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Tobacco use has detrimental effects on health, including oral health. The emergence and increasing popularity of newer tobacco and nicotine products make tobacco use one of the major public health problems in the world. Tobacco use increases the risk of oral diseases such as oral cancer, oral mucosal lesions, periodontal disease, and dental caries, among many other oral diseases and conditions. The dental office is an excellent venue for providing cessation intervention. However, there is a lack of knowledge and training in tobacco use prevention among dental professionals. More efforts are needed for smoking cessation interventions in the dental office. Smoking cessation interventions provided by oral healthcare providers include brief educational, behavioral, and pharmacological interventions. This review provides an overview of the ill effects of tobacco use on oral health and the role of oral healthcare providers in managing and preventing tobacco dependence. [ABSTRACT FROM AUTHOR]

We investigate the occurrence of the "extended solar cycle" (ESC) as it occurs in a host of observational data spanning 140 years. Investigating coronal, chromospheric, photospheric, and interior diagnostics, we develop a consistent picture of solar activity migration linked to the 22-year Hale (magnetic) cycle using superposed epoch analysis (SEA) and previously identified Hale cycle termination events as the key time for the SEA. Our analysis shows that the ESC and Hale cycle, as highlighted by the terminator-keyed SEA, is strongly recurrent throughout the entire observational record studied, some 140 years. Applying the same SEA method to the sunspot record confirms that Maunder's butterfly pattern is a subset of the underlying Hale cycle, strongly suggesting that the production of sunspots is not the fundamental feature of the Hale cycle, but the ESC is. The ESC (and Hale cycle) pattern highlights the importance of 55 ∘ latitude in the evolution, and possible production, of solar magnetism. [ABSTRACT FROM AUTHOR]

Booth (Solar Phys.296, 108, 2021; hereafter B21) is essentially a critique of the Hilbert transform techniques used in our paper (Leamon et al., Solar Phys.295, 36, 2020; hereafter L20) to predict the termination of solar cycles. Here we respond to his arguments; our methodology and parameter choices do extract a mathematically robust signature of terminators from the historical sunspot record. We agree that the attempt in L20 to extrapolate beyond the sunspot record gives a failed prediction for the next terminator of May 2020, and we identify both a possible cause and remedy here. However, we disagree with the B21 assessment that the likely termination of Solar Cycle 24 is two years after the date predicted in L20, and we show why. [ABSTRACT FROM AUTHOR]

In this work, we derive magnetic toroids from surface magnetograms by employing a novel optimization method, based on the trust region reflective algorithm. The toroids obtained in this way are combinations of Fourier modes (amplitudes and phases) with low longitudinal wavenumbers. The optimization also estimates the latitudinal width of the toroids. We validate the method using synthetic data, generated as random numbers along a specified toroid. We compute the shapes and latitudinal widths of the toroids via magnetograms, generally requiring several m's to minimize residuals. A threshold field strength is chosen to include all active regions in the magnetograms for toroid derivation, while avoiding non-contributing weaker fields. Higher thresholds yield narrower toroids, with an m = 1 dominant pattern. We determine the spatiotemporal evolution of toroids by optimally weighting the amplitudes and phases of each Fourier mode for a sequence of five Carrington Rotations (CRs) to achieve the best amplitude and phases for the middle CR in the sequence. Taking more than five causes "smearing" or degradation of the toroid structure. While this method applies no matter the depth at which the toroids actually reside inside the Sun, by comparing their global shape and width with analogous patterns derived from magnetohydrodynamic (MHD) tachocline shallow water model simulations, we infer that their origin is at/near the convection zone base. By analyzing the "Halloween" storms as an example, we describe features of toroids that may have caused the series of space weather events in 2003 October–November. Calculations of toroids for several sunspot cycles will enable us to find similarities/differences in toroids for different major space weather events. [ABSTRACT FROM AUTHOR]

The Sun provides the energy required to sustain life on Earth and drive our planet's atmospheric circulation. However, establishing a solid physical connection between solar and tropospheric variability has posed a considerable challenge. The canon of solar variability is derived from the 400 years of observations that demonstrates the waxing and waning number of sunspots over an 11(‐ish) year period. Recent research has demonstrated the significance of the underlying 22 years magnetic polarity cycle in establishing the shorter sunspot cycle. Integral to the manifestation of the latter is the spatiotemporal overlapping and migration of oppositely polarized magnetic bands. We demonstrate the impact of "terminators"—the end of Hale magnetic cycles—on the Sun's radiative output and particulate shielding of our atmosphere through the rapid global reconfiguration of solar magnetism. Using direct observation and proxies of solar activity going back some six decades we can, with high statistical significance, demonstrate a correlation between the occurrence of terminators and the largest swings of Earth's oceanic indices: the transition from El Niño to La Niña states of the central Pacific. This empirical relationship is a potential source of increased predictive skill for the understanding of El Niño climate variations, a high‐stakes societal imperative given that El Niño impacts lives, property, and economic activity around the globe. A forecast of the Sun's global behavior places the next solar cycle termination in mid‐2020; should a major oceanic swing follow, then the challenge becomes: when does correlation become causation and how does the process work? Key Points: A solar cycle's fiducial clock does not run from the canonical min or max, instead resetting when all old cycle polarity flux is goneObservations over many solar cycles indicate that warm‐to‐cold transitions in the state of ENSO are correlated to the phase of this clockCycle 24 is projected to end in mid‐late 2020. Based on historical correlations, we anticipate a transition to La Niña at that time [ABSTRACT FROM AUTHOR]

The Sun exhibits a well-observed modulation in the number of spots on its disk over a period of about 11 years. From the dawn of modern observational astronomy, sunspots have presented a challenge to understanding—their quasi-periodic variation in number, first noted 175 years ago, has stimulated community-wide interest to this day. A large number of techniques are able to explain the temporal landmarks, (geometric) shape, and amplitude of sunspot "cycles," however, forecasting these features accurately in advance remains elusive. Recent observationally-motivated studies have illustrated a relationship between the Sun's 22-year (Hale) magnetic cycle and the production of the sunspot cycle landmarks and patterns, but not the amplitude of the sunspot cycle. Using (discrete) Hilbert transforms on more than 270 years of (monthly) sunspot numbers we robustly identify the so-called "termination" events that mark the end of the previous 11-yr sunspot cycle, the enhancement/acceleration of the present cycle, and the end of 22-yr magnetic activity cycles. Using these we extract a relationship between the temporal spacing of terminators and the magnitude of sunspot cycles. Given this relationship and our prediction of a terminator event in 2020, we deduce that sunspot Solar Cycle 25 could have a magnitude that rivals the top few since records began. This outcome would be in stark contrast to the community consensus estimate of sunspot Solar Cycle 25 magnitude. [ABSTRACT FROM AUTHOR]

Culebra, a geographically isolated island located 17 miles from the eastern coast of Puerto Rico's main island, suffers from an amalgam of significant environmental health risk and associated social determinants of health that are affecting the community. In 2017, two major Hurricanes (Irma and María) impacted Culebra, resulting in an increase of preexisting environmental health risk. The present study's primary aim was to explore community attitudes, beliefs, and perceptions of environmental health risk, and to describe the social priorities of Culebrenses in relation to these risks and challenges. Semi-structured interview guide and Rapid Qualitative Inquiry (RQI) focused on topics of environmental health risk was followed. Qualitative focus groups and individual interviews were conducted among community members in Culebra before and shortly after Hurricanes Irma and María affected the island. Environmental health factors identified included: presence of mosquitoes, trash disposal, water quality and tourism. Additionally, a strong sentiment of island pride was found potentially generating a sense of community that could facilitate solutions to the existing environmental health challenges. Preexisting environmental health risk magnified after the pass of Hurricanes Irma and María. Sustainable and community engagement approaches are needed to develop strategies that can assist in the mitigation and resolution of the identified environmental health risk and challenges, including factors associated with threats such as disasters and pollution. [ABSTRACT FROM AUTHOR]

Recent research has demonstrated the existence of a new type of solar event, the "terminator." Unlike the Sun's signature events, flares and coronal mass ejections, the terminator most likely originates in the solar interior, at or near the tachocline. The terminator signals the end of a magnetic activity cycle at the Sun's equator and the start of a sunspot cycle at mid-latitudes. Observations indicate that the time difference between these events is very short, less than a solar rotation, in the context of the sunspot cycle. As the (definitive) start and end point of solar activity cycles the precise timing of terminators should permit new investigations into the meteorology of our star's atmosphere. In this article we use a standard method in signal processing, the Hilbert transform, to identify a mathematically robust signature of terminators in sunspot records and in radiative proxies. Using a linear extrapolation of the Hilbert phase of the sunspot number and F10.7 cm solar radio flux time series we can achieve higher fidelity historical terminator timing than previous estimates have permitted. Further, this method presents a unique opportunity to project, from analysis of sunspot data, when the next terminator will occur, May 2020 (+ 4 , −1.5 months), and trigger the growth of Sunspot Cycle 25. [ABSTRACT FROM AUTHOR]

Aim: The primary purpose of an avalanche airbag is to prevent burial during an avalanche. Approximately twenty percent of avalanche victims deploying airbags become critically buried, however. One avalanche airbag actively deflates three minutes after deployment, potentially creating an air pocket. Our objective was to evaluate this air pocket and its potential to prevent asphyxiation.Methods: Twelve participants were fitted with an airbag and placed prone on the snow. Participants deployed the airbag and were buried in 1.5 m of snow for 60 min with vital signs including oxygen saturation (SpO2) and end-tidal CO2 (ETCO2) measured every minute. Participants completed a post-burial survey to determine head movement within the air pocket.Results: Eleven of the 12 participants (92%) completed 60 min of burial. Preburial baseline SpO2 measurements did not change significantly over burial time (P > 0.05). Preburial baseline ETCO2 measurements increased over the burial time (P < 0.02); only one ETCO2 value was outside of the normal ETCO2 range (35-45 mmHg). Participants reported they could move their head forward 11.2 cm (SD 4.8 cm) and backward 6.6 cm (SD 5.1 cm) with the majority of participants stated that they had enough head movement to separate the oral cavity from opposing snow if necessary. Visual examination during extrication revealed a well-defined air pocket in all burials.Conclusion: The avalanche airbag under study creates an air pocket that appears to delay asphyxia, which could allow extra time for rescue and improve overall survival of avalanche victims. [ABSTRACT FROM AUTHOR]

INTRODUCTION Among US adults 40 years and older, about 23% report problems with their ability to smell, and 19% report problems with their ability to taste. Chemosenses are a first line of defence against environmental hazards (e.g. fires and leaking gas). A potential risk factor of chemosensory disorders includes nicotine product use, such as cigarette use. This study aims to assess the relationship of taste and smell alterations with type of recent nicotine product use (e.g. inhaled versus smokeless), recent cigarette use, and mentholation status based on data from NHANES 2013-2014. METHODS A total of 3186 men and women, 40 years and older, from NHANES 2013-2014 were assessed for smell and taste impairment, according to their recent nicotine product use. Taste impairment was identified as inability to identify quinine as bitter in the whole-mouth taste test. Impairment of smell was defined as failing to identify six or more of eight specific odors. Logistic regression models were adjusted for age, gender, and race/ethnicity. RESULTS Approximately 13% of participants failed the smell examination. No significant association between smell examination outcome and recent nicotine product use was found, though recent cigarette use showed a trend toward positive association (OR=1.66, 95% CI: 0.76-3.63) and mentholation status showed a trend toward negative association (OR=0.57, 95% CI: 0.22-1.49) on smell examination results. About 17% of participants failed the taste examination, and trends toward positive association were seen between taste examination outcomes and both recent nicotine product use (OR=1.28, 95% CI: 0.99-1.65) and recent cigarette use (OR=1.30, 95% CI: 0.50-3.40). CONCLUSIONS Findings indicate that recent use of nicotine products has an inconsistent relationship to dysfunctions in taste and smell. However, limiting the use of inhaled nicotine products, such as from cigarette use, could prove beneficial to a person's taste and smell ability. [ABSTRACT FROM AUTHOR]

The article examines issues in trademark legal disputes involving franchises in the U.S., particularly irreparable injury and injunctions. Also cited are the provisions of the Franchise Disclosure Document (FDD) regarding franchisor's trademarks, the definition of a franchise under the Federal Trade Commission (FTC) Rule on Franchising, and the traditional factors for injunctive relief like a possible threat of irreparable injury.

High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of highaltitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer. [ABSTRACT FROM AUTHOR]

We present a new tool, the Solar Eclipse Image Standardisation and Sequencing (SEISS), developed to process multi-source total solar eclipse images by adjusting them to the same standard of size, resolution, and orientation. Furthermore, by analysing the eclipse images, we can determine the relative time between the observations and order them to create a movie of the observed total solar eclipse sequence. We successfully processed images taken at the 14 November 2012 total solar eclipse that occurred in Queensland, Australia, and created a short eclipse proto-movie. The SEISS tool was developed for the Eclipse Megamovie Project (EMP: ), with the goal of processing thousands of images taken by the public during solar eclipse events. EMP is a collaboration among multiple institutes aiming to engage and advance the public interest in solar eclipses and the science of the Sun-Earth connection. [ABSTRACT FROM AUTHOR]

Joint Publication 1-02,Department of Defense Dictionary of Military and Associated Terms,defines instruments of national power as ‘All of the means available to the government in its pursuit of national objectives. They are expressed as diplomatic, economic, informational and military’. At the September 2014 Wales Summit, the Supreme Allied Commander in Europe described Russia’s recent use of one of these listed means as ‘the most amazing information warfare blitzkrieg we have ever seen in the history of information warfare’. The recent use of the Russian media to support this hybrid approach — via controlling the message, the narrative, and thus the perceptions of the Russian street regarding the nation’s aims — is evident to anyone with Internet access. [ABSTRACT FROM PUBLISHER]

Background: Telemedicine has enhanced care for children with illness in Rochester, NY, since May 2001, enabling 13,568 acute illness visits through December 2013. Prior findings included high parent satisfaction with childcare- and school-based telemedicine ('school telemedicine') and potential to replace 85% of office visits for illness. Urban neighborhood telemedicine ('neighborhood telemedicine') was designed to offer convenient care for illness episodes that school telemedicine often cannot serve because illness arises when children are at home or symptoms preclude attendance. This study was designed to characterize health problems prompting neighborhood telemedicine use and to assess parent perceptions of its value. Materials and Methods: A parent satisfaction instrument was developed with input from parents and providers. Neighborhood telemedicine was initiated in January 2009 and totaled 1,362 visits through November 2013. During a 29-month survey period through January 2012, 3,871 acute illness telemedicine visits were completed, 908 (23.5%) of them via neighborhood telemedicine. Instruments were completed for 392 (43.2%) of the 908 visits. Results: Neighborhood telemedicine comprised 27% of all telemedicine visits during the year of peak neighborhood activity. Almost all survey respondents were satisfied or highly satisfied with neighborhood visits (97.6%) and endorsed greater convenience than alternatives (94.5%). Conclusions: Family preferences and the high value placed on neighborhood telemedicine suggest such service is important, especially in health systems driven by patient values. Service provided by neighborhood telemedicine holds potential to meet a large demand for care of acute childhood illness. Financing reform to support patient-centered care (e.g., bundled payments) should encompass sustainable business models for this service. [ABSTRACT FROM AUTHOR]

Risk tolerance is a source of variation in physician decision-making. This variation, if independent of clinical concerns, can result in mistaken utilization of health services. To address such problems, it will be helpful to identify nonclinical factors of risk tolerance, particularly those amendable to intervention - regulatory focus theory suggests such a factor. This study tested whether regulatory focus affects risk tolerance among primary care physicians. Twenty-seven primary care physicians were assigned to promotion-focused or prevention focused manipulations and compared on the Risk Taking Attitudes in Medical Decision Making scale using a randomization test. Results provide evidence that physicians assigned to the promotion-focus manipulation adopted an attitude of greater risk tolerance than the physicians assigned to the prevention focused manipulation (P=0.01). The Cohen's d statistic was conventionally large at 0.92. Results imply that situational regulatory focus in primary care physicians affects risk tolerance and may thereby be a nonclinical source of practice variation. Results also provide marginal evidence that chronic regulatory focus is associated with risk tolerance (P=0.05), but the mechanism remains unclear. Research and intervention targeting physician risk tolerance may benefit by considering situational regulatory focus as an explanatory factor. [ABSTRACT FROM AUTHOR]

Among many other measurable quantities, the summer of 2009 saw a considerable low in the radiative output of the Sun that was temporally coincident with the largest cosmic-ray flux ever measured at 1 AU. Combining measurements and observations made by the Solar and Heliospheric Observatory (SOHO) and Solar Dynamics Observatory (SDO) spacecraft we begin to explore the complexities of the descending phase of solar cycle 23, through the 2009 minimum into the ascending phase of solar cycle 24. A hemispheric asymmetry in magnetic activity is clearly observed and its evolution monitored and the resulting (prolonged) magnetic imbalance must have had a considerable impact on the structure and energetics of the heliosphere. While we cannot uniquely tie the variance and scale of the surface magnetism to the dwindling radiative and particulate output of the star, or the increased cosmic-ray flux through the 2009 minimum, the timing of the decline and rapid recovery in early 2010 would appear to inextricably link them. These observations support a picture where the Sun's hemispheres are significantly out of phase with each other. Studying historical sunspot records with this picture in mind shows that the northern hemisphere has been leading since the middle of the last century and that the hemispheric "dominance" has changed twice in the past 130 years. The observations presented give clear cause for concern, especially with respect to our present understanding of the processes that produce the surface magnetism in the (hidden) solar interior-hemispheric asymmetry is the normal state-the strong symmetry shown in 1996 was abnormal. Further, these observations show that the mechanism(s) which create and transport the magnetic flux are slowly changing with time and, it appears, with only loose coupling across the equator such that those asymmetries can persist for a considerable time. As the current asymmetry persists and the basal energetics of the system continue to dwindle we anticipate new radiative and particulate lows coupled with increased cosmic-ray fluxes heading into the next solar minimum. [ABSTRACT FROM AUTHOR]

Background: Traditionally, physicians have identified which outcome factors are important to measure in order to determine the success or failure of treatment without any input from patients. The purpose of the present study was to ascertain the five outcome factors that are most important to the patient and the impact that age and sex have on these factors. These five most important patient-derived outcome factors were then compared with factors within two of the most commonly used outcome instruments for the foot and ankle. Methods: Informant interviews, pre-testing, consistency analysis, and pilot testing led to the construction of a twenty-item survey of outcome factors that patients identified as being important in the treatment of their foot or ankle problem. Subjects selected the top five factors and rank ordered them from 1 to 5 (with 1 representing extreme importance and 5 representing least importance). One thousand computer simulations identified the top five factors, and these were subsequently stratified for sex and age. Wilcoxon rank-sum and Benjamini-Hochberg tests were used to compare the data between groups. Results: The survey was completed by 783 subjects. The five most important factors were limited walking (p < 0.05), activity-related pain (p < 0.05), constant pain (p < 0.05), difficulty with prolonged standing (p = 0.754), and inability to do one's job or housework (p = 0.995). Shoe-related issues and foot and ankle weakness were significantly different between the sexes. Constant pain, inability to play sports, inability to participate in a job or housework, and recurrent foot or ankle skin sores or infections were significantly different between age groups. Between 38% and 50% of the outcome points found on two commonly used foot and ankle instruments included factors not of primary importance to the patient. Conclusions: There are sex and age-related differences regarding outcome factors following the treatment of disorders affecting the foot and ankle. As many as 50% of the factors in currently used foot and ankle outcome instruments are not of primary importance to patients. [ABSTRACT FROM AUTHOR]

AbstractScott E. McIntosh, Aaron Campbell, David Weber, Jennifer Dow, Elizabeth Joy, and Colin K. Grissom. Mountaineering Medical Events and Trauma on Denali, 1992–2011. High Alt Med Biol13:275–280, 2012.—Denali (Mt. McKinley) is the tallest mountain in North America and a popular climbing destination for high altitude mountaineering expeditions. National Park Service (NPS) personnel care for and manage medical incidences and traumatic injuries for mountaineers each year. We retrospectively examined NPS medical reports from the climbing seasons of 1992–2011. Medical complaints, diagnoses, treatment, provider training, and overall numbers of injuries and illness were analyzed. Fatalities were included only if they were cared for by NPS medical personnel prior to death. Of the 24,079 climbers on Denali during this period, 831 (3.5%) required medical assistance from the NPS. There were 819 diagnoses; 502 were due to medical illness and 317 were traumatic injuries. Patient encounters occurred most frequently (71%) at the 4328?m camp. Frostbite was the most common individual diagnosis (18.1%), while altitude-related syndromes were the most common illness category (29%). Most patients (84%) were treated and released to descend without additional intervention, whereas 11% needed air evacuation, and 4% needed another type of NPS assistance to descend. The only fatality in this series was caused by traumatic brain injury due to a climbing fall. A broad variety of medical complaints were evaluated and treated by NPS personnel, most commonly altitude related problems and frostbite. The results of the study will enhance the awareness of potential illness and injuries encountered by medical providers participating in high altitude mountaineering expeditions. Additionally, providers responsible for evaluating mountaineers prior to their expeditions can educate them on the spectrum of physical and environmental conditions that increase the chances of illness or injury. This ideally will decrease the incidence of morbidity on both Denali and other high altitude mountaineering destinations. [ABSTRACT FROM AUTHOR]

We take stock of recent observations that identify the episodic plasma heating and injection of Alfvénic energy at the base of fast solar wind (in coronal holes). The plasma heating is associated with the occurrence of chromospheric spicules that leave the lower solar atmosphere at speeds of order 100 km/s, the hotter coronal counterpart of the spicule emits radiation characteristic of root heating that rapidly reaches temperatures of the order of 1 MK. Furthermore, the same spicules and their coronal counterparts (“Propagating Coronal Disturbances”; PCD) exhibit large amplitude, high speed, Alfvénic (transverse) motion of sufficient energy content to accelerate the material to high speeds. We propose that these (disjointed) heating and accelerating components form a one-two punch to supply, and then accelerate, the fast solar wind. We consider some compositional constraints on this concept, extend the premise to the slow solar wind, and identify future avenues of exploration. [ABSTRACT FROM AUTHOR]

This analysis begins to explore the complex chromosphere-corona mass cycle using a blend of imaging and spectroscopic diagnostics. Single Gaussian fits (SGFs) to hot emission line profiles (formed above 1MK) at the base of coronal loop structures indicate material blueshifts of 5-10 km s-1, while cool emission line profiles (formed below 1 MK) yield redshifts of a similar magnitude--indicating, to zeroth order, that a temperature-dependent bifurcating flow exists on coronal structures. Image sequences of the same region reveal weakly emitting upward propagating disturbances in both hot and cool emission with apparent speeds of 50-150 km s-1. Spectroscopic observations indicate that these propagating disturbances produce a weak emission component in the blue wing at commensurate speed, but that they contribute only a few percent to the (ensemble) emission line profile in a single spatio-temporal resolution element. Subsequent analysis of imaging data shows material "draining" slowly (~10 km s-1) out of the corona, but only in the cooler passbands. We interpret the draining as the return flow of coronal material at the end of the complex chromosphere-corona mass cycle. Further, we suggest that the efficient radiative cooling of the draining material produces a significant contribution to the red wing of cool emission lines that is ultimately responsible for their systematic redshift as derived from an SGF when compared to those formed in hotter (conductively dominated) domains. The presence of counterstreaming flows complicates the line profiles, their interpretation, and asymmetry diagnoses, but allows a different physical picture of the lower corona to develop. [ABSTRACT FROM AUTHOR]

Solar eruptions, particularly coronal mass ejections (CMEs) and extreme-ultraviolet (EUV) jets, have rarely been investigated with spectroscopic observations. We analyze several data sets obtained by the EUV Imaging Spectrometer on board Hinode and find various types of flows during CMEs and jet eruptions. CME-induced dimming regions are found to be characterized by significant blueshift and enhanced line width by using a single Gaussian fit, while a red-blue (RB) asymmetry analysis and an RB-guided double Gaussian fit of the coronal line profiles indicate that these are likely caused by the superposition of a strong background emission component and a relatively weak (~10%), high-speed (~100 km s-1) upflow component. This finding suggests that the outflow velocity in the dimming region is probably of the order of 100 km s-1, not ~20 km s-1 as reported previously. These weak, high-speed outflows may provide a significant amount of mass to refill the corona after the eruption of CMEs, and part of them may experience further acceleration and eventually become solar wind streams that can serve as an additional momentum source of the associated CMEs. Density and temperature diagnostics of the dimming region suggest that dimming is primarily an effect of density decrease rather than temperature change. The mass losses in dimming regions as estimated from different methods are roughly consistent with each other, and they are 20%-60% of the masses of the associated CMEs. With the guide of RB asymmetry analysis, we also find several temperature-dependent outflows (speed increases with temperature) immediately outside the (deepest) dimming region. These outflows may be evaporation flows that are caused by the enhanced thermal conduction or nonthermal electron beams along reconnecting field lines, or induced by the interaction between the opened field lines in the dimming region and the closed loops in the surrounding plage region. In an erupted CME loop and an EUV jet, profiles of emission lines formed at coronal and transition region temperatures are found to exhibit two well-separated components, an almost stationary component accounting for the background emission and a highly blueshifted (~200 km s-1) component representing emission from the erupting material. The two components can easily be decomposed through a double Gaussian fit, and we can diagnose the electron density, temperature, and mass of the ejecta. Combining the speed of the blueshifted component and the projected speed of the erupting material derived from simultaneous imaging observations, we can calculate the real speed of the ejecta. [ABSTRACT FROM AUTHOR]

Recent spectroscopic observations have revealed the ubiquitous presence of blueward asymmetries of emission lines formed in the solar corona and transition region. These asymmetries are most prominent in loop footpoint regions, where a clear correlation of the asymmetry with the Doppler shift and line width determined from the single-Gaussian fit is found. Such asymmetries suggest at least two emission components: a primary component accounting for the background emission and a secondary component associated with high-speed upflows. The latter has been proposed to play a vital role in the coronal heating process and there is no agreement on its properties. Here we slightly modify the initially developed technique of red-blue (RB) asymmetry analysis and apply it to both artificial spectra and spectra observed by the Extreme-ultraviolet Imaging Spectrometer on board Hinode, and demonstrate that the secondary component usually contributes a few percent of the total emission, and has a velocity ranging from 50 to 150 km s-1 and a Gaussian width comparable to that of the primary one in loop footpoint regions. The results of the RB asymmetry analysis are then used to guide a double-Gaussian fit and we find that the obtained properties of the secondary component are generally consistent with those obtained from the RB asymmetry analysis. Through a comparison of the location, relative intensity, and velocity distribution of the blueward secondary component with the properties of the upward propagating disturbances revealed in simultaneous images from the Atmospheric Imaging Assembly on board the Solar Dynamics Observatory, we find a clear association of the secondary component with the propagating disturbances. [ABSTRACT FROM AUTHOR]

Observations from the Atmospheric Imaging Assembly onboard the Solar Dynamics Observatory reveal ubiquitous episodic outflows (jets) with an average speed around 120 km s-1 at temperatures often exceeding a million degree in plume-like structures, rooted in magnetized regions of the quiet solar atmosphere. These outflows are not restricted to the well-known plumes visible in polar coronal holes, but are also present in plume-like structures originating from equatorial coronal holes and quiet-Sun (QS) regions. Outflows are also visible in the "inter-plume" regions throughout the atmosphere. Furthermore, the structures traced out by these flows in both plume and inter-plume regions continually exhibit transverse (Alfvénic) motion. Our finding suggests that high-speed outflows originate mainly from the magnetic network of the QS and coronal holes (CHs), and that the plume flows observed are highlighted by the denser plasma contained therein. These outflows might be an efficient means to provide heated mass into the corona and serve as an important source of mass supply to the solar wind. We demonstrate that the QS plume flows can sometimes significantly contaminate the spectroscopic observations of the adjacent CHs--greatly affecting the Doppler shifts observed, thus potentially impacting significant investigations of such regions. [ABSTRACT FROM AUTHOR]

Energy is required to heat the outer solar atmosphere to millions of degrees (refs 1, 2) and to accelerate the solar wind to hundreds of kilometres per second (refs 2-6). Alfvén waves (travelling oscillations of ions and magnetic field) have been invoked as a possible mechanism to transport magneto-convective energy upwards along the Sun's magnetic field lines into the corona. Previous observations of Alfvénic waves in the corona revealed amplitudes far too small (0.5?km?s?1) to supply the energy flux (100-200?W?m?2) required to drive the fast solar wind or balance the radiative losses of the quiet corona. Here we report observations of the transition region (between the chromosphere and the corona) and of the corona that reveal how Alfvénic motions permeate the dynamic and finely structured outer solar atmosphere. The ubiquitous outward-propagating Alfvénic motions observed have amplitudes of the order of 20?km?s?1 and periods of the order of 100-500?s throughout the quiescent atmosphere (compatible with recent investigations), and are energetic enough to accelerate the fast solar wind and heat the quiet corona. [ABSTRACT FROM AUTHOR]

We present the application of novel diagnostics to the spectroscopic observation of a Coronal Mass Ejection (CME) on disk by the Extreme Ultraviolet Imaging Spectrometer (EIS) on the Hinode spacecraft. We apply a recently developed line profile asymmetry analysis to the spectroscopic observation of NOAA AR 10930 on 14 – 15 December 2006 to three raster observations before and during the eruption of a 1000 km s−1 halo CME. We see the impact that the observer’s line-of-sight and magnetic field geometry have on the diagnostics used. Further, and more importantly, we identify the on-disk signature of a high-speed outflow behind the CME in the dimming region arising as a result of the eruption. Supported by recent coronal observations of the STEREO spacecraft, we speculate about the momentum flux resulting from this outflow as a secondary momentum source to the CME. The results presented highlight the importance of spectroscopic measurements in relation to CME kinematics, and the need for full-disk synoptic spectroscopic observations of the coronal and chromospheric plasmas to capture the signature of such explosive energy release as a way of providing better constraints of CME propagation times to L1, or any other point of interest in the heliosphere. [ABSTRACT FROM AUTHOR]

We consider the problem of automatically (and robustly) isolating and extracting information about waves and oscillations observed in EUV image sequences of the solar corona with a view to near real-time application to data from the Atmospheric Imaging Array (AIA) on the Solar Dynamics Observatory (SDO). We find that a simple coherence/travel-time based approach detects and provides a wealth of information on transverse and longitudinal wave phenomena in the test sequences provided by the Transition Region and Coronal Explorer (TRACE). The results of the search are pruned (based on diagnostic errors) to minimize false-detections such that the remainder provides robust measurements of waves in the solar corona, with the calculated propagation speed allowing automated distinction between various wave modes. In this paper we discuss the technique, present results on the TRACE test sequences, and describe how our method can be used to automatically process the enormous flow of data (≈1 Tb day−1) that will be provided by SDO/AIA. [ABSTRACT FROM AUTHOR]

The current ethical structure for collaborative international health research stems largely from developed countries’ standards of proper ethical practices. The result is that ethical committees in developing countries are required to adhere to standards that might impose practices that conflict with local culture and unintended interpretations of ethics, treatments, and research. This paper presents a case example of a joint international research project that successfully established inclusive ethical review processes as well as other groundwork and components necessary for the conduct of human behavior research and research capacity building in the host country. [ABSTRACT FROM AUTHOR]

The article focuses on building a second-half team aimed to secure cultural expertise for the battle space in the U.S. According to the author, the U.S. and its allies have necessarily adapted to a new form of urban and asymmetric warfare preferred by the enemy. He stresses that to remain effective, U.S. needs nonkinetic solutions informed by cultural expertise to meet its national security objectives in present and future conflicts.

Others have examined hypercapnia with air pockets ranging from zero to 4 L,[[2]] but to our knowledge no study has examined air pockets of moderate size. These densities were measured near the surface of the snow pack to avoid disrupting the integrity of the air pocket and may be slightly different than the actual snow density close to the participant and air pocket. [Extracted from the article]

Physician office settings play an important role in tobacco cessation intervention. However, few tobacco cessation trials are conducted at these sites, in part because of the many challenges associated with recruiting community physician offices into research. The present study identified and implemented strategies for recruiting physician offices into a randomized clinical trial of tobacco screening and cessation interventions with adolescent patients. A total of 30 community physicians participated in focus groups to elicit their perceptions of facilitators of and barriers to initial engagement of physician practices and the subsequent enrollment of the practices in long‐term research projects. Physicians identified facilitators such as (a) the involvement of office staff in the recruitment process and (b) on‐site presentations of the study's background and aims. Some of the barriers identified were time commitment concerns and the lack of incentives in exchange for participation. These focus group findings were then integrated with theory‐based and empirically driven recruitment strategies for a 12‐month randomized tobacco intervention trial with adolescent patients. Of 185 office practices approached to participate (screened from a pool of 273 practices), 103 agreed to on‐site presentations of the study. Subsequently, almost all of the practices (101) that received the presentation agreed to enroll in the study. Conclusions are that (a) recruitment is a multicomponent process, (b) the processes of communication, engagement, and enrollment must be carefully planned and implemented to achieve maximal results, and (c) the development of effective strategies for recruiting health care provider practices presents an important infrastructure for testing adolescent smoking cessation interventions. [ABSTRACT FROM AUTHOR]

We discuss early results derived from an algorithm that automates the detection, cataloging, and analysis of extreme-ultraviolet (EUV) “bright points” (BP) from 9 years of data acquired by the Extreme-ultraviolet Imaging Telescope (EIT) on the Solar and Heliospheric Observatory (SOHO). The algorithm relies upon the computation of a map of “intensity significance”; this then contains the location of the EUV BPs. By mapping the location of BPs in each image and linking them through long sequences of EIT images we can describe the temporal and spatial variations of the 1.3× 108 EUV BPs observed by SOHO to date. We suggest that there is a considerable amount of physical information about the solar coronal plasma that can be readily gleamed from the BP detection database. In this paper we discuss only a small portion of the possible correlations, but we point to the possibility of BP lifetime distributions that are well described by modified power-laws; the components of which vary with the different temperature filters and with time over the present solar cycle. [ABSTRACT FROM AUTHOR]

The current paper focuses on the process evaluation of recruitment strategies and success in a large study of self-help smoking interventions with mid-life and older smokers in a 15-county area. Recruitment 'channels' were examined: (1) multiple paid newspaper advertisements, (2) free media (i.e., TV and radio), (3) referrals, (4) HMO newsletters, (5) targeted mailings, (6) face-to-face, and (7) passive recruitment. Data were analyzed to determine (1) which channels produced the greatest numbers of information requests, or initial 'recruits', and (2) which produced the greatest number of enrolled subjects. Overall, four channels resulted in the enrollment of 96.4% of the final sample of 1972 subjects. The most reliable, cost-controlled channel was paid newspaper advertisements ($18-19 per enrolled subject), while face-to-face recruitment was inefficient and costly (over $140 per subject). Results can be used to help guide other studies in selecting recruitment strategies for large, geographically diverse, smoking intervention trials. [ABSTRACT FROM AUTHOR]

To inform policy and messaging, this study examined characteristics of adolescents' and young adults' (AYAs') exposure to and engagement with nicotine and tobacco product (NTP) social media (SM) content. In this cross-sectional survey study, AYAs aged 13–26 (N=1,163) reported current NTP use, SM use frequency, and exposure to and engagement with SM content promoting and opposing NTP use (i.e. frequency, source[s], format[s], platform[s]). Participants who used NTPs (vs. did not use) were more likely to report having seen NTP content (p-values<.001). Prevalent sources were companies/brands (46.6%) and influencers (44.4%); prevalent formats were video (65.4%) and image (50.7%). Exposure to content promoting NTP use was prevalent on several popular platforms (e.g. TikTok, Instagram, Snapchat); exposure to content opposing NTP use was most prevalent on YouTube (75.8%). Among those reporting content engagement (i.e. liking, commenting on, or sharing NTP content; 34.6%), 57.2% engaged with influencer content. Participants reported engaging with content promoting and opposing NTP use on popular platforms (e.g. TikTok, Instagram, YouTube). Participants with (versus without) current NTP use were significantly more likely to use most SM platforms and to report NTP content exposure and engagement (p-values<.05). Results suggest that NTP education messaging and enforcement of platforms' content restrictions are needed. [ABSTRACT FROM AUTHOR]

Introduction: Secondhand smoke (SHS) exposure poses risks to pregnant women and children. Though smoking among pregnant women in many low- and middle-income countries is low, exposure to SHS might be higher. We examined the prevalence and predictors of SHS among pregnant women from Costa Rica, the Dominican Republic, and Honduras.Methods: Postpartum women 18+ years old who completed pregnancy in past 5 years were surveyed in health care and community settings.Results: Data for 1,081 women indicated low tobacco use (1.0%-3.7%), frequent exposure to active smokers (29.0%-34.0%), often being close enough to breathe others' smoke (49.4%-66.5%), and most having smoke-free home policies (70.8%-76.2%). Women reporting unintended pregnancy (adjusted odds ratio [aOR]: 1.44, 95% confidence interval [CI] 1.03, 2.00) and alcohol consumption (aOR: 1.92, 95% CI 1.34, 2.77) were more likely to be close enough to breathe others' smoke. Women with health problems during pregnancy (aOR: 1.48 95% CI 1.07, 2.06) were more likely to have home smoking policies. Tobacco use was associated with all SHS exposure outcomes.Conclusions: SHS exposure was high during pregnancy; women with higher risk variables, that is, tobacco use, alcohol consumption, and unintended pregnancy were more likely to be exposed. Addressing SHS exposure in pregnancy in low- and middle-income countries can improve maternal health outcomes in vulnerable populations.Implications: The study results suggest a cluster of multiple risk factors associated with a high prevalence of exposure to SHS among pregnant women in LIMCs from Latin America and Caribbean Region. Interventions, regulations, and policies need to address specific high-risk factors to change behaviors and improve maternal and child health outcomes especially in vulnerable populations. [ABSTRACT FROM AUTHOR]

Abstract: Air in the spinal canal after trauma is uncommon. We report a case of a motor vehicle accident resulting in a thoracic fracture-dislocation. Air was discovered within the spinal canal on a computed tomography (CT) scan. This injury pattern proved to be a diagnostic dilemma because multiple etiologies existed. Pneumothorax, ruptured esophagus, facial sinus fractures, and herniated vertebral discs can result in this entity. [Copyright &y& Elsevier]

We observe the abrupt end of solar-activity cycles at the Sun's Equator by combining almost 140 years of observations from ground and space. These "terminator" events appear to be very closely related to the onset of magnetic activity belonging to the next solar cycle at mid-latitudes and the polar-reversal process at high latitudes. Using multi-scale tracers of solar activity we examine the timing of these events in relation to the excitation of new activity and find that the time taken for the solar plasma to communicate this transition is of the order of one solar rotation – but it could be shorter. Utilizing uniquely comprehensive solar observations from the Solar Terrestrial Relations Observatory (STEREO) and Solar Dynamics Observatory (SDO) we see that this transitional event is strongly longitudinal in nature. Combined, these characteristics suggest that information is communicated through the solar interior rapidly. A range of possibilities exist to explain such behavior: for example gravity waves on the solar tachocline, or that the magnetic fields present in the Sun's convection zone could be very large, with a poloidal field strengths reaching 50 kG – considerably larger than conventional explorations of solar and stellar dynamos estimate. Regardless of the mechanism responsible, the rapid timescales demonstrated by the Sun's global magnetic-field reconfiguration present strong constraints on first-principles numerical simulations of the solar interior and, by extension, other stars. [ABSTRACT FROM AUTHOR]

When will a new cycle's sunspots appear? We demonstrate a novel physical mechanism, namely, that a "solar tsunami" occurring in the Sun's interior shear-fluid layer can trigger new cycle's magnetic flux emergence at high latitudes, a few weeks after the cessation of old cycle's flux emergence near the equator. This tsunami is excited at the equator when magnetic dams, created by the oppositely-directed old cycle's toroidal field in North and South hemispheres, break due to mutual annihilation of toroidal flux there. The fluid supported by these dams rushes to the equator; the surplus of fluid cannot be contained there, so it reflects back towards high latitudes, causing a tsunami. This tsunami propagates poleward at a speed of ~300 m/s until it encounters the new cycle's spot-producing toroidal fields in mid-latitudes, where it perturbs the fields, triggering their surface-eruption in the form of new cycle spots. A new sunspot cycle is preceded for several years by other forms of high-latitude magnetic activity, such as coronal bright points and ephemeral regions, until the tsunami causes the birth of new cycle's spots. The next tsunami is due by 2020, portending the start of intense 'space weather' that can adversely impact the Earth. [ABSTRACT FROM AUTHOR]

Recent observations have demonstrated that waves capable of carrying large amounts of energy are ubiquitous throughout the solar corona. However, the question of how this wave energy is dissipated (on which timescales and length scales) and released into the plasma remains largely unanswered. Both analytic and numerical models have previously shown that Alfvénic turbulence may play a key role not only in the generation of the fast solar wind, but in the heating of coronal loops. In an effort to bridge the gap between theory and observations, we expand on a recent study by analyzing 37 clearly isolated coronal loops using data from the Coronal Multi-channel Polarimeter instrument. We observe Alfvénic perturbations with phase speeds which range from 250 to 750 km s–1 and periods from 140 to 270 s for the chosen loops. While excesses of high-frequency wave power are observed near the apex of some loops (tentatively supporting the onset of Alfvénic turbulence), we show that this excess depends on loop length and the wavelength of the observed oscillations. In deriving a proportional relationship between the loop length/wavelength ratio and the enhanced wave power at the loop apex, and from the analysis of the line widths associated with these loops, our findings are supportive of the existence of Alfvénic turbulence in coronal loops. [ABSTRACT FROM AUTHOR]

Sunspots are a canonical marker of the Sun's internal magnetic field which flips polarity every ∼22 yr. The principal variation of sunspots, an ∼11 yr variation, modulates the amount of the magnetic field that pierces the solar surface and drives significant variations in our star's radiative, particulate, and eruptive output over that period. This paper presents observations from the Solar and Heliospheric Observatory and Solar Dynamics Observatory indicating that the 11 yr sunspot variation is intrinsically tied to the spatio-temporal overlap of the activity bands belonging to the 22 yr magnetic activity cycle. Using a systematic analysis of ubiquitous coronal brightpoints and the magnetic scale on which they appear to form, we show that the landmarks of sunspot cycle 23 can be explained by considering the evolution and interaction of the overlapping activity bands of the longer-scale variability. [ABSTRACT FROM AUTHOR]

Purpose: Biliary complications following liver transplantation are a significant source of morbidity, potentially leading to graft failure necessitating retransplantation. We sought to evaluate smoking as an independent risk factor for post-transplant biliary complications.Methods: The clinical course of all adult primary deceased donor liver transplants at our center from 1992 to 2012 was reviewed. Eligible patients were assigned to cohorts based on their lifetime tobacco exposure: never smokers indicating 0 pack-year exposure and all others were ever smokers. Biliary complications were defined as strictures, leaks, or bilomas requiring intervention. Complication rates were analyzed using univariate regression models correlated with donor and recipient characteristics. Associations found during univariate analysis were included in the final multivariate Cox model.Results: Eight hundred sixty-five subjects were followed for a median of 65 months; 482 (55.7%) of patients had a positive smoking history at the time of transplant. In univariate analysis, positive tobacco smoking history (HR = 1.36; p = 0.037) and increased time from quit date to transplantation (HR = 0.998; p = 0.011) were positive and negative predictors of biliary complication, respectively. Lifetime tobacco exposure remained a significant predictor of biliary complication on multivariate analysis (HR = 1.408; p = 0.023).Conclusions: Smoking status is an independent predictor of post-transplant biliary complications, and the data presented reinforces the importance of early smoking cessation in the pre-transplantation period. [ABSTRACT FROM AUTHOR]

The discovery of ubiquitous low-frequency (3-5 mHz) Alfvénic waves in the solar chromosphere (with Hinode/Solar Optical Telescope) and corona (with CoMP and SDO) has provided some insight into the non-thermal energy content of the outer solar atmosphere. However, many questions remain about the true magnitude of the energy flux carried by these waves. Here we explore the apparent discrepancy in the resolved coronal Alfvénic wave amplitude (∼0.5 km s–1) measured by the Coronal Multi-channel Polarimeter (CoMP) compared to those of the Hinode and the Solar Dynamics Observatory (SDO) near the limb (∼20 km s–1). We use a blend of observational data and a simple forward model of Alfvénic wave propagation to resolve this discrepancy and determine the Alfvénic wave energy content of the corona. Our results indicate that enormous line-of-sight superposition within the coarse spatio-temporal sampling of CoMP hides the strong wave flux observed by Hinode and SDO and leads to the large non-thermal line broadening observed. While this scenario has been assumed in the past, our observations with CoMP of a strong correlation between the non-thermal line broadening with the low-amplitude, low-frequency Alfvénic waves observed in the corona provide the first direct evidence of a wave-related non-thermal line broadening. By reconciling the diverse measurements of Alfvénic waves, we establish large coronal non-thermal line widths as direct signatures of the hidden, or “dark,” energy content in the corona and provide preliminary constraints on the energy content of the wave motions observed. [ABSTRACT FROM AUTHOR]

Using data obtained by the EUV Imaging Spectrometer on board Hinode, we have performed a survey of obvious and persistent (without significant damping) Doppler shift oscillations in the corona. We have found mainly two types of oscillations from February to April in 2007. One type is found at loop footpoint regions, with a dominant period around 10 minutes. They are characterized by coherent behavior of all line parameters (line intensity, Doppler shift, line width, and profile asymmetry), and apparent blueshift and blueward asymmetry throughout almost the entire duration. Such oscillations are likely to be signatures of quasi-periodic upflows (small-scale jets, or coronal counterpart of type-II spicules), which may play an important role in the supply of mass and energy to the hot corona. The other type of oscillation is usually associated with the upper part of loops. They are most clearly seen in the Doppler shift of coronal lines with formation temperatures between one and two million degrees. The global wavelets of these oscillations usually peak sharply around a period in the range of three to six minutes. No obvious profile asymmetry is found and the variation of the line width is typically very small. The intensity variation is often less than 2%. These oscillations are more likely to be signatures of kink/Alfvén waves rather than flows. In a few cases, there seems to be a π/2 phase shift between the intensity and Doppler shift oscillations, which may suggest the presence of slow-mode standing waves according to wave theories. However, we demonstrate that such a phase shift could also be produced by loops moving into and out of a spatial pixel as a result of Alfvénic oscillations. In this scenario, the intensity oscillations associated with Alfvénic waves are caused by loop displacement rather than density change. These coronal waves may be used to investigate properties of the coronal plasma and magnetic field. [ABSTRACT FROM AUTHOR]

Background: The World Conference on Tobacco or Health (WCTOH) is held every three years to foster communication and collaboration on global tobacco control. Very little is known about the nature of interactions between WCTOH attendees and their linkages to tobacco control organizations, so knowing this information could help improve tobacco control efforts.Methods: At the 2015 WCTOH, we implemented an online survey to assess barriers to global tobacco control activities, which information sources they use for tobacco control information, and with whom they interact regarding tobacco control.Results: A total of 169 respondents completed the survey, with responses from all six World Health Organization (WHO) regions. Respondents worked in all areas of tobacco control; the most common were research (29.2%) and patient care/treatment (23.3%). The top barriers faced regarding tobacco control activities were: funding is weak (56.8%), government commitment (45.0%), tobacco industry interference (43.8%), and lack of coordination (34.3%). The network analysis identified Framework Convention Alliance (FCA) and Society for Research on Nicotine and Tobacco (SRNT) as the two most prominent groups that people belonged to and where they went to exchange information and best practices. Important regional and country specific groups also appear to be growing, such as the African Tobacco Control Alliance (ATCA) and the Argentinian Association of Tabacology (ASAT).Discussion: Mapping and better understanding the global tobacco control network is important for informing knowledge exchange and best practices, particularly as increasing attention is being focused on global tobacco control efforts in low- and middle-income countries in particular.Conclusions: The present study demonstrates that even a subsample of the WCTOH shows considerable collaboration. The full WCTOH network should be mapped in order to foster greater collaboration that has the the potential to improve global tobacco control efforts. [ABSTRACT FROM AUTHOR]

Objective. Personal health records (PHRs) may address the needs of children with attention deficit hyperactivity disorder. Among parents, we assessed acceptance, barriers, and intentions regarding use of PHR for their children with attention deficit hyperactivity disorder. Methods. Survey of parents from 3 practices in Rochester, NY. Stepwise logistic regression analysis explored factors predicting respondents’ intentions for future use of PHR, accounting for care coordination needs, caregiver education, socioeconomic status, and satisfaction with providers. Results. Of 184 respondents, 23% had used the PHR for their child, 82% intended future use. No difference was observed between users and nonusers regarding gender, age, race, or education. Users were more likely than nonusers to reside in the suburbs (P = .03). Caregivers were more likely to plan future use of the PHR if they felt engaged as partners in their child’s care (adjusted odds ratio = 2.3, 95% confidence interval = 1.2, 4.5). Conclusions. Parents are enthusiastic about PHRs. Future work should focus on engaging them as members of the health care team. [ABSTRACT FROM PUBLISHER]