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The need for subspecialty-trained neurologists is growing in parallel with increasing disease burden. However, despite the immense burden of neurological diseases, like headache and neurodegenerative disorders, recruitment into these subspecialties remains insufficient in the United States. In this manuscript, a group of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review and discuss the current landscape of neurology fellowships in the United States, the factors driving fellowship recruitment and the educational barriers. Moreover, suggestions to potentially improve recruitment for under-selected fellowships, which can contribute towards an alignment between neurological education and neurological needs, and future educational scenarios are discussed. [ABSTRACT FROM AUTHOR]

Background Few studies have examined the trends in clinical and economic outcomes of patients with acute ischemic stroke (AIS) who receive endovascular therapy (ET) in the real-world setting. Objective To evaluate characteristics and trends in clinical and economic outcomes among commercially insured patients with AIS undergoing ET between 2011 and 2017. Methods Patients with AIS undergoing ET from January 1, 2011 to June 30, 2017 were identified from administrative claims contained in the IBM MarketScan Commercial and Medicare Supplemental databases. The Mann--Kendall trend test was performed to examine clinical and economic trends. Between 2011 and 2017, 3411 patients (mean age 62.85±15 years) with a primary diagnosis of AIS underwent ET (coverage: Commercial 59%, n=2008; Medicare Supplemental 41%, n=1403). In the Commercial cohort, discharge to home increased significantly (from 29.54% to 39.18%, p<0.05). Length of stay declined significantly among the overall cohort (from 10.96 to 9.05 days, p<0.01) and the Medicare Supplemental cohort (from 10.03 to 8.43 days, p<0.05). All-cause 365-day readmission decreased significantly among the overall cohort (from 47.5% to 36.7%, p<0.05) and the Commercial cohort (from 51.54% to 36.43%, p<0.05) but remained unchanged in the Medicare Supplemental cohort. While index procedure cost did not change significantly ($93 955 to $87 906, p=0.8806), total cost significantly declined in the overall cohort (from $166 922 to $130 678, p<0.05). Conclusions Although with some variation across the samples studied, outcomes including discharge to home, length of stay, readmission, and total cost associated with endovascular stroke therapy seemed to have improved between 2011 and 2017. Index admission cost remained unchanged. [ABSTRACT FROM AUTHOR]

Since the mid-1980s, fish-killing blooms of Prymnesium parvum spread throughout the USA. In the south central USA, P. parvum blooms have commonly spanned hundreds of kilometers. There is much evidence that physiological stress brought on by inorganic nutrient limitation enhances toxicity. Other factors influence toxin production as well, such as stress experienced at low salinity and temperature. A better understanding of toxin production by P. parvum remains elusive and the identities and functions of chemicals produced are unclear. This limits our understanding of factors that facilitated the spread of P. parvum blooms. In the south central USA, not only is there evidence that the spread of blooms was controlled, in part, by migration limitation. But there are also observations that suggest changed environmental conditions, primarily salinity, facilitated the spread of blooms. Other factors that might have played a role include altered hydrology and nutrient loading. Changes in water hardness, herbicide use, system pH, and the presence of toxin-resistant and/or P. parvum-inhibiting plankton may also have played a role. Management of P. parvum in natural systems has yet to be attempted, but may be guided by successes achieved in small impoundments and mesocosm experiments that employed various chemical and hydraulic control approaches. [ABSTRACT FROM AUTHOR]

This Article explores the feasibility of adding flexibility to mandates for existing power plants in order to foster technology innovation and reduce compliance costs and emissions. Under new and proposed EPA rules a significant portion of the coal-fired electricity generating capacity will require multi-billion dollar investments to retrofit and comply with emissions standards on SO2, NOx, PM, mercury, toxic metals, acid gases, coal combustion residuals, and cooling water intake rules. A number of plant owners may find preferable to replace these plants with new units that run with today's low cost natural gas. Massive retrofit or replacement of the current coal-fired power generation fleet with today's solutions will harm the conditions for research and development of path-breaking fossil-fired power generation technologies. This would not be a serious problem if the current retrofit and replacement technologies were in fact a solution to the many environmental externalities posed by the coal-fired power plants that are now candidates for expensive retrofitting or retirement. But the technologies available today are far from being a solution commensurate with the climate and environmental risks that fossil-fired generation poses in the United States and the world. This Article finds that a policy with a flexible compliance payment that allows investors to delay the decision of retrofitting or replacing and hence, maintains incentives for innovation in retrofit and new plant technologies, can outperform an inflexible mandate by reducing compliance costs and improving environmental performance. [ABSTRACT FROM AUTHOR]

Despite the potential for hydroelectric dams to help address challenges related to the variability and unpredictability of wind energy, at present there are few systems-based wind-hydro studies available in the scientific literature. This work represents an attempt to begin filling this gap through the development of a systems-based modeling framework for analysis of wind power integration and its impacts on hydropower resources. The model, which relies entirely on publicly available information, was developed to assess the effects of wind energy on hydroelectric dams in a power system typical of the Southeastern US (i.e., one in which hydropower makes up <10% of total system capacity). However, the model can easily reflect different power mixes; it can also be used to simulate reservoir releases at self-scheduled (profit maximizing) dams or ones operated in coordination with other generators to minimize total system costs. The modeling framework offers flexibility in setting: the level and geographical distribution of installed wind power capacity; reservoir management rules, and static or dynamic fuel prices for power plants. In addition, the model also includes an hourly ‘natural’ flow component designed expressly for the purpose of assessing changes in hourly river flow patterns that may occur as a consequence of wind power integration. Validation of the model shows it can accurately reproduce market price dynamics and dam storage and release patterns under current conditions. We also demonstrate the model's capability in assessing the impact of increased wind market penetration on the volumes of reserves and electricity sold by a hydroelectric dam. [ABSTRACT FROM AUTHOR]

Stricter emissions requirements on coal-fired power plants Baseline Scenario together with low natural gas prices have contributed to a recent decline in the use of coal for electricity generation in the United States. Faced with a shrinking domestic market, many coal companies are taking advantage of a growing coal export market. As a result, U.S. coal exports hit an all-time high in 2012, fueled largely by demand in Asia. This paper presents a comparative life cycle assessment of two scenarios: a baseline scenario in which coal continues to be burned domestically for power generation, and an export scenario in which coal is exported to Asia. For the coal export scenario we focus on the Morrow Pacific export project being planned in Oregon by Ambre Energy that would ship 8.8 million tons of Powder River Basin (PRB) coal annually to Asian markets via rail, river barge, and ocean vessel. Air emissions (SOx, NOx, PM10 and CO2e) results assuming that the exported coal is burned for electricity generation in South Korea are compared to those of a business as usual case in which Oregon and Washington's coal plants, Boardman and Centralia, are retrofitted to comply with EPA emissions standards and continue their coal consumption. Findings show that although the environmental impacts of shipping PRB coal to Asia are significant, the combination of superior energy efficiency among newer South Korean coal-fired power plants and lower emissions from U.S. replacement of coal with natural gas could lead to a greenhouse gas reduction of 21% in the case that imported PRB coal replaces other coal sources in this Asian country. If instead PRB coal were to replace natural gas or nuclear generation in South Korea, greenhouse gas emissions per unit of electricity generated would increase. Results are similar for other air emissions such as SOx, NOx and PM. This study provides a framework for comparing energy export scenarios and highlights the importance of complete life cycle assessment in determining net emissions effects resulting from energy export projects and related policy decisions. [ABSTRACT FROM AUTHOR]

The article presents a gender-responsive training and technical assistance (TTA) framework which can be used to reform the juvenile justice system for girls and young women. It cites the life story of Biannela Fernandez who became pregnant at the age of eleven, and how her tragic life events transformed her. It discusses the role of training and technical assistance in the reform of the juvenile justice system for girls in the U.S.

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Abstract: Flexible operation of a CCS plant can lower the cost of foregone electricity sales in competitive wholesale electricity markets but reduces the amount of CO2 captured over the life-time of a CCS plant and increases the capital cost of CCS systems per unit of emissions captured. Whether the benefits of flexible CCS exceed the increased costs depends on a relationship between capital and operating costs and cyclical electricity price differentials. In this paper we explore these trade-offs, propose a method to quantify them and apply this framework to U.S. data on CCS capital costs and electricity prices. [Copyright &y& Elsevier]

Ewing sarcoma, a pediatric tumor characterized by EWSR1-ETS fusions, is predominantly observed in populations of European ancestry. We performed a genome-wide association study (GWAS) of 401 French individuals with Ewing sarcoma, 684 unaffected French individuals and 3,668 unaffected individuals of European descent and living in the United States. We identified candidate risk loci at 1p36.22, 10q21 and 15q15. We replicated these loci in two independent sets of cases and controls. Joint analysis identified associations with rs9430161 (P = 1.4 × 10?20; odds ratio (OR) = 2.2) located 25 kb upstream of TARDBP, rs224278 (P = 4.0 × 10?17; OR = 1.7) located 5 kb upstream of EGR2 and, to a lesser extent, rs4924410 at 15q15 (P = 6.6 × 10?9; OR = 1.5). The major risk haplotypes were less prevalent in Africans, suggesting that these loci could contribute to geographical differences in Ewing sarcoma incidence. TARDBP shares structural similarities with EWSR1 and FUS, which encode RNA binding proteins, and EGR2 is a target gene of EWSR1-ETS. Variants at these loci were associated with expression levels of TARDBP, ADO (encoding cysteamine dioxygenase) and EGR2. [ABSTRACT FROM AUTHOR]

With the recent growth of reality television programing and its appeal to adolescent viewers, marketers, advertisers, and public policy experts need to understand what motivations drive adolescents to watch reality programs. By understanding adolescent viewer motivations, professionals will be able to craft effective marketing strategies and develop public policy programs for improving the welfare of adolescents. This research involves an exploratory study that examines adolescents' motivations for watching reality programs through a content analysis of free-response data from a national sample of 800 adolescents in the United States, members of a Harris Online panel. Theoretical, managerial, and public policy implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

The water planning and management policies of the Rio Grande basin no longer respond to the sustainable needs of water users, environment, and international commitments of this transboundary basin between Mexico and the United States. This paper describes how groundwater banking through an in lieu method is one approach leading to better water management in this basin. In lieu groundwater banking is a conjunctive water allocation policy applicable to water users supplied from surface water and groundwater sources. A basin simulation model of the Rio Grande basin, built in the water evaluation and planning system (WEAP) software, was used to evaluate the groundwater banking policy. Two scenarios are discussed: a baseline scenario without new water allocation policies implemented and a groundwater banking scenario considering the in lieu groundwater banking method implemented in the Meoqui aquifer. Results show that groundwater banking can significantly improve water management in the basin, increasing system storage, improving water supply for users in the basin, and enhancing compliance with the treaty obligations. [ABSTRACT FROM AUTHOR]

Purpose - Latinos comprise 12.5 percent of the overall population in the USA, and are the fastest-growing minority, among which the Mexican-origin population makes up about 66 percent. Undocumented Latino immigrants are a small, yet important group within the immigrant population. The purpose of this paper is to review the literature and discuss the most important factors that prevent immigrants from accessing health care. Design/methodology/approach - Literature review was conducted from the library database. A total of 50 items of literature related to the subject were reviewed. Findings - Border states have the highest concentration of Mexican-origin people. The concentration of immigrants in the border has unique health and economic implications due to the vital role they have in US society, contributing both to the economy and diversity of the USA. Despite their important role, they disproportionately lack health insurance, and receive fewer health care services than US-born citizens. This lack of insurance puts a burden on the nation's economy, and their health status deteriorates as they become more prone to chronic health conditions, and their complications due to lack of primary medical attention. Originality/value - Tailored public health interventions that address the health needs of Latino immigrants in the USA need to be based on reliable data and statistics in order to effectively place resources, and to track achievements and flaws. [ABSTRACT FROM AUTHOR]

We evaluated the effectiveness of statewide bicycle legislation using direct observation of the number of elementary and middle school children riding bicycles with and without helmets to or from school over a 7-year period. The percentage of children wearing helmets increased dramatically over the past 7 years (to a high of 81%) due to the passage of state law that required helmet usage. Rates for elementary school children were consistently higher than rates of middle school children. Numerous children still do not wear helmets, particularly older children. Further interventions are needed to promote helmet wearing. [ABSTRACT FROM AUTHOR]

Describes the application of total quality (TQ) principles to the research and development (R&D) efforts at Coors Brewing Co. Adoption of TQ as a working model for daily R&D operations; Development of results-oriented culture; Alignment of R&D activities with business goals. INSET: Observations on the planning process..

BACKGROUND: Complicated skin and skin structure infections (cSSSI) are common in children. Due to safety and resistance issues with recommended agents, new treatment options would be advantageous. METHODS: Multicenter, evaluator-blinded clinical trial. Patients 1 to 17 years old with cSSSI caused by Gram-positive pathogens were randomized 2:1 to intravenous daptomycin or standard-of-care (SOC) treatment for ≤14 days. Daptomycin was administered once daily with dosing by patient age: 12 to 17 years, 5 mg/kg; 7 to 11 years, 7 mg/kg; 2 to 6 years, 9 mg/kg; 12 to 23 months, 10 mg/kg. The primary objective was to evaluate daptomycin safety. The secondary objective was to assess the efficacy of daptomycin compared with SOC. The intent-to-treat (ITT) population consisted of all randomized patients with any dose of study drug. RESULTS: The ITT population comprised 257 daptomycin and 132 SOC patients (primarily clindamycin or vancomycin); 35% had confirmed methicillin-resistant Staphylococcus aureus. The most common adverse events were diarrhea (7% daptomycin, 5% SOC) and increased creatine phosphokinase (6% daptomycin, 5% SOC). The proportions of safety population patients with treatment-related adverse events were similar between the daptomycin (14%) and SOC (17%) groups. Clinical success rates (blinded evaluator-assessed complete/partial resolution of cSSSI signs and symptoms 7-14 days after end-of-treatment) in the ITT population were also similar for the daptomycin (91%) and SOC groups. CONCLUSIONS: Once-daily daptomycin was well tolerated, with safety and efficacy comparable to SOC in children/adolescents with cSSSI caused by Gram-positive pathogens, including community-acquired methicillin-resistant S aureus. [ABSTRACT FROM AUTHOR]

Objectives: To examine metabolic monitoring rates in commercially insured children and adolescents treated with a second-generation antipsychotic (SGA) during calendar years (CYs) 2016 and 2017. Methods: In this retrospective study, data were collected from a large national commercial health plan for the period covering January 1, 2016 to December 31, 2017. Commercially insured children and adolescents, aged 8-19 years with ≥2 SGA prescription claims during the CY, were identified for the CY2016 and CY2017 cohorts. The primary outcome of interest was the percentage of subjects with any glucose or lipid metabolism parameter monitoring. Other calculated metabolic testing rates included glucose, hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), other cholesterol (including triglycerides), and combined glucose and lipid metabolism testing (≥1 test for blood glucose or HbA1c and ≥1 test for LDL-C or other cholesterol). Results: In CY2016 and CY2017, 1502 and 1239 subjects, respectively, were identified for this study. The most common psychiatric diagnoses in CY2016 and CY2017 were major depressive disorder (57.1%, 56.5%, respectively), anxiety disorders (42.9%, 47.5%), attention-deficit/hyperactivity disorder (41.6%, 45.8%), and bipolar disorder (24.1%, 25.9%). The rate of any metabolic testing was 53.5% in CY2016 and 51.3% in CY2017. Glucose testing (50.3%, 46.9%, respectively) was most common in both CYs, followed by LDL-C testing (31.2%, 28.5%). Rates of combined glucose and lipid metabolism testing were 30.7% in CY2016 and 26.9% in CY2017. Conclusions: Given the known potential for adverse cardiometabolic effects, rates of metabolic monitoring associated with SGA use in children and adolescents urgently need to be improved. There is a critical need for understanding barriers to routine monitoring, particularly of lipids, and developing interventions to enhance metabolic monitoring. [ABSTRACT FROM AUTHOR]

Although Mesoproterozoic silicic rocks are predominant in the St. Francois Mountains of southeastern Missouri, basalts, basaltic andesites and their plutonic equivalents are not uncommon. These mafic rocks fall into two distinct petrologic suites as first discerned by Sylvester (Ph.D. thesis (1984) 588). One, the Silver Mines suite, consists of mafic rocks formed contemporaneously with the voluminous silicic rocks. The second suite, the Skrainka suite, originated from mafic magmatism that may have postdated silicic activity. The rocks of both suites have a number of incompatible element indices typically associated with subduction zone environments. This suggests that the voluminous silicic magmatism of the St. Francois Mountains, and contemporaneous portions of the Granite–Rhyolite Provinces, originated during subduction along an active continental margin or during post-subduction (orogenic) extensional collapse. We favor the former tectonic setting, but an active margin in which extensional stresses were prevalent in the overriding plate. [Copyright &y& Elsevier]