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Background: Alcohol use is a concerning issue for the military given its potential negative impact on human performance. Limited data are available regarding the incidence of alcohol use disorder in the military, which is critical to understand to evaluate force readiness, as well as for preventative initiatives and treatment planning. The aim was to examine the alcohol use disorder incidence rates (overall and across demographics) among active duty service members from 2001 to 2018. Methods: Data on 208,870 active duty service members between 2001 and 2018 from the Defense Medical Epidemiology Database was examined. Incidence rates were analyzed to determine the diagnostic rates of AUD (including both alcohol abuse and dependence), which were then examined by sex, age, service branch, military pay grade, marital status, and race. Results: Incidence rates of AUD in active duty service members (per 1,000 service members) ranged from 6.45 to 10.50 for alcohol abuse and 5.21 to 7.11 for alcohol dependence. Initial diagnoses of new-onset AUD occurred most frequently within 20-24 year-old, white, male, and non-married U.S. Army service members in the enlisted pay grades of E-1 to E-4. Statistically significant differences (p

Between 1965 and 1980, disposable diapers became the norm among middle-class American families, altering resource flows as they became more popular. Diapers crafted from wood and water of t...

Objective This study aimed to examine the use of therapeutic plasma exchange (TPE) as adjunctive therapy in neonatal septic shock. Study Design This retrospective cohort study was performed on a convenience sample of neonates in a quaternary children's hospital between January 2018 and February 2019. Results We identified three neonates with septic shock who received TPE. Two neonates had adenovirus sepsis, and one had group B streptococcal sepsis. All neonates were on extracorporeal life support (ECLS) when TPE was started. The median duration of TPE was 6 days (interquartile range [IQR]: 3–15), with a median of four cycles (IQR: 3–5). Lactate levels decreased significantly after TPE (median before TPE: 5.4 mmol/L [IQR: 2.4–6.1] vs. median after TPE: 1.2 mmol/L [IQR: 1.0–5.8]; p Conclusion TPE can be safely performed in neonates with septic shock. TPE may have a role as an adjunctive therapy in neonates with septic shock requiring ECLS.

Objective Determine the feasibility, strengths, and barriers of offering extracorporeal membrane oxygenation (ECMO) telerounding to neonatal intensive care unit (NICU) care providers. Study design NICU providers were invited to join ECMO rounds by teleconference. Data were collected on telerounding participation and ECMO concepts discussed. A survey was sent to all providers. Results From March 2018 to February 2020, telerounding on 24 neonatal ECMO patients (168 ECMO days) was performed in a Level IV NICU. A mean of four providers joined telerounds per ECMO day with an increase from 3 to 6 providers over the study period. Nearly all respondents felt telerounding lowered barriers to attending ECMO rounds (94%), promoted engagement (89%), and improved continuity of care (78%). Barriers to ECMO telerounding were suboptimal audio connections and limited ability to participate in the clinical discussion. Conclusion ECMO telerounding is well-received by NICU providers. It can improve provider participation, complement existing in-person ECMO rounds, and ECMO education.

Consistently and actively engaging in self-care has been shown to improve the performance of mental health practitioners by reducing burnout, vicarious trauma, compassion fatigue, and other stress-related psychological problems. Not only is this important to the individual practitioner's well-being, but ethical standards also mandate the recognition and remediation of any physical, mental, or emotional self-impairment to maintain high standards of care for clients. Professionals in small communities, like the Deaf community, however, confront unique challenges in attending to their self-care. This article investigates these challenges-as well as the rewards-experienced by Deaf and hearing counselors working in mental health care with deaf clients.

Search Terms: spinal cord injury AND sport* AND community* AND integration* OR participation; spinal cord injury AND physical activity AND community* reintegration* OR participation; paraplegia OR quadriplegia AND sport* AND community* AND integration OR participation; spinal cord injury AND exercise AND integration OR participation Years: 2001–2013 Databases: Academic Search Complete, Academic Search Premier, ATRJ, CINAHL, EBSCO, MEDLINE, PsycARTICLES, PsycINFO, PubMed, SPORTDiscus Number of Articles Reviewed: 7 Subscribe to TRJ

In the current study, we examined the effects of response prompting strategies (i.e., constant time delay, system of least prompts) and frames on sentence writing for three participants, ages 7 to 12, with moderate intellectual disability. We used a concurrent multiple probe across behaviors design to evaluate the efficacy of the intervention package and posttest probes to assess generalized responding to untrained stimulation. During intervention, the teacher taught two students to construct sentences using selection-based software and another to generate handwritten responses across three different writing frames (i.e., I want _________, I see _____, The _____ is ______). Our findings suggest that the package was effective and produced variable levels of maintenance and generalized responding for all three participants.

Between 1945 and 1970, the introduction of antibiotics in agriculture forced veterinarians to articulate the boundaries of their professional identity. While veterinarians welcomed the new aid to arrest infectious diseases of livestock, they worried as farmers took animal healing into their own hands without veterinary supervision, and resented the competition from retail outlets that sold the drugs. Veterinary antibiotics also set off heated debates within the field about whether the profession should position itself as preventers or healers of disease, debates that were akin to the kinds of professional discourses among physicians and pharmacists in the same period. By calling attention to the social context that helped facilitate an increasing reliance on the veterinary antibiotics, this article helps explain the sources of present-day overuse of such antibiotics in American agriculture.

Loss of native riparian vegetation and dominance of invasive species can have negative consequences for river and floodplain dynamics, trophic interactions, water quality, and riparian systems’ ability to buffer some of the impacts of climate change. In response, restoration and enhancement efforts have increased in scope and scale in recent years, despite the fact that there is limited information on the effectiveness of techniques. This paper describes one approach to riparian restoration and enhancement, termed Rapid Riparian Revegetation (R3), which promotes rapid cover of woody plants in a composition designed to mimic reference site conditions. Limited peer-to-peer learning opportunities and the significant investment in time and resources required to document practices, monitor outcomes and disseminate findings hampers practitioners’ ability to both systematically improve ecological restoration practices and to share lessons learned with broader audiences. This paper seeks to narrow this gap by describing in detail riparian revegetation project planning, management actions, and costs incurred within typical grant funded projects. Initial planting densities prescribed in this approach are typically in the range of 5,400 to 6,400 stems per hectare (approx. 2,200 to 2,600 per acre), with inter-planting in the second year at 1,300 to 1,600 stems per hectare (approx. 530 to 650 per acre). Most sites are established over six to seven years at a total cost of $11,000 to $20,000 per hectare (approx. $4,500 to $8,100 per acre). This approach evolved in and is tailored to Oregon’s Willamette Basin, but principles and practices are applicable to other regions.

Keywords: Collective impact, watershed restoration, funding partnership, Willamette River, Meyer Memorial Trust, Bonneville Environmental Foundation, Oregon Watershed Enhancement Board, watershed council, environmental restorationIntroductionFunders collaborate in many ways to increase the impact of their grantmaking on complex societal problems. They come together as affinity groups to learn from subject-matter experts and one another. They may also pool resources to address common priorities or co-fund campaigns that are difficult for institutions acting alone to support at a meaningful level.Until recently, however, relatively few grantmakers have entered into formal strategic partnerships with other funders and stakeholders aimed at achieving specific goals and objectives in a defined area of need. Such "collective impact" approaches to catalyzing large-scale social change, as described by Mark Kramer and John Kania in the Winter 2011 issue of the Stanford Social Innovation Review and other publications, have great potential to improve outcomes by aligning stakeholders from philanthropy, nonprofits, business, and government around common priorities, strategies, and measures of success. To date, funder experimentation with the collective impact model has focused largely on examples from human services, public health, and education, but a modified collective impact framework may also be suited to tackling complex, large-scale environmental challenges. In Oregon, a network of public and private funders, their grantees, and key partner organizations are experimenting with collective impact principles in a 10-year collaboration aimed at improving the health of the Wil lamette River system. In 2012, the International River Foundation awarded the Willamette River collaboration with the Thiess International Riverprize for best practices in river management.The goals of this article are to (1) describe the rationale behind the nontraditional funding initiative developed by the Oregon partners, (2) describe the actions and strategies being deployed, and (3) identify key challenges and lessons learned to date, with specific reference to the collective impact framework. In sharing our approach, we seek feedback that will help us refine and improve our own efforts. We also hope to encourage other funders to experiment with unconventional approaches to addressing complex environmental problems.The ProblemAs ever-greater demands are placed on freshwater resources, government agencies, nongovernmental organizations, and community groups are pursuing a variety of approaches to protect and restore river systems and the landscapes they drain - usually referred to as "watersheds" or "basins" (see Figure 1 for an overview of watershed restoration terms and tools). Top-down policy or regulatory approaches, while desirable for their consistency and enforceability, can be a poor fit for physically, demographically, and jurisdictionally complex watersheds. Such solutions frequently encounter resistance at the local level. Moreover, evidence suggests that locally endorsed, collaborative initiatives may provide one of the best means for addressing restoration and management challenges at the watershed or ecosystem scale (Bonnell and Koontz, 2007; Moseley 1999; Born and Genskow 2001). As a result, governments at all levels and many communities are turning to local solutions to stream and river restoration challenges.It has been estimated that public and private funders invest an average of $1 billion each year on river and stream restoration (Bernhardt et al., 2005), and local efforts have produced thousands of individual restoration projects across the U.S., such as fencing to keep livestock out of streams, removal of small dams, and tree planting in streamside areas. However, as yet there is little evidence that these projects have produced outcomes on the scale needed to reverse hundreds of years of environmental damage. …

Breast cancer is one of the most common types of cancer among women in North America (McDonough, Sabiston, & Crocker, 2008; Ray & Verhoef, 2013). While advancements in treatment have resulted in higher survival rates, women often experience considerable stress associated with their diagnosis and treatment (McDonough, Sabiston, & Ullrich- French, 2011). Furthermore, the impact of the breast cancer experience often results in survivors feeling a loss of power or control over their bodies (Mitchell, Yakiwchuk, Griffin, Gray, & Fitch, 2007) and challenges often continue for years after treatment is complete (McDonough et al., 2011). It is well documented that physical activity can positively influence cancer survivors’ physical, psychological and social well-being (McDonough et al., 2008), as well as overall quality of life (Carter et al., 2012). Recently, there has been an increase in cancer survivors participating in the team based sport, dragon boating, where 22 paddlers row a canoelike boat in synchronization for 500–650 meters (Mitchell et al., 2007).

Bertha Harris self-consciously deploys images of medieval female saints in her 1976 novel Lover, prefacing many narrative episodes with their vitae. Her novel's lesbian concerns resonate with the early medieval virgin martyrs, and cross-pollinating this seminal work with aspects of medieval hagiography reciprocally illuminates how each culture represents the highly politicized nexus of the female body, temporality, and erotics. These concerns converge within the relic, an object that tightly knits together the erotic and the aesthetic realms. Such objects can lead to radical relationality across time and participate in generating localized sites where female bodies can achieve possible utopias through aesthetic enshrinement.

New ways of understanding milk purity accompanied the introduction of veterinary antibiotics to the dairy farm. Antibiotics—once viewed as substances that could rid milk of bacterial hazards—became understood as food adulterants when residues of the drugs were detected in milk. Although consumers’ concerns about food purity became critical in the postwar era, only in the late 1950s and early 1960s did public health officials and consumers take interest in the potential human health effects of antibiotic residues. Veterinarians and milk processors, not consumers, led the effort to curb indiscriminate use of antibiotics in the 1940s and 1950s. Paying close attention to the context in which farmers chose to use antibiotics and monitored drug residues, this article seeks to explain why farm people adopted veterinary drugs and how they adapted to new regulatory structures and shifting ideas about milk purity.

Background/Purpose: Initial laboratory and clinical data suggest that partial liquid ventilation (PLV) can enhance pulmonary function and that lung growth can be induced via distension of the newborn lung using perfluorocarbon in patients with congenital diaphragmatic hernia (CDH). The authors, therefore, performed a prospective, randomized pilot study evaluating PLV and perfluorocarbon-induced lung growth (PILG) in newborns with CDH on extracorporeal life support (ECLS) at 6 medical centers. Methods: Patients were selected randomly using a permuted block design to PLV/PILG (n = 8) or conventional mechanical ventilation (CMV/control, n=5). Patients in the PILG group received daily doses which filled the lungs with perflubron for up to 7 days and were placed on continuous positive airway pressure of 5 to 8 cm H 2 O. CMV patients were treated with standard mechanical ventilation while on extracorporeal membrane oxygenation (ECMO). Results: A total of 13 patients were evaluated in this study. All 3 patients enrolled without being on ECLS rapidly transitioned to ECLS. The study, therefore, effectively evaluated PILG (n = 8) versus standard ventilation (control, n=5) on ECLS. Mean (± SE) gestational age was 37 ± 1 weeks and weight was 3.1 ± 0.1 kg. Time on ECMO was 9.8 ± 2.3 days in the PILG and 14.5 ± 3.5 days ( P =.58) in the control group. Survival rate in the PILG group was 6 of 8 (75%), whereas survival rate was 2 of 5 (40%) in the control group ( P =.50). The number of days free from the ventilator in the first 28 days (VFD) was 6.3 ± 3.3 days with PILG and 4.6 ± 4.6 days with control ( P =.9). Causes of death in the PILG group included sepsis and renal failure in one patient and pulmonary hypertension in the other. There were no safety issues, and the deaths in the PILG group did not appear to be related to the administration of perflubron. Conclusions: These data show that PILG can be performed safely. The survival rate, VFD, and time on ECMO data, although not conclusive, are encouraging and indicate the need for a definitive trial of this novel intervention in these neonates with high mortality. J Pediatr Surg 38:283-289. Copyright 2003, Elsevier Science (USA). All rights reserved.

We hypothesized that semester goal attainment provides a route to short-term psychological growth. In an attempt to enhance this process, we randomly assigned participants to either a goal-training program or to a control condition. Although there were no main effects of program participation on later goal attainment, important interactions were found. Consistent with a "prepared to benefit" model, participants already high in goal-based measures of personality integration perceived the program as most useful and benefited the most from the program in terms of goal attainment. As a result, they became even more integrated and also increased in their levels of psychosocial well-being and vitality. Implications for theories of short-term growth and positive change are discussed, as is the unanswered question of how to help less-integrated persons grow.

The authors investigated the short- and long-term (5-month) effectiveness of a theoretically driven, programmatic rape prevention intervention on a sample of primarily White and Black college men. A racially diverse sample was included, and the potential effectiveness of both a culturally relevant and a traditional colorblind intervention was assessed. In contrast to earlier investigations, which have consistently reported an overall rebound of scores at the follow-up assessment, results from a hierarchical cluster analysis indicated 3 patterns of treatment response: improving, deteriorating, and rebounding. Results also indicated that Black students in the culturally relevant treatment condition were more cognitively engaged in the intervention than their peers in the traditional treatment condition.