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Introduction: Training in clinical cardiac electrophysiology (CCEP) involves the development of catheter handling skills to safely deliver effective treatment. Objective data from analysis of ablation data for evaluating trainee of CCEP procedures has not previously been possible. Using the artificial intelligence cloud‐based system (CARTONET), we assessed the impact of trainee progress through ablation procedural quality. Methods: Lesion‐ and procedure‐level data from all de novo atrial fibrillation (AF) and cavotricuspid isthmus (CTI) ablations involving first‐year (Y1) or second‐year (Y2) fellows across a full year of fellowship was curated within Cartonet. Lesions were automatically assigned to anatomic locations. Results: Lesion characteristics, including contact force, catheter stability, impedance drop, ablation index value, and interlesion time/distance were similar over each training year. Anatomic location and supervising operator significantly affected catheter stability. The proportion of lesion sets delivered independently and of lesions delivered by the trainee increased steadily from the first quartile of Y1 to the last quartile of Y2. Trainee perception of difficult regions did not correspond to objective measures. Conclusion: Objective ablation data from Cartonet showed that the progression of trainees through CCEP training does not impact lesion‐level measures of treatment efficacy (i.e., catheter stability, impedance drop). Data demonstrates increasing independence over a training fellowship. Analyses like these could be useful to inform individualized training programs and to track trainee's progress. It may also be a useful quality assurance tool for ensuring ongoing consistency of treatment delivered within training institutions. [ABSTRACT FROM AUTHOR]

Objective: Alcohol use disorder (AUD) is a leading cause of preventable death and is a frequent diagnosis in the emergency department (ED). Treatment in the ED, however, typically focuses on managing the sequelae of AUD, such as acute withdrawal, rather than addressing the underlying addiction. For many patients, these ED encounters are a missed opportunity to connect with medication for AUD. In 2020, our ED created a pathway to offer patients with AUD treatment with naltrexone (NTX) during their ED visit. The aim of this study was to identify what barriers and facilitators patients perceive to NTX initiation in the ED. Methods: Adopting the theoretical framework of the behavior change wheel (BCW), we conducted qualitative interviews with patients to elicit their perspectives on ED initiation of NTX. Interviews were coded and analyzed using both inductive and deductive approaches. Themes were categorized according to patients' capabilities, opportunities, and motivations. Barriers were then mapped through the BCW to design interventions that will improve our treatment pathway. Results: Twenty‐eight patients with AUD were interviewed. Facilitators of accepting NTX included having recently experienced sequelae of AUD, rapid management of withdrawal symptoms by the ED provider, having a choice between intramuscular and oral formulations of the medication, and experiencing positive interactions in the ED that destigmatized the patient's AUD. Barriers to accepting treatment included lack of provider knowledge about NTX, dependence on alcohol as self‐treatment for psychiatric trauma and physical pain, perceived discriminatory treatment and stigma about AUD, aversion to potential side effects, and lack of access to continued treatment. Conclusions: Initiation of treatment of AUD with NTX in the ED is acceptable to patients and can be facilitated by knowledgeable ED providers who create a destigmatizing environment, effectively manage withdrawal symptoms, and connect patients to providers who will continue treatment. [ABSTRACT FROM AUTHOR]

Background: High venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that specific clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE). Methods: We performed a retrospective observational case-control study of 158 consecutive patients hospitalized in one of four Mount Sinai Hospitals with COVID-19 between March 1 and May 8, 2020, who received a Chest CT Pulmonary Angiogram (CTA) to diagnose a PE. We analyzed demographic, clinical, laboratory, radiological, treatment characteristics, and outcomes in COVID-19 patients with and without PE. Results: 92 patients were negative (CTA-), and 66 patients were positive for PE (CTA+). CTA + had a longer time from symptom onset to admission (7 days vs. 4 days, p = 0.05), higher admission biomarkers, notably D-dimer (6.87 vs. 1.59, p < 0.0001), troponin (0.015 vs. 0.01, p = 0.01), and peak D-dimer (9.26 vs. 3.8, p = 0.0008). Predictors of PE included time from symptom onset to admission (OR = 1.11, 95% CI 1.03–1.20, p = 0.008), and PESI score at the time of CTA (OR = 1.02, 95% CI 1.01–1.04, p = 0.008). Predictors of mortality included age (HR 1.13, 95% CI 1.04–1.22, p = 0.006), chronic anticoagulation (13.81, 95% CI 1.24–154, p = 0.03), and admission ferritin (1.001, 95% CI 1-1.001, p = 0.01). Conclusions: In 158 hospitalized COVID-19 patients with respiratory failure evaluated for suspected PE, 40.8% patients had a positive CTA. We identified clinical predictors of PE and mortality from PE, which may help with early identification and reduction of PE-related mortality in patients with COVID-19. [ABSTRACT FROM AUTHOR]

Mississippi River basin floods impart large socioeconomic impacts over the central United States. Improving flood predictability depends on our understanding of the dynamical controls on Mississippi basin hydroclimate. However, short instrumental records make it difficult to constrain the connections between flooding and climate variability. Here, we use the Paleo Hydrodynamics Data Assimilation product, spanning the Last Millennium, to investigate the impacts of tropical Pacific and North Atlantic sea surface temperature (SST) variability on hydrological extremes across the Mississippi River and its major tributaries. Wet extremes are associated with strong El Niño‐like warming over the tropical Pacific, but specific SST patterns matter: dry (wet) conditions occur during Central Pacific (Eastern Pacific) El Niño events. The influence of North Atlantic SSTs is less clear, but cool SSTs contribute to Ohio basin wet extremes. These results are relevant for seasonal‐to‐interannual flood hazard prediction on the fourth largest river basin in the world. Plain Language Summary: Large floods on the Mississippi River during the last century have proven costly, both in economic and social terms. To improve flood hazard prediction, it is critical to understand how patterns in Earth's climate system contribute to Mississippi floods. However, relatively few flooding events occurred during the 20th century, which limits our ability to evaluate the statistics of these events. This work seeks to use records of past climate (from archives such as corals, ice cores, and trees) spanning the last 1,000 years to investigate the drivers of Mississippi flooding. Specifically, we focus on how sea surface temperature (SST) changes over the tropical Pacific and North Atlantic affect the hydrological cycle over the basin. We find that very wet periods are strongly associated with warm SSTs in the eastern tropical Pacific, but central tropical Pacific warming causes dry conditions. The impact of North Atlantic SST variability is much weaker, but, in combination with tropical Pacific warming, cool SSTs over the North Atlantic can amplify wet conditions over the eastern Mississippi River basin's tributaries. Our results harbor implications for seasonal‐to‐interannual flood hazard prediction, and can help stakeholders prepare for and mitigate flooding in the 21st century. Key Points: We investigate the drivers of Mississippi River basin hydroclimate extremes over the last millenniumPaleoclimate data assimilation reveals dry (wet) conditions during central Pacific (eastern Pacific) El Niño eventsSelf‐organizing maps expose a North Atlantic tripole pattern which modulates moisture supply over the Ohio river basin [ABSTRACT FROM AUTHOR]

Periodic measurement of the size and behaviors of the Jewish population is of vital importance to Jewish communal planners, both nationally and in communities throughout the United States. Methodological design decisions, such as the choice of a sampling frame, mode of data collection, nonresponse follow-up protocols, and definition of eligibility can have significant impacts on population estimates. This paper demonstrates how two studies, one national and one for the Jewish Federation of Greater Philadelphia used the current state-of-the-art address-based sampling methodology and other methodological improvements to significantly increase coverage and reduce bias in the survey results compared to other methodologies. [ABSTRACT FROM AUTHOR]

Considers both the recent critical and older, more favorable evaluations of Canadian Indian policy and contrasts Canadian policy with that that developed in the United States. (DR)

We examine oceanic drivers of widespread droughts over the contiguous United States (herein pan‐CONUS droughts) during the Common Era in what is one of the first analyses of the new Paleo Hydrodynamics Data Assimilation (PHYDA) product. The canonical understanding of oceanic influences on North American hydroclimate suggests that pan‐CONUS droughts are forced by a contemporaneous cold tropical Pacific Ocean and a warm tropical Atlantic Ocean. We test this hypothesis using the paleoclimate record. Composite analyses find a robust association between pan‐CONUS drought events and cold tropical Pacific conditions, but not with warm Atlantic conditions. Similarly, a self‐organizing map analysis shows that pan‐CONUS drought years are most commonly associated with a global sea surface temperature pattern displaying strong La Niña and cold Atlantic Multidecadal Oscillation (AMO) conditions. Our results confirm previous model‐based findings for the instrumental period and show that cold tropical Pacific Ocean conditions are the principal driver of pan‐CONUS droughts on annual timescales. Plain Language Summary: Widespread summer droughts across the contiguous United States (pan‐CONUS droughts) pose unique challenges because of their potential to strain multiple water resources simultaneously, and the financial damages from these droughts are significant. For example, pan‐CONUS droughts in 1988 and 2012 cost an estimated $40 and $30 billion, respectively. We provide a millennium‐length perspective on the causes of these droughts using a new paleo reconstruction product that merges climate model information with multiple climate proxies including tree rings, ice cores, and corals. We characterize pan‐CONUS droughts from 850 to 1850 CE and demonstrate how ocean variability has helped cause these events. We find that La Niña events in the tropical Pacific are the principal oceanic influence on these droughts, while variability in the Atlantic has not played a significant role. These findings are at odds with previous work that has estimated a role for the Atlantic in causing pan‐CONUS droughts but support conclusions from a more recent model‐based study of the causes of pan‐CONUS droughts over the instrumental record. Our findings are important for predictions of pan‐CONUS droughts and for determining how the occurrence of these droughts may change in the future due to increases in greenhouse gas emissions. Key Points: Widespread summer droughts in the contiguous United States have been endemic over much of the Common Era based on a new paleo data assimilation productLa Niñas are the principal driver of these widespread droughts, while the Atlantic is shown to have played a passive roleThe oceanic drivers of these droughts over the paleo record is consistent with previous model‐based findings over the instrumental record [ABSTRACT FROM AUTHOR]

The article presents a study which examines and compares differences between gender groups regarding benefits, constraints, and willingness to pay related to university outdoor recreation programs. Information on the method, the results, and conclusion are discussed. An understanding of the demographic groups and decision makers with developing, marketing, and funding outdoor recreation programs targeted at higher education groups is provided.

Summary: Spine fracture prevalence is similar in men and women, increasing from <5 % in those <60 to 11 % in those 70-79 and 18 % in those ≥80 years. Prevalence was higher with age, lower bone mineral density (BMD), and in those meeting criteria for spine imaging. Most subjects with spine fractures were unaware of them. Introduction: Spine fractures have substantial medical significance but are seldom recognized. This study collected contemporary nationally representative spine fracture prevalence data. Methods: Cross-sectional analysis of 3330 US adults aged ≥40 years participating in NHANES 2013-2014 with evaluable Vertebral Fracture Assessment (VFA). VFA was graded by semiquantitative measurement. BMD and an osteoporosis questionnaire were collected. Results: Overall spine fracture prevalence was 5.4 % and similar in men and women. Prevalence increased with age from <5 % in those <60 to 11 % in those 70-79 and 18 % in those ≥80 years. Fractures were more common in non-Hispanic whites and in people with lower body mass index and BMD. Among subjects with spine fracture, 26 % met BMD criteria for osteoporosis. Prevalence was higher in subjects who met National Osteoporosis Foundation (NOF) criteria for spine imaging (14 vs 4.7 %, P < 0.001). Only 8 % of people with a spine fracture diagnosed by VFA had a self-reported fracture, and among those who self-reported a spine fracture, only 21 % were diagnosed with fracture by VFA. Conclusion: Spine fracture prevalence is similar in women and men and increases with age and lower BMD, although most subjects with spine fracture do not meet BMD criteria for osteoporosis. Since most (>90 %) individuals were unaware of their spine fractures, lateral spine imaging is needed to identify these women and men. Spine fracture prevalence was threefold higher in individuals meeting NOF criteria for spine imaging (∼1 in 7 undergoing VFA). Identifying spine fractures as part of comprehensive risk assessment may improve clinical decision making. [ABSTRACT FROM AUTHOR]

In this interview, NYU Law Professor Christopher Sprigman discusses his experience conceiving, drafting and producing the Indigo Book, a manual of legal citation that replicates the uniform system of citation expressed by Harvard Law Review's Bluebook. Formerly known as "Baby Blue," the Indigo Book is published by Public.Resource.Org under a creative commons license and may be freely modified or distributed without restriction under copyright law. Professor Sprigman details his vision for the Indigo Book, the legal copyright and trademark uncertainties the project faced, and his plans for the citation manual's future. [ABSTRACT FROM AUTHOR]

There is a need for a constitutional theory of imperative participation, as no comprehensive theory of participation exists to date and people everywhere in the world are asking for more influence in the exercise of public authority. The United States, as the oldest still-functioning democracy, with its well-developed participatory mechanisms, is the natural place to turn in order to find such a theory. Still, the United States Constitution only tacitly addresses participation, aside from the provisions governing the election of Congress and the President. However, participation can be conceptualized through the separation of powers doctrine. The latter can be understood not only as a system of checks and balances, but as an organizational principle balancing democracy (i.e., collective self-determination) and rule of law (i.e., individual self-determination). The United States Constitution's implicit rules on participation will be made explicit in this article in order to answer the two most important questions about any public participation in any given case. Firstly, who may participate in the exercise of public authority? Secondly, what legal effect does the participation possess? In this analysis, participation in the executive's delegated rulemaking procedures--which touches all three branches of government--will serve as the theory's litmus test. [ABSTRACT FROM AUTHOR]

Detailed knowledge regarding the whereabouts of people and their social activities in urban areas with high spatial and temporal resolution is still widely unexplored. Thus, the spatiotemporal analysis of Location Based Social Networks (LBSN) has great potential regarding the ability to sense spatial processes and to gain knowledge about urban dynamics, especially with respect to collective human mobility behavior. The objective of this paper is to explore the semantic association between georeferenced tweets and their respective spatiotemporal whereabouts. We apply a semantic topic model classification and spatial autocorrelation analysis to detect tweets indicating specific human social activities. We correlated observed tweet patterns with official census data for the case study of London in order to underline the significance and reliability of Twitter data. Our empirical results of semantic and spatiotemporal clustered tweets show an overall strong positive correlation in comparison with workplace population census data, being a good indicator and representative proxy for analyzing workplace-based activities. [ABSTRACT FROM AUTHOR]

Close parent-child relationships are viewed as important for the development of global self-esteem. Cross-sectional research supports this hypothesis, but longitudinal studies provide inconsistent prospective effects. The current study uses data from Germany (N = 982) and the United States (N = 451) to test longitudinal relations between parent-child closeness and adolescent self-esteem. The authors used self-, parent-, and observer-reported parent-child closeness and self-reported self-esteem from ages 12 to 16. Results replicated concurrent correlations found in the literature, but six longitudinal models failed to show prospective relations. Thus, the longitudinal effect of parent-child closeness and self-esteem is difficult to detect with adolescent samples. These findings suggest the need for additional theorizing about influences on adolescent self-esteem development and longitudinal research with younger samples. [ABSTRACT FROM AUTHOR]

A bstract Here, we examine the distribution, habitat use, and migratory destinations of North Pacific humpback whales wintering off Central America. Coastal boat surveys were conducted off Costa Rica and Panama between 1996 and 2003. In 1999, a broader survey was conducted along most of Central America. Over 23,000 km were surveyed, with the greatest effort off southern Costa Rica. We made 191 sightings of 320 individual humpback whales. Whales were seen between 14°N and 8°N, making this the most southerly of the North Pacific wintering areas. Encounters included singles, adult pairs, singers, and mother/calf pairs. Mother/calf pairs accounted for 27% of all groups sighted, which is one of the highest sighting rates reported among North Pacific wintering areas. Sixty percent of sightings occurred in depths <50 m. Average sea surface temperature was 28.6°C (±1.0 SD). Ninety percent of the 77 unique whales photo-identified were also seen in the California-Oregon-Washington feeding aggregation. The 1999 survey showed that humpback whales were widely distributed along the Central American coast at relatively low densities. The extensive distribution of animals, the higher proportion of calves, and the almost exclusive migration to a single feeding area contrast with observations in other regions. [ABSTRACT FROM AUTHOR]

Using a population-based, panel survey, we study how egocentric social networks change over time, and the relationship between egocentric network properties and health and pro-social behaviors. We find that the number of prosocial activities is strongly positively associated with having more friends, or an increase in degree, with approximately 0.04 more prosocial behaviors expected for every friend added. Moreover, having more friends is associated with an improvement in health, while being healthy and prosocial is associated with closer relationships. Specifically, a unit increase in health is associated with an expected 0.45 percentage-point increase in average closeness, while adding a prosocial activity is associated with a 0.46 percentage-point increase in the closeness of one's relationships. Furthermore, a tradeoff between degree and closeness of social contacts was observed. As the number of close social contacts increases by one, the estimated average closeness of each individual contact decreases by approximately three percentage-points. The increased awareness of the importance of spillover effects in health and health care makes the ascertainment of egocentric social networks a valuable complement to investigations of the relationship between socioeconomic factors and health. [ABSTRACT FROM AUTHOR]

The article discusses how ectogenesis will change the status, birth, and viability of an unborn child. It says that biologist Aldous Huxley envisioned the so-called ectogenesis in which human ova are fertilized in vitro and develop in an artificial uterus. It states that a child of ectogenesis would never be born naturally as stated in the U.S. Constitution. It also provides an impression of ectogenesis, the condition of science and law involved, and the need for changes in the law.

The author offers insights about measuring work which values productivity in health care in the U.S. The author discusses a study which aims to provide concepts on productivity management. He then mentions the impact of measuring work based on a purely economic taxonomy that has changed the value system from Hipporactic ideals.

Cloud-to-ground (CG) lightning, radar, and radiosonde data were examined to determine how frequently lake-effect storms (rain/snow) with lightning occurred over and near the lower Great Lakes region (Lakes Erie and Ontario) from September 1995 through March 2007. On average, lake-effect lightning occurred on 7.9 days and with 5.8 storm events during a particular cool season (September–March). The CG lightning with these storms had little inland extent and was usually limited to a few flashes per storm. Some storms had considerably more, with the most intense storm (based on National Lightning Detection Network observations) producing 1551 CG flashes over a 4-day period. Thundersnow events were examined in more detail because of the rarity of this phenomenon across the United States. Most lake-effect thundersnow events (75%) occurred in November and December. An analysis of model sounding data using the Buffalo Toolkit for Lake Effect Snow (BUFKIT) software package in which lower boundary conditions can be modified by lake surfaces showed that thundersnow events had an 82% increase in the mean height of the -10°C level when compared with nonelectrified lake-effect snowstorms (1.2 vs 0.7 km AGL), had higher lake-induced equilibrium levels (EL; above 3.6 km AGL) and convective available potential energy (CAPE; >500 J kg-1), had low wind shear environments, and were intense, single-band storms. A nomogram of the altitude of the -10°C isotherm and EL proved to be useful in predicting lake-effect thundersnowstorms. [ABSTRACT FROM AUTHOR]

The article focuses on the establishment by the U.S. of radar bases in the Czech Republic, which were strongly opposed by the public despite approval by the government. The U.S. opened official negotiations with the Czech Republic and Poland over the establishment of the bases in January 2007. However, reports revealed that negotiations had already started as early as May 2002. A Communist youth organization was able to collect around 90,000 signatures opposing the establishment of the bases. Information about the arguments in support of the petition initiative is provided.

Discusses the importance of collaboration among faculty and administrators for the development of electronic learning courseware in the U.S. Ways of encouraging the faculty to explore applications of digital technology for teaching, including incentives and clear ownership of intellectual property; Arguments against key misconceptions about electronic learning; Implications of copyright laws for faculty and administrators. INSET: Digital Chemistry at Berkeley.

Examines the use of interactive voice response (IVR) for market research in the U.S. Automated telephone systems; Advantages of IVR; Customer satisfaction with IVR.

Examines hypersensitivity of bulimic individuals to social interactions in the United States. Extent to which social factors precipitate discrete binge-eating episodes; Association of negative social interactions with increases in self-criticism; Precedence of binge episodes; Influences of interpersonal sensitivity in bulimic syndromes.

Diagnostic criteria lot anorexia nervosa emphasize characteristic behavioral and psychological symptomatology, including weight ‘phobia,’ willful pursuit of thinness, body-image distortion, obsessionality, and perfectionism. We find numerous examples among patients exhibiting low body weight and other anorexic-like symptomatology who, despite the presence of a definite eating disorder, fail to meet formal criteria for anorexia nervosa. We report five cases of this type, reviewing common features as a basis for proposing a subtype of Atypical Eating Disorders that has specific symptomatology and psychological characteristics, that can presently not be defined as either an anorexic or bulimic disorder. We offer speculations as to a possibly distinct etiology of such atypical eating disorders. [ABSTRACT FROM AUTHOR]

Despite considerable refinement in scientific concepts of skill, common sense concepts of skill prevail in the workplace. This paper examines common sense notions of skill and craft in United States building construction workplaces, focusing on the informal designations of construction labour (the `good craftsman,' `specialist,' and `jack-of-all-trades and master-of-none') and formal designations of union and non-union labour, using data drawn from empirical investigation. This skill ideology is examined for its role in social closure as well as contradictory aspects that may undermine collective interests. Further research on ideological discourses justifying pay, power and privilege is called for. [ABSTRACT FROM AUTHOR]

Previous research (Steiger and Wardell 1992) assessed post-industrial society and labor process hypotheses using data representing the entire United States paid workforce for 1950, 1970, and 1990. Results indicate a better fit between changes in the skill composition of the workforce as expected by labor process theory than by post-industrial society theory. The present research focuses on the United States service sector from 1950 to 1990 using detailed occupation by industry data. The research questions are whether the knowledge-based work of the services industries encourages 1) an upgraded and 2) a less gender segregated distribution of workers over time. We find that inclusion of women from the latent labor reserve offsets, in some industries severely, an otherwise upward shift in the proportion of service workers occupying higher skilled jobs. Moreover, where women have maintained a numerical majority, such as in professional services, their standing in the skill structure relative to men significantly deteriorated over the forty years. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to a January 31 editorial on obesity and the goal of the Department of Health and Human Services in the United States.

This paper examines the impact of citizen initiatives on Washington State's system of structured sentencing. Criminal justice sentencing guidelines were implemented in Washington's juvenile court system in 1978 and in its adult felony courts in 1984. In the twenty years since, both systems have experienced significant changes, many of which impact judicial and administrative discretion. Early modifications to the guidelines were driven by legislative and administrative concerns (budgeting, prison population management). More recent changes have been driven by citizen initiatives fostered as a response to public fear of crime and violence. Increasingly, the public has rejected the advice and management of adult sentencing guidelines by criminal justice professionals, and taken a direct hand through the initiative process in setting the limits of judicial and administrative discretion. As a result, structured sentencing has become more complicated and less internally consistent. It remains unclear whether this is the inevitable price of growth in single issue politics and more direct public involvement in the determination of sentencing policy. [ABSTRACT FROM AUTHOR]