Half of US population exposed to adverse lead levels in early childhood.

SignificanceConsiderable effort is expended to protect today's children from lead exposure, but there is little evidence on the harms past lead exposures continue to hold for yesterday's children, who are victims of what we term legacy lead exposures. We estimate that over 170 million Americans alive today were exposed to high-lead levels in early childhood, several million of whom were exposed to five-plus times the current reference level. Our estimates allow future work to plan for the health needs of these Americans and to inform estimation of the true contributions of lead exposure to population health. We estimate population-level effects on IQ loss and find that lead is responsible for the loss of 824,097,690 IQ points as of 2015.

Comprehensive ECG reference intervals in C57BL/6N substrains provide a generalizable guide for cardiac electrophysiology studies in mice.

Reference ranges provide a powerful tool for diagnostic decision-making in clinical medicine and are enormously valuable for understanding normality in pre-clinical scientific research that uses in vivo models. As yet, there are no published reference ranges for electrocardiography (ECG) in the laboratory mouse. The first mouse-specific reference ranges for the assessment of electrical conduction are reported herein generated from an ECG dataset of unprecedented scale. International Mouse Phenotyping Consortium data from over 26,000 conscious or anesthetized C57BL/6N wildtype control mice were stratified by sex and age to develop robust ECG reference ranges. Interesting findings include that heart rate and key elements from the ECG waveform (RR-, PR-, ST-, QT-interval, QT corrected, and QRS complex) demonstrate minimal sexual dimorphism. As expected, anesthesia induces a decrease in heart rate and was shown for both inhalation (isoflurane) and injectable (tribromoethanol) anesthesia. In the absence of pharmacological, environmental, or genetic challenges, we did not observe major age-related ECG changes in C57BL/6N-inbred mice as the differences in the reference ranges of 12-week-old compared to 62-week-old mice were negligible. The generalizability of the C57BL/6N substrain reference ranges was demonstrated by comparison with ECG data from a wide range of non-IMPC studies. The close overlap in data from a wide range of mouse strains suggests that the C57BL/6N-based reference ranges can be used as a robust and comprehensive indicator of normality. We report a unique ECG reference resource of fundamental importance for any experimental study of cardiac function in mice.

Racial Slurs by Police and Posttraumatic Stress Symptoms: Intrusive Policing and Perceived Injustice.

Using the Future of Families and Child Wellbeing Study (N = 785), this article considers the ramifications of police use of racial slurs, a type of intrusive behavior, toward minority youth for posttraumatic stress (PTS). We also examine whether other intrusive police behaviors exacerbate this relationship and test whether perceptions of injustice mediate it. Results indicated that hearing a police officer use a racial slur was positively associated with PTS after controlling for intrusive police behaviors and other covariates. Intrusive policing tended to co-occur with the use of racial slurs and was positively associated with PTS. The association between hearing a racial slur and PTS did not vary by the number of intrusive behaviors exhibited by police. The association between hearing a slur and PTS was partially mediated by perceived procedural injustice. Overall, the use of racial slurs by police may do harm to minority adolescents by putting them at risk for posttraumatic stress disorder. Our results are consistent with prior research that racial slurs may contribute to PTS by eroding the bounds of what is considered just and fair. Interestingly, the association between racial slurs and PTS was independent of other intrusive policing behaviors. Mental health screeners should ask not only about being stopped by police but the characteristics of that encounter as well - including those imbued with racial animus.

Postpartum Depressive Symptoms during the Beginning of the COVID-19 Pandemic: An Examination of Population Birth Data from Central New Jersey.

OBJECTIVES: To examine the mental health of women in the perinatal period prior to and during the COVID-19 pandemic. METHODS: We use provisional vital statistics data for births occurring in the central region of New Jersey. The Edinburgh Postnatal Depression Scale is employed to assess depressive symptoms. Our focal analysis uses linear regression models to test whether giving birth during the pandemic is associated with elevated depressive symptoms. All analyses are performed using time-matched (September 2019-April 2020; n = 18,531) and month-matched (January 2019-April 2019 and January 2020- April 2020; n = 18,346) samples. RESULTS: Women who gave birth in March and not in April reported higher levels of depressive symptoms than those who gave birth prior to the pandemic in our time-matched (b = 0.09) and month-matched (b = 0.09) samples. The magnitude of this association is approximately one-third the magnitude of the association between preterm birth and depressive symptoms. CONCLUSION: These findings suggest that researchers and practitioners should pay special attention to signs of postpartum depression and women's adaptive coping responses in the early stages of pandemics.

Marital characteristics and the sexual relationships of U.S. older adults: an analysis of national social life, health, and aging project data.

We tested several hypotheses regarding the relationship between marital characteristics and sexual outcomes among 1,656 married adults ages 57-85 years from the 2005-2006 National Social Life, Health, and Aging Project. Results showed that individuals in their first marriage had more frequent sex than remarried individuals; marital duration had a curvilinear (U-shaped) relationship with frequency of sex; and a linear relationship between marital duration and frequency of sex varied by gender such that men had more frequent sex than women in younger marriages. We speculate that relationship permanency may drive the greater sexual activity in first marriages and sicker men in younger marriages may drive frequency of sex for women in younger marriages.

Electrocoagulation treatment of metal finishing wastewater.

Electrocoagulation has been found to be a consistent and reliable industrial wastewater treatment process capable of removing heavy metals to levels well below pretreatment discharge standards. Results from the testing of a 113 L/min pilot scale electrocoagulation unit indicated that electrocoagulation was capable of decreasing the cadmium, chromium, and nickel concentrations from 0.14, 18.1, and 0.06 parts per million (ppm) to 0.029, 0.039, and 0.020 ppm respectively, at a 1-min hydraulic retention time. In the presence of a strong chelating substance, electrocoagulation performance was found to be effective in reducing both chromium and nickel concentrations to levels well below discharge limits. At a pH of 8.0, chromium and nickel influent concentrations of 0.328 and 0.062 ppm, respectively, were reduced to 0.005 and 0.04 ppm. The electrocoagulation removal efficiency for chromium remained high at over 98% and appeared to be unaffected by the presence of chelating substances. Utilizing aluminum as the sacrificial anode improved the removal efficiency of targeted heavy metals when the industrial wastewater was treated under acidic conditions. At a pH of 5.6, the influent concentrations of the regulated heavy metals cadmium, chromium, and nickel were reduced from 0.55, 49.7, and 13.7 ppm, respectively, to 0.013, 2.7, and 0.8 ppm at a 1-min hydraulic retention time. The results of these tests suggest that the formation of ferric hydroxide and aluminum hydroxide through the electrocoagulation process may be an effective approach for treating metal finishing wastewaters.

Protecting groundwater resources at biosolids recycling sites.

In developing the national biosolids recycling rule (Title 40 of the Code of Federal Regulation Part 503 or Part 503), the USEPA conducted deterministic risk assessments whose results indicated that the probability of groundwater impairment associated with biosolids recycling was insignificant. Unfortunately, the computational capabilities available for performing risk assessments of pollutant fate and transport at that time were limited. Using recent advances in USEPA risk assessment methodology, the present study evaluates whether the current national biosolids pollutant limits remain protective of groundwater quality. To take advantage of new risk assessment approaches, a computer-based groundwater risk characterization screening tool (RCST) was developed using USEPA's Multimedia, Multi-pathway, Multi-receptor Exposure and Risk Assessment program. The RCST, which generates a noncarcinogenic human health risk estimate (i.e., hazard quotient [HQ] value), has the ability to conduct screening-level risk characterizations. The regulated heavy metals modeled in this study were As, Cd, Ni, Se, and Zn. Results from RCST application to biosolids recycling sites located in Yakima County, Washington, indicated that biosolids could be recycled at rates as high as 90 Mg ha, with no negative human health effects associated with groundwater consumption. Only under unrealistically high biosolids land application rates were public health risks characterized as significant (HQ ≥ 1.0). For example, by increasing the biosolids application rate and pollutant concentrations to 900 Mg ha and 10 times the regulatory limit, respectively, the HQ values varied from 1.4 (Zn) to 324.0 (Se). Since promulgation of Part 503, no verifiable cases of groundwater contamination by regulated biosolids pollutants have been reported.

Income Inequality and Population Health: Examining the Role of Social Policy.

Studies of the relationship between income inequality and life expectancy often speculate about the role of policy, but direct empirical research is limited. Drawing on the neo-materialist perspective, we examine whether the longitudinal association between income inequality and life expectancy is mediated and moderated by policy liberalism in U.S. states (2000-2014). More liberal policy contexts are characterized by greater efforts to regulate the economy, redistribute income, and protect vulnerable groups and lesser efforts to penalize deviant social behavior. We find that state-level income inequality is inversely associated with policy liberalism and life expectancy. The association between income inequality and life expectancy was not mediated by policy liberalism but was moderated by it. The association is attenuated in states with more liberal policy contexts, supporting the neo-materialist perspective. This finding illustrates how states like New York and California (with liberal policy contexts) can exhibit high income inequality and high life expectancy.

Evaluation of Patient Experience with Veterans Affairs Clinical Pharmacist Practitioners Providing Comprehensive Medication Management.

Patient experience is considered an important dimension of health care quality and thus is included as part of the quadruple aim of health care. The VHA Clinical Pharmacist Practitioner (CPP) operates as an advanced practice provider (APP) providing comprehensive medication management (CMM) with authority to initiate, discontinue or modify medication under a scope of practice (SOP). The VHA CPP practices in many different outpatient clinical areas to include but not limited to primary care, mental health, pain management, cardiology, substance use disorder and anticoagulation. While literature regarding the ability of the VHA CPP to increase access and quality of care is well published, very little information exist regarding patient experience with the VHA CPP. We sought to report the patient experience with VHA CPP as measured electronically over 1 year by Veterans. Patient experience surveys were electronically sent to randomly selected Veterans via email to evaluate a recent outpatient healthcare encounter at a VA medical center or outpatient clinic with a CPP with scoring on a Likert scale of 1-5 with 5 being optimal. A total of 743 Veteran surveys were completed for a response rate of 20%. For individual domains of patient experience based on respondent scores of 4 or 5, ease and simplicity were rated at 94.4%, quality 91.9%, employee helpfulness 94.9%, satisfaction 95.0% and confidence/trust 91.9%. Results demonstrate that Veterans' experience with the CPP in every patient care experience domain was positive with scores ranging from the low to high 90th percentile.

Role of aggressive LDL reduction in patients with coronary heart disease.

The aim of the present study was to integrate research evidence with the care of the patient with coronary heart disease (CHD) and place into perspective the importance of intensive statin therapy. We reviewed five major trials and select related post hoc analyses that examined the beneficial effects from intensive low-density lipoprotein (LDL) reduction on combined morbidity and mortality end points in patients with stabilized CHD and those with recent acute coronary syndrome.Accumulating evidence since the publication of the pivotal Heart Protection Study and Adult Treatment Panel III supports a more intensive LDL reduction than that recommended in the 2004 Adult Treatment Panel III update. An LDL reduction of 49% from baseline in statin-naïve patients with stable CHD or a 41% to 44% reduction in LDL from postadmission values in patients with acute coronary syndrome improves composite morbidity and mortality end points.Current evidence suggests that a more intensive LDL reduction of approximately 45% to 50% from a patient's baseline in acute and stable CHD is warranted. The decrease in recurrent events associated with the use of statin regimens that can achieve this degree of reduction in LDL may offer a financial incentive for managed care healthcare systems; however, statin therapy should be selected upon careful consideration of both dose and agent.

Male body satisfaction: factorial and construct validity of the Body Parts Satisfaction Scale for Men.

Given the centrality of body dissatisfaction in the manifestation of eating, exercise, and affective disturbances in men, measurement of this construct becomes essential. Across 2 studies with male undergraduates (Ns = 189 and 188), the psychometric properties, including incremental validity and factor structure, of the 25-item Body Parts Satisfaction Scale for Men (BPSS-M) were examined. Three factors--Upper Body, Legs, and Face--that included items measuring both muscularity and leanness were established. The factors were internally consistent and temporally stable (over 6 months), and support was found for their convergent, discriminant, and concurrent validity. Further, we established that, after controlling for social desirability and drive for muscularity, body satisfaction contributes uniquely to men's experience of disordered eating, negative affect and mood, and psychological well-being. The BPSS-M yielded reliable and valid scores with undergraduate men, suggesting that it may be useful for understanding not only body satisfaction but disordered eating and affective disturbances as well.

Chemical treatment of chelated metal finishing wastes.

This study evaluated two chemical approaches for treatment of commingled cadmium-cyanide (Cd-CN) and zinc-nickel (Zn-Ni) wastewaters. The first approach, which involved application of sodium hypochlorite (NaOCl), focused on elimination of chelating substances. The second approach evaluated the use of sodium dimethyldithiocarbamate (DMDTC) to specifically target and precipitate regulated heavy metals. Results demonstrated that by maintaining a pH of 10.0 and an oxidation-reduction potential (ORP) value of +600 mV, NaOCl treatment was effective in eliminating all chelating substances. Cadmium, chromium, nickel, and zinc solution concentrations were reduced from 0.27, 4.44, 0.06, and 0.10 ppm to 0.16, 0.17, 0.03, and 0.06 ppm, respectively. Similarly, a 1% DMDTC solution reduced these same metal concentrations in commingled wastewater to 0.009, 1.142, 0.036, and 0.320 ppm. Increasing the DMDTC concentration to 2% improved the removal of all regulated heavy metals except zinc, the removal of which at high pH values is limited by its amphotericity.

Applying Cultural Intelligence to Improve Vaccine Hesitancy Among Black, Indigenous, and People of Color.

Despite the overwhelming evidence to support the benefits of vaccines for preventable diseases and improving health outcomes throughout the world, vaccine hesitancy and resistance continues to be a concern during the COVID-19 pandemic. Although Black, Indigenous, and People of Color (BIPOC) experience the highest rates of morbidity and mortality from COVID-19, mistrust and historical unethical research and medical practices continue to preclude this population from getting the vaccine. This article urges clinicians to subscribe to development and application of cultural intelligence to understand the impact of structural racism and cultural considerations of BIPOC to partner in strategy development.

Gun ownership, community stress, and sleep disturbance in America.

OBJECTIVE: Although there is widespread speculation about guns helping people to sleep better, this idea has only recently faced empirical scrutiny. We test whether people who own guns tend to exhibit healthier sleep outcomes than people who do not own guns and whether the association between community stress and sleep is less pronounced for people who own guns. DESIGN: We use ordinary least squares, multinomial logistic, and binary logistic regression to model cross-sectional survey data. SETTING: Our data span the United States. PARTICIPANTS: The 2021 Crime, Health, and Politics Survey (CHAPS) is based on a national probability sample of 1714 adults. MEASUREMENTS: Our analyses include multiple measures of gun ownership (personal ownership, keeping a gun in one's bedroom, and COVID-19 pandemic gun purchases), community stress (neighborhood disorder, neighborhood danger during the pandemic, and perceptions of police protection), and sleep (insomnia symptoms, sleep duration, and pandemic sleep). RESULTS: We found that people who own guns and people who do not own guns tend to exhibit similar sleep outcomes and that people who experience community stressors tend to exhibit similar sleep outcomes regardless of gun ownership. CONCLUSION: Our analyses confirm that gun ownership is unrelated to sleep and that guns are insufficient to mitigate the detrimental effects of community stress on sleep. We extend prior work by (a) using more detailed measurements of gun ownership, community stress, and sleep, (b) assessing whether people keep a gun in their bedroom, and (c) exploring the intersection of pandemic gun purchases and pandemic sleep quality.

The adverse effects of policing on population health: A conceptual model.

While negative encounters between police and the community are not a new trend, recent high profile deaths of unarmed people of color have gained widespread national attention and ignited new movements demanding reform, accountability, and progress. Increasingly over the past few decades, researchers have examined the most extreme cases of lethal use of force, describing the context of these violent encounters, situational and personal characteristics, and underlying risk factors. More recent research has aimed to define the broader and more nuanced adverse effects that policing can have on population health. We propose a holistic and multidisciplinary model for the relationship between policing and population health in the U.S. that incorporates contextual, situational, and individual-level factors while also recognizing the direct and vicarious mechanisms by which policing exposures can negatively affect population health. The model captures the short and long term health effects of policing and the cyclic nature by which those effects at the individual, community, and systemic levels can influence each other. We consider the unique qualities of different communities that may influence these pathways, the historical trends of the criminal justice and policing systems, and recommend applications of the model in policing agencies, medicine, and research.

Increasing rural patient access using clinical pharmacy specialist providers: Successful practice integration within the Department of Veterans Affairs.

PURPOSE: Access to care is a critical issue facing healthcare and affects patients living in rural and underserved areas more significantly. This led the Department of Veterans Affairs (VA) to launch a project that leveraged the expertise of the clinical pharmacy specialist (CPS) provider, embedding 180 CPS providers into primary care, mental health, and pain management across the nation. METHODS: This multidimensional project resulted in hiring 111 CPS providers in primary care, 40 CPS providers in mental health, and 35 CPS providers in pain management to serve rural veterans' needs. From October 2017 to March 2020, CPS providers provided direct patient care to 213,477 veterans within 606,987 visits. This was an average of 43,000 additional visits each quarter to support comprehensive medication management services, demonstrating an additional 219,823 visits in fiscal year 2018 and 232,030 visits in fiscal year 2019. Over the course of the project, the team provided mentorship to 164 CPS providers, performed consultative visits at 27 VA facilities, and trained 180 CPS providers in educational boot camps. CONCLUSION: VA funding of rural health initiatives adding CPS providers to primary care, mental health, and pain teams has resulted in positive measures of comprehensive medication management, interdisciplinary team satisfaction, facility leadership acceptance, and multiple positive outcomes.

Use of biosolids to enhance rangeland forage quality.

Biosolids land application was demonstrated to be a potentially cost-effective means for restoring forage productivity and enhancing soil-moisture-holding capacity on disturbed rangelands. By land-applying aerobically digested, anaerobically digested, composted, and lime-stabilized biosolids on rangeland test plots at rates of up to 20 times (20X) the estimated nitrogen-based agronomic rate, forage yields were found to increase from 132.8 kg/ha (118.2 lb/ac) (control plots) to 1182.3 kg/ha (1052.8 lb/ac). Despite the environmental benefits associated with increased forage yield (e.g., reduced soil erosion, improved drainage, and enhanced terrestrial carbon sequestration), the type of forage generated both before and after biosolids land application was found to be dominated by invasive weeds, all of which were characterized as having fair to poor nutritional value. Opportunistic and shallow rooting invasive weeds not only have marginal nutritional value, they also limit the establishment of native perennial grasses and thus biodiversity. Many of the identified invasive species (e.g., Cheatgrass) mature early, a characteristic that significantly increases the fuel loads that support the increased frequency and extent of western wildfires.

Life cycle cost evaluation of the digital opacity compliance system.

The US Environmental Protection Agency (EPA) has established EPA Reference Method 9 (Method 9) as the preferred enforcement approach for verifying compliance with federal visible opacity standards. While Method 9 has an extensive history of successful employment, reliance on human observers to quantify visible emissions is inherently subjective, a characteristic that exposes Method 9 results to claims of inaccuracy, bias and, in some cases, outright fraud. The Digital Opacity Compliance System (DOCS), which employs commercial-off-the-shelf digital photography coupled with simple computer processing, is a new approach for quantifying visible opacity. The DOCS technology has been previously demonstrated to meet and, in many cases, surpass the Method 9 accuracy and reliability standards (McFarland et al., 2006). Beyond its performance relative to Method 9, DOCS provides a permanent visual record of opacity, a vital feature in legal compliance challenges. In recent DOCS field testing, the opacity analysis of two hundred and forty one (241) regulated air emissions from the following industrial processes: 1) industrial scrubbers, 2) emergency generators, 3) asphalt paving, 4) steel production and 5) incineration indicated that Method 9 and DOCS were statistically equivalent at the 99% confidence level. However, a life cycle cost analysis demonstrated that implementation of DOCS could potentially save a facility $15,732 per trained opacity observer compared to utilization of Method 9.

How Are Income and Education Related to the Prevention and Management of Diabetes?

Objective: To understand whether income and education have unique contributions in the prevention and management of diabetes, as measured by Hba1c levels among diagnosed and undiagnosed individuals. Method: Data were obtained from the Nashville Stress and Health Study (N = 1,189). Ordinary least squares regression analyses were used to examine the associations among education, annual household income, diabetes onset, and diabetes management (Hba1c). Results: Education, but not income, was inversely associated with Hba1c in undiagnosed participants. Income, but not education, was inversely associated with Hba1c among diagnosed participants. Discussion: These results support the idea that education and income provide non-fungible social and economic resources that vary in their consequences for Hba1c level depending on whether someone has been diagnosed with diabetes. The social resources provided by education may be more important in delaying the onset of disease, whereas resources provided by income may be more important for disease management.

Twelve-month outcomes of an ab interno gelatin stent combined with cataract surgery or as a standalone procedure in pseudophakic eyes with open-angle glaucoma.

PURPOSE: To provide safety and effectiveness outcomes at 12 months postsurgery for an ab interno transscleral gelatin stent in patients with advanced refractory glaucoma or intolerant of medical therapy. SETTING: Multisubspecialty ophthalmology practice and surgery center. DESIGN: Retrospective, single-arm, cohort study. METHODS: All patients implanted with the gelatin stent either combined with cataract surgery or as a solo procedure between February 2017 and April 2018 and meeting eligibility criteria were included. Outcome measures included proportion of patients achieving a 20% reduction in intraocular pressure (IOP), proportions at or below 12 mm Hg, 15 mm Hg, and 18 mm Hg, IOP, medication usage, needling rate, and adverse events. RESULTS: The study included 92 eyes of 69 patients. Mean preoperative IOP and medications were 16.6 mm Hg on 2.1 medications. Average visual field mean deviation was -13.7 dB. Half (48%) of the patients achieved the primary endpoint of 20% reduction while medication use decreased by -1.7 medications. Most patients at 12 months had IOP of 18 mm Hg or less on zero medications (74%), whereas 34% were medication free and had IOP of 12 mm Hg or less. Bleb needling was required for only 14% of patients. There were few adverse events (13% of eyes), the most common being corrected distance visual acuity loss and hyphema. CONCLUSIONS: Eyes with advanced glaucoma despite maximum tolerated medical therapy achieved lower target IOP on fewer medications after implantation with the gelatin microstent.