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This paper reports on the first stage of an international comparative study for the project "'Digital educational architectures: Open learning resources in distributed learning infrastructures--EduArc,'" funded by the German Federal Ministry of Education and Research. This study reviews the situation of digital educational resources (or (O)ER) framed within the digital transformation of ten different Higher Education (HE) systems (Australia, Canada, China, Germany, Japan, South Africa, South Korea, Spain, Turkey and the United States). Following a comparative case study approach, we investigated issues related to the existence of policies, quality assurance mechanisms and measures for the promotion of change in supporting infrastructure development for (O)ER at the national level in HE in the different countries. The results of this mainly documentary research highlight differences and similarities, which are largely due to variations in these countries' political structure organisation. The discussion and conclusion point at the importance of understanding each country's context and culture, in order to understand the differences between them, as well as the challenges they face.

Purpose: This study uses a holistic approach to learning at work to examine the role of reflection in the formal-informal learning interaction. The purpose of this study is to investigate how the reflection on a formal training affects the subsequent informal learning activities. This study also aims to provide insights into the effects of national culture values (in terms of uncertainty avoidance) on learning in the context of a globalized world of work. Design/methodology/approach: In a longitudinal study, 444 employees working for a global acting automotive company located in 6 countries were surveyed 2 times (4-6 weeks between both measurements). Participants reflected on a training they participated in (t[subscript 1]: satisfaction and utility) and indicated their informal learning activities (t[subscript 2]). Structural equation modelling was used to investigate the effect of the reflection of training (t[subscript 1]) on the proceeding use of informal learning strategies (t[subscript 2]) and how uncertainty avoidance affects the use of different learning forms. Findings: Results show a spillover effect: when employees reflect a formal training and rate it as satisfying, more use of informal learning proceeds. No effects were found for utility. Uncertainty avoidance had direct effects: high uncertainty avoidance results in better evaluations and more informal learning. Furthermore, uncertainty avoidance had an indirect effect on informal learning via reflection. Originality/value: To the best of the authors' knowledge, this study is the first to investigate the formal-informal learning interaction longitudinally and to introduce reflection as a mediator within this process. Furthermore, the study provides evidence that uncertainty avoidance is an important factor for formal and informal learning in the globalized world of work.

Objective: To determine intrapartum factors associated with perineal laceration at delivery. Methods: This was a planned secondary analysis of a multicenter randomized clinical trial of delayed versus immediate pushing among term nulliparous women in labor with neuraxial analgesia conducted in the United States. Intrapartum characteristics were extracted from the medical charts. The primary outcome was perineal laceration, defined as second degree or above, characterized at delivery in women participating in longer term pelvic floor assessments post-delivery. Multivariable logistic regression was used to refine risk estimates while adjusting for randomization group, birth weight, and maternal age. Results: Among the 941 women participating in the pelvic floor follow-up, 40.6% experienced a perineal laceration. No first stage labor characteristics were associated with perineal laceration, including type of labor or length of first stage. Receiving an amnioinfusion appeared protective of perineal laceration (adjusted odds ratio, 0.48; 95% confidence interval 0.26–0.91; P = 0.01). Second stage labor characteristics associated with injury were length of stage (2.01 h vs. 1.50 h; adjusted odds ratio, 1.36; 95% confidence interval 1.18–1.57; P < 0.01) and a prolonged second stage (adjusted odds ratio, 1.64; 95% confidence interval 1.06–2.56; P < 0.01). Operative vaginal delivery was strongly associated with perineal laceration (adjusted odds ratio, 3.57; 95% confidence interval 1.85–6.90; P < 0.01). Conclusion: Operative vaginal delivery is a modifiable risk factor associated with an increased risk of perineal laceration. Amnioinfusion appeared protective against injury, which could reflect a spurious finding, but may also represent true risk reduction similar to the mechanism of warm perineal compress. Significance: The objective of this study was to examine intrapartum factors associated with an increased risk of perineal laceration at delivery among nulliparous women. Operative vaginal delivery and the length of second stage, particularly prolonged second stage, are modifiable risk factors associated with an increased risk of perineal laceration. Receiving an amnioinfusion appeared to be protective against perineal laceration. There are few intrapartum modifiable risk factors other than operative delivery for perineal laceration in nulliparous women. Length of the second stage is an important risk factor for perineal lacerations that is modifiable through active management. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer is one of the leading causes of cancer-related deaths in the US. Lately, there has been a rise in colorectal cancer in younger patients; however, there is a paucity of data on geographical variations of early-onset colorectal cancer in the US. Thus, our study aimed to evaluate the temporal change in early-onset colorectal cancer incidence rates in different regions in the US and assess these trends by sex and histopathological subtypes. We analyzed data from 2001 to 2020 from the United States Cancer Statistics database, which encompasses nearly 98% of the US population. Our results demonstrated that early-onset colorectal cancer incidence rates and time trends increased in men and women across different regions in the US, with the steepest increase noted in the west and the least in the south. These findings persisted across both main colorectal cancer histopathological subtypes (adenocarcinoma and neuroendocrine tumors) with neuroendocrine tumors showing a more pronounced increase compared to adenocarcinoma, especially in the west and northeast. Our findings hold public health implications prompting healthcare policies and future research to investigate any disproportional exposure to region-specific risk factors over the past two decades in the US, especially in western regions. Background: Colorectal cancer remains the second leading cause of cancer-related death in the US. As early-onset colorectal cancer (EO-CRC) becomes more prevalent in the US, research attention has shifted towards identifying at-risk populations. Previous studies have highlighted the rising rate of early-onset adenocarcinoma (ADC) and neuroendocrine tumors (NET) in the US. However, data on geographical variations of EO-CRC are scarce. Hence, our study aims to analyze time trends in EO-CRC incidence rates across various US regions and to assess these trends by sex and histopathological subtypes (ADC and NET). Methods: We analyze data spanning from 2001 to 2020 from the United States Cancer Statistics (USCS) database, covering nearly 98% of the US population. Using SEER*Stat software version (8.4.2, NCI), we calculated EO-CRC incidence rates among adults aged 20–54 years, adjusting for the age standard 2000 US population. The rates were categorized by sex and US geographical regions into west, midwest, northeast, and south. Time trends, reported as annual percentage change (APC) and average APC (AAPC), were generated via Joinpoint Regression software (v.5.0.2, NCI) utilizing the weighted Bayesian Information Criteria "BIC" method to generate the best-fit trends with a two-sided p-value cutoff at 0.05. The rates were also stratified by histopathology into ADC and NET. Results: Between 2001 and 2020, a total of 514,875 individuals were diagnosed with early-onset CRC in the US, with 54.78% being men. Incidence rates and trends varied across geographical regions. In the western region (comprising 106,685 patients, 54.85% men), incidence rates significantly increased in both women (AAPC = 1.37, p < 0.001) and men (AAPC = 1.34, p < 0.001). Similarly, in the midwestern region (with 110,380 patients, 55.46% men), there were significant increases in incidence rates among women (AAPC = 1.06, p < 0.001) and men (AAPC = 1.35, p < 0.001). The northeastern region (with 94,758 patients, 54.53% men) also witnessed significant increases in incidence rates for both women (AAPC = 0.71, p < 0.001) and men (AAPC = 0.84, p < 0.001). In contrast, the southern region (with 203,052 patients, 54.48% men) experienced slower increases in incidence rates among both women and men (AAPC = 0.25, p < 0.05 in women; AAPC = 0.66, p < 0.05 in men). When stratified by histopathology, incidence rates for adenocarcinomas (ADC) increased in all regions, most notably in the west (AAPC = 1.45, p < 0.05), and least in the south (AAPC = 0.46, p < 0.05). Conversely, for neuroendocrine tumors (NET), while incidence rates increased similarly across all regions, the pace was notably faster compared to ADC, particularly in the west (AAPC = 3.26, p < 0.05) and slower in the south (AAPC = 2.24, p < 0.05) Discussion: Our analysis of nationwide US data spanning two decades and encompassing over half a million early-onset CRC patients, representing nearly 98% of the US population, highlights significant temporal variation in incidence rates across various geographical regions. The most substantial increases in incidence rates were observed in the west, while the least pronounced changes were noted in the south, affecting both men and women. These trends persisted across the main CRC histopathological subtypes, with NET exhibiting a notably swifter pace of increase compared with ADC. These findings hold important implications for public health strategies and underscore the need for targeted interventions to address the rising burden of early-onset CRC across different regions in the US. [ABSTRACT FROM AUTHOR]

The purpose of this mixed methods, cross-sectional patient survey was to characterize patient experience, to explore the frequency of and reasons for infertility treatment discontinuation and return to infertility treatments. Participants were recruited from United States patient support groups. Participants had received or were receiving ovulation induction (OI) with or without intrauterine insemination (IUI), with or without subsequent in vitro fertilization (IVF), or IVF with no other previous infertility treatment. Live birth was achieved by 62% of participants. Compared with participants treated with OI/IUI only, participants who underwent OI/IUI followed by ≥1 IVF cycle were less likely to consider discontinuing care (64% vs 77%; P =.014) or to discontinue treatment without achieving a pregnancy (40% vs 58%; P =.004). The most commonly cited reasons for treatment discontinuation were financial (62%) and psychological burden/treatment fatigue (58%). Expected versus actual time to pregnancy differed greatly. Continued desire for a child (60%) was the most frequently cited reason for continuing or resuming treatment. Expanded access to treatment, counseling and fostering realistic expectations regarding cumulative time to pregnancy may reduce treatment discontinuation. [ABSTRACT FROM AUTHOR]

Developing, sustaining, and improving student engagement is of vital importance to higher education instructors. Educational technology has been linked to student engagement, and preservice and in-service teachers need to develop information communication and technology (ICT) skills and knowledge to apply them in the classroom as well as to develop ICT skills in students. Thus, further investigation of this link in the field of education is needed. This narrative systematic review is a synthesis of 42 peer-reviewed articles from across four international databases, published between 2007-2016 and is a subset of a larger systematic review. The results indicate that the majority of research has been undertaken within undergraduate preservice teacher education, predominantly in the US, Hong Kong, and the UK, with limited attention given to grounding research in theory. This review found educational technology supports student engagement, with behavioral and affective being the most prevalent dimensions. Social networking tools (SNT), knowledge organization and sharing tools, text-based tools, and website creation tools were the most effective at promoting engagement. However, caution is needed when employing SNT and assessment tools, as they were also more likely to lead to disengagement. Further research is needed on how educational technology affects disengagement, how tools are used in online teacher education programs, and how to effectively integrate SNT in education programs.

Background: Optimal management after posterior cruciate ligament (PCL) injury remains an active area of research, as reconstruction is technically challenging and poses unique risks in the posterior knee. Studies have reported variable rates of complications. Purpose: To describe the rates of readmission, emergency department (ED) visits, and postoperative complications within 90 days of isolated PCL reconstruction (PCLR) in a large, national cohort to better understand the perioperative variables that influence a practitioner's decision of whether to pursue operative versus nonoperative management. Study design: Descriptive epidemiology study. Methods: PCLRs from January 1, 2010, through August 31, 2020, were identified in PearlDiver, a national administrative database. Patients with concomitant ligament surgery and those with fewer than 90 days of postoperative database activity were excluded. Deep vein thromboses, pulmonary embolisms, surgical site infections, compartment syndrome, and vascular events within 90 days of surgery were identified, as were 90-day readmissions and ED visits. Logistic regression models were built in PearlDiver to calculate odds ratios (ORs) for ED utilization. Results: The final cohort consisted of 1154 patients with isolated PCLR (mean age, 34 ± 16 years; 62% male). Most patients were located in the Southern United States (n = 417; 36.1%), and most had commercial insurance (n = 992; 86%). The 90-day rates of adverse events were as follows: deep vein thrombosis (13; 1.1%), pulmonary embolism (19; 1.6%), surgical site infection (<11; <1%), compartment syndrome (<11; <1%), vascular event (<11; <1%), readmission (13, 1.1%), and ED utilization (99; 8.6%). The majority of emergency department visits (52%) occurred in the first 2 weeks postoperatively. Predictive factors for ED utilization included Elixhauser Comorbidity Index score (OR = 1.31 per 2-point increase) and Medicaid insurance (OR = 2.03 relative to commercial insurance). Conclusion: The current study reported rates of adverse events after isolated PCLR in a large, national cohort. The results provide important context for decisions about optimal management of PCL injury. [ABSTRACT FROM AUTHOR]

A mass‐conserving method to downscale precipitation from global climate models (GCMs) using sub‐grid‐scale topography and modeled 700‐mb wind direction is presented. Runoff is simulated using a stand‐alone hydrological model, with this and several other methods as inputs, and compared to runoff simulated using historical observations over the western contiguous United States. Results suggest the mitigation of grid‐scale biases is more critical than downscaling for some regions with large wet biases (e.g., the Great Basin and Upper Colorado). In other regions (e.g., the Pacific Northwest) the new method produces more realistic sub‐grid‐scale variability in runoff compared to unadjusted GCM output and a simpler downscaling method. The presented method also brings the runoff centroid timing closer to that simulated with observations for all subregions examined. Plain Language Summary: Due to limitations in computing power which necessitates coarse spatial resolution, climate models do not include many details on mountains and their impact on precipitation. For this reason, it is difficult to estimate the impact of climate change on the availability of water for human consumption in places like the western United States, where mountain snowpack is an important source of water. This paper presents a way to adjust precipitation estimates from climate models by using some simple statistics about nearby mountains and valleys. The adjusted precipitation is then used in a hydrologic model to calculate the runoff that is simulated with different precipitation inputs. Results show that in most cases, the precipitation adjustment improves estimates of the resultant runoff relative to simulations with observed precipitation. The main exceptions are in very dry areas where the climate model produces far too much precipitation. With further work, the proposed adjustment may be integrated into the climate model itself to make it easier for those managing water resources (e.g., controlling reservoir levels) to use the model output to plan and adapt to climate change. Key Points: A mass‐conserving method for downscaling orographic precipitation improves modeled runoff from the CESM2Considering upwind topography further improves modeled runoff compared to simpler adjustmentsNot tuning to individual model grid points makes this method more generalizable than many existing statistical downscaling methods [ABSTRACT FROM AUTHOR]

Background: Electronic cigarettes (e-cigarettes) have become the most common tobacco product used among adolescents in the United States (US). Prior research has shown that peer e-cigarette use was associated with increased risk of own e-cigarette use. Nonetheless, there is little empirical evidence on the directionality of these associations—if peer use predicts own use (peer influence) or if own use predicts peer use (peer selection). Methods: We estimated the association between peer and own e-cigarette use among US adolescents 12–17 years of age. We used the cross-lagged model to investigate the mutual relationship between peer and own e-cigarette use over time using data from a population-based longitudinal study, Population Assessment of Tobacco and Health. Stratified analyses were conducted by sex and age subgroups. Results: Results from a cross-lagged model showed a statistically significant predicting path leading from peer use at the prior time point to own use at the following time point, but not vice versa. Conclusions: We found strong relationships between peer e-cigarette use and own e-cigarette use at within-individual levels. Peer influence paths were more robust than peer selection paths for e-cigarette use. Incorporating peers into prevention and intervention programs may help enhance these strategies. [ABSTRACT FROM AUTHOR]

As federal partners, the Veterans Health Administration (VA) and the Indian Health Service (IHS) agreed to share resources, such as education. The VA Geriatric Scholars Program, a workforce development program, provides one of its training programs on team-based primary care of elders to clinicians working in IHS and Tribal Health Programs. The practical impact of that training is described. A mixed methods approach was applied to the course's evaluation survey at five clinics in the Northwestern Plains, Southwest, Pacific Coast, and Alaska. Quantitative approaches assessed participants' self-reported intention to improve recognition and assessment of common geriatric syndromes. A qualitative approach applied to open-ended text responses revealed intensions to improve team-based care. Among the 51 respondents in our sample, we found significant improvements in self-reported ability to recognize previously unfamiliar potential risks to elders' health and safety, t(49) = 8.0233, p <.001, as well as increased comfort with conducting geriatric assessments and increased confidence in interprofessional team-based communication. Improvements to team-based care included enhanced clinical skills, organizational factors and the need to train additional employees. This evaluation demonstrates the value of sharing resources among federal partners and its value for participants in IHS and Tribal Health Programs. [ABSTRACT FROM AUTHOR]

Multiple introductions of tea (Camellia sinensis) to the United States since the 1850s have resulted in US tea germplasm that are currently poorly characterized. To resolve questions concerning the relatedness and regional adaptability of US tea germplasm, 32 domestic individuals were evaluated using 10 InDel markers, and compared with a background population of 30 named and registered Chinese varieties of tea. The marker data were analyzed via a neighbor-joining cladistic tree derived from Nei’s genetic distance, STRUCTURE, and Discriminant Analysis of Principal Components, which revealed four genetic groups. Nineteen individuals selected from the four groups were assessed for seven leaf traits, two floral descriptors, and leaf yield, to identify plants best adapted to Florida field conditions. Our analyses compared with available historical records led us to estimate the most likely provenance of some of the US individuals, to precisely identify tea plant material and to choose most diverse accessions for breeding tea improved for adaptability, yield and quality. [ABSTRACT FROM AUTHOR]

Reproductive abnormalities, that could lead to possible effects at the population level, have been observed in wild fish throughout the United States, with high prevalence in largemouth bass (LMB; Micropterus salmoides) and smallmouth bass (Micropterus dolomieu). Estrone (E1) and atrazine (ATR) are common environmental contaminants often associated with agricultural land use. 17alpha-ethinylestradiol (EE2) is a contaminant associated with wastewater treatment effluent, and a representative, well-studied estrogen commonly used for fish toxicity testing. Our objective was to assess whether early gonad recrudescence in adult fish was a period of sensitivity for alterations in reproductive condition and function. Adult male LMB were exposed from post-spawning to early gonad recrudescence to either a mixture of E1 (47.9 ng/L) + ATR (5.4 µg/L), or EE2 (2.4 ng/L) in outdoor experimental ponds. Gonad samples were collected from fish just prior to the start of exposure (July), at the end of the exposure period (December), the following spring just prior to spawning (April), and post spawning (May). Gonadosomatic index (GSI) was significantly reduced in E1 + ATR-exposed and EE2-exposed males compared to control at every post-exposure time point. Reduced sperm count and sperm motility were observed in the mixture treatment (E1 + ATR) compared to the control. Sperm motility was also reduced in the EE2 treatment. These data together indicate that estrogenic endocrine-disrupting compounds can lessen the reproductive condition of adult male LMB, and that effects of exposure during early gonad recrudescence can persist at least through the subsequent spawning cycle. [ABSTRACT FROM AUTHOR]

Introduction: The standard of care consolidation therapy for acute myeloid leukemia is high-dose cytarabine or intermediate-dose cytarabine, which are traditionally given inpatient. At Moffitt Cancer Center, we have moved the administration of high-dose cytarabine and intermediate-dose cytarabine to the outpatient setting through the inpatient/outpatient program. To facilitate outpatient administration, high-dose cytarabine and intermediate-dose cytarabine are given in a shorter interval of every 10 h instead of 12 h. The safety of a shorter duration interval of high-dose cytarabine and intermediate-dose cytarabine is unknown. This study aims to assess the safety and feasibility of administering high-dose cytarabine and intermediate-dose cytarabine consolidation therapy in the inpatient/outpatient setting. Methods: This is a retrospective chart review to analyze acute myeloid leukemia patients treated with inpatient/outpatient high-dose cytarabine or intermediate-dose cytarabine consolidation therapy at Moffitt Cancer Center from January 1, 2015, through November 1, 2018. The primary objective was to determine the incidence of hospitalization during the inpatient/outpatient administration of high-dose cytarabine or intermediate-dose cytarabine. Results: Two hundred fifty-three of 255 cycles of high-dose cytarabine/intermediate-dose cytarabine were delivered outpatient over the reviewed time period to 118 patients. No patients receiving outpatient high-dose cytarabine/intermediate-dose cytarabine consolidation required hospitalization during chemotherapy. Our incidence of hospitalization (24%) after chemotherapy is consistent with the reported literature. Through the inpatient/outpatient administration of high-dose cytarabine and intermediate-dose cytarabine, 1265 inpatient days were saved with an approximate revenue of $3,135,176 generated in our study period. Conclusion: Inpatient/outpatient administration of high-dose cytarabine and intermediate-dose cytarabine is both safe and feasible. Moving high-dose cytarabine/intermediate-dose cytarabine administration to the outpatient setting resulted in significant additional revenue vs. inpatient administration. [ABSTRACT FROM AUTHOR]

Ten novel breeding lines of quinoa (Chenopodium quinoa Willd) suitable to be grown in the Pacific Northwest of the United States were developed and utilized for extrusion processing. Understanding how a particular breeding line performs during food processing and which properties determine its performance can promote the use of quinoa as an ingredient in value‐added products, such as extruded snacks. In this study, extrusion characteristics of the whole seed flours of the novel quinoa breeding lines were evaluated using a co‐rotating twin‐screw extruder at two temperatures (110°C and 125°C), three screw speeds (200, 350, and 500 rpm), and a moisture content of 18% (w.b.). The expansion ratio (ER) ranged from 1.15 to 2.33 and was negatively influenced by the fat content in the flours. Breeding line 11WAQ‐104.88 (WAQ10) exhibited the greatest potential for use in direct expanded foods as it had the highest ER for all conditions studied. Strong correlations were found between ER and pasting properties of the flours, proving the usefulness of the pasting test for flour quality evaluation before extrusion processing. The results demonstrate the potential of using quinoa for producing direct expanded food products and highlight the importance of selecting specific breeding lines for desired product characteristics. Practical Application: This study provides the extrusion processing characteristics of 10 new quinoa breeding lines. Based on the information gained, it will be easier for the food industry, including breeders as well as processors, to select the right quinoa variety based on their requirements, and may further help to enhance the use of quinoa. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic led to school closure and loss of in-person instruction during the 2019-2020 academic year across the United States, which had a profound impact on the reading development of beginning readers. In this study we tested if a research-informed educational technology (EdTech) program-GraphoLearn-could help alleviate the COVID-19 slide. We also sought to understand the profiles of children who benefitted most from this EdTech program. Methods: We tested participants' (N = 172 K-2 children) early literacy skills using a standardized measure (STAR) before and after playing GraphoLearn, and used the pre to post difference as the dependent variable. We first compared children's STAR actual and expected growth. Then we conducted a multiple regression analysis with data about engagement with GraphoLearn included as predictors. Additional predictors were extracted from GraphoLearn performance at study onset to assess children's letter-sound knowledge, rime awareness, and word recognition. Results: The difference between actual average reading growth and expected growth in a regular school year was not statistically significant. This suggests that children in our sample seem to be gaining reading skills as expected in a regular school year. Our multiple linear regression model (which accounted for R2 = 48% of reading growth) showed that older children, with higher baseline GraphoLearn word recognition, who played more units in a fixed number of days, made significantly more early literacy progress. Discussion: While lacking a control group, our preliminary results suggest that an EdTech program such as GraphoLearn may be a useful reading instructional tool during school shutdowns. In addition, our results suggest that practice with GraphoLearn was more effective and efficient when foundational instruction was already in place. [ABSTRACT FROM AUTHOR]

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The skill of NOAA's official monthly U.S. precipitation forecasts (issued in the middle of the prior month) has historically been low, having shown modest skill over the southern United States, but little or no skill over large portions of the central United States. The goal of this study is to explain the seasonal and regional variations of the North American subseasonal (weeks 3–6) precipitation skill, specifically the reasons for its successes and its limitations. The performances of multiple recent-generation model reforecasts over 1999–2015 in predicting precipitation are compared to uninitialized simulation skill using the atmospheric component of the forecast systems. This parallel analysis permits attribution of precipitation skill to two distinct sources: one due to slowly evolving ocean surface boundary states and the other to faster time-scale initial atmospheric weather states. A strong regionality and seasonality in precipitation forecast performance is shown to be analogous to skill patterns dictated by boundary forcing constraints alone. The correspondence is found to be especially high for the North American pattern of the maximum monthly skill that is achieved in the reforecast. The boundary forcing of most importance originates from tropical Pacific SST influences, especially those related to El Niño–Southern Oscillation. We discuss physical constraints that may limit monthly precipitation skill and interpret the performance of existing models in the context of plausible upper limits. Significance Statement: Skillful subseasonal precipitation predictions have societal benefits. Over the United States, however, NOAA's official U.S. monthly precipitation forecast skill has been historically low. Here we explore origins for skill of North American week-3 to week-6 precipitation predictions. Skill arising from initial weather states is compared to that arising from ocean surface boundary states alone. The monthly and seasonally varying pattern of U.S. monthly precipitation skill is appreciably derived from boundary constraints, linked especially with El Niño–Southern Oscillation. Forecasts of opportunity are identified, despite the low skill of monthly precipitation forecasts on average. Potential limits of monthly precipitation skill are explored that provide insight on the juxtaposition of "skill deserts" over the central United States with high skill regions over western North America. [ABSTRACT FROM AUTHOR]

The article discusses a study which found that the largest marijuana companies engage in corporate social responsibility activities that mimic those the tobacco industry uses to influence politics and regulation, encourage increased consumption, and target marginalized communities. Topics include risks to youth, risks to disadvantaged communities, and recommendations to minimize harm.

Introduction: Government and health organizations in the United States and the United Kingdom have taken different stances on e-cigarettes policy. To explore the potential effects of these policies, we describe e-cigarette user characteristics, intentions to quit, and perceived attitudes toward vaping.Methods: We used the online crowdsourcing platform Prolific to conduct a cross-sectional survey of current vapers in both countries. Measures were drawn from international surveys.Results: The sample included 1044 vapers (524 United Kingdom; 520 United States) with a mean age of 34. Samples differed by gender (United States: 57% male vs 45% in United Kingdom), race (United States: 79% White vs 90% in United Kingdom) and employment (United States: 73% employed vs 79% in United Kingdom). UK respondents were more likely than US respondents to be ever smokers (89% vs 71%, p < .0001); be daily vapers (69% vs 53%, p < .0001) and to use e-cigarettes to quit smoking (75% vs 65%, p < .0007). Most vapers in the United Kingdom and the United States want to stop vaping (62% vs 61%; p < .9493), but US respondents plan to quit significantly sooner (odds ratio 0.47, p < .0004). Attitudes differed as well. Over half (56%) of UK respondents reported their government-approved e-cigarette use, and 24% felt health care providers had positive views on e-cigarettes versus 29% and 13% from the United States, respectively (p < .0004 for both).Conclusions: Plans for quitting and perceptions regarding e-cigarettes differ markedly between demographically similar groups of vapers in the two countries. Future research should determine whether e-cigarette cessation for adults should be a public health goal, and if so, identify effective ways to stop.Implications: The contribution of this study is that it describes differences in behaviors and attitudes of vapers recruited through the same research platform and adjusted to account for minor demographic differences across country samples. For clinicians, these findings suggest that most vapers would welcome assistance in quitting. For researchers and policymakers, findings suggest that government policy regarding nicotine devices might influence behaviors and attitudes related to use and also that future research is needed to determine effective ways to quit. [ABSTRACT FROM AUTHOR]

Objectives: Human papillomavirus (HPV) vaccination coverage in the United States is far below coverage for other routine adolescent vaccines. We examined whether missed opportunities for HPV vaccination among adolescents differ by parental nativity (country of origin) in Minnesota. Methods: We retrospectively analyzed birth record and immunization information data for adolescents in Minnesota born during 2004-2007 using data from January 1, 2015, through December 31, 2018. Using logistic regression, we assessed the association between parental nativity and missed opportunities for HPV vaccine initiation, or receipt of other vaccines without receipt of the HPV vaccine. We adjusted for parent/child demographic and vaccination characteristics. We defined nativity as the number of non–US-born parents and maternal region of birth. Results: Adolescents with mothers born in Eastern Europe (adjusted odds ratio [aOR] = 2.33; 95% CI, 2.01-2.73) and Africa (aOR = 1.36; 95% CI, 1.28-1.43) had greater adjusted odds of missed opportunities for HPV vaccination than adolescents with US-born mothers. However, adolescents with mothers from Latin America and the Caribbean had lower odds of missed opportunities than adolescents with US-born mothers (aOR = 0.61; 95% CI, 0.58-0.65). Adolescents with 1 or 2 non–US-born parents had lower odds of missed opportunities for HPV vaccination than adolescents with 2 US-born parents (1 parent: aOR = 0.92; 95% CI, 0.88-0.96; 2 parents: aOR = 0.90; 95% CI, 0.87-0.94). Conclusions: Future studies should evaluate outreach to groups with HPV vaccination disparities and identify other drivers of missed opportunities among adolescents with US-born parents, such as multiparity. [ABSTRACT FROM AUTHOR]

The deep regolith of the southeastern United States has undergone rapid erosion in the last two centuries due to intensive agricultural practices, which has altered the landscape and its inherent fertility. Parent material, landscape position, and land use are important factors in controlling the mineral and elemental composition of soil profiles. Independent quantitative X-ray diffraction (QXRD) and whole-rock chemical analysis of eight weathering profiles agreed well and allow mineral reaction pathways to be constrained as particles are conveyed in the subsurface. QXRD analysis of saprolite, argillic, and soil A-horizons in the profiles highlights the imprint of bedrock on the regolith, which includes Neoproterozoic meta-tonalitic to meta-granodioritic and Paleozoic meta-granitic to biotite- and amphibolite-gneissic lithologies. Also, aeolian input slightly influenced A-horizon composition. The clay mineral assemblage is dominated by kaolinite, but profiles differ in the amount of interstratified clay minerals, halloysite, hematite, goethite, and gibbsite. Rare-earth element totals vary between 30 and 1048 ppm and are generally correlated positively with clay and clay mineral content. Eu and Ce anomalies reflect parent rocks and subsequent hydrolysis and redox history, with trends depending upon landscape position and clay content in the weathering profile. Weathering profiles on a high-order interfluve and those that were actively cultivated have thick argillic horizons (as defined by clay mineral abundance) and are depleted in alkali and alkaline-earth elements. Profiles proximally developed on old-field pine and never-cultivated hardwood forest land do not show large differences in mineral composition trends, whereas profiles on old-field sites with ongoing cultivation exhibit assemblages enriched in clay minerals and (oxyhydr)oxides. Old-field pine sites that were historically eroded by previous cultivation tend to have shallower and thinner argillic horizons, which may well impact critical-zone processes involving gas and water fluxes. This study highlights that mineral compositions of deep regolith, saprolite, and shallow soil horizons are dependent on local geomorphology (i.e. watershed- and hillshed-orders). Quantifying soil and regolith compositional trends across the landscape is a prerequisite for determining rates of chemical and physical erosion on human and geologic time scales. [ABSTRACT FROM AUTHOR]

Precise measurement of urban land (UL) is an essential tool for planning in a world of accelerating change and increasing risk, but analysis has traditionally faced methodological and conceptual challenges. This review traces the evolution of UL measurement in the United States (US) from early attempts at quantification through current innovative approaches that analyze the qualities of UL. Researchers now have tools better suited to multi-scalar and complex conceptualization of urban systems. Given this maturation, critical reflection on research design has become essential to UL research, in particular the alignment of measurement tools with desired outcomes and planning goals. [ABSTRACT FROM AUTHOR]

Background: In June 2020, the U.S. Preventive Services Task Force (USPSTF) issued a final recommendation on screening for unhealthy drug use in adults and adolescents. It assigned a "B" rating on a recommendation for screening in primary care for adults when services for accurate diagnosis, effective treatment, and appropriate care can be provided or referred, but declined to recommend the same for adolescents, concluding that current evidence is insufficient to assess the balance of benefits and harms. Objectives: To examine and provide recommendations to address gaps in the USP ST recommendation on screening for unhealthy drug use. Results: The lack of recommendation to screen adolescents represents a critical gap and highlights the need for research on adolescent substance use screening. While research is limited, available evidence shows short-term benefits from youth screening and early intervention and no evidence of harm. The lack of recommendation for youth leaves practitioners without guidance and incentive to intervene with youth who use substances, discourages expansion/support of youth screening, and reinforces treatment barriers. The statement also lacks guidance to address barriers to implementing screening in adults. Despite promotion of the practice, implementation in primary care is sporadic. Providers should be made aware of implementation barriers and the clinical guides and training available to facilitate implementation. Conclusions/Importance: Screening and intervention are vital for addressing the addiction crisis, and USPSTF recommendations are critical for making preventive health care services accessible and affordable. These gaps must be addressed for the recommendation statement to reach its full life-saving potential. [ABSTRACT FROM AUTHOR]

Proximity soundings have long been used to explore how the vertical structure of temperature, humidity, and winds influence convective storms and their associated hazards. In severe thunderstorm research and forecasting, convective parameters are often used to summarize certain characteristics of the sounding. While extremely useful, these parameters are unable to describe the rich complexity that is readily apparent in hodographs and skew T–logp diagrams. Motivated by a desire to retain more of these details, the present study uses self-organizing maps (SOMs) to group soundings based on their full vertical structure. The analysis makes use of a sample of more than 10 000 model proximity soundings for right-moving supercells associated with tornadoes and significant severe hail and straight-line winds in the contiguous United States (CONUS). Separate SOMs are developed for the wind and thermodynamic profiles, each with 3 × 3 nodes, resulting in a set of nine hodographs and nine skew T–logp diagrams that broadly represent the spectrum of near-storm environments for significant severe right-moving supercells in the CONUS. Both SOMs are shown to provide a good representation of the variability in key convective parameters, although, for the thermodynamic SOM, variations in LCL heights and midlevel lapse rates are somewhat limited. Based on the soundings assigned to them, the SOM nodes are characterized in terms of their associated hazards, their relationship with storm mode and mesocyclone strength, and their spatial and temporal variability. Potential applications of the SOMs in severe weather forecasting and idealized numerical simulations are also highlighted. [ABSTRACT FROM AUTHOR]

Objective: To determine whether vaginal progesterone for programmed endometrial preparation is noninferior to intramuscular progesterone in terms of live birth rates from frozen embryo transfer (FET).Design: Three-armed, randomized, controlled noninferiority trial.Setting: Multicenter fertility clinic.Patient(s): A total of 1,346 volunteer subjects planning vitrified-warmed transfer of high-quality nonbiopsied blastocysts were screened, of whom 1,125 subjects were ultimately enrolled and randomly assigned to treatment.Intervention(s): The subjects were randomly assigned to receive, in preparation for FET, 50 mg daily of intramuscular progesterone (control group), 200 mg twice daily of vaginal micronized progesterone plus 50 mg of intramuscular progesterone every third day (combination treatment), or 200 mg twice daily of vaginal micronized progesterone.Main Outcome Measure(s): The primary outcome was live birth rate per vitrified-warmed embryo transfer. The secondary outcomes were a positive serum human chorionic gonadotropin test 2 weeks after FET, biochemical pregnancy loss, clinical pregnancy, clinical pregnancy loss, total pregnancy loss, serum luteal progesterone concentration 2 weeks after FET, and patient's experience and attitudes regarding the route of progesterone administration, on the basis of a survey administered to the subjects between FET and pregnancy test.Result(s): A total of 1,060 FETs were completed. The live birth rate was significantly lower in women receiving only vaginal progesterone (27%) than in women receiving intramuscular progesterone (44%) or combination treatment (46%). Fifty percent of pregnancies in women receiving only vaginal progesterone ended in miscarriage.Conclusion(s): The live birth rate after vaginal-only progesterone replacement was significantly reduced, due primarily to an increased rate of miscarriage. Vaginal progesterone supplemented with intramuscular progesterone every third day was noninferior to daily intramuscular progesterone, offering an effective alternative regimen with fewer injections.Clinical Trial Registration Number: NCT02254577. [ABSTRACT FROM AUTHOR]

The last few years have seen a marked shift in the public's response to mass incarceration. Some state legislatures have responded by changing criminal statutes and sentencing schemes to reduce the number of people incarcerated in jails and prisons and lessen the collateral consequences faced by those previously convicted of crimes. Although these efforts are laudable, they may fail to consider the limitations imposed upon convicted persons seeking to avail themselves of these benefits without the assistance of counsel. This essay argues that, in addressing the question of how best to effectuate the progressive goals of criminal justice reform, it is critical to view the issue through Fourteenth Amendment theories supporting the right to counsel on appeal. This avenue promises a reasonable and feasible method of providing the type of legal support that is necessary to ensure reform statutes are accessible to those they were created to help. [ABSTRACT FROM AUTHOR]

Background Intake of trans fatty acids (TFAs) increases LDL cholesterol, decreases HDL cholesterol, and increases the risk of heart disease morbidity and mortality. Many food products potentially contain industrially produced or ruminant TFAs. However, little is known about the dietary sources of plasma TFA concentrations. Objective The objective of this study was to examine associations between foods consumed and plasma TFA concentrations using 24-h dietary recall data and plasma TFA measures among adults aged ≥20 y who participated in the NHANES 2009–2010 in the United States. Methods Over 4400 food products in the dietary interview data were categorized into 32 food and beverage groups/subgroups. Four major plasma TFAs (palmitelaidic acid, elaidic acid, vaccenic acid, linolelaidic acid) and the sum of the 4 TFAs (sumTFAs) were analyzed using GC-MS. Multivariable linear regression analyses were conducted to identify associations of plasma TFAs with all 32 food and beverage groups/subgroups, controlling for the potential confounding effects of 11 demographic, socioeconomic, behavioral, lifestyle, and health-related variables. Results Consumption of the following food groups/subgroups was significantly associated with elevated plasma TFA concentrations: cream substitutes (P  < 0.001 for palmitelaidic acid, elaidic acid, vaccenic acid, and sumTFAs); cakes, cookies, pastries, and pies (P  < 0.001 for elaidic acid, vaccenic acid, and sumTFAs; P  < 0.05 for linolelaidic acid); milk and milk desserts (P  < 0.01 for palmitelaidic acid and vaccenic acid; P  < 0.05 for linolelaidic acid and sumTFAs); beef/veal, lamb/goat, and venison/deer (P  < 0.01 for vaccenic acid; P  < 0.05 for sumTFAs); and butters (P  < 0.001 for palmitelaidic acid and vaccenic acid; P  < 0.05 for sumTFAs). Conclusions The findings suggest that the above 5 food groups/subgroups could be the main dietary sources of plasma TFAs among adults in the United States in 2009–2010. [ABSTRACT FROM AUTHOR]

Background/Purpose: Value-based purchasing (VBP) is increasing in influence in the health care industry; however, questions remain regarding the structural factors associated with improved performance. This study evaluates the association between age of hospital infrastructure and VBP outcomes. Methodology: Data on 1,911 hospitals from three sources (the American Hospital Association Annual Survey Database, the American Hospital Association DataViewer Financial Module, and the Centers for Medicare & Medicaid Services Hospital VBP Total Performance Scores data set) were evaluated. Age of health care facilities was represented by the "average age of plant" financial ratio. VBP performance was measured by an aggregate Total Performance Score composed of four equally weighted domains, including Efficiency and Cost Reduction, Clinical Care, Patient- and Caregiver-Centered Experience, and Patient Safety. We hypothesize that average age of plant is negatively correlated with each of these measures. Results: Hospitals within the lowest quartile of average age of plant (0--8.13 years) were found to have a total Performance Score of 2.35 points higher than hospitals with a an average age of plant in the fourth quartile (14.63 years and above; R² = 21.5%; p < .001) while controlling for hospital ownership, size, teaching status, geographic location, service mix, case mix, length of stay, community served, and labor force relative cost. Comparable results were found within the VBP domains, specifically for Clinical Care (β = 4.09, p < .001) and Patient Experience (β = 3.41, p < .001). Findings for the Patient Safety and Efficiency domains were not significant. A secondary and more granular examination of capitalized assets indicates organizations with higher building asset accumulated depreciation per bed in service were associated with lower total performance (β = -.25, p < .001), Clinical Care (β = -.31, p < .05), and Patient Experience scores (β = -.45, p < .001). Conclusions: The results of this study provide evidence of an inverse association between a hospital's age of plant and specific elements of VBP performance. Practice Implications: To date, no studies have investigated the relationship between hospital age of plant and value-based care. The results of our study may serve as supportive foundational evidence for health care leaders to target future capital investments to improve VBP outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the need to amend Federal Rule of Evidence 106 and pre-Rules common law doctrine of completeness. It mentions potential amendment alternatives for Rule 106 designed to address the fairness deficit currently permitted by some interpretations of the Rule. It also mentions completion over a hearsay objection, and by covering oral statements specifically under the Rule and cross-examine witnesses and limited exception to standard operating procedure.

Background The Infectious Diseases Society of America recommends pneumococcal urinary antigen testing (UAT) when identifying pneumococcal infection would allow for antibiotic de-escalation. However, the frequencies of UAT and subsequent antibiotic de-escalation are unknown. Methods We conducted a retrospective cohort study of adult patients admitted with community-acquired or healthcare-associated pneumonia to 170 US hospitals in the Premier database from 2010 to 2015, to describe variation in UAT use, associations of UAT results with antibiotic de-escalation, and associations of de-escalation with outcomes. Results Among 159 894 eligible admissions, 24 757 (15.5%) included UAT performed (18.4% of intensive care unit [ICU] and 15.3% of non-ICU patients). Among hospitals with ≥100 eligible patients, UAT proportions ranged from 0% to 69%. Compared to patients with negative UAT, 7.2% with positive UAT more often had a positive Streptococcus pneumoniae culture (25.4% vs 1.9%, P <.001) and less often had resistant bacteria (5.2% vs 6.8%, P <.05). Of patients initially treated with broad-spectrum antibiotics, most were still receiving broad-spectrum therapy 3 days later, but UAT-positive patients more often had coverage narrowed (38.4% vs 17.0% UAT-negative and 14.6% untested patients, P <.001). Hospital rate of UAT was strongly correlated with de-escalation following a positive test. Only 3 patients de-escalated after a positive UAT result were subsequently admitted to ICU. Conclusions UAT is not ordered routinely in pneumonia, even in ICU. A positive UAT result was associated with less frequent resistant organisms, but usually did not lead to antibiotic de-escalation. Increasing UAT and narrowing therapy after a positive UAT result are opportunities for improved antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Introduction: Smoking is a key determinant of mortality among people living with HIV (PLWH).Methods: To better understand the effects of smoking cessation interventions in PLWH, we conducted a pooled analysis of four randomized controlled trials of hospital-initiated smoking interventions conducted through the Consortium of Hospitals Advancing Research on Tobacco (CHART). In each study, cigarette smokers were randomly assigned to usual care or a smoking cessation intervention. The primary outcome was self-reported past 30-day tobacco abstinence at 6-month follow-up. Abstinence rates were compared between PLWH and participants without HIV and by treatment arm, using both complete-case and intention-to-treat analyses. Multivariable logistic regression was used to determine the effect of HIV status on 6-month tobacco abstinence and to determine predictors of smoking cessation within PLWH.Results: Among 5550 hospitalized smokers, there were 202 (3.6%) PLWH. PLWH smoked fewer cigarettes per day and were less likely to be planning to quit than smokers without HIV. At 6 months, cessation rates did not differ between intervention and control groups among PLWH (28.9% vs. 30.5%) or smokers without HIV (36.1% vs. 34.1%). In multivariable regression analysis, HIV status was not significantly associated with smoking cessation at 6 months. Among PLWH, confidence in quitting was the only clinical factor independently associated with smoking cessation (OR 2.0, 95% CI = 1.4 to 2.8, p < .01).Conclusions: HIV status did not alter likelihood of quitting smoking after hospital discharge, whether or not the smoker was offered a tobacco cessation intervention, but power was limited to identify potentially important differences.Implications: PLWH had similar quit rates to participants without HIV following a hospital-initiated smoking cessation intervention. The findings suggest that factors specific to HIV infection may not influence response to smoking cessation interventions and that all PLWH would benefit from efforts to assist in quitting smoking.Trial Registration: (1) Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial: NCT01305928. (2) Web-based smoking cessation intervention that transitions from inpatient to outpatient: NCT01277250. (3) Effectiveness of smoking-cessation interventions for urban hospital patients: NCT01363245. (4) Effectiveness of Post-Discharge Strategies for Hospitalized Smokers (HelpingHAND2): NCT01714323. [ABSTRACT FROM AUTHOR]

The desire to conquer old age is as old as humanity itself, yet the pursuit of youthfulness acquired a fiercer urgency with the rise of post-Enlightenment conceptions of youth as a redemptive social force. This introductory essay widens the circle of what constitutes modern rejuvenation by moving beyond the standard focus on anti-aging medicine and lays out the historiographical and methodological stakes of conceptualizing rejuvenation more broadly. Its main contention is that rejuvenation can serve as an analytical linchpin to reveal unrecognized connections between various historically specific projects of regeneration and repair that were comprised in individual flesh-and-blood as well as in imagined collective bodies such as nations and empires. [ABSTRACT FROM AUTHOR]

In recent decades, public and private environmental entities have been purchasing or leasing water rights across the Western United States (U.S.) in efforts to restore river flows and aquatic ecosystems. The need to pay for flow restoration arises from the fact that state governments did not begin to reserve water for instream purposes until the 1970s, long after water rights had become over‐appropriated and flows were substantially depleted in most rivers. As a consequence, flow depletion has become the leading cause of fish endangerment in the U.S., including the imperilment of two‐thirds of all native fish species in the Colorado River system. This paper takes stock of the progress made in buying water for the environment, specifically by reviewing and analyzing more than 50 transactions executed by public and private entities and the sources of funding underpinning these transactions. We conclude that nongovernmental actors — such as environmental organizations and state water trusts — are integral to regional efforts to restore river flows; these nongovernmental actors executed more than two‐thirds of the transactions we documented. However, we also conclude that the long‐term success of these nongovernmental actors depends upon the availability of sustained public funding that enables them to build capacity and engage in the large number of transactions needed to restore flows across each state. Research Impact Statement: River flow restoration is needed to stem widespread aquatic species declines but much greater public/private funding and transactional expertise is needed. [ABSTRACT FROM AUTHOR]

Objective To quantify the representation of women trainees and faculty and to explore associations between them at Pain Medicine (PM) fellowship programs in the United States. Setting PM fellowship programs accredited by the Accreditation Council for Graduate Medical Education. Methods All PM programs approved for at least four fellows as of December 2017 were identified. Websites of these programs were reviewed to determine the number and gender of current fellows and faculty, and programs were contacted to verify the information. Results A total of 56 PM programs were eligible; of these, 48 PM programs (86%) provided information about the gender distribution of fellows. Women comprised ∼25% of PM fellows. PM programs with a female rather than male fellowship program director (PD) had 2.40 times increased odds of a female trainee. Proportion of female faculty and division chief gender were not significantly associated with trainee gender composition. The adjusted odds of a faculty member being female was 1.99 times greater for PM programs with a female vs male PD and 3.13 times greater for programs with a female vs male division chief. Conclusions Women are underrepresented throughout all levels of academic pain medicine. The presence of women in leadership roles is associated with higher proportions of female trainees and faculty, highlighting the need for more female role models in academic pain medicine. [ABSTRACT FROM AUTHOR]

The number of science, technology, engineering, and math (STEM) jobs in the United States, particularly within agriculture, currently outpaces the number of qualified applicants. Undergraduate general education science requirements in agriculture colleges promote agricultural STEM fields and recruit students. These courses may reach large numbers and provide real-world context that increases student career interest. One factor affecting student career choice is identity, but little research examines the impacts of these general education courses on identity development. Using a Likert-scale instrument to measure science identity in students in a general education biohistory course at a large university in the southeastern U.S., we found differences among students: in face-to-face versus online versions of the course, among gender and ethnic groups, and from beginning to end of the course. This instrument can help identify groups that may benefit from particular attention, as well as ways courses may impact groups differently. [ABSTRACT FROM AUTHOR]

Toddler milk products are ultraprocessed milk-based beverages promoted for children aged 9 through 36 months. They often contain added sugars, which may contribute to unhealthy dietary habits. Aggressive promotion of toddler milk, particularly to the Latinx population, has likely led to rapid rises in sales. The study aims were to qualitatively explore caregivers' experiences with, beliefs about, and attitudes toward toddler milk; to explore caregivers' reactions to health claims and product warnings on toddler milk packaging; and explore whether perceptions of toddler milk differ by Latinx ethnicity. Focus group discussions and in-depth interviews were conducted. Fifteen online in-depth interviews and 4 online focus groups with US caregivers of children aged 9 through 36 months who reported serving toddler milk to their children were conducted in 2021. Audio files were transcribed, coded, and analyzed in NVivo. A thematic analysis with a hybrid analytical approach of deductive and inductive coding was conducted. Caregivers struggled to discern toddler milk from infant formula and perceived formula as a larger term that included toddler milk. Participants described offering toddler milk to their children for its convenience, nutritional profile, and perceived benefits tied to health claims present on the labels. Participants reported that health claims on toddler milk packaging attracted their attention; most participants did not express skepticism about the veracity of the claims. An "added sugar" warning increased understanding of the presence of added sugar in a toddler milk product. Latinx and non-Latinx participants largely reported similar perceptions, beliefs, and patterns of provision of toddler milk. Health claims may lead caregivers to perceive toddler milk as a nutritionally adequate product. Research is needed to investigate caregiver-directed interventions for informing caregivers about the distinction between infant formula and toddler milk. [ABSTRACT FROM AUTHOR]

Introduction: Many countries are enacting tobacco treatment training, guidelines and policies in order to fulfil Framework Convention on Tobacco Control (FCTC) treaty agreements. This study tapped the perspectives of international treatment providers to identify challenges and recommendations for improvement. Methods: The cross-sectional survey included closed- and open-ended items. Distribution included professional listservs (ATTUD; Global Bridges; ENSH Global) and word-of-mouth. The survey collected data using an open-source platform (Enketo Smart Paper/Ona). We used R for quantitative analysis and Google Sheets to categorize open-ended responses. Results: There were 155 respondents from 49 countries. Most (78.6%) provided direct services. Almost half (48.1%) reported receiving less than 6 hours of tobacco treatment training; respondents from low and lower-middle income countries (LMICs) received significantly less training (Fisher's p < 0.014). Likewise, among all respondents, 43% rated poor access to treatment; this rose to 100% among LMICs (Fisher's p < 0.001). To improve treatment and training, respondents suggested increasing government funding for pharmacotherapy and behavioural services; providing training in local languages and in the treatment of smokeless tobacco forms; trainee certification and access to online support for providers. Conclusions: Globally, half of front-line treatment providers reported having poor access to training; this was true for all providers in LMICs and most in upper middle-income countries. Existing online trainings, available mainly in English, could be migrated to open-access formats to permit countries to tailor them to their local needs and languages. Countries in geographical proximity or historical linguistic/political alliances could forge cross-country mentoring relationships and mutual support for training. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to improve understanding of the differences in cigarette use behavior and exposure for participants smoking their own brand of cigarettes in a clinical setting versus smoking under natural conditions. Methods: Adult daily smokers (N = 163) attended 2 clinic visits where they smoked through a CReSS™ topography device. Participants collected cigarette butts smoked without a CReSS™ device and completed a diary of location, mood, and activity for each cigarette smoked. Cigarette butts were used to determine mouth level nicotine (MLN). Least square means (LSMs) were estimated from mixed effects models. Results: The LSM for MLN was higher among participants who smoked cigarettes in the clinical setting. LSM MLN was 1.589 [95% CI: 1.312, 1.924] mg/cig for cigarettes smoked in the clinic and 1.087 [95% CI: 0.902, 1.310] mg/cig for cigarettes smoked outside of the clinic; we found differences between race and sex. Conclusions: Our results show nicotine intake and some smoking behavior are significantly biased upwards when studied in a clinical setting. Therefore, tobacco smoke exposure determinations in a clinical setting may not be completely generalizable to smoke exposure determinations in naturalistic settings. [ABSTRACT FROM AUTHOR]

Loop-mediated isothermal amplification (LAMP) has gained wide popularity in the detection of Salmonella in foods owing to its simplicity, rapidity, and robustness. This multi-laboratory validation (MLV) study aimed to validate a Salmonella LAMP-based method against the United States Food and Drug Administration (FDA) Bacteriological Analytical Manual (BAM) Chapter 5 Salmonella reference method in a representative animal food matrix (dry dog food). Fourteen independent collaborators from seven laboratories in the United States and Canada participated in the study. Each collaborator received two sets of 24 blind-coded dry dog food samples (eight uninoculated; eight inoculated at a low level, 0.65 MPN/25 g; and eight inoculated at a high level, 3.01 MPN/25 g) and initiated the testing on the same day. The MLV study used an unpaired design where different test portions were analyzed by the LAMP and BAM methods using different preenrichment protocols (buffered peptone water for LAMP and lactose broth for BAM). All LAMP samples were confirmed by culture using the BAM method. BAM samples were also tested by LAMP following lactose broth preenrichment (paired samples). Statistical analysis was carried out by the probability of detection (POD) per AOAC guidelines and by a random intercept logistic regression model. Overall, no significant differences in POD between the Salmonella LAMP and BAM methods were observed with either unpaired or paired samples, indicating the methods were comparable. LAMP testing following preenrichment in buffered peptone water or lactose broth also resulted in insignificant POD differences (P > 0.05). The MLV study strongly supports the utility and applicability of this rapid and reliable LAMP method in routine regulatory screening of Salmonella in animal food. [ABSTRACT FROM AUTHOR]

Background: As financial pressures on hospitals increase because of changing reimbursement structures and heightened focus on quality and value, the association between patient safety performance and financial outcomes remains unclear. Purpose: The purpose of this study is to investigate if hospitals with higher patient safety performance are associated with higher levels of profitability than those with lower safety performance. Methodology/Approach: Using multinomial logistic regression, we analyzed data from the spring 2014 Leapfrog Hospital Safety Score and the 2014 American Hospital Association to determine the association between Leapfrog Hospital Safety Score performance and three dimensions of organizational profitability: operating margin, net patient revenue, and operating income. Results: Our findings suggest that improved hospital safety scores are associated with a relative risk of being in the top versus bottom quartile of financial performance: 5.41 times greater (p < .001) for operating margin, 10.98 times greater (p < .001) for net patient revenue, and 4.03 times greater (p < .001) for operating income. Practice Implications: Our findings suggest that improved patient safety performance, as evaluated within the Leapfrog Hospital Safety Score, is associated with improved financial performance at the hospital level. Targeted focus on patient safety may allow hospitals to improve financial performance, maximize scarce resources, and generate additional capital to continue to positively evolve care. [ABSTRACT FROM AUTHOR]

Objectives: Although many states have expanded Medicaid coverage of cessation medications, utilization remains low. Anecdotal reports suggest that beneficiaries are at times denied coverage of cessation medications at the pharmacy counter. We conducted an observational community-wide case study of Medicaid beneficiary attempts to fill over-the-counter nicotine replacement therapy at pharmacies.Methods: We recruited tobacco-using beneficiaries from a Federally Qualified Health Center, whose providers wrote paper prescriptions for nicotine patches. Study staff escorted beneficiaries to all eligible pharmacies (n = 18) in a Midwestern community to observe fill attempts. Study staff recorded encounters via smartphone into a secure database on a university server.Results: Seven of 18 pharmacies (39%) did not fill the prescription on the day of the attempt. Of these, 6 offered to order the patch for pick-up at a later date. All (4/4) chain pharmacies filled the prescription; 2/3 mass merchant pharmacies failed to fill. Combining successful same-day fills with offers to order for pick-up, 17/18 (94%) would ultimately have been able to obtain patches.Conclusion: This pilot study found that many beneficiaries left pharmacies without a prescription in hand. Successful same-day fills varied markedly by store type. For people with low incomes, transportation presents a major barrier for delayed pick-up. In addition, delays can fuel ambivalence toward quitting. Future research based on this pilot study might address whether patients who fail to secure a same-day prescription ever fill the prescription and, if not, the degree to which this barrier contributes to success or failure in quitting. [ABSTRACT FROM AUTHOR]

This article examines the correlation between uncertainty and real GDP growth. We use the volatility of real GDP growth from a VAR, stock market volatility, survey‐based forecast dispersion and macro uncertainty index as proxies for uncertainty. In each case, a stronger negative correlation emerged in 2008. We contend the zero lower bound (ZLB) on the federal funds rate contributed to our finding. To test our theory, we estimate a New Keynesian model with a ZLB constraint to generate a data‐driven, forward‐looking uncertainty measure. The correlations between that measure and real GDP growth are close to the values in the data. [ABSTRACT FROM AUTHOR]

The Trump administration has undertaken an assault on the Environmental Protection Agency (EPA), an agency critical to environmental health. This assault has precedents in the administrations of Ronald Reagan and George W. Bush. The early Reagan administration (1981-1983) launched an overt attack on the EPA, combining deregulation with budget and staff cuts, whereas the George W. Bush administration (2001-2008) adopted a subtler approach, undermining science-based policy. The current administration combines both these strategies and operates in a political context more favorable to its designs on the EPA. The Republican Party has shifted right and now controls the executive branch and both chambers of Congress. Wealthy donors, think tanks, and fossil fuel and chemical industries have become more influential in pushing deregulation. Among the public, political polarization has increased, the environment has become a partisan issue, and science and the mainstream media are distrusted. For these reasons, the effects of today's ongoing regulatory delays, rollbacks, and staff cuts may well surpass those of the administrations of Reagan and Bush, whose impacts on environmental health were considerable. [ABSTRACT FROM AUTHOR]

Because the effects of children’s exposure to intimate partner violence (IPV) carry long lasting consequences for the affected children, IPV exposure may impose a significant economic burden to localities, states, and society at large, made explicit over the victim’s lifetime and over a wide range of behaviors and outcomes, including use of social services, health and healthcare utilization, educational outcomes, workforce productivity, and criminal behavior. While much research has been conducted on the effect of IPV exposure on multiple short- and long-term outcomes, no research to date has examined the economic burden associated with IPV exposure. Using an incidence-based approach, we estimated the aggregate discounted costs associated with healthcare spending, criminal behavior, and labor market productivity accrued by a 20-year-old victim in 2016 projected to the age of 65, applying a 3% discount rate. The average lifetime costs derived from childhood IPV exposure are estimated to be over $50,000 per victim (2016 U.S. dollars) due to increased healthcare costs ($11,000), increased crime costs ($14,000), and productivity losses ($26,000). Over an annual birth cohort of young adults, these costs amount to over $55 billion nationwide. IPV exposure imposes a substantial economic burden to society at large in the form of increased healthcare costs, increased crime costs, and reduced productivity. This study offers an explicit quantification of substantial lifetime costs, which should encourage policy makers to redouble efforts to reduce the incidence of IPV and successfully ameliorate its effects on IPV-exposed children. [ABSTRACT FROM AUTHOR]