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"Arctic greening" will alter vegetation quantity and quality in northern watersheds, with possible consequences for lake metabolic balance. We used paleolimnology from six Arctic lakes in Greenland, Norway, and Alaska to develop a conceptual model describing how climate‐driven shifts in terrestrial vegetation (spanning herb to boreal forest) influence lake autotrophic biomass (as chlorophyll and carotenoid pigments). Major autotrophic transitions occurred, including (1) optimal production of siliceous algae and cyanobacteria/chlorophytes at intermediate vegetation cover (dwarf shrub and Betula; dissolved organic carbon (DOC) range of 2–4 mg L−1), below and above which UVR exposure (DOC; < 2 mgL−1) and light extinction (DOC; > 4 mgL−1), respectively limit algal biomass, (2) an increase in potentially mixotrophic cryptophytes with higher forest cover and allochthonous carbon supply. Vegetation cover appears to influence lake autotrophs by changing influx of (colored) dissolved organic matter which has multiple interacting roles—as a photoprotectant—in light attenuation and in macronutrient (carbon, nitrogen) supply. [ABSTRACT FROM AUTHOR]

We examine the core curricula of the master’s degree programs of thirty planning schools in the United States and Canada and discuss patterns in core requirements. We compare current planning core curricula to those described more than fifteen years ago by John Friedmann and explore several questions surrounding core curricula, planning practice, and the demands of academic legitimacy. The article concludes with a brief case study highlighting the implementation of a new core curriculum at the University of Illinois at Urbana-Champaign. [ABSTRACT FROM PUBLISHER]

Abstract: Annexation, the process of bringing land from one jurisdiction to another is the means by which municipalities physically expand in the United States. The process of annexation is implemented through procedures at the local level and authorized by general state enabling legislation. State annexation policy varies widely across the United States, but it has the potential to play a significant role in facilitating or constraining local annexation activity. This paper details the effects of specific provisions of state annexation law on municipal annexation activity. A sample of over 900 cities containing at least 10,000 people that annexed during the 1990–1999 decade was used to explore the effects. Eleven different provisions of state law were included in the analysis, including whether the state has a boundary agency overseeing annexation and whether an election is required to complete the annexation process. Results show that nearly all state provisions affect the frequency of municipal annexation, although some had unexpected results. State provisions also affect rates of annexation and acre growth through annexation, but not as consistently as they affect frequencies. The paper concludes with a discussion of the efficacy of state policy to influence local annexation activity. [ABSTRACT FROM AUTHOR]

The article presents an exploration into the history of the 1861 blockade efforts of Savannah, Georgia and Charleston, South Carolina and the literary views of the author Herman Melville against the maneuvers. A detailed account of the events are given, describing the destruction of 25 whaling ships in the process. The popular rejection of these actions and the implications seen by nautical culture is also analyzed.

In this paper we present a new approach to measuring government efficiency, based on the theory that communities that allocate resources efficiently in the local public sector maximize property values. We use Data Envelopment Analysis (DEA) to identify the counties in Minnesota that are characterized by property-value maximization and hence an efficient public sector. The results indicate that the dominant source of public sector inefficiency is an inappropriate scale of operations. It appears that some county jurisdictions are too large to service the population efficiently. The size and concentration of government power are also responsible in part for observed inefficiencies. [ABSTRACT FROM AUTHOR]

Background: Pediatric cervical spine injury (PCSI) in children is rare. Incidence of PCSI requiring intervention is not known, and imaging practices for screening in United States trauma centers are not well described., Methods: The 2016 NTDB was queried for patients younger than 15 years with PCSI. Incidence of PCSI, operative interventions, and imaging rates were analyzed by age and ACS accreditation status., Results: Of 84,554 children, 873 (1.03%) had PCSI. Patients <4 years were less likely to have PCSI (0.68% vs. 1.1%, RR 0.59, p < 0.001). 165 children (0.20%) required an intervention for PCSI. 12.8% of all children were screened for PCSI with imaging, 9.3% with CT, and 3.2% with plain X-rays. In spite of similar injury and intervention rates, stand-alone pediatric trauma centers were less likely than others to image patients without PCSI (11% vs. 13% p < 0.001), less likely to utilize CT scan (5.8% vs. 10.6% p < 0.001) and more likely to utilize plain films (5.2% vs. 2.4% p < 0.001)., Conclusion: Despite exceedingly low rates of PSCI requiring intervention (0.2%), imaging rates for screening are significant. Stand-alone pediatric trauma centers outperform others in limiting unnecessary imaging., Level of Evidence: IV., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Liberal use of CT scanning in children with blunt trauma risks unnecessary radiation exposure and cost. Recent literature questions the utility of whole-body CT in stable children without clinical evidence of significant injury, but this is often done based on injury mechanism. The purpose of this study is to quantify the utilization of CT scans of the head, chest, abdomen, and pelvis based on injury severity in these body regions and to assess the impact of American College of Surgeons (ACS) pediatric trauma center designation on CT utilization in children with minor or no injuries., Methods: We queried the National Trauma Databank for 2014, 2015, and 2016 to identify all patients 14 years and younger. Using Abbreviated Injury Scale (AIS) score as a proxy for injury severity, we analyzed the number of head, thoracic, and abdominal CT scans done for patients at low levels of injury severity (AIS 0-2) in each of these body regions and according to trauma center level designation (ACS I, II, III, standalone pediatric I or II, and non ACS accredited)., Results: Of 257,661 children who were entered into the database for any reason, overall CT utilization was 20% for head, 5% for the chest and 9% for the abdomen and pelvis. Children with no injuries or minimal injury to the head were scanned 7% and 46% of the time, respectively, for the chest 3% and 13% and for the abdomen 6% and 30%. For all body regions and all levels of injury severity, level 1 stand-alone pediatric centers displayed significantly lower CT utilization rates than others., Conclusion: CT scan rates for children with minimal or no injuries to the head, chest, abdomen and pelvis are significant. Level 1 stand-alone pediatric trauma centers are least likely to perform these studies. Widespread education and acceptance of clinical guidelines for imaging in stable patients throughout trauma systems could alleviate this disparity., Level of Evidence: Level III retrospective comparative study., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: The military uses "just-in-time" training to refresh deploying medical personnel on skills necessary for medical and surgical care in the theater of operations. The burden of pediatric care at Role 2 facilities has yet to be characterized; pediatric predeployment training has been extremely limited and primarily informed by anecdotal experience. The goal of this analysis was to describe pediatric care at Role 2 facilities to enable data-driven development of high-fidelity simulation training and core knowledge concepts specific to the combat zone., Setting and Patients: A retrospective review of the Role 2 Database was conducted on all pediatric patients (< 18 yr) admitted to Role 2 in Afghanistan from 2008-2014., Interventions: Three cohorts were determined based on commercially available simulation models: Group 1: less than 1 year, Group 2: 1-8 years, Group 3: more than 8 years. The groups were sub-stratified by point of injury care, pre-hospital management, and Role 2 facility medical/surgical management., Measurements and Main Results: Appropriate descriptive statistics (chi square and Student t test) were utilized to define demographic and epidemiologic characteristics of this population. Of 15,404 patients in the Role 2 Database, 1,318 pediatric subjects (8.5%) were identified. The majority of patients were male (80.0%) with a mean age of 9.5 years (± SD, 4.5). Injury types included: penetrating (56%), blunt (33%), and burns (7%). Mean transport time from point of injury to Role 2 was 198 minutes (±24.5 min). Mean Glasgow Coma Scale and Revised Trauma Score were 14 (± 0.1) and 7.0 (± 1.4), respectively. Role 2 surgical procedures occurred for 424 patients (32%). Overall mortality was 4% (n = 58)., Conclusions: We have described the epidemiology of pediatric trauma admitted to Role 2 facilities, characterizing the spectrum of pediatric injuries that deploying providers should be equipped to manage. This analysis will function as a needs assessment to facilitate high-fidelity simulation training and the development of "pediatric trauma core knowledge concepts" for deploying providers.

Background: Massive transfusion (MT) in pediatric patients remains poorly defined. Using the largest existing registry of transfused pediatric trauma patients, we sought a data-driven MT threshold., Methods: The Department of Defense Trauma Registry was queried from 2001 to 2013 for pediatric trauma patients (<18 years). Burns, drowning, isolated head injury, and missing Injury Severity Score (ISS) were excluded. MT was evaluated as a weight-based volume of all blood products transfused in the first 24 hours. Mortality at 24 hours and in the hospital was calculated for increasing transfusion volumes. Sensitivity and specificity curves for predicting mortality were used to identify an optimal MT threshold. Patients above and below this threshold (MT+ and MT-, respectively) were compared., Results: The Department of Defense Trauma Registry yielded 4,990 combat-injured pediatric trauma patients, of whom 1,113 were transfused and constituted the study cohort. Sensitivity and specificity for 24-hour and in-hospital mortality were optimal at 40.1-mL/kg and 38.6-mL/kg total blood products in the first 24 hours, respectively. With the use of a pragmatic threshold of 40 mL/kg, patients were divided into MT+ (n = 443) and MT- (n = 670). MT+ patients were more often in shock (68.1% vs. 47.0%, p < 0.001), hypothermic (13.0% vs. 3.4%, p < 0.001), coagulopathic (45.0% vs. 29.6%, p < 0.001), and thrombocytopenic (10.6% vs. 5.0%, p = 0.002) on presentation. MT+ patients had a higher ISS, more mechanical ventilator days, and longer intensive care unit and hospital stay. MT+ was independently associated with an increased 24-hour mortality (odds ratio, 2.50; 95% confidence interval, 1.28-4.88; p = 0.007) and in-hospital mortality (odds ratio, 2.58; 95% confidence interval, 1.70-3.92; p < 0.001)., Conclusion: Based on this large cohort of transfused combat-injured pediatric patients, a threshold of 40 mL/kg of all blood products given at any time in the first 24 hours reliably identifies critically injured children at high risk for early and in-hospital death. This evidence-based definition will provide a consistent framework for future research and protocol development in pediatric resuscitation., Level of Evidence: Diagnostic study, level II. Prognostic/epidemiologic study, level III.

Background: The purpose of this study was to define the scope of combat- and noncombat-related inpatient pediatric humanitarian care provided from 2002 to 2012 by the United States (US) Military in Iraq and Afghanistan., Study Design: A review of the Patient Administration Systems and Biostatistics Activity (PASBA) database for all admissions from 2002 to 2012 by US military hospitals in Afghanistan and Iraq for children 14 years of age and younger provided data to analyze the use of medical care. North Atlantic Treaty Organization Standardization Agreement (STANAG) injury codes provided injury cause and the ICD-codes provided diagnosis. In-hospital mortality, blood usage, number of invasive procedures, and hospital stay were analyzed by country and injury category., Results: There were 6,273 admissions that met inclusion criteria. In Afghanistan, there were more than twice as many pediatric noncombat-related admissions (2,197) as pediatric combat-related admissions (1,095). In Iraq, the difference was minimal (1,391 noncombat vs 1,590 combat). The most common cause of noncombat-related admission in both countries was injury: primarily motor vehicle related and burns, which varied significantly by age. Older patients (older than 8 years in Afghanistan and older than 4 years in Iraq) were more likely combat victims. Mortality was highest for combat trauma in Iraq (11%) and noncombat trauma in Afghanistan (8%). The in-hospital mortality in both countries was 5% for admissions unrelated to trauma. Resource use was highest for combat trauma in both countries., Conclusions: Noncombat-related medical care was the primary reason for pediatric humanitarian admissions to United States military combat hospitals in Iraq and Afghanistan from 2002 to 2012. Combat-related injuries have a higher mortality than noncombat injuries or other admissions., (Published by Elsevier Inc.)

Librarians at the University of Florida Health Science Center Libraries partnered with faculty to promote awareness of and access to research on women's health and sex and gender resources in an outreach project funded by the National Library of Medicine and the National Institutes of Health Office of Research on Women's Health. The project featured elements that facilitated cross-disciplinary collaboration (using CoLAB Planning Series®, or CoLABs), instruction to various groups (including faculty, undergraduate students, graduate students, and professional students), collection development, and information dissemination. Librarians leveraged existing partnerships with faculty and built new ones. Success in this project demonstrates that libraries can partner effectively with their faculty on emerging trends and new initiatives.

In an effort to reach out to library users and make the library a more relevant, welcoming place, the University of Florida's Health Science Center Library hosted exhibits from the National Library of Medicine's (NLM) Traveling Exhibition Program. From 2010 through 2012, the library hosted four NLM exhibits and created event series for each. Through reflection and use of a participant survey, lessons were learned concerning creating relevant programs, marketing events, and forming new partnerships. Each successive exhibit added events and activities to address different audiences. A survey of libraries that have hosted NLM exhibits highlights lessons learned at those institutions.

Background: Humanitarian and civilian emergency care accounts for up to one-third of US military combat support hospital (CSH) admissions. Almost half of these admissions are children. The purpose of this study is to describe the features of pediatric wartime admissions to deployed CSHs in Iraq and Afghanistan., Methods: A retrospective database review was conducted using the Patient Administration Systems and Biostatistics Activity. Details of 2,060 pediatric admissions to deployed CSHs were analyzed., Results: Nontraumatic diagnoses were responsible for 25% of all pediatric admissions. Penetrating injuries (76.3%) dominate the trauma admissions. The primary mechanisms of injury were gunshot wound (39%) followed by explosive injuries (32%). Categorizing the injuries by location revealed 38.3% extremity wounds, 23.6% torso injuries, 23.5% head, face, and neck injuries, and 13.3% burns. More than half of the children required two or more invasive or surgical procedures, 19.8% needed a transfusion, and 5.6% required mechanical ventilation. The mortality rate was 6.9%. The primary cause of death involved head trauma (29.5%) and burns (27.3%), followed by infectious diagnoses (7.2%). The case fatality rate for head injury and burn patients was 20.1% and 15.9%, respectively, in contrast to the fatality rate for all other diagnoses at 3.8% (p < 0.01). Excluding emergency department deaths, mortality rates for Afghanistan (6.2%) and Iraq (3.9%) significantly differ (p < 0.02)., Conclusion: Pediatric patients account for approximately 10% of all CSH admissions in Afghanistan and Iraq. Burns and penetrating head injury account for the majority of pediatric mortality at the CSH.