The U.S. has a higher adolescent pregnancy rate than other industrialized countries. School-based health centers can improve access to contraceptives among youth, which can prevent unplanned ...pregnancies. This cross-sectional study examines the characteristics and predictors of contraceptive provision at school-based health centers in 2016–2017 and changes in and barriers to provision between 2001 and 2017.
In 2020–2021, the authors conducted analyses of the National School-Based Health Care Census data collected from 2001 to 2017. The primary outcome of interest was whether adolescent-serving school-based health centers dispense contraceptives, and a secondary outcome of interest was the policies that prohibit school-based health centers from dispensing contraceptives. A multivariate regression analysis examined the associations between contraceptive provision and various covariates, including geographic region, years of operation, and provider team composition.
Less than half of adolescent-serving school-based health centers reported providing contraceptives on site. Those that provided contraceptives were more likely located in the Western and Northeastern regions of the U.S., older in terms of years of operation, and staffed by a wide variety of health provider types. Among school-based health centers that experienced policy barriers to providing access to contraceptive methods, most attributed the source to the school or school district where the school-based health center was located.
School-based health centers are an evidence-based model for providing contraceptives to adolescents but not enough are providing direct access. Understanding the predictors, characteristics, and barriers influencing the provision of contraceptives at school-based health centers may help to expand the number doing so.
Habitat specificity plays a pivotal role in forming community patterns in coral reef fishes, yet considerable uncertainty remains as to the extent of this selectivity, particularly among newly ...settled recruits. Here we quantified habitat specificity of juvenile coral reef fish at three ecological levels; algal meadows vs. coral reefs, live vs. dead coral and among different coral morphologies. In total, 6979 individuals from 11 families and 56 species were censused along Ningaloo Reef, Western Australia. Juvenile fishes exhibited divergence in habitat use and specialization among species and at all study scales. Despite the close proximity of coral reef and algal meadows (10's of metres) 25 species were unique to coral reef habitats, and seven to algal meadows. Of the seven unique to algal meadows, several species are known to occupy coral reef habitat as adults, suggesting possible ontogenetic shifts in habitat use. Selectivity between live and dead coral was found to be species-specific. In particular, juvenile scarids were found predominantly on the skeletons of dead coral whereas many damsel and butterfly fishes were closely associated with live coral habitat. Among the coral dependent species, coral morphology played a key role in juvenile distribution. Corymbose corals supported a disproportionate number of coral species and individuals relative to their availability, whereas less complex shapes (i.e. massive & encrusting) were rarely used by juvenile fish. Habitat specialisation by juvenile species of ecological and fisheries importance, for a variety of habitat types, argues strongly for the careful conservation and management of multiple habitat types within marine parks, and indicates that the current emphasis on planning conservation using representative habitat areas is warranted. Furthermore, the close association of many juvenile fish with corals susceptible to climate change related disturbances suggests that identifying and protecting reefs resilient to this should be a conservation priority.
Is the destruction or removal of atmospheric methane a worthwhile option? Nisbet-Jones, Peter B R; Fernandez, Julianne M; Fisher, Rebecca E ...
Philosophical transactions - Royal Society. Mathematical, Physical and engineering sciences/Philosophical transactions - Royal Society. Mathematical, physical and engineering sciences,
01/2022, Letnik:
380, Številka:
2215
Journal Article
Recenzirano
Odprti dostop
Removing methane from the air is possible, but do the costs outweigh the benefits? This note explores the question of whether removing methane from the atmosphere is justifiable. Destruction of ...methane by oxidation to CO
eliminates 97% of the warming impact on a 100-yr time scale. Methane can be oxidized by a variety of methods including thermal or ultraviolet photocatalysis and various processes of physical, chemical or biological oxidizers. Each removal method has energy costs (with the risk of causing embedded CO
emission that cancel the global warming gain), but in specific circumstances, including settings where air with high methane is habitually present, removal may be competitive with direct efforts to cut fugitive methane leaks. In all cases however, great care must be taken to ensure that the destruction has a net positive impact on the total global warming, and that the resources required would not be better used for stopping the methane from being emitted. This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part 2)'.
Stroke Early Supported Discharge (ESD) involves provision of responsive and intensive rehabilitation to stroke survivors at home and it is recommended as part of the stroke care pathway. Core ...components have been identified to guide the delivery of evidence-based ESD, however, service provision in England is of variable quality. The study sought to understand how and in what conditions the adoption of these components drives the delivery of responsive and intensive ESD services in real world settings.
This qualitative study was part of a wider multimethod realist evaluation project (WISE) conducted to inform large-scale ESD implementation. Overarching programme theories and related context-mechanism-outcome configurations were used as a framework to guide data collection and analysis. Six case study sites were purposively selected; interviews and focus groups with ESD staff members were conducted and analysed iteratively.
We interviewed 117 ESD staff members including clinicians and service managers. Staff highlighted the role of certain core components including eligibility criteria, capacity, team composition and multidisciplinary team (MDT) coordination in achieving responsive and intensive ESD. Regardless of the geographical setting, adhering to evidence-based selection criteria, promoting an interdisciplinary skillset and supporting the role of rehabilitation assistants, allowed teams to manage capacity issues and maximise therapy time. Gaps in the stroke care pathway, however, meant that teams had to problem solve beyond their remit to cater for the complex needs of patients with severe disabilities. Adjusting MDT structures and processes was seen as key in addressing challenges posed by travel times and rural geography.
Despite variations in the wider service model of operation and geographical location, the adoption of core components of ESD helped teams manage the pressures and deliver services that met evidence-based standards. Findings point to a well-recognised gap in service provision in England for stroke survivors who do not meet the ESD criteria and emphasise the need for a more integrated and comprehensive stroke service provision. Transferable lessons could be drawn to inform improvement interventions aimed at promoting evidence-based service delivery in different settings.
ISRCTN: 15,568,163, registration date: 26 October 2018.
OBJECTIVES/GOALS: This study aims to assess associations over time between several area-based indices of concentration at the extremes and COVID-19 hospitalization and death in Los Angeles County, ...from January 2020 to June 2023. These measures reflect concentrations of racial/ethnic and economic segregation at the census tract level. METHODS/STUDY POPULATION: Indices of concentration at the extremes (ICEs) for economic segregation, racial/ethnic segregation, and a combination of the two were constructed for each Los Angeles County (LAC) census tract, using 2015-2019 ACS data. The index ranges from -1 to 1 and is the number of advantaged households (HH) minus the number of disadvantaged HH over the total number of HH measured. Economic segregation is HH income over $100,000 vs. below $25,000 per year and racial/ethnic segregation defined as White and Non-Hispanic vs. non-White or Hispanic HH. The distribution of index scores was divided into quintiles (Q1-Q5) for all LAC census tracts. Age-adjusted hospitalization and death rates were derived at the census tract level by quarter (QTR) based on Los Angeles County Department of Public Health surveillance data. RESULTS/ANTICIPATED RESULTS: Age-adjusted hospitalization and death rates were consistently higher across all quarters in Q1 (most deprived) vs. Q5 (most privileged) for all ICE measures. For ICE of economic segregation, the age-adjusted hospitalization and death rate ratios between Q1 and Q5 were 2.12 (range: 1.32 - 4.15; peak 2020 QTR2) and 2.02 (range: 1.46 - 3.21; peak 2021 QTR1), respectively. For ICE of racial segregation, the age-adjusted hospitalization and death rate ratio between Q1 and Q5 was 2.03 (range: 1.08 - 3.95; peak 2020 QTR3) and 1.77 (range: 1.03 - 2.80; peak 2021 QTR1). The ICE of economic/racial segregation combined was the highest, with averages of the age-adjusted hospitalization and death rate ratios between Q1 and Q5 being 2.26 (1.16 - 4.43; peak 2020 QTR2) and 1.99 (range: 1.22 - 3.32; peak 2021 QTR1). DISCUSSION/SIGNIFICANCE: This study assesses the impact of geographic segregation based on indices that quantify the concentration of both deprivation, privilege, and racial/ethnic group, demonstrating that segregation and economic deprivation are consistently associated with higher rates of age-adjusted hospitalization and death from COVID-19 in LAC.
Abstract Introduction : Robotic surgery is a rapidly expanding field. Thus far training for robotic techniques has been unstructured and the requirements are variable across various regions. Several ...projects are currently underway to develop a robotic surgery curriculum and are in various stages of validation. We aimed to outline the structures of available curricula, their process of development, validation status and current utilization. Methods : We undertook a literature review of papers including the MeSH terms “Robotics” and “Education”. When we had an overview of curricula in development, we searched recent conference abstracts to gain up to date information. Results : The main curricula are the FRS, the FSRS, the Canadian BSTC and the ERUS initiative. They are in various stages of validation and offer a mixture of theoretical and practical training, using both physical and simulated models. Discussion : Whilst the FSRS is based on tasks on the RoSS virtual reality simulator, FRS and BSTC are designed for use on simulators and the robot itself. The ERUS curricula benefits from a combination of dry lab, wet lab and virtual reality components, which may allow skills to be more transferable to the OR as tasks are completed in several formats. Finally, the ERUS curricula includes the OR modular training programme as table assistant and console surgeon. Conclusion : Curricula are a crucial step in global standardisation of training and certification of surgeons for robotic surgical procedures. Many curricula are in early stages of development and more work is needed in development and validation of these programmes before training can be standardised.
Reptiles are the only amniotes that maintain the capacity to regenerate appendages. This study presents the first anatomical and histological evidence of tail repair with regrowth in an archosaur, ...the American alligator. The regrown alligator tails constituted approximately 6-18% of the total body length and were morphologically distinct from original tail segments. Gross dissection, radiographs, and magnetic resonance imaging revealed that caudal vertebrae were replaced by a ventrally-positioned, unsegmented endoskeleton. This contrasts with lepidosaurs, where the regenerated tail is radially organized around a central endoskeleton. Furthermore, the regrown alligator tail lacked skeletal muscle and instead consisted of fibrous connective tissue composed of type I and type III collagen fibers. The overproduction of connective tissue shares features with mammalian wound healing or fibrosis. The lack of skeletal muscle contrasts with lizards, but shares similarities with regenerated tails in the tuatara and regenerated limbs in Xenopus adult frogs, which have a cartilaginous endoskeleton surrounded by connective tissue, but lack skeletal muscle. Overall, this study of wild-caught, juvenile American alligator tails identifies a distinct pattern of wound repair in mammals while exhibiting features in common with regeneration in lepidosaurs and amphibia.
The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is frequently used to evaluate parenting capacity in cases of child abuse and neglect. This study examined MMPI-2 profiles of 59 males and ...217 females who completed the test as part of a parenting capacity evaluation following substantiated allegations of child abuse or neglect. After removing 46 (16.7%) invalid profiles, 230 profiles remained. Of these, 119 (52.7%) had T scores on L (Lie) that were at or above 70, indicating a high frequency of underreporting. Mean T scores on the clinical, restructured clinical (RC), content, and PSY-5 scales were all below 65, and 62 (27.0%) profiles contained no elevations (≥65T) on any of these scales. Elevations on the K-corrected clinical scales were more common than elevations on the other scales. The most commonly elevated scales were RC6, clinical scales 4, 8, 9, 1, 6, 5, and non-K-corrected scale 4. The least frequently elevated scales were ANG, RC9, OBS, and DISC. Multivariate Analyses of Variance (MANOVA) comparing cases with L < 70T and L ≥ 70T showed that elevated scores on L had the greatest effect on the content scales, followed by the RC scales, PSY-5 scales, and the clinical scales without the K-correction. Least affected by elevations on L were the K-corrected clinical scales. The study suggests that efforts to present oneself in a favorable light suppress scores on the MMPI-2 scales to different degrees and that the K-correction is helpful in mitigating the effects of underreporting.
Public Significance Statement
Although the MMPI-2 is frequently used to evaluate parenting capacity in cases of child abuse and neglect, underreporting of problems is common in these samples. This study found that scores on the K-corrected clinical scales were less likely to be suppressed by underreporting than the scores on the non-K-corrected clinical scales, RC scales, content scales or PSY-5 scales.
Methane (CH
4
) mole fractions from the large semiseasonal Llanos de Moxos wetlands (∼70,000 km
2
) in northern Bolivia were measured by aircraft flights and ground sampling during early March 2019 ...(late wet season). Daily fluxes of CH
4
determined from the measurements using box models and inverse modeling were between 168 (± 50) and 456 (± 145) mg CH
4
⋅m
−2
⋅d
−1
for the areas overflown, very high compared with those of previous Amazon basin studies. If the seasonality of the CH
4
emissions is comparable to other parts of the Amazon Basin, the region could contribute as much as 8% of annual Amazonian CH
4
emissions.
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