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Background: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has long recognized and championed increasing diversity within the surgical workplace. SAGES initiated the Fundamentals of Leadership Development (FLD) Curriculum to address these needs and to provide surgeon leaders with the necessary tools and skills to promote diversity, equity, and inclusion (DEI) in surgical practice. In 2019, the American College of Surgeons issued a request for anti-racism initiatives which lead to the partnering of the two societies. The primary goal of FLD was to create the first surgeon-focused leadership curriculum dedicated to DEI. The rationale/development of this curriculum and its evaluation/feedback methods are detailed in this White Paper. Methods: The FLD curriculum was developed by a multidisciplinary task force that included surgeons, education experts, and diversity consultants. The curriculum development followed the Analysis, Design, Development, Implementation and Evaluation (ADDIE) instructional design model and utilized a problem-based learning approach. Competencies were identified, and specific learning objectives and assessments were developed. The implementation of the curriculum was designed to be completed in short intervals (virtual and in-person). Post-course surveys used the Kirkpatrick's model to evaluate the curriculum and provide valuable feedback. Results: The curriculum consisted of interactive online modules, an online discussion forum, and small group interactive sessions focused in three key areas: (1) increasing pipeline of underrepresented individuals in surgical leadership, (2) healthcare equity, and (3) conflict negotiation. By focusing on positive action items and utilizing a problem-solving approach, the curriculum aimed to provide a framework for surgical leaders to make meaningful changes in their institutions and organizations. Conclusion: The FLD curriculum is a novel leadership curriculum that provided surgeon leaders with the knowledge and tools to improve diversity in three areas: pipeline improvement, healthcare equity, and conflict negotiation. Future directions include using pilot course feedback to enhance curricular effectiveness and delivery. [ABSTRACT FROM AUTHOR]

Introduction: Poor communication is a leading root cause of preventable maternal mortality in the United States. Communication challenges are compounded with the presence of biases, including racism. Hospital administrators and clinicians are often aware that communication is a problem, but understanding where to intervene can be difficult to determine. While clinical leadership routinely reviews incident reports and acts on them to improve care, we hypothesized that reviewing incident reports in a systematic way might reveal thematic patterns, providing targeted opportunities to improve communication in direct interaction with patients and within the healthcare team itself. Methods: We abstracted incident reports from the Women's Health service and linked them with patient charts to join patient's race/ethnicity, birth outcome, and presence of maternal morbidity and mortality to the incident report. We conducted a qualitative content analysis of incident reports using an inductive and deductive approach to categorizing communication challenges. We then described the intersection of different types of communication challenges with patient race/ethnicity and morbidity outcomes. Results: The use of incident reports to conduct research on communication was new for the health system. Conversations with health system‐level stakeholders were important to determine the best way to manage data. We developed a thematic codebook based on prior research in healthcare communication. We found that we needed to add codes that were equity focused, as this was missing from the existing codebook. We also found that clinical and contextual expertise was necessary for conducting the analysis—requiring more resources to conduct coding than initially estimated. We shared our findings back with leadership iteratively during the work. Conclusions: Incident reports represent a promising source of health system data for rapid improvement to transform organizational practice around communication. There are barriers to conducting this work in a rapid manner, however, that require further iteration and innovation. [ABSTRACT FROM AUTHOR]

The high prevalence and costs of urinary incontinence and related pelvic floor disorders in adults highlights the need for competent nurses and advanced practice nurses who can provide high-quality continence and pelvic health care. However, challenges exist in recognizing this as a nursing specialty, preparing new and experienced nurses with specialty knowledge and skills, increasing the number and diversity of the workforce, and promoting individual achievement and professional recognition as a continence and pelvic health nursing specialist. This White Paper provides recommendations based on evidence and expert opinion to support the Society of Urologic Nurses and Associate's efforts in advancing the roles of registered nurses and advanced practice registered nurses in the expanded specialty area of continence and pelvic health nursing. [ABSTRACT FROM AUTHOR]

A significant amount of researcher and practitioner effort has focused on developing new chemical controls for the parasitic Varroa destructor mite in beekeeping. One outcome of that has been the development and testing of "glycerol–oxalic acid" mixtures to place in colonies for extended periods of time, an off-label use of the otherwise legal miticide oxalic acid. The majority of circulated work on this approach was led by practitioners and published in nonacademic journals, highlighting a lack of effective partnership between practitioners and scientists and a possible failure of the extension mandate in beekeeping in the United States. Here, we summarize the practitioner-led studies we could locate and partner with a commercial beekeeper in the Southeast of the United States to test the "shop towel–oxalic acid–glycerol" delivery system developed by those practitioners. Our study, using 129 commercial colonies between honey flows in 2017 split into 4 treatment groups, showed no effectiveness in reducing Varroa parasitism in colonies exposed to oxalic acid–glycerol shop towels. We highlight the discrepancy between our results and those circulated by practitioners, at least for the Southeast, and the failure of extension to support practitioners engaged in research. [ABSTRACT FROM AUTHOR]

The article discusses an article by M. R. Larochelle and colleagues about disparities in overdose deaths. Topics include reason that the opioid overdose crisis most heavily affected non-Hispanic White people, major events that could not have been predicted at the time the article by Larochelle and colleagues was written, and lessons learned about the need for timely data on drug use patterns and overdoses to guide interventions.

The rise of fentanyl and fentanyl analogs in the drug supply pose serious threats to public health. Much of these compounds enter the United States through shipping routes. Here we provide a method for fentanyl screening and analysis that utilizes pressure‐sensitive adhesive (PSA) lined paper to recover drug residues from parcel‐related surfaces. The paper used is commercially available repositionable notes (also called post‐it or sticky notes). From this paper, mass spectra were obtained by paper spray‐mass spectrometry (PS‐MS), where PSA paper served as both a sampling and analysis substrate. Seven fentanyl‐related compounds were analyzed: fentanyl, 4‐anilino‐N‐phenethylpiperidine (4‐ANPP), N,1‐diphenethyl‐N‐phenylpiperidin‐4‐amine (phenethyl‐4‐ANPP), valerylfentanyl, 4‐fluoroisobutyrylfentanyl (4‐FIBF), carfentanil, and p‐fluorofentanyl. These compounds were recovered by PSA paper and identified by PS‐MS from packaging tape and plastic at 50 ng and from cardboard and shipping labels at 100 ng. The impact of cutting agents on PS‐MS analysis of fentanyl analogs was explored. No trends of analyte suppression were found at high concentrations of the cutting agents caffeine, diphenhydramine, and lidocaine when recovered from surfaces. A cartridge that required no precise cutting of PSA paper prior to sampling or analysis was evaluated for use in PS‐MS for fentanyl screening. Recovery and detection of fentanyl from plastic sheeting was demonstrated with this cut‐free cartridge. The cut‐free cartridge showed somewhat less consistency and lower analyte signal than the standard cartridge, but performance was suitable for potential screening applications. In combining PSA surface sampling with PS‐MS for drug screening, both sampling and detection of fentanyl‐related compounds is simple, rapid, and low‐cost. [ABSTRACT FROM AUTHOR]

The onset of the COVID-19 pandemic revealed significant gaps in the United States' pandemic and public health emergency response system. In this position paper, the American College of Physicians (ACP) offers several policy recommendations for enhancing federal, state, and local preparedness for future pandemics and public health emergencies. The onset of the COVID-19 pandemic revealed significant gaps in the United States' pandemic and public health emergency response system. At the federal level, government responses were undercut by a lack of centralized coordination, inadequately defined responsibilities, and an under-resourced national stockpile. Contradictory and unclear guidance throughout the early months of the pandemic, along with inconsistent funding to public health agencies, also created notable variance in state and local responses. The lack of a coordinated response added pressure to an already overwhelmed health care system, which was forced to resort to rationing care and personal protective equipment, creating moral distress and trauma for health care workers and their patients. Despite these severe shortcomings, the COVID-19 pandemic also highlighted successful policies and approaches, such as Operation Warp Speed, which led to the fastest development and distribution of a vaccine in history. In this position paper, the American College of Physicians (ACP) offers several policy recommendations for enhancing federal, state, and local preparedness for future pandemic and public health emergencies. This policy paper builds on various statements produced by ACP throughout the COVID-19 pandemic, including on the ethical distribution of vaccinations and resources, conditions to resume economic and social activity, and efforts to protect the health and well-being of medical professionals, among others. [ABSTRACT FROM AUTHOR]

The United States' public health sector plays a crucial role in preventing illness and promoting health. However, public health is underfunded and underappreciated, forcing the field to do more with fewer resources. In this position paper, the American College of Physicians updates its 2012 policy recommendations on strengthening the nation's public health infrastructure. The United States' public health sector plays a crucial role in preventing illness and promoting health. Public health drove massive gains in life expectancy during the 20th century by supporting vaccination campaigns, promoting motor vehicle safety, and preventing and treating tobacco use. However, public health is underfunded and underappreciated, forcing the field to do more with fewer resources. In this position paper, the American College of Physicians (ACP) updates its 2012 policy recommendations on strengthening the nation's public health infrastructure. ACP calls for effective coordination of public health activities, robust and stable year-to-year funding of public health services, a renewed and well-supported public health workforce, action to address health-related dis- and misinformation, modernized public health data systems, and greater coordination between public health and medical sectors. [ABSTRACT FROM AUTHOR]

Drawing on Michel de Certeau's conceptualisation of the city space in The Practice of Everyday Life, in conversation with AbdouMaliq Simone's approach to the African city, this article explores the problem of belonging in Ufrieda Ho's Paper Sons and Daughters: Growing Up Chinese in South Africa (2011). The text's navigation of the manifold ascribed and asserted identities of the autobiographical self is made prominent through Ho's tracing of the traversals of both her father and herself across Johannesburg. In particular, the illegal gambling game of fahfee and its operation become emblematic of the imbrication of Chinese immigrants within the urban space, positioning the figures in the text within the broader historical and literary archive of Johannesburg and thereby asserting a rootedness within the (post-)apartheid city. It highlights the complexity of the relationship between the self and the (post-)apartheid city and the formulations of belonging that arise as a result. [ABSTRACT FROM AUTHOR]

The paper industry is a high-carbon emission and energy-intensive industry. From the perspective of low-carbon trade and carbon neutrality, its energy conservation and emission reduction are worthy of attention. This study used the input-output model to calculate the embodied carbon emissions of China’s paper industry’s export trade to the United States from 2006 to 2020 and used the logarithmic mean division index (LMDI) method to analyze influencing factors of the change of embodied carbon emissions. The study found that the embodied carbon emissions of China’s paper industry’s export trade to the United States generally shows a stable downward trend after reaching the peak with the increase of export trade scale; scale effect is the main factor that causes the embodied carbon emissions, while technological progress, policy support, and environmental regulations are important driving forces to promote carbon emission reduction. The research results of this paper not only can test and guide China’s paper industry trade policies and industrial policies, but they can also provide decision-making reference for China and the United States to promote the carbon emission reduction of the paper industry. [ABSTRACT FROM AUTHOR]

Classifying papers according to the fields of knowledge is critical to clearly understand the dynamics of scientific (sub)fields, their leading questions, and trends. Most studies rely on journal categories defined by popular databases such as WoS or Scopus, but some experts find that those categories may not correctly map the existing subfields nor identify the subfield of a specific article. This study addresses the classification problem using data from each paper (Abstract, Title, Keywords, and the KeyWords Plus) and the help of experts to identify the existing subfields and journals exclusive of each subfield. These "exclusive journals" are critical to obtain, through a pattern detection procedure that uses machine learning techniques (from software NVivo), a list of the frequent terms that are specific to each subfield. With that list of terms and with the help of optimization procedures, we can identify to which subfield each paper most likely belongs. This study can contribute to support scientific policy‐makers, funding, and research institutions—via more accurate academic performance evaluations—, to support editors in their tasks to redefine the scopes of journals, and to support popular databases in their processes of refining categories. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this bibliometric analysis was twofold: to identify the 100 most cited research articles on thymoma and to highlight future research opportunities in light of past and current research efforts. Methods: The Web of Science database was queried to identify the 100 most cited articles on thymoma. Imformations relevant to scientific research were extracted and analyzed: first author, journal, impact factor, type of article, year of publication, country, organization and keywords. Results: The publication year of the top 100 most cited articles ranged from 1981 to 2018, and the number of citations ranged from 97 to 1182. Most of the included articles are original (75/100) and are mainly retrospective studies (52/75). The United States has the most published articles and citations, and the Annals of Thoracic Surgery is the most sourced journal (n = 16). Through VOSviewer analysis, high-density keywords mainly come from thymic carcinoma/invasive thymoma management, immune-related diseases, and laboratory research. Conclusions: To our knowledge, this is the first bibliometric study on thymoma. We found most of the top 100 most cited articles are original and retrospective research. The United States has the published and cited works. Presently, the hot keywords for thymoma research has gradually tilted towards immune-related diseases and laboratory research. [ABSTRACT FROM AUTHOR]

COVID‐19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ranging from lesions to open wounds are concerning because they increase the susceptibility of viral infection and transmission to other individuals. Early into the COVID‐19 pandemic (April 2020), the U. S. National Pressure Injury Advisory Panel (NPIAP) developed a series of position statements to improve wear‐ability of PPE and protect healthcare professionals and their patients as safe from harm as possible under the circumstances. The NPIAP positions, which were formed by conducting a systematic review of what was known at the time, include: (a) Prepare skin before and after wearing PPE with skin sealants, barrier creams and moisturisers; (b) Frequent PPE offloading to relieve pressure and shear applied to skin; (c) treat visible skin injuries immediately caused by PPE to minimise future infection; (d) non‐porous dressings may provide additional skin protection, but lack evidence; (e) health systems should take care to educate clinicians about placement and personal hygiene related to handling PPE. Throughout all of these practices, handwashing remains a top priority to handle PPE. These NPIAP positions provided early guidance to reduce the risk of skin injury caused by PPE based on available research regarding PPE injuries, a cautious application of evidence‐based recommendations on prevention of device‐related pressure injuries in patients and the expert opinion of the NPIAP Board of Directors. Clinicians who adhere to these recommendations reduce the prospects of skin damage and long‐term effects (e.g. scarring). These simple steps to minimise the risk of skin injury and reduce the risk of coronavirus infection from PPE can help. [ABSTRACT FROM AUTHOR]

Racial and ethnic disparities have been clearly documented in schizophrenia studies, but it is unclear how much research attention they receive among US-based studies published in high-impact journals. The current paper updates Lewine and Caudle's (1999) and Chakraborty and Steinhauer's (2010) works, which quantified how frequently schizophrenia studies included information on race and ethnicity in their analyses. We examined all US-based papers on schizophrenia-spectrum, first-episode psychosis, and clinical high-risk groups, published between 2014 to 2016 in four major psychiatric journals: American Journal of Psychiatry, Journal of the American Medical Association – Psychiatry, Schizophrenia Bulletin, and Schizophrenia Research. Of 474 US-based studies, 62% (n = 295) reported analyses by race or ethnicity as compared to 20% in Lewine and Caudle's (1999) study. The majority of papers (59%) reported sample descriptions, a 42% increase from Lewine and Caudle's (1999) study. Additionally, 47% matched or compared the racial/ethnic composition of primary study groups and 12% adjusted for race (e.g., as a covariate). However, only 9% directly analyzed racial and/or ethnic identity in relation to the primary topic of the paper. While schizophrenia studies report analyses by race and ethnicity more frequently than 20 years ago, there remains a strong need for systematic, nuanced research on this topic. The authors offer recommendations for how to conceptualize and report upon race and ethnicity in schizophrenia research. [ABSTRACT FROM AUTHOR]

While we have the tools to achieve this goal, the persistent barriers to healthcare services experienced by too many individuals will need to be addressed to make significant progress and improve the health and quality of life of all people with human immunodeficiency virus (HIV). The necessary structural changes require actions by federal, state, and local policymakers and range from ensuring universal access to healthcare services to optimizing care delivery to ensuring a robust and diverse infectious diseases and HIV workforce. In this article, we outlines 10 key principles for policy reforms that, if advanced, would make ending the HIV epidemic in the United States possible and could have much more far-reaching effects in improving the health of our nation. [ABSTRACT FROM AUTHOR]

The confluence of the two major challenges has combined to create special challenges for rural nonprofits serving victims of crime: the fluctuation of federal funding, and the Covid-19 pandemic. We discuss the challenges faced by Child Advocacy Centers in northwestern South Carolina in the context of these shifting challenges. From qualitative interviews conducted at 14 centers in this primarily rural region, we explain the challenges they face and the potential effects on the communities they serve interpreted through the lens of Resource Dependence Theory, which predicts that organizations reduce uncertainty of funding through increasing their partnership bonds with cooperative entities. [ABSTRACT FROM AUTHOR]

This study focused on how adopted adults who have reunited with at least one birth family member experienced identity shifts related to their original birth certificates (OBCs). Framed by the Communication Theory of Identity (CTI), 50 adopted adults discussed their experiences related to their OBCs and how their identities are connected to this symbol through three of the layers of CTI, the personal, enacted, and relational layers. Participants discussed the presence of an ambiguous and unsolvable identity that interpenetrated with their other identity layers. Findings extend CTI to include an additional layer for adoptees – phantom identity – which can explain the life adoptees would have lived had they not been adopted. This identity was salient for participants as it manifested in ways such as expressing frustration with obstacles in gaining access to their OBC and refocusing their professional life to support other adopted adults. Moreover, findings offer implications for the examination into current adoption record practices in the United States, additional state mutual consent registries, and increased access to adoption-competent counselors for adoptees. [ABSTRACT FROM AUTHOR]

The article offers information on how to submit articles about American Christmas to be published in the journal, including topics like Christmas costumes, Yuletide fashions and styles, and Christmas riots.

C. Wright Mills' The Sociological Imagination (1959) represents one of the most influential texts of postwar American sociology. The title has become a catchphrase that stands for a style of thought that transcends both theoretical dogma and the constraints of mere methodological rule following. This article sets out to show that Mills' vision of the sociological imagination had more in common with the then dominant lines of scholarship than his broadside against Parsonian grand theory and Lazarsfeldian abstracted empiricism in the main part of the book would suggest. Among the tools that Mills introduced as fostering the sociological imagination were 2 × 2 tables. The article traces the use of such tables over time and across scholarly communities and shows that, contrary to Mills' own estimate, these tables describe a common nexus between his own work and that of Parsons and Lazarsfeld. All three scholars made ample use of this formal tool to construct sociological arguments at central places of their oeuvre. Given its shared use across otherwise divergent schools, the 2 × 2 table is a prime example for what historians of science have called paper tools, i.e. statistical formulas, algorithms, tables, diagrams, graphs, etc., that structure scientific research across different schools of thought and theoretical approaches. Drawing on the notion of paper tools, the article advances a post-Kuhnian perspective on the history of sociology that shifts the research focus from substantive ideas to formal tools and demonstrates elements of commensurability among presumably incommensurable schools of thought. [ABSTRACT FROM AUTHOR]

Comments on the `The Salmon P. Chase Papers, Volume 5, Correspondence, 1865-1873,' published by the Kent State University Press in Kent, Ohio. Value of the book to scholars and students of nineteenth-century American politics; Life story of politician Salmon P. Chase; Ambition to become president; Multifaceted aspects of Chase's years in politics and reform; Career as chief justice in 1865.

This essay reflects on the materiality of migration with a focus on passports and other kinds of documentary permissions for travel. It argues that throughout the history of the Americas passports have acquired meanings exceeding contemporary associations with national citizenship that are discernible in literary works and in the archival record. It looks to documentary practices in Latin America and the Caribbean to decenter the United States from studies of border crossing and Latinx subjectivities, suggesting intersecting hemispheric practices that delineate the relative importance of being documented or undocumented. [ABSTRACT FROM AUTHOR]

Hydroxychloroquine (HCQ) and chloroquine (CQ) are well‐established medications used in treating systemic lupus erythematosus and rheumatoid arthritis, as well as skin conditions such as cutaneous lupus erythematosus. In rare cases, arrhythmias and conduction system abnormalities, as well as cardiomyopathy, have been reported in association with HCQ/CQ use. Recently, however, the corrected QT interval (QTc)–prolonging potential of these medications, and risk of torsade de pointes (TdP) in particular, have been highlighted in the setting of their experimental use for COVID‐19 infection. This report was undertaken to summarize the current understanding of HCQ/CQ cardiac toxicity, describe QTc prolongation and TdP risks, and discuss areas of priority for future research. A working group of experts across rheumatology, cardiology, and dermatology performed a nonsystematic literature review and offered a consensus‐based expert opinion. Current data clearly indicate that HCQ and CQ are invaluable medications in the management of rheumatic and dermatologic diseases, but they are associated with QTc prolongation by directly affecting cardiac repolarization. Prescribing clinicians should be cognizant of this small effect, especially in patients taking additional medications that prolong the QTc interval. Long‐term use of HCQ/CQ may lead to a cardiomyopathy associated with arrhythmias and heart failure. Risk and benefit assessment should be considered prior to initiation of any medication, and both initial and ongoing risk–benefit assessments are important with regard to prescription of HCQ/CQ. While cardiac toxicity related to HCQ/CQ treatment of rheumatic diseases is rarely reported, it can be fatal. Awareness of the potential adverse cardiac effects of HCQ and CQ can increase the safe use of these medications. There is a clear need for additional research to allow better understanding of the cardiovascular risk and safety profile of these therapies used in the management of rheumatic and cutaneous diseases. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is the leading cause of death of women in the United States, yet cardiovascular research is disproportionately conducted using male human subjects and male animal models. This article deploys Katrina Hutchison's (2019) analysis of gender disparity in clinical trials as a moral aggregation problem to address the problem of underrepresentation of women in cardiovascular research. I identify cost concerns, convenience, pregnancy, and negligence as potential reasons for the underrepresentation of women in CVD research. Finally, I suggest that multilevel strategies will be needed to eliminate sex disparity in CVD research and improve patient care. [ABSTRACT FROM AUTHOR]

Feminist classrooms employ a variety of teaching strategies that empower students and inspire equity and justice. In this paper, we argue that integrating student-made documentary filmmaking into the college classroom is a powerful and effective form of feminist teaching. Specifically, feminist pedagogy views students as knowledge creators and demands collaborative, non-hierarchical learning experiences. These outcomes suggest that documentary filmmaking is a compelling and effective way to engage students in our increasingly visual and video-based culture. Based on our experiences teaching sociology at a women's college in the U.S., we illustrate the impact that documentary filmmaking has for student learning, empowerment, and justice work. We also develop and strengthen students' technical, multi-media skills, arguing this outcome expands feminist pedagogy to meet contemporary culture. [ABSTRACT FROM AUTHOR]

The Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) measure has appropriately established sepsis as a national priority. However, the Infectious Diseases Society of America (IDSA and five additional endorsing societies) is concerned about SEP-1's potential to drive antibiotic overuse because it does not account for the high rate of sepsis overdiagnosis and encourages aggressive antibiotics for all patients with possible sepsis, regardless of the certainty of diagnosis or severity of illness. IDSA is also concerned that SEP-1's complex "time zero" definition is not evidence-based and is prone to inter-observer variation. In this position paper, IDSA outlines several recommendations aimed at reducing the risk of unintended consequences of SEP-1 while maintaining focus on its evidence-based elements. IDSA's core recommendation is to limit SEP-1 to septic shock, for which the evidence supporting the benefit of immediate antibiotics is greatest. Prompt empiric antibiotics are often appropriate for suspected sepsis without shock, but IDSA believes there is too much heterogeneity and difficulty defining this population, uncertainty about the presence of infection, and insufficient data on the necessity of immediate antibiotics to support a mandatory treatment standard for all patients in this category. IDSA believes guidance on managing possible sepsis without shock is more appropriate for guidelines that can delineate the strengths and limitations of supporting evidence and allow clinicians discretion in applying specific recommendations to individual patients. Removing sepsis without shock from SEP-1 will mitigate the risk of unnecessary antibiotic prescribing for noninfectious syndromes, simplify data abstraction, increase measure reliability, and focus attention on the population most likely to benefit from immediate empiric broad-spectrum antibiotics. [ABSTRACT FROM AUTHOR]

The article discusses the paper recovery rate in United States as per the statistics released by the American Forest and Paper Association (AFPA). It individually mentions the rate of recovery for packaging, paper and paperboard and old corrugated containers. It also discusses the sustainability efforts of United States with recycling of paper.

• This is a case study of a small modular reactor supplying steam and electricity to a pulp and paper mill. • Resulting steam conditions in the mill are analyzed using steady-state and dynamic models. • Models of the paper mill were built in Aspen HYSYS and Dymola, a Modelica Ecosystem. • Integrated SMRs with pulp and paper mills is feasible but may present cost limitations. Small modular reactors (SMRs) are reactor designs producing less than 300 MWe and are generally planned for deployment as multimodule nuclear power plants. The possibility of factory-manufactured, flexibly sized plants expands the opportunities for nuclear power to different communities and industries, including manufacturing plants that currently utilize fossil fuels to produce both steam and electricity. This paper examines the feasibility of coupling a NuScale SMR with a midsize pulp and paper mill in the Southeastern United States. A steady-state mill model was developed in Aspen HYSYS, based on real data from the operation of the mill, and modified it to include the SMR while maintaining steam quality requirements and making as few changes as possible to existing equipment. Dynamic plant models were also developed Dymola to demonstrate possible plant conditions, using three configurations. Preliminary results suggest that, while SMR coupling is physically feasible, its economic feasibility is limited by the differences in steam and electricity demands. Because of limitations in the amount of steam the mill can take from the SMR, sizing the SMR for the plant's steam demand may result in an electricity deficit, or vice versa. Dynamic analyses show that the addition of a thermal storage system could reduce such deficits, but this entails its own challenges. Each plant must determine the best configuration and control scheme for itself, based on its electricity and heat needs, including the peak duration and intensity for both. Ultimately, an implementation of SMRs with manufacturing processes would benefit from partnering with a local utility to purchase excess electricity generated by the SMR. This will help manufacturing facilities meet their environmental and cost-savings goals, in addition to meeting the need for cost-effective baseload power across the United States. [ABSTRACT FROM AUTHOR]

Introduction: Race and ethnicity along with social determinants of health have been identified as risk factors for COVID-19. The purpose of this clinical paper is to provide an overview of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), present COVID-19 epidemiological data on five racial–ethnic groups, identify culturally congruent health care strategies for each group, and provide directions for practice and research. Method : NCEMNA collaborated to provide a clinical paper that addresses information about COVID-19 and culturally congruent health care in five racial–ethnic groups. Results : Every organization presented common themes across the different groups and unique perspectives that each group is faced with during this challenge. Discussion : This article provides an introduction to the issues that minority groups are facing. It is imperative that data are collected to determine the extent of the impact of COVID-19 in diverse communities in the country. [ABSTRACT FROM AUTHOR]

This Article explores the application of the terrorism bar in immigration law to noncitizens who have participated in an independence movement. It proposes a uniform standard that immigration adjudicators can use to determine whether a foreign entity is a state in order to promote accurate applications of the terrorism bar. The terrorism bar in the Immigration and Nationality Act is broad—it can bar most forms of immigration relief, including asylum, and reaches far beyond ordinary definitions of terrorism. For example, the terrorism bar can block immigration relief for noncitizens who nonviolently supported a militia fighting for independence against a repressive state or who received military-type training from such an organization. The terrorism bar applies even if that militia is supported by the United States. The bar can also ensnare a noncitizen’s spouse and children who have not themselves participated in those activities. Especially in light of its far reach and harsh consequences, it is of the utmost importance to accurately apply the bar, which can be challenging for cases on the margins. One such area is the application of the bar to noncitizens who have supported independence movements leading to the creation of new states, which are situations that often produce large numbers of asylum seekers and refugees. The complexity arises because the terrorism bar requires unlawful conduct, but participation in and support of a state’s armed forces are not unlawful. During an independence movement, a new state can emerge, and support of its armed forces is not unlawful even though hostilities may continue with the state from which it seceded. Adjudicators need to be able to determine when an entity achieved statehood because it could mean the difference between a noncitizen participating in unlawful rebellion, which could trigger the terrorism bar, and supporting the armed forces of a state, which would not. However, there is currently no uniform framework for analyzing questions of statehood in the context of the terrorism bar. Drawing from international law and domestic law, this Article proposes a standard that immigration adjudicators can use to assess questions of statehood to avoid the creation of “paper terrorists”— noncitizens who have participated in independence movements and are mistakenly labeled as terrorists under the Immigration and Nationality Act. This proposal stems from, and is consistent with, the statutory language of the Immigration and Nationality Act, and therefore does not require any legislative action. The proposed standard encourages immigration adjudicators to give full effect to the statutory language to promote more accurate applications of the terrorism bar. [ABSTRACT FROM AUTHOR]

In this article, the author reconstructs the data on Virginia's paper money regime using forensic accounting techniques. He corrects the existing data on the amounts authorized and outstanding, and reconstructs yearly data on previously unknown aspects of Virginia's paper money regime, including printings, net new emissions, redemptions and removals, denominational structures, expected redemption tax revenues, and specie accumulating in the treasury for paper money redemption. These new data form the foundation for narratives written on the social, economic, and political history of Virginia, as well as for testing models of colonial paper money performance. [ABSTRACT FROM AUTHOR]

System barriers to effective healthcare engagement and navigation contribute to healthcare disparities among Latino children with immigrant parents in the US. We evaluated a nine-minute educational video supporting healthcare navigation and engagement skills of Spanish-speaking Latino parents of infants. Participants viewed the video at their child's 2-month well-visit, completed a pre-and post-video knowledge evaluation, and answered open-ended questions on video style. A paired t test was used to examine differences in knowledge and open-ended responses were coded using an iterative, consensus-based process. Of the 79 participants, 63.3% had an education level below high school diploma/GED and 84.8% were at risk for limited health literacy. There was a significant gain in healthcare navigation and engagement knowledge after watching the video (p < 0.001). Parents expressed that the video was interesting and provided useful information. Parents valued the knowledge gained and preferred videos over written materials for receiving culturally and linguistically tailored health education. [ABSTRACT FROM AUTHOR]

Media outlets provide crucial inputs into the democratic process, yet they face increasingly severe economic challenges. I study how a newly salient manifestation of this pressure, reduced reporting capacity, influences political coverage. Focusing on newspapers in the United States, where industry‐wide employment fell over 40% between 2007 and 2015, I use panel data to assess the relationship between reporting capacity and political coverage. Staff cuts substantially decrease the amount of political coverage newspapers provide. Across different samples and measurement approaches, a typical cutback to a newspaper's reporting staff reduces its annual political coverage by between 300 and 500 stories. These political news declines happen against the backdrop of similar reductions in nonpolitical coverage, meaning the share of newspaper articles focused on politics remains stable over this period. This demonstrates that economic pressure affects the political information environment by shaping the media's capacity to cover politics. [ABSTRACT FROM AUTHOR]

I decompose the market value of Colonial New Jersey's paper money into its component parts, namely its real-asset present value and transaction premium. Its market value was predominately determined by its real-asset present value. I also find a small transaction premium that is positively associated with the quantity of paper money in circulation and with the land-bank method of paper money injection. This paper money was not a fiat currency. It traded below face value due to time-discounting not depreciation. [ABSTRACT FROM AUTHOR]

Background The recent emergence of Chikungunya Virus (CHIKV) in the Americas constitutes a major public health problem on this continent, where the mosquito vector is widespread. The rapid diagnosis of suspected cases is essential for the monitoring and control of this ongoing outbreak. However, this requires reliable tools that are difficult to establish in areas without specialized laboratories. Objectives The aim was to evaluate the performances of serum samples spotted onto filter paper for molecular and serological diagnosis of Chikungunya infection. Study design Analyses were performed from frozen sera and serum spotted onto filter paper provided from 121 Chikungunya suspected cases collected at a biological laboratory on Saint-Martin Island. Results This approach performed well in comparisons with standard methods, with a sensitivity of 100% and a specificity of 93.6% for the combined technical approaches (RT-PCR and serological results). Comparisons of serum samples spotted onto filter paper and frozen samples showed a concordance rate of 94.8% in molecular tests and 98.2% in serological tests. Conclusions This simple sampling technique could overcome the problems of the lack of efficient CHIKV diagnosis tools in remote regions, providing good results regardless of the molecular or serological approach used. This simple filter paper-based method can be used to diagnose both chikungunya and dengue infections, as previously demonstrated following transport at ambient temperature to specialized laboratories. Given the set-up costs and high performance of this method, it could be recommended for the monitoring and control of Chikungunya virus expansion in the Americas and in other affected regions. [ABSTRACT FROM AUTHOR]

As drug overdose deaths across the United States continue to rise, there is increasing interest in field testing of illicit substances. This work discusses a paper‐based analytical device (idPAD) that can run a library of 12 colorimetric tests at the same time, each detecting different chemical functional groups and materials found in illicit drugs, distractor substances, and cutting agents. The idPAD requires no electricity, costs less than $2 USD, and requires minimal training to operate. The results of the 12 tests form a color barcode which is "read" by comparison to standard images. The accuracy of the idPAD was assessed using samples of heroin, cocaine HCl, crack, and methamphetamine at concentrations of 25%–100% in a lactose matrix, as well as pure lactose. Based on 840 "reads" by three different users, the idPAD showed 95% sensitivity and 100% specificity for detecting these drugs; the most common error was mistaking cocaine HCl for crack or crack for cocaine HCl. In a second step, samples of heroin, cocaine, and methamphetamine (n = 30) and distractor substances (pharmaceuticals, cutting agents, and other illicit drugs, n = 64) were tested by two readers, yielding a sensitivity of 100% and specificity of 97%. Targeted substances were detected reliably at 55–180 μg/lane, and the idPAD was found to be stable for at least 3 months when stored at room temperature. The library approach used in the idPAD may provide the accuracy and robustness necessary for a presumptive field drug test. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has resulted in school closures and distancing requirements that have disrupted both work and family life for many. Concerns exist that these disruptions caused by the pandemic may not have influenced men and women researchers equally. Many medical journals have published papers on the pandemic, which were generated by researchers facing the challenges of these disruptions. Here we report the results of an analysis that compared the gender distribution of authors on 1893 medical papers related to the pandemic with that on papers published in the same journals in 2019, for papers with first authors and last authors from the United States. Using mixed-effects regression models, we estimated that the proportion of COVID-19 papers with a woman first author was 19% lower than that for papers published in the same journals in 2019, while our comparisons for last authors and overall proportion of women authors per paper were inconclusive. A closer examination suggested that women's representation as first authors of COVID-19 research was particularly low for papers published in March and April 2020. Our findings are consistent with the idea that the research productivity of women, especially early-career women, has been affected more than the research productivity of men. [ABSTRACT FROM AUTHOR]

In this paper, I draw on two childhood ethnographies to ask basic questions about the foundation of child writing. The first question is, where does writing come from in young children's lives? Answering this question will lead us to childhood play as the foundation of writing. The second question is, how do educators negotiate an inclusive, playful classroom culture in racially divisive and neoliberal times? This question will lead to a critical consideration of forming an inclusive culture in a racially and culturally diverse classroom. In this time of uniform, mandated curricula, rampant in the United States and elsewhere, and of the dismissive attitude towards play and towards childhood diversity (e.g., in race, culture and socioeconomic class), it is worth revisiting basic questions about the beginnings of writing in childhoods. The questions are relevant whether a child is writing on paper, screen, slate, or sand. [ABSTRACT FROM AUTHOR]

The Territorial Papers of the United States are a valuable and underused resource containing almost 10,000 documents written between 1789 and 1848 about the formation of new sovereign states from US territory. These communications between the federal government and frontier settlers comprise the actual discourse of the nation's expansion over six decades. Digitizing the Territorial Papers permits the possibility of analyzing the entire corpus globally. Text mining and topic modeling methods give us a lens on the language patterns through which new state governments and the expanding nation were formed. An initial statistical analysis of the textual information provides a visualization of content, helps discern how ideals about governance emerged, and lays the foundation for developing more sophisticated hypotheses and theoretical constructs. [ABSTRACT FROM AUTHOR]

Over the past several decades, citizenship status has become more important in immigrant lives and communities in the United States. Undocumented adults who arrived as children, the 1.5 generation, comprise a growing percentage of the immigrant population. Although they are similar to children of immigrants born in the United States (the second generation) they face a variety of barriers to integration due to their lack of legal status. Based on over five years of ethnographic fieldwork with mainly 1.5 and second generation Mexican-American men during a period of major healthcare reform, this paper addresses how citizenship status and embeddedness within multi-status communities impacts immigrant experiences in the healthcare domain. In particular, I argue that the Affordable Care Act (ACA) has contributed to an institutionalization of the status differences and a further differentiation in the social integration of these groups of children of immigrants. The novel methodological approach and the data which emerges through fieldwork reveals important insights into the process whereby healthcare reforms have consequences for immigrant communities which I show through highlighting the status-signaling event that is generated through various forms of direct and indirect interaction with the ACA. The implications of this extend beyond healthcare, and I discuss its impact on issues including ethnic identity and psychological well-being. This paper makes contributions to both our understanding of intergroup dynamics in immigrant integration and the health implications of immigration policies more generally. [ABSTRACT FROM AUTHOR]

Pancreatic ductal adenocarcinoma (PDA) is the third leading cause of cancer-related death in the United States and is projected to be the second by 2030. Systemic combination chemotherapy is considered an essential first-line treatment for the majority of patients with PDA, in both the neoadjuvant and palliative settings. In addition, a number of novel therapies are being tested in clinical trials for patients with advanced PDA. In all cases, accurate and timely assessment of treatment response is critical to guide therapy, reduce drug toxicities and cost from a failing therapy, and aid adaptive clinical trials. Conventional morphological imaging has significant limitations, especially in the context of determining primary tumor response and resectability following neoadjuvant therapies. In this article, we provide an overview of current therapy options for PDA, highlight several morphological imaging findings that may be helpful to reduce over-staging following neoadjuvant therapy, and discuss a number of emerging imaging, and non-imaging, tools that have shown promise in providing a more precise quantification of disease burden and treatment response in PDA. [ABSTRACT FROM AUTHOR]

Over the last decade, dozens of states and the federal government have enacted “second chance” reforms that increase the eligibility of individuals arrested, charged, or convicted of crimes to shorten their sentences, clear their criminal records, and/or regain the right to vote. While much fanfare has accompanied the increasing availability of “second chances,” little attention has been paid to their delivery. This study introduces the concept of the “second chance gap,” which it defines as the difference between eligibility and delivery of second chance relief; explores its causes; and approximates its size in connection with several second chance laws and initiatives. Using administrative and other data, it finds that among a host of petition-based second chance opportunities, to shorten sentences, restore one’s vote, and clear one’s criminal convictions, only a small fraction (less than 10 percent) of those eligible for relief actually received it. Extrapolating based on a novel analysis of around sixty thousand criminal histories of persons primarily seeking gigeconomy work and of the expungement laws governing nonconvictions of all fifty states applying the nonconviction expungement laws of all fifty states to around sixty thousand criminal histories of persons primarily seeking gigeconomy work, this study estimates that at least twenty to thirty million [ABSTRACT FROM AUTHOR]

Studies are largely optimistic about the ability of standardized procedures to constrain decision-makers' biases and produce more equitable results across fields. However, work that embraces standardization as an equalizing force stands in contrast to research on standardization and street-level bureaucrats, which asserts that standardized procedures are not self-actuating and cannot be understood apart from the environments in which they are used. I examine how frontline workers vary in their approach to an actuarial-based tool intended to standardize judgments. In a highly controlled decision-making environment, child welfare workers whose racial and sex characteristics afford them higher status report subverting the tool; conversely, workers in the same position whose ascriptive characteristics yield them lower status in terms of race and sex describe following the rules. In an environment where the same tool is adopted only ceremonially, all workers experience decision-making as unconstrained, regardless of their ascriptive characteristics. This work fills gaps in knowledge about how social status and organizational context intersect to affect rule abidance. Examining these dynamic relationships advances understanding of how organizations reproduce inequality and the limits and potential for standardization to transform social hierarchies. [ABSTRACT FROM AUTHOR]

This paper was written in 2013 as the faculty of the Reconstructionist Rabbinical College (RRC) was considering a policy barring prospective rabbinical students from being partnered with non-Jews. Composed by Rabbi Deborah Waxman, Ph.D., prior to her assuming the presidency of Reconstructing Judaism, it recommends that RRC set aside this policy and replace it with a clearly articulated preference that rabbinical students create for themselves homes with rich Jewish practice, and a requirement that children in the home be raised exclusively in the Jewish tradition. The recommendation emerges from a review of classical Reconstructionist positions as articulated by Mordecai M. Kaplan, the 1968 and 1979 Reconstructionist stands on patrilineal descent, the nature of religious authority, the impact of second-wave feminism on American Jewish life, and consideration of universalism versus particularism. The ultimate conclusion is that RRC's mission is to attract Jews to Jewish living and not to police boundaries and that adopting a more inclusive partner status policy is an affirmation of key Reconstructionist principles, including fostering diverse expressions of Jewish identity and inclusive Jewish communities, and an authentic step in an evolving understanding of the Jewish civilization. [ABSTRACT FROM AUTHOR]

The United States faces an increasingly complicated set of national security and economic threats. Chief among these are (1) progressively more sophisticated and damaging cyberattacks that threaten national security; harm government institutions, for-profit enterprises (including defense contractors), and institutions of higher learning; and undermine the country's system of property rights; and (2) rising levels of national debt held by foreign competitors. China poses the greatest threat in both regards. China's government carries out, organizes, and/or facilitates cyberattacks to misappropriate intellectual property with serious consequences to the U.S.'s national security and economy. China also has acquired significant holdings in U.S. government-issued debt instruments. Mounting U.S. government debt restricts annual federal government budgetary decisions, negatively affects the U.S.'s international standing as a borrower, and threatens national security by giving foreign debt holders, such as China, potential leverage in foreign relations negotiations. No policy prescription to date has achieved meaningful and lasting success in addressing these threats, and there are indications that the threats are only worsening. The National Trade Secret Protection and Remedy Strategy ("NTSPS") policy prescription proposed by this Article addresses the cyberattack and federal debt threats in a way that links and transforms them from vulnerabilities into leverage to protect the U.S.'s national security, system of property rights, and future economic well-being. Specifically, the U.S, government should pursue trade secret theftrelated litigation and remedies against the Chinese government and its surrogates in U.S. federal courts. The proposed NTSPS would (1) create a specific, limited government property interest in intellectual property developed under government defense contracts; (2) create extra-territorial jurisdiction for the U.S. government and personal jurisdiction over foreign nations that engage in trade secret misappropriation either directly or indirectly through state-supported or enabled entities or persons; and (3) provide for readily available pre-judgment remedies, such as attachment and liens, to secure the government's remedy, and satisfaction of judgments through execution on U.S. debt held instruments held by the misappropriator-in this case, China. Successful implementation of the NTSPS would require amendments to several existing federal statutes and defense-contracting regulations and procedures. Implementing the NTSPS strategy will allow the U.S. federal government to (1) compensate itself and U.S.-based companies for the damages each has suffered as the result of Chinese-led or -sponsored cyberattacks; (2) deter future Chinese cyberattacks by conveying a strong message that the U.S. will take meaningful action in response to said attacks; (3) slow the advancement of Chinese military technology by forcing China to internalize the significant research and development expenses incurred by the U.S. to develop the technological capabilities often targeted by cyber espionage initiatives; (4) significantly reduce U.S. debt and consequently the restrictions and burdens it places on the U.S. economy and national defense capability; and (5) pare down the financial leverage China holds over the U.S. in foreign relations. [ABSTRACT FROM AUTHOR]

The printing press helped to spread literacy, civic discourse, and even political dissent in colonial America. Without paper, however, the invention of the moveable type printing press would have been insignificant. This crucial communication medium was hobbled by a critical shortage of the raw material needed for printed matter. Paper was in short supply in the colonies and in the new nation as it could only be made from rags, and there was constant difficulty in obtaining enough rags to keep the presses rolling. Pleas for this essential ingredient were constantly seen in the newspapers in early America and there were severe shortages of both paper and the rags from which it was made during the American Revolution. This article examines how desperate were the early Americans for the paper which was necessary both for firing the muskets and for spreading the rhetoric of Revolution. [ABSTRACT FROM PUBLISHER]

Indigenous peoples in the United States experience many health disparities and barriers to accessing health care services. In addition, Indigenous communities experience poor social drivers of health, including disproportionately high rates of food insecurity, violence, and poverty, among others. These challenges are unsurprising, given historical societal discrimination toward Indigenous peoples and government policies of violence, forced relocation with loss of ancestral home, and erasure of cultures and traditions. Indigenous peoples have displayed resilience that has sustained their communities through these hardships. Through treaties between the federal government and Indigenous nations, the federal government has assumed a trust responsibility to provide for the health and well-being of Indigenous populations through the direct provision of health care services and financial support of tribally operated health systems. However, despite serving a population that has endured substantial historical trauma and subsequent health issues, federal programs serving Indigenous peoples receive inadequate federal funding and substantially fewer resources compared with other federal health care programs. Access to care is further challenged by geographic isolation and health care workforce vacancies. Given the history of Indigenous peoples in the United States and their treatment by the federal government and society, the American College of Physicians (ACP) asserts the federal government must faithfully execute its trust responsibility through increased funding and resources directed toward Indigenous communities and the undertaking of concerted policy efforts to support the health and well-being of Indigenous people. ACP believes that these efforts must be community-driven, Indigenous-led, and culturally appropriate and accepted, and center values of respect and self-determination. [ABSTRACT FROM AUTHOR]

The article discusses the relevance of the release of U.S. government documents related to its involvement in the Vietnam War known as the Pentagon Papers in the 1970s to the early 21st century release of information by the journalistic organization WikiLeaks, particularly concerning the concepts of freedom of the press and censorship. The article examines the classified study of the Vietnam War conducted by the U.S. agency the Defense Department commissioned by U.S. defense secretary Robert McNamara, the role of U.S. military analyst Daniel Ellsberg in releasing the Pentagon Papers, and the actions of the administration of U.S. president Richard M. Nixon that led to the U.S. Supreme Court case New York Times v. United States. It also discusses former U.S. agency the National Security Administration (NSA) analyst Edward Snowden.