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Cumulative impact mapping is a commonly applied spatial representation of the impacts of human activities on the ocean. This spatial model has been applied at varying scales around the world, in part due to its ability to visually communicate complicated information in a simple way. The application of the model to decision-making processes requires an understanding of the reliability and stability of its outputs. This paper represents both an updated regional application in Pacific Canada and an evaluation of the tool over two iterations, 2015 and 2023. The regional application utilised higher model resolution and new and improved data inputs including 38 habitats and 46 activities across five sectors. High impact hotspots were found around major population centres and ports, as well as in fishing and shipping areas along the continental shelf. Commercial fishing, shipping, and climate change (sea surface temperature change) remained the major drivers of cumulative impacts in the region, and cumulative impacts per unit area continued to be highest in kelp and seagrass. Results suggest evidence of decreased impacts where improved protection for sponge reefs were implemented but show an overall increase in cumulative impacts for the region. Results showed consistency and reliability in the location of cumulative impact hotspots. Refinements in data quality and resolution of spatial data inputs contributed towards increasing the spatial precision of hot spot areas identified. Confidence in the cumulative impact mapping outputs and applications for marine spatial planning, marine protected area designation and management, research, and decision support 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., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Anchorages are specific areas used by vessels to maintain position and are used as waiting areas for freighters wanting to enter ports. The surge in demand experienced by ports from 2019 to 2022 significantly extended wait times at anchorages, heightening concerns of potential ecological and socio-economic effects among coastal communities. Effective anchorage management requires a connected and holistic approach to understand these diverse and complex effects. We summarise current knowledge on the cumulative effects of anchoring on ecological and socio-economic endpoints in a Pathways of Effects conceptual model informed by scientific literature and public consultation documents. We developed a Pathways of Effects Matrix (PoEM), a graphical advance designed to concisely visualise complex effects and explore mitigation scenarios, demonstrated in the example for commercial anchoring in Pacific Canada. In addition to supporting management decisions, this simple visual tool can also provide a way for communities to communicate their concerns in a structured way., Competing Interests: Declaration of competing interest 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., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Occurrence of perfluoroalkyl acids (PFAAs) in wastewater effluent coupled with increasingly stringent regulations has increased the need for more effective sorption-based PFAA treatment approaches. This study investigated the impact of ozone (O 3 )- biologically active filtration (BAF) as integral components of non-reverse osmosis (RO)-based potable reuse treatment trains and as a potential pretreatment option to improve adsorptive PFAA removal from wastewater effluent by nonselective (e.g., granular activated carbon (GAC) and selective (e.g., anionic exchange resins (AER) and surface-modified clay (SMC)) adsorbents. For nonselective GAC, O 3 and BAF resulted in similar PFAA removal improvements, while BAF alone performed better than O 3 for AER and SMC. O 3 -BAF in tandem resulted in the highest PFAA removal performance improvement among pretreatments investigated for selective and nonselective adsorbents. Side by side evaluation of the dissolved organic carbon (DOC) breakthrough curves and size exclusion chromatography (SEC) for each pretreatment scenario suggested that despite the higher affinity of selective adsorbents towards PFAAs, the competition between PFAA and effluent organic matter (EfOM) (molecular weights (MWs): 100-1000 Da) negatively impacts the performance of these adsorbents. The SEC results also demonstrated that transformation of hydrophobic EfOM to more hydrophilic molecules during O 3 and biotransformation of EfOM during BAF were the dominant mechanisms responsible for alleviating the competition between PFAA and EfOM, resulting in PFAA removal improvement., 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.)

To meet the educational needs of students, most schools in the United States (U.S.) reopened for in-person instruction during the 2021-2022 school year implementing a wide range of COVID-19 prevention strategies (e.g., mask requirements). To date, there have been limited studies examining facilitators and barriers to implementing each of the recommended COVID-19 prevention strategies in schools. Twenty-one semistructured interviews were conducted with public school staff from across the U.S. responsible for overseeing prevention strategy implementation. MAXQDA was used for thematic analysis. Findings identified key facilitators including utilizing Centers for Disease Control and Prevention guidance and district policies to guide decision-making at the school level, possessing financial resources to purchase supplies, identifying key staff for implementation, and having school health services infrastructure in place. Key barriers included staff shortages, limited resources, and community opposition. Findings from this study provide important insight into how schools can prepare for future public health emergencies.

Per- and polyfluoroalkyl substance (PFAS) contamination in aqueous matrices has intensified the search for PFAS adsorbents with elevated capacity, selectivity, and cost effectiveness. A novel surface modified organoclay (SMC) adsorbent was evaluated for PFAS removal performance in parallel with granular activated carbon (GAC) and ion exchange resin (IX) for the treatment of five distinct PFAS impaired waters including groundwater, landfill leachate, membrane concentrate and wastewater effluent. Rapid small scale column tests (RSSCTs) and breakthrough modeling were coupled to provide insight on adsorbent performance and cost for multiple PFAS and water types. IX exhibited the best performance with respect to adsorbent use rates in treatment of all tested waters. IX was nearly four times more effective than GAC and two times more effective than SMC in the treatment of PFOA from water types excluding groundwater. Employed modeling strengthened the comparison of adsorbent performance and water quality to infer adsorption feasibility. Further, evaluation of adsorption was extended beyond PFAS breakthrough with the inclusion of unit adsorbent cost as a decision metric influencing adsorbent selection. An analysis of levelized media cost indicated treatment of landfill leachate and membrane concentrate was at least three times more expensive than groundwaters or wastewaters evaluated., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Christopher Bellona reports financial support was provided by US Department of Defense. Christopher Bellona reports financial support was provided by Colloidal Environmental Technologies., (Copyright © 2023 Elsevier B.V. All rights reserved.)

During the COVID-19 pandemic, US schools have been encouraged to take a layered approach to prevention, incorporating multiple strategies to curb transmission of SARS-CoV-2. Using survey data representative of US public K-12 schools (N = 437), we determined prevalence estimates of COVID-19 prevention strategies early in the 2021-22 school year and describe disparities in implementing strategies by school characteristics. Prevalence of prevention strategies ranged from 9.3% (offered COVID-19 screening testing to students and staff) to 95.1% (had a school-based system to report COVID-19 outcomes). Schools with a full-time school nurse or school-based health center had significantly higher odds of implementing several strategies, including those related to COVID-19 vaccination. We identified additional disparities in prevalence of strategies by locale, school level, and poverty. Advancing school health workforce and infrastructure, ensuring schools use available COVID-19 funding effectively, and promoting efforts in schools with the lowest prevalence of infection prevention strategies are needed for pandemic preparedness.

Understanding the cumulative effects of multiple stressors is a research priority in environmental science. Ecological models are a key component of tackling this challenge because they can simulate interactions between the components of an ecosystem. Here, we ask, how has the popular modeling platform Ecopath with Ecosim (EwE) been used to model human impacts related to climate change, land and sea use, pollution, and invasive species? We conducted a literature review encompassing 166 studies covering stressors other than fishing mostly in aquatic ecosystems. The most modeled stressors were physical climate change (60 studies), species introductions (22), habitat loss (21), and eutrophication (20), using a range of modeling techniques. Despite this comprehensive coverage, we identified four gaps that must be filled to harness the potential of EwE for studying multiple stressor effects. First, only 12% of studies investigated three or more stressors, with most studies focusing on single stressors. Furthermore, many studies modeled only one of many pathways through which each stressor is known to affect ecosystems. Second, various methods have been applied to define environmental response functions representing the effects of single stressors on species groups. These functions can have a large effect on the simulated ecological changes, but best practices for deriving them are yet to emerge. Third, human dimensions of environmental change - except for fisheries - were rarely considered. Fourth, only 3% of studies used statistical research designs that allow attribution of simulated ecosystem changes to stressors' direct effects and interactions, such as factorial (computational) experiments. None made full use of the statistical possibilities that arise when simulations can be repeated many times with controlled changes to the inputs. We argue that all four gaps are feasibly filled by integrating ecological modeling with advances in other subfields of environmental science and in computational statistics., 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 The Authors. Published by Elsevier B.V. All rights reserved.)

Salmon and herring support both land and ocean predators and are critical to ecosystem resilience. Their linkages across land and sea realms make them highly susceptible to human activities, which can have flow-on effects up the food web. We quantify and compare the potential cumulative effects of human-driven pressures on interdependent species in salmon- and herring-linked ecosystems of western Canada using a risk assessment methodology. Adding indirect risks resulted in 68% greater total risks for land species than for direct risk alone, versus 15% for marine species. Inclusion of climate change pressures resulted in the greatest change in risk for low trophic marine species and habitats (greater than 25% increase). Forestry-related pressures accounted for the highest risk to all species and projected management of these pressures resulted in a total reduction of risk across all ecosystem components that was more than 14% greater than management of fisheries pressures. Ignoring land food web linkages and pressures underestimated cumulative risk by more than 40% for salmon and herring. This simple framework can be used to evaluate potential risk of existing human uses and future change to inform immediate management of linked land-sea ecosystems and help species avoid the 'death by a thousand cuts'. This article is part of the theme issue 'Nurturing resilient marine ecosystems'.

Effective COVID-19 prevention in kindergarten through grade 12 (K-12) schools requires multicomponent prevention strategies in school buildings and school-based transportation, including improving ventilation (1). Improved ventilation can reduce the concentration of infectious aerosols and duration of potential exposures (2,3), is linked to lower COVID-19 incidence (4), and can offer other health-related benefits (e.g., better measures of respiratory health, such as reduced allergy symptoms) (5). Whereas ambient wind currents effectively dissipate SARS-CoV-2 (the virus that causes COVID-19) outdoors,* ventilation systems provide protective airflow and filtration indoors (6). CDC examined reported ventilation improvement strategies among a nationally representative sample of K-12 public schools in the United States using wave 4 (February 14-March 27, 2022) data from the National School COVID-19 Prevention Study (NSCPS) (420 schools), a web-based survey administered to school-level administrators beginning in summer 2021. † The most frequently reported ventilation improvement strategies were lower-cost strategies, including relocating activities outdoors (73.6%), inspecting and validating existing heating, ventilation and air conditioning (HVAC) systems (70.5%), and opening doors (67.3%) or windows (67.2%) when safe to do so. A smaller proportion of schools reported more resource-intensive strategies such as replacing or upgrading HVAC systems (38.5%) or using high-efficiency particulate air (HEPA) filtration systems in classrooms (28.2%) or eating areas (29.8%). Rural and mid-poverty-level schools were less likely to report several resource-intensive strategies. For example, rural schools were less likely to use portable HEPA filtration systems in classrooms (15.6%) than were city (37.7%) and suburban schools (32.9%), and mid-poverty-level schools were less likely than were high-poverty-level schools to have replaced or upgraded HVAC systems (32.4% versus 48.8%). Substantial federal resources to improve ventilation in schools are available. § Ensuring their use might reduce SARS-CoV-2 transmission in schools. Focusing support on schools least likely to have resource-intensive ventilation strategies might facilitate equitable implementation of ventilation improvements., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Kenneth R. Mead and Stephen B. Martin, Jr. report multiple roles on technical and standard committees within ASHRAE. No other potential conflicts of interest were disclosed.

Previous laboratory scale studies indicate nanofiltration (NF) and UV-sulfite photochemical treatments as promising technologies for the removal and destruction, respectively, of per- and polyfluoroalkyl substances (PFASs) from contaminated water. This study reports on a field demonstration of a pilot-scale hybrid NF and UV-sulfite treatment train for the remediation of 12 PFASs detected in groundwater impacted by aqueous film-forming foam (AFFF) at a U.S. Department of Defense installation. For most of the detected PFASs, NF rejection was consistently ≥ 95% over a 30-day field trial when operating at 90% total permeate recovery. Rejection of short-chain perfluorosulfonic acids (PFSAs) by NF decreased when recoveries increased from 90 to 97%; tests with a reverse osmosis (RO) membrane showed ≥ 99% rejection of all PFASs regardless of increasing recovery. UV treatment of the NF reject following 90% permeate recovery resulted in variable destruction of individual PFASs, with rates also being dependent on pH and the identity and concentration of UV photosensitizer. Rates of perfluorocarboxylic acid (PFCA) degradation were greater than those measured for PFSAs and perfluoroalkyl acid (PFAA) precursors and were independent of perfluoroalkyl chain length. In contrast, rates of PFSA degradation increased with increasing chain length. Consistent levels of PFAS degradation by UV-sulfite were observed during a 30-day demonstration experiment in NF reject water amended with 10 mM sulfite and adjusted to pH 11.2. Collectively, > 75% of the detected PFAS mass in the NF reject was destroyed after 4 h of UV treatment, increasing to > 90% after 8 h of treatment. An analysis of electrical energy inputs for the hybrid NF/UV-sulfite treatment train showed energy per order magnitude (EE/O) requirements ranging from ≤ 13.1 kWh/m 3 for PFCAs and 14.1 kWh/m 3 for PFOS to values > 100 kWh/m 3 for more recalcitrant short-chain PFSA analogues. The UV reactor and water-cooling system were the major contributors to overall energy requirements and represent the greatest opportunities for improving efficiency of the technology., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Schools support teachers in their professional learning, just as teachers support students in their learning. To accomplish this, schools can provide support systems that enhance teachers' knowledge, comfort, and instructional skills. This study examined the impact of two district-provided supports (curriculum and professional development) on sexual health instruction among middle and high school health education teachers. Data were abstracted and analyzed using inductive coding from 24 teacher interviews (2015-2016). Findings illustrate outcomes from both curriculum and PD on teachers' self-reported knowledge, comfort, and skills. The district-provided supports appeared to contribute to improved teachers' self-efficacy in delivering sexual health education., Competing Interests: Conflicting interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: To describe the clinical activity patterns and nature of interventions of hospital-based liaison psychiatry services in England., Methods: Multi-site, cross-sectional survey. 18 acute hospitals across England with a liaison psychiatry service. All liaison staff members, at each hospital site, recorded data on each patient they had face to face contact with, over a 7 day period. Data included location of referral, source of referral, main clinical problem, type of liaison intervention employed, staff professional group and grade, referral onto other services, and standard assessment measures., Results: A total of 1475 face to face contacts from 18 hospitals were included in the analysis, of which approximately half were follow-up reviews. There was considerable variation across sites, related to the volume of Emergency Department (ED) attendances, number of hospital admissions, and work hours of the team but not to the size of the hospital (number of beds). The most common clinical problems were co-morbid physical and psychiatric symptoms, self-harm and cognitive impairment. The main types of intervention delivered were diagnosis/formulation, risk management and advice. There were differences in the type of clinical problems seen by the services between EDs and wards, and also differences between the work conducted by doctors and nurses. Almost half of the contacts were for continuing care, rather than assessment. Eight per cent of all referrals were offered follow up with the LP team, and approximately 37% were referred to community or other services., Conclusions: The activity of LP services is related to the flow of patients through an acute hospital. In addition to initial assessments, services provide a wide range of differing interventions, with nurses and doctors carrying out distinctly different roles within the team. The results show the volume and diversity of LP work. While much clinical contact is acute and confined to the inpatient episode, the LP service is not defined solely by an assessment and discharge function; cases are often complex and nearly half were referred for follow up including liaison team follow up.

Background: Liaison psychiatry services provide mental health care for patients in physical healthcare (usually acute hospital) settings including emergency departments. Liaison work involves close collaboration with acute hospital staff so that high quality care can be provided. Services however are patchy, relatively underfunded, heterogeneous and poorly integrated into acute hospital care pathways., Methods: We carried out in-depth semi-structured interviews with 73 liaison psychiatry and acute hospital staff from 11 different acute hospitals in England. The 11 hospitals were purposively sample to represent hospitals in which four different types of liaison services operated. Staff were identified to ensure diversity according to professional background, sub-specialism within the team, and whether they had a clinical or managerial focus. All interviews were audio-recorded and transcribed. The data were analysed using a best-fit framework analysis., Results: Several key themes emerged in relation to facilitators and barriers to the effective delivery of integrated services. There were problems with continuity of care across the secondary-primary interface; a lack of mental health resources in primary care to support discharge; a lack of shared information systems; a disproportionate length of time spent recording information as opposed to face to face patient contact; and a lack of a shared vision of care. Relatively few facilitators were identified although interviewees reported a focus on patient care. Similar problems were identified across different liaison service types., Conclusions: The problems that we have identified need to be addressed by both liaison and acute hospital teams, managers and funders, if high quality integrated physical and mental health care is to be provided in the acute hospital setting.

Introduction: Teen pregnancy prevention typically focuses on young women, overlooking the unique prevention needs of young men. Identifying factors associated with teen pregnancy for young men is essential to developing relevant and effective programming., Methods: We conducted a scoping review of studies with findings on factors associated with pregnancies/birth specific to young men. We searched Scopus, OVID, and PubMed databases for peer-reviewed articles published from 2000 to 2015. We reviewed 1750 articles for inclusion of studies conducted in the United States with a sample size greater than 200 that assessed the effect of factors on teen pregnancy/birth using multivariate, male-specific analyses. Two coders abstracted 48 articles (having established 80% reliability with 10% of the articles). We grouped study variables into factors and used a matrix to summarize findings for each factor. During analysis, 29 articles were excluded for a final sample of 19 articles, each describing a separate study., Results: Study settings included households, healthcare organizations, schools, neighborhoods, and correctional facilities. Factors showing associations with teen pregnancy/birth included: experiencing childhood abuse; engaging in serious or repeated delinquent behaviors; substance abuse; having a teen parent; serious family disruption; not living with either parent; and Hispanic ethnicity. No studies assessed knowledge and attitudes about contraceptive methods, or access and use of clinical services; and few assessed relationship factors (n = 4) or gender and power (n = 1)., Conclusions: Factors related to disadvantaged social contexts were associated with teen pregnancy/birth. Resilience-based research may identify protective factors to support vulnerable families and youth., (Published by Elsevier Ltd.)

Background: Studies have examined relationships between teacher characteristics and student achievement in courses such as math and science. This study is among the first to examine effects of teacher characteristics on student knowledge in a health course., Methods: Student (N = 6143) pretest and posttest data were linked to teacher (N = 67) data. Changes in student knowledge scores from pre- to postcourse were explored using mixed-effects linear models. Teacher characteristics included professional development (PD) attendance, having a dedicated classroom, certification type, educational background, years' experience, and athletic coaching status., Results: Teacher characteristics associated with greater student knowledge gains included: being certified to teach health versus not certified (p < .001), having a dedicated classroom versus no classroom (p = .017), and for middle school teachers, having attended ≥3 PD sessions versus ≤2 (p = .023). Less knowledge gain was associated with teachers that coached versus noncoaches (p = .040) and having a health degree versus no health degree (p = .049). Post hoc analyses revealed the negative effect of health degree was only significant among coaches (p = .026)., Conclusions: Findings suggest opportunities for maximizing student knowledge gains through tailored selection of health teachers and provision of appropriate teaching support., (© 2019, American School Health Association.)

Background: In an attempt to increase high school students' sexually transmitted disease (STD) testing rates, the Centers for Disease Control and Prevention's Division of Adolescent and School Health partnered with ICF and Chicago Public Schools to adapt and implement the "GYT: Get Yourself Tested" health marketing campaign for a high school., Methods: Clinic record data and student retrospective self-report surveys (n = 193) tested for differences between the GYT intervention school and a comparison school on a number of outcomes, including human immunodeficiency virus and STD testing., Results: Clinic record data showed that testing increased significantly more for the intervention than the comparison school during the GYT implementation period (B, 2.9; SE, 1.1, P < 0.05). Furthermore, the odds of being tested at the referral clinic were more than 4 times (odds ratio, 4.4) as high for students in the campaign school than for those in the comparison school (95% confidence interval, 2.3-8.2). Survey data did not show increased self-reported testing but, more students in the GYT school (92.7%) were aware of where to receive free, low-cost, or affordable human immunodeficiency virus and STD testing than students in the comparison school (76.0%; P < 0.01). Among sexually experienced students (n = 142), significantly more from the campaign school reported that they intended to test for STDs in the next 3 months (48.4% strongly agree and 33.2% agree) compared with those at the comparison school (27.4% strongly agree and 32.9% agree; P < 0.05)., Conclusions: Our pilot suggests that a student-led GYT campaign in high schools may successfully increase STD testing of students. Although some of the findings from this pilot evaluation are promising, they are limited, and broader implementation and evaluation is needed. Future evaluation efforts can include more rigorous study designs, multiple schools or districts, longer campaign and evaluation across an entire school or calendar year, or in combination with other school-based testing strategies like a mass school-based screening event.

Contamination of drinking water sources with per- and polyfluoroalkyl substances (PFASs) is a major challenge for environmental engineers. While granular activated carbon (GAC) is an effective adsorbent-based treatment technology for long-chained PFASs, GAC is less effective for removal of short-chained compounds, necessitating a more complete treatment strategy. Super-fine powder activated carbon (SPAC; particle diameter <1 um) is potentially a superior adsorbent to GAC due to high specific surface area and faster adsorption kinetics. This study served to evaluate SPAC coupled with ceramic microfiltration (CMF) for PFAS removal in a continuous flow system. Comparison of PFAS mass loading rates onto SPAC and GAC to 10% breakthrough of PFASs using contaminated groundwater indicates that SPAC has nearly double the adsorption potential of GAC. Limitations reaching breakthrough for the SPAC system led to additional higher mass loading experiments where PFAS adsorption onto SPAC reached 2990 μg/g (for quantifiable PFASs), 480x greater than GAC and is thought to be a function of adsorbent size, pore content and PFAS chain length. Additional analysis of system performance through the application of liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QToF-MS) revealed the presence of additional PFASs in influent samples that were removed by the SPAC/CMF system., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Mechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice., Method: We synthesised data from a variety of sources including a large national survey, 73 in-depth interviews with acute and liaison staff working in hospitals with different types of liaison mental health services, and relevant local, national and international literature. We generated logic models for two common performance indicators used to assess organisational outcomes for LMHS: response times in the emergency department and hospital length of stay for people with mental health problems., Results: We identified 8 areas of complexity that influence performance, and 6 trade-offs which drove the models in different directions depending upon the balance of the trade-off. The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred., Conclusions: Our findings are important for commissioners of liaison services. Reliance on simple target setting may result in services that are unbalanced and not patient-centred. Targets need to be reviewed on a regular basis, together with other data that reflect the wider impact of the service, and any external changes in the system that affect the performance of LMHS, which are beyond their control.

Background: Child Health research is reported to be at worryingly low level by the Royal College of Paediatrics and Child Health. Recent survey showed that 54.5% of paediatric consultants in the United Kingdom do not do any research at all. We conducted a mixed methods study to understand barriers and facilitators for research involvement among paediatric trainees who are going to fill these consultant posts in the future., Methods: A questionnaire based on a validated index for research and development was completed by 136 paediatric trainees within a region in the North of England (Yorkshire and Humber). Twelve semi-structured interviews were conducted with stratified purposive sampling. Descriptive statistics and Chi-Square test for independence were used for quantitative analysis. Thematic content analysis was done for interviews based on analysis method framework., Results: 136 out of 396 trainees responded to the survey. There was a significant relationship between confidence in using research in practice and ability to understand research terminology. This was not related to research experience or training. Males were significantly more likely to have presented a research paper, know how research influences practice and have more confidence in using research in practice than females. There was no significant relationship between gender and research training or highest qualification. Time constraints and lack of academic culture were the most frequently mentioned barriers in the survey. Over-arching themes identified from the interviews were related to lack of academic culture, opportunities provided in current training scheme and constraints related to time availability along with workforce management., Conclusion: Paediatric research requires a supportive academic culture with more flexibility in training scheme and immediate attention to a pressing staffing crisis.

The abundance of marine macro-debris was quantified with high spatial resolution by applying an image processing technique to archived shoreline aerial photographs taken over Vancouver Island, Canada. The photographs taken from an airplane at oblique angles were processed by projective transformation for georeferencing, where five reference points were defined by comparing aerial photographs with satellite images of Google Earth. Thereafter, pixels of marine debris were extracted based on their color differences from the background beaches. The debris abundance can be evaluated by the ratio of an area covered by marine debris to that of the beach (percent cover). The horizontal distribution of percent cover of marine debris was successfully computed from 167 aerial photographs and was significantly related to offshore Ekman flows and winds (leeway drift and Stokes drift). Therefore, the estimated percent cover is useful information to determine priority sites for mitigating adverse impacts across broad areas., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Marine debris is one of the leading threats to the ocean and the Great East Japan Earthquake and tsunami on March 11, 2011 washed away an estimated 5million tons of debris in a single, tragic event. Here we used shoreline surveys, disaster debris reports and ocean drift models to investigate the temporal and spatial trends in the arrival of tsunami marine debris. The increase in debris influx to surveyed North American and Hawaiian shorelines was substantial and significant, representing a 10 time increase over the baseline in northern Washington State where a long term dataset was available. The tsunami event brought different types of debris along the coast, with high-windage items dominant in Alaska and British Columbia and large, medium-windage items in Washington State and Oregon. Recorded cumulative debris landings to North America were close to 100,000 items in the four year study period. The temporal peaks in measured shoreline debris and debris reports match the ocean drift model solutions. Mitigation and monitoring activities, such as shoreline surveys, provide crucial data and monitoring for potential impacts should be continued in the future., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

Nearly 300 coastal marine species collected from >630 debris items from the 2011 Great East Japan earthquake and tsunami have landed alive along the North American Pacific coast and the Hawaiian Archipelago. We synthesized life history, environmental, and distributional traits for 103 of these species and compared species with (n=30) and without (n=62) known invasion histories. The species represent 12 phyla, and Mollusca, Crustacea, and Bryozoa accounted for 71 of the 103 species. The majority are native to the Northwest Pacific and the Central Indo-Pacific. Species with known invasion history were more common on artificial and hardpan substrates, in temperate reef, fouling, and flotsam habitats, at subtropical and tropical temperatures, and exhibited greater salinity tolerance than species with no prior invasion history. Thirty-five Japanese tsunami marine species without prior invasion history overlapped in ordination trait space with known invaders, indicating a subset of species in this novel assemblage that possess traits similar to species with known invasion history., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Environmental assessment is the process that decision-makers rely on to predict, evaluate, and prevent biophysical, social, and economic impacts of potential project developments. The determination of significance in environmental assessment is central to environmental management in many nations. We reviewed ten recent environmental impact assessments from British Columbia, Canada and systematically reviewed and scored significance determination and the approaches used by assessors, the use of thresholds in significance determination, threshold exceedances, and the outcomes. Findings of significant impacts were exceedingly rare and practitioners used a combination of significance determination approaches, most commonly relying upon reasoned argumentation. Quantitative thresholds were rarely employed, with less than 10% of the valued components evaluated using thresholds. Even where quantitative thresholds for significance were exceeded, in every case practitioners used a variety of rationales to demote negative impacts to non-significance. These reasons include combinations of scale (temporal and spatial) of impacts, an already exceeded baseline, model uncertainty and/or substituting less stringent thresholds. Governments and agencies can better protect resources by requiring clear and defensible significance determinations, by making government-defined thresholds legally enforceable and accountable, and by requiring or encouraging significance determination through inclusive and collaborative approaches.

Sexual health education (SHE) provides students with knowledge and skills to establish healthy relationships, understand sexual development, and prevent risk behaviors; therefore, it is critical to understand how to optimize the delivery and receipt of this education. Using a grounded theory approach, interviews with middle school health education teachers (n=13) and focus groups with students (n=41) were conducted to examine factors that influence perceived comfort delivering and receiving SHE in a public school district. Findings identified key barriers including disruptive behavior, insufficient time, and lack of dedicated classrooms. Some key facilitators to comfort included professional development and establishing ground rules., Competing Interests: Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The multi-scalar complexity of social-ecological systems makes it challenging to quantify impacts from human activities on ecosystems, inspiring risk-based approaches to assessments of potential effects of human activities on valued ecosystem components. Risk assessments do not commonly include the risk from indirect effects as mediated via habitat and prey. In this case study from British Columbia, Canada, we illustrate how such "indirect risks" can be incorporated into risk assessments for seventeen ecosystem components. We ask whether (i) the addition of indirect risk changes the at-risk ranking of the seventeen ecosystem components and if (ii) risk scores correlate with trophic prey and habitat linkages in the food web. Even with conservative assumptions about the transfer of impacts or risks from prey species and habitats, the addition of indirect risks in the cumulative risk score changes the ranking of priorities for management. In particular, resident orca, Steller sea lion, and Pacific herring all increase in relative risk, more closely aligning these species with their "at-risk status" designations. Risk assessments are not a replacement for impact assessments, but-by considering the potential for indirect risks as we demonstrate here-they offer a crucial complementary perspective for the management of ecosystems and the organisms within., Competing Interests: The authors have declared that no competing interests exist.

Background: Sepsis from bacteremia occurs in 250,000 cases annually in the United States, has a mortality rate as high as 60%, and is associated with a poorer prognosis than localized infection. Because of these high figures, empiric antibiotic administration for patients with systemic inflammatory response syndrome (SIRS) and suspected infection is the second most common indication for antibiotic administration in intensive care units (ICU)s. However, overuse of empiric antibiotics contributes to the development of opportunistic infections, antibiotic resistance, and the increase in multi-drug-resistant bacterial strains. The current method of diagnosing and ruling out bacteremia is via blood culture (BC) and Gram stain (GS) analysis., Methods: Conventional and molecular methods for diagnosing bacteremia were reviewed and compared. The clinical implications, use, and current clinical trials of polymerase chain reaction (PCR)-based methods to detect bacterial pathogens in the blood stream were detailed., Results: BC/GS has several disadvantages. These include: some bacteria do not grow in culture media; others do not GS appropriately; and cultures can require up to 5 d to guide or discontinue antibiotic treatment. PCR-based methods can be potentially applied to detect rapidly, accurately, and directly microbes in human blood samples., Conclusions: Compared with the conventional BC/GS, particular advantages to molecular methods (specifically, PCR-based methods) include faster results, leading to possible improved antibiotic stewardship when bacteremia is not present., Competing Interests: Author Disclosure Statement The authors have no financial disclosures to report. Funding: None. The content of this publication is the sole responsibility of the authors and does not necessarily reflect the views or policies of the Department of Defense or the Departments of the United States Army. Mention of trade names, commercial products, or organization does not imply endorsement by the United States Government.

Background: Black teenagers have relatively high rates of sexually transmitted diseases (STDs), and recent research suggests the role of contextual factors, as well as risk behaviors. We explore the role of 4 categories of risk and protective factors on having a biologically confirmed STD among black, female teenagers., Methods: Black teenage girls (14-19 years old) accessing services at a publicly funded family planning clinic provided a urine specimen for STD testing and completed an audio computer-assisted self-interview that assessed the following: risk behaviors, relationship characteristics, social factors, and psychosocial factors. We examined bivariate associations between each risk and protective factor and having gonorrhea and/or chlamydia, as well as multivariate logistic regression among 339 black female teenagers., Results: More than one-fourth (26.5%) of participants had either gonorrhea and/or chlamydia. In multivariate analyses, having initiated sex before age 15 (adjusted odds ratio [aOR], 1.87) and having concurrent sex partners in the past 6 months (aOR, 1.55) were positively associated with having an STD. Living with her father (aOR, 0.44), believing that an STD is the worst thing that could happen (aOR, 0.50), and believing she would feel dirty and embarrassed about an STD (aOR, 0.44) were negatively associated with having an STD., Conclusions: Social factors and attitudes toward STDs and select risk behaviors were associated with the risk for STDs, suggesting the need for interventions that address more distal factors. Future studies should investigate how such factors influence safer sexual behaviors and the risk for STDs among black female teenagers.

Although genital HPV is the most prevalent STI in the US, rates of vaccination uptake among high-risk subgroups remain low. Investigations of vaccine compliance have mainly targeted mother-daughter dyads, which in some settings may prove difficult. This study examines an innovative culturally tailored, computer-delivered media-based strategy to promote HPV vaccine uptake. Data, inclusive of sociodemographics, sexual behaviors, knowledge, attitudes, and beliefs about HPV and vaccination were collected via ACASI from 216 African American adolescent females (ages 14-18 years) seeking services in family planning and STI public health clinics in metropolitan Atlanta. Data were obtained prior to randomization and participation in an interactive media-based intervention designed to increase HPV vaccination uptake. Medical record abstraction was conducted 7 month post-randomization to assess initial vaccine uptake and compliance. Participants in the intervention were more compliant to vaccination relative to a placebo comparison condition (26 doses vs. Seventeen doses; p=0.12). However, vaccination series initiation and completion were lower than the national average. Thorough evaluation is needed to better understand factors facilitating HPV vaccine uptake and compliance, particularly perceived susceptibility and the influence of the patient-provider encounter in a clinical setting.

Substance use is prevalent among African American men living in urban communities. The impact of substance use on the social, psychological, and physical health of African American men has important public health implications for families, communities, and society. Given the adverse consequences of alcohol and drug abuse within communities of color, this study evaluated the relationship between city stress, alcohol consumption, and drug use among African American men. Eighty heterosexual, African American men, 18 to 29 years old, completed psychosocial risk assessments that assessed substance use and city stress. Multiple logistic regression analyses, controlling for age, indicated that participants reporting high levels of urban stress, relative to low levels of urban stress, were more likely to report a history of marijuana use (AOR = 5.19, p = .05), history of ecstasy and/or GHB use (AOR = 3.34, p = .04), having family/friends expressing strong concerns about their illicit drug use (AOR = 4.06, p = .02), and being unable to remember what happened the night before due to drinking (AOR = 4.98, p = .01). African American men living within the confines of a stressful urban environment are at increased risk for exposure to and utilization of illicit substances. Culturally competent public health interventions for substance use/abuse should address psychological factors, such as stress and neighborhood violence.

Objective: We assessed young African American women's understanding of "dual protection" (DP) (i.e., strategies that simultaneously protect against unintended pregnancies and sexually transmitted diseases [STDs]) and how relationship factors influence their use of DP methods., Methods: We conducted 10 focus groups with African American women (n=51) aged 15-24 years in Atlanta, Georgia, to identify barriers to and facilitators of their DP use. Focus group participants also completed a brief self-administered questionnaire that assessed demographics and sexual behaviors. We analyzed focus group data by theme: relationships, planning for sex, pregnancy intentions, STD worries, the trade-off between pregnancy and STDs, attitudes toward condoms and contraceptives, and understanding of DP., Results: From the questionnaire, 51% of participants reported that an STD would be the "worst thing that could happen," and 26% reported that being pregnant would be "terrible." Focus group data suggested that most participants understood what DP was but thought it was not always feasible. Relationship factors (e.g., trust, intimacy, length of relationship, and centrality) affected pregnancy intentions, STD concerns, and use of DP. Social influences (e.g., parents) and pregnancy and STD history also affected attitudes about pregnancy, STDs, and relationships., Conclusions: Although participants identified risks associated with sex, a complex web of social and relationship factors influenced the extent to which they engaged in protective behavior. The extent to which relationship factors influence DP may reflect developmental tasks of adolescence and should be considered in any program promoting sexual health among young African American women.

Sexually active African American females are at increased risk for acquiring HIV or STIs. However, some reduce their risk by abstaining from sex for various periods of time following initiation, a practice known as secondary abstinence. Although this may be a valuable mechanism for reducing HIV or STI rates in this population, little is known about those interested in secondary abstinence. Baseline data were obtained from a sample of African American adolescent females, ages 14-20 years, prior to participation in an HIV-risk reduction intervention trial (N = 701). Differences in individual-level and interpersonal-level factors, as well as sociodemographic variables were examined between participants who reported strong interest in secondary abstinence and those who did not. 144 (20.5%) participants reported strong interest in secondary abstinence. Young women with strong interest in abstinence had higher odds of reporting a history of STIs and feeling negative emotions following sex because of their religious beliefs. They also had higher odds of believing their partner may be interested in abstaining and being less invested in their relationship with their main partner. Additionally, adolescents reported less interpersonal stress and more social support. African American females who are interested in practicing secondary abstinence and those who are not differ in their sexual health education needs. Findings from this study characterizing young women interested in secondary abstinence can help researchers provide more targeted health education by identifying those who may be more responsive to abstinence-promoting messages.

This manuscript assesses priorities and challenges of adolescent females by conducting a meeting with teen advisory board (TAB) members to collect information regarding their lives and experiences pre-, during and post-incarceration in a juvenile detention facility. Multiple themes emerged regarding the impact of incarceration on young African-American females, including experiencing a loss of personal liberties, the importance of making money upon release, unfaithfulness by partners on the 'outside', substance use and lack of control over their environment upon release, including parents, peers and male sexual partners. Based on feedback from TAB members, unique barriers and challenges were identified that suggested areas where adaptations to an evidenced-based HIV/sexually transmitted disease (STD) intervention would be justified to more adequately meet the needs of this particular subgroup of young African-American women. Adaptations to the evidence-based interventions included enhancing activities related to goal setting, emotion regulation skills, decision-making, recognizing and utilizing support networks and addressing the relationship between substance use and risky sexual behavior. Future health education efforts focusing on either the creation of new HIV/STD interventions or adaptations to existing interventions should consider utilizing advisory boards with members of the priority population at the earliest stages of intervention planning.

Purpose: Social networks directly and indirectly influence sexually transmitted infections (STIs) risk. The objective was to explore associations between sex with a male recently released from incarceration and sexual risk and intimate partner violence (IPV) among African American adolescent females., Methods: Sociodemographic, psychosocial, and sexual behavior data were collected at baseline, 6, and 12 months from African American females, aged 15-21 years, participating in an HIV/STI prevention trial. Among 653 participants with ≥1 follow-up assessments, generalized estimating equations tested associations during follow-up between having a recently released partner and STI acquisition, sexual risk behaviors, and IPV, adjusting for age, treatment assignment, and corresponding baseline measure., Results: Eighty-three (13.6%) participants had a recently released partner at 6 months and 56 (9.3%) at 12 months. Participants with a recently released partner were more likely to have the following: vaginal (adjusted odds ratio [AOR]: 5.48), anal (AOR: 2.43), and oral (AOR: 1.51) sex, a casual partner (AOR: 1.66), sex while high/drunk (AOR: 1.57) or with a high/drunk partner (AOR: 2.27); use condoms inconsistently (AOR: .58); acquire Chlamydia (AOR: 1.80), and experience emotional (AOR: 4.09), physical (AOR: 2.59), or sexual abuse (AOR: 4.10) by a boyfriend. They had a greater number of sex partners, lower partner communication and refusal self-efficacy, were high/drunk during sex more frequently, and used condoms during oral sex less frequently., Conclusions: A recently released sex partner is associated with sexual risk and IPV among African American adolescent females. Prevention programs should inform adolescents about potential risks associated with recently released partners as well as provide adolescents with skills to establish and maintain healthy sexual relationships., (Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Pulsed shortwave diathermy (PSWD) is a form of therapy commonly used to enhance tissue repair and reduce pain. It is normally considered to be an athermal form of treatment; however, there is some evidence to suggest that thermal effects can arise with adequate dosage. The purpose of this study was to determine the pulse repetition rate (PRR) required to generate a 'possible' and 'definite' thermal sensation when PSWD was applied to the thigh., Method: Thirty healthy subjects were randomly assigned to placebo or treatment groups. The treatment group was exposed to PSWD at a constant setting of pulse duration (400 microseconds) and pulse power (190 W) while the PRR was increased from 26 Hz to 400 Hz in 10 increments. Each dose was applied for a period of two minutes. At the end of each application, subjects were asked if they felt a (1) 'possible' or (2) 'definite' thermal sensation. Skin temperature was measured immediately after each application. Placebo subjects were exposed to PSWD at its lowest settings throughout the experiment (pulse power = 5 W; pulse duration = 65 microseconds and PRR = 26 Hz)., Results: The results showed a significant correlation (p < 0.048) between PRR at 'definite' thermal sensation and skin temperature post-treatment and PRR at 'possible' thermal sensation (p < 0.001). Mean skin temperature increased significantly as PRR was increased, from 28.69 (+/- 0.75) degrees C pre-treatment to 31.14 (+/- 1.04) degrees C post-treatment, a mean difference of 2.34 degrees C., Conclusions: These results suggest that PSWD at adequate dosages can generate thermal effects, and that there is a relationship between these thermal effects and the PRR used. These results may have significant implications for the safe use of PSWD in the clinical arena.

Objective: To measure the effect of war trauma on the functional health and mental health status of Cambodian adolescents living in a refugee camp on the Thai-Cambodian border., Method: A multistage probability sample identified 1,000 households in the camp known as Site Two. Interviews were conducted in each household with randomly selected adults 18 years of age and older. All adolescents aged 12 and 13 years old, along with one parent were interviewed. One hundred eighty-two adolescents (94 girls, 88 boys) and their parents participated. Culturally sensitive instruments were used including Cambodian versions of the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR)., Results: Parents and adolescents reported the latter having experienced high levels of cumulative trauma, especially lack of food, water, and shelter. Mean Total Problem scores were in ranges similar to those of adolescents receiving clinical care in the United States, Netherlands, and Israel. Nearly 54% (53.8%) had Total Problem scores in the clinical range by parent report on the CBCL and 26.4% by adolescent report on the YSR. The most commonly reported symptoms were somatic complaints social withdrawal attention problems, anxiety, and depression. The dose-effect relationship between cumulative trauma and symptoms was strong for parent reporting on the CBCL; the subscales on both the YSR and CBCL for Anxious/Depressed and Attention Problems revealed dose-effect associations. Dose-effect relationships between cumulative trauma and social functioning or health status were lacking., Conclusion: The high levels of emotional distress in this population of Cambodian adolescents and corresponding dose-effect relationships reveal the important negative psychosocial impact of violence on Cambodian adolescents. Lack of findings related to physical health status and the presence of positive social functioning of many youths should not deter health care providers and public health officials from diagnosing and treating underlying high levels of psychological distress.