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Simple Summary: Corn and cotton that produce insecticidal toxins derived from Bacillus thuringiensis (Bt) are widely adopted in the United States to control corn earworm/cotton bollworm, Helicoverpa zea (Boddie), which has resulted in major benefits to growers and the general public. However, resistance evolution in H. zea populations has become a major threat to the sustainability of these crops. Bt sweet corn producing the same toxins as Bt field corn is more attractive to H. zea than field corn and, thus, can function as a sentinel plant to detect early stages of resistance. As part of an existing sentinel monitoring network, this study evaluated changes in H. zea resistance during 2020–2022 by estimating the phenotypic and resistance allele frequencies for toxins in sentinel Bt corn. Transgenic corn and cotton that produce Cry and Vip3Aa toxins derived from Bacillus thuringiensis (Bt) are widely planted in the United States to control lepidopteran pests. The sustainability of these Bt crops is threatened because the corn earworm/bollworm, Helicoverpa zea (Boddie), is evolving a resistance to these toxins. Using Bt sweet corn as a sentinel plant to monitor the evolution of resistance, collaborators established 146 trials in twenty-five states and five Canadian provinces during 2020–2022. The study evaluated overall changes in the phenotypic frequency of resistance (the ratio of larval densities in Bt ears relative to densities in non-Bt ears) in H. zea populations and the range of resistance allele frequencies for Cry1Ab and Vip3Aa. The results revealed a widespread resistance to Cry1Ab, Cry2Ab2, and Cry1A.105 Cry toxins, with higher numbers of larvae surviving in Bt ears than in non-Bt ears at many trial locations. Depending on assumptions about the inheritance of resistance, allele frequencies for Cry1Ab ranged from 0.465 (dominant resistance) to 0.995 (recessive resistance). Although Vip3Aa provided high control efficacy against H. zea, the results show a notable increase in ear damage and a number of surviving older larvae, particularly at southern locations. Assuming recessive resistance, the estimated resistance allele frequencies for Vip3Aa ranged from 0.115 in the Gulf states to 0.032 at more northern locations. These findings indicate that better resistance management practices are urgently needed to sustain efficacy the of corn and cotton that produce Vip3Aa. [ABSTRACT FROM AUTHOR]

The United States National Science and Technology Council has made a call for improving STEM (Science, Technology, Engineering, and Mathematics) education at the convergence of science, technology, engineering, and mathematics. The National Science Foundation (NSF) views convergence as the merging of ideas, approaches, and technologies from widely diverse fields of knowledge to stimulate innovation and discovery. Teaching convergency requires moving to the transdisciplinary level of integration where there is deep integration of skills, disciplines, and knowledge to solve a challenging real-world problem. Here we present a summary on convergence and transdisciplinary teaching.We then provide examples of convergence and transdisciplinary teaching in plant biology, and conclude by discussing limitations to contemporary conceptions of convergency and transdisciplinary STEM. [ABSTRACT FROM AUTHOR]

Most disputes about the Establishment Clause center on its substantive meaning; whether, for example, a state subsidy promotes religion, the phrase "In God We Trust" can appear on currency, or a display of the Ten Commandments is unconstitutional. Often overlooked and lurking behind these substantive disputes is a question about what remedies are available when an Establishment Clause violation is found. Typically, an injunction prohibiting the subsidy, practice, or display is the choice. In Salazar v. Buono, however, the Supreme Court was confronted with an unusual case for two reasons. First, the doctrine of res judicata formally barred the Court from reaching the substantive finding that a Latin cross on federal property violated the Establishment Clause. Second, because the district court had declared invalid a federal statute transfering the land to a private party, and--unable to address the substantive ruling--the Court was forced to address the law of remedies in an atypical posture. Reversing the lower courts, in Buono a plurality of the Court held that the district court erred when it invalidated the land transfer. This Essay critically analyzes Buono and argues that the plurality failed to appreciate the remedial significance of the challenge to the land transfer. The plurality, it seems, attempted to re-litigate the substantive Establishment Clause violation despite the res judicata bar. In so doing, I argue, the Court put form over substance and ignored the essential command of the Establishment Clause--government neutrality. To make my case, I draw on political theory to clarify the concept of neutrality, and propose a novel way of thinking about Establishment Clause remedies by drawing on decisions considering the extent of Congress's Section 5 Enforcement Power under the Fourteenth Amendment. I conclude by trying to blur the sharp distinction the plurality draws between public and private space. Buono is a significant case, but not because it contributes to or clarifies the law regarding the Establishment Clause. Instead, Buono is significant because it demonstrates how important remedial flexibility is to ensuring rights, while at the same time exemplifying the perils of remedial formalism. "The legal result must be the same, for what cannot be done directly cannot be done indirectly. The Constitution deals with substance, not shadows. Its inhibition was leveled at the thing, not the name. It intended that the rights of the citizen should be secure against deprivation for past conduct by legislative enactment, under any form, however disguised. If the inhibition can be evaded by the form of the enactment, its insertion in the fundamental law was a vain and futile proceeding." --Cummings v. Missouri. [ABSTRACT FROM AUTHOR]

The author comments on the decision of the U.S. Supreme Court in Herring versus United States and Pearson versus Callahan, cases that are said to deal solely with the remedies in the Fourth Amendment of the Constitution. He cites the refusal of the Court to apply the exclusionary rule to evidence obtained in an arrest made where the officer erroneously believed that a valid warrant justified the arrest in Herring. The Court is said to unanimously invoke qualified immunity to bar a suit linked to section 1983 of the U.S. Code in Pearson.

Total mercury concentrations were measured in diamondback terrapin blood and scutes collected from four sites in South Carolina, USA, and at a superfund site in Brunswick, Georgia, USA. There was a strong correlation between mercury concentrations in the two terrapin body compartments (Kendall's tau = 0.79, p < 0.001). Mercury concentrations in terrapin scute and blood and in salt marsh periwinkles, Littoraria irrorata, were significantly higher in Brunswick (scute x = 3810.2 ng/g, blood x = 746.2 ng/g) than from all other sites (scute x = 309.5 ng/g, blood x = 43.2 ng/g, p < 0.001). Seasonal fluctuations of total mercury in the blood and scutes of terrapins collected in the Ashley River, South Carolina, were significantly lower in August than in April, June, or October in blood (p < 0.001); however, scute concentrations did not vary seasonally. Overall, we found higher concentrations of mercury in the scutes of females than males (n < 32, p < 0.05). Larger females may preferentially prey on larger food items, like large periwinkles, which had significantly higher mercury levels in their body tissues than smaller periwinkles (p < 0.001). Methylmercury levels in terrapin scutes were measured, revealing that 90% of the total mercury stored in this compartment was in the organic form. A methylmercury biomagnification factor of 173.5 was calculated from snails to terrapin scutes, and we found that mercury levels in scutes were representative of the mercury levels in other compartments of the ecosystem. These findings show that terrapin scutes are good predictors of mercury pollution and that this species could be used as a bioindicator for assessing mercury contamination of estuarine systems. [ABSTRACT FROM AUTHOR]

Discusses the delegation of authority made by the local governments of North Carolina and how the courts interpreted these delegations. Judicial construction of the scope of local authority; Implications of substantial delegation to growth management programs; Future directions.

The article discusses a study which examines the adoption and diffusion of technological innovations in an organization in the U.S. and how its members contribute in the selection process. Findings reveal that most firms preferred safe innovations over risky schemes and they often incorporate private and public information on their decisions. It also indicates that their decisions significantly improve through critical analysis and randomization.

The Kemp's ridley, Lepidochelys kempii, is the most endangered sea turtle in the world. Anthropogenic mortality of Kemp's ridleys has been well documented in the Gulf of Mexico (GOM), USA. We evaluated the reproductive maturity of 75 Kemp's ridley sea turtles found dead on GOM beaches on Mustang Island and North Padre Island, Texas, USA, 1994–1999. Straight carapace length (SCL) ranged from 40.8 to 68.7 cm. Preserved gonads and associated tissues were examined and measured. Gonadal measurements were then compared with SCL. Adults and juveniles shared a larger range of carapace measurements than expected, supporting the idea that juveniles spend several years in a pubertal state. Our results suggest caution when using SCL, tail length, or curved front claws alone as indicators of sexual maturity. In fact, SCL can be used to discern adults from juveniles with more predictive power when coupled with testis length or oviduct length measurements, thus allowing endangered species managers to more clearly identify demographic shifts in the number of mature animals, which can precede population changes. This study shows that information gained from the examination of stranded sea turtles allows wildlife managers to make more informed decisions regarding conservation priorities. [ABSTRACT FROM AUTHOR]

The state of North Carolina, amid much discussion and controversy, established a regional resource management program for the protection of its coastal resources in 1974. Through the successful resolution of several critical issues, including creating a local land use planning process and managing oceanfront development, the program has built its credibility, its popular and political support, and its ability to address remaining critical management needs. [ABSTRACT FROM AUTHOR]

Sea turtles are among several hundred species whose sex is determined by incubation conditions during critical developmental periods. Consequently, these marine reptiles may be vulnerable to global climate change, and under the assumption of continued climate warming, numerous studies pose dire predictions for future populations based primarily on hatchling sex ratio data. Alternatively, as long-lived species that take decades to reach maturity, without inherent coping mechanisms for such change, sea turtles could not have persisted across geological epochs. Globally, loggerhead Caretta caretta [Linnaeus, 1758] sea turtles occupy temperate zones, with ontogenetic development that spans the entirety of gyres associated with respective ocean basins. The largest rookery for this species occurs in the Northwest Atlantic Ocean (NWA) population, where a 30-year cycle in annual nest counts is reported through 2018. Complementary studies document a lagged association between these annual nest counts and the Atlantic Multidecadal Oscillation (AMO); however, the underlying mechanism for this association remains elusive. Therefore, objective 1 evaluated the effect of AMO-mediated cohort resonance on the demographic structure of a theoretical neritic assemblage under variable cohort abundance and female proportion but stable annual survival during 165-year runs (i.e., extent of AMO data). For objective 2, blood samples were used to assign sex to 2217 loggerhead sea turtles captured by research trawling (2000 to 2019) on the inner continental shelf from St. Augustine, FL (29.9°N) to Winyah Bay, SC (33.1°N). Shorter oceanic duration of less female-biased cohorts from the AMO cold phase synchronized peak adult male and adult female co-occurrence during subsequent warm phases three decades later. Grand sex ratio predicted from testosterone was 67% female (n = 1484), with a slight temporal female decline. Our findings suggest greater population sex ratio plasticity than predicted solely from terrestrial nesting data., (© 2021 The Authors. Global Change Biology published by John Wiley & Sons Ltd.)

Objectives: Current estimates of aortic stenosis (AS) frequency have mostly relied on cross-sectional echocardiographic or longitudinal administrative data, making understanding of AS burden incomplete. We performed case adjudications to evaluate the frequency of AS and assess differences by age, sex and race in an older cohort with long-term follow-up., Methods: We developed case-capture methods using study echocardiograms, procedure and diagnosis codes, heart failure events and deaths for targeted review of medical records in the Cardiovascular Health Study to identify moderate or severe AS and related procedures or hospitalisations. The primary outcome was clinically significant AS (severe AS or procedure). Assessment of incident AS burden was based on subdistribution survival methods, while associations with age, sex and race relied on cause-specific survival methods., Results: The cohort comprised 5795 participants (age 73±6, 42.2% male, 14.3% Black). Cumulative frequency of clinically significant AS at maximal 25-year follow-up was 3.69% (probable/definite) to 4.67% (possible/probable/definite), while the corresponding 20-year cumulative incidence was 2.88% to 3.71%. Of incident cases, about 85% had a hospitalisation for severe AS, but roughly half did not undergo valve intervention. The adjusted incidence of clinically significant AS was higher in men (HR 1.62 [95% CI 1.21 to 2.17]) and increased with age (HR 1.08 [95% CI 1.04 to 1.11]), but was lower in Blacks (HR 0.43 [95% CI 0.23 to 0.81])., Conclusions: In this community-based study, we identified a higher burden of clinically significant AS than reported previously, with differences by age, sex and race. These findings have important implications for public health resource planning, although the lower burden in Blacks merits further study., Competing Interests: Competing interests: JRK discloses stock ownership in Abbott, Bristol-Myers Squibb, Johnson & Johnson, Medtronic, Merck and Pfizer., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Preparticipation screening for conditions associated with sudden cardiac death (SCD) is required in college athletes. Previous cost analyses used theoretical models based on variable assumptions, but no study used real-life outcomes., Objective: The purpose of this study was to compare disease prevalence, positive findings, and costs of 2 different screening strategies: history and physical examination alone (H&P) or with an electrocardiogram (H&P+ECG)., Methods: De-identified preparticipation data (2009-2017) from Pacific-12 Conference institutions were abstracted for cardiovascular history questions, cardiovascular physical examination, and ECG result. Secondary testing, cardiac diagnoses, return to play outcomes, and complications from testing were recorded. The costs of screening and secondary testing were based on the Centers for Medicare & Medicaid Services Physician Fee Schedule., Results: A total of 8602 records (4955 H&P, 3647 H&P+ECG) were included. Eleven conditions associated with SCD were detected (2 H&P only, 9 H&P+ECG). The prevalence of cardiovascular conditions associated with SCD discovered with H&P alone was 0.04% (1/2454) compared to 0.24% (1/410) when ECG was added (P = .01) (odds ratio 5.17; 95% confidence interval 1.28-20.85; P = .02). Cost of screening and secondary testing with H&P alone was $130 per athlete and in the ECG-added group was $152 per athlete. The cost per diagnosis was $312,407 in the H&P group and $61,712 in the ECG-added group. There were no adverse outcomes from secondary testing or treatment., Conclusion: H&P with the addition of ECG is 6 times more likely to detect a cardiovascular condition associated with SCD than without. The addition of ECG improves the cost efficiency per diagnosis by 5-fold and should be considered at college institutions with appropriate resources., (Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background Preparticipation cardiovascular screening in athletes is fully endorsed by major medical societies, yet the most effective screening protocol remains debated. We prospectively compared the performance of the American Heart Association ( AHA ) 14-point screening evaluation and a resting ECG for cardiovascular screening of high school athletes. Methods and Results Competitive athletes participating in organized high school or premier/select level sports underwent cardiovascular screening using the AHA 14-point history and physical examination, and an ECG interpreted with the Seattle Criteria. A limited echocardiogram was performed for all screening abnormalities. The primary outcome measure was identification of a cardiovascular disorder associated with sudden cardiac death. From October 2014 to June 2017, 3620 high school athletes (median age, 16 years; range 13-19; 46.2% female; 78.6% white, 8.0% black) were screened. One or more positive responses to the AHA 14-point questionnaire were present in 814 (22.5%) athletes. The most common history responses included chest pain (8.1%), family history of inheritable conditions (7.3%), and shortness of breath (6.4%). Abnormal physical examination was present in 356 (9.8%) athletes, and 103 (2.8%) athletes had an abnormal ECG . Sixteen (0.4%) athletes had conditions associated with sudden cardiac death. The sensitivity (18.8%), specificity (68.0%), and positive predictive value (0.3%) of the AHA 14-point evaluation was substantially lower than the sensitivity (87.5%), specificity (97.5%), and positive predictive value (13.6%) of ECG . Conclusions The AHA 14-point evaluation performs poorly compared with ECG for cardiovascular screening of high school athletes. The use of consensus-derived history questionnaires as the primary tool for cardiovascular screening in athletes should be reevaluated.

Background Hypertrophic cardiomyopathy is defined as unexplained left ventricular ( LV ) hypertrophy (wall thickness ≥15 mm) and is prevalent in 0.2% of adults (1:500) in population-based studies using echocardiography. Cardiac magnetic resonance imaging ( MRI ) allows for more accurate wall thickness measurement across the entire ventricle than echocardiography. The prevalence of unexplained LV hypertrophy by cardiac MRI is unknown. MESA (Multi-Ethnic Study of Atherosclerosis) recruited individuals without overt cardiovascular disease 45 to 84 years of age. Methods and Results We studied 4972 individuals who underwent measurement of regional LV wall thickness by cardiac MRI as part of the MESA baseline exam. American Heart Association criteria were used to define LV segments. We excluded participants with hypertension, LV dilation (≥95% predicted end-diastolic volume) or dysfunction (ejection fraction ≤50%), moderate-to-severe left-sided valve lesions by cardiac MRI , severe aortic valve calcification by cardiac computed tomography (aortic valve Agatston calcium score >1200 in women or >2000 in men), obesity (body mass index >35 kg/m 2 ), diabetes mellitus, and current smoking. Sixty-seven participants (aged 64±10 years, 9% female) had unexplained LV hypertrophy (wall thickness ≥15 mm in at least 2 adjacent LV segments), representing 1.4% (1 in 74) participants, 2.6% of men and 0.2% of women. Prevalence was similar across categories of race/ethnicity. Hypertrophy was focal in 17 (25.4%), intermediate in 44 (65.7%), and diffuse in 5 (7.5%) participants. Conclusions The prevalence of unexplained LV hypertrophy in a population-based cohort using cardiac MRI was 1.4%. This may have implications for the diagnosis of patients with hypertrophic cardiomyopathy and will require further study.

The most effective protocol for cardiovascular screening of competitive athletes remains highly controversial. This study was a prospective, multicenter trial of cardiovascular screening at 35 National Collegiate Athletic Association institutions. Screening included a standardized history and physical examination (PE) as recommended by the American Heart Association and a 12-lead electrocardiogram (ECG) at rest. Centralized electrocardiographic interpretation was provided using the Seattle criteria. Athletes with screening abnormalities underwent additional evaluation directed by the host institution medical team. Primary outcomes included the proportion of total and false-positive screens; the sensitivity, specificity, and positive predictive value of history, PE, and ECG; and the prevalence of serious cardiovascular disorders associated with severe morbidity or sudden cardiac death. From August 2012 to June 2014, 5,258 athletes from 17 intercollegiate sports were screened: 55% men (mean age 20.1 years), 73% Caucasian, 16% African-American, and 11% other/mixed race. At least 1 positive cardiac symptom or family history response was reported by 1,750 athletes (33.3%). PE was abnormal in 108 athletes (2.1%), and electrocardiographic abnormalities were present in 192 athletes (3.7%). Thirteen athletes (0.25%) were identified with serious cardiac conditions including hypertrophic cardiomyopathy (1), large atrial septal defect with right ventricular dilation (1), and ventricular pre-excitation (11). The false-positive rate for history was 33.3%, PE 2.0%, and ECG 3.4%. The sensitivity/specificity/positive predictive value for history was 15.4%/66.9%/0.1%, PE 7.7%/98.2%/0.9%, and ECG 100%/96.6%/6.8%. In conclusion, electrocardiographic screening in National Collegiate Athletic Association athletes has a low false-positive rate and provides superior accuracy compared with a standardized history and PE to detect athletes with potentially dangerous cardiovascular conditions., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Importance: Plasma low-density lipoprotein cholesterol (LDL-C) has been associated with aortic stenosis in observational studies; however, randomized trials with cholesterol-lowering therapies in individuals with established valve disease have failed to demonstrate reduced disease progression., Objective: To evaluate whether genetic data are consistent with an association between LDL-C, high-density lipoprotein cholesterol (HDL-C), or triglycerides (TG) and aortic valve disease., Design, Setting, and Participants: Using a Mendelian randomization study design, we evaluated whether weighted genetic risk scores (GRSs), a measure of the genetic predisposition to elevations in plasma lipids, constructed using single-nucleotide polymorphisms identified in genome-wide association studies for plasma lipids, were associated with aortic valve disease. We included community-based cohorts participating in the CHARGE consortium (n = 6942), including the Framingham Heart Study (cohort inception to last follow-up: 1971-2013; n = 1295), Multi-Ethnic Study of Atherosclerosis (2000-2012; n = 2527), Age Gene/Environment Study-Reykjavik (2000-2012; n = 3120), and the Malmö Diet and Cancer Study (MDCS, 1991-2010; n = 28,461)., Main Outcomes and Measures: Aortic valve calcium quantified by computed tomography in CHARGE and incident aortic stenosis in the MDCS., Results: The prevalence of aortic valve calcium across the 3 CHARGE cohorts was 32% (n = 2245). In the MDCS, over a median follow-up time of 16.1 years, aortic stenosis developed in 17 per 1000 participants (n = 473) and aortic valve replacement for aortic stenosis occurred in 7 per 1000 (n = 205). Plasma LDL-C, but not HDL-C or TG, was significantly associated with incident aortic stenosis (hazard ratio [HR] per mmol/L, 1.28; 95% CI, 1.04-1.57; P = .02; aortic stenosis incidence: 1.3% and 2.4% in lowest and highest LDL-C quartiles, respectively). The LDL-C GRS, but not HDL-C or TG GRS, was significantly associated with presence of aortic valve calcium in CHARGE (odds ratio [OR] per GRS increment, 1.38; 95% CI, 1.09-1.74; P = .007) and with incident aortic stenosis in MDCS (HR per GRS increment, 2.78; 95% CI, 1.22-6.37; P = .02; aortic stenosis incidence: 1.9% and 2.6% in lowest and highest GRS quartiles, respectively). In sensitivity analyses excluding variants weakly associated with HDL-C or TG, the LDL-C GRS remained associated with aortic valve calcium (P = .03) and aortic stenosis (P = .009). In instrumental variable analysis, LDL-C was associated with an increase in the risk of incident aortic stenosis (HR per mmol/L, 1.51; 95% CI, 1.07-2.14; P = .02)., Conclusions and Relevance: Genetic predisposition to elevated LDL-C was associated with presence of aortic valve calcium and incidence of aortic stenosis, providing evidence supportive of a causal association between LDL-C and aortic valve disease. Whether earlier intervention to reduce LDL-C could prevent aortic valve disease merits further investigation.

Background: The pathogenesis of sudden cardiac death in college athletes has not been defined by systematic case identification., Methods and Results: A total of 45 cases of sudden cardiac death were identified in National Collegiate Athletic Association (NCAA) athletes from 2004 to 2008 based on an internal reporting system and review of media reports. Autopsy reports were reviewed and adjudicated by a multidisciplinary panel. Cause of death could be reasonably determined in 36 cases; 3 athletes had no autopsy, 5 autopsy reports could not be obtained, and 1 autopsy had insufficient information to determine cause of death. The most common finding at death was a structurally normal heart or autopsy-negative sudden unexplained death (11, 31%), followed by coronary artery abnormalities (5, 14%), dilated cardiomyopathy (3, 8%), myocarditis related (3, 8%), aortic dissection (3, 8%), and idiopathic left ventricular hypertrophy/possible hypertrophic cardiomyopathy (HCM; 3, 8%). There was 1 case each (3%) of hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, commotio cordis, and Kawasaki disease. There was 1 case of death in a sickle cell positive athlete who also had left ventricular hypertrophy. The adjudicated diagnosis agreed with the official pathology report in only 59% of cases., Conclusions: Unexplained death with a structurally normal heart is the most common finding after suspected sudden cardiac death in NCAA athletes. Hypertrophic cardiomyopathy is infrequently seen, and conclusions in autopsy reports may not accurately reflect the pathological findings. Standardized protocols for cardiovascular autopsies in athletes are needed, including postmortem genetic testing, particularly in autopsy-negative cases.

Multiple studies have demonstrated an age-related attenuation in risk associations of lipoproteins and lipoprotein ratios with cardiovascular disease events. We recently reported a similar age-related attenuation in risk associations of lipoproteins and lipoprotein ratios with coronary artery calcium. We assessed risk associations of lipoproteins and lipoprotein ratios with carotid intima-media thickness (CIMT), which has not been reported previously. We performed multivariable linear regression using data from the Multi-Ethnic Study of Atherosclerosis (MESA). MESA participants were community-dwelling adults 45 to 84 years of age without clinically apparent cardiovascular disease at baseline, and 4,961 met inclusion criteria for these analyses. In fully adjusted models, differences in CIMT were similar across the MESA age spectrum, with differences in internal CIMT per SD increase in low-density lipoprotein of 0.037 mm (95% confidence interval 0.018 to 0.055) for those 45 to 54 years old and 0.087 mm (95% confidence interval 0.027 to 0.146) for those 75 to 84 years old (p for interaction = 0.2). Similarly, the difference in internal CIMT per SD increase in the total/high-density lipoprotein cholesterol ratio was 0.029 mm (95% confidence interval 0.009 to 0.049) for those 45 to 54 years old and 0.101 mm (95% confidence interval 0.033, 0.169) for those 75 to 84 years old (p for interaction = 0.03). In general, risk associations of lipoproteins and lipoprotein ratios were associated with similar differences in CIMT across all age categories. In conclusion, abnormal lipoproteins and lipoprotein ratios in middle-aged and older patients are powerful risk factors for early atherosclerosis as manifested by an increased CIMT., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Previous epidemiologic studies have shown that low-density lipoprotein is an independent risk factor for prevalent aortic valve calcification (AVC); however, to our knowledge, the interactions between plasma lipoprotein concentrations and age on the relative risks (RRs) for AVC prevalence and severity have not been examined in a large, racially and ethnically diverse cohort., Methods: Using stepwise RR regression, the relationships of baseline fasting lipid levels and lipoprotein levels to baseline prevalence and severity of AVC were determined in 5801 non-statin-using participants in the Multi-Ethnic Study of Atherosclerosis (MESA)., Results: In age-stratified, adjusted analyses, the low-density lipoprotein-associated RRs (95% confidence intervals) for prevalent AVC were higher for younger compared with older participants (age 45-54 years, 1.69 [1.19-2.39]; age 55-64 years, 1.48 [1.24-1.76]; age 65-74 years, 1.09 [0.95-1.25]; and age 75-84 years, 1.16 [0.99-1.36]; P interaction = .04]. There was a similar, significant interaction of age with total cholesterol-associated RR for prevalent AVC (P interaction = .04). In contrast, total- to high-density lipoprotein cholesterol ratio RRs were similar across all age strata (P interaction = .68). At multivariate analyses, no lipoprotein parameter was associated with AVC severity., Conclusions: In this racially and ethnically diverse, preclinical cohort, low-density lipoprotein was a risk factor for AVC only in participants younger than 65 years, whereas the total cholesterol/high-density lipoprotein cholesterol ratio was associated with a modest increased risk of AVC across all ages. These findings may have important implications for the efficacy of and targets for dyslipidemia therapies in calcific aortic valve disease.

On January 24, 2002, the Washington State Department of Health, in collaboration with local and federal agencies, conducted an exercise of the Centers for Disease Control and Prevention's National Pharmaceutical Stockpile dispensing portion of the Washington State plan. This exercise included predrill planning, training, and the orchestration of services of more than 40 dispensary site workers. These workers provided education and post-exposure prophylaxis for over 230 patient volunteers in the aftermath of a simulated exposure to B. anthracis. This article discusses findings of a postdrill questionnaire completed by 90% of these dispensary site workers who provided triage, education, dispensary, security and other services during this exercise. In general, this dispensing drill promoted confidence in the worker participants and provided an opportunity for these participants to coordinate their activities. This mock bioterrorist preparedness exercise allowed worker participants and observers to review and evaluate the Washington State plan for dispensing the National Pharmaceutical Stockpile. This article is apparently the first published account of dispensary site workers' subjective impressions and quantitative analysis of their postdrill opinions following a simulated bioterrorist post-exposure chemoprophylaxis dispensing exercise.

The Centers for Disease Control and Prevention's National Pharmaceutical Stockpile (NPS) program is designed to ensure the availability of life-saving antibiotics, other medical supplies, and equipment and their prompt delivery to the site of a disaster, including a possible bioterrorist incident, anywhere in the United States. On January 24, 2002, the Washington State Department of Health conducted an exercise, simulating a mass exposure to Bacillis anthracis, to test the NPS dispensing portion of the Washington State plan. This drill included the recruitment, education, and postexposure prophylaxis of over 230 volunteer patients. This article describes and discusses findings from an exit survey completed by these patient volunteers.