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This article advances an argument about two "imagined environments"--my term for the frameworks that human groups use to depict and dwell in more-than-human worlds. The first of these imagined environments arose around the US-Mexican Boundary Commission (1849-59): while failing to fulfill its official objective of building physical border monuments, this team of explorers and engineers still made media that helped two settler states conceptualize and control their borderlands. Against this increasingly efficient exploitation of both humans and nonhumans, a second imagined environment persisted in Mescalero Apache pictographs, Chihene Apache performances, and other Apache media. On our precarious planet, this imagined environment can teach us to stop defining ourselves around fixed places and to remain resilient while migrating through shifting spaces. [ABSTRACT FROM AUTHOR]

The article examine the constitutional structure concerning the enforcement of federal law by state officers, addressing the unresolved question of whether such enforcement is compatible with the U.S. governmental framework.

Background: Nutrition incentive (NI) programs help low-income households better afford fruits and vegetables (FVs) by providing incentives to spend on FVs (e.g., spend $10 to receive an additional $10 for FVs). NI programs are heterogeneous in programmatic implementation and operate in food retail outlets, including brick-and-mortar and farm-direct sites. Objective: This study aimed to explore NI program implementation factors and the amount of incentives redeemed. Methods: A total of 28 NI projects across the United States including 487 brick-and-mortar and 1078 farm-direct sites reported data between 2020 and 2021. Descriptive statistics and linear regression analyses (outcome: incentives redeemed) were applied. Results: Traditional brick-and-mortar stores had 0.48 times the incentives redeemed compared with small brick-and-mortar stores. At brick-and-mortar sites, automatic discounts had 3.47 times the incentives redeemed compared with physical discounts; and auxiliary services and marketing led to greater redemption. Farm-direct sites using multilingual and direct promotional marketing had greater incentives redeemed. Conclusions: To our knowledge, this is the first national study to focus on NI program implementation across sites nationwide. Factors identified can help inform future programming and research. [ABSTRACT FROM AUTHOR]

High temporal and spatial resolution precipitation datasets are essential for hydrological and flood modeling to assist water resource management and emergency responses, particularly for small watersheds, such as those in Hawai'i in the United States. Unfortunately, fine temporal (subdaily) and spatial (<1 km) resolutions of rainfall datasets are not always readily available for applications. Radar provides indirect measurements of the rain rate over a large spatial extent with a reasonable temporal resolution, while rain gauges provide "ground truth." There are potential advantages to combining the two, which have not been fully explored in tropical islands. In this study, we applied kriging with external drift (KED) to integrate hourly gauge and radar rainfall into a 250 m × 250 m gridded dataset for the tropical island of O'ahu. The results were validated with leave-one-out cross validation for 18 severe storm events, including five different storm types (e.g., tropical cyclone, cold front, upper-level trough, kona low, and a mix of upper-level trough and kona low), and different rainfall structures (e.g., stratiform and convective). KED-merged rainfall estimates outperformed both the radar-only and gauge-only datasets by 1) reducing the error from radar rainfall and 2) improving the underestimation issues from gauge rainfall, especially during convective rainfall. We confirmed the KED method can be used to merge radar with gauge data to generate reliable rainfall estimates, particularly for storm events, on mountainous tropical islands. In addition, KED rainfall estimates were consistently more accurate in depicting spatial distribution and maximum rainfall value within various storm types and rainfall structures. Significance Statement: The results of this study show the effectiveness of utilizing kriging with external drift (KED) in merging gauge and radar rainfall data to produce highly accurate, reliable rainfall estimates in mountainous tropical regions, such as O'ahu. The validated KED dataset, with its high temporal and spatial resolutions, offers a valuable resource for various types of rainfall-related research, particularly for extreme weather response and rainfall intensity analyses in Hawai'i. Our findings improve the accuracy of rainfall estimates and contribute to a deeper understanding of the performance of various rainfall estimation methods under different storm types and rainfall structures in a mountainous tropical setting. [ABSTRACT FROM AUTHOR]

Mixed evidence exists of associations between mobility data and coronavirus disease 2019 (COVID-19) case rates. We aimed to evaluate the county-level impact of reducing mobility on new COVID-19 cases in summer/fall of 2020 in the United States and to demonstrate modified treatment policies to define causal effects with continuous exposures. Specifically, we investigated the impact of shifting the distribution of 10 mobility indexes on the number of newly reported cases per 100,000 residents 2 weeks ahead. Primary analyses used targeted minimum loss-based estimation with Super Learner to avoid parametric modeling assumptions during statistical estimation and flexibly adjust for a wide range of confounders, including recent case rates. We also implemented unadjusted analyses. For most weeks, unadjusted analyses suggested strong associations between mobility indexes and subsequent new case rates. However, after confounder adjustment, none of the indexes showed consistent associations under mobility reduction. Our analysis demonstrates the utility of this novel distribution-shift approach to defining and estimating causal effects with continuous exposures in epidemiology and public health. [ABSTRACT FROM AUTHOR]

Objectives: The use of alternative nicotine products by middle and high school students is a growing concern due to industry marketing techniques, availability, and popularity of new products, and ambiguous nicotine concentrations. The 2021 National Youth Tobacco Survey (NYTS) provides information about the frequency, and characteristics of middle, and high school students who have used nicotine pouches. Methods: The National Youth Tobacco Surveys provide important information about the frequency of use of tobacco and alternative nicotine products by a representative sample of students in schools in the United States. The 2021 survey included questions about the use of nicotine pouches/dissolvable tobacco products. The results from the survey were analysis using descriptive statistics, and logistic regression to model the association between the use of these alternative nicotine products, and the use of electronic cigarettes or the use of conventional cigarettes. Results: A total of 20 413 students participated in the survey year 2021; 17 842 were included in the final data analysis. Their ages ranged from 9 to 18+. Identified risk factors for the use of alternative nicotine products included race, and age. The adjusted odds ratio (OR) was lower in non-Hispanic Black and Hispanic students, as compared to non-Hispanic White students. Older students had a substantially higher risk of using nicotine/dissolvable tobacco products, specifically, compared to students less than or equal to 13 years old. The OR increased 174% (OR: 2.74; 1.70-4.41) in 17-year-old students. The perception of harm associated with electronic cigarettes increased the likelihood of using alternative nicotine products. Students who did not smoke cigarettes (OR: 0.39; 0.27-0.56) or did not smoke electronic cigarettes (OR: 0.20; 0.18-0.40) had significantly lower OR for using alternative nicotine products. Conclusions: The 2021 National Youth Tobacco Survey indicates that a relatively small percentage of middle school and high school student have used nicotine pouches. However, with the increase in new, alternative tobacco products, understanding adolescent use in comparison to other tobacco products is an important trend to monitor. [ABSTRACT FROM AUTHOR]

Copy number variations (CNVs) in the Neurexin 1 (NRXN1) gene, which encodes a presynaptic protein involved in neurotransmitter release, are some of the most frequently observed single-gene variants associated with autism spectrum disorder (ASD). To address the functional contribution of NRXN1 CNVs to behavioral phenotypes relevant to ASD, we carried out systematic behavioral phenotyping of an allelic series of Nrxn1 mouse models: one carrying promoter and exon 1 deletion abolishing Nrxn1α transcription, one carrying exon 9 deletion disrupting Nrxn1α protein translation, and one carrying an intronic deletion with no observable effect on Nrxn1α expression. We found that homozygous loss of Nrxn1α resulted in enhanced aggression in males, reduced affiliative social behaviors in females, and significantly altered circadian activities in both sexes. Heterozygous or homozygous loss of Nrxn1α affected the preference for social novelty in male mice, and notably, enhanced repetitive motor skills and motor coordination in both sexes. In contrast, mice bearing an intronic deletion of Nrxn1 did not display alterations in any of the behaviors assessed. These findings demonstrate the importance of Nrxn1α gene dosage in regulating social, circadian, and motor functions, and the variables of sex and genomic positioning of CNVs in the expression of autism-related phenotypes. Importantly, mice with heterozygous loss of Nrxn1, as found in numerous autistic individuals, show an elevated propensity to manifest autism-related phenotypes, supporting the use of models with this genomic architecture to study ASD etiology and assess additional genetic variants associated with autism. Author summary: Deletions of one of the two copies of the Neurexin1 (NRXN1) gene are among the most common genetic anomalies in autism spectrum disorder (ASD), a neurodevelopmental condition afflicting 1 in every 44 children in the United States. How NRXN1 deletions, which can occur at various positions across the gene, contribute to behaviors associated with autism remains unknown. Here we investigated mouse models carrying different deletions across the Nrxn1 gene, mimicking three distinct ASD-associated deletions observed in humans, and assessed autism-related mouse behaviors. We found that ASD-relevant behavioral traits in mice are dependent on the sex of the animal and the position of the deletion, and that losing one copy of the Nrxn1 gene (producing a similar genetic structure to humans with ASD) elicits behaviors akin to the core symptoms of autism: impaired social communication and restricted/repetitive behaviors. Additionally, circadian activity is markedly altered in mice lacking functional Nrxn1 product, consistent with sleep disturbance being the most common comorbidity in autism. Our findings support the importance of sex, genetic structure, and the amount of functional NRXN1 product in eliciting ASD-relevant behaviors, and the need for animal models carrying anomalies at multiple genes to elucidate the genetic underpinnings of autism. [ABSTRACT FROM AUTHOR]

In the United States, September marks the return to school, the start of fall, and National Suicide Prevention Awareness Month. Throughout the month, there is a public health push for dissemination of suicide prevention strategies for adolescents, as it is well‐established that suicide is one of the leading causes of death in young people. Experts highlight the importance of safe‐handling protocols for lethal means like gun locks and prescription blister packs, accessible health insurance plans that provide mental health care, increased support for national suicide prevention lifelines and text lines, calls for the overhauls of the juvenile justice and foster care systems... the list goes on. Yet, one topic that we may forget about when talking about suicide and adolescent mental health is access to reproductive and family planning services, including abortions. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has strained health care systems and has resulted in widespread critical care staffing shortages, negatively impacting the quality of care delivered.Research Question: How have hospitals' emergency responses to the pandemic influenced the well-being of frontline intensivists, and do any potential strategies exist to improve their well-being and to help preserve the critical care workforce?Study Design and Methods: We conducted semistructured interviews of intensivists at clusters of tertiary and community hospitals located in six regions across the United States between August and November 2020 using the "four S" framework of acute surge planning (ie, space, staff, stuff, and system) to organize the interview guide. We then used inductive thematic analysis to identify themes describing the influence of hospitals' emergency responses on intensivists' well-being.Results: Thirty-three intensivists from seven tertiary and six community hospitals participated. Intensivists reported experiencing substantial moral distress, particularly because of restricted visitor policies and their perceived negative impacts on patients, families, and staff. Intensivists also frequently reported burnout symptoms as a result of their experiences with patient death, exhaustion over the pandemic's duration, and perceived lack of support from colleagues and hospitals. We identified several potentially modifiable factors perceived to improve morale, including the proactive provision of mental health resources, establishment of formal backup schedules for physicians, and clear actions demonstrating that clinicians are valued by their institutions.Interpretation: Restrictive visitation policies contributed to moral distress as reported by intensivists, highlighting the need to reconsider the risks and benefits of these policies. We also identified several interventions as perceived by intensivists that may help to mitigate moral distress and to improve burnout as part of efforts to preserve the critical care workforce. [ABSTRACT FROM AUTHOR]

Produce prescription programs within clinical care settings can address food insecurity by offering financial incentives through "prescriptions" for fruits and vegetables to eligible patients. The electronic health record (EHR) holds potential as a strategy to examine the relationship between these projects and participant outcomes, but no studies address EHR extraction for programmatic evaluations. We interviewed representatives of 9 grantees of the U.S. Department of Agriculture's Gus Schumacher Nutrition Incentive Grant Program's Produce Prescription Projects (GusNIP PPR) to understand their experiences with and capacity for utilizing EHR for evaluation. Five grantees planned to use EHR data, with 3 main strategies: reporting aggregate data from health clinics, contracting with external/third party evaluators, and accessing individual-level data. However, utilizing EHRs was prohibitive for others due to insufficient knowledge, training and/or staff capacity; lack of familiarity with the Institutional Review Board process; or was inappropriate for select target populations. Policy support for produce prescription programs requires a robust evidence base, deep knowledge of best practices, and an understanding of expected health outcomes. These insights can be most efficiently and meaningfully achieved with EHR data, which will require increased financial support and technical assistance for project operators. [ABSTRACT FROM AUTHOR]

Background: Exposure to armed conflict and fleeing country of origin for refugees has been associated with poorer psychological health. Methods: Within the first month following their arrival in the United States, 152 Syrian and Iraqi refugees were screened in a primary care setting for posttraumatic stress disorder (PTSD), anxiety, and depression and rated their perceived health, and perceived level of adversity of violence, armed conflict/flight. The moderating effects of psychiatric symptoms on the relation between perceived adversity and perceived health were assessed. Results: Three models based on diagnosis (PTSD, anxiety, and depression) were tested. While significant effects were found on perceived adversity negatively influencing perceived health across diagnoses, slightly different patterns emerged based on diagnosis. Discussion: Findings suggest that refugees' perception regarding adversity of violence, armed conflict, and flight may contribute to perceived health, with a moderating role of clinically significant symptoms of PTSD, anxiety, and depression. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study is to examine the extent to which numeric rating scale (NRS) scores collected during usual care are associated with more robust and validated measures of pain, disability, mental health, and health-related quality of life (HRQOL). Design We conducted a secondary analysis of data from a prospective cohort study. Subjects We included 186 patients with musculoskeletal pain who were prescribed long-term opioid therapy. Setting VA Portland Health Care System outpatient clinic. Methods All patients had been screened with the 0–10 NRS during routine outpatient visits. They also completed research visits that assessed pain, mental health and HRQOL every 6 months for 2 years. Accounting for nonindependence of repeated measures data, we examined associations of NRS data obtained from the medical record with scores on standardized measures of pain and its related outcomes. Results NRS scores obtained in clinical practice were moderately associated with pain intensity scores (B's  =   0.53–0.59) and modestly associated with pain disability scores (B's  =   0.33–0.36) obtained by researchers. Associations between pain NRS scores and validated measures of depression, anxiety, and health related HRQOL were low (B's  =   0.09–0.26, with the preponderance of B 's < .20). Conclusions Standardized assessments of pain during usual care are moderately associated with research-administered measures of pain intensity and would be improved from the inclusion of more robust measures of pain-related function, mental health, and HRQOL. [ABSTRACT FROM AUTHOR]

Rare, chronic diseases such as hemophilia and other congenital coagulation disorders require coordinated delivery of services for optimal outcomes. Hemophilia Treatment Centers (HTCs) are specialized, multidisciplinary health-care centers providing team-based care to meet the physical, psychosocial, and emotional needs of people with hemophilia (PWH) and may serve as a model for other rare coagulation disorders. Health-care purchasers, as well as the general medical community, may not appreciate the breadth and quality of services provided by HTCs. They exemplify the acculturalization and actualization of integrated care by providing comprehensive diagnostic and treatment services that reduce morbidity, mortality, avoidable emergency room visits, hospitalizations, and overall costs, while promoting a longer lifespan and improved patient functioning and outcomes. This is accomplished by a team-based approach relying upon a shared decision-making model to effectively prevent complications and manage symptoms in PWH, who are dependent on high-cost treatments. This article provides a concise yet comprehensive description of the core components of an HTC and the regional and national networks in the United States, which together achieve their incomparable value for all stakeholders. [ABSTRACT FROM AUTHOR]

Introduction: Gene therapy has shown promise in clinical trials for patients with haemophilia, but patient preference studies have focused on factor replacement treatments. Aim: We conducted a discrete choice experiment (DCE) to investigate the relative importance and differential preferences patients provide for gene therapy attributes. Methods: We surveyed male adults with haemophilia in the United States recruited from patient panels including the National Hemophilia Foundation Community Voices in Research platform using an online survey over 4 months in 2020/21. Participants indicated preferences for gene therapy attributes including dosing frequency/durability, effect on annual bleeding, uncertainty related to side effects, impact on daily activities, impact on mental health, and post‐treatment requirements. The relative importance of each attribute was analysed overall and for subgroups based on haemophilia type and severity. Results: A total of 183 males with haemophilia A (n = 120) or B (n = 63) were included. Half (47%) had severe haemophilia; most (75%) were White. Overall, participants gave effect on bleeding rate the greatest relative importance (31%), followed by dose frequency/durability (26%), uncertainty regarding safety issues (17%), and impact on daily activities (11%). Dose frequency/durability had the greatest importance for those with haemophilia B (35%). Conclusion: People with haemophilia prioritised reduced bleeding and treatment burden; the former was more important in haemophilia A and the latter in haemophilia B, followed by safety and impact on daily life in this DCE of gene therapy attributes. These findings and differences can inform clinical and health policy decisions to improve health equity for people with haemophilia. [ABSTRACT FROM AUTHOR]

Introduction: People with inherited and long‐term conditions such as haemophilia have been shown to adapt to their levels of disability, often reporting better quality of life (QoL) than expected from the general population (the disability paradox). Aim: To investigate the disability paradox in people with haemophilia in the United States by examining preference differences in health state valuations versus the general population. Methods: We conducted a discrete choice experiment including duration to capture valuations of health states based on patient‐reported preferences. Participants indicated their preferences for hypothetical health states using the EQ‐5D‐5L, where each participant completed 15 of the 120 choice tasks. Response inconsistencies were evaluated with dominated and repeated scenarios. Conditional‐logit regressions with random sampling of the general population responses were used to match the sample of patients with haemophilia. We compared model estimates and derived preferences associated with EQ‐5D‐5L health states. Results: After removing respondents with response inconsistencies, 1327/2138 (62%) participants remained (177/283 haemophilia; 1150/1900 general population). Patients with haemophilia indicated higher preference value for 99% of EQ‐5D‐5L health states compared to the general population (when matched on age and gender). The mean health state valuation difference of 0.17 indicated a meaningful difference compared to a minimal clinically important difference threshold of 0.07. Results were consistent by haemophilia type and severity. Conclusion: Our findings indicated the presence of a disability paradox among patients with haemophilia, who reported higher health states than the general population, suggesting the impact of haemophilia may be underestimated if general population value sets are used. [ABSTRACT FROM AUTHOR]

Background Periodontitis is a major cause of tooth loss globally. Risk factors include age, smoking, and diabetes. Intake of specific nutrients has been associated with periodontitis risk but there has been little research into the influence of overall diet, potentially more relevant when formulating dietary recommendations. Objectives We aimed to investigate potential associations between diet and periodontitis using novel statistical techniques for dietary pattern analysis. Methods Two 24-h dietary recalls and periodontal examination data from the cross-sectional US NHANES, 2009–2014 (n = 10,010), were used. Dietary patterns were extracted using treelet transformation, a data-driven hierarchical clustering and dimension reduction technique. Associations between each pattern [treelet component (TC)] and extent of periodontitis [proportion of sites with clinical attachment loss (CAL) ≥ 3 mm] were estimated using robust logistic quantile regression, adjusting for age, sex, ethnicity, education level, smoking, BMI, and diabetes. Results Eight TCs explained 21% of the variation in diet, 1 of which (TC1) was associated with CAL extent. High TC1 scores represented a diet rich in salad, fruit, vegetables, poultry and seafood, and plain water or tea to drink. There was a substantial negative gradient in CAL extent from the lowest to the highest decile of TC1 (median proportion of sites with CAL ≥ 3 mm: decile 1 = 19.1%, decile 10 = 8.1%; OR, decile 10 compared with decile 1: 0.67; 95% CI: 0.46, 0.99). Conclusions Most dietary patterns identified were not associated with periodontitis extent. One pattern, however, rich in salad, fruit, and vegetables and with plain water or tea to drink, was associated with lower CAL extent. Treelet transformation may be a useful approach for calculating dietary patterns in nutrition research. [ABSTRACT FROM AUTHOR]

Background: The 5-year survival for Black women with breast cancer in the United States is lower than White women for stage-matched disease. Our past and ongoing work and that of others suggest that symptom incidence, cancer-related distress, and ineffective communication contribute to racial disparity in dose reduction and early therapy termination. Although race is perhaps the most studied social determinant of health, it is clear that race alone does not account for all disparities. Objectives: The aim of the study was to present a study protocol of Black and White women prescribed breast cancer chemotherapy. The aims are to (1) examine and compare chemotherapy received/prescribed over time and in total; (2a) examine and compare symptom incidence, distress, and management and clinical encounter, including patient-centeredness of care and management experience over time and (2b) correlate symptom incidence, distress, and management experience to Aim 1; and (3) explore the effects of social determinants of health, including age, income, education, zip code, and lifetime stress exposure, on Aims 1, 2a, and 2b. Methods: A longitudinal, repeated-measures (up to 18 time points), comparative, mixed-methods design is employed with 179 White and 179 Black women from 10 sites in Western Pennsylvania and Northeast Ohio over the course of chemotherapy and for 2 years following completion of therapy. Results: The study began in January 2018, with estimated complete data collection by late 2023. Discussion: This study is among the first to explore the mechanistic process for racial disparity in dosage and delay across the breast cancer chemotherapy course. It will be an important contribution to the explanatory model for breast cancer treatment disparity and may advance potential mitigation strategies for racial survival disparity. [ABSTRACT FROM AUTHOR]

Rationale: Because of improvements in screening, there is an increasing number of patients with early-stage non-small-cell lung cancer (NSCLC) who are making treatment decisions.Objectives: Among patients with suspected stage I NSCLC, we evaluated longitudinal patient-centered outcomes (PCOs) and the association of changes in PCOs with treatment modality, stereotactic body radiotherapy (SBRT) compared with surgical resection.Methods: We conducted a multisite, prospective, observational cohort study at seven medical institutions. We evaluated minimum clinically important differences of PCOs at four time points (during treatment, 4-6 wk after treatment, 6 mo after treatment, and 12 mo after treatment) compared with pretreatment values using validated instruments. We used adjusted linear mixed models to examine whether the association between treatment and European Organization for Research and Treatment of Cancer global and physical quality-of-life (QOL) scales differed over time.Results: We included 127 individuals with stage I NSCLC (53 surgery, 74 SBRT). At 12 months, approximately 30% of patients remaining in each group demonstrated a clinical deterioration on global QOL from baseline. There was a significant difference in slopes between treatment groups on global QOL (-12.86; 95% confidence interval [CI], -13.34 to -12.37) and physical QOL (-28.71; 95% CI, -29.13 to -28.29) between baseline and during treatment, with the steeper decline observed among those who underwent surgery. Differences in slopes between treatment groups were not significant at all other time points.Conclusions: Approximately 30% of patients with stage I NSCLC have a clinically significant decrease in QOL 1 year after SBRT or surgical resection. Surgical resection was associated with steeper declines in QOL immediately after treatment compared with SBRT; however, these declines were not lasting and resolved within a year for most patients. Our results may facilitate treatment option discussions for patients receiving treatment for early-stage NSCLC. [ABSTRACT FROM AUTHOR]

In the United States (US), long-term opioid therapy has been commonly prescribed for chronic pain. Since recognition of the opioid overdose epidemic, clinical practice guidelines have recommended tapering long-term opioids to reduced doses or discontinuation. The Effects of Prescription Opioid Changes for veterans (EPOCH) study is a national population-based prospective observational study of US Veterans Health Administration primary care patients designed to assess effects of evolving opioid prescribing practice on patients treated with long-term opioids for chronic pain. A stratified random sampling design was used to identify a survey sample from the target population of patients treated with opioid analgesics for ≥ 6 months. Demographic, diagnostic, visit, and pharmacy dispensing data were extracted from existing datasets. A 2016 mixed-mode mail and telephone survey collected patient-reported data, including the main patient-reported outcomes of pain-related function (Brief Pain Inventory interference; BPI-I scores 0–10, higher scores = worse) and health-related quality of life. Data on survey participants and non-participants were analyzed to assess potential nonresponse bias. Weights were used to account for design. Linear regression models were used to assess cross-sectional associations of opioid treatment with patient-reported measures. Of 14,160 patients contacted, 9253 (65.4%) completed the survey. Participants were older than non-participants (63.9 ± 10.6 vs. 59.6 ± 13.0 years). The mean number of bothersome pain locations was 6.8 (SE 0.04). Effectiveness of pain treatment and quality of pain care were rated fair or poor by 56.1% and 45.3%, respectively. The opioid daily dosage range was 1.6 to 1038.2 mg, with mean = 50.6 mg (SE 1.1) and median = 30.9 mg (IQR 40.7). Among the 73.2% of patients who did not receive long-acting opioids, the mean daily dosage was 30.4 mg (SE 0.6) and mean BPI-I was 6.4 (SE 00.4). Among patients who received long-acting opioids, the mean daily dosage was 106.2 mg (SE 2.8) and mean BPI-I was 6.8 (SE 0.07). Higher daily dosage was associated with worse pain-related function and quality of life among patients without long-acting opioids, but not among patients with long-acting opioids. Future analyses will use follow-up data to examine effects of opioid dose reduction and discontinuation on patient outcomes. [ABSTRACT FROM AUTHOR]

Classroom teachers' responses to a 2-year professional development program are presented. Sixteen 4th- and 5th-grade teachers involved in Project SPARK completed structured interviews, questionnaires, and written evaluations of program sessions. Although in Year 1 more than half of the teachers expressed concerns about schedules and equipment management, results indicated that the program helped increase their self-confidence when teaching physical education. Participants believed that students benefitted from their enhanced knowledge and instructional behaviors. Program components most appreciated included: the input received and responsiveness of the design team; opportunities to collaborate, discuss concerns, and problem-solve with each other and the facilitators; and having on-site and large-group-session modeling. Results indicated that the teachers were less enthusiastic about a self-management curriculum due to its behavioral emphasis, yet supported the assertion that an ongoing, supportive professional development program can substantially improve classroom teachers' physical education programs. [ABSTRACT FROM AUTHOR]

In this article, we systematically reviewed 116 veterans' medical records to explore the mitigating factors in sleep disturbance, polytrauma clinical triad (PCT), and suicide. We discovered that a particular nonaction (i.e., no standardized completion of sleep-disturbance screenings) had strong implications for resulting suicides among veterans with reported sleep disturbances, PCT, and suicidal ideations. This study provides strong propositions for the further study of this veteran cohort—Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND)—with regard to the impact of sleep disturbance on PCT and its relationship with suicide symptoms, ideation, and completion. The purpose of this study was to examine the outcomes of sleep disturbances on complex relationships among the three primary diagnoses—posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and chronic pain—that establish the PCT cluster. We identified that those diagnosed with sleep disturbances had increased suicidal ideations and rates of completed suicides. We analyzed these factors in veterans returning from the current wars in Afghanistan and Iraq. We hypothesized that (a) clinicians were not completing sleep-disturbance screenings as a standard practice for the OEF/OIF/OND veterans diagnosed with PCT who reported sleep disturbance concerns within the U.S. Department of Veterans Affairs; (b) if no sleep-disturbance screening instruments were used by clinicians, veterans would be at a greater risk of suicide completion. [ABSTRACT FROM AUTHOR]

Background: Technology has multiple potential applications to dementia from diagnosis and assessment to care delivery and supporting ageing in place. Objectives: To summarise key areas of technology development in dementia and identify future directions and implications. Method: Members of the US Alzheimer's Association Technology Professional Interest Area involved in delivering the annual pre-conference summarised existing knowledge on current and future technology developments in dementia. Results: The main domains of technology development are as follows: (i) diagnosis, assessment and monitoring, (ii) maintenance of functioning, (iii) leisure and activity, (iv) caregiving and management. Conclusions: The pace of technology development requires urgent policy, funding and practice change, away from a narrow medical approach, to a holistic model that facilitates future risk reduction and prevention strategies, enables earlier detection and supports implementation at scale for a meaningful and fulfilling life with dementia. [ABSTRACT FROM AUTHOR]

Background: Injuries from nail guns are a unique type of penetrating trauma seen in emergency departments (EDs), rising in prevalence in the United States. These devices can lead to life-threatening injuries that require rapid diagnosis to help guide management.Case Report: An elderly man was brought to the ED having sustained a nail gun injury to the chest. After loss of pulses, brief closed chest compressions and rapid blood product administration led to a return of spontaneous circulation. Using bedside ultrasound, a metallic foreign body was identified tracking through the right ventricle with associated pericardial fluid and pericardial clot. This rapid diagnosis with bedside ultrasound helped facilitate timely transport to the operating room for median sternotomy, foreign body removal, and pledgeted cardiac repair. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With continued developments in image quality and acquisition, and improvements of physician operator performance, ultrasonography has continued to make significant impacts in traumatically injured patients in new ways. We present this case report to highlight precordial nail gun injuries and to emphasize the diagnostic capabilities of bedside ultrasound for these patients. [ABSTRACT FROM AUTHOR]

Recent regulations of the U.S. Internal Revenue Service regarding tax deductibility of expenditures for "institutional" advertising tend to restrict and discourage the use of advertising by business management as a method of mass communication. The author points out that the concept of "institutional" advertising which the Internal Revenue Service has followed for forty years is narrow and, for many purposes, outdated. Attempts to modify present regulations under the old concept are not satisfactory. According to the author, there is need for a recognition on the part of the U.S. Treasury officials of the growing responsibilities of management and of the expanded function of advertising to carry messages, of a public-relations and public-interest nature, as a means of informing and influencing public attitudes and opinions. [ABSTRACT FROM AUTHOR]

The article discusses the post-war-delivery installment sales plan of the U.S. Office of Price Administration. The author points out that after the end of World War II, many people will want to purchase durable goods that have disappeared from the market because of wartime rationing. The market for these items is expected to be larger than the production capacity, and in these cases prices would be expected to rise significantly. However, the Emergency Price Control Act of 1942 was written to extend one year beyond the cessation of the war. Moreover, the author also feels the need for government control of demand on these goods, which the post-war-delivery installment sales should provide.

Objectives. To describe long-term national trends in health insurance coverage among US veterans from 2000 to 2016 in the context of recent health care reform. Methods. We used 2000 to 2016 National Health Interview Survey data on veterans aged 18 to 64 years to examine trends in insurance coverage and uninsurance by year, income, and state Medicaid expansion status. We also explored the current proportions of veterans with each type of insurance by age group. Results. The percentage of veterans with private insurance decreased from 70.8% in 2000 to 56.9% in 2011, whereas between 2000 and 2016 Department of Veterans Affairs (VA) health care coverage (only) almost tripled, Medicaid (without concurrent TRICARE or private coverage) doubled, and TRICARE coverage of any type tripled. After 2011, the percentage of veterans who were uninsured decreased. In 2016, low-income veterans in Medicaid expansion states had double the Medicaid coverage (41.1%) of low-income veterans in nonexpansion states (20.1%). Conclusions. Our estimates, which are nationally representative of noninstitutionalized veterans, show marked increases in military-related coverage through TRICARE and VA health care. In 2016, only 7.2% of veterans aged 18 to 64 years and 3.7% of all veterans (aged 18 years or older) remained uninsured. [ABSTRACT FROM AUTHOR]