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Indigenous people are among the populations most vulnerable to climate change. However, indigenous societies' potential contributions to addressing climate change and related issues of food security are vast but poorly recognized. The objective of this report is to inform the nutrition and public health communities about the potential contributions of ancient Andean technologies to address these contemporary challenges. Our research examines these ancient farming technologies within the frame of climate change and dietary potential. Specifically, we focus on 4 technologies derived from 3 case studies from Ecuador. These technologies were analyzed using evidence mainly of adaptation to climate change in indigenous-based agriculture. Our examination of these technologies suggests they could be effective mechanisms for adapting to climate change and protecting food sovereignty. Thus, although highly vulnerable to climate change, indigenous peoples in the Andes should also be seen as “agents of change.”, This research aims to inform audiences working in nutrition and public health about the potential contributions of ancestral Andean technologies to addressing climate change and food insecurity. This report studies terraces, waru-waru (raised beds), and qochas and albarradas (jagueyes) (2 different types of reservoirs) as ancient farming technologies, as part of an observational and integrative study combining: 1) secondary information; 2) 3 relevant, independent, primary research experiences in Ecuador; and 3) plant species grown using ancient farming technologies and their micronutrient content. From this analysis, we can conclude that the identified ancestral technologies could be used to mitigate emissions and successfully adapt to some of the effects of climate change, such as soil erosion, drought, hailstorm, frost, and flooding. At the same time, they allow production of highly nutritious crops that improve access to culturally adequate foods within indigenous communities. Around the globe indigenous people are among the populations most vulnerable to climate change. However, evidence suggests that through their ancestral knowledge they should also be considered agents capable of addressing climate change and food security challenges.

To evaluate open bedside tracheostomy (OBT) and compare it with open operating room (OR) tracheostomy and bedside percutaneous dilatational tracheostomy (PDT) in complications and cost. To determine the tracheostomy practice patterns of academic otolaryngology programs.Retrospective cohort study and cross-sectional study.Public hospital and tertiary care hospital.Otolaryngology program directors were surveyed to determine their institutions' tracheostomy practice patterns and the factors preventing the implementation of open bedside tracheostomies. A retrospective chart review was done of tracheostomies performed at our institutions from 2009 to 2019 for prolonged mechanical ventilation. Complications, length of intubation, comorbidities, body mass index, demographics, mortality rates, and decannulation rates were recorded. A cost analysis between OBT and PDT was conducted.Data from 802 patients were analyzed for 449 OBTs, 206 PDTs, and 147 open OR tracheostomies. Complication rates were low. PDTs were more likely to have perioperative tracheal bleeding (OBT can be done safely in patients with multiple comorbidities and has a cost that can be less than PDT. Despite these benefits, only 50% of academic institutions routinely performed OBT.3.

Approximately 5% of patients with cutaneous squamous cell carcinoma (CSCC) may develop recurrent or metastatic disease. The management of such cases is challenging and requires multi-disciplinary care. Immunotherapy using PD-1 inhibition was approved to treat unresectable or metastatic CSCC in 2018. Given limited data regarding clinical outcomes outside of published trials, we describe our experience using this therapy.We retrospectively reviewed all patients treated with PD-1 inhibition as therapy for locally advanced, regionally metastatic or distant metastatic CSCC at the University of Southern California. Clinicopathological characteristics, treatment data using PD-1 inhibitors, and outcomes were assessed.Among 26 patients treated with PD-1 inhibition, the objective response rate was 42.3%, with 19.2% of patients having partial response and 23.1% having complete response to therapy. The median progression-free survival was 5.4 months. Median tumor mutational burden (TMB) was higher among responders compared to non-responders (60 vs. 9 Mut/Mb, p = 0.04). Primary CSCC tumor location on the head/neck was also associated with response to PD-1 inhibition (p = 0.04). Two patients with mutations affecting mismatch repair deficiency were noted to have complete response to treatment. No other variables were associated with treatment outcomes.PD-1 inhibition produces durable responses among patients with advanced or metastatic CSCC. PD-1 inhibition therapy is well tolerated, but patients should be monitored closely for immune-related adverse events, particularly frail or immune-suppressed patients. Further investigation of potential biomarkers to help identify patients who will derive the most benefit from this therapeutic option is needed.

Background: Aside from racial and socioeconomic disparities in computerized neurocognitive testing and symptomology, there is a scarcity of research representing more diverse populations on other widely used tests for concussion, including vestibular and visual assessment. Aim: The aim of the study was to investigate if racial and socioeconomic differences exist on baseline vestibular/ocular motor screening (VOMS) and King-Devick (K-D) test performance in high school student-athletes. Methods: A total of 670 participants (66.1% White, 33.9% Black) with a mean age of 15.43±1.2 years were administered a baseline VOMS, average Near Point of Convergence (NPC) distance, and K-D test. The exposure variables included race (White or Black) and socioeconomic status (SES), defined as free and reduced lunch status (FRL or No-FRL). FRL status was determined by each participant’s school SES. The outcome variables consisted of baseline VOMS item symptom provocation scores, average NPC distance, and K-D baseline time. A series of Mann–Whitney U tests were performed for K-D baseline time, NPC distance, and VOMS items with FRL status or race as a between-subject factor. Two multivariable linear regressions were run to assess the association of (1) K-D baseline times using FRL, race, sex, and corrected vision as variables in the model and (2) average NPC distance using FRL, race, sex, and corrected vision as variables in the model. Results: When adjusting for multiple comparisons, FRL athletes had slower (worse) K-D times (P

OBJECTIVE The utility of robotic instrumentation is expanding in neurosurgery. Despite this, successful examples of robotic implementation for endoscopic endonasal or skull base neurosurgery remain limited. Therefore, the authors performed a systematic review of the literature to identify all articles that used robotic systems to access the sella or anterior, middle, or posterior cranial fossae. METHODS A systematic review of MEDLINE and PubMed in accordance with PRISMA guidelines performed for articles published between January 1, 1990, and August 1, 2021, was conducted to identify all robotic systems (autonomous, semiautonomous, or surgeon-controlled) used for skull base neurosurgical procedures. Cadaveric and human clinical studies were included. Studies with exclusively otorhinolaryngological applications or using robotic microscopes were excluded. RESULTS A total of 561 studies were identified from the initial search, of which 22 were included following full-text review. Transoral robotic surgery (TORS) using the da Vinci Surgical System was the most widely reported system (4 studies) utilized for skull base and pituitary fossa procedures; additionally, it has been reported for resection of sellar masses in 4 patients. Seven cadaveric studies used the da Vinci Surgical System to access the skull base using alternative, non–TORS approaches (e.g., transnasal, transmaxillary, and supraorbital). Five cadaveric studies investigated alternative systems to access the skull base. Six studies investigated the use of robotic endoscope holders. Advantages to robotic applications in skull base neurosurgery included improved lighting and 3D visualization, replication of more traditional gesture-based movements, and the ability for dexterous movements ordinarily constrained by small operative corridors. Limitations included the size and angulation capacity of the robot, lack of drilling components preventing fully robotic procedures, and cost. Robotic endoscope holders may have been particularly advantageous when the use of a surgical assistant or second surgeon was limited. CONCLUSIONS Robotic skull base neurosurgery has been growing in popularity and feasibility, but significant limitations remain. While robotic systems seem to have allowed for greater maneuverability and 3D visualization, their size and lack of neurosurgery-specific tools have continued to prevent widespread adoption into current practice. The next generation of robotic technologies should prioritize overcoming these limitations.

Avian eggshells serve the dual purposes of protecting the developing embryo from the external environment while also facilitating the loss of water vapor and the required exchange of CO2 and O2 gases. Pores that span the eggshell enable the loss of water and trans-shell gas exchange. Although knowledge of the geometry of these spaces is necessary to generate accurate estimates of the rate of gas diffusion across the shell, few techniques exist to obtain these data. Estimates of gas conductance across eggshells are typically calculated from eggshell thickness and the size and number of the pores on the exterior eggshell surface; the trans-shell pore spaces are assumed to be cylindrical in shape. To enable the testing of this assumption, we devised a novel method to visualize the three-dimensional morphology of eggshell pores using PU4ii, a polyurethane-based resin. Casts of the pores of eggshells of the domestic chicken (Gallus gallus )a nd House Sparrow (Passer domesticus) were unbranched and varied in diameter throughout their length, while casts of the pores of eggshells of the Ostrich (Struthio camelus) revealed a complex network of interconnected spaces. The simplicity of this technique and the stability and resilience of the resulting casts provide opportunities to predict gas flux across the shell and to evaluate the morphology of eggshell pores among birds from different taxonomic groups.

Objectives In traditionally underserved communities, faith-based interventions have been shown to be effective for health promotion. Religious leaders-generally the major partner in such interventions-however, are seldom are consulted about community health priorities and health promotion preferences. These insights are critical to ensure productive partnerships, effective programming, and sustainability. Methods Mixed-methods surveys were administered in one of the nation's most under-resourced regions: rural Appalachia. A sample of 60 religious leaders, representing the main denominations in central Appalachia, participated. Measures included closed- and open-ended survey questions on health priorities and recommendations for health promotion. Descriptive statistics were used for closed-ended survey items and conventional qualitative content analysis was used for open-ended responses. Results Substance abuse, diabetes mellitus, suboptimal dietary intake and obesity/overweight, and cardiovascular and respiratory illnesses constitute major health concerns. Addressing these challenging conditions requires realistically acknowledging sparse community resources (particularly healthcare provider shortages); building in accountability; and leveraging local assets and traditions such as testimonials, intergenerational support, and witnessing. Conclusions With their extensive reach within the community and their accurate understanding of community health threats, practitioners and researchers may find religious leaders to be natural allies in health-promotion and disease-prevention activities.

In the United States, community coalitions are an important part of the public health milieu, and thus, subject to many of the same external pressures as other organizations—including changes in required strategic orientation. Many funding agencies have shifted their funding agenda from program development to policy change. Thus, the Florida Prevention Research Center created the Community-Based Prevention Marketing (CBPM) for Policy Development framework to teach community coalitions how to apply social marketing to policy change. The research reported here was designed to explicate the framework’s theory of change. We describe and demonstrate a hybrid evaluation approach: utilization-focused developmental evaluation. The research question was “What are the linkages and connections among CBPM inputs, activities, immediate outcomes, intermediate outcomes, and ultimate impacts?” We implemented a case study design, with the case being a normative community coalition. The study adhered to a well-developed series of steps for system dynamics modeling. Community coalition leaders may expect CBPM to provide immediate gains in coalition performance. Results from causal diagramming show how gains in performance are delayed and follow an initial decline in performance. We discuss the practical implications for CBPM’s developers—for example, importance of managing coalition expectations—and other social marketers—for example, expansion of the evaluation toolkit.

Community-based prevention marketing (CBPM) is a community-driven framework for program planning, which applies social marketing concepts and techniques to the development of health behavior interventions. Whereas community members who comprise an action committee or coalition set the goals and make programmatic decisions, social marketing provides the planning framework to guide program design, implementation, and evaluation. CBPM has guided successful initiatives to promote physical activity in both youth and adults, to increase safety eyewear use in agricultural settings, and to delay alcohol and tobacco initiation among youth. However, the emergence of evidence-based policy has fostered renewed interest in “upstream” approaches to health behavior change that, in the United States, have included community partnerships as an important tool for policy development. Unfortunately, these community partnerships have had variable success because of the lack of a systematic framework for identifying, selecting, tailoring, and promoting evidence-based policies. We describe the adaptation and application of CBPM to improve community capacity for identifying and promoting evidence-based policies. The resulting framework, CBPM for Policy Development, is comprised of the following eight steps: (1) build a strong foundation for success; (2) review evidence-based policy options; (3) select a policy to promote; (4) identify priority audiences among beneficiaries, stakeholders, and policy makers; (5) conduct formative research with priority audiences; (6) develop a marketing plan for promoting the policy; (7) develop a plan for monitoring implementation and evaluating impact; and (8) advocate for policy change. We provide a description of each step and an examination of the experiences and lessons learned in applying it to youth obesity prevention.

As this issue suggests, medical and applied anthropologists have been working in Appalachia for many years. Many applied medical anthropologists have cautioned about the limits of seeing the people of this special region as a uniform group, defined by cultural difference and isolated from broader society (Drew and Schoenberg 2011). Appalachian perspectives about health often vary widely, suggesting a diversity that may better demonstrate Appalachia's connection to the rest of the United States, rather than indicate its difference. Anthropologists have illuminated the diversity of groups within Appalachia as they have examined different dimensions of health. For example, cultural differences in community organization and values about child raising between white and Cherokee Appalachian youth shape distinct patterns in the timing of reproduction between the groups (Brown, Hruschka, and Worthman 2009). Examinations of health at the household level have revealed variation in health outcomes even within families. Crooks' analysis of childhood nutrition in Eastern Kentucky reveals that the factors associated with childhood stunting vary by child gender (Crooks 1999), demonstrating the importance of family-level influences on health.

Most Americans consume far below the recommended daily intake (RDI) for fruits and vegetables and far above the RDI for suboptimal foods.1–3 Such dietary patterns have been linked to overweight and obesity, metabolic syndrome, and other chronic conditions.4 Rural residents are more likely than their urban counterparts to experience these conditions, oftentimes leading to premature mortality.5 Social determinants, including lower socioeconomic status, lower likelihood of health insurance coverage, and more limited access to safety net and preventive medical services, place rural residents at elevated risk of and from these chronic conditions.6 Kentucky residents, particularly those living in the rural, Appalachian portion of the state, suffer even higher rates of overweight, obesity, and associated chronic conditions than other rural residents.7 In 2005, 62.5% of adults in Kentucky were overweight or obese, as compared to 58.5% for the United States.8 Residents of the eastern Appalachian portion of Kentucky have among the highest rates of obesity and overweight in the United States, estimated between 62.5% and 76.2% (See Figure 1, which also highlights study counties. Data obtained from the CDC’s Behavioral Risk Factor Surveillance System).8–10 Rates of diabetes and cardiovascular disease in Appalachian counties in Kentucky also are among the highest in the state and the United States.10–12 Figure 1 Overweight and Obesity Among Adults in Kentucky 2008–2010 Likely associated with these negative health outcomes, Kentucky ranks third nationally for those least likely to consume the RDI of fruits and vegetables; only 21.1% of Kentuckians and 19% of Appalachian residents meet this RDI, compared with 23.4% of Americans nationwide.13 In part, these consumption patterns stem from regional food ways, which tend to emphasize meats, biscuits, and fried foods over vegetables; these food preferences have become important components of rural Appalachian identities.15 Common uses of locally acquired ingredients and methods of preparation shared among rural Appalachians serve as an expression of belonging that not only reaffirms cultural ties to place, but also to family and community.14 The preference for these unhealthy foods among rural Appalachians, including the expectation that these culturally appropriate foods should be present at home and community events, has been identified as a potential barrier for individuals in the region to making healthy dietary choices.15 Dietary patterns in rural Appalachia also are shaped by a broad range of interacting social, cultural, geographical, and economic processes. For instance, some research has suggested that the economic transition in the region from farming and mining to employment in the service industry has contributed to a rising dependence on fast foods.16 Coupled with issues of food affordability,15 limited access to high-quality grocery stores,17 and increased demands on the use of time, the spiking number of fast food establishments in rural Appalachian communities has been met with a corresponding dependence on these foods in regional diets. This dependence sometimes supplants former food practices which are viewed as more time intensive to prepare.12 Given that Appalachian residents experience disproportionate risk of overweight, obesity, and associated negative health outcomes, new approaches to improve dietary intake are needed. These approaches will be most successful if they are grounded in local perspectives and address the interactions between regional food ways and shifting social, cultural, and economic contexts. Thus, the purpose of this article is to explore how rural, Appalachian residents think about healthy eating and their ideas for improving dietary intake.

Background:Most children in the United States receive far less physical activity (PA) than is optimal. In rural, under resourced areas of Appalachian Kentucky, physical inactivity rates are significantly higher than national levels. We sought to understand children’s perceptions of PA, with the goal of developing culturally appropriate programming to increase PA.Methods:During 11 focus groups, we explored perspectives on PA among 63 Appalachian children, ages 8−17. Sessions were tape recorded, transcribed, content analyzed, and subjected to verification procedures.Results:Several perspectives on PA emerged among these rural Appalachian youth, including the clear distinction between PA (viewed as positive) and exercise (viewed as negative) and an emphasis on time and resource factors as barriers to adequate PA. Additional PA determinants expressed in the focus groups are similar to those of other populations. We include children’s recommendations for appealing PA programs.Conclusions:Appalachian and other rural residents contend with the loss of rural health advantages (due to declines in farming/other occupational and avocational transitions). At the same time, Appalachian residents have not benefitted from urban PA facilitators (sidewalks, recreational facilities, clubs and organized leisure activities). Addressing low PA levels requires extensive community input and creative programming.

Many nations have witnessed a dramatic increase in the prevalence of obesity and overweight across their population. Recognizing the influence of the household environment on energy balance has led many researchers to suggest that intergenerational interventions hold promise for addressing this epidemic. Yet few comprehensive reviews of intergenerational energy balance interventions have been undertaken. Our review of the literature over the past decade revealed that intergenerational intervention approaches to enhance energy balance use a broad array of designs, target populations, and theoretical models, making results difficult to compare and “best practices” challenging to identify. Additional themes include variation in how interventions incorporate the intergenerational component; an increasing acknowledgment of the importance of ecological models; variations in the location of interventions delivery; diversity in the intervention flexibility/structure, intensity, and duration; and variation in outcomes and measures used across studies. We discuss implications and future directions of intergenerational energy balance approaches.

Background: Assessing actual consumption of school cafeteria meals presents challenges, given recall problems of children, the cost of direct observation, and the time constraints in the school cafeteria setting. This study assesses the use of digital photography as a technique to measure what elementary-aged students select and actually consume from school cafeteria meals. Methods: Before and after still digital photographs were taken of labeled trays for every lunch served to elementary students over 4 lunch periods. Two analysts visually estimated the amount of each item consumed from every tray, and those estimates were compared to evaluate interrater reliability. Results: Collection of photographic data was rapid and did not disrupt the busy elementary cafeteria setting. Analysts’ estimates of consumption levels of meal components (main and side dishes) were within 10% of each other in 92% of the cases. Only 0.2% of items could not be analyzed due to children playing with food or otherwise obstructed photographs. Conclusions: Digital photography offers researchers and school food service personnel a highly accurate and cost-effective tool to measure actual consumption of school cafeteria meals. Data collected through this method can be evaluated by simple counts of servings of produce or other food groups or by more detailed analyses of nutritional composition.

Exposure to asphalt fumes is widely recognized as a potential occupational health concern for paving and roofing workers. Two studies suggest that asphalt fumes generated in the laboratory are carcinogenic to mice. In this study, asphalt fume condensate (AFC) was collected from the head space of an operating hot mix asphalt storage tank and from a laboratory fume-generating apparatus operating at approximately 149 degrees C and 316 degrees C. Salmonella assays for mutagenesis, in vitro chromosomal aberration assays using Chinese hamster ovary (CHO) cells, chemical analyses, and simulated distillations were performed using gas chromatography to characterize the toxicological and chemical properties of AFCs generated by these two methods. The 316 degrees C lab AFC sample was more mutagenic in the Salmonella assay than the 149 degrees C lab AFC sample, with mutagenicity indices (MIs) of 8.3 and 5.3, respectively. AFCs collected from the storage tank were not mutagenic. Chromosomal aberration assays of all AFCs were negative. Chemical analyses and simulated distillations showed substantial differences in the chemical composition of the AFC samples. The 316 degrees C lab AFC sample contained more higher-boiling-point (three- and four-ring) polycyclic aromatic sulfur heterocycle compounds than the 149 degrees C lab AFC sample, and both lab AFC samples contained 5 to 100 times more of these compounds than AFC samples collected from the asphalt storage tank. These results are consistent with other data reported in the scientific literature describing the carcinogenicity of higher-boiling-point sulfur heterocycle compounds. In contrast to other recent studies, the results of this study indicate that the chemical composition and toxicological properties of laboratory-generated asphalt fumes are not representative of those properties of fumes to which workers and the public might be exposed.

Extensive attention has been focused on improving the dietary intake of Americans. Such focus is warranted due to increasing rates of overweight, obesity, and other dietary-related disease. To address suboptimal dietary intake requires an improved, contextualized understanding of the multiple and intersecting influences on healthy eating, particularly among those populations at greatest risk of and from poor diet, including rural residents.During 8 focus groups (N = 99) and 6 group key informant interviews (N = 20), diverse Appalachian rural residents were queried about their perceptions of healthy eating, determinants of healthy food intake, and recommendations for improving the dietary intake of people in their communities. Participants included church members and other laypeople, public health officials, social service providers, health care professionals, and others.Participants offered insights on healthy eating consistent with the categories of individual, interpersonal, community, physical, environmental, and society-level influences described in the socioecological model. Although many participants identified gaps in dietary knowledge as a persistent problem, informants also identified extraindividual factors, including the influence of family, fellow church members, and schools, policy, advertising and media, and general societal trends, as challenges to healthy dietary intake. We highlight Appalachian residents' recommendations for promoting healthier diets, including support groups, educational workshops, cooking classes, and community gardening.We discuss the implications of these findings for programmatic development in the Appalachian context.

Objective Patterns of overweight and obesity have an unequal geographic distribution, and there are elevated rates in Appalachia. Perceptions of Appalachian youth toward healthful eating and influences on food choice were examined as part of formative research to address these disparities. Methods Eleven focus groups, averaging 6 youth (n = 68) and moderated by experienced local residents, were conducted with participants aged 8–17. Session transcripts were coded for thematic analysis, using measures to enhance rigor and transferability. Results Participants discussed numerous internal and external factors affecting dietary choices. They expressed confidence in their own nutritional knowledge, and they stressed the importance of taste preferences, cost, convenience, social influences, and advertising on diet. Conclusions and Implications Appalachian youth awareness of the multiple influences on diet may create opportunities for multifaceted, ecologically based interventions. In particular, participants stressed the importance of social influences on diet and on successful nutrition programming.

Purpose. Despite the well-established benefits of physical activity (PA), most Americans, especially those in rural, traditionally underserved areas, engage in considerably less PA than recommended. This study examines perceived barriers to and facilitators of PA and promising organized PA programs among rural Appalachians. Design. Eight focus groups and seven group key informant interviews were conducted. Setting. This study was conducted in eastern Kentucky, in central Appalachia. Subjects. One hundred and fourteen rural Appalachian residents (74% female, 91% white) participated. Measures. Open-ended, semistructured, and structured questions regarding perceptions of, barriers to/facilitators of, and examples of successful/failed PA programs were asked. Analysis. Qualitative data analysis was conducted, including codebook development and steps taken to ensure rigor and transferability. Interrater reliability was over 94%. Results. In addition to barriers that are consistent with those found in other populations, rural Appalachian residents indicated that travel time, family commitments, and inadequate community resources undermine PA. Suggested avenues to increase PA include partnership with churches and the U.S. Department of Agriculture's Cooperative Extension Service; programs that include families, are well advertised, and focus on health rather than appearance; and, underlying all suggestions, culturally relevant yet nonstereotyping activities. Conclusions. When developing PA interventions in rural Appalachia, it is important to employ community-based participatory approaches that leverage unique assets of the population and show potential in overcoming challenges to PA.

We examined how slicing apples and oranges affected elementary students' selection and consumption of fruit. Slicing increased the percentage of children selecting and consuming oranges, while a similar effect was not found for apples. The impact of slicing fruit was greatest among younger students. These findings suggest that school cafeterias can increase accessibility and consumption of foods through simple, inexpensive food preparation techniques, with the impact of such measures varying by foods and student characteristics.

This chapter introduces the text at the center of the inquiry, the anonymous Melkite apology found in Sinai Arabic MS 154 and entitled by its first editor On the Triune Nature of God. After that, it gives some illustrations of the range of uses of scripture found in this text. In a final section, the chapter focuses on the early Melkite literature's use of the ancient Christian literary genre of testimonia, that is, of collections of Old Testament 'prophesies' of or 'witnesses' to the life of Christ and to Christian doctrines and practices. These Old Testament texts are often referred to as 'proof-texts', but this chapter argues that, in our literature, they function in ways that move far 'beyond prooftexting'.Keywords: Christ; Christian doctrines; Christian literary genre; God; Old Testament texts; scripture; testimonia

Recent terrorist bomb attacks on buildings have resulted in increased interest in the protection of key buildings. Various research programs have provided improved design and analysis techniques as well as new mitigation methods. Advanced finite element methods provide the best analytical results because they can take into account the time varying load, dynamic structural response, non-liner material properties, and the non-linear interaction of various response modes (e.g., shear and flexure). These methods require not only time but also specialized expertise to obtain good results. They are therefore generally unpractical for typical blast design problems. Simplified methods can provide reasonable approximations that are adequate for design. A variety of types of simplified models exist. Typical models include single or multi-degree-of-freedom, pressure-impulse (P-I) diagrams, and response surfaces developed from finite element analyses. This paper describes some recently developed simplified models and associated research.

This paper presents a field case study describing how 3-D geological data are used in reservoir simulation to improve performance forecast and help optimize the development of the Serang Field, East Kalimantan, Indonesia. The Serang field consists of complex stacked fluvial and deltaic channel sands under a large gas cap and over a strong aquifer. Development of the field is a challenge with the reservoir heterogeneity nature of the sands and the dynamic movement of fluid flow. Reservoir management is even more difficult as the originally thick oil columns have now become thinner with long-term production as adding infill wells or planning workovers require more accuracy for target locations. The study demonstrates the workflow involved in integrating the 3D geological data for constructing a reservoir model for field management. The model constructed helps explain the reservoir fluid flow behavior, identify by-passed oil under reservoir heterogeneity, plan for infill locations and workovers and long-term development strategy of the field. It shows the key benefits include a faster work process of building a reliable model that accounts for crucial heterogeneity, flexibility in varying reservoir properties with new data, and quicker history matching of the production data. These allow for quick turn-around to evaluate multiple development plans while improving production forecast. The paper also discusses the practical and operational use of the model results in planning, implementing and operating wells for optimizing oil and gas recoveries.

This report presents the transcripts of oral history interviews conducted as part of an effort to document the construction and World War II-era operations of the Holston Army Ammunition Plant (HAAP), Kingsport, Tennessee. This project was undertaken as part of a larger Legacy Resource Program demonstration project to assist small installations and to aid in the completion of mitigation efforts set up in a 1993 Programmatic Agreement among the Army Materiel Command, the Advisory Council on Historic Preservation, and Multiple State Historic Preservation Officers concerning a program to cease maintenance, excess, and dispose of particular properties. The major focus of the project at HAAP was to document the impacts that the construction and World War II operation of the facility had on the state and local environments.

Not long ago, the management of age-related macular degeneration (AMD) was confined to rehabilitating whatever vision had not been damaged by the disease. The recent suc - cesses of the anti-vascular endothelial growth factor agents and the antioxidant clinical trials have revolutionized AMD treatment. For the first time, there is realistic hope that the progression of AMD can be slowed down or stopped and near normal vision can be preserved. Developments in new vision tests, imaging modalities, and genetic testing have greatly improved the chance of detecting the onset of AMD and choroidal neovascularization. However, because the current treatments still cannot revive degenerated retinal cells, the best patient outcome that can be achieved is early detection of the disease and application of the appropriate treatment before too much retinal damage has occurred. The opportunities and challenges offered by the new treat- ment options and disease detection methods have redefined the role of primary care optometrists in AMD management. This review of literature and practice guidelines demonstrates that, in addition to the traditional roles of refraction and visual rehabilitation, the unique position of optometrists as the first-line eye-care providers has allowed them to play an important role in the early detection of AMD, patient education, lifestyle-change counseling, disease monitor- ing and referral, and nutrition supplement counseling. The active participation of primary care optometrists in the shared care of AMD management is likely to result in great improvement in patient outcomes. Optometrists also need to improve their competence in these areas to meet the new challenges. Although primary care optometrists have always managed patients with AMD, their role in managing this sight-threatening disease has not been adequately documented. In light of the recent game-changing developments in AMD treatment, it is important to review what primary care optometrists are doing, what they can do, and what they should do to improve patient outcomes in the new era of AMD management.

Objective. —To evaluate the persistence of effects on health and development at age 5 years of the Infant Health and Development Program, an early childhood intervention that was provided to low-birth-weight (LBW) premature infants from neonatal discharge through age 3 years. Design. —Randomized, controlled, multicenter trial, stratified by two LBW groups: lighter (≤2000 g) and heavier (2001 to 2500 g). Setting. —Eight socioeconomically heterogeneous clinical sites. Participants. —Of 985 eligible infants weighing 2500 g or less and at 37 weeks' or less gestational age, 377 infants were randomly assigned to the intervention group and 608 to the follow-up only group. About two thirds of the infants in each group were in the lighter LBW stratum, and one third were in the heavier LBW stratum. Intervention. —The intervention group received home visits (from neonatal discharge through age 3 years) as well as center-based schooling (from 1 to 3 years of age). Children in both groups received pediatric surveillance. Main Outcome Measures. —Cognitive development, behavioral competence, and health status. Results. —At age 5 years, the intervention group had full-scale IQ scores similar to children in the follow-up only group. However, in the heavier LBW stratum, children in the intervention group had higher full-scale IQ scores (3.7 points higher;P=.03) and higher verbal IQ scores (4.2 points higher;P=.02). No significant differences between intervention and follow-up only groups in cognitive measures at age 5 years were noted in the lighter LBW infants. The intervention and follow-up groups were similar in behavior and health measures regardless of LBW stratum. Conclusion. —The early childhood intervention provided in the first 3 years of life had effects on heavier LBW premature infants' IQ and verbal performance at age 5 years that were not observed for lighter LBW premature infants. The intervention did not affect health or behavior at age 5 years in either LBW stratum. (JAMA. 1994;272:1257-1262)