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Using a coalescence–dispersion model of the continuous flow-stirred tank reactor (CSTR), we study the effect of premixed vs nonpremixed reactant flows on chemical bistability. The region of bistability is smaller for segregated feed streams than for a fully premixed feed stream. The transition from flow branch to thermodynamic branch is particularly sensitive to the feed stream configuration. [ABSTRACT FROM AUTHOR]

Background: We examined the association of multilevel social determinants of health with incident apparent treatment-resistant hypertension (aTRH)., Methods and Results: We analyzed data from 2774 White and 2257 Black US adults from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study taking antihypertensive medication without aTRH at baseline to estimate the association of social determinants of health with incident aTRH. Selection of social determinants of health was guided by the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment, and health care access. Blood pressure (BP) was measured during study visits, and antihypertensive medication classes were identified through a pill bottle review. Incident aTRH was defined as (1) systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg for those with diabetes or chronic kidney disease while taking ≥3 classes of antihypertensive medication or (2) taking ≥4 classes of antihypertensive medication regardless of BP level, at the follow-up visit. Over a median 9.5 years of follow-up, 15.9% of White and 24.0% of Black adults developed aTRH. A percent of the excess aTRH risk among Black versus White adults was mediated by low education (14.2%), low income (16.0%), not seeing a friend or relative in the past month (8.1%), not having someone to care for them if ill or disabled (7.6%), lack of health insurance (10.6%), living in a disadvantaged neighborhood (18.0%), and living in states with poor public health infrastructure (6.0%)., Conclusions: Part of the association between race and incident aTRH risk was mediated by social determinants of health.

Background: High rates of hypertension and poverty in the rural south contribute to health disparities with Black adults experiencing higher rates of cardiovascular disease than White adults, underscoring the need to identify prevention strategies., Methods: The equity in prevention and progression of hypertension by addressing barriers to nutrition and physical activity (EPIPHANY) study is a cluster randomized controlled trial testing a multilevel intervention to reduce barriers to a healthy lifestyle to lower blood pressure (BP) among rural, Black adults. Health education fairs offered to 20 churches in the Alabama Black Belt are being used to screen and enroll adults with elevated BP or stage 1 hypertension (systolic BP 120-139 mmHg and diastolic BP < 90 mmHg) who are not recommended for antihypertensive medication, according to the 2017 American College of Cardiology/American Heart Association BP guideline. Participants (n = 240) in churches randomized to the control condition are offered access to online resources including cooking and exercise classes. Participants (n = 240) in churches randomized to the intervention are receiving access to online resources; telephone-based peer support for lifestyle modification; funding for churches to develop programs to address food access and/or barriers to physical activity; and training of church members to serve as church champions to deliver training for church members on lifestyle modification. We will employ a Type 1 hybrid implementation-effectiveness design to assess effectiveness and implementation., Conclusions: The EPIPHANY study is designed to prevent hypertension among rural, Black adults by addressing structural and individual barriers to lifestyle modification through peer support., (© The Author(s) 2023. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: A high proportion of individuals with HIV have hypertension, and the incidence of cardiovascular disease (CVD) is high in individuals with HIV., Methods: We determined if the association between hypertension and CVD, including acute myocardial infarction (AMI), stroke, and heart failure, differs between individuals with and without HIV. We analyzed data for 108 980 adults with HIV matched (1:4) to 435 920 adults without HIV in 2011 to 2019 from the Marketscan database, which includes US adults with health insurance. The primary outcome, incident CVD, defined by an AMI, stroke or heart failure, was identified using validated claims-based algorithms., Results: Over a median follow-up of 2.3 years, there were 4027 CVD events, including 2345 AMI, 1153 stroke, and 684 heart failure events. After multivariable adjustment, the hazard ratio for CVD associated with hypertension was 1.56 (95% CI, 1.44-1.69) among individuals without HIV and 1.73 (95% CI, 1.52-1.96) among individuals with HIV ( P value for interaction=0.159). The multivariable-adjusted hazard ratio for AMI associated with hypertension was 1.35 (95% CI, 1.22-1.51) among individuals without HIV and 1.70 (95% CI, 1.44-2.01) among individuals with HIV ( P value for interaction=0.017). Hypertension was associated with stroke and heart failure among individuals without and with HIV with no evidence of effect modification ( P value for interaction >0.40)., Conclusions: Hypertension was associated with increased CVD, AMI, stroke, and heart failure risk among individuals with and without HIV, with a stronger association for AMI among individuals with versus without HIV. This study emphasizes the high CVD risk associated with hypertension among individuals with HIV.

Objectives: With an increasingly dynamic global illicit drug market, including the emergence of novel psychoactive substances, many jurisdictions have moved to establish toxicosurveillance systems to enable timely detection of harmful substances in the community. This paper describes the methodology for the Emerging Drugs Network of Australia - Victoria (EDNAV) project, a clinical registry focused on the collection of high-quality clinical and analytical data from ED presentations involving illicit drug intoxications. Drug intelligence collected from the project is utilised by local health authorities with the aim to identify patterns of drug use and emerging drugs of concern., Methods: The project involves 10 public hospital EDs in Victoria, Australia. Patients 16 years and over, presenting to a network ED with a suspected illicit drug-related toxicity and a requirement for venepuncture are eligible for inclusion in the study under a waiver of consent. Clinical and demographic parameters are documented by site-based clinicians and comprehensive toxicological analysis is conducted on patient blood samples via specialised forensic services. All data are then deidentified and compiled in a project specific database., Results: Cases are discussed in weekly multidisciplinary team meetings, with a view to identify potentially harmful substances circulating in the community. High-risk signals are escalated to key stakeholders to produce timely and proportionate public health alerts with a focus on harm minimisation., Conclusions: The EDNAV project represents the first centralised system providing near real-time monitoring of community drug use in Victoria and is fundamental in facilitating evidence-based public health intervention., (© 2022 Australasian College for Emergency Medicine.)

Lumbrifiltration (LF) has been promoted as a low-cost, low maintenance and efficient solution for domestic and municipal wastewater treatment especially. However, there have been limited studies investigating the optimal operating conditions and long-term performances of LF systems (especially in temperate climates). The key objectives of this study were to (i) to present an outcome of the operating conditions and associated performance of LF the systems studied in the literature regarding removal efficiencies for nutrients and organic matter (OM) in municipal and domestic wastewater (WW) treatment contexts, (ii) to generate long term and reliable results on the potential performances of LF systems for the treatment of real municipal WW (for both OM and nutrients), (iii) to optimize operational conditions such as active layer height, earthworms density, HLR and earthworms type, conditions for which it is still unclear from the current literature which are optimal, and (iv) to assess the performances of the LF in a "temperate climate" context. Overall, LF systems showed high removal efficiencies for organic matter and nutrients for all the operating conditions tested. The study also confirmed the positive impact of earthworms in achieving high level of nitrification of ammonium after a short start-up period. The system operation and performances were maintained without maintenance for the whole duration of the study (over 250 days), showing the potential for keeping high level of performances for long-term periods. Recommendations are given in relation to LF system design such as optimal active layer height and hydraulic loading rate. The study also demonstrated the applicability and potential of Dendrobaena veneta as an alternative to Eisenia fetida (the latter generally being used in previous studies but are less available in some areas of Europe) for application in municipal wastewater treatment by LF., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

COVID-19 has disproportionately affected persons who identify as non-Hispanic American Indian or Alaska Native (AI/AN) (1). The Blackfeet Tribal Reservation, the northern Montana home of the sovereign Blackfeet Nation, with an estimated population of 10,629 (2), detected the first COVID-19 case in the community on June 16, 2020. Following CDC guidance,* and with free testing widely available, the Indian Health Service and Blackfeet Tribal Health Department began investigating all confirmed cases and their contacts on June 25. The relationship between three community mitigation resolutions passed and enforced by the Blackfeet Tribal Business Council and changes in the daily COVID-19 incidence and in the distributions of new cases was assessed. After the September 28 issuance of a strictly enforced stay-at-home order and adoption of a mask use resolution, COVID-19 incidence in the Blackfeet Tribal Reservation decreased by a factor of 33 from its peak of 6.40 cases per 1,000 residents per day on October 5 to 0.19 on November 7. Other mitigation measures the Blackfeet Tribal Reservation used included closing the east gate of Glacier National Park for the summer tourism season, instituting remote learning for public school students throughout the fall semester, and providing a Thanksgiving meal to every household to reduce trips to grocery stores. CDC has recommended use of routine public health interventions for infectious diseases, including case investigation with prompt isolation, contact tracing, and immediate quarantine after exposure to prevent and control transmission of SARS-CoV-2, the virus that causes COVID-19 (3). Stay-at-home orders, physical distancing, and mask wearing indoors, outdoors when physical distancing is not possible, or when in close contact with infected or exposed persons are also recommended as nonpharmaceutical community mitigation measures (3,4). Implementation and strict enforcement of stay-at-home orders and a mask use mandate likely helped reduce the spread of COVID-19 in the Blackfeet Tribal Reservation., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Objective: To determine the frequency of finger thoracostomy performed by intensive care flight paramedics after the introduction of a training programme in this procedure and complications of the procedure that were diagnosed after hospital arrival., Methods: This was a retrospective cohort study of adult and paediatric trauma patients undergoing finger thoracostomy performed by paramedics on a helicopter emergency medical service between June 2015 and May 2018. Hospital data were obtained through a manual search of the medical records at each of the three receiving major trauma services. Additional data were sourced from the Victorian State Trauma Registry., Results: The final analysis included 103 cases, of which 73.8% underwent bilateral procedures with a total of 179 finger thoracostomies performed. The mean age of patients was 42.8 (standard deviation 21.4) years and 73.8% were male. Motor vehicle collision was the most common mechanism of injury accounting for 54.4% of cases. The median Injury Severity Score was 41 (interquartile range 29-54). There were 30 patients who died pre-hospital, with most (n = 25) having finger thoracostomy performed in the setting of a traumatic cardiac arrest. A supine chest X-ray was performed prior to intercostal catheter insertion in 38 of 73 patients arriving at hospital; of these, none demonstrated a tension pneumothorax. There were three cases of potential complications related to the finger thoracostomy., Conclusion: Finger thoracostomy was frequently performed by intensive care flight paramedics. It was associated with a low rate of major complications and given the deficiencies of needle thoracostomy, should be the preferred approach for chest decompression., (© 2020 Australasian College for Emergency Medicine.)

Introduction: The best strategy to increase awareness of and access to living kidney donation remains unknown. To build upon the existing strategies, we developed the Living Donor Navigator program, combining advocacy training of patient advocates with enhanced health-care systems training of patient navigators to address potential living donor concerns during the evaluation process. Herein, we describe a systematic assessment of the delivery and content of the program through focus group discussion., Methods: We conducted focus groups with 9 advocate participants in the Living Donor Navigator program to identify knowledge, skills, and abilities needed for both advocates and navigators. We focused on 2 organizational levels: (1) the participant level or the advocacy training of the advocates and (2) the programmatic level or the support role provided by the navigators and administration of the program., Findings: From 4 common themes (communication, education, support, and commitment), we identified several core competencies and promising practices, at both the participant and programmatic levels. These themes highlighted the potential for several improvements of program content and delivery, the importance of cultural sensitivity among the Living Donor navigators, and the opportunity for informal caregiver support and accountability provided by the program., Discussion: These competencies and promising practices represent actionable strategies for content refinement, optimal training of advocates, and engagement of potential living donors through the Living Donor Navigator program. These findings may also assist with program implementation at other transplant centers in the future.

Background: To date, no living donation program has simultaneously addressed the needs of both transplant candidates and living donors by separating the advocacy role from the candidate and improving potential donor comfort with the evaluation process. We hypothesized that the development of a novel program designed to promote both advocacy and systems training among transplant candidates and their potential living kidney donors would result in sustained increases in living-donor kidney transplantation (LDKT). To this end, we developed and implemented a Living Donor Navigator (LDN) Program at the University of Alabama at Birmingham., Methods: We included adult patients awaiting kidney-only transplant in a retrospective cohort analysis. Using time-varying Cox proportional hazards regression, we explored likelihood of living donor screening and approval by participation in the LDN program., Results: There were 56 LDN participants and 1948 nonparticipants (standard of care). LDN was associated with a 9-fold increased likelihood of living donor screenings (adjusted hazard ratio, 9.27; 95% confidence interval, 5.97-14.41, P < 0.001) and a 7-fold increased likelihood of having an approved living donor (adjusted hazard ratio, 7.74; 95% confidence interval, 3.54-16.93; P < 0.001) compared with the standard of care. Analyses by participant race demonstrated higher likelihood of screened donors and a similar likelihood of having an approved donor among African Americans compared with Caucasians., Conclusions: These data suggest that both advocacy and systems training are needed to increase actual LDKT rates, and that LDN programs may mitigate existing racial disparities in access to LDKT.

•Engaged Empowerment Town Halls promote self-actualization through collective agency.•Optimal collective agency may promote participation in clinical trials.•Distrust in institutions may correlate with participation in research studies.

Determination of the sludge volume index is key to describing the settling characteristics of sludge in the aeration process of wastewater treatment plants (WWTPs). The two core components of this calculation are the settled sludge volume (SSV) and suspended solids. While the measurement procedure for SSV is generally defined by national or international standards, in practice a wide variety of vessel sizes and shapes are used by operators to monitor WWTP performance. Furthermore, differences in how these tests are carried out can lead to poor data, inefficient WWTP operation and a lack of comparable metrics for WWTP operational monitoring. Thus, there is a requirement to improve operational performance of WWTPs to meet the increasingly stringent legislation regarding discharge limits. The aim of this study was to utilise a novel image-processing system (AutoSSV) to (i) determine its efficacy in describing SSV and (ii) measure and compare different methodologies for measurement of SSV. The AutoSSV system was tested using samples from various WWTPs and the results compared to those determined by standard manual measurement. Both standard and modified settlement tests were conducted on 30 mixed liquor samples, with modified settlement tests consistently resulting in lower SSV measurements. Results from the study showed a strong correlation between the SSV measurements provided by the AutoSSV system and results obtained from current manual measurement methods. The proposed technique would help to standardise the measurement in practice and increase the frequency of monitoring, particularly in small-scale rural WWTPs where there may not be permanent operators on site, and thus provide sufficient performance monitoring for efficient and effective operation.

Wastewater treatment facilities are continually challenged to meet both environmental regulations and reduce running costs (particularly energy and staffing costs). Improving the efficiency of operational monitoring at wastewater treatment plants (WWTPs) requires the development and implementation of appropriate performance metrics; particularly those that are easily measured, strongly correlate to WWTP performance, and can be easily automated, with a minimal amount of maintenance or intervention by human operators. Turbidity is the measure of the relative clarity of a fluid. It is an expression of the optical property that causes light to be scattered and absorbed by fine particles in suspension (rather than transmitted with no change in direction or flux level through a fluid sample). In wastewater treatment, turbidity is often used as an indicator of effluent quality, rather than an absolute performance metric, although correlations have been found between turbidity and suspended solids. Existing laboratory-based methods to measure turbidity for WWTPs, while relatively simple, require human intervention and are labour intensive. Automated systems for on-site measuring of wastewater effluent turbidity are not commonly used, while those present are largely based on submerged sensors that require regular cleaning and calibration due to fouling from particulate matter in fluids. This paper presents a novel, automated system for estimating fluid turbidity. Effluent samples are imaged such that the light absorption characteristic is highlighted as a function of fluid depth, and computer vision processing techniques are used to quantify this characteristic. Results from the proposed system were compared with results from established laboratory-based methods and were found to be comparable. Tests were conducted using both synthetic dairy wastewater and effluent from multiple WWTPs, both municipal and industrial. This system has an advantage over current methods as it provides a multipoint analysis that can be easily repeated for large volumes of wastewater effluent. Although the system was specifically designed and tested for wastewater treatment applications, it could have applications such as in drinking water treatment, and in other areas where fluid turbidity is an important measurement.

The current study assesses the intercoder reliability of one of the most important skin tone measurement instruments-the Massey-Martin scale. This scale is used in several high-profile social surveys, but has not yet been psychometrically evaluated. The current evaluation is only possible because, for the first time, the General Social Survey's 2010-2014 panel used the instrument to guide interviewers' skin tone observation of the same respondents in two different years (2012 and 2014). Despite the widespread use of the Massey-Martin scale to investigate potential effects of skin tone on social attitudes and outcomes, the data suggest that the measure has low intercoder reliability. Implications for researchers and survey practitioners are discussed.

Using a community-engaged participatory research approach, this study identified surrounding community residents' expectations for how a HOPE VI housing initiative might affect their community and individual health and physical activity. Fifty-nine women and men engaged in concept mapping, which is a mixed methods approach, where participants generate, sort, and rate ideas. Participants generated 197 unique statements. Thirteen thematic clusters related to expected changes for the community, health and physical activity emerged. Residents' rated 'Increased Pride in the Neighborhood' and 'Increased Safety' as the most important factors related to HOPE VI whereas 'Drawbacks of HOPE VI' was rated as least important. This research provides insight into the potential impacts of housing initiatives from the perspective of those most affected by such initiatives. The findings also highlight environmental changes as potential mechanisms that may improve residents' perceptions of the community and encourage healthy lifestyles.

Objectives: This study uses a mixed methods approach to 1) identify surrounding residents' perceived expectations for Housing Opportunities for People Everywhere (HOPE VI) policy on physical activity outcomes and to 2) quantitatively examine the odds of neighborhood-based physical activity pre-/post-HOPE VI in a low socioeconomic status, predominantly African American community in Birmingham, Alabama., Methods: To address aim one, we used group concept mapping which is a structured approach for data collection and analyses that produces pictures/maps of ideas. Fifty-eight residents developed statements about potential influences of HOPE VI on neighborhood-based physical activity. In the quantitative study, we examined whether these potential influences increased the odds of neighborhood walking/jogging. We computed block entry logistic regression models with a larger cohort of residents at baseline (n = 184) and six-months (n = 142, 77% retention; n = 120 for all informative variables). We examined perceived neighborhood disorder (perceived neighborhood disorder scale), walkability and aesthetics (Neighborhood Environment Walkability Scale) and HOPE VI-related community safety and safety for physical activity as predictors., Results: During concept mapping, residents generated statements that clustered into three distinct concepts, "Increased Leisure Physical Activity," "Safe Play Areas," and "Generating Health Promoting Resources." The quantitative analyses indicated that changes in neighborhood walkability increased the odds of neighborhood-based physical activity (p = 0.04). When HOPE VI-related safety for physical activity was entered into the model, it was associated with increased odds of physical activity (p = 0.04). Walkability was no longer statistically significant., Conclusions: These results suggest that housing policies that create walkable neighborhoods and that improve perceptions of safety for physical activity may increase neighborhood-based physical activity. However, the longer term impacts of neighborhood-level policies on physical activity require more longitudinal evidence to determine whether increased participation in physical activity is sustained., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The relationship between unemployment and suicide has changed over time and in particular during the Great Recession. Using state-level panel data covering the years 1979-2010, the study indicates that unemployment's impact was insignificant during the first half of the sample period, but was highly significant during the second half. In addition, while the impact has generally become stronger over recent decades, it fell during the Great Recession although remained significant. Evidence suggesting that increased economic insecurity helps explain the growing sensitivity over time is offered. The models fit the data well, explaining up to 90% of the variation in state suicide rates., (© 2014 The American Association of Suicidology.)

This study examines the association of neighborhood environment, as measured by housing factors, with physical activity among older African Americans. Context is provided on the effects of structural inequality as an inhibitor of health enhancing neighborhood environments. The study population included African Americans participating in the UAB Study of Aging (n=433). Participants demonstrated the ability to walk during a baseline in-home assessment. The strength and independence of housing factors were assessed using neighborhood walking for exercise as the outcome variable. Sociodemographic data, co-morbid medical conditions, and rural/urban residence were included as independent control factors. Homeownership, occupancy, and length of residency maintained positive associations with neighborhood walking independent of control factors. Housing factors appear to be predictive of resident engagement in neighborhood walking. Housing factors, specifically high rates of homeownership, reflect functional and positive neighborhood environments conducive for physical activity. Future interventions seeking to promote health-enhancing behavior should focus on developing housing and built-environment assets within the neighborhood environment.

Objective: To examine associations between the built environment and leisure-time physical activity (LTPA) among African Americans and Whites., Method: Independent and control variables were produced from the literature and theory to represent key components of built environment, sense of community, sociodemographic, and health status characteristics. Logistic regression analysis and descriptive statistics were used to measures correlative relationships with physical activity., Results: Built environment elements, especially homeownership, were associated with LTPA, particularly among older African American rural residents., Discussion: Recommendations include transferring the concept of community ownership to residents living in areas where rates of physical activity are low.

Objectives: To describe how nominal group technique (NGT) was used to inform the development of a sexual health education program for black high school youth in the South., Methods: NGT was used with a community advisory board (CAB) to obtain information regarding the key components of a sexual health program for youth in their community., Results: The CAB identified 5 priorities to include in the program: sex education, "keeping it real," responsibility/consequences, self-esteem, and female aggressiveness., Conclusions: Findings can be useful in modeling the successful use of NGT as a formative step toward developing health education programs for minority youth.

This paper examines whether children of marginalized racial/ethnic groups have an awareness of race at earlier ages than youth from non-marginalized groups, documents their experiences with racial discrimination, and utilizes a modified racism-related stress model to explore the relationship between perceived racial discrimination and self-esteem. Data were collected for non-Hispanic black, non-Hispanic white, and Hispanic children aged 7 - 12 using face-to-face interviews (n = 175). The concept of race was measured by assessing whether children could define race, if not a standard definition was provided. Racial discrimination was measured using the Williams Every-day-Discrimination Scale, self-esteem was measured using the Rosenberg Scale, and ethnic identity was assessed using the Multi-group Ethnic Identity Measure. Non-Hispanic black children were able to define race more accurately, but overall, Hispanic children encountered more racial discrimination, with frequent reports of ethnic slurs. Additionally, after accounting for ethnic identity, perceived racial discrimination remained a salient stressor that contributed to low self-esteem.

Background: African Amercians afflicted with head and neck squamous cell carcinoma (HNSCC) have a strikingly worse survival than do whites. One apparent cause is an advanced stage of presentation in African Americans. This study was designed to identify barriers to early treatment among African American men., Methods: Twenty-four African American male HNSCC survivors completed structured interviews. Interviewers elicited the participants' experiences from symptom recognition to receiving definitive care., Results: Most participants were seen with advanced-stage HNSCC. Overall, 10% experienced barriers to obtaining early medical care, though 30% were hesitant to seek care due to perceived barriers. Definitive treatment began for 81% within 3 months of initial care seeking., Conclusion: Once participants sought care, most of them received definitive treatment within a reasonable time frame. To explain the advanced stage at presentation, either tumor growth rate was extremely rapid or participants sought care when the tumor was quite advanced. The themes suggested by this elicitation study require further validation.