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What makes some human rights campaigns for the physical integrity rights of prisoners more effective than others? Despite various normative arguments condemning these practices, only limited systematic analysis documents the relative effectiveness of different arguments on individuals. This is surprising, because the success of human rights campaigns depends on getting individuals to care about and support policy positions that protect human rights. We constructed an experiment to compare the effects of six different arguments against prisoner abuse and torture. We found that an argument which emphasized the suffering of the prisoner had a consistently positive and significant effect on opposition to torture and prisoner abuse. However, this effect was largely contingent on subjects’ political ideology. Political conservatives actually became less opposed to torture, on average, after reading the same argument emphasizing the prisoners’ suffering or the sacredness of human beings.

Low 25-hydroxyvitamin D (25OHD), a biomarker of vitamin D status, is associated with reduced immune function and adverse pregnancy outcomes, such as preterm birth. Observational studies indicate that long-term, high level exposure to metals such as cadmium (Cd) and lead (Pb) can impact a person's vitamin D status. However, the directionality of the association is uncertain, particularly for low-level exposures. We used three distinct longitudinal data analysis methods to investigate cross-sectional, longitudinal and bidirectional relationships of Cd and Pb biomarkers with 25-hydroxyvitamin D (25OHD) in a Canadian pregnancy cohort. Maternal whole blood Cd and Pb and plasma 25OHD concentrations were measured in the 1st (n = 1905) and 3rd (n = 1649) trimester and at delivery (25OHD only, n = 1542). Our multivariable linear regression analysis showed weak inverse associations between Cd and 25OHD concentrations cross-sectionally and longitudinally while the latent growth curve models showed weak associations with Pb on the 25OHD intercept. In the bidirectional analysis, using cross lagged panel models, we found no association between 1st trimester metals and 3rd trimester 25OHD. Instead, 1st trimester 25OHD was associated with 9% (-15%, -3%) lower 3rd trimester Cd and 3% (-7, 0.1%) lower Pb. These findings suggest the 25OHD may modify metal concentrations in pregnancy and demonstrates the value of controlling for contemporaneous effects and the persistence of a biomarker over time, in order to rule out reverse causation.

Collaborative planning is increasingly common in the context of natural resource management in the United States. However, there is no universal way to organize collaborative groups, and, subsequently, collaborative structures vary from collaborative group to collaborative group. In order to contribute to the growing knowledge base about the implications of different collaborative structures, we conducted a case study of the Tapash Sustainable Forestry Collaborative, a group located in Washington State that is focused on forest restoration. By analyzing interviews and archival data, we documented the organizational structure of the collaborative group and explored the outcomes of that structure in terms of trust and relationship. We illustrate how the structure of the Tapash Sustainable Forestry Collaborative led to both positive and negative outcomes and additionally describe the steps the group took to address the negative outcomes. Our findings will be useful for anyone considering how to structure their own collaborative group. It can also serve to as an example for scholars interested in the characteristics that support successful collaborative natural resource planning and management. Additionally, the case study provides readers with a background information about several content areas including public participation in forest plan and management, national-level legislation related to forest planning and management, trust and trust repair, adaptive governance, and adaptive management.

Introduction Sleep is a predictor of cardiometabolic disease (CMD) risk, and new evidence links early childhood sleep to later CMD risk. This study examines the impact of early childhood sleep duration, bedtime timing, and sleep disturbance on a CMD risk score in early adolescence. Methods Within the Health Outcomes and Measures of Environment (HOME) Study, a prospective pregnancy and birth cohort study, we assessed sleep patterns among 346 children using the Children’s Sleep Habits Questionnaire from ages 2 to 8 years. We calculated cardiometabolic risk scores ate age 12 for 183 of these children from visceral adiposity area, blood pressure, fasting serum triglyceride, high density lipoprotein, leptin, and adiponectin concentrations. We used a group-based semi-parametric mixture model to identify distinct trajectories in sleep duration, bedtime timing, and sleep disturbance for the entire sample. We then examined the associations between sleep trajectories and CMD risk score using general linear models for children with a CMD risk score, using both an unadjusted model (no covariates) and an adjusted model (adjusting for child pubertal stage, child sex, duration of breastfeeding, household income, and maternal education). Results Three sleep trajectories emerged for bedtime timing (late timing, medium timing, and early timing) and for sleep disturbance (high, medium, and low), and two for sleep duration (high and low). In the unadjusted model, we found significant differences in CMD risk scores by trajectories of sleep disturbance. Children in the ‘high’ trajectory had higher CMD risk scores (Least Square Mean=1.51; 95% CI: 0.39, 2.64) than those in the ‘low’ trajectory (Least Square Mean =-0.51; 95% CI: -1.16, 0.15; p=.002) and ‘medium’ trajectory (Least Square Mean=-0.15; 95% CI: -1.14, 0.85; p=.03). These findings only approached significance after adjusting for covariates. No significant differences in CMD risk were observed for bedtime timing or total sleep time trajectories in the unadjusted or adjusted models. Conclusion In this cohort, parent-reported sleep disturbance in early childhood was associated with more adverse cardiometabolic profiles in early adolescence. Our findings suggest that trials to reduce CMD risk via sleep interventions – which have been conducted in adolescents and adults – may be implemented too late. Support (If Any) National Institute of Environmental Health Sciences grants PO1 ES11261, R01 ES014575, R01 ES020349, R01 ES027224, R01 ES025214.

Background Hospitalized patients with coronavirus disease 2019 (COVID-19) infection have higher rates of venous thromboembolism (VTE).Higher mortality rates have been reported in severe cases of COVID-19 including those who have elevated D-dimer levels and have thromboembolic phenomena. Objective The objective of this retrospective and observational study was to ascertain which type and dosages of anticoagulation provide a mortality benefit and decrease the risk of developing VTE. Methods We evaluated the risk factors for VTEs in patients with a confirmed polymerase chain reaction test positive for COVID-19 who were admitted to our facility from April 1 to July 1, 2020. In addition, we performed a logistic regression to examine the relationship between mortality and intensive care unit (ICU) admission, specific risk factors outlined in the study, D-dimer, ferritin, prothrombin time (PT) and international normalized ratio (INR). Patients with a history of VTE, those already on anticoagulation (AC) prior to hospitalization, and patients on comfort care were excluded from study. Results There were originally 331 patients in the data set. Of those, 111 patients were excluded based on exclusion criteria and 4 additional patients were removed as they were the only individual patients in their specific AC covariant group. The analysis was performed on the remaining 216 patients. We divided the AC medications administered to the patients into five separate covariates: 1. enoxaparin 40 mg subcutaneous (sq) daily, 2. enoxaparin 40 mg sq every 12 hours (q12h), 3. heparin 5000 mg sq q12h, 4. heparin 5000 mg sq every 8 hours (q8h), 5. Patients taking multiple AC or deep venous thrombosis (DVT) prophylaxis medications. 6. No AC and examined them via logistic regression for mortality at 28 days and 60 days (Table 1). Patients in enoxaparin 40 mg daily group had statistically significant lower 28 day mortality. There was no statistically significant relationship between the use of enoxaparin 40 mg q12h and 28 day mortality rate. Patients in both heparin groups did not have significantly lower 28 day mortality rates. Patients in groups 5 & 6 had significantly higher 28 day mortality rates (Table 1). It is important to note that 33 patients underwent a pulmonary computed tomography angiography due to concern for pulmonary embolism and 38 patients underwent an ultrasound of their lower extremities to rule out the development of DVT. For patients with additional risk factors defined as chronic kidney disease, chronic obstructive pulmonary disease, organ transplant recipient, obesity (BMI > 30), cardiac disease (heart failure, coronary artery disease or cardiomyopathy), sickle cell disease, diabetes mellitus and smoking history, the odds of death at 28 days increased by a factor of 1.71, at 60 days by a factor of 1.63 and being admitted to the ICU by a factor of 1.41. Patients with 3-5 risk factors are 2.48 times more likely to be admitted to the ICU than patients with 0-2 risk factors. Patients with 4 or 5 risk factors are 3.56 times more likely to be admitted to the ICU than patients with 0-3 risk factors (Table 2). Predictably, patients that were admitted to the ICU had a significantly increased rate of mortality compared to those who were not (Table 3). Per our analysis, there was no relationship between PT or INR and mortality. At 28 days and 2 months, the D-dimer > 4000 was indicative of a higher odds of death versus patients with a D-dimer < 4000. An increased ferritin was also indicative of a higher mortality rate (Table 4). Conclusion Patients receiving enoxaparin 40 mg daily benefited more than any other AC regimen with respect to the development of VTE at both 28 days and 2 months. Increasing the dosing to twice daily did not decrease mortality. Additionally, patients receiving heparin did not have a decreased mortality. It is important to note that there was no standard protocol used to determine which patients received daily or twice daily dosing. The type and dose of AC was determined based on the clinical judgment of intensivists in each case. It is also possible that patients with severe COVID-19 infection were more likely to be given twice daily dosing which could account for the lack of mortality benefit with more frequent dosing. We did not report bleeding rates in AC groups in our study and this can be a possible reason for no mortality benefit among higher dose AC groups. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

While children's exposure to environmental lead in the United States has decreased, areas of elevated levels remain. Because lead exposure is a risk factor for developmental delays, it should be considered when studying neurodevelopmental effects of in utero antiretroviral medication (ARV) exposure in the growing population of perinatally HIV-exposed, uninfected (PHEU) children. We compared blood lead levels (BPb) in PHEU children enrolled in the Surveillance Monitoring of ART Toxicities (SMARTT) Study to U.S. children, assessed associations with neurodevelopment, and explored whether associations between in utero ARV and neurodevelopment are modified by BPb. Prevalence of elevated BPb (≥5 μg/dl) at ages 1–2 years was calculated by year and race/ethnicity and compared to that for children in the National Health and Nutrition Examination Survey (NHANES 2002–2010). Associations between elevated BPb and neurodevelopment at 1 and 3 years were assessed. Associations between ARVs (tenofovir disoproxil fumarate [TDF]; atazanavir) and neurodevelopment were evaluated within BPb level (≥5 μg/dl vs.

Whether low-level benzene exposure produces health effects is controversial. We used routinely collected data from our medical/industrial hygiene system to study 387 workers with daily 8-hour time-weighted exposures averaging 0.55 ppm. The cross-sectional repeated survey design included 553 unexposed workers. Lymphopenia is considered to be the earliest and most sensitive indicator of benzene toxicity. We found no increase in the prevalence of lymphopenia among benzene-exposed workers (odds ratio, 0.6; 95% confidence interval, 0.2 to 1.8), taking into account smoking, age, and sex. There also was no increase in risk among workers exposed 5 or more years (odds ratio, 0.6; 95% confidence interval, 0.2 to 1.9). Examination of other measures of hematotoxicity, including mean corpuscular volume and counts of total white blood cells, red blood cells, hemoglobin, and platelets, produced similar results. We conclude that risk of lymphopenia and other early indicators of hematotoxicity are not increased among workers in this study who were exposed to low levels of benzene.

Federal Aviation Regulations require that structures critical to the safe operation of an aircraft must not fail within their expected lifetimes due to damage caused by the repe ated loads typical to its operations. Yet, loads related aircraft accidents do occur periodically sometimes attracting much media attention. A low-cost lightweight flight data recorder for general aviation aircraft has been developed and installed on fleet airplanes. This paper presents sample data recorded during 1200 flight hours of normal training operations in Florida and Arizona.

Study Objectives: We compare the results of a provider "self-adjudicating" outpatient emergency department claims using a "presenting symptom–based" system with the managed care organization (MCO) adjudicating the claims using a "final diagnosis–based" system. Methods: All outpatient visits from one MCO to an urban, university hospital between January 1, 1998, and February 28, 1999, were included. Each record was reviewed by 2 methods to determine whether the visit qualified for payment under the MCO's benefit structure. Under the provider adjudication, symptom-based system, all visits with nursing triage levels of immediate/emergency were approved automatically. Those with triage levels of delayed/nonurgent were reviewed by an emergency physician and approved if, in the physician's opinion, the presenting symptoms met the emergency criteria under the District of Columbia's Access to Emergency Services Act. A second claims review, blinded to the first, was performed with the diagnosis-based system used by the MCO before approval of the prudent layperson standard. This review divided the records into "approve," "deny," and "suspend" categories according to the discharge International Classification of Diseases, ninth revision code. The results of the 2 reviews were compared. Results: We reviewed 1,830 records; 836 (46%) cases were triaged as immediate/emergency and 994 (54%) as delayed/nonurgent. Of the 994 delayed/nonurgent visits, physician review determined that 607 (61%) met the prudent layperson standard and 387 (39%) did not. Overall, the provider self-adjudication system determined that 1,443 (78.8%) of the 1,830 visits should be approved for insurance coverage. The MCO's system approved 966 (53%), denied 335 (18%), and suspended 529 (29%). Provider self-adjudication using a symptom-based system resulted in the immediate approval of 1,443 (77.8%) visits compared with 966 (52.7%) by a diagnosis-based system ( P P Conclusion: Compared with the standard ED claims review process used by the managed care industry, provider self-adjudication using a symptom-based system approves a greater proportion of visits, avoids rejection of many ED visits, and identifies many nonemergency visits that mistakenly appear to be emergencies. The possibility of providers and MCOs working together to adjudicate outpatient ED claims should be explored. [Shesser R, Holtermann K, Smith J, Braun J. Results of provider self-adjudication using the prudent layperson standard compared with the managed care organization's emergency department claim review process. Ann Emerg Med. September 2000;36:212-218.]

This invention relates to a novel, fully automated spectrophotometric analyzer and method used for testing blood samples in the clinical laboratory for thrombosis and hemostasis properties. The analyzer tests samples in a fully randomized format, and is fully automated in the areas of specimen handling, sample preparation, optical inspection, data analysis and total quality control for imprecision and bias.