Rethinking narratives about youth experiencing homelessness: The influence of self-determined motivation and peer relations on coping.

Using the cognitive appraisal theory of coping and the self-determination theory of motivation, we examined the shared variance of motivational orientations, attachment relationships, and gender on adaptive and maladaptive coping among youth experiencing homelessness. Several scales including The Global Motivation Scale (assessing motivational orientations; i.e., autonomous and controlled motivation), the Brief Cope (adaptive and maladaptive coping strategies), and the Inventory of Parent and Peer Attachment (self-perceptions of relationships with mothers, fathers, and peers) were administered to 102 youth aged between 16 and 24 (Mage = 20, SD = 2.07) years recruited from an evening program for youth experiencing homelessness in Montreal, Canada. Autonomous motivation was positively associated with engagement in effective coping strategies, while controlled motivation was positively linked to maladaptive coping. Moderation analyses were used to examine whether gender and relationships with attachment figures moderated the relationship between motivation and coping. A significant main effect of peer attachment on adaptive coping emerged, in which greater peer attachment was related to more adaptive coping among the youth. No interaction effects resulted. Although no significant moderating effects were associated with essential relationships and gender, further research implementing a more nuanced approach to assessing the interaction between these constructs may be warranted. Overall, the findings highlight the importance of intervention programs for youth experiencing homelessness, that focus on enhancing autonomous motivation and utilizing peer support to optimize the use of adaptive coping strategies.

Pre-exposure prophylaxis (PrEP) use, anticipated PrEP stigma, and bisexual identity among a Black and Hispanic/Latino sexual and gender diverse sample.

Black and Hispanic/Latino sexual minority men and gender diverse (SMMGD) individuals are disproportionately impacted by the HIV epidemic. Uptake and adherence to pre-exposure prophylaxis (PrEP) is suboptimal among SMMGD Black and Hispanic/Latino individuals, but most research has approached this population as homogenous (e.g., a group operationalized as men who have sex with men). Bisexual men are less likely to disclose their sexual identity and report more mental health problems than their gay counterparts, but there is less attention to the impact of different sexual identities on PrEP use over time. We utilized data from three waves of a national longitudinal study (2020-2021) to characterize Black and Hispanic/Latino SMMGD participants' PrEP use including: 1) PrEP uptake during the study; 2) consistent PrEP use across the study; and 3) discontinuation of PrEP use since study baseline. We found bisexual men were significantly less likely than gay men to be consistent PrEP users and were more likely to discontinue PrEP use over the course of the study. Of the sample who reported PrEP use across surveys, 10% initiated PrEP during the study period, 0% of whom were bisexual. Additionally, bisexual participants reported statistically significantly higher anticipated PrEP stigma relative to gay participants. These findings have implications for HIV prevention interventions. Given the differences in PrEP experiences as a function of sexual identity, researchers and clinicians should consider the disruptive role of stigma (both biphobia and anticipated PrEP stigma) in PrEP care and adherence.

Navigating the turbulent seas: Experiences of peer mentorship on the journey to becoming a nurse scholar.

BACKGROUND: Peer mentorship is a vital component of doctoral education; however, few studies describe peer mentorship in Doctor of Philosophy in Nursing (PhDN) programs. OBJECTIVES: Explore characteristics, benefits, and challenges of peer mentorship experienced by PhD-N students. DESIGN: An electronic survey was sent to PhD-N program administrators at member institutions of the American Association of Colleges of Nursing in the United States. Contacts were asked to distribute the survey to current and recently graduated PhD-N students. Descriptive statistics were used to analyze participant demographics. Thematic analysis was used to analyze survey responses. RESULTS: Respondents (n = 213) provided perspectives from every PhD-N program phase, with 43.3 % (n = 91) pre-candidacy, 41.0 % (n = 86) candidacy, and 15.7 % (n = 33) recently graduated students. A total of 55.2 % (n = 117) received some form of peer mentorship. Thematic analysis revealed three peer mentorship levels (map, compass, first mate) representing varying degrees of emotional investment. Peer mentorship benefits included feeling connected to peers and the institution, strengthening research skills, and feeling supported. Barriers to peer mentorship include lack of time and institutional support, fear of burdening others, and poorly matched mentors. CONCLUSION: Given that peer mentorship recipients reported feeling supported and less isolated, academic institutions should build a culture that promotes and supports peer mentorship. Future research should examine peer mentorship effects on PhD-N students' mental health, academic success, and faculty transition.

Factors associated with changes in illicit opioid use during the COVID-19 pandemic among incarcerated people who use drugs in Quebec, Canada.

PURPOSE: People who use drugs (PWUD) have been disproportionately affected by the COVID-19 pandemic. This study aims to examine changes in illicit opioid use and related factors among incarcerated PWUD in Quebec, Canada, during the pandemic. DESIGN/METHODOLOGY/APPROACH: The authors conducted an observational, cross-sectional study in three Quebec provincial prisons. Participants completed self-administered questionnaires. The primary outcome, "changes in illicit opioid consumption," was measured using the question "Has your consumption of opioid drugs that were not prescribed to you by a medical professional changed since March 2020?" The association of independent variables and recent changes (past six months) in opioid consumption were examined using mixed-effects Poisson regression models with robust standard errors. Crude and adjusted risk ratios with 95% confidence intervals (95% CIs) were calculated. FINDINGS: A total of 123 participants (median age 37, 76% White) were included from January 19 to September 15, 2021. The majority (72; 59%) reported decreased illicit opioid consumption since March 2020. Individuals over 40 were 11% less likely (95% CI 14-8 vs 18-39) to report a decrease, while those living with others and with a history of opioid overdose were 30% (95% CI 9-55 vs living alone) and 9% (95% CI 0-18 vs not) more likely to report decreased illicit opioid consumption since March 2020, respectively. ORIGINALITY/VALUE: The authors identified possible factors associated with changes in illicit opioid consumption among incarcerated PWUD in Quebec. Irrespective of opioid consumption patterns, increased access to opioid agonist therapy and enhanced discharge planning for incarcerated PWUD are recommended to mitigate the harms from opioids and other drugs.

PhD student perspectives on maintaining and formalizing peer mentorship during the COVID-19 pandemic.

Mentorship is important for doctoral education and development. Students in Doctor of Philosophy (PhD) in Nursing programs traditionally receive formal mentorship from more experienced faculty mentors, creating a top-down, mentor-mentee relationship. Peer mentorship, characterized by a mentor-mentee relationship between peers in similar career stages, provides unique opportunities for career development and socialization. The emergence of the COVID-19 pandemic limited in-person interactions and introduced new, complex challenges to peer mentorship. The authors, current and recently graduated PhD in Nursing students, were forced to create new ways of connecting with peers and sought to explore how other PhD in Nursing students experienced and maintained peer mentorship in their respective programs during the pandemic. In this article, the authors share their personal experiences with peer mentorship during the pandemic, their process of creating a formal peer mentor model, and findings from a national, cross-sectional survey on COVID-related, peer mentorship experiences among PhD in Nursing students from other academic institutions. Most respondents were able to maintain peer mentorship throughout the pandemic, however, less than half reported receiving faculty support to do so. Recommendations for PhD in Nursing program administrators are provided, based on the experiences of the authors and survey results from PhD in Nursing students across the United States.

Sexual minorities are at elevated risk of cardiovascular disease from a younger age than heterosexuals.

Cardiovascular disease is the leading cause of death worldwide. In this study, we assessed factors related to cardiovascular disease risk and outcomes among sexual minorities (SM). Data from multiple waves of the PATH study were used in this analysis. Multivariable regression models were used to assess the association between sexual identity and: tobacco or e-cigarette use, adverse cardiovascular events, and age at first diagnosis of adverse cardiovascular disease events. In our sample (N = 23,205), 1,660 (7.15%) participants identified as SM. SM men, relative to heterosexual men, are more likely to be diagnosed with high blood pressure (aRR = 1.27; 95% CI 1.10, 1.47), high cholesterol (aRR = 1.32; 95% CI: 1.12, 1.55), congestive heart failure (aRR = 2.29; 95% CI 1.13, 4.65), stroke (aRR = 2.39; 95% CI: 1.14, 5.04), heart attack (aRR = 2.40; 95% CI 1.42, 4.04), and other heart conditions (aRR = 1.52; 95% CI: 1.06, 2.18). Although no simple differences were observed among SM women compared to heterosexual women, SM women were more likely to be diagnosed at a younger age for high blood pressure (aRR = -0.69; 95% CI - 1.08, - 0.29), high cholesterol (aRR = -0.77; 95% CI - 1.15, - 0.38), stroke (aRR = - 1.04; 95% CI - 1.94, - 0.13), and heart attack (aRR = - 1.26; 95% CI - 2.42, - 0.10). SM men were only diagnosed at a younger age for stroke (aRR = - 1.18; 95% CI - 2.06, - 0.30). Compared to heterosexuals, sexual minorities are at higher risk for cardiovascular disease, more likely to develop cardiovascular disease at an earlier age, and more likely to use tobacco products. Future research should focus on decreasing cardiovascular risk among sexual minorities including reducing tobacco use and stress. Screening recommendations for sexual minority populations should also be reviewed in light of a growing body of literature suggesting elevated risk from a young age.

Seroprevalence and Risk Factors for Severe Acute Respiratory Syndrome Coronavirus 2 Among Incarcerated Adult Men in Quebec, Canada, 2021.

BACKGROUND: People in prison are at increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We examined the seroprevalence of SARS-CoV-2 and associated carceral risk factors among incarcerated adult men in Quebec, Canada. METHODS: We conducted a cross-sectional seroprevalence study in 2021 across 3 provincial prisons, representing 45% of Quebec's incarcerated male provincial population. The primary outcome was SARS-CoV-2 antibody seropositivity (Roche Elecsys serology test). Participants completed self-administered questionnaires on sociodemographic, clinical, and carceral characteristics. The association of carceral variables with SARS-CoV-2 seropositivity was examined using Poisson regression models with robust standard errors. Crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95% CIs) were calculated. RESULTS: Between 19 January 2021 and 15 September 2021, 246 of 1100 (22%) recruited individuals tested positive across 3 prisons (range, 15%-27%). Seropositivity increased with time spent in prison since March 2020 (aPR, 2.17; 95% CI, 1.53-3.07 for "all" vs "little time"), employment during incarceration (aPR, 1.64; 95% CI, 1.28-2.11 vs not), shared meal consumption during incarceration ("with cellmates": aPR, 1.46; 95% CI, 1.08-1.97 vs "alone"; "with sector": aPR, 1.34; 95% CI, 1.03-1.74 vs "alone"), and incarceration post-prison outbreak (aPR, 2.32; 95% CI, 1.69-3.18 vs "pre-outbreak"). CONCLUSIONS: The seroprevalence of SARS-CoV-2 among incarcerated individuals was high and varied among prisons. Several carceral factors were associated with seropositivity, underscoring the importance of decarceration and occupational safety measures, individual meal consumption, and enhanced infection prevention and control measures including vaccination during incarceration.

Substance use treatment partially mitigates association between methamphetamine use and STI risk: findings from the NSDUH cohort.

BACKGROUND: In recent years, both methamphetamine use and STIs have been on the rise in the USA. In this analysis, we sought to ascertain whether the risk of STIs and HIV among methamphetamine users was moderated on the basis of participation in substance use treatment programmes. METHODS: Data came from the National Survey on Drug Use and Health, 2015-2019. Among adult participants, survey-weighted logistic regression analyses were used to assess the relationship between past year methamphetamine use and risk of HIV and STIs, stratified by methamphetamine treatment utilisation and adjusted for demographic and other risk factors. RESULTS: Among participants in the analytic sample (n=210 392), 1862 (0.9%) reported past year methamphetamine use, 566 (0.3%) reported receiving treatment for its use, 5471 (2.6%) tested positive for any STI in the past year and 395 (0.2%) for HIV ever in their lifetime. Past year methamphetamine use was associated with increased risk of STIs among those who did not receive treatment (adjusted OR=3.628; 95% CI 2.75 to 4.92). Significant moderation was also present between past-year methamphetamine use, risk of STI, and substance use treatment. CONCLUSION: In this analysis, we demonstrated a strong relationship between methamphetamine use and risk of STIs that differed based on receipt of substance use treatment. These findings suggested that integrated STI and substance use treatment programmes may yield substantial public health benefits.

Impacts of low-disturbance dairy manure incorporation on ammonia and greenhouse gas fluxes in a corn silage-winter rye cover crop system.

Manure and fertilizer applications contribute to greenhouse gas (GHG) and ammonia (NH3 ) emissions. Losses of NH3 and nitrous oxide (N2 O) are an economic loss of nitrogen (N) to farms, and methane (CH4 ), N2 O, and carbon dioxide (CO2 ) are important GHGs. Few studies have examined the effects of low-disturbance manure incorporation (LDMI) on both NH3 and GHG fluxes. Here, NH3 , N2 O, CH4 , and CO2 fluxes in corn (Zea mays L.)-winter rye (Secale cereale L.) field plots were measured under fall LDMI (aerator/band, coulter injection, strip-till, sweep inject, surface/broadcast application, broadcast-disk) and spring-applied urea (134 kg N ha-1 ) treatments from 2013 to 2015 in central Wisconsin. Whereas broadcast lost 35.5% of applied ammonium-N (NH4 -N) as NH3 -N, strip-till inject and coulter inject lost 0.11 and 4.5% of applied NH4 -N as NH3 , respectively. Mean N2 O loss ranged from 2.7 to 3.6% of applied total N for LDMI, compared with 4.2% for urea and 2.6% for broadcast. Overall, greater CO2 fluxes for manure treatments contributed to larger cumulative GHG fluxes compared with fertilizer N. There were few significant treatment effects for CH4 (P > .10); however, fluxes were significantly correlated with changes in soil moisture and temperature. Results indicate that LDMI treatments significantly decreased NH3 loss but led to modest increases in N2 O and CO2 fluxes compared with broadcast and broadcast-disk manure incorporation. Tradeoffs between N conservation versus increased GHG fluxes for LDMI and other methods should be incorporated into nutrient management tools as part of assessing agri-environmental farm impacts.

CBD Suppression of EAE Is Correlated with Early Inhibition of Splenic IFN-γ + CD8+ T Cells and Modest Inhibition of Neuroinflammation.

In this study cannabidiol (CBD) was administered orally to determine its effects and mechanisms in the experimental autoimmune encephalomyelitis (EAE) model of multiple sclerosis (MS). We hypothesized that 75 mg/kg of oral CBD given for 5 days after initiation of disease would reduce EAE severity through suppression of either the early peripheral immune or late neuroimmune response. EAE was induced in C57BL/6 mice at two different magnitudes, and peripheral inflammatory and neuroinflammatory responses were measured at days 3, 10, and 18. Th1, Th17, Tc1, Tc17, Tregs, and myeloid derived suppressor cells (MDSC) were identified from the lymph nodes and spleens of each mouse to determine if CBD altered the suppressor cell or inflammatory cell populations in secondary lymphoid tissues. Additionally, neuroinflammation was identified in brain and spinal cord tissues using various immunohistochemical techniques and flow cytometry. Early treatment of EAE with oral CBD reduced clinical disease at the day 18 timepoint which correlated with a significant decrease in the percentage of MOG35-55 specific IFN-γ producing CD8+ T cells in the spleen at day 10. Analysis of both T cell infiltration and lesion size within the spinal cord also showed a moderate reduction in neuroinflammation within the central nervous system (CNS). These results provide evidence that oral CBD suppressed the peripheral immune response that precedes neuroinflammation; however, analysis of the neuroinflammatory endpoints also suggest that the modest reduction in neuroinflammation was only partially responsible for CBD's neuroprotective capability. Graphical Abstract CBD was administered orally for the first 5 days following initiation of EAE. CBD attenuated clinical disease, and we found that CBD suppressed IFN-γ producing CD8+ T cells in the spleen at day 10. There was also modest suppression of neuroinflammation. Together these data demonstrate that early, oral administration of CBD protected mice from disease, but the modest effects on neuroinflammation suggest other mechanisms participate in CBD's neuroprotective effect in EAE.

Runoff water quality after low-disturbance manure application in an alfalfa-grass hay crop forage system.

The impacts of low-disturbance manure application (LDMA) on runoff water quality in hay crop forages are not well known. Our objective in this study was to determine surface runoff losses of total nitrogen (TN), ammonium N (NH4 -N), nitrate N (NO3 -N), total phosphorus (TP), dissolved reactive P (DRP), and suspended sediment from alfalfa (Medicago sativa L.)-grass plots in central Wisconsin after surface broadcasting manure and LDMA compared with no application. Treatments were (a) surface banding (BAND), (b) surface banding with aeration (A/B), (c) shallow disk injection (INJECT), (d) surface broadcast (BCAST), and (e) a no-manure control (CONT). Runoff events were generated (n = 7) from replicated plots following a standardized rainfall simulation protocol. Although runoff was variable across plots and within treatments, mean runoff concentrations of TN (P = .03), NH4 -N (P = .03), TP (P = .001), and DRP (P < .0001) were lower for incorporated (INJECT and A/B) vs. unincorporated (BCAST and BAND) treatments. INJECT had lower mean DRP concentration (P = .02) than A/B and was similar to CONT and had lower cumulative TN (P = .05), TP (P = .07), and DRP (P = .01) loads than A/B. Additionally, TP, TN, DRP, and NH4 -N loads and concentrations were strongly related with soil surface manure coverage extent (R2 = 0.50-0.84; P < .0001), suggesting that manure was a main source of N and P losses. Although INJECT appeared to be the most effective in mitigating nutrient loss in surface runoff, more research is needed to determine LDMA impacts on farm economics, soil properties, and runoff water quality.

Influence of low-disturbance fall liquid dairy manure application on corn silage yield, soil nitrate, and rye cover crop growth.

Tillage incorporation of manure can mitigate nutrient loss but increases erosion potential and damages cover crops. More information on the effects of low-disturbance manure application (LDMA) on corn yield, cover crop establishment, and soil properties is needed to better predict manure management practice trade-offs. Here, corn silage (Zea mays L.) yield, winter rye (Secale cereale L.) establishment, and soil nitrate concentrations were compared for a range of manure application methods, including broadcast incorporation, broadcast/disk, fertilizer N (spring applied at 67, 134, and 202 kg N ha-1 ), and a no-manure control, at the University of Wisconsin's Marshfield Agricultural Research Station from 2012 to 2015. Compared with the control, manure and fertilizer N treatments increased corn yield by an average of 1.1- to 1.6-fold and 1.4- to 1.6-fold, respectively. Of the LDMA treatments (sweep-, strip till-, and coulter-injection; aerator/band; broadcast), corn yield was greatest for sweep injection, which did not differ from the high N fertilizer rate (P < .0001). Corn yield averaged across LDMA treatments did not differ from the 134 or 202 kg N ha-1 yields. Compared with disking, LDMA maintained more crop residue (P < .0001), with levels comparable to the control. Soil nitrate-N at depths of 0-30 and 30-60 cm was influenced by LDMA and fertilizer N; however, leaching to 60-90 cm was comparable among treatments. Results indicate that LDMA with injection conserved more N, caused less damage to winter rye, and had similar yields to fertilizer N treatments with improved soil aggregate stability and higher total carbon content.

Perceptions, needs and preferences of chronic disease self-management support among men experiencing homelessness in Montreal.

OBJECTIVE: This study explored the perceptions, needs and preferences for chronic disease self- management (SM) and SM support among men experiencing homelessness. DESIGN: A qualitative interpretive approach was used. Eighteen semi-structured interviews were conducted with 18 homeless men with a chronic disease at an emergency overnight shelter of Welcome Hall Mission (WHM) in Montreal, Quebec. Interviews were audio-recorded, transcribed verbatim and thematically analysed. RESULTS: The majority of participants perceived SM as important, described confidence to perform medical SM behaviours, and creatively adapted their SM behaviours to homelessness. Emotional SM was described as most challenging, as it was intertwined with the experience of homelessness. Three vulnerable groups were identified: (a) those with no social networks, (b) severe physical symptoms and/or (c) co-morbid mental illness. The preferred mode of delivery for SM support was through consistent contacts with health-care providers (HCPs) and peer-support initiatives. DISCUSSION AND CONCLUSIONS: Despite competing demands to fulfill basic needs, participants valued chronic disease SM and SM support. However, SM support must address complex challenges relating to homelessness including emotional SM, multiple vulnerabilities and barriers to forming relationships with HCPs.

Measuring Phosphorus Release in Laboratory Microcosms for Water Quality Assessment.

Phosphorus (P) is a critical limiting nutrient in agroecosystems requiring careful management to reduce transport risk to aquatic environments. Routine laboratory measures of P bioavailability are based on chemical extractions performed on dried samples under oxidizing conditions. While useful, these tests are limited with respect to characterizing P release under prolonged water saturation. Labile orthophosphate bound to oxidized iron and other metals can rapidly desorb to solution in reducing environments, increasing P mobilization risk to surface runoff and groundwater. To better quantify P desorption potential and mobility during extended saturation, a laboratory microcosm method was developed based on repeated sampling of porewater and overlying floodwater over time. The method is useful for quantifying P release potential from soils and sediments varying in physicochemical properties and can improve site-specific P mitigation efforts by better characterizing P release risk in hydrologically active areas. Advantages of the method include its ability to simulate in situ dynamics, simplicity, low cost, and flexibility.

Nutrient Runoff Losses from Liquid Dairy Manure Applied with Low-Disturbance Methods.

Manure applied to cropland is a source of phosphorus (P) and nitrogen (N) in surface runoff and can contribute to impairment of surface waters. Tillage immediately after application incorporates manure into the soil, which may reduce nutrient loss in runoff as well as N loss via NH volatilization. However, tillage also incorporates crop residue, which reduces surface cover and may increase erosion potential. We applied liquid dairy manure in a silage corn ( L.)-cereal rye ( L.) cover crop system in late October using methods designed to incorporate manure with minimal soil and residue disturbance. These include strip-till injection and tine aerator-band manure application, which were compared with standard broadcast application, either incorporated with a disk or left on the surface. Runoff was generated with a portable rainfall simulator (42 mm h for 30 min) three separate times: (i) 2 to 5 d after the October manure application, (ii) in early spring, and (iii) after tillage and planting. In the postmanure application runoff, the highest losses of total P and dissolved reactive P were from surface-applied manure. Dissolved P loss was reduced 98% by strip-till injection; this result was not statistically different from the no-manure control. Reductions from the aerator band method and disk incorporation were 53 and 80%, respectively. Total P losses followed a similar pattern, with 87% reduction from injected manure. Runoff losses of N had generally similar patterns to those of P. Losses of P and N were, in most cases, lower in the spring rain simulations with fewer significant treatment effects. Overall, results show that low-disturbance manure application methods can significantly reduce nutrient runoff losses compared with surface application while maintaining residue cover better than incorporation by tillage.

Low-income working immigrant families in Quebec: Exploring their challenges to well-being.

OBJECTIVES: To identify low-income working families' health challenges and understand their barriers and facilitators to navigating those challenges. METHODS: We conducted a focused ethnographic study in a food bank in Montreal, Quebec. Using purposeful sampling, we recruited participants who had at least one employed family member and one live-in child. Sensitizing concepts included social determinants of health (SDH) and family strengths. Participant observation, focus groups and in-depth interviews constituted the primary means of data collection. Thematic and contextual analyses were conducted iteratively. RESULTS: We recruited 25 participants, 22 clients (15 women and 7 men with up to 5 children per family) and 3 members of staff. All clients were immigrants, having been in Canada for a range of 2 months to 23 years, thus reflecting the ethnic demography of the site. Families described health as physical, mental and socio-cultural well-being. Challenges to well-being included insufficient finances, non-standard work, hurdles in professional equivalency, isolation, children's acculturation, inadequate access to health care and the Canadian winter. Personal and structural barriers and facilitators to navigating challenges centred on parents' sense of the challenges being finite, control over discrete dimensions of life and hope of children's future success. Families who incorporated these perceptions into their narratives seemed to describe the challenges as navigable. Importantly, the SDH model did not anticipate the degree to which challenges would be defined by immigration factors. CONCLUSION: In order to help low-income working immigrant families face diverse challenges to well-being, community workers and policy-makers must consider the specific challenges of immigration and the importance of individual families' outlooks as they navigate them.

The Density of States and the Transport Effective Mass in a Highly Oriented Semiconducting Polymer: Electronic Delocalization in 1D.

The determination of the band structure along k parallel to the chain direction demonstrates significant electronic delocalization. The small effective mass [m* = 0.106mo ] is consistent with the high measured mobility.

Quantifying and Reducing Uncertainty in Estimated Microcystin Concentrations from the ELISA Method.

We discuss the uncertainty associated with a commonly used method for measuring the concentration of microcystin, a group of toxins associated with cyanobacterial blooms. Such uncertainty is rarely reported and accounted for in important drinking water management decisions. Using monitoring data from Ohio Environmental Protection Agency and from City of Toledo, we document the sources of measurement uncertainty and recommend a Bayesian hierarchical modeling approach for reducing the measurement uncertainty. Our analysis suggests that (1) much of the uncertainty is a result of the highly uncertain "standard curve" developed during each test and (2) the uncertainty can be reduced by pooling raw test data from multiple tests. Based on these results, we suggest that estimation uncertainty can be effectively reduced through the effort of either (1) regional regulatory agencies by sharing and combining raw test data from regularly scheduled microcystin monitoring program or (2) the manufacturer of the testing kit by conducting additional tests as part of an effort to improve the testing kit.

Testing the Feasibility of Skype and FaceTime Updates With Parents in the Neonatal Intensive Care Unit.

BACKGROUND: Effective provider-parent relationships are essential during critical illness when treatment decisions are complex, the environment is crowded and unfamiliar, and outcomes are uncertain. OBJECTIVES: To evaluate the feasibility of daily Skype or FaceTime updates with parents of patients in the neonatal intensive care unit (NICU) and to assess the intervention's potential for improving parent-provider relationships. METHODS: A pre/post mixed-methods approach was used. NICU parent participants received daily Skype or FaceTime updates for 5 days and completed demographic and feasibility surveys. Parents also completed Penticuff's Parents' Understanding survey before and after the intervention. Nurses and physicians completed feasibility surveys after each update. RESULTS: Twenty-six parents were enrolled and 15 completed the study. More than 90% of providers and parents perceived the intervention to be reliable and easy to use, and about 80% of parents and providers rated video and audio quality as either excellent or good. Frozen screens and missed updates due to scheduling problems were challenges. Two of the 4 subscores on the Parents' Understanding survey improved significantly. Qualitative data favor the intervention as meaningful for parents. CONCLUSIONS: Real-time videoconferencing via Skype or FaceTime is feasible for providing updates for parents when they cannot be present in the NICU and can be used to include parents in bedside rounds. Videoconferencing updates may improve relationships between parents and the health care team.

Follicular and Hürthle cell lesions of the thyroid: can inconclusive results be minimized?

OBJECTIVE: To assess the cytologic criteria for distinguishing neoplastic from nonneoplastic follicular cell and Hürthle cell thyroid lesions. STUDY DESIGN: Ten previously described and commonly used cytologic criteria were evaluated and graded on a 0-4 scale in a consecutive series of thyroid fine needle aspirations (FNAs) reported as follicular or Hürthle cell neoplasms or lesions. Scoring was compared to subsequent surgical outcome. RESULTS: A total of 93 (57fo llicular cell and 36 Hühle cell) cases was analyzed. No individual cytologic feature was helpful in distinguishing benign neoplarms from malignancy in either category (p > 0.05), but 4 or more coexistent cytologic features in combination were identified in 50.0% of follicular neoplasms, 13.6% of Hürthle cell neoplasms and none of the nonneoplastic lesions. An unexpected number (13 of 93, 14.0%) of unrecognized papillary carcinomas, some of follicular subtype, was encountered. CONCLUSION: In this series, the indeterminate thyroid FNA category could have been reduced by diagnosis of samples with 4 or more of the studied criteria as definite follicular (50% of cases) or Hürthle cell (13.6% of cases) neoplasms and by more astute recognition of papillary carcinomas (14.0% of cases), which blend into this category, often as a result of less-than-optimal sampling or preservation.