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Background Lingering symptoms have been reported by survivors of Ebola virus disease (EVD). There are few data describing the persistence and severity of these symptoms over time. Methods Symptoms of headache, fatigue, joint pain, muscle pain, hearing loss, visual loss, numbness of hands or feet were longitudinally assessed among participants in the Liberian Ebola Survivors Cohort study. Generalized linear mixed effects models, adjusted for sex and age, were used to calculate the odds of reporting a symptom and it being rated as highly interfering with life. Results From June 2015 to June 2016, 326 survivors were enrolled a median of 389 days (range 51–614) from acute EVD. At baseline 75.2% reported at least 1 symptom; 85.8% were highly interfering with life. Over a median follow-up of 5.9 years, reporting of any symptom declined (odds ratio for each 90 days of follow-up = 0.96, 95% confidence interval [CI]: .95, .97; P < .0001) with all symptoms declining except for numbness of hands or feet. Rating of any symptom as highly interfering decreased over time. Among 311 with 5 years of follow-up, 52% (n = 161) reported a symptom and 29% (n = 47) of these as highly interfering with their lives. Conclusions Major post-EVD symptoms are common early during convalescence and decline over time along with severity. However, even 5 years after acute infection, a majority continue to have symptoms and, for many, these continue to greatly impact their lives. These findings call for investigations to identify the mechanisms of post-EVD sequelae and therapeutic interventions to benefit the thousands of effected EVD survivors.

Critical airway incidents are a major cause of morbidity and mortality during anesthesia. Delayed management of airway obstruction quickly leads to severe complications due to the reduced apnea tolerance in infants and neonates. The decision of whether to intubate the trachea during anesthesia is therefore of great importance, particularly as an increasing number of procedures are performed outside of the operating room.In this retrospective cohort study, we evaluated airway management for infants below 6 months of age undergoing percutaneous endoscopic gastrostomy insertion. We compared demographic, procedural, and health outcome-related data for infants undergoing percutaneous endoscopic gastrostomy insertion under general endotracheal anesthesia (n = 105) to those receiving monitored anesthesia care (n = 44) without endotracheal intubation.A retrospective chart review was completed for all infants6 months of age who underwent percutaneous endoscopic gastrostomy insertion in our institution's endoscopy suite between January 2002 and January 2017. Descriptive statistics summarized numeric variables using medians and corresponding ranges (minimum-maximum), and categorical variables using frequencies and percentages. Differences in study outcomes between patients undergoing general anesthesia or monitored anesthesia care were evaluated with univariate quantile or Firth logistic regression for numerical and categorical outcomes, respectively. Results are presented as β [95% confidence interval] or odds ratio [95% confidence interval] along with corresponding p-values.Both groups were similar in distribution of age, race, and gender. However, patients selected for general anesthesia had lower median body weights (3.9 kg [range: 2.0-6.7] vs. 4.4 kg [range: 2.6-6.9]), higher percentages of cardiac (95.2% vs. 84.1%), and/or neurologic comorbidities (74.3% vs. 56.8%) and were more frequently given American Society of Anesthesiologists level IV classifications (41.9% vs. 29.6%) indicating that these infants may have had more severe disease than patients selected for monitored anesthesia care. Three monitored-anesthesia-care patients required intraoperative conversion to general anesthesia. General anesthesia patients experienced greater odds of intraoperative hypoxemia (45.2% vs. 29.0%; odds ratio: 2.0 [0.9-4.3], p-value: .09) and required postoperative airway intervention more frequently than monitored-anesthesia-care patients (13.03% vs. 2.3%; odds ratio: 4.6 [0.8-25.6], p-value: .08). Procedure times were identical in both groups (6 min), but general anesthesia resulted in longer median anesthesia times (44 min [range: 22-292] vs. 12 min [range:19-136]; β:13 [95% 6.9-19.1], p-value: .001).Study results suggest that providers selected general anesthesia over monitored anesthesia care for infants and neonates with low body weights, cardiac comorbidities, and neurologic comorbidities. Increased rates of airway intervention, and increased length of stay may be at least partially related to more severe patient comorbidity, as indicated by higher American Society of Anesthesiologists classifications. However, due to the exploratory nature of these analyses, further confirmatory studies are needed to evaluate the impact of airway selection during PEG on postoperative patient outcomes.

Introduction: Vaccination against COVID-19 is an effective strategy to curb the burden of COVID-19, but vaccine acceptance and uptake among African healthcare workers (HCWs) remain low. This study investigated the determinants of COVID-19 vaccine hesitancy among HCWs in Cameroon and Nigeria. Methods: We conducted an analytic cross-sectional study from May to June 2021, including consenting HCWs > 18 years identified using snowball sampling. Vaccine hesitancy was defined as indecisiveness or unwillingness to receive the COVID-19 vaccine. Multilevel logistic regression yielded adjusted odds ratios (aOR) for vaccine hesitancy. Results: We included a total of 598 (~60% women) participants. Vaccine hesitancy was estimated at 56.9% and 42.4% in Cameroon and Nigeria. Little or no trust in the approved COVID-19 vaccines (aOR= 2.28, 95% CI=1.24-4.20), lower perception of the importance of the vaccine on their personal health (5.26, 2.38-11.6), greater concerns about vaccine-related adverse effects (3.45, 1.83-6.47), and uncertainty about colleagues’ acceptability of the vaccine (2.98, 1.62-5.48) were associated with higher odds of vaccine hesitancy. In addition, participants with chronic disease (aOR= 0.34, 95% CI=0.12-0.97) and higher levels of concerns about getting COVID-19 (0.40, 0.18-0.87) were less likely to be hesitant to receive the COVID-19 vaccine. Conclusion: COVID-19 vaccine hesitancy among HCWs in this study was high and was determined, broadly, by the perceived risk of COVID-19 and COVID-19 vaccines on personal health, mistrust in COVID-19 vaccines, and uncertainty about colleagues’ vaccine acceptability. Targeted interventions addressing these concerns are warranted to improve COVID-19 uptake among HCWs in these settings.

Infective endocarditis of the tricuspid valve is rare in non-intra-venous drug abusers. Few cases of psoas abscess complicated by tricuspid infective endocarditis have been reported. A 61-year-old man underwent a laminectomy. Three weeks later he developed persistent fever, abdominal pain, back pain and hip pain, weight loss, gradually and abdominal distension. Abdomino-thoracic computed tomographic scan showed a left psoas muscle abscess and cavitary pulmonary lesions suggestive of septic pulmonary emboli. Two dimensional transthoracic echocardiography showed an oscillating mass on the anterior leaflet of the tricuspid valve compatible with a vegetation. There was severe tricuspid regurgitation with right atrial and right ventricular dilatation. Secondary psoas abscess though rare is an important cause of bacteremia and there is a potential of bacteremia progressing to serious systemic infection like tricuspid endocarditis which can be fatal without prompt and appropriate treatment.

Background: Perforations are major complications of peptic ulcer disease and surgical emergencies with important mortality and morbidity. Helicobacter pylori (H. pylori) has been identified as one of the commonest factors associated with peptic ulcer disease. However, little is known about its implication in cases of perforations in Cameroon. We aimed to determine the frequency of Helicobacter pylori infections in cases of perforated peptic ulcers, describe clinical features and outcomes of these cases in Cameroon. Method: A hospital-based retrospective cross-sectional study was conducted through the review of patients’ records admitted for peptic ulcer perforations in Laquintinie and Douala General Hospitals over a period of 5 years (January 2014 - December 2018). We defined H. pylori infection as; positive result on tissue biopsy at time of surgery. We used SPSS version 23.0 to analyse data and set an alpha value at P = 0.05. Results: We reviewed 115 cases of peptic ulcer perforation, with a mean age of 40 years and sex ratio (M:F) of 5:1. All patients underwent emergency laparotomy, 48 (41%) cases had a biopsy report and the prevalence of H. pylori infection in these cases was 47.9 %. Smoking, alcohol consumption and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) use, were not associated with peptic ulcer perforation. The morbidity was at 43.7% and mortality at 14%. Mortality was increasing with a higher Mannheim Peritonitis Index score (OR: 23.51, 95% CI: 4.197 - 143.003, P-value: 0.000). Conclusion: We observed a high prevalence of H. pylori infection in patients with peptic ulcer perforations. We recommend systematic H. pylori screening in cases of perforations and that larger studies should be carried out to evaluate the association of H. pylori infection with peptic ulcer perforation in Sub-Saharan Africa.

Background and ObjectivesMissense variants of the valosin-containing protein (VCP) gene cause a progressive, autosomal dominant disease termed VCP multisystem proteinopathy (MSP1). The disease is a constellation of clinical features including inclusion body myopathy (IBM), Paget disease of bone (PDB), frontotemporal dementia (FTD), and amyotrophic lateral sclerosis (ALS), typically reported at a frequency of 90%, 42%, 30%, and 9%, respectively. The Hispanic population is currently underrepresented in previous reports of VCP myopathy. We expand our genotype-phenotype studies in 5 Hispanic families with the c.476G>A, p.R159HVCPvariant.MethodsWe report detailed clinical findings of 11 patients in 5 Hispanic families with the c.476G > A, p.R159HVCPvariant. In addition, we report frequencies of the main manifestations in 28 additional affected members of the extended family members. We also compared our findings with an existing larger cohort of patients with VCP MSP1.ResultsFTD was the most prevalent feature reported, particularly frequent in females. PDB was only seen in 1 patient in contrast to the earlier reported cohorts. The overall frequency of the different manifestations: myopathy, PDB, FTD, and ALS in these 5 families was 39%, 3%, 72%, and 8%, respectively. The atypical phenotype and later onset of manifestations in these families resulted in a noticeable delay in the diagnosis of VCP disease.DiscussionStudying eachVCPvariant in the context of ethnic backgrounds is pivotal in increasing awareness of the variability of VCP-related diseases across different ethnicities, enabling early diagnosis, and understanding the mechanism for these genotype-phenotype variations.

Despite major setbacks to its health infrastructure and health workforce capacity, Liberia began its first post-graduate training program for physicians in 2013. Specialty training in Internal Medicine, Pediatrics, General Surgery and Obstetrics and Gynecology were the four inaugural Residency programs that recruited graduates from the country's only medical school, A.M. Dogliotti College of Medicine. The Obstetrics and Gynecology residency program was designed to combat the rising maternal mortality and strengthen health systems to improve maternal care. The program adapted in the face of challenges posed by limited financial support, lack of specialist-faculty and general physician shortages and the Ebola virus outbreak. The manuscript discusses the challenges and successes of the program and demonstrates how the shortage of teaching faculty was addressed by developing a collaboration between local government and educational communities, a United States (US) academic institution and volunteers from the Global Health Service Partnership.

Education is regarded as an avenue for success while the under-educated are disproportionately more likely to be incarcerated and remain within the correctional system. Current prison reforms have focused on increasing access to educational programming. However, these programs are not designed to address the lack of control, poor self-regulation, low emotional intelligence, inadequate social skills, or lack of internal motivation that hinder progress. Art therapy has been found effective in mitigating these impediments. Recognizing this, a partnership arose between a state Department of Corrections and a State University’s graduate art therapy program out of which emerged an Art Therapy in Prisons Program, funded through the Individuals with Disabilities Education Act. Two art therapists provided services to youthful male and female offenders in four institutions to assuage these obstacles. This article explores the genesis and development of this program, and the flexible adjustments required to address the impending COVID-19. We conclude how those who participated did indeed demonstrate improvement.

Widespread degradation of ice wedges has been observed during the last decades in numerous areas within the continuous permafrost zone of Eurasia and North America. To study ice-wedge degradation, we performed field investigations at Prudhoe Bay and Barrow in northern Alaska during 2011–2016. In each study area, a 250-m transect was established with plots representing different stages of ice-wedge degradation/stabilization. Field work included surveying ground- and water-surface elevations, thaw-depth measurements, permafrost coring, vegetation sampling, and ground-based LiDAR scanning. We described cryostratigraphy of frozen soils and stable isotope composition, analyzed environmental characteristics associated with ice-wedge degradation and stabilization, evaluated the vulnerability and resilience of ice wedges to climate change and disturbances, and developed new conceptual models of ice-wedge dynamics that identify the main factors affecting ice-wedge degradation and stabilization and the main stages of this quasi-cyclic process. We found significant differences in the patterns of ice-wedge degradation and stabilization between the two areas, and the patterns were more complex than those previously described because of the interactions of changing topography, water redistribution, and vegetation/soil responses that can interrupt or reinforce degradation. Degradation of ice wedges is usually triggered by an increase in the active-layer thickness during exceptionally warm and wet summers or as a result of flooding or disturbance. Vulnerability of ice wedges to thermokarst is controlled by the thickness of the intermediate layer of the upper permafrost, which overlies ice wedges and protects them from thawing. In the continuous permafrost zone, degradation of ice wedges rarely leads to their complete melting; and in most cases wedges eventually stabilize and can then resume growing, indicating a somewhat cyclic and reversible process. Stabilization of ice wedges after their partial degradation makes them better protected than before degradation because the intermediate layer is usually 2 to 3 times thicker on top of stabilized ice wedges than on top of initial ice wedges in undisturbed conditions. As a result, the likelihood of formation of large thaw lakes in the continuous permafrost zone triggered by ice-wedge degradation alone is very low.

To describe the ocular findings, visual impairment, and association of structural complications of uveitis with visual impairment in a cohort of survivors of Ebola virus disease (EVD) in Monrovia, Liberia.Retrospective, uncontrolled, cross-sectional study.Survivors of EVD who were evaluated in an ophthalmology clinic at Eternal Love Winning Africa (ELWA) Hospital in Monrovia, Liberia.A cohort of EVD survivors who underwent baseline ophthalmic evaluation at ELWA Hospital were retrospectively reviewed for demographic information, length of Ebola treatment unit (ETU) stay, visual acuity (VA), and ophthalmic examination findings. For patients with uveitis, disease activity (active vs. inactive) and grade of inflammation were recorded according to Standardization of Uveitis Nomenclature criteria. The level of VA impairment was categorized according to World Health Organization classification for VA impairment as follows: normal/mild, VA 20/70 or better; moderate, VA 20/70-20/200; severe, VA 20/200-20/400; blindness, VA20/400. Visual acuity, length of ETU stay, and structural complications were compared between EVD survivors with and without uveitis. Structural complications associated with moderate VA impairment or poorer were analyzed.Frequency of ocular complications including uveitis and optic neuropathy in EVD survivors, level of VA impairment in EVD survivors with uveitis, and structural complications associated with VA impairment in EVD survivors.A total of 96 survivors of EVD were examined. A total of 21 patients developed an EVD-associated uveitis, and 3 patients developed an EVD-associated optic neuropathy. Visual acuity was blind (VA20/400) in 38.5% of eyes with uveitis. Anatomic subtypes of uveitis included anterior, posterior, and panuveitis in 2, 13, and 6 patients, respectively. Examination findings associated with at least moderate visual impairment by World Health Organization criteria (VA20/70) included keratic precipitates (P0.002), posterior synechiae (P0.002), vitritis (P0.005), and chorioretinal scars (P0.02).Survivors of EVD are at risk for uveitis, which may lead to secondary structural complications, visual impairment, and blindness. Eye care resources should be mobilized for EVD survivors in West Africa because of the frequency of this spectrum of disease complication and its potential for severe VA impairment and blindness.

Ice cellars are a natural form of refrigeration constructed within permafrost. They are traditionally employed by indigenous Arctic peoples to store harvested wildlife. Recent reports from Alaska i...

IN BRIEF “Quality Improvement Success Stories” are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a successful project from the Division of General Internal Medicine at the University of South Florida Morsani College of Medicine, Tampa, to improve A1C, systolic blood pressure, and weight in patients with type 2 diabetes.

The diverse needs of persons living with dementia in nursing home settings presents challenges for Certified Nursing Assistants (CNAs) to provide quality care. There is a lack of educational preparedness among nursing home CNAs regarding dementia knowledge and skills required to care for a person living with dementia. As direct caregivers for persons living with dementia, CNAs play an important role in long-term care. This pilot study evaluated the dementia knowledge and caregiving skills of newly trained CNA students. The students were trained by an instructor certified using Teepa Snow’s Positive Approach to Care (PAC) curriculum. Conducted in a rural southwestern Indiana community, this study evaluated CNA students’ knowledge and perception of dementia, as well as their skill performing the Positive Physical Approach™ (PPA™) technique to approach and connect. A 38-item knowledge and perception survey and a 12-step observed skills assessment using a standardized patient encounter were administered to CNA students. Data were analyzed using descriptive statistics and bivariate analysis. Preliminary results indicate that 100% of students correctly answered the survey item regarding non-confrontational body language, while 29% of students correctly performed the corresponding PPA skill. There is a statistically significant association between the knowledge that people find pressure in their palm comforting and the ability to perform the corresponding Hand-under-Hand® and PPA techniques. Incorporation of PAC into current CNA curriculum may equip CNAs with the knowledge and skills required to provide better care, with the potential to improve the overall quality of life for persons living with dementia.

Providing quality care for older adults in long-term care can be challenging, and this issue appears to be more pressing with people living with dementia. Using the Positive Approach® to Care (PAC) model, a 2-hour module for new staff nursing home orientation curriculum was designed to help introduce the concept of working with people living with dementia. Twelve undergraduate students participated in a beta-test of the nursing home orientation. A pre-and-post 38-item survey was administered to measure knowledge level and improvement. Participants also responded to qualitative semi-structured questions after the orientation. Descriptive statistics and bivariate analysis were conducted. Results indicated an improvement on dementia-related knowledge in most of the survey items (21 of 34 items). Examples of statistically significant differences in the pretest and post-test identified are knowledge on the effect of pressure in the palm to comfort a person with dementia (p-0.039), vision as the most powerful sensory input during dementia caregiving (p-0.001), and functionalities lost when the left temporal lobe shrinks (p-0.014). The qualitative evaluation showed that most of the participants indicated a change in dementia caregiving views — including how to pause if permission is not given to engage, and to respect personal space. These findings prove important because the PAC orientation curriculum was successful in improving the students’ knowledge and perspectives on dementia. This training program could be a useful tool if implemented into nursing home employee orientation.

In some regions underlain by ice-rich permafrost, a consistent, long-term increase in ALT under changing climatic conditions is not supported by observations. The apparent lack of ALT may be attributed to soil consolidation from thawing of the uppermost ice-rich permafrost and subsidence of the ground surface. Four plots established in 1962 at Barrow, Alaska, were re-instrumented in 2003 and surveyed annually using differential GPS technology, accompanied by active-layer probing. Elevation change from 1962 to 2003 was within the interannual variability of the 2003–15 period, indicating net stability in the area. Over the 2003–15 period, however, all four plots experienced subsidence trends of 0.4–1.0 cm/year, resulting in a net elevation change of 8–15 cm. Warmer winters and increased snow depth during this period decreased the potential for frost heave. Warmer summers resulted in thaw penetration into the ice-rich transient layer and ice wedges, leading to the net subsidence in recent years. Copyright © 2016 John Wiley & Sons, Ltd.

Many areas of the Arctic are simultaneously affected by rapid climate change and rapid industrial development. These areas are likely to increase in number and size as sea ice melts and abundant Arctic natural resources become more accessible. Documenting the changes that have already occurred is essential to inform management approaches to minimize the impacts of future activities. Here, we determine the cumulative geoecological effects of 62 years (1949-2011) of infrastructure- and climate-related changes in the Prudhoe Bay Oilfield, the oldest and most extensive industrial complex in the Arctic, and an area with extensive ice-rich permafrost that is extraordinarily sensitive to climate change. We demonstrate that thermokarst has recently affected broad areas of the entire region, and that a sudden increase in the area affected began shortly after 1990 corresponding to a rapid rise in regional summer air temperatures and related permafrost temperatures. We also present a conceptual model that describes how infrastructure-related factors, including road dust and roadside flooding are contributing to more extensive thermokarst in areas adjacent to roads and gravel pads. We mapped the historical infrastructure changes for the Alaska North Slope oilfields for 10 dates from the initial oil discovery in 1968-2011. By 2010, over 34% of the intensively mapped area was affected by oil development. In addition, between 1990 and 2001, coincident with strong atmospheric warming during the 1990s, 19% of the remaining natural landscapes (excluding areas covered by infrastructure, lakes and river floodplains) exhibited expansion of thermokarst features resulting in more abundant small ponds, greater microrelief, more active lakeshore erosion and increased landscape and habitat heterogeneity. This transition to a new geoecological regime will have impacts to wildlife habitat, local residents and industry.

Objectives To develop the Test Your Memory (TYM)—Spanish version (TYM-S), a self-administered cognitive screening test, in a Chilean older sample and to estimate its psychometric properties and diagnostic accuracy. Methods The TYM was translated into Spanish and adapted for a Chilean population to develop the TYM-S. Measures of global cognitive impairment and executive dysfunction were administered to 30 controls, 30 dementia patients, and 14 subjects with mild cognitive impairment (MCI). All participants' proxies were interviewed with assessments of dementia severity, functionality in daily living activities, and cognitive change. Convergent validity and internal consistency reliability of the TYM-S were estimated. Cut-off points, sensitivity, and specificity were determined to test its diagnostic capacity for dementia or MCI. Results Regarding convergent validity, the TYM-S was significantly correlated (p

Background In the wake of the West African Ebola virus disease (EVD) outbreak of 2014–2016, thousands of EVD survivors began to manifest a constellation of systemic and ophthalmic sequelae. Besides systemic arthralgias, myalgias, and abdominal pain, patients were developing uveitis, a spectrum of inflammatory eye disease leading to eye pain, redness, and vision loss. To investigate this emerging eye disease, resources and equipment were needed to promptly evaluate this sight-threatening condition, particularly given our identification of Ebola virus in the ocular fluid of an EVD survivor during disease convalescence. Methodology/Principal findings A collaborative effort involving ophthalmologists, infectious disease specialists, eye care nurses, and physician leadership at Eternal Love Winning Africa (ELWA) Hospital in Liberia led to the development of a unique screening eye clinic for EVD survivors to screen, treat, and refer patients for more definitive care. Medications, resources, and equipment were procured from a variety of sources including discount websites, donations, purchasing with humanitarian discounts, and limited retail to develop a screening eye clinic and rapidly perform detailed ophthalmologic exams. Findings were documented in 96 EVD survivors to inform public health officials and eye care providers of the emerging disease process. Personal protective equipment was tailored to the environment and implications of EBOV persistence within intraocular fluid. Conclusions/Significance A screening eye clinic was feasible and effective for the rapid screening, care, and referral of EVD survivors with uveitis and retinal disease. Patients were screened promptly for an initial assessment of the disease process, which has informed other efforts within West Africa related to immediate patient care needs and our collective understanding of EVD sequelae. Further attention is needed to understand the pathogensis and treatment of ophthalmic sequelae given recent EVD outbreaks in West Africa and ongoing outbreak within Democratic Republic of Congo., Author summary The West African Ebola virus disease (EVD) outbreak from 2014–2016 resulted in thousands of EVD survivors at-risk for uveitis, an inflammatory eye condition with the potential for vision impairment or blindness if not promptly diagnosed and treated. Given the equipment and resource limitations within West Africa, particularly for subspecialty eye care, a screening eye clinic was developed at ELWA Hospital in Liberia to promptly screen, treat, and refer patients with eye disease. The implementation of a screening eye clinic in collaboration with leadership at ELWA Hospital was of immediate relevance given our limited understanding of this eye disease prior to the recent EVD outbreak. Resourceful procurement of medications and equipment, as well as the development of modular systems within an eye clinic setting, facilitated patient examination, teaching, and documentation of this spectrum of ophthalmic illness. Development of a screening eye clinic and its rapid implementation were needed to improve our collective undersanding of the spectrum of uveitis as a disease sequelae of EVD, relevant for recent and future outbreaks.

We report the case of a seven-year-old boy with an ingested foreign body, which was retained within the appendix for a known duration of ten months, ultimately requiring appendectomy. The ingested foreign body was incidentally discovered by abdominal x-ray at an emergency room visit for constipation. Despite four bowel cleanouts, subsequent x-rays showed persistence of the foreign body in the right lower quadrant. While the patient did not have signs or symptoms of acute appendicitis, laparoscopic appendectomy was performed due to the risk of this foreign body causing appendicitis in the future. A small metallic object was found within the appendix upon removal. This case highlights the unique challenge presented by foreign body ingestions in non-verbal or developmentally challenged children and the importance of further diagnostic workup when concerns arise for potential retained foreign bodies.

Arctic permafrost coasts are sensitive to changing climate. The lengthening open water season and the increasing open water area are likely to induce greater erosion and threaten community and industry infrastructure as well as dramatically change nutrient pathways in the near-shore zone. The shallow, mediterranean Arctic Ocean is likely to be strongly affected by changes in currently poorly observed arctic coastal dynamics. We present a geomorphological classification scheme for the arctic coast, with 101,447 km of coastline in 1,315 segments. The average rate of erosion for the arctic coast is 0.5 m year(-1) with high local and regional variability. Highest rates are observed in the Laptev, East Siberian, and Beaufort Seas. Strong spatial variability in associated database bluff height, ground carbon and ice content, and coastline movement highlights the need to estimate the relative importance of shifting coastal fluxes to the Arctic Ocean at multiple spatial scales.

Bay City (pseudonym) is one of the nation's urban epicenters of the HIV epidemic. Although researchers have examined HIV risk behaviors among juvenile offenders detained in juvenile facilities, no study has examined these risk behaviors among youth offenders who have been waived to adult criminal court and detained in U.S. jails. In the present study, qualitative data were collected from 30 African American male youth (ages 15–17) detained at the Bay City Jail. These rich, descriptive narratives provide important insight into the HIV risk behaviors within this population.