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The Missouri Air Conservation Commission regulations include regulations that limit the amount of acceptable odor from confined animal feeding operations (CAFOs). The regulations concerning odor designate the use of a scentometer as a screening tool. The rules dictate that if an odor is detectable by an investigator at a dilution ratio of 5.4 using a scentometer then an air sample should be collected and sent to an olfactometry laboratory for an odor panel to determine the detection threshold and the intensity of the odor sample. The detection thresholds are determined following ASTM E679-91 and EN13725. The intensity is determined following ASTM E544-99. If the olfactometry laboratory determined the detection threshold of the sample to be above seven, then the CAFO would be in violation. If the olfactometry laboratory determined the intensity level to be above a level equivalent to 225 ppm of n-butanol, then the source of odor would be in violation. The CAFO odor rules came under scrutiny by representatives of the largest hog producer in the State of Missouri. Specifically, they argued that the detection threshold limit of seven in the CAFO portion of the rule was too low for the rule to realistically identify a violation. This paper presents the results of a study to find the appropriate regulatory level of odor as determined by laboratory olfactometry. The study took place from November 2001 to October 2002. Samples were collected from field locations that exhibited odor produced by confined animal feeding operations and from areas exhibiting no apparent odor. The odors were categorized based upon the scentometer level at which the odors were detectable, and then samples were sent to an odor evaluation laboratory for analysis by olfactometry. [ABSTRACT FROM AUTHOR]

A standard method for measuring and quantifying odour in the ambient air utilizes a portable odour detecting and measuring device known as a field olfactometer (US Public Health Service Project Grant A-58-541). The field olfactometer dynamically dilutes the ambient air with carbon-filtered air in distinct ratios known as "Dilutions-to-Threshold" dilution factors (D/Ts), i.e. 2, 4, 7, 15, etc. Thirteen US states and several cities in North America currently utilize field olfactometry as a key component of determining compliance to odour regulations and ordinances. A controlled environmental chamber was utilized, with hydrogen sulfide as the known test odorant. A hydrogen sulfide environment was created in this controlled chamber using an Advanced Calibration Designs, Inc. Cal2000 Hydrogen Sulfide Generator. The hydrogen sulfide concentration inside the chamber was monitored using an Arizona Instruments, Inc. Jerome Model 631 H2S Analyzer. When the environmental chamber reached a desired test concentration, test operators entered the chamber. The dilution-to-threshold odour concentration was measured using a Nasal Ranger Field Olfactometer (St Croix Sensory, Inc.) and a Barnebey Sutcliffe Corp. Scentometer. The actual hydrogen sulfide concentration was also measured at the location in the room where the operators were standing while using the two types of field olfactometers. This paper presents a correlation between dilution-to-threshold values (D/T) and hydrogen sulfide ambient concentration. For example, a D/T of 7 corresponds to ambient H2S concentrations of 5.7-15.6 µg/m³ (4-11 ppbv). During this study, no significant difference was found between results obtained using the Scentometer or the Nasal Ranger® (r = 0.82). Also, no significant difference was found between results of multiple Nasal Ranger® users (p = 0.309). The field olfactometers yielded hydrogen sulfide thresholds of 0.7-3.0 µg/m³ (0.5-2.0 ppbv). Laboratory olfactometry yielded comparable thresholds of 0.64-1.3 µg/m³ (0.45-0.9 ppbv). These thresholds are consistent with published values. [ABSTRACT FROM AUTHOR]

Observations of crack damage in the tooth structure from in vivo studies and in vitro experimental thermal cycling studies were combined with numerical analysis techniques to identify and isolate the influence of thermal stresses on the creation and propagation of cracks in teeth. The factors considered in this study included: (a) variations in tooth type or geometry (molar, bicuspid, etc.), (b) tooth age, (c) material properties of the tooth, (d) the magnitude of the change in the temperature of the environment surrounding the tooth, and (e) the thermal resistance between the tooth and the medium surrounding the tooth. [ABSTRACT FROM AUTHOR]

The service-learning pedagogy attempts to enhance student learning by integrating academic study with meaningful community service. This paper discusses lessons learned when attempting to integrate direct service (having S-L students provide science lessons for primary students) and indirect service (having S-L students prepare curriculum guides for use by primary teachers) to maximize academic learning in a course entitled “Ecology: The Science of the Environment” at Lingnan University in Hong Kong. Although the course covered fewer topics when taught using the service-learning pedagogy, S-L students reported that participating in the service-learning project (i) increased their academic learning, (ii) enhanced their interest in science, and (iii) improved their communication and problem solving skills. Based on student feedback received, attempts were made to improve the service-learning experience by (i) altering the course outline so that S-L students have learned the material in class before sharing with the primary students, (ii) providing more input to the focus of their topics, (iii) allowing S-L students to interact with the primary students during their on-site orientation, and (iv) encouraging the primary school teachers to provide immediate feedback to the S-L students at the end of each lesson.

Background: Midwife-managed programmes of care are being widely implemented although there has been little investigation of their efficacy. We have compared midwife-managed care with shared care (ie, care divided among midwives, hospital doctors, and general practitioners) in terms of clinical efficacy and women's satisfaction.Methods: We carried out a randomised controlled trial of 1299 pregnant women who had no adverse characteristics at booking (consent rate 81.9%). 648 women were assigned midwife-managed care and 651 shared care. The research hypothesis was that compared with shared care, midwife-managed care would produce fewer interventions, similar (or more favourable) outcomes, similar complications, and greater satisfaction with care. Data were collected by retrospective review of case records and self-report questionnaires. Analysis was by intention to treat.Findings: Interventions were similar in the two groups or lower with midwife-managed care. For example, women in the midwife-managed group were less likely than women in shared care to have induction of labour (146 [23.9%] vs 199 [33.3%]; 95% CI for difference 4.4-14.5). Women in the midwife-managed group were more likely to have an intact perineum and less likely to have had an episiotomy (p = 0.02), with no significant difference in perineal tears. Complication rates were similar. Overall, 32.8% of women were permanently transferred from midwife-managed care (28.7% for clinical reasons, 3.7% for non-clinical reasons). Women in both groups reported satisfaction with their care but the midwife-managed group were significantly more satisfied with their antenatal (difference in mean scores 0.48 [95% CI 0.41-0.55]), intrapartum (0.28 [0.18-0.37]), hospital-based postnatal care (0.57 [0.45-0.70]), and home-based postnatal care (0.33 [0.25-0.42]).Interpretation: We conclude that midwife-managed care for healthy women, integrated within existing services, is clinically effective and enhances women's satisfaction with maternity care. [ABSTRACT FROM AUTHOR]

Rural regions face significant health care disparities, including decreased access to insurance, increased access barriers to specialty care, worse medical outcomes, and increased mortality rates. People with multiple sclerosis (MS) residing in rural regions in the United States, as well as globally, face similar barriers to accessing MS care and experience poorer disease outcomes. Barriers to health care access include cultural and financial constraints, scarcity of services, a lack of trained physicians, insufficient public transport, and poor availability of broadband internet service. The Appalachian region, which contains a high degree of rurality, experiences increased disparities compared with the rest of the nation and can be used to highlight the unique challenges rural populations face. Appalachian residents can identify as private, and mistrust is a major factor in providing health care. Increasing the quantity and retention of Appalachian providers is essential to building trust. Still, it has proved difficult due to issues with compensation, taxes, malpractice fees, adverse actions against physicians, and high turnover rates. Telehealth interventions such as Project ECHO (Extension for Community Healthcare Outcomes) have improved rural outcomes in multiple diseases, including MS, but limited technology and technological literacy in rural areas impede the implementation of these interventions. Given the increasing rural population and ongoing disparities these communities face, there is a need to develop targeted interventions to improve access and outcomes in rural populations., (© 2025 Consortium of Multiple Sclerosis Centers.)

This study evaluated disease activity in people with Multiple Sclerosis (PwMS) who received immune checkpoint inhibitors (ICIs) compared to PwMS not treated with ICIs. There were 108 PwMS included (27 PwMS+ICIs and 81 PwMS controls), matched on age, sex, disease duration, DMTs, and MS disease course. Of 27 PwMS+ICIs, one (4%) had a relapse and four (15%) developed new MRI lesions without clinical symptoms. Time to relapse and MRI activity were compared using Kaplan-Meier curves and Cox regression models. There was no significant difference for either time to relapse (p = 0.34) or MRI activity (p = 0.15) in PwMS+ICIs compared to controls., (© 2024 The Author(s). Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

Background: A digital adaptation of the nine-hole peg test (9HPT) was developed with the potential to provide novel disability features for patients with multiple sclerosis (PwMS)., Objectives: The objectives were to evaluate the 9HPT features based on reliability, prognosis, and discrimination between treatment groups., Methods: The MS partners Advancing Technology and Health Solutions (MS PATHS) cohort data were used to derive new features including completion time and speed. Association and reliability between features and clinical outcomes were tested by intraclass correlation coefficients (ICCs) with repeated measures. The added prognostic value of the features for a clinically meaningful decline was assessed by time-to-event analyses with likelihood ratio tests. The estimated effect size between treatment efficacy groups was acquired from linear mixed-effects models. Sample size was calculated for a hypothetical randomized clinical trial., Results: For the 10,843 PwMS, speed and completion time were associated with MS disability. Compared with time, speed showed higher reliability (ICC = 0.78 vs 0.74), added benefits in predicting disability worsening ( p < 0.001), better discrimination between high- and low-efficacy groups (effect size: 0.035 vs 0.015), and an 18% reduction in required sample size for a 1-year clinical trial., Conclusion: Integrating horizontal hand distances traveled over the 9HPT pegboard can be a more reliable measure of hand function., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M.M. serving on scientific advisory boards for Genzyme and Genentech and research support from AHRQ, Biogen, NIH, and Novartis. R.B. received consultant fees for Biogen, Genentech, Genzyme, and Novartis; research support from Biogen, Genentech, and Novartis; and shares rights to intellectual property underlying the Multiple Sclerosis Performance Test, currently licensed to Qr8 Health and Biogen. D.O. received research support from Genentech, Genzyme, and Novartis and consulting fees from Biogen, Genentech-Roche, Genzyme, Novartis, and Merck. R.T.N. has consulted for Alexion Pharmaceuticals, Biogen, Bristol Myers Squibb, Celltrion, Genentech, Genzyme, EMD Serono, Horizon Therapeutics, Lundbeck, and TG Therapeutics. X.J. and Z.S. are the employees of and may hold stock/stock options in Biogen. N.L. is the former employee of and may hold stock/stock options in Biogen. R.H. and J.v.B are the former employees of and may hold stock/stock options in Biogen and TW1 Healthcare and consultant for International Registry for Alzheimer’s Disease and other dementias (InRAD). N.C. is the former employee of and may hold stock/stock options in Biogen and current employee of Janssen Scientific Affairs, LLC. CB. is the former employee of and may hold stock/stock options in Biogen and current employee of Novartis. J.J. and J.A. have no disclosures.

Introduction: Using the Five Cs model of positive youth development (PYD), this study aimed to provide a socio-structural and cultural understanding of PYD in Indigenous Tayal youth by examining the specificity in the development of Five Cs (Competence, Confidence, Character, Caring, and Connection) between Tayal and Han youth in Taiwan., Methods: A sample of 847 Tayal and Han adolescents (43.8% Tayal, 47.9% girls, M age  = 14.83, SD = 0.50) were drawn from a larger study (September 2014 to August 2017). Adolescent participants completed questionnaires asking about their Five Cs, contribution behavior, and depressive symptomatology., Results: Measurement invariance was conducted to explore specificity between Tayal and Han youth's Five Cs performance. A bi-factor Five Cs model was identified and partial metric and partial scalar measurement invariance was established between the two samples. Across both groups an overarching PYD factor, which was associated with increased contribution and lower depressive symptomatology, was identified. Specificity was observed in the Tayal sample, particularly relating to indicators of Competence, Character, Caring, and Connection., Conclusion: The findings of this study provide a sociocultural-informed lens regarding the specificity of development in Tayal youth. Character, Caring, and Connection appear to contribute significantly more to the overall PYD for Tayal adolescents than their Han peers. Findings relating to Competence suggest that the educational environment may not be aligned with the learning style of Tayal youth. This study has policy and practical implications for Tayal youth, and can further help inform program development in Taiwan and internationally., (© 2024 Foundation for Professionals in Services to Adolescents.)

Background: Multiple sclerosis (MS) affects nearly 1 million people and is estimated to cost $85.4 billion in the United States annually. People with MS have significant barriers to receiving care and telemedicine could substantially improve access to specialized, comprehensive care. In cross-sectional analyses, telemedicine has been shown to be feasible, have high patient and clinician satisfaction, reduce patient costs and burden, and enable a reasonable assessment of disability. However, no studies exist evaluating the longitudinal impact of telemedicine care for MS. Here we describe the study protocol for VIRtual versus UsuAL In-office care for Multiple Sclerosis (VIRTUAL-MS). The main objective of the study is to evaluate the impact of telemedicine for MS care on: patient clinical outcomes, economic costs, patient, and clinician experience., Methods: This two-site randomized clinical trial will enroll 120 adults with a recent diagnosis of MS and randomize 1:1 to receive in-clinic vs. telemedicine care for 24 months. The primary outcome of the study is worsening in any one of the four Multiple Sclerosis Functional Composite 4 (MSFC4) measures at 24 months. Other study outcomes include patient and clinician satisfaction, major healthcare costs, Expanded Disability Status Scale, treatment adherence, and digital outcomes., Conclusion: The results of this study will directly address the key gaps in knowledge about longitudinal telemedicine-enabled care in an MS population. It will inform clinical care implementation as well as design of trials in MS and other chronic conditions., Trial Registration: NCT05660187., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Marisa McGinley has received research support from the National Institutes of Health, Novartis, Biogen, and Genentech. She has also received consulting fees from Genentech, EMD Serono, and Octave. Josh Carlson has received research support from the National Institutes of Health and the Institute for Clinical and Economic Review. He has also received consulting fees from Genentech, Pfizer, and Takeda. Jennifer Reihm reports no disclosures. Matthew Plow has received research support from the NIH, American Heart Association, National Multiple Sclerosis Society, Patient-Centered Outcomes Research Institute, Agency for Healthcare Research and Quality, Consortium of Multiple Sclerosis Centers, Department of Defence, Seibyl Foundation. Megan Roser reports no disclosures. Nikki Sisodia reports no disclosures. Jeffrey A. Cohen has received personal compensation for consulting for Astoria, Bristol-Myers Squibb, Convelo, EMD Serono, FiNS Therapeutics, INMune, and Sandoz; and serving as an Editor of Multiple Sclerosis Journal. Anita D. Misra-Hebert has received research support from the Patient-Centered Outcomes Research Institute, National Institutes of Health, Agency for Healthcare Research and Quality, Ohio Department of Medicaid, Bayer, Novo Nordisk and Merck. Ann Lazar has received research support from the PCORI, NIH, DOD, and the University of California Office of the President Historically Black Colleges and University Initiative. She serves on NIH funded Data and Safety Monitoring Board (DMSB). She also receives funding for her role as the Statistical Editor for World Journal of Surgery and International Journal of Radiation Oncology, Biology, Physics. Riley Bove has received research support from NIH, DOD, National Multiple Sclerosis Harry Weaver Award, and from Biogen, Novartis, Eli Lilly and F Hoffman-LaRoche. She has received personal advisory board or consulting fees from EMD Serono, Horizon, Janssen, and TG Therapeutics., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Several oral disease-modifying therapies (DMTs) have been approved by the Food and Drug Administration for the treatment of relapsing-remitting multiple sclerosis (RRMS). In the absence of head-to-head randomized data, matching-adjusted indirect comparisons (MAICs) can evaluate the comparative effectiveness and safety of ozanimod versus other oral DMTs in RRMS., Objectives: To synthesize results from the published MAICs of ozanimod and other oral DMTs for 2-year outcomes in RRMS., Methods: Published MAICs involving ozanimod for the treatment of RRMS were identified. Extracted data elements included efficacy [annualized relapse rate (ARR), confirmed disability progression (CDP), and brain volume loss] and safety [adverse events (AEs), serious AEs (SAEs), AEs leading to discontinuation, and infection] outcomes., Results: The four MAIC studies identified compared ozanimod with fingolimod, teriflunomide, dimethyl fumarate (DMF), and ponesimod. All comparisons were adjusted for differences in age, sex, relapses within the previous year, Expanded Disability Status Scale score, and percentage of patients with prior DMTs. Outcomes at 2 years were analyzed based on comparisons that lacked a common comparator arm. Ozanimod was associated with significantly lower ARR versus teriflunomide [ARR ratio (95% CI) 0.73 (0.62, 0.84) and DMF 0.80 (0.67, 0.97)], with no significant difference versus fingolimod or ponesimod. The proportions of patients treated with ozanimod or fingolimod had similar 3- and 6-month CDP. Compared with teriflunomide and DMF, ozanimod was associated with a significantly lower risk of 3-month CDP; 6-month CDP was comparable. Ozanimod was associated with significantly lower rates of any AE and AEs leading to discontinuation compared with the other oral DMTs evaluated. Ozanimod also had significantly lower rates of SAEs versus teriflunomide and DMF and lower rates of reported infection outcomes versus fingolimod and ponesimod., Conclusion: Compared with the other oral DMTs evaluated in MAICs, ozanimod was associated with a favorable safety profile and improved or comparable efficacy outcomes., (© The Author(s), 2024.)