afro-Caribbean Countries and US-Caribbean patients. Our results highlight countries where genetic landscapes remain severely understudied and support recommending multigene testing in Caribbean-born patients. They highlight a need for further research on the genetic paradigm of HBOC in the Afro-Caribbean population to improve genetic testing/counseling and the subsequent adoption of early detection and risk reduction strategies.

During the past decade, US orthopedic residency graduates have become increasingly subspecialized presumably for decreased patient complications; however, no study has examined this clinical utility for foot and ankle (F&A) surgeries among different fellowship subspecialties. Data from American Board of Orthopaedic Surgery 1999 to 2016 Part II Board Certification Examinations were used to assess patients treated by F&A fellowship-trained, trauma fellowship-trained, and all other fellowship-trained orthopedic surgeons performing ankle fracture repair. Adverse events were compared by surgical complexity and fellowship status. Factors independently associated with surgical complications were identified using a binary multivariate logistic regression. A total of 45,031 F&A cases met inclusion criteria. From 1999 to 2016, the percentage of F&A procedures performed by F&A fellowship surgeons steadily increased. Surgical complications were significantly different between fellowship trainings (F&A, 7.23%; trauma, 6.65%; and other, 7.84%). This difference became more pronounced with more complicated fracture pattern. On multivariate regression, F&A fellowship training was associated with significantly decreased likelihood of surgeon-reported complications (odds ratio, 0.83; 95% CI, 0.76-0.92; P <.001), as was trauma fellowship training (odds ratio, 0.90; 95% CI, 0.81-0.99; P =.035). Despite presumed increased complexity of cases treated by F&A fellowship-trained surgeons, these patients had significantly decreased risk of surgeon-reported surgical complications, thus highlighting the value of F&A fellowship training. In the absence of vital patient comorbidity data in the American Board of Orthopaedic Surgery database, further research must examine specific patient comorbidities and case acuity and their influence on treatments and surgical complications between fellowship-trained and other orthopedic surgeons to further illuminate the value of subspecialty training. [ Orthopedics . 2023;46(4):e237-e243.].

Monitoring cancer incidence data by geography is useful for planning public health activities. However, due to anticipated confidentiality and statistical reliability issues, data on cancer incidence and mortality are more often displayed at a national, state, or county level, rather than at more local levels. To address this gap in displaying cancer data at the local level, the CDC's National Environmental Public Health Tracking Program and 21 National Program of Cancer Registries worked together on a pilot project to examine the feasibility of displaying sub-county-level incidence of selected cancer types diagnosed during 2007-2016. The results from this project are important steps for building sub-county cancer displays into data visualizations and using the data in a way that provides meaningful insights. The availability of sub-county cancer data may allow researchers to better examine cancer data at a local level which may help guide public health decisions regarding community-based interventions and screening services., Competing Interests: Declaration of Competing Interest The authors declare no potential conflicts of interest., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Breast cancer remains a leading cause of morbidity and mortality among women in the United States. Previous analyses show that breast cancer incidence increased from 1999 to 2018. The purpose of this article is to examine trends in breast cancer mortality., Methods: Analysis of 1999 to 2020 mortality data from the Centers for Disease Control and Prevention, National Center for Health Statistics, among women by race/ethnicity, age, and US Census region., Results: It was found that overall breast cancer mortality is decreasing but varies by race/ethnicity, age group, and US Census region. The largest decrease in mortality was observed among non-Hispanic White women, women aged 45 to 64 years of age, and women living in the Northeast; whereas the smallest decrease in mortality was observed among non-Hispanic Asian or Pacific Islander women, women aged 65 years or older, and women living in the South., Conclusion: This report provides national estimates of breast cancer mortality from 1999 to 2020 by race/ethnicity, age group, and US Census region. The decline in breast cancer mortality varies by demographic group. Disparities in breast cancer mortality have remained consistent over the past two decades. Using high-quality cancer surveillance data to estimate trends in breast cancer mortality may help health care professionals and public health prevention programs tailor screening and diagnostic interventions to address these disparities., (Published 2022. This article is a U.S. Government work and is in the public domain in the USA.)