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Many refugee children experience trauma in early childhood. Effective, tailored interventions are needed to improve refugee children's access to preventive mental health. We interviewed refugee-serving stakeholders and parents participating in an evidence-based preventive mental health and wellness intervention adapted for Afghan refugee children and families who may have experienced trauma. Interview guide development was informed by two implementation science frameworks: the Consolidated Framework for Implementation Research and the Model for Adaptation Design and Impact. A three-person team coded transcripts via rapid qualitative analysis, and the study team reached consensus on themes. Six refugee-serving facilitators and five refugee parents discussed key determinants of successful implementation. Themes included: (i) modeling cultural humility to promote communication about emotions; (ii) needed linguistic support and referral networks to avoid miscommunications and missed communications; (iii) bridging connections between children, families and schools; (iv) different takeaways, or differing goals and expectations between facilitators and participants; and (v) timely, specific cultural considerations to overcome participation barriers. Overall, we found key determinants of successful implementation of a preventive mental health and wellness intervention for refugee children and families included adaptations to enhance cultural humility and sensitivity to cultural context while strengthening communication among facilitators, children and families. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To explore clinicians' perspectives about the impact of group well-child care (GWCC) on equitable health care delivery. METHODS: In this qualitative study, we conducted semistructured interviews with clinicians engaged in GWCC recruited via purposive and snowball sampling. We first conducted a deductive content analysis using constructs from Donabedian's framework for health care quality (structure, process, and outcomes) followed by inductive thematic analysis within these constructs. RESULTS: We completed 20 interviews with clinicians who deliver or research GWCC in 11 institutions across the United States. Four major themes around equitable health care delivery in GWCC emerged from clinicians' perspectives: 1) shifts in power dynamics (process); 2) enabling relational care, social support, and a sense of community (process, outcome); 3) centering multidisciplinary care delivery around patient and family needs (structure, process, and outcomes); and 4) unaddressed social and structural barriers limit patient and family participation. CONCLUSIONS: Clinicians perceived that GWCC enhances equity in health care delivery by shifting hierarchies in clinical visits and promoting relational, patient, and family-centered care. However, potential opportunities exist to further address provider implicit bias in group care delivery and structural inequities at the level of the health care institution. Clinicians underscored the need to address barriers to participation so that GWCC can more fully enhance equitable health care delivery. [ABSTRACT FROM AUTHOR]

Electric vehicles (EVs) have been introduced as an alternative to gasoline and diesel cars to reduce greenhouse gas emissions, optimize fossil fuel use, and protect the environment. Predicting EV sales is momentous for stakeholders, including car manufacturers, policymakers, and fuel suppliers. The data used in the modeling process significantly affects the prediction model's quality. This research's primary dataset contains monthly sales and registrations of 357 new vehicles in the United States of America from 2014 to 2020. In addition to this data, several web crawlers were used to gather the required information. Vehicles sale were predicted using long short-term memory (LSTM) and Convolutional LSTM (ConvLSTM) models. To enhance LSTM performance, the hybrid model with a new structure called "Hybrid LSTM with two-dimensional Attention and Residual network" has been proposed. Also, all three models are built as Automated Machine Learning models to improve the modeling process. The proposed hybrid model performs better than the other models based on the same evaluation units, including Mean Absolute Percentage Error, Normalized Root Mean Square Error, R-square, slope, and intercept of fitted linear regressions. The proposed hybrid model has been able to predict the share of EVs with an acceptable Mean Absolute Error of 3.5%. [ABSTRACT FROM AUTHOR]

Background: Little is known about the impact of the ecosystem disruption and its contribution on the non-tuberculosis mycobacteria (NTM) diseases (cases) rate in Florida (FL), a state with a high prevalence of NTM in the United States. We aimed to evaluate the epidemiological distribution of NTM in FL and identify its association with extreme weather events.Methods: We used OneFlorida Clinical Research Consortium dataset and extracted data on NTM cases using ICD codes 9- CM 031.0 and ICD-10 A31 during 2012-2018. The number of hurricanes during the study period which affected FL were extracted data from the National Hurricane Center (NHC) and the National Oceanic and Atmospheric Administration (NOAA).Results: Prevalence of NTM gradually increased during the study period. The rate was 2012: 14.3/100,000, 2015; 20.1/100,000 and 2018; 22.6/100,00 except in 2014 where there was an 8% decrease. The incidences were 2012; 6.5/100,00, 2015; 4.9/100,000 and in 2015; 5.4/100,000. Geographical analysis demonstrated a gradual expansion of the NTM cases in Alachua, and Marion Counties throughout the study period. Notably, the 2018 heat map showed higher prevalence of NTM in the northwestern, panhandle region of FL which had been absent in the heat maps for years 2012-2018. High number of the hurricanes was associated with the higher number of the new cases of NTM infection for years 2012, 2016-2018, while the lower number of the hurricanes was associated with the lower number of the new cases of NTM infection for years 2014-2015.Conclusion: The current study found the prevalence rates of NTM disease in FL rose from 2012 to 2018. A higher prevalence was seen following the hurricanes. [ABSTRACT FROM AUTHOR]

Purpose: Opioids have been the main factor for drug overdose deaths in the United States. Current naloxone delivery systems are effective in mitigating the opioid effects only for hours. Naloxone-loaded poly(lactide-co-glycolide) (PLGA) microparticles were prepared as quick- and long-acting naloxone delivery systems to extend the naloxone effect as an opioid antidote. Methods: The naloxone-PLGA microparticles were made using an emulsification solvent extraction approach with different formulation and processing parameters. Two PLGA polymers with the lactide:glycolide (L:G) ratios of 50:50 and 75:25 were used, and the drug loading was varied from 21% to 51%. Two different microparticles of different sizes with the average diameters of 23 μm and 50 μm were produced using two homogenization-sieving conditions. All the microparticles were critically characterized, and three of them were evaluated with β-arrestin recruitment assays. Results: The naloxone encapsulation efficiency (EE) was in the range of 70–85%. The EE was enhanced when the theoretical naloxone loading was increased from 30% to 60%, the L:G ratio was changed from 50:50 to 75:25, and the average size of the particles was reduced from 50 μm to 23 μm. The in vitro naloxone release duration ranged from 4 to 35 days. Reducing the average size of the microparticles from 50 μm to 23 μm helped eliminate the lag phase and obtain the steady-state drug release profile. The cellular pharmacodynamics of three selected formulations were evaluated by applying DAMGO, a synthetic opioid peptide agonist to a μ-opioid receptor, to recruit β-arrestin 2. Conclusions: Naloxone released from the three selected formulations could inhibit DAMGO-induced β-arrestin 2 recruitment. This indicates that the proposed naloxone delivery system is adequate for opioid reversal during the naloxone release duration. [ABSTRACT FROM AUTHOR]

Objectives: Comprehensive training in ultrasound (US) imaging during radiology residency is crucial if radiologists are expected to maintain a substantial role in this widely used imaging modality. This study aimed to evaluate the current curriculum of US training among radiology residency programs across the country via a nationwide survey. Methods: A 28‐question survey was distributed among all academic radiology departments in the United States and their radiology residents. The survey consisted of 4 sections: general demographic information, training information, clinical competency, and adequacy of training (perspective). The Student t test and 1‐way analyses of variance were performed to assess statistical significance. Results: Overall, 256 residents from 32 states completed the questionnaire. Only 114 (45%) residents reported having a dedicated rotation for performing US studies. Although 228 (89%) of trainees believed they received adequate experience for interpreting US studies, only 66 (26%) of them had the same belief about performing them. Only 116 (45%) of the residents were comfortable operating the US machines in their departments. Higher years of residency training, having a dedicated rotation for performing US studies, and having more than 10 hours per year of didactic lectures and/or more than 5 hours per year of case conferences dedicated to US had a positive impact on the residents' clinical competency and perspective (all P <.05). Conclusions: Most radiology residents do not feel confident in performing US examinations by themselves. However, higher clinical competency was reported in the residents who had dedicated rotations for performing US studies and received more hours of US lectures and case conferences throughout their residency. [ABSTRACT FROM AUTHOR]

Phosphodiesterase type 5 inhibitors (PDE5Is) may increase intraocular pressure (IOP) by increasing blood flow to the ciliary body. Although clinical studies of changes in IOP after single and multiple doses of PDE5Is show variable results, most are limited by small sample sizes, absence of control groups and blinding, and use of normal patient volunteers who have no risk factors for glaucoma. However, multiple case reports of glaucoma have been published, and one epidemiologic analysis of the National Health and Nutrition Examination Survey (NHANES) database of US respondents suggested a significant association of prolonged sildenafil use and self-reported glaucoma. With the widespread use of PDE5Is for treatment of erectile dysfunction in males with risk factors for glaucoma, and the potential of PDE5Is to worsen optic nerve damage in patients with glaucoma, we recommend a vision screening exam prior to the initiation of the PDE5I and careful follow-up thereafter, particularly if the patient is taking tadalafil, a long-acting PDE5I, if the patient is taking high doses of a PDE5I daily and persistently, and if the patient has risk factors for glaucoma or if the patient is at risk of worsening glaucoma. [ABSTRACT FROM AUTHOR]

We are examining the impact of a course-based undergraduate research experience (CURE) at a land-grant, Hispanicserving institution in the southwestern United States. Students in our CURE completed one or two extended research projects over a single semester. Our CURE enrolled a high proportion of underrepresented minority students (70.3%), including 60.2% Hispanic students. One year after CURE completion, 31.5% of CURE students had graduated with a STEM degree, and 54.3% were enrolled in a STEM major. Pre- and postcourse surveys of indicators of persistence including scientific selfefficacy, scientific identity, valuing scientific community objectives, and intention to persist showed positive shifts. Impacts on STEM persistence have implications for the role of our CURE in diversifying the STEM pipeline, particularly for students historically underrepresented in STEM. [ABSTRACT FROM AUTHOR]

Background: Considering the aging population associated with higher osteoporotic fracture risk, high prevalence of diabetes and its effect on bone health along with lack of information on bone quality using common methods (BMD) the aim of present study was to determine the association between trabecular bone score (TBS) and diabetes in an elderly population participating in Bushehr Elderly Health (BEH) program. Materials and methods: This cross-sectional study was performed on data collected during the BEH Program, stage II. Anthropometric indices were measured based on NHANES III protocol. Diabetes and pre-diabetes were defined according to ADA Guideline 2018. Bone density was measured using DXA method (DXA, Discovery WI, Hologic Inc., USA). A software installed on the same device (TBS iNsight® software) was applied to assess TBS values. Variables related to bone health were compared based on their glycemic status (participants with diabetes, participants with prediabetes, and normoglycemic) using analysis of variance. Univariate and multivariate linear and logistic regression models were used to determine the association between TBS values and bone density in different glycemic states. Results: The data of 2263 participant aged 60 years and over were analyzed. Mean TBS values were significantly different between participants with diabetes, participants with prediabetes, and normoglycemic groups (P = 0.004;, however, P trend was not significant (0.400)). Mean BMD values at femoral neck and lumbar spine were significantly higher in diabetics compared with those diagnosed with pre-diabetes; the latter also had higher bone density compared with normoglycemic individuals (both P ANOVA test and P trends for means were < 0.01]. In univariate linear regression model, TBS values were negatively associated with pre-diabetes (β = −0.070; P < 0.001) but not with diabetes (β = −0.002, P = 0.915). This significant relationship disappeared when the results were adjusted for BMI. In fully adjusted multivariate logistic regression models, odds ratio linking pre-diabetes and diabetes with spinal osteoporosis was 0.861 (CI 95% 0.670–1.105) and 0.525 (CI 95% 0.392–0.701), respectively. As for femoral osteoporosis, odds ratio was 0.615 (CI 95% 0.407–0.928) and 0.968 (CI 95% 0.629–1.489), correspondingly. Moreover, for cumulative osteoporosis, the odds were 0.843 (CI 95% 0.676–1.106) and 0.551 (CI 95% 0.415–0.732), respectively. Conclusion: Our findings suggest that subjects with pre-diabetes and diabetes have higher bone mineral density than normoglycemic subjects; the quality of bone, however, was not different between them. The discordance between BMD and TBS values in participants with diabetes suggest that although these patients have higher BMD values, their quality of bone microarchitecture may not be better than normoglycemic subjects. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. METHODS: In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. RESULTS: The expected population reach of a 10-year national implementation is -2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per lifeyear with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention's effect worsened the former. CONCLUSIONS: A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence. [ABSTRACT FROM AUTHOR]

Objectives. To determine whether proximity to a supermarket modified the effects of an obesity intervention. Methods. We examined 498 children aged 6 to 12 years with a body mass index (BMI) at or above the 95 th percentile participating in an obesity trial in Massachusetts in 2011 to 2013. The practice-based interventions included computerized clinician decision support plus family self-guided behavior change or health coaching. Outcomes were 1-year change in BMI z-score, sugar-sweetened beverage intake, and fruit and vegetable intake. We examined distance to the closest supermarket as an effect modifier. Results. Distance to supermarkets was an effect modifier of 1-year change in BMI z-score and fruit and vegetable intake but not sugar-sweetened beverage intake. With each 1 -mile shorter distance to a supermarket, intervention participants increased their fruit and vegetable intake by 0.29 servings per day and decreased their BMI z-score by -0.04 units relative to controls. Conclusions. Living closer to a supermarket is associated with greater improvements in fruit and vegetable intake and weight status in an obesity intervention. [ABSTRACT FROM AUTHOR]

This article situates the Kurdish language within the diasporic context of the United States, and explores the roles that the language plays for the community. This is investigated through a mixed method encompassing literature and media reviews, interviews with community members and leaders, and a survey conducted among the Kurds in Southern California. The findings show that both first and second generation Kurds see their language not only as a symbol of their cultural identity and survival but a means of building and maintaining relations with each other, with other Kurds in the US, with relatives in the homeland, and also with their heritage. Nevertheless, members of the second generation think that language constitutes one of the most challenging cultural heritage elements to keep for many linguistic, socio-economic, cultural, and political reasons. The article concludes that there are no easy ways of maintaining minority languages like Kurdish much less transmitting them to future generations. The prospect for a promising future seems highly unlikely as long as heritage languages in the US are perceived as personal choices only, and the state does not assume responsibility for their maintenance let alone their transmission to future generations of newer immigrants. [ABSTRACT FROM AUTHOR]

Text messaging is a promising means of intervening on an array of health issues among varied populations, but little has been published about the development of such interventions. The authors describe the development and implementation of an interactive text messaging campaign for parents to support behavior change among children in a childhood obesity randomized controlled trial. The authors invited 160 parents to participate in a text messaging intervention that provided behavior change support in conjunction with health coaching phone calls and mailed materials on behavioral goals. Throughout the 1-year intervention, the authors sent 1–2 text messages per week. The first asked how the child did with a target behavior the day before; parents who replied received an immediate feedback message tailored to their response. The second included a tip about how to work toward a behavioral goal. Baseline surveys indicate that text messaging is a common means of communication for parents, and many are willing to use text messaging to support behavior change for their child. Results at 1 year indicate a high level of engagement with the text messaging intervention, with nearly two thirds responding to 75% or more of the questions they were sent by text. [ABSTRACT FROM AUTHOR]

Multi-attribute utility theory (MAUT) provides a way to model decisions involving trade-offs among different aspects or goals of a problem. We used MAUT to model prostate cancer patients' preferences for their own health state and we compared this model to patients' global judgments of health state utility. 57 patients with prostate cancer (mean age = 70) at two Chicago Veterans Administration health clinics were asked to evaluate health states described in terms of five health attributes affected by prostate cancer: pain, mood, sexual function, bladder and bowel function, and fatigue and energy. Each attribute had three levels that were used to form three clinically realistic health state descriptions (A = high, B = moderate, C = low). A fourth personalized health description (P) matched the patient's current health. We first measured patients' preferences using time trade-off (TTO) judgments for the three health states (A, B, and C) and for their own current health state (P). The TTO for the patient's own health state (P) was standardized by comparing it to TTO judgments for states A and C. We next constructed a multi-attribute model using the relative importance of the five attributes. The MAU scores were moderately correlated with the TTO preference judgments for the personalized state (Pearson r = 0.38, N = 57, p < 0.01). Thus, patients' preference judgments are moderately consistent and systematic. MAUT appears to be a potentially feasible method for evaluating preferences of prostate cancer patients and may prove helpful in assisting with patient decision making. [ABSTRACT FROM AUTHOR]

Abstract: As the building blocks of cities, neighborhoods play a major role in helping to achieve global sustainability. In the past decade, several assessment tools worldwide have been developed to evaluate the effectiveness of the increasing number of neighborhood (re)development plans. While there is a plethora of research investigating various aspects of building assessment tools, until now little studies have looked at the empirical aspects of neighborhood sustainability assessment. To address this lacuna in literature, this study explores the uptake of sustainability criteria in projects certified under neighborhood sustainability assessment tools. In addition, it examines three cases from the US, the UK, and Japan that have been highly ranked under LEED-ND, BREEAM Communities, and CASBEE-UD, respectively. This is done through investigating compliance of each case with the principles of sustainable development. Furthermore, a series of comparative case studies are undertaken to evaluate each case using assessment tools other than the ones that have, in reality, been used for certifying the selected developments. In addition to highlighting strengths and weaknesses of each development, results show that social, economic, and institutional aspects are not adequately accounted for in theory and practice. Practice of neighborhood sustainability assessment is, to a large extent, market-driven and characterized by the dominance of the environmental aspects of sustainability. Also, results indicate that assessment tools can co-evolve through learning from their successes and failures. Results of this study can be used for optimizing the assessment tools. [Copyright &y& Elsevier]

Abstract: Neighborhood sustainability assessment tools have become widespread since the turn of 21st century and many communities, mainly in the developed world, are utilizing these tools to measure their success in approaching sustainable development goals. In this study, seven tools from Australia, Europe, Japan, and the United States are selected and analyzed with the aim of providing insights into the current situations; highlighting the strengths, weaknesses, successes, and failures; and making recommendations for future improvements. Using a content analysis, the issues of sustainability coverage, pre-requisites, local adaptability, scoring and weighting, participation, reporting, and applicability are discussed in this paper. The results of this study indicate that most of the tools are not doing well regarding the coverage of social, economic, and institutional aspects of sustainability; there are ambiguities and shortcomings in the weighting, scoring, and rating; in most cases, there is no mechanism for local adaptability and participation; and, only those tools which are embedded within the broader planning framework are doing well with regard to applicability. [Copyright &y& Elsevier]

Prostate cancer is the second leading cause of cancer death for men in the United States. Tumor progression is driven by conversion of testosterone by 5α-reductase to dihydrotestosterone, which both bind and activate the androgen receptor (AR). Androgen deprivation therapy (ADT), or depletion of gonadal testosterone, blocks this sequence of events, and has been the mainstay of upfront systemic treatment for prostate cancer for 70 years. ADT is achieved by surgical or pharmacological means. Although the majority of circulating testosterone is depleted, intratumoral testosterone and dihydrotestosterone persist after ADT, implying the existence of alternative source(s) of these androgens. Importantly, the generation of intratumoral androgens and ensuing AR activation is a major mechanism that drives resistance to ADT. The goal of this review is to summarize the approaches to ADT, effects on the tumor, clinical benefits and mechanisms of resistance. [Copyright &y& Elsevier]

The article looks into the disparity in the Sixth Amendment right of confrontation given to criminal defendants at trial and the one granted by the Federal Death Penalty Act of 1994 (FDPA) during death-eligibility determinations in the U.S. The authors point out that the Confrontation Clause of the Sixth Amendment grants the accused the right to be confronted. They mention that 18 U.S.C. § 3593(c) prevents capital defendants of the Sixth Amendment right of confrontation.

Soil total nitrogen (N) concentration is commonly measured by Kjeldahl and combustion methods. In this study, a method based on determination of ammonium (NH4)-N produced by steam distillation of the soil sample with sodium hydroxide solution (NaOH-DD) is developed and evaluated for estimating soil total N concentration. The method was evaluated using two sample sets: (A) 44 samples collected from contrasting land uses in central Iran and (B) 344 samples collected from contrasting arable soils across Canada and Maine, USA. Based on this experiment, 10-min distillation of 5.0 g soil with 20 mL 12.5 M NaOH were selected as the optimum conditions. The NH4-N released by the NaOH-DD method was highly correlated with total N concentration in the sample sets A and B (r = 0.79 and 0.94, respectively). The NaOH-DD method provides a simple, rapid means of analysis with reduced measurement cost and better health and safety precautions than the traditional Kjeldahl method. [ABSTRACT FROM AUTHOR]

The Sarbanes-Oxley Act (SOX) has fundamentally altered the legal landscape for corporate governance and financial reporting. But it has also had a profound effect on M&A—as a menacing “deal killer.” How can you stop SOX from souring your deal? © 2006 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Authors from the National Cancer Institute present a study which assessed the time to androgen independence and overall survival for patients with metastatic prostate cancer. They reported a longer than expected survival with androgen-independent prostate cancer, and make original observations on the time to metastatic disease for patients with no evidence of radiographic disease. The new wave of chemotherapeutic agents for hormone-resistant prostate cancer has generated a new interest in producing more. Dr Cora Sternberg from Rome presents information on satraplatin, a third-generation orally available platinum analogue that shares more structural similarities with cisplatin. There are several other papers in this section on prostate bladder and renal cancer, and finally a paper from London on penile cancer, asking what surgical resection margins are required to achieve oncological control, and finding that the traditional 2 cm margin may be unnecessary, with excision margins of only a few millimetres needed to give excellent control. OBJECTIVE To determine the natural history of patients with prostate cancer who start initial androgen-deprivation therapy (ADT) for biochemical failure with no radiographic evidence of disease (D0) or with radiographic metastatic disease (D2), as the history is either not well-defined or is changing, and such data are critical for guiding therapy after prostate cancer recurrence. PATIENTS AND METHODS We retrospectively assessed the time to androgen-independence (AI), defined as the first sustained rise in prostate-specific antigen (PSA) level on ADT, time to metastatic disease and overall survival for 80 patients with metastatic prostate cancer in clinical trials at the National Cancer Institute. RESULTS ADT was initiated after metastatic disease in 37 patients and before metastatic disease in 43 patients; in these 43 patients, the median time to developing metastatic disease on ADT was 37.8 months. The median time to AI from the initiation of ADT was 19.3 and 13.1 months in D0 and D2 patients, respectively. The median overall survival from the start of ADT was 89.0 and 63.0 months, and the median overall survival from the time of AI was 63.1 and 44.2 months in D0 and D2 patients, respectively. These 80 patients, which included 43 who had no metastatic disease when starting ADT, had a median survival of 54.8 months after AI prostate cancer. CONCLUSIONS We describe the natural history of AI prostate cancer in D0 patients who eventually developed metastasis, and in D2 patients. The results suggest a longer than expected survival with AI prostate cancer, and to our knowledge this is the first study to report the time to metastatic disease for D0 patients from ADT and from AI. These results can be used to help design clinical trials in patients with D0 prostate cancer. [ABSTRACT FROM AUTHOR]

Studies were conducted in the central Mojave Desert to quantify how creosote bushes (Larrea tridentata) respond to physical damage during large-scale military training exercises. Creosote bush possesses a resilient growth form that recovers from repeated physical damage via resprouts arising from meristems in stem bark below severed or crushed canopy units. At high levels of disturbance by heavy vehicles, nearly all individuals showed measurable breakage, but without additional damage each plant can regain a full canopy within 5 years under arid field conditions. Resprouts exhibited more vigorous growth and doubled the biomass accumulation stimulated by high rainfall of 1998, an El Nin˜o year, vs. a normal year. New shoots of resprouted individuals were markedly different in morphological traits than canopy old growth and had slightly higher predawn shoot water potentials. The natural ability of this evergreen species to recover from cutting and crushing bodes well for re-establishment of creosote bush desert scrub communities following episodes of severe damage by vehicles. [Copyright &y& Elsevier]

Windblown dust, an environmental problem in many disturbed arid lands, has the potential to affect the physiological performance of desert shrubs. Physiological parameters of gas exchange for three species (Larrea tridentate, Hymenoclea salsola and Atriplex canescens) were measured at a Mojave Desert site, at which both undisturbed and heavily dusted shrubs occurred. Maximum rates of net photosynthesis (A) of dusted organs were reduced to 21% of those of control plants in resinous leaflets of Larrea, to 44% in resinous leaves and photosynthetic stems of Hymenoclea, and to 58% in non-resinous C4 leaves of Atriplex, which have vesiculated trichomes. Dusted plants of all three species showed reduced maximum leaf conductance (g), transpiration (E) and instantaneous water-use efficiency (A/E). Intrinsic water-use efficiency (A/g) was also reduced, except in Atriplex, in which it remained unchanged. Temperatures of dusted leaves and photosynthetic stems were 2–3 C higher than those of control plants, due to greater absorptance of infra-red radiation. Dust also significantly increased photosynthetically active radiation (PAR) reflectance. Heavily dusted shrubs had smaller leaf areas and greater leaf-specific masses, suggesting that the short-term effects of reduced photosynthesis and decreased water-use efficiency may cause lowered primary production in desert plants exposed to dust during seasons when photosynthesis is occurring. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Expansion of insurance eligibility is associated with positive health outcomes. We compared uninsurance and health care utilization for (1) all children, and (2) children in immigrant families (CIF) and non-CIF who resided inside and outside of the seven US states/territories offering public health insurance to children regardless of documentation status ("extended-eligibility states/territories"). METHODS: Using the cross-sectional, nationally representative National Survey of Children's Health-2019, we used survey-weighted, multivariable Poisson regression to assess the association of residence in nonextended- versus extended-eligibility states/territories with uninsurance and with health care utilization measures for (1) all children, and (2) CIF versus non-CIF, adjusting for demographic covariates. RESULTS: Of the 29 433 respondents, the 4035 (weighted 27.2%) children in extended- versus nonextended-eligibility states/territories were more likely to be CIF (27.4% vs 20.5%, P < .001), 12 to 17 years old (37.2% vs 33.2%, P = .048), non-White (60.1% vs 45.9%, P < .001), and have a non-English primary language (20.6% vs 11.1%, P < .001).The relative risk of uninsurance for children in nonextended- versus extended-eligibility states/territories was 2.0 (95% confidence interval 1.4-3.0), after adjusting for covariates. Fewer children in extended- versus nonextended-eligibility states/territories were uninsured (adjusted prevalence 3.7% vs 7.5%, P < .001), had forgone medical (2.2% vs 3.1%, P = .07) or dental care (17.1% vs 20.5%, P = .02), and had no preventive visit (14.3% vs 17.0%, P = .04). More CIF than non-CIF were uninsured, regardless of residence in nonextended- versus extended-eligibility states/territories: CIF 11.2% vs 5.7%, P < .001; non-CIF 6.1% vs 3.1% P < .001. CONCLUSIONS: Residence in nonextended-eligibility states/territories, compared with in extended-eligibility states/territories, was associated with higher uninsurance and less preventive health care utilization. [ABSTRACT FROM AUTHOR]

On May 8, 2018, the United States announced that it was withdrawing from the Iran nuclear deal. This has resulted in reimposition of the economic hardship on Iran. We investigated the patients' perceptions of hardship in obtaining their antiepileptic drugs (AEDs) after the reimposition of sanctions. We surveyed patients with epilepsy visiting three centers in Iran on February 2nd to 6th (easy sampling) on their perceptions on two issues: 1. What has been your experience on obtaining your AEDs in the past six months? 2. Have you experienced any changes in your seizure control in the past six months? Two hundred and forty-four patients participated. Ninety-two patients (37.7%) claimed that they have had significant difficulty obtaining their AEDs, and 37 patients (15.2%) said that their AED(s) was not accessible. Ninety-six people (72%) of those receiving imported AEDs and 33 patients (30%) of those receiving homemade AEDs had significant hardship obtaining their drugs (p = 0.00001). Forty-seven patients (36%) of those who reported significant hardship obtaining their AEDs and 25 (22%) of those who did not, perceived worsening of their seizures (p = 0.017). Sanctions have affected ordinary people, especially those who are vulnerable the most (i.e., patients), significantly. • 244 patients participated. • 92 patients (37.7%) claimed that they have had significant difficulty obtaining their AEDs. • 37 patients (15.2%) said that their AED(s) was not accessible. • 72% of those receiving imported AEDs and 30% of those receiving home-made AEDs had hardship (p = 0.00001). • Sanctions has affected ordinary people, especially those who are vulnerable the most (i.e., patients), significantly. [ABSTRACT FROM AUTHOR]

Abstract: Background: The debate on the quality of health care provided in the United States has continued to be waged as concerns have grown over the years. Stress, sleep deprivation, poor diet, and lack of exercise may lead to inadequate work performance by physicians. Objective: This study was undertaken to determine whether Emergency Medicine (EM) residents satisfy daily recommendations for total number of steps taken per day set forth by the Centers for Disease Control and Prevention and Surgeon General in a 12-h shift. Methods: An observational prospective cohort study was conducted between August 2009 and November 2009 at an urban Level I trauma center with an annual census of over 165,000 Emergency Department (ED) visits per year. The mean number of steps taken by EM residents during 12-h shifts was measured. Results: Mean steps taken during a shift were 7333 (95% confidence interval 6901–7764). Only nine (9.9%) pedometer readings reached the target level of 10,000 (10K) steps or above. A t-test was used to compare steps with the hypothesized 10K steps target. Recordings of 10K steps or greater were not correlated with ED sections (p =0.60) shift (medical vs. surgical, p =0.65) or ED census (r 2 <0.0017). Conclusion: A majority of residents (90%) did not meet the target number of steps for shifts. More rigorous charting needs, overcrowding, or even spatial limitations may explain this. This warrants further investigation to determine if some daily physical activity regimens may help improve the overall well-being of EM residents. [Copyright &y& Elsevier]

Understanding the relationship between urban form and CO 2 emissions is essential for developing mitigation measures. However, most studies so far have been limited to examining the urban form at the macro level. Existing studies have limitations, such as a lack of granularity and a standardized approach, and focus on a limited set of urban form indicators. To address these issues, this study employs the Local Climate Zones (LCZ) framework to investigate the relationship between urban form and CO 2 emissions at the micro level in three American cities: Baltimore, Indianapolis, and Los Angeles. Results indicate that LCZ offers a valuable framework for mapping emissions at the building and street level and facilitates a better understanding of different urban forms' emission behavior. According to the findings, emission intensity in compact areas with few or no trees and limited green space is up to 3.5 times higher than in areas characterized by open layouts, scattered trees, and abundant plant cover. Also, per capita emissions in compact areas are, on average, two times higher than in areas with more open layouts. Additionally, the results show that compact high-rise and mid-rise areas without trees and greenery (LCZ 1 and 2), particularly in Baltimore and Indianapolis, experience higher emissions levels than other LCZs during the daytime. The findings suggest that the LCZ framework holds promise for understanding the link between urban form and emissions in intricate urban settings, as well as for low-carbon urban planning and climate change mitigation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)