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This article compares activities of the University of Michigan School of Public Health Public Health Action Support Team (PHAST) to the Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Applied Epidemiology Competencies (AECs) to determine the utility of using the competencies to assess extracurricular student training. We mapped the activities from eight PHAST trips occurring from 2006 to 2009 to the 34 AECs for Tier 1 epidemiologists by examining project activities to determine how closely they aligned with the AECs. PHAST trips provided students with opportunities to address 65% of the AECs; 29% of the AECs were addressed by all eight trips. The domains of AECs most often addressed by PHAST trips were leadership and systems thinking, cultural competency, and community dimensions of practice. Mapping PHAST trips to the AECs was useful for all public health students, not just epidemiologists in training. [ABSTRACT FROM AUTHOR]

This paper describes a reciprocal service-learning project between Master of Occupational Therapy (MOT) students and a Head Start program on the Texas-Mexico border. Education of occupational therapy students at the University of Texas Health Science Center at San Antonio includes local community learning experiences. However, this project challenged the students and faculty to step outside of and beyond their boundaries to address the unique needs of children in Del Rio, Texas. In a reciprocal service-learning situation, students provided developmental screenings, presentations, and classroom suggestions to the Head Start staff. In turn, the Head Start staff reciprocated by providing presentations and classroom cultural inclusion experiences to the students. The project outcomes suggest that collaborative participation can give students and their community partners broader frameworks from which to view enablement and a sense of mutual responsibility. From this starting point students can he encouraged to explore issues of social inclusion and occupational justice. [ABSTRACT FROM AUTHOR]

This article presents the textual analysis of the responses of 373 occupational therapists working in school systems across the United States of America who responded to the question 'List any obstacles to providing occupational therapy services to school aged students with severe emotional disturbance' on a recent survey. The purpose of the analysis is to describe some of the barriers and solutions to the provision of occupational therapy services to school aged students with emotional disturbance. The 754 responses received were categorized into themes. The themes which emerged from the occupational therapists' responses were: (1) role confusion; (2) limited knowledge base; (3) identification and provision of occupational therapy services; (4) administrative factors; (5) lack of efficient teaming; (6) classroom factors; (7) the behaviors of the student with emotional disturbance; and (8) parental factors. The respondents' suggestions for improving the provision of occupational therapy services to this population are discussed. [ABSTRACT FROM AUTHOR]

Photodegradation of plastic consumer products is known to accelerate weathering and facilitate the release of chemicals and plastic particles into the aquatic environment. However, these processes are complex. In our presented pilot study, eight plastic consumer products were leached in distilled water under strong ultraviolet (UV) light simulating eight months of Central European climate and compared to their respective dark controls (DCs). The leachates and formed plastic particles were exploratorily characterized using a range of chemical analytical tools to describe degradation and leaching processes. These techniques covered (a) microplastic analysis, showing substantial liberation of plastic particles further increased under UV exposure, (b) non-targeted mass spectrometric characterization of the leachates, revealing several hundreds of chemical features with typically only minor agreement between the UV exposure and the corresponding DCs, (c) target analysis of 71 organic analytes, of which 15 could be detected in at least one sample, and (d) metal(loid) analysis, which revealed substantial release of toxic metal(loid)s further enhanced under UV exposure. A data comparison with the US-EPA's ToxVal and ToxCast databases showed that the detected metals and organic additives might pose substantial health and environmental concerns, requiring further study and comprehensive impact assessments., 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 The Authors. Published by Elsevier B.V. All rights reserved.)

We developed a Target Plastic Model (TPM) to estimate the critical plastic burden of organic toxicants in five types of plastics, namely, polydimethylsiloxane (PDMS), polyoxymethylene (POM), polyacrylate (PA), low-density polyethylene (LDPE), and polyurethane ester (PU), following the Target Lipid Model (TLM) framework. By substituting the lipid-water partition coefficient in the TLM with plastic-water partition coefficients to create TPM, we demonstrated that the biomimetic nature of these plastic phases allows for the calculation of critical plastic burdens of toxicants, similar to the notion of critical lipid burdens in TLM. Following this approach, the critical plastic burdens of baseline ( n = 115), less-inert ( n = 73), and reactive ( n = 75) toxicants ranged from 0.17 to 51.33, 0.04 to 26.62, and 1.00 × 10 -6 to 6.78 × 10 -4 mmol/kg of plastic, respectively. Our study showed that PDMS, PA, POM, PE, and PU are similar to biomembranes in mimicking the passive exchange of chemicals with the water phase. Using the TPM, median lethal concentration (LC 50 ) values for fish exposed to baseline toxicants were predicted, and the results agreed with experimental values, with RMSE ranging from 0.311 to 0.538 log unit. Similarly, for the same data set of baseline toxicants, other widely used models, including the TLM (RMSE: 0.32-0.34), ECOSAR (RMSE: 0.35), and the Abraham Solvation Model (ASM; RMSE: 0.31), demonstrated comparable agreement between experimental and predicted values. For less inert chemicals, predictions were within a factor of 5 of experimental values. Comparatively, ASM and ECOSAR showed predictions within a factor of 2 and 3, respectively. The TLM based on phospholipid had predictions within a factor of 3 and octanol within a factor of 4, indicating that the TPM's performance for less inert chemicals is comparable to these established models. Unlike these methods, the TPM requires only the knowledge of plastic bound concentration for a given plastic phase to calculate baseline toxic units, bypassing the need for extensive LC 50 and plastic-water partition coefficient data, which are often limited for emerging chemicals. Taken together, the TPM can provide valuable insights into the toxicities of chemicals associated with environmental plastic phases, assisting in selecting the best polymeric phase for passive sampling and designing better passive dosing techniques for toxicity experiments.

Introduction: Public safety personnel (PSP) experience operational stress injuries (OSIs), which can put them at increased risk of experiencing mental health and functional challenges. Such challenges can result in PSP needing to take time away from the workplace. An unsuccessful workplace reintegration process may contribute to further personal challenges for PSP and their families as well as staffing shortages that adversely affect PSP organizations. The Canadian Workplace Reintegration Program (RP) has seen a global scale and spread in recent years. However, there remains a lack of evidence-based literature on this topic and the RP specifically. The current qualitative study was designed to explore the perspectives of PSP who had engaged in a Workplace RP due to experiencing a potentially psychologically injurious event or OSI., Methods: A qualitative thematic analysis analyzed interview data from 26 PSP who completed the RP. The researchers identified five themes: (1) the impact of stigma on service engagement; (2) the importance of short-term critical incident (STCI) program; (3) strengths of RP; (4) barriers and areas of improvement for the RP; and (5) support outside the RP., Discussion: Preliminary results were favorable, but further research is needed to address the effectiveness, efficacy, and utility of the RP., Conclusion: By addressing workplace reintegration through innovation and research, future initiatives and RP iterations can provide the best possible service and support to PSP and their communities.

Coastal German waters contain about 1.6 million tons of dumped munition, mostly left after World Wars. This study investigated the benthic macrofauna around the 'Kolberger Heide' munition dumpsite (Baltic Sea). A total of 93 macrofauna grab samples were obtained in the proximity of the munition dumpsite and in reference areas. Environmental variables analysed included the latitude/longitude, depth, terrain ruggedness, sediment grainsize distribution, TNT concentration in the bottom water and distance to the centre of munition dumpsite. The overall abundance, biomass and diversity varied among these groups, though demonstrated no clear differences regarding the proximity to munition and modelled near-bottom dissolved TNT. Among individual taxa, however, a total of 16 species demonstrated significant correlation with TNT concentration. Moreover, TNT may serve as a predictor for the distribution of three species: molluscs Retusa truncatula, Varicorbula gibba and polychaete Spio goniocephala. Possible reasons for the species distribution including their biological traits are discussed., 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 © 2023. Published by Elsevier Ltd.)

Objective: Peer support providers are part of the behavioral health workforce. Research indicates that peer support helps care recipients achieve recovery and engage with behavioral health services. This article investigated how many U.S. behavioral health facilities offer peer support services and compared the frequencies of peer support services in facilities providing mental health and substance use services., Methods: The authors conducted a secondary analysis of facilities in the Substance Abuse and Mental Health Services Administration's National Mental Health Services Survey (N=11,582) and the National Survey of Substance Abuse Treatment Services (N=13,585), including descriptive and comparative analyses on reported mental health and substance use treatment services in the 50 U.S. states in 2017., Results: The findings revealed state-to-state variation in the number and availability of mental health and substance use service facilities and in facilities that reported providing peer support services. Facilities providing substance use treatment services offered peer support services at more than twice the rate (56.6%) found in mental health facilities (24.7%). The authors also identified program characteristics associated with the inclusion of peer support services in behavioral health. Provision of peer support services was more frequently reported by public facilities than by for-profit and nonprofit facilities., Conclusions: Behavioral health facilities that serve individuals with serious mental illness and co-occurring substance use and mental health conditions reported offering peer support at a higher rate than did other facilities. Inconsistent definitions of peer support in the two surveys limited the comparability of the findings between the two reports., Competing Interests: The contents in this article are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. government.The authors report no financial relationships with commercial interests.

Mercury (Hg) fulminate was used as a primary fuse in World War (WW) munitions, and may consequently be a Hg source for impacted environments. Mercury is a conspicuous and persistent pollutant, with methylmercury (MeHg) acting as a notorious neurotoxin. Considerable amounts of munitions were intentionally dumped in the North Sea and Baltic Sea following the First and Second WWs. After more than 70 years on the seafloor many munitions have corroded and likely release explosive compounds, including Hg fulminate. The Germany coastal city of Kiel was a manufacturing centre for submarines, and accordingly a prominent target for bombing and post-war disarmament. We collected water and sediment samples around Kiel Bay to assess regional levels and quantify any Hg contamination. The munition dump site Kolberger Heide (KH) and a former anti-aircraft training center Dänisch-Nienhof are situated in Kiel Bay, and were targeted for sampling. Sediment Hg concentrations around KH were notably elevated. Average Hg concentrations in KH sediments were 125 ± 76 ng/g, compared to 14 ± 18 ng/g at background (control) sites. In contrast, dissolved Hg in the water column exhibited no site variations, all ranging between 0.8 and 2.1 pM. Methylmercury in sediments and waters did not have enhanced concentrations amongst sites (<30 pg/g and <50 fM, respectively). Sediment-water exchange experiments showed elevated Hg and MeHg fluxes (i.e. >400 pmol m -2 d -1 MeHg) at one KH location, however remaining cores had low to no Hg and MeHg output (<0-27 pmol m -2 d -1 MeHg). Thus, sediments in Kiel Bay proximate to WW munitions could harbor and form a source of Hg, however water column mixing and removal processes attenuate any discharge from the seafloor to overlying waters., 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 © 2023 Elsevier Ltd. All rights reserved.)

Armed conflicts have, in addition to severe impacts on human lives and infrastructure, also impacts on the environment, which needs to be assessed and documented. On September the 26th 2022, unknown perpetrators deliberately ruptured the two gas pipelines Nord Stream 1 and 2 with four coordinated explosions near a major chemical munition dump site near the Danish island of Bornholm in the Baltic Sea. While the massive release of natural gas into atmosphere raised serious concerns concerning the contribution to climate change-this paper assesses the overlooked direct impact of the explosions on the marine ecosystem. Seals and porpoises within a radius of four km would be at high risk of being killed by the shockwave, while temporary impact on hearing would be expected up to 50 km away. As the Baltic Proper population of harbour porpoises (Phocoena phocoena) is critically endangered, the loss or serious injury of even a single individual is considered a significant impact on the population. The rupture moreover resulted in the resuspension of 250000 metric tons of heavily contaminated sediment from deep-sea sedimentary basin for over a week, resulting in unacceptable toxicological risks towards fish and other biota in 11 km 3 water in the area for more than a month., (© 2023. The Author(s).)

Isolation and detection of microplastics (MP) in marine samples is extremely cost- and labor-intensive, limiting the speed and amount of data that can be collected. In the current work, we describe rapid measurement of net-collected MPs (net mesh size 300 µm) using a benchtop near-infrared hyperspectral imaging system during a research expedition to the subtropical North Atlantic gyre. Suspected plastic particles were identified microscopically and mounted on a black adhesive background. Particles were imaged with a Specim FX17 near-infrared linescan camera and a motorized stage. A particle mapping procedure was built on existing edge-finding algorithms and a polymer identification method developed using spectra from virgin polymer reference materials. This preliminary work focused on polyethylene, polypropylene, and polystyrene as they are less dense than seawater and therefore likely to be found floating in the open ocean. A total of 27 net tows sampled 2534 suspected MP particles that were imaged and analyzed at sea. Approximately 77.1% of particles were identified as polyethylene, followed by polypropylene (9.2%). A small fraction of polystyrene was detected only at one station. Approximately 13.6% of particles were either other plastic polymers or were natural materials visually misidentified as plastics. Particle size distributions for PE and PP particles with a length greater than 1 mm followed an approximate power law relationship with abundance. This method allowed at-sea, near real-time identification of MP polymer types and particle dimensions, and shows great promise for rapid field measurements of microplastics in net-collected samples., (© 2023. The Author(s).)

The abundance of plastic debris (PDs) and its correlation with phthalic acid esters (PAEs), a class of pollutants associated with plastics, is not well understood, although PDs have been reported in relation to the release and distribution of aquatic pollutants such as PAEs. Few studies have linked the distribution of these pollutants in seawater. The current study examined the abundance and relationship of PDs and PAEs in seawater from Sharm Obhur and the Red Sea. Estimates were also made of their ecological impacts. Sharm Obhur is a semi-enclosed bay on the eastern shore of the Red Sea, near Jeddah, Saudi Arabia, and is heavily impacted by human activities. Contaminants from Sharm Obhur may be transported into the deep waters of the Red Sea by the subsurface outflow. The PAEs concentrations in the study area ranged from 0.8 to 1224 ng/L. Among the six PAEs studied, diethyl phthalate (DEP) (22-1124 ng/L), di-n-butyl phthalate (DBP) (9-346 ng/L) and di (2-ethylhexyl) phthalate (DEHP) (62-640 ng/L) were the predominant additives detected across all the sampling sits. Whereas the other PAEs, dimethyl phthalate (DMP) (5-76 ng/L), benzyl butyl phthalate (BBP) (4-25 ng/L) and di-n-octyl phthalate DnOp (0.5-80 ng/L) were generally lower in most samples. The sum of the six analyzed PAEs (∑ 6 PAEs) was lower at Sharm Obhur (587 ± 82 ng/L) and in the Red Sea shelf (677 ± 182 ng/L) compared to the Red Sea shelf break (1266 ± 354 ng/L). This suggests that degradation and adsorption of PAEs were higher in Sharm Obhur and on the shelf than on the shelf break. In contrast, there was no difference in the abundance of PDs between Sharm Obhur (0.04 ± 0.02 PDs/m 3 ), Red Sea shelf (0.05 ± 0.02 PDs/m 3 ) and in the Red Sea shelf break (0.03 ± 0.1 PDs/m 3 ). Polyethylene (32%) and polypropylene (8%) were dominant, mostly smaller than 5 mm 2 (78%), with the majority consisting of white (52%) and black (24%) fragments (39%), fibers (35%) and films (24%). A positive correlation between PAE concentration and abundance of PDs, suggests either a common source or a causal link through leaching. The ecological risk of ∑ 4 PAEs (DMP, DEP, DBP and DEHP) ranged from (0.20-0.78), indicating a low to moderate risk for the Red Sea. The pollution index of PDs ranged from (0.14-0.36), showing that the Sharm Obhur and both sites of Red Sea suffered relatively low pollution., 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 © 2022 Elsevier Ltd. All rights reserved.)

Study Background: Back injuries are common among nurses worldwide with lifetime prevalence of lower back pain ranging from 35% to 80%, making nursing a profession at great risk for back injuries., Purpose: This systematic scoping review explored and mapped existing evidence regarding the prevention of low back injury and pain among nurses and nursing students., Methods: Using a scoping review methodology, six databases were searched initially in September 2017 and updated June 2020. Studies investigating interventions designed to reduce back injuries and pain among regulated nurses and student nurses, published in peer-review journals and written in English, were eligible for inclusion in this review. Quantitative, qualitative, and mixed methods studies of regulated nurses, nursing students, and nursing aides were included. Two independent reviewers screened, critically analysed studies using a quality appraisal tool, extracted data, and performed quality appraisals., Results: Two searches yielded 3,079 abstracts and after title, abstract and screening, our final synthesis was based on 48 research studies., Conclusions: Forty years of research has demonstrated improvements in quality over time, the efficacy of interventions to prevent back injury and pain remains unclear, given the lack of high-quality studies. Further research, using multi-dimensional approaches and rigorous study designs, are needed.

Mercury fulminate (HgFu) was used as an initial detonator for World War I and II munitions. Its presence in previously discarded and dumped munitions could potentially supply mercury pollution into coastal ecosystems where bygone weaponries reside. There is evidence that historical munitions have already contributed mercury pollution in coastal environments, and millions remain embedded in sediments and subjected to further weakening via corrosion under environmental conditions. Experiments were undertaken assessing HgFu dissolution under varying temperature and salinity conditions to constrain controls on mercury release into marine environments. Our results show that HgFu discharge is strongly temperature dependent, with dissolution rate constants increasing from ∼0.4 mg cm -2 d -1 at 5 °C to ∼2.7 mg cm -2 d -1 at 30 °C. No significant differences were observed between freshwater and seawaters up to 36 psu, except at 5 °C. These experiments provide a basis for modeling HgFu release from underwater munitions and its dynamics in coastal environments., 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 © 2022 Elsevier Ltd. All rights reserved.)

In this study, the leaching of six phthalic acid esters (PAEs) from three common consumer plastics was investigated: low and high density polyethylene (LDPE, HDPE) and recycled polyethylene (RP). The effects of salinity, temperature, and ultraviolet irradiation (UVR) on leaching were investigated. The study of leaching of phthalates in aqueous environments in batch experiments is challenging due to their readsorption by the high hydrophobicity of PAEs, and there are no standard methods to study release processes. Here with the experiments, leaching (A) and spiking (B) using six PAEs to study the readsorption in the leaching process. PAEs were identified and quantified using GC-MS. Dibutyl phthalate (DBP) and benzyl butyl phthalate (DEHP) showed considerable leaching during the 5-day incubation: 14 ± 1 to 128 ± 14 and 25 ± 2 to 79 ± 5 ng/cm 2 , respectively, under UVR, corresponding approximately to (1.9-13%) and (12.4-22.4%) of the solvent extracted mass. The highest K d values were measured for RP polymers (0.3-9.4), followed by LDPE (0.5-5.4) and HDPE (0.2-2.2) polymers. Thus, readsorption of PAEs at the surface removed 30-80% of the leached PAEs in the dissolved phase. For example in LDPE, the calculated total release of DBP was up to 54 ± 4 ng/cm 2 , while the dissolved amount was 8.5 ± 1 ng/cm 2 during the 5-day incubation under freshwater conditions. Increasing salinity negatively affected the leaching rate, which decreased for DBP from 54 ± 4 ng/cm 2 in freshwater to 44 ± 3 and 38 ± 3 ng/cm 2 at salinity of 20 and 40 g/L, respectively, from LDPE during the 5-day incubation. Temperature and UVR had a positive effect on the leaching rate, with the release of DBP from LDPE increasing from 44 ± 3 ng/cm 2 at room temperature (25 °C) to 60 ± 6 and 128 ± 14 ng/cm 2 at high temperature (40 °C) and UVR, respectively. Overall, this study highlights the positive relationship between temperatures, UVR on the extent of leaching and surface adsorption on the leaching measurements., 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 © 2022. Published by Elsevier B.V.)

Summary: Primary hyperparathyroidism (PHP) is the most common aetiology for hypercalcaemia. The incidence of PHP in pregnant women is reported to be 8/100 000 population/year. It presents a threat to the health of both mother (hyperemesis, nephrolithiasis) and fetus (fetal death, congenital malformations, and neonatal severe hypocalcaemia-induced tetany). However, there is a lack of clear guidance on the management of primary hyperparathyroidism in pregnancy. In this study, we describe the case of a 26-year-old female patient who presented with severe hypercalcaemia secondary to PHP and underwent successful parathyroid adenectomy under local anaesthesia., Learning Points: Primary hyperparathyroidism is a rare complication in pregnancy, but the consequences for mother and fetus can be severe. A perceived risk of general anaesthesia to the fetus in the first trimester has resulted in a general consensus to delay parathyroid surgery to the second trimester when possible - although the increased risk of fetal loss may occur before planned surgery. If the patient presents with severe or symptomatic hypercalcaemia, minimally invasive surgery under local anaesthetic should be considered regardless of the gestational age of the pregnancy.

Objective: The objective of this review is to examine the perceptions and experiences of health care professionals and staff in implementing or coordinating animal-assisted interventions in health care settings., Introduction: Animal-assisted interventions are applied in the areas of health, education, and human services to help improve individuals' health and wellness. The positive effects of animal-assisted interventions on individuals have been shown in multiple health disciplines, from pediatrics to long-term care, and include outcomes such as decreased feelings of loneliness and increased feelings of support. The increase of animal-assisted interventions in human health has initiated growing research on health care professionals' perceptions and experiences of these interventions. No current qualitative systematic reviews have focused solely on health care professionals' and staff's perceptions of animal-assisted interventions. Conducting such a review will advance understanding of how these providers perceive and engage with animal-assisted interventions as well as their influence and role in coordinating these interventions., Inclusion Criteria: This review will consider qualitative primary studies that address the perceptions and experiences of health care professionals and staff in implementing or coordinating animal-assisted interventions in health care settings., Methods: Nine bibliographic databases will be systematically searched for published and unpublished studies by employing a three-step search strategy. Studies published from database inception to present and in English will be considered. Two reviewers will independently appraise the studies and extract qualitative data using the standardized JBI critical appraisal and data extraction instruments. Findings from the review will be categorized according to similarity in meaning, and categories will be subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings., Systematic Review Registration Number: PROSPERO CRD42021258909., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 JBI.)

The public health workforce broadly-across disciplines, tiers, and settings-requires strategic skills to advance population health outcomes. In early 2020, the Region V Public Health Training Center conducted a competency-based training needs assessment survey with all 501 local health departments in the 6-state region, including small agencies that were previously excluded from available national data sources. Health officials or designees from 290 agencies responded (58% response rate) with perspectives regarding the ability of their staff to sufficiently apply strategic skills. Findings highlight training needs among the region's local governmental public health workforce and differences in those needs by the size of population served by the agency. Notable training priorities include the skill domains of Budgeting & Financial Management and Change Management, among others., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Relic munitions are a hazardous legacy of the two world wars present in coastal waters worldwide. The southwest Baltic Sea has an especially high prevalence of unexploded ordnance and dumped munition material, which represent a large potential source of toxic explosive chemicals (munition compounds, MC). In the current study, diverse biota (plankton, macroalgae, tunicate, sponge, mollusc, echinoderm, polychaete, anemone, crustacea, fish) were collected from the Kiel Bight and a munitions dumpsite at Kolberger Heide, Germany, to evaluate the potential bioaccumulation of explosives and their derivatives (2,4,6-trinitrotoluene, TNT; 2-amino-4,6-dinitrotoluene and 4-amino-2,6-dinitrotoluene, ADNT; 2,4-diamino-6-nitrotoluene and 2,6-diamino-4-nitrotoluene, DANT; 1,3-dinitrobenzene, DNB; and 1,3,5-trinitro-1,3,5-triazinane, RDX). One or more MCs were detected in >98% of organisms collected throughout the study region (n = 178), at a median level of 6 pmol/g (approximately 1 ng/g) and up to 2 × 10 7  pmol/g (TNT in Asterias rubens collected from Kolberger Heide). In most cases, TNT and its transformation product compounds ADNT and DANT were significantly higher in biota from the munitions dumpsite compared with other locations. Generally, DNB and RDX were detected less frequently and at lower concentrations than TNT, ADNT, and DANT. In commercially important fish species (plaice, flounder) from Kolberger Heide, TNT and ADNT were detected in 17 and 33% of samples, respectively. In contrast DANT was detected in every fish sample, including those outside the dumpsite. Dinitrobenzene was the second most prevalent MC in fish tissue. Fish viscera (stomach, kidney, liver) showed higher levels of DANT than edible muscle flesh, with highest DANT in liver, suggesting reduced risk to seafood consumers. This study provides some of the first environmental evidence for widespread bioaccumulation of MC in a coastal marine food web. Although tissue MC content was generally low, corrosion of munition housings may lead to greater MC release in the future, and the ecological risk of this exposure is unknown., 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 © 2021 Elsevier B.V. All rights reserved.)

Objective: The objective of this scoping review is to map the evidence related to how consumer-targeted wearable and mobile technology is being used to measure and/or promote sleep among adolescents., Introduction: Sleep is a key component of physical and mental health and is required for healthy development in adolescence. Efforts to improve insufficient and poor-quality sleep among adolescents have resulted in limited and temporary enhancements in sleep habits. Since good sleep hygiene is established through the development of daily routines, wearable technology offers a potential solution by providing real-time feedback, allowing adolescents to monitor and manage their sleep habits., Inclusion Criteria: Studies that focus on adolescents between 13 and 24 years who use mobile or wearable technology to measure and/or promote sleep health will be considered for inclusion., Methods: Using a scoping methodology, the authors will conduct a review of studies on the use of commercially available, wearable technology or mobile devices designed to measure and/or improve sleep among adolescents. Literature searched will include published primary studies, reviews, and dissertations from database inception to present. Databases searched will include MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL, SPORTDiscus, JBI Evidence Synthesis, Cochrane Database of Systematic Reviews, Scopus, and ProQuest Dissertations and Theses. The search will be conducted using identified keywords and indexed terms, and studies will be limited to the English language. Data extracted will include study population, methods, description of sleep technology reported, sleep outcomes, and strategies used to promote healthy sleep behaviors. Quality assessment of included studies will be conducted to facilitate data mapping and synthesis., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 JBI.)

Context: Peer providers with lived experiences of mental health and substance use are a growing component of the workforce responsible for the prevention and treatment of behavioral health disorders. This systematic literature review aims to better define the roles of peers and their unique contributions to behavioral health care., Evidence Acquisition: Researchers searched MEDLINE, CINAHL Complete, PsycINFO, Cochrane Central, and Scopus databases for studies published between January 1, 2013 and April 3, 2020. Studies were included if they (1) were experimental or observational studies, (2) included an adult population of people with a behavioral health disorder, and (3) used paid peer providers in addition to traditional behavioral health services. Researchers extracted sample demographics, intervention characteristics, outcome data, and significant associations from studies that met inclusion criteria and assessed the trends in these data in May 2020., Evidence Synthesis: A total of 23 articles assessing peer-provided services were included. Peers were employed most frequently in mental healthcare roles in the Department of Veterans Affairs, hospital, and community health facilities. A total of 14 studies observed significant clinical improvements in participants' social functioning, quality of life, patient activation, and behavioral health. A majority of studies involved the supervision of peers and required peers to have completed training in service delivery., Conclusions: Peers are effective providers of behavioral health treatment and relapse prevention services who encourage recovery through resilience building, empowerment, and self-advocacy. There remains a need for more evidence-based interventions on the efficacy of peers in substance use disorder treatment and the impact of formalized certification and training opportunities., (Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Bacteria are ubiquitous and live in complex microbial communities. Due to differences in physiological properties and niche preferences among community members, microbial communities respond in specific ways to environmental drivers, potentially resulting in distinct microbial fingerprints for a given environmental state. As proof of the principle, our goal was to assess the opportunities and limitations of machine learning to detect microbial fingerprints indicating the presence of the munition compound 2,4,6-trinitrotoluene (TNT) in southwestern Baltic Sea sediments. Over 40 environmental variables including grain size distribution, elemental composition, and concentration of munition compounds (mostly at pmol⋅g -1 levels) from 150 sediments collected at the near-to-shore munition dumpsite Kolberger Heide by the German city of Kiel were combined with 16S rRNA gene amplicon sequencing libraries. Prediction was achieved using Random Forests (RFs); the robustness of predictions was validated using Artificial Neural Networks (ANN). To facilitate machine learning with microbiome data we developed the R package phyloseq2ML. Using the most classification-relevant 25 bacterial genera exclusively, potentially representing a TNT-indicative fingerprint, TNT was predicted correctly with up to 81.5% balanced accuracy. False positive classifications indicated that this approach also has the potential to identify samples where the original TNT contamination was no longer detectable. The fact that TNT presence was not among the main drivers of the microbial community composition demonstrates the sensitivity of the approach. Moreover, environmental variables resulted in poorer prediction rates than using microbial fingerprints. Our results suggest that microbial communities can predict even minor influencing factors in complex environments, demonstrating the potential of this approach for the discovery of contamination events over an integrated period of time. Proven for a distinct environment future studies should assess the ability of this approach for environmental monitoring in general., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Janßen, Beck, Werner, Dellwig, Alneberg, Kreikemeyer, Maser, Böttcher, Achterberg, Andersson and Labrenz.)

Introduction: Due to the COVID-19 pandemic and prompted by recent federal and state policy shifts impacting behavioral health care delivery, the use of telebehavioral health has rapidly increased. This qualitative study describes behavioral health provider perspectives on the use of telebehavioral health before and during the pandemic and how policy changes impacted access to and utilization of behavioral health services in Michigan. Materials and Methods: A convenience sample of 31 licensed and nonlicensed behavioral health providers operating in Michigan participated in semi-structured interviews between July and August 2020. Interviews were audio-recorded, transcribed, and analyzed by using inductive methods. Results: The thematic analysis resulted in four overarching themes: (1) increased access to care; (2) maintenance of quality of care; (3) minimal privacy concerns; and (4) client and provider satisfaction. Discussion: During and post-pandemic, providers need flexibility to determine whether in-person or telebehavioral health services, including audio-only, best meet client needs. Providers identified several populations for which telebehavioral health was less accessible: clients with serious mental illness and substance use disorder, those with no broadband Internet access, children, and older adults. Additional training in telebehavioral health service provision can positively impact quality of care. Conclusion: Policies that support reimbursement parity and expand provider use of telebehavioral health services should be maintained after the COVID-19 pandemic ends to avoid imposing barriers to accessing behavioral health care barriers post-pandemic.

Introduction: Collaborative research approaches, such as co-production, co-design, engaged scholarship and integrated knowledge translation (IKT), aim to bridge the evidence to practice and policy gap. There are multiple benefits of collaborative research approaches, but studies report many challenges with establishing and maintaining research partnerships. Researchers often do not have the opportunity to learn how to build collaborative relationships, and most graduate students do not receive formal training in research partnerships. We are unlikely to make meaningful progress in strengthening graduate and postgraduate training on working collaboratively with the health system until we have a better understanding of how students are currently engaging in research partnership approaches. In response, this scoping review aims to map and characterise the evidence related to using an IKT or other research partnership approach from the perspective of health research trainees., Methods and Analysis: We will employ methods described by the Joanna Briggs Institute and Arksey and O'Malley's framework for conducting scoping reviews. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews checklist. We will include both published and unpublished grey literature and search the following databases: MEDLINE, Embase, CINAHL, PsycINFO, ProQuest Dissertations & Theses Global databases, Google Scholar and websites from professional bodies and other organisations. Two reviewers will independently screen the articles and extract data using a standardised data collection form. We will narratively describe quantitative data and conduct a thematic analysis of qualitative data. We will map the IKT and other research partnership activities onto the Knowledge to Action cycle and IAP2 Levels of Engagement Framework., Ethics and Dissemination: No ethical approval is required for this study. We will share the results in a peer-reviewed, open access publication, conference presentation and stakeholder communications., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Evidence demonstrates that medications for treating opioid use disorder (MOUD) -namely buprenorphine, methadone, and extended-release naltrexone-are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications., Methods: To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods., Results: Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers-such as a lack of addiction treatment specialists-as additional barriers to prescribing medications to treat OUD., Conclusions: Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications.

As postsecondary tuition and debt levels continue to rise, the value proposition of higher education has been increasingly called into question by the popular media and the general public. Recent data from the National Center for Education Statistics now show early career earnings and debt, by program, for thousands of institutions across the United States. This comes at an inflection point for public health education-master's degrees have seen 20 years of growth, but forecasts now call for, at best, stagnation.Forces inside and outside the field of public health are shifting supply and demand for public health master's degrees. We discuss these forces and identify potential monetary and nonmonetary costs and benefits of these degrees.Overall, we found a net benefit in career outcomes associated with a public health master's degree, although it is clear that some other master's degrees likely offer greater lifetime earning potentials or lower lifetime debt associated with degree attainment. We outline the issues academic public health must engage in to successfully attract and train the next generation of public health graduates.

Rivers are a major supplier of particulate and dissolved material to the ocean, but their role as sources of bio-essential dissolved iron (dFe) is thought to be limited due to rapid, efficient Fe removal during estuarine mixing. Here, we use trace element and radium isotope data to show that the influence of the Congo River margin on surface Fe concentrations is evident over 1000 km from the Congo outflow. Due to an unusual combination of high Fe input into the Congo-shelf-zone and rapid lateral transport, the Congo plume constitutes an exceptionally large offshore dFe flux of 6.8 ± 2.3 × 10 8  mol year -1 . This corresponds to 40 ± 15% of atmospheric dFe input into the South Atlantic Ocean and makes a higher contribution to offshore Fe availability than any other river globally. The Congo River therefore contributes significantly to relieving Fe limitation of phytoplankton growth across much of the South Atlantic.

OBJECTIVE: To examine the size and distribution of the advanced practice psychiatric nurse workforce relative to the total psychiatry workforce to determine whether nurses are predominantly working in areas with higher or lower levels of behavioral health specialists. METHODS: State-level data for psychiatric nurses were obtained from the American Nurses Credentialing Center, and included mental health psychiatric nurse practitioners, adult psychiatric nurse practitioners, child psychiatric clinical nurse specialists, and adult psychiatric clinical nurse specialists. Supply estimates of the full psychiatry workforce were calculated for comparison purposes. State population estimates were obtained from U.S. Census Bureau data. State workforce estimates were converted to a 1:100,000 provider-to-population ratio to analyze the density of providers across states. RESULTS: In 2018, the psychiatric workforce supply was estimated to be composed of 66,740 providers, including psychiatrists ( n = 47,046; 71%), psychiatric nurses ( n = 17,534; 26%), physician assistants ( n = 1,164; 2%), and psychiatric pharmacists ( n = 966; 1%). Overall, psychiatric providers appeared to be most densely concentrated in the northeast region of the United States. A dearth of providers was most pronounced within areas in the 12-state Midwest region, southern states, California, and Nevada. The average concentration of psychiatric workers was 22.61 per 100,000 population. CONCLUSIONS: The findings of this study find inconsistent pattern of how psychiatric nurses are distributed relative to the rest of the workforce, but reinforce the idea that they are essential in addressing care needs in areas with low concentrations of psychiatry specialists-especially if they are authorized to work to the full extent of their training/education.

As a consequence of World War II, large amounts of munition have been deposited in coastal waters. Deterioration of the mines and bombs is resulting in a release of munition compounds (MCs) like trinitrotoluene to the surrounding marine environment, with potential implications to ecosystems. Analytical methods have thus far been unable to detect these compounds reliably in seawater. We present a highly sensitive method for the analysis of MCs in the marine environment. We combine preconcentration and sample clean up by solid phase extraction with separation and detection by ultra-high performance liquid chromatography - electrospray ionisation - mass spectrometry (UHPLC-ESI-MS) for the detection of MCs dissolved in filtered (< 0.2 µm) seawater. For biota, dried and ground samples were extracted in acetonitrile and analysed after simple dilution. Eleven MCs were detected by UHPLC-ESI-MS with limits of detection between 0.01 and 25 pg. For the first time, we used heavy isotopes of trinitroluene and dinitrobenzene to improve quantification in environmental samples. We detected 7 MCs in waters sampled at a known munition disposal site in the Baltic Sea after a 1000-fold preconcentration and using an injection volume of 25 µL. Trinitrotoluene and dinitrobenzene were the most abundant MCs, occurring at concentrations between 0.1 and 11.8 ng L -1 . We observed 10 MCs at concentrations up to 24 µg g -1 dry weight in benthic organisms sampled from the site. The enhanced sensitivity of our method allowed us to detect MCs at concentrations relevant for assessment and management of munitions disposal sites in the marine environment., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Multiple-choice examinations (MCEs) are commonly used to evaluate nursing students. Nurse educators require support to develop questions and engage in postexam analysis to ensure reliable assessment of student learning. We surveyed nurse educators and conducted focus groups to investigate current writing practices associated with MCEs. Using appreciative inquiry, participants proposed ideals to strengthen MCE practice: guidelines and expectations for faculty, faculty-developed test banks, team development, and an assessment blueprint at the curriculum level. Faculty supports are necessary to strengthen current MCE practices and best utilize the skills of educators.

Underwater munitions containing millions of tons of toxic explosives are present worldwide in coastal marine waters as a result of unexploded ordnance and intentional dumping. The dissolution flux of solid explosives following corrosion of metal munition housings controls the exposure of biological receptors to toxic munition compounds (MC), including TNT: 2,4,6-trinitrotoluene, RDX: 1,3,5-trinitro-1,3,5-triazinane, and DNB: 1,3-dinitrobenzene. Very little is known about the dissolution behavior of MC in the marine environment. In this work, we exploit a unique marine study site in the Baltic Sea with exposed solid explosives to quantify in situ MC dissolution fluxes using dissolved MC gradients near the exposed explosive surface, as well as benthic chamber incubations. The gradient method gave dissolution fluxes that ranged between 0.001 and 3.2, between 0.0001 and 0.04, and between 0.003 and 1.7 mg cm -2 day -1 for TNT, RDX, and DNB, respectively. Benthic chamber incubations indicated dissolution fluxes of 0.0047-0.277, 0-0.11, and 0.00047-1.45 mg cm -2 day -1 for TNT, RDX, and DNB, respectively. In situ dissolution fluxes estimated in the current study were lower than most dissolution rates reported for laboratory experiments, but they clearly demonstrated that MC are released from underwater munitions to the water column in the Baltic Sea.

Interprofessional education (IPE) is based on the concept that health professional students are best trained on the skills, knowledge, and attitudes that promote population health when they learn with and about others from diverse health science fields. Previously, IPE has focused almost exclusively on the clinical context. This study piloted and evaluated an IPE learning experience that emphasizes population health in a sample of public health undergraduate students. We hypothesized that students who completed the 2-hour online asynchronous module would better understand the value of public health's role in interprofessional teams, the benefit of interprofessional teamwork in improving health outcomes, and the value of collaborative learning with other interprofessional students. Students engaged in pre- and post-training assessments and individual reflections throughout the module. Sixty-seven undergraduate public health students completed the module and assessments. After completion, a greater proportion strongly agreed that students from different health science disciplines should be educated in the same setting to form collaborative relationships with one another (19 vs. 39% before and after completion, respectively). A greater proportion also strongly agreed that care delivered by an interprofessional team would benefit the health outcomes of a patient/client after the training (60 vs. 75% before and after, respectively). Mean scores describing how strongly students agreed with the above two statements significantly increased post-training. A greater proportion of students strongly agreed that incorporating the public health discipline as part of an interprofessional team is crucial to address the social determinants of health for individual health outcomes after taking the training (40 vs. 55% before and after, respectively). There was little change in attitudes about the importance of incorporating public health as part of an interprofessional team to address social determinants of health for population health outcomes, which were strongly positive before the training. Most students reported being satisfied with the module presentation and felt their understanding of interprofessional practice improved. This training may be useful for students from all health disciplines to recognize the benefits of engaging with and learning from public health students and to recognize the important role of public health in interprofessional practices.

Public health workforce size and composition have been difficult to accurately determine because of the wide variety of methods used to define job title terms, occupational categories, and worker characteristics. In 2014, a preliminary consensus-based public health workforce taxonomy was published to standardize the manner in which workforce data are collected and analyzed by outlining uniform categories and terms. We summarize development of the taxonomy's 2017 iteration and provide guidelines for its implementation in public health workforce development efforts. To validate its utility, the 2014 taxonomy was pilot tested through quantitative and qualitative methods to determine whether further refinements were necessary. Pilot test findings were synthesized, themed by axis, and presented for review to an 11-member working group drawn from the community of experts in public health workforce development who refined the taxonomy content and structure through a consensus process. The 2017 public health workforce taxonomy consists of 287 specific classifications organized along 12 axes, intended for producing standardized descriptions of the public health workforce. The revised taxonomy provides enhanced clarity and inclusiveness for workforce characterization and will aid public health workforce researchers and workforce planning decision makers in gathering comparable, standardized data to accurately describe the public health workforce.

Objective: Approximately 25% of the public health workforce plans to retire by 2020. Succession planning is a core capability of the governmental public health enterprise; however, limited data are available regarding these efforts in state health agencies (SHAs)., Methods: We analyzed 2016 Workforce Gaps Survey data regarding succession planning in SHAs using the US Office of Personnel Management's (OPM's) succession planning model, including 6 domains and 27 activities. Descriptive statistics were calculated for all 41 responding SHAs., Results: On average, SHAs self-reported adequately addressing 11 of 27 succession planning activities, with 93% of SHAs adequately addressing 1 or more activities and 61% adequately addressing 1 or more activities in each domain., Conclusions: The majority of OPM-recommended succession planning activities are not being addressed, and limited succession planning occurs across SHAs. Greater activity in the OPM-identified succession planning domains may help SHAs contend with significant turnover and better preserve institutional knowledge.

The behavioral health workforce, which encompasses a broad range of professions providing prevention, treatment, and rehabilitation services for mental health conditions and substance use disorders, is in the midst of what is considered by many to be a workforce crisis. The workforce shortage can be attributed to both insufficient numbers and maldistribution of workers, leaving some communities with no behavioral health providers. In addition, demand for behavioral health services has increased more rapidly as a result of federal legislation over the past decade supporting mental health and substance use parity and by healthcare reform. In order to address workforce capacity issues that impact access to care, the field must engage in extensive planning; however, these efforts are limited by the lack of timely and useable data on the behavioral health workforce. One method for standardizing data collection efforts is the adoption of a Minimum Data Set. This article describes workforce data limitations, the need for standardizing data collection, and the development of a behavioral health workforce Minimum Data Set intended to address these gaps. The Minimum Data Set includes five categorical data themes to describe worker characteristics: demographics, licensure and certification, education and training, occupation and area of practice, and practice characteristics and settings. Some data sources align with Minimum Data Set themes, although deficiencies in the breadth and quality of data exist. Development of a Minimum Data Set is a foundational step for standardizing the collection of behavioral health workforce data. Key challenges for dissemination and implementation of the Minimum Data Set are also addressed., Supplement Information: This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services., (Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study is to reconcile public health workforce supply and demand data to understand whether the expected influx of public health graduates can meet turnover events., Methods: Four large public health workforce data sources were analyzed to establish measures of workforce demand, voluntary separations, and workforce employees likely to retire at state and local health departments. Data were collected in 2014-2016 and analyzed in 2016 and 2017. Potential workforce supply (i.e., candidates with formal public health training) was assessed by analyzing data on public health graduates. Supply and demand data were reconciled to identify potential gaps in the public health workforce., Results: At the state and local level, ≅197,000 staff are employed in health departments. This is down more than 50,000 from 2008. In total, ≥65,000 staff will leave their organizations during fiscal years 2016-2020, with ≤100,000 staff leaving if all planned retirements occur by 2020. During 2000-2015, more than 223,000 people received a formal public health degree at some level. More than 25,000 students will receive a public health degree at some level in each year through 2020., Conclusions: Demands for public health staff could possibly be met by the influx of graduates from schools and programs of public health. However, substantial implications exist for transferal of institutional knowledge and ability to recruit and retain the best staff to sufficiently meet demand., (Copyright © 2018 American Journal of Preventive Medicine. All rights reserved.)

Acute myeloid leukemia (AML) is an aggressive hematological malignancy with limited treatment options. Inflammation is often a contributing factor to the development and progression of AML, and related diseases, and can potentiate therapy failure. Previously, we had identified anti-inflammatory roles and anti-AML efficacy for blueberry extracts. The present study extended these observations to determine that the polyphenol quercetin inhibited neutral sphingomyelinase (N-SMase) activity and exerted anti-AML efficacy. Moreover, quercetin was shown to exert combinatorial anti-AML efficacy with nanoliposomal ceramide. Overall, this demonstrated that quercetin could block the pro-inflammatory actions of N-SMase and augment the efficacy of anti-AML therapeutics, including ceramide-based therapeutics.