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Although understandings of scientific inquiry (as opposed to conducting inquiry) are included in science education reform documents around the world, little is known about what students have learned about inquiry during their elementary school years. This is partially due to the lack of any assessment instrument to measure understandings about scientific inquiry. However, a valid and reliable assessment has recently been developed and published, Views About Scientific Inquiry (VASI; Lederman et al. [2014], Journal of Research in Science Teaching, 51, 65-83). The purpose of this large-scale international project was to collect the first baseline data on what beginning middle school students have learned about scientific inquiry during their elementary school years. Eighteen countries/regions spanning six continents including 2,634 students participated in the study. The participating countries/regions were: Australia, Brazil, Chile, Egypt, England, Finland, France, Germany, Israel, Mainland China, New Zealand, Nigeria, South Africa, Spain, Sweden, Taiwan, Turkey, and the United States. In many countries, science is not formally taught until middle school, which is the rationale for choosing seventh grade students for this investigation. This baseline data will simultaneously provide information on what, if anything, students learn about inquiry in elementary school, as well as their beginning knowledge as they enter secondary school. It is important to note that collecting data from all of the approximately 200 countries globally was not humanly possible, and it was also not possible to collect data from every region of each country. The results overwhelmingly show that students around the world at the beginning of grade seven have very little understandings about scientific inquiry. Some countries do show reasonable understandings in certain aspects but the overall picture of understandings of scientific inquiry is not what is hoped for after completing 6 years of elementary education in any country.

Background and Purpose: To determine the incidence of acute neuroimaging (NI) findings and comorbidities in the coronavirus disease of 2019 (COVID‐19)‐infected subjects in seven U.S. and four European hospitals. Methods: This is a retrospective study of COVID‐19‐positive subjects with the following inclusion criteria: age >18, lab‐confirmed COVID‐19 infection, and acute NI findings (NI+) attributed to COVID‐19 on CT or MRI brain. NI+ and comorbidities in total hospitalized COVID‐19‐positive (TN) subjects were assessed. Results: A total of 37,950 COVID‐19‐positive subjects were reviewed and 4342 underwent NI. NI+ incidence in subjects with NI was 10.1% (442/4342) including 7.9% (294/3701) in the United States and 22.8% (148/647) in Europe. NI+ incidence in TN was 1.16% (442/37,950). In NI (4342), incidence of ischemic stroke was 6.4% followed by intracranial hemorrhage (ICH) (3.8%), encephalitis (0.5%), sinus venous thrombosis (0.2%), and acute disseminated encephalomyelitis (ADEM) (0.2%). White matter involvement was seen in 57% of NI+. Hypertension was the most common comorbidity (54%) before cardiac disease (28.8%) and diabetes mellitus (27.7%). Cardiac disease (p <.025), diabetes (p <.014), and chronic kidney disease (p <.012) were more common in the United States. Conclusion: This multicenter, multinational study investigated the incidence and spectrum of NI+ in 37,950 hospitalized adult COVID‐19 subjects including regional differences in incidences of NI+, associated comorbidities, and other demographics. NI+ incidence in TN was 1.16% including 0.95% in the United States and 2.09% in Europe. ICH, encephalitis, and ADEM were common in Europe, while ischemic strokes were more common in the United States. In this cohort, incidence and distribution of NI+ helped characterize the neurological complications of COVID‐19. [ABSTRACT FROM AUTHOR]

This article focuses on children's engagement in extracurricular activities from the perspective of middle-class parents in Rome, Italy, and Los Angeles, California. Analysis of parents' accounts captured in interviews and ethnographic fieldwork reveals that both sets of parents perceive activities as important for children's success. Yet Roman parents consider activities as part of "children's world," downplaying intense involvement and performance. Conversely, L.A. parents view activities as preparing children for adult life, emphasizing competition and accomplishment. (Contains 1 table and 13 excerpts.)

Tracking students into different classrooms according to their prior academic performance is controversial among both scholars and policymakers. If teachers find it easier to teach a homogeneous group of students, tracking could enhance school effectiveness and raise test scores of both low- and high-ability students. If students benefit from learning with higher-achieving peers, tracking could disadvantage lower-achieving students, thereby exacerbating inequality. Debates over tracking reached their high point in the United States in the 1990s. An influential report published in 1998 by the Thomas B. Fordham Foundation argued that the available research did not support the contention that tracking doomed impoverished students to inferior schooling, nor did it support universal adoption of the practice. Over the last decade, patterns in grouping students have changed markedly in the U.S.; high school students are no longer placed in rigidly defined general-education or noncollege tracks but have the flexibility to move between course levels for different subjects. These changes may have assuaged some critics, but the broader debate over tracking remains unsettled. The authors shed light on these issues using data from Kenya. In 2005, each of 140 primary schools in western Kenya received funds from the nongovernmental organization International Child Support (ICS) Africa to hire an extra teacher. One hundred twenty-one of these schools had a single 1st-grade class and used the new teacher to split the students into two classes. In 61 randomly selected schools, students were assigned to classes based on prior achievement as measured by test scores. In the remaining 60 schools, students were randomly assigned to one of the two classes, without regard to their prior academic performance. The results showed that all students benefited from tracking, including those who started out with low, average, and high achievement. At the tracking schools, the test scores of students who started out in the middle of their class do not seem to be affected by which section (top or bottom) the students were later assigned to. In other words, any negative effects of being with lower-achieving peers were more than offset in tracked settings by the benefit of the teacher being able to better tailor instruction to students' needs. (Contains 2 figures.)

Proposals for education reform generally focus on teachers and curricula. The most important factor in education may be the student himself or herself. A growing number of states, including Georgia, Michigan, New York, and Massachusetts, have established programs that provide financial rewards in the form of merit scholarships for college for students who perform well academically. However, such programs are controversial with some educators, and the structure of many existing programs in the United States makes it difficult to evaluate rigorously the impact of such incentive programs, because it is hard to identify for comparison a credible group of students who were not eligible for the program. Examining the experiences of programs outside the United States may well be informative in helping to understand the impact of incentives for students. This article describes a study conducted by the authors on the value of using scholarships as incentives to learn. The authors collected evidence from a program in Kenya, in which girls in public schools who performed well were offered merit scholarships that covered the cost of the fees charged by public schools at the time. Their families were offered grants to help cover the cost of school supplies. The program was implemented by a nonprofit organization, which phased it into a number of schools in random order, allowing the authors to compare schools that were eligible for the program with other schools where the program had not yet been introduced. The results of their evaluation, conducted in 2001 and 2002, indicate that the program significantly improved the test scores of girls. Moreover, the program had salutary spillover effects: test scores of students who were not eligible for--or had no hope of earning--the award also improved, as did school attendance for both students and teachers. (Contains 3 figures.)

Examined social realities of high-functioning autistic children mainstreamed in public school classrooms. Distinguished positive and negative actions and stances displayed by others. Found autistic children to be cognizant of and distressed by neglect, rejection, derision, and scorn. Reactions included oblivion, immediate behavior responses, and emotionally charged accounts to family members. (Author/DLH)

Autism spectrum disorder (ASD) impacts approximately 1 in 44 children in the United States. Common characteristics of ASD are marked deficits in communication and social connectedness. As autistic children approach adolescence, there is a lack of interventions available to them. Mentoring can provide adolescents with a relationship that facilitates social connectedness with another person who has a shared life experience, filling a gap in services. The Autism Mentorship Program (AMP) was designed to provide autistic adolescents a meaningful relationship with an autistic young adult. Via participation in focus groups, mentees (n = 5), mentors (n = 6), and parents of mentees (n = 6) shared their experience of participating in an afterschool, youth mentoring intervention. Themes were developed from an open coding procedure. Results showed that AMP was associated with helping mentees find social connection within their mentoring relationship and among the group of mentees. Mentors also reported mutual benefits in social connectedness. Perceived benefits of the program, including improved academic performance, and suggestions for future programming are reported. AMP appears to be a promising program that provides social benefits for adolescents with ASD who may have few options for this type of support. Practitioner points: A mentoring program for autistic youth, with autistic mentors, has the potential to offer social benefits for mentors and mentees.Parents of mentees in the program perceive academic benefits for their youth.Mentees report experiencing increased social engagement within the mentee group. [ABSTRACT FROM AUTHOR]

Physical child abuse continues to be a serious public health issue in the United States. This study expands on previous research by exploring trends in physical child abuse diagnoses among children admitted to emergency departments (EDs) across the United States. The analysis aimed to explicate the association between physical child abuse and both sociodemographic and behavioral health covariates to better inform and identify risk factors associated with ED admissions for abuse. The study also explicated differences between confirmed and suspected physical child abuse cases. The study utilized a nationally representative sample of hospital-owned EDs that included 319,676,625 ED admissions between 2006 and 2017 for children under 18-years-old. The analysis included a trend analysis, bivariate descriptive statistics, and multivariate logistic regression models were employed. Children with a physical child abuse diagnosis were less likely to be from higher income communities (a OR = 0.61, 95% CI [0.53, 0.71]), less likely to be female (a OR = 0.93, 95% CI [0.90, 0.96]), and more likely to be uninsured (a OR = 1.65, 95% CI [1.48, 1.84]). Children with attention-deficit hyperactivity disorder (a OR = 1.36, 95% CI [1.14, 1.62]) and a conduct disorder (a OR = 1.28, 95% CI [1.04, 1.58]) were more likely to have a physical abuse diagnosis. The sex-stratified analyses found that the higher rates of physical abuse among children with attention-deficit hyperactivity disorder were driven by the male subsample, while higher rates of abuse for those with conduct disorders were the result of the female subsample. A supplemental analysis of suspected versus confirmed physical child abuse for the fourth quarter of 2015 through 2017 also revealed sociodemographic and behavioral health differences. This study supports the need to consider sociodemographic and behavioral risk factors associated with physical child abuse to inform treatment and potential reoccurrence of abuse. [ABSTRACT FROM AUTHOR]

In the current study, we sought to determine the effects of parent visits on a range of psychological outcomes among children of incarcerated parents. Drawing on data from the Mentoring Children of Incarcerated Parents Enhancement Demonstration Project, a recent, large‐scale evaluation of mentoring programme practices, we hypothesized that ongoing contact would lead to an improved parent–child relationship which, in turn, would promote a range of psychosocial outcomes in children. Results of a structural equation model (n = 228) revealed a significant positive association between child's frequency of visits with their incarcerated parent and child–parent relationship quality, which in turn, was significantly associated with the child's life purpose and depression/loneliness. Findings from the current study shed light on the importance of children's visits with their incarcerated parent for later psychological outcomes. [ABSTRACT FROM AUTHOR]

Objective: Eating disorder symptoms, including eating disorder diagnosis, binge eating, and unhealthy weight loss, are associated with health risks, and adolescence may be an optimal time to provide education on healthy alternatives. This research explored whether in‐school health information during adolescence is associated with eating disorder symptoms in young adulthood. Method: Data were used from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of American youth, including information from Wave I, when participants were in Grades 7–12, and from Wave III, when participants were aged 18–26. Logistic regression analyses predicted eating disorder symptoms from in‐school health information, adjusting for demographic and educational covariates. In‐school health information and eating disorder symptoms were based on participant self‐report. Results: In‐school health information about both diet (the foods you should and should not eat) and the importance of exercise compared to no health information reduced the odds of youth‐reported eating disorder history odds ratio ((OR) = 0.23, 95% CI = 0.11–0.48). Individuals who received information on exercise alone compared to no health information were also less likely to use weight pills to control weight (OR = 0.26, 95% CI = 0.11–0.61). There was no difference in binge‐eating symptoms based on school health class. Discussion: Findings from this exploratory research study indicate that in‐school receipt of information on diet and exercise has modest associations with eating disorder symptoms, including lower odds of a self‐reported eating disorder and lower odds of using weight loss pills. Further research is needed to definitely test the role of school health class on eating disorder symptoms. [ABSTRACT FROM AUTHOR]

Objective: Comparative effectiveness research can inform treatment decisions regarding the choice of biologics for rheumatoid arthritis (RA). The objective of this study is to compare the efficacy of tumor necrosis factor inhibitors (TNFis) and non‐TNFis (nTNFis) in real‐world patients with RA and past TNFi experience. Methods: Comparative Effectiveness Registry to study Therapies for Arthritis and Inflammatory Conditions (CERTAIN) was nested within the United States Corrona registry. Adult patients with RA with moderate to high disease activity (Clinical Disease Activity Index [CDAI] >10) with exposure to one or more prior TNFis who were switching to a new TNFi or nTNFi (choice of therapy per physician choice) were enrolled. The primary outcome was the achievement of low disease activity (LDA) at 12 months (CDAI ≤10; disease activity score in 28 joints based on C‐reactive protein [DAS28‐CRP] <2.67). Propensity score modeling probability of treatment with nTNFi versus TNFi adjusted for imbalanced factors. The response rate was modeled using mixed‐effect logistic regression models, adjusting for a priori and imbalanced baseline factors and accounting for the practice‐related treatment patterns. Results: After applying inclusion criteria, 939 biologic initiations were analyzed, 505 (53.7%) nTNFis and 434 (46.3%) TNFis. Patients who started nTNFis were significantly more likely to have longer disease duration, more prior TNFi use, and higher patient fatigue scores and were more likely to have government insurance. At 12 months, 28% of nTNFi and 24% of TNFi initiators were in LDA by CDAI, and 22% of nTNFi and 19% of TNFi initiators were in LDA by DAS28‐CRP. After multivariable adjustment and controlling for the influence of site‐related confounding, there were no significant differences in the likelihood to reach LDA by CDAI (adjusted odds ratio [aOR] = 1.12; 95% confidence interval [CI], 0.78‐1.62) or DAS28‐CRP (aOR = 1.16; 95% CI, 0.77‐1.75). Conclusion: In this large, real‐world study enrolling patients with RA with prior TNFi exposure, switching to an nTNFi biologic was comparable in its clinical effectiveness with switching to another TNFi. [ABSTRACT FROM AUTHOR]

In 1990, the last time the decennial census included a question on domestic drinking water source, it was estimated that private domestic water wells (PDWs) supplied household water to about 15.1 million housing units (15% of the population) in the United States (U.S.). PDWs are not regulated by the Safe Drinking Water Act, and with few exceptions, are not subject to the water quality testing required of public water suppliers. We expanded two methods in estimating housing units reliant on PDWs from an Oklahoma pilot study (Weaver et al. 2017), nationally. Both use 1990 census data on drinking water sources as a baseline. The first method uses housing unit change and private well drilling logs for 20 states. This allows for the rate of well use to change between 1990 and 2010 in these states. The second, based solely on housing unit change, assumes a constant rate of well use. Ordinary least squares regression demonstrated (R² = 0.78) that the methods yield similar estimates for nationwide well use. Using the housing unit change method, it is estimated that in 2010, 23 million housing units were reliant on PDWs (17% of the population). We provide these estimates at the census block group and census block resolution. This dataset will assist in a better understanding of the reliance on PDWs in the U.S., and position local, tribal, state, and national groups to better protect this water resource from contaminant sources. [ABSTRACT FROM AUTHOR]

Objective: Though randomized controlled trials have demonstrated relatively comparable clinical outcomes with triple therapy (methotrexate [MTX], sulfasalazine [SSZ], and hydroxychloroquine [HCQ]) compared to combination therapy (tumor necrosis factor inhibitor [TNFi] and MTX), real-world experiences comparing these strategies have not been well studied.Methods: We evaluated the clinical effectiveness and effects of medication discontinuation of triple therapy with MTX/SSZ/HCQ versus combination therapy with TNFi/MTX in rheumatoid arthritis (RA) patients enrolled in the Corrona RA Drug Safety & Effectiveness Registry. Propensity score matching was used to match patients up to a ratio of 1:3 to adjust for imbalances between treatment groups, with stratification performed according to biologics-naive or biologics-exposed status of study participants.Results: Patients eligible for analysis in this study included biologics-naive RA patients (3,926 who received combination therapy with TNFi/MTX and 262 who received triple therapy with MTX/SSZ/HCQ) and biologics-exposed RA patients (3,365 who received combination therapy with TNFi/MTX and 130 patients who received triple therapy with MTX/SSZ/HCQ). Before propensity score matching, numerous factors were imbalanced between the treatment groups, with triple therapy patients generally being older, having a longer disease duration of RA and lower RA disease activity, and more likely having a history of malignancy and other comorbidities. After matching, almost all (93-98%) triple therapy patients could be matched to TNFi/MTX therapy patients, and cohort characteristics were generally well balanced. Discontinuation of medication was greater in triple therapy patients referent to TNFi/MTX therapy patients (adjusted hazard ratio [HR] of 2.17 [95% confidence interval 1.63-2.88] in the biologics-naive group; adjusted HR of 1.51 [95% confidence interval 1.06-2.15] in the biologics-exposed group). At 6 months, the proportion of biologics-naive patients attaining low disease activity was significantly greater in the TNFi/MTX treatment group (49.2% in TNFi/MTX therapy patients versus 33.3% in triple therapy patients), as was the mean change in Clinical Disease Activity Index scores (-9.3 units versus -5.5 [95% confidence interval -1.5, -6.1]). Corresponding results in the biologics-exposed patients numerically favored TNFi/MTX therapy compared to triple therapy but did not reach statistical significance.Conclusion: Few patients receive triple therapy with MTX/SSZ/HCQ in the US. In the present study, drug persistence and clinical effectiveness outcomes were less favorable in triple therapy patients compared to TNFi/MTX therapy patients. [ABSTRACT FROM AUTHOR]

In this paper, we proposed a multi-method modeling approach to community-level spreading of COVID-19 disease. Our methodology was composed of interconnected age-stratified system dynamics models in an agent-based modeling framework that allowed for a granular examination of the scale and severity of disease spread, including metrics such as infection cases, deaths, hospitalizations, and ICU usage. Model parameters were calibrated using an optimization technique with an objective function to minimize error associated with the cumulative cases of COVID-19 during a training period between March 15 and October 31, 2020. We outlined several case studies to demonstrate the model's state- and local-level projection capabilities. We further demonstrated how model outcomes could be used to evaluate perceived levels of COVID-19 risk across different localities using a multi-criteria decision analysis framework. The model's two, three, and four week out-of-sample projection errors varied on a state-by-state basis, and generally increased as the out-of-sample projection period was extended. Additionally, the prediction error in the state-level projections was generally due to an underestimation of cases and an overestimation of deaths. The proposed modeling approach can be used as a virtual laboratory to investigate a wide range of what-if scenarios and easily adapted to future high-consequence public health threats. [ABSTRACT FROM AUTHOR]

Background: Pediatric regulations enacted in both Europe and the USA have disrupted the pharmaceutical industry, challenging business and drug development processes, and organizational structures. Over the last decade, with science and innovation evolving, industry has moved from a reactive to a proactive mode, investing in building appropriate structures and capabilities as part of their business strategy to better tackle the challenges and opportunities of pediatric drug development. Methods: The EFGCP Children's Medicines Working Party and the IQ Pediatric working group have joined their efforts to survey their member company representatives to understand how pharmaceutical companies are organized to fulfill their regulatory obligations and optimize their pediatric drug development programs. Results: Key success factors and recommendations for a fit-for-purpose Pediatric Expert Group (PEG) were identified. Conclusion: Pediatric structures and expert groups were shown to be important to support optimization of the development of pediatric medicines. [ABSTRACT FROM AUTHOR]

Purpose: This article addresses the lack of formal design guidance that supports flexibility within the architectural and engineered systems of manufacturing facilities through the development of a taxonomy and associated terminology. Design/methodology/approach: This research performed a comparative analysis of 15 manufacturing facilities located both within the United States (73 percent of cases) and internationally (27 percent of cases). These case studies provided details on how and where flexibility was incorporated into the design of a manufacturing facility. Specific consideration was given to the primary design features that enabled a decoupling of the facility from the manufacturing process. These design features were then clustered to identify main design strategies that enable flexibility. Findings: By grouping the design features together and creating a common vocabulary, three coherent design approaches for flexible facilities were identified, each having a different potential for responding to short-term and long-term changes. These include general purpose, scalable, and dedicated facilities. Research limitations/implications: By delineating three high-level strategies for early flexible facility design, this research synthesizes a conceptual understanding of flexibility with practical and implementable designs. This synthesis provides an incremental advance to a complex challenge for researchers. It also provides decision support to design teams by aiding in project definition, when flexibility is desirable. This research is primarily limited by the number of cases reviewed. With more cases, additional facility design strategies may be identified. Practical implications: The findings in this research allow for a basic understanding of how a flexible facility can be designed with only limited or vague information about the product and manufacturing processes contained within. The development of terminology associated with each facility design strategy provides standardization for the discussion and implementation of flexibility early in the design process. In doing so, flexible designs become easier to create and more efficient to implement. Originality/value: This research provides the first synthesized approach for considering flexible facility design strategies within the manufacturing sector. [ABSTRACT FROM AUTHOR]

Objective: To identify the extent to which opioid prescribing rates for patients with rheumatoid arthritis (RA) vary in the US and to determine the implications of baseline opioid prescribing rates on the probability of future long‐term opioid use. Methods: We identified patients with RA from physicians who contributed ≥10 patients within the first 12 months of participation in the Corrona RA Registry. The baseline opioid prescribing rate was calculated by dividing the number of patients with RA reporting opioid use during the first 12 months by the number of patients with RA providing data that year. To estimate odds ratios (ORs) for long‐term opioid use, we used generalized linear mixed models. Results: During the follow‐up period, long‐term opioid use was reported by 7.0% (163 of 2,322) of patients of physicians with a very low rate of opioid prescribing (referent) compared to 6.8% (153 of 2,254) of patients of physicians with a low prescribing rate, 12.5% (294 of 2,352) of patients of physicians with a moderate prescribing rate, and 12.7% (307 of 2,409) of patients of physicians with a high prescribing rate. The OR for long‐term opioid use after the baseline period was 1.16 (95% confidence interval [95% CI] 0.79–1.70) for patients of low‐intensity prescribing physicians, 1.89 (95% CI 1.27–2.82) for patients of moderate‐intensity prescribing physicians, and 2.01 (95% CI 1.43–2.83) for patients of high‐intensity prescribing physicians, compared to very low‐intensity prescribing physicians. Conclusion: Rates of opioid prescriptions vary widely. Our findings indicate that baseline opioid prescribing rates are a strong predictor of whether a patient will become a long‐term opioid user in the future, after controlling for patient characteristics. [ABSTRACT FROM AUTHOR]

Medical errors are among the top 3 causes of patient deaths in the United States, with up to 400,000 preventable deaths occurring in hospitalized patients each year. Although improvements have been made in anesthesia patient safety, adverse outcomes continue to occur. This study used thematic analysis to examine anesthesia closed claims that were associated with preventable morbidity and mortality. Investigators determined that 123 closed malpractice claims files from the American Association of Nurse Anesthetists (AANA) Foundation closed claims database involved events that the involved Certified Registered Nurse Anesthetist could have prevented. Factors that were associated with preventable closed claims included communication failures, violations of the AANA Standards for Nurse Anesthesia Practice, and errors in judgment. [ABSTRACT FROM AUTHOR]

Introduction: Anti-citrullinated protein antibodies (ACPAs) are highly specific serological biomarkers that are indicative of a poor prognosis in patients with rheumatoid arthritis (RA). The effectiveness of biologic disease-modifying antirheumatic drugs (bDMARDs) with different mechanisms of action may vary, based on patients' serostatus. The aim of this study is to compare the effectiveness of abatacept versus tumor necrosis factor inhibitors (TNFis) in patients with RA who were anti-cyclic citrullinated peptide antibody positive (anti-CCP+). Methods: Abatacept or TNFi initiators with anti-CCP+ status (≥ 20 U/ml) at or prior to treatment initiation were identified from a large observational US cohort (1 December 2005–31 August 2016). Using propensity score matching (1:1), stratified by prior TNFi use (0, 1 and ≥ 2), effectiveness at 6 months after initiation was evaluated. Primary outcome was mean change in Clinical Disease Activity Index (CDAI) score. Secondary outcomes included achievement of remission (CDAI ≤ 2.8), low disease activity/remission (CDAI ≤ 10), modified American College of Rheumatology 20/50/70 responses and mean change in modified Health Assessment Questionnaire score. Results: After propensity score matching, the baseline characteristics between 330 pairs of abatacept and TNFi initiators (biologic naïve, n = 97; TNFi experienced, n = 233) were well balanced with absolute value standardized differences of ≤ 0.1. Both overall, and in the biologic-naïve cohort, there were no significant differences in mean change in CDAI score at 6 months. However, in the TNFi-experienced cohort, there was a significantly greater improvement in CDAI score at 6 months with abatacept versus TNFi initiators (p = 0.033). Secondary outcomes showed similar trends. Conclusions: Improvements in clinical disease activity were seen in anti-CCP+ abatacept and TNFi initiators. TNFi-experienced anti-CCP+ patients with RA had more improvement in disease activity with abatacept versus TNFis, whereas outcomes were similar between treatments in the overall population and in biologic-naïve patients. Trial Registration: ClinicalTrials.gov identifier: NCT01625650. Funding: This study is sponsored by Corrona, LLC and funded by Bristol-Myers Squibb. Bristol-Myers Squibb funded the publication of this manuscript. [ABSTRACT FROM AUTHOR]

This article examines morality as it is experienced in the quotidian running of family life through an analysis of video‐recorded spontaneous family interactions in Los Angeles, California. It argues that certain interactions afford the unfolding of morality experience through reflexive talk, in which speakers "bracket" the ongoing experience in order to critically reflect on it, thus making the ethical known. It demonstrates that often the underlying moral trouble is not immediately apparent and is not necessarily concerned with the momentary details. Instead, the interactional moment incites the speaker to shift to a reflexive stance and address a moral concern. The ubiquitous nature of this moral work exposes the contemporary pressures that parents experience as they negotiate the best ways to parent, raise moral children, and become virtuous families. [ABSTRACT FROM AUTHOR]

Background & Aims: Patients are not screened adequately for hepatitis C virus infection in Belgium. In the USA, the Center for Disease Control recommends screening for patients born in the babyboom period (1945‐1965). In Europe, the babyboom cohort was born between 1955 and 1974, but no screening policy has been targeted to this group. We aimed to study the prevalence of hepatitis C virus in an emergency department population in Belgium and the risk factors associated with hepatitis C virus infection. Method: We performed a monocentric, cross‐sectional seroprevalence study between January and November 2017 in a large Belgian non‐university hospital. Patients aged 18‐70 years presenting at the emergency department were eligible. Patients completed a risk assessment questionnaire and were screened for hepatitis C virus antibodies (Ab) with reflex hepatitis C virus ribonucleic acid testing. Results: Of 2970 patients, 2366 (79.7%) agreed to participate. hepatitis C virus Ab prevalence was 1.31%. Twenty‐one (67.7%) hepatitis C virus Ab‐positive patients were born between 1955 and 1974. With a previous treatment uptake of 54.5%, the prevalence of viremia was 0.9% in retrospect; 0.2% were newly diagnosed. The weighted multiple logistic regression model identified males born in the 1955‐1974 cohort, intravenous drug use and high endemic birth country as significant risk factors for hepatitis C virus infection (P < 0.05). Conclusion: Although the prevalence of hepatitis C virus Ab at the emergency department was higher than previously estimated for the general population in Belgium, the number of newly diagnosed patients with viremia was low. To optimize screening strategies, screening should be offered to males born in the 1955‐1974 cohort, but especially in drug users, the prison population and immigrants from high endemic countries. [ABSTRACT FROM AUTHOR]

Abstract The present study explores whether college-going norms of parents and peers are intertwined or distinct in their contributions to college-going attitudes. Latent class analysis identified latent groups based on youth's social norms from parents and friends. Data was used from the High School Longitudinal Study (HSLS:09), a nationally representative and longitudinal study of ninth grade American students (N = 10,663). Four classes were identified: universal college norms (53.57%, N = 5712), which included youth with high support from both parents and friends; parent college norms (12.71%, N = 1355), wherein youth's parents demonstrated high support while friends displayed low school engagement; friend college norms (27.53%, N = 2935), in which youth had highly engaged peers but limited parental support; and limited college norms (6.20%, N = 661), comprised of youth whose parents and friends displayed limited academic engagement. Findings indicate that parents and friends play separate roles in the development of college-going attitudes. Highlights • Most youth have both parents and friends with strong college-going norms. • Roughly 40% of youth have parents and friends with discordant college-going norms. • Parents and peers play separate roles in developing college-going attitudes. [ABSTRACT FROM AUTHOR]

Objectives: To assess the cost-effectiveness of Embrace, an integrated primary care service for older adults.Data Sources: Care and support claims from health care insurers, long-term care administration, and municipalities for enrolled older adults between 2011 and 2013.Study Design: A total of 1,456 older adults, listed with 15 general practitioners practices in the Netherlands, were stratified into risk profiles ("Robust," "Frail," and "Complex care needs") and randomized to Embrace or care-as-usual groups. Incremental costs were calculated per quality-adjusted life year, per day able to age in place, and per percentage point risk profile improvement.Principal Findings: Total average costs were higher for Embrace compared to care-as-usual. Differences in health-associated outcomes were small and not statistically significant. Probabilities that Embrace is cost-effective were below 80 percent, except for "risk profile improvements" within risk profile "Complex care needs." Complete case analysis resulted in smaller differences in total average costs across conditions and differences in health-associated outcomes remained small.Conclusions: According to current standards, Embrace is not considered cost effective after 12 months. However, it could be considered worthwhile in terms of "risk profile improvements" for older adults with "Complex care needs," if society is willing to invest substantially. [ABSTRACT FROM AUTHOR]

National data indicate that prescription painkillers are the second most commonly misused prescription drug on college campuses. Although much research has focused on the motivations given for the nonmedical use of these drugs, few studies explore justifications for use. This article fills that gap by explicating the justifications college students incite to defend their nonmedical use of these drugs. Drawing on semistructured interviews with students (N = 76) from a large public northwestern university, inductive analysis uncovered social learning theories of crime, more specifically Sykes and Matza's neutralization theory, as helping to inform students' justifications for use. These justifications were combined to form two broad justification categories: "the safety factor" and "authoritative enabling." Given that justifications helped students to resolve any guilt, shame, or stigma associated with their deviant use of prescription painkillers, it is important that future research continue to explore and disentangle motivations from justifications. [ABSTRACT FROM AUTHOR]

This study estimates long-run impacts of a child health investment, exploiting community-wide experimental variation in school-based deworming. The program increased labor supply among men and education among women, with accompanying shifts in labor market specialization. Ten years after deworming treatment, men who were eligible as boys stay enrolled for more years of primary school, work 17% more hours each week, spend more time in nonagricultural self-employment, are more likely to hold manufacturing jobs, and miss one fewer meal per week. Women who were in treatment schools as girls are approximately one quarter more likely to have attended secondary school, halving the gender gap. They reallocate time from traditional agriculture into cash crops and nonagricultural self-employment. We estimate a conservative annualized financial internal rate of return to deworming of 32%, and show that mass deworming may generate more in future government revenue than it costs in subsidies. [ABSTRACT FROM AUTHOR]

A significant body of research suggests that environmental risks are more likely to be found in minority and low-income communities. Few studies have questioned whether communities of lower socioeconomic status may be less protected by regulatory agencies through the use of fines in instances of noncompliance. Using the Environmental Inequality Formation perspective (EIF) and data drawn from the U.S. Environmental Protection Agency’s (EPA) administrative enforcement cases within the U.S. Pacific Northwest from 2007 to 2011, this project finds that the factors primarily influencing fine severity include the type and severity of the offense. However, after controlling for other factors, fines are less severe against facilities surrounded by low-income households. This research confirms the need for scholars, policy makers, and activists to develop greater linkages between the EIF perspective and environmental sentencing by more clearly teasing out the roles that facilities, enforcement agencies, and especially communities play in these outcomes. [ABSTRACT FROM AUTHOR]

Curious about the geographical distribution of publications in reproductive medicine, we compared the numbers of publications in Human Reproduction (HR) and Fertility and Sterility (F&S). The annual number of publications from the individual countries was obtained by searching the Medline database using the internet provider PubMed. The data were analysed and normalized to population size, gross domestic product (GDP) and total number of Medline publications. The 8511 publications of both journals in the 1990s came from 56 countries. The number of publications per year was increasing in HR and remained constant in F&S. In absolute numbers, the UK produced the most publications in HR (21%) and the USA in F&S (45%) as well as in both journals together (28%). Relatively, Israel was the most productive country per million inhabitants (8.4 +/- 2.1 publications/year), per billion US dollars GDP (0.85 +/- 0.21 publications/year) and per 1000 Medline publications (15 +/- 4 publications/year). Europe was the most productive world region in absolute numbers (54%) and Australia/New Zealand in relative numbers per million inhabitants and per 1000 billion US dollars GDP. Almost 87% of all publications in HR and F&S came from the 18 countries with a GDP per capita of >10 000 US dollars. In conclusion, the geographical distribution of publications in HR and F&S follows the pattern of the distribution of publications in general biomedical research. Most publications come from affluent countries. Although the USA and the UK appear to be the most productive countries in absolute numbers, smaller affluent countries like Israel and Belgium are more productive when the numbers are normalized to population or GDP. [ABSTRACT FROM AUTHOR]

Objective: To identify the rheumatoid arthritis (RA) characteristics associated with increased herpes zoster (HZ) risk in the Corrona registry RA patients, and to evaluate the risk in initiators of tumor necrosis factor inhibitors (TNFi) or non-TNFi biologic agents or (among those who were currently on or had been previously treated with methotrexate [MTX]) conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) other than MTX.Methods: Cox regression modeling estimated the association between first HZ incidence and selected RA characteristics, including disease activity. Medication-related risk for HZ in RA patients taking current or past MTX (to exclude milder RA disease) were categorized by treatment initiation (TNFi versus non-TNFi versus csDMARD). Hazard ratios (HRs) estimated HZ risk of each treatment initiation category after stratification on trimmed propensity score (PS) quintiles to control for potential confounders.Results: A total of 28,852 patients contributed 95,287 person-years. Seven hundred twenty-nine observed HZ cases yielded a 7.7 (95% confidence interval [95% CI] 7.1-8.2) per 1,000 patient-years crude incidence rate, lower than found in prior RA cohorts. However, consistent with prior studies, increasing age (HR 1.14, 95% CI 1.09-1.19 per 5 years) and prednisone therapy ≥7.5 mg/day (HR 1.81, 95% CI 1.23-2.67) were associated with a higher HZ risk. Referent to TNFi exposure, PS-stratified analysis showed an HR for csDMARDs of 1.36 (95% CI 0.82-2.25) and for non-TNFi of 0.83 (95% CI 0.51-1.38).Conclusion: In the Corrona registry, the HZ risk in RA patients taking prior or current MTX increased with older age and higher prednisone dose. The HZ risk among these patients with RA was comparable after initiation of TNFi versus non-TNFi versus csDMARDs. [ABSTRACT FROM AUTHOR]

Many challenges currently facing agriculture require long-term data on landscape-scale hydrologie responses to weather, such as from the Goodwater Creek Experimental Watershed (GCEW), located in northeastern Missouri, USA. This watershed is prone to surface runoff despite shallow slopes, as a result of a significant smectitic clay layer 30 to 50 cm deep that restricts downward flow of water and gives rise to a periodic perched water table. This paper is the first in a series that documents the database developed from GCEW. The objectives of this paper are to (i) establish the context of long-term data and the federal infrastructure that provides it, (ii) describe the GCEW/Central Mississippi River Basin (CMRB) establishment and the geophysical and anthropogenic context, (iii) summarize in brief the collected research results published using data from within GCEW, (iv) describe the series of papers this work introduces, and (v) identify knowledge gaps and research needs. The rationale for the collection derives from converging trends in data from long-term research, integration of multiple disciplines, and increasing public awareness of increasingly larger problems. The outcome of those trends includes being selected as the CMRB site in the USDA-ARS Long-Term Agro-Ecosystem Research (LTAR) network. Research needs include quantifying watershed scale fluxes of N, P, K, sediment, and energy, accounting for fluxes involving forest, livestock, and anthropogenic sources, scaling from near-term point-scale results to increasingly long and broad scales, and considering whole-system interactions. This special section informs the scientific community about this database and provides support for its future use in research to solve natural resource problems important to US agricultural, environmental, and science policy. [ABSTRACT FROM AUTHOR]

Objective To compare the incidence rates of malignancy among patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA) in the Consortium of Rheumatology Researchers of North America (CORRONA) registry. Methods We analyzed 2,970 patients with PsA (7,133 patient-years of followup) and 19,260 patients with RA (53,864 patient-years of followup). Using a standardized adjudication process, we identified 40 confirmed malignancies in the patients with PsA and 307 confirmed malignancies in those with RA. Incidence rates were calculated per 100 patient-years. Incidence rate ratios were estimated, with adjustment for age, sex, disease duration, body mass index, disease activity, year of enrollment, and medication use. Results The overall malignancy incidence per 100 patient-years was similar between patients with PsA and patients with RA (0.56 [95% confidence interval (95% CI) 0.40−0.76] and 0.56 [95% CI 0.50−0.63], respectively). Nonmelanoma skin cancer was the most common type of cancer in the overall cohort, with an incidence rate of 0.21 (95% CI 0.12−0.35) in PsA, and 0.20 (95% CI 0.17−0.24) in RA, with a calculated incidence rate ratio of 1.05 (95% CI 0.61−1.80; P = 0.85). Lymphoma rates were similar in PsA and RA (0.04 [95% CI 0.01−0.12] and 0.04 [95% CI 0.02−0.06], respectively; incidence rate ratio 1.00 [95% CI 0.17−3.11]; P = 0.67). The adjusted incidence rate ratio of malignancy in PsA versus RA was 1.17 (95% CI 0.82−1.69; P = 0.37). Conclusion The incidence rates across malignancy subtypes were similar in the PsA and RA cohorts from a US registry. [ABSTRACT FROM AUTHOR]

This Viewpoint details lessons learned from a county-private-university collaboration in San Diego to stand up a coronavirus vaccine superstation to immunize 4500-5000 people daily, detailing optimization of patient throughput and ways to monitor adverse events and document vaccine administration at scale. [ABSTRACT FROM AUTHOR]

This article describes the complex nature of the medical device development (MDD) process and presents a product design process model to aid designers engaged in MDD. Basically, the model serves as a conceptual framework and provides a set of formalisms to define the development landscape for medical devices. Specifically, the model describes the phases of MDD and their relationships, including the testing and approval environment that impacts this process. The Food and Drug Administration (FDA) is an essential part of this environment, acting as the regulatory agency for medical devices in the USA. FDA approval is a significant milestone which industry developers must achieve before the actual release of their devices in the US market. In this article, the relevant literature addressing the regulations and the MDD process models are reviewed. The development and organisation of the model are discussed in detail with descriptions of the building process, concepts, granularity, utility and overall contribution. The model is the result of a documentation analysis and is supported by a content validation survey and a case study. The model is proposed as an aid for designers to proactively use in handling the complexities of MDD. [ABSTRACT FROM AUTHOR]

Abstract: Emergency Department (ED) crowding is a major problem in the U.S. like in many other countries world-wide. This problem is adversely affecting the safety of the patients who rely on receiving a timely treatment in EDs. As a part of solving this problem, a triage process is utilized. Triage is a pre-hospital process by which patients are sorted according to the severity of their illnesses or injuries. Improvements to this process would affect the patient flow positively, and in turn would enhance patient satisfaction and quality of care. In a previous study, we developed a triage algorithm that uses Fuzzy Analytic Hierarchy Process (FAHP) and Multi-Attribute Utility Theory (MAUT) to rank the patients according to their characteristics: chief complaint, age, gender, pain level, and vital signs. The main purpose of this study is to compare two triage systems using Discrete Event Simulation (DES); one system uses the typical Emergency Severity Index (ESI), and the other uses the FAHP and MAUT algorithm. Overall, there was no strong statistical evidence that either system would do better than the other for all the performance measures when the average is taken across all ESI levels. On the other hand, the collected simulated data by each ESI level showed that the FAHP–MAUT algorithm tends to balance the time-to-bed (TTB) and length of stay (LOS) for ESI levels 2–5. In terms of the percentage of tardy patients, FAHP–MAUT system significantly outperforms the ESI system for ESI levels 4 and 5; 34% vs. 61% and 25% vs. 70%, respectively. Both systems were performing about equally for ESI level 1 and level 3 patients; 25% vs. 26% and 64% vs. 67%, respectively. While ESI system slightly outperforms FAHP–MAUT system for ESI level 2 patients, 56% vs. 66%. Based on these results, we recommend using FAHP–MAUT not only because it performs better in terms of minimizing the number of patients with longer than the allotted upper limits of wait times, but also it reduces potential bias and errors in decision making in clinical settings; and thus, it can be used as the basis of an expert system to advise triage nurses. [Copyright &y& Elsevier]

Many hospital emergency departments (EDs) in the United States have implemented the use of the five-level Emergency Severity Index (ESI) as their clinical decision support method to enhance clinical decision making in the triage process. The ESI designates the most acutely ill patients as level 1 or 2 and those who do not meet these criteria are assigned to levels 3–5 based on estimated resource utilization. Although the number of resources is the primary decision rule to determine levels 3–5, physiological and descriptive variables can also be used to predict the ESI level. This study uses several physiological and descriptive variables as predictors to determine the ESI value. The physiological variables include heart rate, blood pressure, temperature, respiration rate, and oxygen level, whereas the descriptive variables include age, gender, pain level, and patient complaint. An ordered probit model was developed for ESI prediction. In addition, a linear regression model was also developed to demonstrate the necessity of having a decision making tool that allows for non-integer values. The results of this research can be used to enhance the precision of the ESI and the nurse's ability to prioritize treatment based on triage acuity. The decision making tool can also be used to stratify patients who are classified in the same priority group and may eliminate the necessity of grouping patients into different categories. [ABSTRACT FROM PUBLISHER]

Objective To examine prescribing practices in the use of biologic and nonbiologic disease-modifying antirheumatic drugs (DMARDs) to treat patients with rheumatoid arthritis (RA), before and after publication of the American College of Rheumatology (ACR) treatment recommendations. Methods Biologics-naive RA patients under the care of a rheumatologist in the US were identified from the Consortium of Rheumatology Researchers of North America registry. Patients were included if their visits occurred prior to and/or at least 6 months after publication of the ACR treatment recommendations (time periods of February 2002-June 2008 versus December 2008-December 2009). The population was divided into 2 mutually exclusive cohorts: 1) methotrexate (MTX) monotherapy users, and 2) multiple nonbiologic DMARD users. Initiation or dose escalation of biologic and nonbiologic DMARDs in response to active disease was assessed cross-sectionally and longitudinally in comparison to the ACR recommendations. The impact of the publication of the ACR recommendations on treatment practices was assessed using logistic regression, stratified by disease activity and adjusted for clustering of physicians and geographic region. Results After 1 visit, 24-37% of patients receiving MTX monotherapy who had moderate disease activity and a poor prognosis or high disease activity received care consistent with the ACR recommendations; after 2 visits, 34-56% of the MTX monotherapy group received care consistent with the recommendations. In the patients receiving multiple nonbiologic DMARDs, 31-47% of those with moderate or high disease activity received care consistent with the recommendations after 1 visit, and 43-51% received such care after 2 visits. Publication of the recommendations did not significantly change treatment patterns for those with active disease. Conclusion Substantial numbers of RA patients with active disease did not receive care consistent with the current ACR treatment recommendations. Innovative approaches to improve care are necessary. [ABSTRACT FROM AUTHOR]

The article discusses Jefferson City, Missouri as a seat of hostilities during the American Civil War. The decision of slave-owning Missouri Governor Claiborne Fox Jackson to join the Southern secessionist states and the Battle of Boonville are presented. Jefferson City's occupation by Union troops, including those under General Ulysses S. Grant, is presented. Divided allegiances between supporters of the Confederate states and supporters of the Union in Jefferson City and the suspicions that arose between them are also provided.

Intercropping alleys in agroforestry provides an income source until the tree crop produces harvestable yields. However, cultivation of annual crops decreases soil organic matter and increases soil erosion potential, especially on sloping landscapes. Perennial crops maintain a continuous soil cover, increase water infiltration, reduce soil erosion, and improve overall soil quality. The objective of this on-farm study was to assess the effects of a perennial legume, kura clover ( Trifolium ambiguum M. Bieb.), on soil quality in a recently established pecan ( Carya illinoinensis Wangenh. C. Koch) orchard. The pecan-kura clover agroforestry practice was established on deep loess soils of the Missouri River hills landscape. These silt loams are on 2-20% slopes and can be highly erosive. Kura clover, introduced as the alley crop 5 years after pecan planting, was selected based on its perennial growth habit, nitrogen-fixing ability, winter hardiness, high forage quality, and soil conservation properties. Kura clover was seeded in 2001 and harvested for hay annually beginning 2003. Soil quality indicators of total organic C, total N, water-stable aggregates, and selected soil enzymes were determined on surface soil samples collected annually after kura clover establishment. Soil organic C and activities of soil enzymes increased compared with cultivated and grass pasture control soils by the eighth year of establishment. Water-stable aggregation improved by 50% and surface soil shear strength improved significantly ( P < 0.05) in alleys compared with control sites. Results illustrate that kura clover as the alley-cropped component improved soil fertility and biological activity through increased organic matter and improved soil structure, and yielded high quality forage valuable for the cattle-feeding operation. Kura clover maintained or improved soil quality, reduced soil erosion potential, and benefited pecan growth by providing a source of soil nitrogen and improving soil structure for adequate water infiltration and aeration. [ABSTRACT FROM AUTHOR]

Serologic studies for swine influenza viruses (SIVs) in humans with occupational exposure to swine have been reported from the Americas but not from Europe. We compared levels of neutralizing antibodies against 3 influenza viruses--pandemic (H1N1) 2009, an avian-like enzootic subtype H1N1 SIV, and a 2007-08 seasonal subtype H1N1--in 211 persons with swine contact and 224 matched controls in Luxembourg. Persons whose profession involved contact with swine had more neutralizing antibodies against SIV and pandemic (H1N1) 2009 virus than did the controls. Controls also had antibodies against these viruses although exposure to them was unlikely. Antibodies against SIV and pandemic (H1N1) 2009 virus correlated with each other but not with seasonal subtype H1N1 virus. Sequential exposure to variants of seasonal influenza (H1N1) viruses may have increased chances for serologic cross-reactivity with antigenically distinct viruses. Further studies are needed to determine the extent to which serologic responses correlate with infection. [ABSTRACT FROM AUTHOR]

The housing crisis has changed many U.S. neighborhoods, including decreasing the number of homeowners. For neighborhoods whose place identity is home ownership, this presents a challenge. This examination explores perceptions of neighborhood and neighborhood identity in a "zone of workingmen's homes" (Burgess 1925) where home ownership is a primary symbol of both individual and neighborhood identity. It is further suggested that in places where identity includes home ownership, the current home owners will resist demographic challenges to that symbol by pointing to the increasing number of rental properties and residents of those properties as the source of social disorganization. [ABSTRACT FROM AUTHOR]

A computational scheme has been developed and tested to simulate property exchange by advection and dispersion in estuaries at time and space scales that are well suited to ecological and management simulations, but are coarse relative to the demands of physical hydrodynamic models. An implementation of the Regional Ocean Model System (ROMS) for the Providence River and Narragansett Bay (RI, USA) was used to determine property exchanges between the spatial elements of an ecological box model. The basis for the method is the statistical tabulation of numerical dye experiments done with the full ROMS physical model. The ROMS model domain was subdivided into fifteen coarse boxes, each with two vertical layers, defining 30 elements that were used for the box model simulations. Dye concentrations were set to arbitrary initial concentrations for all ROMS grids in the large elements, and the ROMS model was run for 24h. The final distribution of the dye among the elements was used as a tracer for property exchange over that day and was used to develop an exchange matrix. Box model predictions of salinity over 77 days in each element compared favorably with ROMS simulated salinity averaged over the same spatial elements, although the disparity was greater in areas where large river inflows caused strong gradients in ROMS within elements assumed to be homogeneous in the box model. The 77-day simulation included periods of high and low river flow. Despite the large size of the spatial elements, dispersion artifacts were small, much less than the modeled daily exchanges. While others have taken a similar approach, we found a number of theoretical and practical considerations deserved careful attention for this approach to perform satisfactorily. Whereas the full ROMS model takes 9 days on a powerful computing cluster to compute the physics simulation for 77 days, the box model simulates physics and biology for the same interval in 5s on a personal computer, and a full year in under 1min. The exchange matrix mixing model is a fast, cost effective, and convenient way to simulate daily variation of complex estuarine physics in ecological modeling at appropriate scales of space and time. [Copyright &y& Elsevier]

In the United States, working middle class parents organize for their children's future success and, increasingly, extra-curricular activity becomes the socializing mechanism for this preparation. In this article, we take an anthropological approach to examine the following: 1) the nature and amount of extra-curricular activity families organize for their children; 2) the meanings parents' attribute to their children's well-being and future educational and personal success. At the same time, the augmented commitment to arranging children's lives has resulted in a new family form defined by intensified busyness as families negotiate the demands of work, home, and children's development. [ABSTRACT FROM AUTHOR]

In this article, we examine U.S. and Italian parents' discourses on family time in parent-filled weekly activity charts and interviews with parents. Analysis indicates that in Los Angeles, California, parents talk about sheltering and isolating their nuclear family from the outside world and from everyday routine by creating special times and special activities for the nuclear family. In contrast, Roman parents' discourse allows for spontaneous times with the family that are diffused within routines and merged with other community members, institutions, and social spaces. We argue that differences displayed in parents' discourses are shaped by culturally specific orientations toward time, family, and individual versus shared responsibility. Through this cross-cultural comparison we contribute to the understanding of how local cultural models shape different ways in which parents interpret time spent in family and influence individuals' perceptions of their everyday lives. [family, time, responsibility, United States, Italy]. [ABSTRACT FROM AUTHOR]

Background and aims: An algorithm based on a 2 log10 decline in hepatitis C virus (HCV) RNA at week (W) 12 has been proposed in US and European recommendations for the management of patients with chronic hepatitis C treated with pegylated-interferon and ribavirin. Methods: We examined rapid virological response (RVR; at W2 and W4 after the initiation of therapy) in HIV/HCV co-infected patients. Using HCV RNA measurements (Versant HCV RNA 3.0, Cobas Amplicor HCV 2.0), RVR was studied in 323 patients from the ANRS HCO2 RIBAVIC trial, comparing interferon α2b 3 MU x3/week with pegylated interferon α2b 1.5 μg/kg/week, each combined with ribavirin 800 mg/day over 48 weeks. Results: The best positive and negative predictive values of sustained virological response (SVR) were obtained with an undetectable HCV RNA at W4 (97%) and with more than a 2 log10 decrease at W12 (99%), respectively. Prediction of non-SVR was obtained in all patients by using HCV RNA cut-off levels above 460 000 lU/ml at W4 and above 39 000 UI/mI at W 12 irrespective of the HCV genotype and arm of treatment. Conclusion: We propose a new algorithm based on RVR thresholds using HCV RNA that allows for excellent prediction of non-SVR as early as W4. [ABSTRACT FROM AUTHOR]

Mixing across racial and ethnic lines could spur understanding or inflame tensions between groups. We find that white students at a large state university randomly assigned African American roommates in their first year were more likely to endorse affirmative action and view a diverse student body as essential for a high quality education. They were also more likely to say they have more personal contact with, and interact more comfortably with, members of minority groups. Although sample sizes are too small to provided definitive evidence, the results suggest students become more empathetic with the social groups to which their roommates belong. (JEL I28, J15,, J18, Z13). [ABSTRACT FROM AUTHOR]

Daily and annual integrated rates of primary productivity and community respiration were calculated using physiological parameters measured in oxygen-based photosynthesis-irradiance (P-I) incubations at 8 stations throughout central and western Long Island Sound (cwLIS) during the summer and autumn of 2002 and 2003 and the late spring of 2003. Each calculation takes into account actual variations in incident irradiance over the day and underwater irradiance and standing stock with depth. Annual peak rates, ±95% confidence interval of propagated uncertainty in each measurement, of gross primary production (GPP, 1,730 ± 610 mmol O2 m-2 d-1), community respiration (Rc, 1,660 ± 270 mmol O2 m-2 d-1), and net community production (NCP, 1,160 ± 1,100 mmol O2 m-2 d-1) occurred during summer at the western end of the Sound. Lowest rates of GPP (4 ± 11 mmol O2 m-2 d-1), Rc (-50 ± 300 mmol O2 m-1 d-1), and NCP (-1,250 ± 270 mmol O2 m-2 d-1) occurred during late autumn-early winter at the outer sampled stations. These large ranges in rates of GPP, Rc, and NCP throughout the photic zone of cwLIS are attributed to seasonal and spatial variability. Algal respiration (Ra) was estimated to consume an average of 5% to 52% of GPP, using a literature-based ratio of Ra : Rc. From this range, we established that the estimated Ra accounts for approximately half of GPP, and was used to estimate daily net primary production (NPP), which ranged from 2 to 870 mmol O2 m-2 d-1 throughout cwLIS during the study. Annual NPP averaged 40 ± 8 mol O2 m-2 yr-1 for all sampled stations, which more than doubled along the main axis of the Sound, from 32 ± 14 mol O2 m-2 yr-1 at an eastern station to 82 ± 25 mol O2 m-2 yr-1 at the western-most station. These spatial gradients in productivity parallel nitrogen loads along the main axis of the Sound. Daily integrals of productivity were used to test and formulate a simple, robust biomass-light model for the prediction of phytoplankton production in Long Island Sound, and the slope of the relationship was consistent with reports for other systems. [ABSTRACT FROM AUTHOR]

In January 2006, students from CUSSW and Union Theological Seminary participated in an immersion course entitled, Katrina: Poverty, Race, and Social Work Practice. The aim of the course was to explore experientially the inequality exposed by Hurricane Katrina and its effect on some of the poorest communities and individuals in the United States. This paper presents an overview of the course development. In addition, the authors describe some of their experiences and observations before, during, and after their travels to the Gulf Coast and other communities affected by Hurricane Katrina. The specific focus of the article is on the themes of poverty, racism, violence, governmental irresponsibility and disregard in the wake of this tragedy, and describes some of the efforts made towards supporting social justice in the Gulf Coast as it rebuilds. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the community need for mental health and health promotion services provided by advanced practice nursing faculty at a small university in the midwestern United States. Fifty participants from a three-county service area were selected to complete a needs assessment survey. Survey results indicated a strong community need for primary mental health services for low-income residents, older adults, pregnant women, and families with children. Mental health services (particularly for depression), health promotion, wellness information, and primary mental health care were among the leading areas of need. In addition, low-cost mental health services were identified as the most significant need, which was magnified in the underserved, Hispanic population. [ABSTRACT FROM AUTHOR]

Abstract In both the United States and Europe about 10,000 patients suffer from spinal cord injury (SCI) each year and 20% die before being admitted to hospital. Prehospital management of SCI is very important since 25% of SCI damage may occur after the initial event. Emergency treatment includes examination of the patient, spinal immobilization, careful airway management, cardiovascular stabilization (maintenance of mean arterial blood pressure above 90mmHg) and glucose levels within the normal range. From an evidence-based point of view, it is still not known whether additional specific therapy is useful and studies have not convincingly demonstrated that methylprednisolone (MPS) or other substances have clinically important benefits. Recently published statements from the US do not support the therapeutic use of MPS in patients suffering from SCI in the prehospital setting. Moreover, it is not known whether hypothermia or any other pharmacological interventions have beneficial effects. Networks for clinical studies in SCI patients should be established as a basic requirement for further improvement in outcome in these patients. [ABSTRACT FROM AUTHOR]