Climate change and seismic resilience: Key considerations for Alaska's infrastructure and built environment.

Alaska is one of the most seismically active regions of the world. Coincidentally, the state has also experienced dramatic impacts of climate change as it is warming at twice the rate of the rest of the United States. Through mechanisms such as permafrost thaw, water table fluctuation, and melting of sea ice and glaciers, climatic-driven changes to the natural and built-environment influence the seismic response of infrastructure systems. This paper discusses the challenges and needs posed by earthquake hazards and climate change to Alaska's infrastructure and built environment, drawing on the contributions of researchers and decision-makers in interviews and a workshop. It outlines policy, mitigation, and adaptation areas meriting further attention to improve the seismic resilience of Alaska's built environment from the perspectives of engineering and complementary coupled human-environmental systems.

Creating a Chest Wall Injury and Reconstructive program: A single center experience with rib fractures.

BACKGROUND: New Chest Wall Injury and Reconstructive Centers (CWIRC) are emerging; this study aims to investigate the potential benefits of implementing a CWIRC at a single institution. We hypothesized that patients treated at CWIRC will have improved outcomes. METHODS: We instituted a CWIRC in 2019 at our American College of Surgeons (ACS) Level One Trauma Center. We retrospectively compared trauma patients with rib fractures who presented to our center 18 months before (PRE-C) and 18 months after CWIRC implementation (POST-C). Outcomes measured included mortality, length of stay (LOS), intensive care unit (ICU-LOS), readmission rates, and unplanned ICU admission. RESULTS: There were 192 PRE-C patients, compared to 388 POST-C. The mortality in PRE-C was not significantly different compared to the POST-C group (11.46% vs 8.8%, p=0.308). There were also no differences in LOS, ICU-LOS, readmission, and unplanned ICU admission. ICU utilization was dramatically different: PRE-C 17.8% were admitted to ICU compared to 35.6% POST-C (p<0.0001). CONCLUSIONS: The number of patients admitted with rib fractures to our center nearly doubled after CWIRC establishment. Early diagnosis and triage led to significantly more admissions to higher levels of care. There are trends toward improved outcomes using practice management protocols, albeit with higher ICU utilization. Establishment of a CWIRC should be considered for level 1 ACS trauma centers and as utilization of established CWIRC protocols are increased, patients will have improved outcomes. LEVEL OF EVIDENCE: IV STUDY TYPE: Retrospective chart review.

Application and outcomes of extracorporeal life support in emergency general surgery and trauma.

BACKGROUND: We analyzed the use of Extracorporeal Membranous Oxygenation (ECMO) in acute care surgery patients at our Level-1 trauma center. We hypothesized that this patient population has improved ECMO outcomes. METHODS: This was a retrospective analysis of emergency general surgery and trauma patients placed on ECMO between the periods of October 2013 and February 2020. There were 10 surgical and 12 trauma patients studied, who eventually required ECMO support. ECMO support and ECMO type/modality were analyzed with injury and survival prognostic scores examined. MAIN RESULTS: Overall, 16 of the 22 patients survived to hospital discharge, for a survival rate of 73%. Mean age was 34.18 years. Mean hospital length of stay was 23.4 days with mean days on ECMO equal to 7.5. The net negative fluid balance was 5.36 L. CONCLUSIONS: The survival of our ECMO cohort is notably higher than previously cited studies. Our group demonstrated decreased length of time on ECMO, decreased length of stay in the hospital, and similar rates of complications compared to prior reports. ECMO is a useful modality in acute care surgical patients and should be considered in these patient populations. Our focus on net negative fluid balance for ECMO patients demonstrates improved survival. ECMO should be considered early in surgical patients and early in advanced trauma life support.

Academy of Nutrition and Dietetics Nutrition Research Network: A Home Garden Intervention Improves Child Length-for-Age Z-Score and Household-Level Crop Count and Nutritional Functional Diversity in Rural Guatemala.

Home gardens may help address childhood malnutrition in low- and middle-income countries. In this quasi-experimental pilot study, the Academy of Nutrition and Dietetics, in collaboration with Maya Health Alliance, evaluated the feasibility of augmenting a standard-of-care nutrition-specific package for Maya children with length-for-age z score ≤-2 (stunting) in rural Guatemala with a nutrition-sensitive home garden intervention. Two agrarian municipalities in Guatemala were included. Families of 70 children with stunting from 1 municipality received the standard-of-care package (food supplementation, multiple micronutrient powders, monthly nutrition home visits, group nutrition classes). Families of 70 children with stunting from another municipality received the standard-of-care package plus a home garden intervention (garden materials, monthly agricultural home visits, agriculture classes). Maternal and child dietary diversity, household food insecurity, child growth, and agricultural indicators were collected at baseline and 6 months later and were analyzed using mixed linear and logistic regression models. Compared with the standard-of-care group, the garden intervention group had improved child (odds ratio [OR] 3.66, 95% CI 0.89-15.10, P = 0.07) and maternal dietary diversity (OR 2.31, 95% CI 0.80-6.65, P = 0.12) and decreased food insecurity (OR 0.38, 95% CI 0.11-1.35, P = 0.14); however, these effects were not statistically significant. Participation in gardens predicted a higher length-for-age z-score (change difference [CD] 0.22 SD, 95% CI 0.05-0.38, P = 0.009), greater crop species count (CD 2.97 crops, 95% CI 1.79-4.16, P < 0.001), and greater nutritional functional diversity (CD 0.04 points, 95% CI 0.01-0.07, P = 0.006) than standard-of-care alone. Home garden interventions are feasible in rural Guatemala and may have potential benefits for child growth when added to other nutrition-specific interventions.

ECMO after cardiac surgery: a single center study on survival and optimizing outcomes.

BACKGROUND: The study purpose is to examine survival prognostic and extracorporeal membrane oxygenation (ECMO) application outcomes at our tertiary care center. METHODS: This is a retrospective analysis, January 2014 to September 2019. We analyzed 60 patients who underwent cardiac surgery and required peri-operative ECMO. All inpatients with demographic and intervention data was examined. 52 patients (86.6%) had refractory cardiogenic shock, 7 patients (11.6%) had pulmonary insufficiency, and 1 patient (1.6%) had hemorrhagic shock, all patients required either venous-arterial (VA) (n = 53, 88.3%), venous-venous (VV) (n = 5, 8.3%) or venous-arterial-venous (VAV) (n = 2, 3.3%) ECMO for hemodynamic support. ECMO parameters were analyzed and common postoperative complications were examined in the setting of survival with comorbidities. RESULTS: In-hospital mortality was 60.7% (n = 37). Patients who survived were younger (52 ± 3.3 vs 66 ± 1.5, p < 0.001) with longer hospital stays (35 ± 4.0 vs 20 ± 1.5, p < 0.03). Survivors required fewer blood products (13 ± 2.3 vs 25 ± 2.3, p = 0.02) with a net negative fluid balance (- 3.5 ± 1.6 vs 3.4 ± 1.6, p = 0.01). Cardiac re-operations worsened survival. CONCLUSION: ECMO is a viable rescue strategy for cardiac surgery patients with a 40% survival to discharge rate. Careful attention to volume management and blood transfusion are important markers for potential survival.

An Investigation into the Processing of Lexicalized English Blend Words: Evidence from Lexical Decisions and Eye Movements During Reading.

New words enter the language through several word formation processes [see Simonini (Engl J 55:752-757, 1966)]. One such process, blending, occurs when two source words are combined to represent a new concept (e.g., SMOG, BRUNCH, BLOG, and INFOMERCIAL). While there have been examinations of the structure of blends [see Gries (Linguistics 42:639-667, 2004) and Lehrer (Am Speech 73:3-28, 1998)], relatively little attention has been given to how lexicalized blends are recognized and if this process differs from other types of words. In the present study, blend words were matched to non-blend control words on length, familiarity, and frequency. Two tasks were used to examine blend processing: lexical decision and sentence reading. The results demonstrated that blend words were processed differently than non-blend control words. However, the nature of the effect varied as a function of task demands. Blends were recognized slower than control words in the lexical decision task but received shorter fixation durations when embedded in sentences.

A Feasibility Study Evaluating Extraoral Photobiomodulation Therapy for Prevention of Mucositis in Pediatric Hematopoietic Cell Transplantation.

OBJECTIVE: The objective of this study was to determine the feasibility, safety, and tolerability of providing extraoral photobiomodulation therapy (PBT) for prevention of oral mucositis (OM) in pediatric hematopoietic cell transplantation (HCT). BACKGROUND DATA: OM is a frequent complication in pediatric HCT. METHODS: Patients 4-21 years of age scheduled for myeloablative HCT were eligible to participate. PBT was delivered using a THOR Model LX2M with a 69 Diode LED Cluster Probe (34 × 660 nm 10 mW, 35 × 850 nm 30 mW; 1390 mW total power output) at an irradiance of 50 mW/cm(2). Daily treatment exposed six sites (right, left, and midline face and neck) for 60 sec each, for a total dose of 3.0 J/cm(2). Treatment was initiated on the 1st day of conditioning, through day +20. OM assessments were completed at baseline then daily, from day -1 through day +20. Feasibility assessment included both qualitative and quantitative measures and outcomes from patients and providers. RESULTS: Thirteen patients with a median age of 15 years (range, 4.8-21.6) were consented and enrolled, and completed the protocol. The incidence of severe OM [World Health Organization (WHO) Grade ≥3] was 77%, with a median duration of 4 days (range, 1-14). Of 355 attempted PBT administrations, there were six refusals, and the mean proportion of days with data submitted was 96.2% [95% confidence interval (CI): 78.5-97.2%]. The 10 trained nurses all reported that the device was accessible, maneuverable, and lightweight, and that training was effective. There was no reported toxicity attributed to the PBT. CONCLUSIONS: Daily delivery of external PBT and completion of OM evaluations is feasible in children undergoing HCT.

Cytosolic chaperones mediate quality control of higher-order septin assembly in budding yeast.

Septin hetero-oligomers polymerize into cytoskeletal filaments with essential functions in many eukaryotic cell types. Mutations within the oligomerization interface that encompasses the GTP-binding pocket of a septin (its "G interface") cause thermoinstability of yeast septin hetero-oligomer assembly, and human disease. When coexpressed with its wild-type counterpart, a G interface mutant is excluded from septin filaments, even at moderate temperatures. We show that this quality control mechanism is specific to G interface mutants, operates during de novo septin hetero-oligomer assembly, and requires specific cytosolic chaperones. Chaperone overexpression lowers the temperature permissive for proliferation of cells expressing a G interface mutant as the sole source of a given septin. Mutations that perturb the septin G interface retard release from these chaperones, imposing a kinetic delay on the availability of nascent septin molecules for higher-order assembly. Un-expectedly, the disaggregase Hsp104 contributes to this delay in a manner that does not require its "unfoldase" activity, indicating a latent "holdase" activity toward mutant septins. These findings provide new roles for chaperone-mediated kinetic partitioning of non-native proteins and may help explain the etiology of septin-linked human diseases.

From experiential knowledge to public participation: social learning at the community fisheries action roundtable.

Extensive research demonstrates that public participation in environmental decision making can increase understanding of diverse worldviews and knowledge bases, public faith in governance institutions, and compliance with resulting rules. Concerns linger around costs, possibilities of polarization and decreased legitimacy in cases of poorly executed processes, and the ability of newly empowered groups to gain political leverage over others. If participants in public processes can bracket their personal experience to better assess other viewpoints, establishing mutual respect and understanding through deliberative exchange, they increase the likelihood of maximizing participatory benefits and minimizing risks. Such reflexivity indicates double-loop social learning, change undertaken through collective discussion and interaction. A capacity-building workshop program aims to foster such learning within the Maine fishing industry. Case material draws primarily on participant observation and interview data, using a grounded theory approach to qualitative analysis. Evidence indicates that in social contexts removed from the norms of daily life and the frustrations of past fishery management confrontations, harvesters acquire knowledge and skills that facilitate more strategic and productive behavior in formal and informal marine resource decision venues. Suspensions of longstanding spatio-temporal assumptions around the prosecution and management of fisheries comprise key learning moments, and yield corresponding changes in industry attitudes and actions. With heightened appreciation for a diversity of experiences and management priorities, harvesters can better mobilize a broad spectrum of local knowledge to develop viable regulatory proposals and collaborative decision processes.

Identification of gustatory-olfactory flavor mixtures: effects of linguistic labeling.

Two experiments, using different ranges and numbers of stimuli, examined how linguistic labels affect the identification of flavor mixtures containing different proportions of sucrose (gustatory flavorant) and citral (olfactory flavorant). Both experiments asked subjects to identify each stimulus as having either "mostly sugar" or "mostly citrus." In one condition, no labels preceded the flavor stimuli. In another condition, each flavor stimulus followed a label, either SUGAR or CITRUS, which, the subjects were informed, usually though not always named the stronger flavor component; that is, the labels were probabilistically valid. The results of both experiments showed that the labels systematically modified the identification responses: Subjects responded "sugar" or "citrus" more often when the flavor stimulus followed the corresponding label, SUGAR or CITRUS. But the labels hardly affected overall accuracy of identification. Accuracy was possibly limited, however, by both the confusability of the flavor stimuli per se and the way that confusability could limit the opportunity to discern the probabilistic associations between labels and individual flavor stimuli. We describe the results in terms of a decision-theoretic model, in which labels induce shifts in response criteria governing the identification responses, or possibly effect changes in the sensory representations of the flavorants themselves.

An innovative process for engaging hospital leaders.

hospital in northern Arizona got rid of 36 degree feedback and installed a new evaluation system that raised patient satisfaction scores and boosted employee engagement.

Scheduling the first prenatal visit: office-based delays.

OBJECTIVE: The purpose of this study was to evaluate the office-based component of delayed entry into prenatal care. STUDY DESIGN: Phone numbers for all obstetrics offices in a single state were obtained from a commercial list. A research assistant who posed as a newly pregnant, fully insured woman asked each clinic when she should come in for her first prenatal visit. RESULTS: Information was provided by 239 of the 279 (86%) offices. The recommended appointment times ranged from immediately (4 weeks of gestation) to 10.6 weeks, which averaged 6.37 weeks. Twenty-five percent of clinics recommended a first appointment at >/=8 weeks. Scheduling calls were not a source of prenatal advice: <5% of clinics asked about smoking, alcohol, or medical condition; 88% of clinics did not mention vitamins. CONCLUSION: Office-based delays in scheduling the first prenatal visit occur in a substantial proportion of clinics, even for fully insured women. There is a need for a standard source of advice in early pregnancy.

Utilization of home pregnancy testing among women at risk for unintended pregnancy.

PURPOSE: We sought to determine whether a brief intervention increased home pregnancy test utilization among women at risk for unintended pregnancy. METHODS: The intervention included education, consultation with a nurse, and the provision of a free home pregnancy test kit. Participants were 35 women aged 18-39 years from a Medicaid population who were having unprotected intercourse and who were not trying to conceive. The women received education on pregnancy testing and the importance of early recognition of pregnancy. All women received a free home pregnancy test kit. The main outcome measures were pregnancy test use and appropriateness of use. MAIN FINDINGS: During the 3-month follow-up period, 62% of participants used the home pregnancy test kit, which was approximately 3 times higher than the self-reported testing rate before the study (p < .001). The most common reason for use was a late period (median 5 days late when test was done). Women also purchased additional kits to confirm the initial test result (median 2 kits per episode of use). CONCLUSION: The intervention increased utilization of home pregnancy test kits among women at risk of unintended pregnancy. All study participants used the test appropriately. These results can serve as a framework for interventions to improve early pregnancy recognition.

Why women risk unintended pregnancy.

BACKGROUND: To reduce unintended pregnancy, it is necessary to understand why women have unprotected intercourse when they do not desire pregnancy. METHODS: We devised a survey of 42 potential reasons why women have unprotected intercourse based on the responses of a focus group we had previously convened. We administered the survey to women between the ages of 18 and 39 years who were visiting primary care clinics and were not trying to get pregnant. RESULTS: Of the 151 respondents, 84 (56%) were having unprotected intercourse. Women gave an average of 9 reasons for having unprotected intercourse. The most common reasons fell into 3 categories: lack of thought/preparation (87% of respondents), being in a long-term or strong relationship (70%), and concerns about side effects of contraception (80%). Eighty-three of the 84 women (99%) chose at least 1 of these categories. CONCLUSION: Basing survey questions on focus group responses provided important insights into the reasons women risk unintended pregnancy. A deeper understanding of this issue is critical to reducing unintended pregnancy.

Self-testing for pregnancy among women at risk: a randomized controlled trial.

BACKGROUND: The timing of pregnancy recognition affects early pregnancy and the timing of prenatal care. Little research has been done on how to make women at risk more alert to the possibility of pregnancy. DESIGN: The study was an RCT performed and analyzed between 2006 and 2007. SETTING/PARTICIPANTS: Participants were low-income, adult women who were having unprotected intercourse and were not actively trying to conceive. INTERVENTION: Women in the intervention group received a free home-pregnancy test kit and were able to order more kits as needed. Six-month follow-up information was obtained. MAIN OUTCOME MEASURES: The main outcome measures were suspicion and testing for pregnancy. RESULTS: Ninety-one percent of the 198 participants completed the study. Women in the intervention group suspected pregnancy 2.3 times during the 6-month period compared to 1.2 times for women in the control group (p<0.0001). Women in the intervention group tested for pregnancy 93% of the time when they suspected pregnancy. Women in the control group tested for pregnancy only 64% of the time when they suspected pregnancy (p<0.0001). CONCLUSIONS: Women who were having unprotected intercourse were more likely to suspect and test for pregnancy if they were supplied with a free home-pregnancy test kit.

Reasons for unprotected intercourse in adult women.

BACKGROUND: Despite the increased availability of contraception, unprotected intercourse and unintended pregnancy are common among adult women. We sought to identify reasons why adult women at risk of unintended pregnancy have unprotected intercourse. METHODS: A comprehensive search of electronic databases of MEDLINE, CINAHL, and PSYCHOINFO, from 1995 to 2005, was conducted. Reference lists from relevant published papers and reviews related to contraceptive practices and pregnancy intendedness were also hand searched. The Bronfenbrenner ecological framework was used as a guide in the discussion of the findings. RESULTS: There were 16 studies that met inclusion criteria, and these provided numerous reasons why adult women had unprotected intercourse. Reasons were found at the individual, interpersonal, and societal levels. Individual reasons included concerns with contraceptive side effects, a low perceived risk for pregnancy, lack of knowledge, and attitudes and beliefs. Interpersonal reasons included partners, families, or friends who discouraged the use of contraception. Societal reasons included access problems, inconvenience, and cost. CONCLUSIONS: There are multiple reasons why women have unprotected intercourse. These reasons were located in overlapping domains of influence. Factors in a woman's environment at the interpersonal and societal level may significantly influence her contraceptive use behavior.

Reasons for unprotected intercourse: analysis of the PRAMS survey.

OBJECTIVES: This study was conducted to identify reasons why women had unprotected intercourse that led to an unintended pregnancy. METHODS: As part of the Pregnancy Risk Assessment Monitoring System (PRAMS) survey, women with a recent unintended viable pregnancy were asked after the birth why they had not used birth control. RESULTS: Of 7856 respondents, 33% felt they could not get pregnant at the time of conception, 30% did not really mind if they got pregnant, 22% stated their partner did not want to use contraception, 16% cited side effects, 10% felt they or their partner were sterile, 10% cited access problems and 18% selected "other." Latent class analysis showed seven patterns of response, each identifying strongly with a single reason. CONCLUSIONS: Almost half of women with viable unintended pregnancies ending in a birth felt they could not/would not get pregnant at the time of conception. Most women identified with a single reason for having unprotected intercourse.

Reasons for unprotected intercourse in adult women: a qualitative study.

Despite the focus on adolescents, most unintended pregnancies occur in adults. The objective of this study was to identify reasons why adult women have unprotected intercourse when they do not desire pregnancy. We held 4 focus groups to explore reasons for unprotected intercourse. Participants were adult women aged 18 to 39 who were unmarried, fertile, not currently pregnant, not desiring pregnancy, and who had recently had intercourse without using effective contraception. Sessions were audiotaped and transcripts were analyzed thematically. Women gave 146 reasons for unprotected intercourse. Four major categories emerged: method-related, user-related, partner-related, and cost/access-related reasons. The reasons for unprotected intercourse were numerous, but could be organized into a logical framework. The results suggest that multidimensional interventions may be needed to effectively reduce the rate of unintended pregnancy.

Epidemiology and prevention of unintended pregnancy in adolescents.

Recent declines in adolescent pregnancy are encouraging, but current rates are still too high. Pregnancy prevention is a complex issue in the adolescent population, but much has been learned about effective interventions. Clinicians can and must play a key role in adolescent pregnancy prevention.