Residential Greenspace and Urban Adolescent Substance Use: Exploring Interactive Effects with Peer Network Health, Sex, and Executive Function.

While urban greenspace is increasingly recognized as important to mental health, its role in substance use is understudied. This exploratory study investigates the interaction of greenspace with peer network health, sex, and executive function (EF) in models of substance use among a sample of disadvantaged, urban youth. Adolescents and their parents were recruited from a hospital in the mid-Atlantic region of the U.S. Residential greenspace at the streetscape level was derived from analysis of Google Street View imagery. Logistic regression models were used to test the moderating effect of greenspace on the association between peer network health and substance use, as well as additional moderating effects of sex and EF. The significant negative association of peer network health with substance use occurred only among youth residing in high greenspace environments, a moderating effect which was stronger among youth with high EF deficit. The moderating effect of greenspace did not differ between girls and boys. Greenspace may play an important role in moderating peer influences on substance use among disadvantaged, urban adolescents, and such moderation may differ according to an individual's level of EF. This research provides evidence of differences in environmental susceptibility regarding contextual mechanisms of substance use among youth, and it informs the development of targeted substance use interventions that leverage social and environmental influences on adolescent substance use.

Patient experience after modifying visit delivery during the COVID-19 pandemic.

OBJECTIVES: To describe real-time changes in medical visits (MVs), visit mode, and patient-reported visit experience associated with rapidly deployed care reorganization during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: Cross-sectional time series from September 29, 2019, through June 20, 2020. METHODS: Responding to official public health and clinical guidance, team-based systematic structural changes were implemented in a large, integrated health system to reorganize and transition delivery of care from office-based to virtual care platforms. Overall and discipline-specific weekly MVs, visit mode (office-based, telephone, or video), and associated aggregate measures of patient-reported visit experience were reported. A 38-week time-series analysis with March 8, 2020, and May 3, 2020, as the interruption dates was performed. RESULTS: After the first interruption, there was a decreased weekly visit trend for all visits (ß3 = -388.94; P < .05), an immediate decrease in office-based visits (ß2 = -25,175.16; P < .01), increase in telephone-based visits (ß2 = 17,179.60; P < .01), and increased video-based visit trend (ß3 = 282.02; P < .01). After the second interruption, there was an increased visit trend for all visits (ß5 = 565.76; P < .01), immediate increase in video-based visits (ß4 = 3523.79; P < .05), increased office-based visit trend (ß5 = 998.13; P < .01), and decreased trend in video-based visits (ß5 = -360.22; P < .01). After the second interruption, there were increased weekly long-term visit trends for the proportion of patients reporting "excellent" as to how well their visit needs were met for all visits (ß5 = 0.17; P < .01), telephone-based visits (ß5 = 0.34; P < .01), and video-based visits (ß5 = 0.32; P < .01). Video-based visits had the highest proportion of respondents rating "excellent" as to how well their scheduling and visit needs were met. CONCLUSIONS: COVID-19 required prompt organizational transformation to optimize the patient experience.

Use of medical marijuana in cystic fibrosis patients.

BACKGROUND: The usage and attitudes towards medical marijuana in Cystic Fibrosis (CF) patients is unknown. Through the use of a survey we aim to clarify rates and reasons for use. METHODS: An anonymous survey was sent out to six centers in the Mid-Atlantic region of the United States. Use of and reason for medical marijuana was assessed, along with attitudes of the perceived utility of medical marijuana. RESULTS: A total of 637 surveys were sent out, and 193 surveys were returned (30.3% return rate). Three did not give consent, and one was empty, for a total of 189 completed surveys. 31 subjects (16.5%) reported having used marijuana for medical purposes in their lifetime, with 29 (15.4%) of these in the past year. The most used forms were edible and vaporized. The most common indications for usage were pain and stress. 28 out of 31 found marijuana to be a great deal effective for their symptoms. 21 of the 31 rated marijuana very important or important to their health. There were two reported side effects, both mild. Of 156 subjects who responded to the question if they would be interested in medical marijuana if available, 72 (46.2%) replied yes. CONCLUSION: The use of marijuana for medical reasons was 15.4% in the past year in this sample CF population, although more expressed interest if it was available through prescription. Side effects were rare. CF physicians are going to have to familiarize themselves with advantages and disadvantages of medical marijuana as there is a great deal of interest within the community, and legalization becomes more common.

Yoga for warriors: An intervention for veterans with comorbid chronic pain and PTSD.

OBJECTIVE: Comorbid chronic pain and posttraumatic stress disorder (PTSD) is common in veterans; this comorbidity is associated with increased severity and poorer prognosis when compared to each outcome alone. Yoga has been shown to be effective for chronic pain and promising for PTSD, but yoga for comorbid pain and PTSD has not been examined. This article offers empirical support for a yoga intervention for comorbid chronic pain and PTSD in a veteran population. METHOD: Results are presented from a 4-year pilot yoga intervention for comorbid chronic pain and PTSD at a large, urban Veterans Affairs Medical Center. Based on the fear avoidance model of pain, the intervention used a cross-sectional, open-trial design with pre- and postmeasures. T test analyses were conducted on program completers (N = 49; out of 87 initially enrolled, 44% attrition rate), who were primarily African American (69%) and male (61%) and had a mean age of 51.41 years (SD = 11.32). RESULTS: Results indicated trend-level reductions in overall PTSD symptoms, as measured by the PTSD Checklist for DSM-5 (p = .02, d = 0.38) and in symptom cluster scores of negative alterations of cognitions and mood (p = .03, d = 0.36) and arousal and reactivity (p = .03, d = 0.35). Veterans reported significant improvement in ability to participate in social activities (p < .001, d = 0.44) and significant reductions in kinesiophobia (fear of movement or physical activity; p < .001, d = 0.85). On a satisfaction measure with a range of 1 (quite dissatisfied) to 4 (extremely satisfied), the mean rating was 3.74 (SD = 0.33). CONCLUSION: Yoga is a feasible and effective intervention for veterans with comorbid chronic pain and PTSD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Integrated Care: Provider referrer perceptions of occupational therapy services for homeless adults in an integrated primary care setting.

BACKGROUND: Occupational therapists have a long history of addressing community performance and participation challenges faced by individuals with complex, chronic conditions, including those with serious mental illnesses (SMI) and cognitive issues that present with a traumatic brain injury (TBI). Healthcare reform has shifted incentives to support practices that promote successful community life for people with complex medical conditions. Community based care models emphasizing integrated primary care, such as Federally Qualified Health Centers (FQHC) are emerging, and a generalist role for occupational therapy is being defined. Those with complex comorbid conditions such as mental illness, substance abuse and traumatic brain injury are at risk for negative health outcomes that are further compounded by homelessness. There is a critical need to understand effective treatment options for this population to reduce the negative effects of chronic health conditions. As occupational therapists further define a role serving traditional clients in less traditional settings, such as the FQHC, it is helpful to explore the perceptions of the utility of OT services on the part of provider referrers. OBJECTIVE: This study explored provider referrer perceptions of a new occupational therapy service for homeless adults in an FQHC to assist effective allocation of scarce resources. METHODS: Twelve provider referrers at an FQHC were interviewed regarding their perception of the role and utility of occupational therapy in this setting. Interviews were then coded for themes. RESULTS: Providers identified the unique value of occupational therapy, emphasizing critical information gleaned from the performance-based assessment of functional cognition, and the positive impact on team interactions and subsequent care decisions. CONCLUSION: Occupational therapy provides a distinct perspective on client performance in FQHC settings indicating benefit for inclusion of services.

Use of posttreatment imaging and biomarkers in survivors of early-stage breast cancer: Inappropriate surveillance or necessary care?

BACKGROUND: Advanced imaging and serum biomarkers are commonly used for surveillance in patients with early-stage breast cancer, despite recommendations against this practice. Incentives to perform such low-value testing may be less prominent in integrated health care delivery systems. The purpose of the current study was to evaluate and compare the use of these services within 2 integrated systems: Kaiser Permanente (KP) and Intermountain Healthcare (IH). The authors also sought to distinguish the indication for testing: diagnostic purposes or routine surveillance. METHODS: Patients with American Joint Committee on Cancer stage 0 to II breast cancer diagnosed between 2009 and 2010 were identified and the use of imaging and biomarker tests over an 18-month period were quantified, starting at 1 year after diagnosis. Chart abstraction was performed on a random sample of patients who received testing to identify the indication for testing. Multivariate regression was used to explore associations with the use of nonrecommended care. RESULTS: A total of 6585 patients were identified; 22% had stage 0 disease, 44% had stage I disease, and 34% had stage II disease. Overall, 24% of patients received at least 1 imaging test (25% at KP vs 22% at IH; P = .009) and 28% of patients received at least 1 biomarker (36% at KP vs 13% at IH; P<.001). Chart abstraction revealed that 84% of imaging tests were performed to evaluate symptoms or signs. Virtually all biomarkers were ordered for routine surveillance. Stage of disease, medical center that provided the services, and provider experience were found to be significantly associated with the use of biomarkers. CONCLUSIONS: Advanced imaging was most often performed for appropriate indications, but biomarkers were used for nonrecommended surveillance. Distinguishing between inappropriate use for surveillance and appropriate diagnostic testing is essential when evaluating adherence to recommendations.

Characterizing phosphorus speciation of Chesapeake Bay sediments using chemical extraction, 31P NMR, and X-ray absorption fine structure spectroscopy.

Nutrient contamination has been one of the lingering issues in the Chesapeake Bay because the bay restoration is complicated by temporally and seasonally variable nutrient sources and complex interaction between imported and regenerated nutrients. Differential reactivity of sedimentary phosphorus (P) pools in response to imposed biogeochemical conditions can record past sediment history and therefore a detailed sediment P speciation may provide information on P cycling particularly the stability of a P pool and the formation of one pool at the expense of another. This study examined sediment P speciation from three sites in the Chesapeake Bay: (i) a North site in the upstream bay, (ii) a middle site in the central bay dominated by seasonally hypoxic bottom water, and (iii) a South site at the bay-ocean boundary using a combination of sequential P extraction (SEDEX) and spectroscopic techniques, including (31)P NMR, P X-ray absorption near edge structure spectroscopy (XANES), and Fe extended X-ray absorption fine structure (EXAFS). Results from sequential P extraction reveal that sediment P is composed predominantly of ferric Fe-bound P and authigenic P, which was further confirmed by solid-state (31)P NMR, XANES, and EXAFS analyses. Additionally, solution (31)P NMR results show that the sediments from the middle site contain high amounts of organic P such as monoesters and diesters, compared to the other two sites, but that these compounds rapidly decrease with sediment depth indicating remineralized P could have precipitated as authigenic P. Fe EXAFS enabled to identify the changes in Fe mineral composition and P sinks in response to imposed redox condition in the middle site sediments. The presence of lepidocrocite, vermiculite, and Fe smectite in the middle site sediments indicates that some ferric Fe minerals can still be present along with pyrite and vivianite, and that ferric Fe-bound P pool can be a major P sink in anoxic sediments. These results provide improved insights into sediment P dynamics, particularly the rapid remineralization of organic P and the stability of Fe minerals and the ferric Fe-bound P pool in anoxic sediments in the Chesapeake Bay.

Pilot Test of a Preconception and Midwifery Care Promotion Program for College Women.

INTRODUCTION: College campuses remain an underused setting for implementing the 10 strategies for promoting preconception health proposed by the US Centers for Disease Control and Prevention. This setting can also be used to educate young women about their options for care in future pregnancies, including midwifery care. To address these needs, the author and 2 peer educators developed and pilot-tested a multiweek health education program for college women. METHODS: Women from a small public liberal arts college in the mid-Atlantic region of the United States were recruited to participate in the pilot program, which offered 6 hours of education over 4 weeks in an interactive, participant-led format. Of 26 women who participated, 20 completed at least 3 of the 4 sessions, as well as the pre- and posttests. RESULTS: The program group reported greater awareness of the importance of preconception health and an increased preference for midwifery care in future pregnancies. Program participants experienced an increase in knowledge about preconception health, midwifery care, and risks associated with cesarean birth, labor induction, and preterm birth, but did not report a statistically significant change in behavior related to preconception health, including lifestyle changes and immunizations. DISCUSSION: Further research should be conducted with a larger sample, longer follow-up, and a more rigorous evaluation design to assess the potential contributions of this promising pilot program.

Hepatitis C screening trends in a large integrated health system.

BACKGROUND: As new hepatitis C virus (HCV) therapies emerge, only 1%-12% of individuals are screened in the US for HCV infection. Presently, HCV screening trends are unknown. METHODS: We utilized the Kaiser Permanente Mid-Atlantic States' (KPMAS) data repository to investigate HCV antibody screening between January 1, 2003 and December 31, 2012. We identified the proportion screened for HCV and 5-year cumulative incidence of screening, the screening positivity rate, the provider types performing HCV screening, patient-level factors associated with being screened, and trends in screening over time. RESULTS: There were 444,594 patients who met the inclusion criteria. Overall, 15.8% of the cohort was ever screened for HCV. Adult primary care and obstetrics and gynecology providers performed 75.9% of all screening. The overall test positivity rate was 3.8%. Screening was more frequent in younger age groups (P <.0001) and those with a documented history of illicit drug use (P <.0001). Patients with missing drug use history (46.7%) were least likely to be screened (P <.0001). While the rate of HCV screening increased in the later years of the study among those enrolled in KPMAS 2009-2012, only 11.8% were screened by the end of follow-up. CONCLUSION: Screening for HCV is increasing but remains incomplete. Targeting screening to those with a history of injection drug will not likely expand screening, as nearly half of patients have no documented drug use history. Routine screening is likely the most effective approach to expand HCV screening.

Detection of vancomycin-resistant enterococci (VRE) at four U.S. wastewater treatment plants that provide effluent for reuse.

Vancomycin-resistant enterococci (VRE), a leading cause of hospital-acquired infections, can occur in wastewater. However, to date, no previous studies have evaluated the occurrence of VRE at wastewater treatment plants (WWTPs) that send their treated effluent to reuse sites. We evaluated the occurrence, concentration, and antimicrobial resistance patterns of VRE at U.S. WWTPs associated with reuse sites. We collected 44 wastewater samples, representing treatment steps from influent to effluent, from two Mid-Atlantic and two Midwest WWTPs between October 2009 and October 2010. Samples were analyzed for total enterococci and VRE using membrane filtration. Isolates were confirmed using biochemical tests and PCR. Antimicrobial susceptibility testing was performed by Sensititre microbroth dilution. Data were analyzed by two-sample proportion tests and analysis of variance. We detected VRE in 27% (12/44) of all wastewater samples collected and VRE represented 3% of total enterococci detected at all WWTPs. More samples were VRE-positive from the Mid-Atlantic compared to the Midwest WWTPs (p=0.008). VRE concentrations decreased as treatment progressed at all WWTPs, except at Mid-Atlantic WWTP1 where there was an increase in VRE concentrations in activated sludge reactor samples. VRE were not detected in chlorinated effluent, but were detected in one un-chlorinated effluent sample. All unique VRE isolates were multidrug resistant. Fifty-five percent (12/22) of the isolates displayed high-level aminoglycoside resistance. Our findings show that chlorination reduces the occurrence of VRE in wastewater. However, WWTP workers could be exposed to VRE during wastewater treatment. Our data also raise potential concerns about VRE exposure among individuals who come into contact with un-chlorinated reclaimed water.

Getting in and getting out whole: nurse-patient connections in the psychiatric setting.

As a strong component in patient healing, interpersonal connection in the psychiatric/mental health setting can threaten nurses' health. Participant observation on four behavioral health and addiction units revealed a process of connecting with patients' emotional pain, delineating strategies applicable to nurses' multiple world views and practice styles. Findings from 12 nurses highlighted connectedness as a process and personal decision that, with self-awareness and individualized self-protective/self-separating strategies, can enhance patient healing as well as nurse satisfaction and growth. The evolved model may help nurses ease emotional labor, combat compassion fatigue, enhance performance, and preserve their self in today's complex acute care setting.

Methicillin-resistant Staphylococcus aureus (MRSA) detected at four U.S. wastewater treatment plants.

BACKGROUND: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections is increasing in the United States, and it is possible that municipal wastewater could be a reservoir of this microorganism. To date, no U.S. studies have evaluated the occurrence of MRSA in wastewater. OBJECTIVE: We examined the occurrence of MRSA and methicillin-susceptible S. aureus (MSSA) at U.S. wastewater treatment plants. METHODS: We collected wastewater samples from two Mid-Atlantic and two Midwest wastewater treatment plants between October 2009 and October 2010. Samples were analyzed for MRSA and MSSA using membrane filtration. Isolates were confirmed using biochemical tests and PCR (polymerase chain reaction). Antimicrobial susceptibility testing was performed by Sensititre® microbroth dilution. Staphylococcal cassette chromosome mec (SCCmec) typing, Panton-Valentine leucocidin (PVL) screening, and pulsed field gel electrophoresis (PFGE) were performed to further characterize the strains. Data were analyzed by two-sample proportion tests and analysis of variance. RESULTS: We detected MRSA (n = 240) and MSSA (n = 119) in 22 of 44 (50%) and 24 of 44 (55%) wastewater samples, respectively. The odds of samples being MRSA-positive decreased as treatment progressed: 10 of 12 (83%) influent samples were MRSA-positive, while only one of 12 (8%) effluent samples was MRSA-positive. Ninety-three percent and 29% of unique MRSA and MSSA isolates, respectively, were multidrug resistant. SCCmec types II and IV, the pvl gene, and USA types 100, 300, and 700 (PFGE strain types commonly found in the United States) were identified among the MRSA isolates. CONCLUSIONS: Our findings raise potential public health concerns for wastewater treatment plant workers and individuals exposed to reclaimed wastewater. Because of increasing use of reclaimed wastewater, further study is needed to evaluate the risk of exposure to antibiotic-resistant bacteria in treated wastewater.

Spatial and temporal modeling of daily pollen concentrations.

Accurate assessments of pollen counts are valuable to allergy sufferers, the medical industry, and health researchers; however, monitoring stations do not exist in most areas. In addition, the degree of spatial reliability provided by the limited number of monitoring stations is poorly understood. We developed and compared spatial models to estimate pollen concentrations in locations without monitoring stations. Daily Acer, Quercus, and overall tree, grass, and weed pollen counts, in grains/m(3), were obtained from 14 aeroallergen monitoring stations located in the northeastern and mid-Atlantic region of the United States from 2003 to 2006. Pollen counts were spatially interpolated using ordinary kriging. Mixed effects and generalized estimating equations incorporating daily and seasonal weather characteristics, pollen season characteristics and land-cover information were also developed to estimate daily pollen concentrations. We then compared observed values from a monitoring station to model estimates for that location. Observed counts and kriging estimates for tree pollen differed (p = 0.04), but not when peak periods were removed (p = 0.29). No differences between observed and kriging estimates of Acer (p = 0.46), Quercus (p = 0.24), grass (p = 0.31) or weed pollen (p = 0.29) were found. Estimates from longitudinal models also demonstrated good agreement with observed counts, except for the extremes of pollen distributions. Our results demonstrate that spatial interpolation techniques as well as regression methods incorporating both weather and land-cover characteristics can provide reliable estimates of daily pollen concentrations in areas where monitors do not exist for all but periods of extremely high pollen.

Sacred healing stories told at the end of life.

INTRODUCTION: Cancer is a challenging disease to diagnose and treat, and oftentimes even with the best medical intervention, it spreads and is deemed incurable, requiring a shift from cure to end-of-life care. This study used a spirituality measure and the PATS© storytelling intervention developed by the principal investigator to better understand the experience of being diagnosed with cancer and being told no further curative treatments are warranted. PURPOSE: The purpose of this exploratory study was to implement a storytelling approach to explore the experience of living with terminal cancer. Second, the study documented the presence of spirituality and healing in the narratives. METHOD: The qualitative data were analyzed by narrative analysis developed by Riessman. FINDINGS: Seven synoptic stories were written and later sorted into healing categories. The narrative analysis yielded three themes. There were instances of religion and spirituality found in the transcribed stories. The participants' scores on the Spiritual Health Inventory indicated the presence of spirituality. CONCLUSION: Storytelling allowed the seven study participants to share personal experiences and achieve a sense of connectedness and intimacy. The use of the PATS© intervention is a way to facilitate physical, emotional, and spiritual healing and provide holistic end-of-life care.

Effects of hydrology and field management on phosphorus transport in surface runoff.

Phosphorus (P) losses from agricultural landscapes arise from the interaction of hydrologic, edaphic, and management factors, complicated by their spatial and temporal variability. We monitored sites along two agricultural hillslopes to assess the effects of field management and hydrology on P transfers in surface runoff at different landscape positions. Surface runoff varied by landscape position, with saturation excess runoff accounting for 19 times the volume of infiltration excess runoff at the north footslope position, but infiltration excess runoff dominated at upslope landscape positions. Runoff differed significantly between south and north footslopes, coinciding with the extent of upslope soil underlain by a fragipan. Phosphorus in runoff was predominantly in dissolved reactive form (70%), with the highest concentrations associated with upper landscape positions closest to fields serving as major sources of P. However, the largest loads of P were from the north footslope, where runoff volumes were 24 times larger than from all other sites combined. Loads of P from the north footslope appeared to be primarily chronic transfers of desorbed soil P. Although runoff from the footslope likely contributed directly to stream flow and hence to stream water quality, 27% of runoff P from the upslope sites did not connect directly with stream flow. Findings of this study will be useful for evaluating the critical source area concept and metrics such as the P-Index.

Topical treatment of white-tailed deer with an acaricide for the control of Ixodes scapularis (Acari: Ixodidae) in a Connecticut Lyme borreliosis hyperendemic Community.

The 4-Poster device for the topical treatment of white-tailed deer, Odocoileus virginianus (Zimmermann), against ticks using the acaricide amitraz, was evaluated in a Lyme borreliosis endemic community in Connecticut. As part of a 5-year project from 1997 to 2002, 21-24 of the 4-Posters were distributed at residential sites in Old Lyme, CT, in a core treatment area of approximately 5.2 km(2) in fall 1997. The 4-Posters were active October to mid-December and March into May, corresponding to the peak periods of activity for adult Ixodes scapularis in this particular area. Corn consumption ranged from 361 to 4789 kg/month for October and November and 696-3130 kg/month during April. Usage of 4-Posters by deer generally was high (>90%), except during acorn masts in fall 1998 and 2001. Amitraz was applied by rollers at the estimated rate of 1.3 g active ingredient/ha/year. The abundance of host-seeking I. scapularis nymphs declined significantly (p < 0.001) in the core treatment area, as compared to a control community in Old Saybrook, CT, through 2004, over the project period from 1998 to 2003, from 9.3/100m(2) to 0.97/100m(2), rising to 1.90/100m(2) in 2004. From 1999 through 2003, there were 46.1%, 49.6%, 63.4%, 64.6%, and 70.2% reductions, respectively, in the nymphal tick population in comparison with the untreated community and initial tick abundance in 1998. Control of I. scapularis adults declined to only 19.1% in 2004; 2 years after the treatment of deer was discontinued. Differences in nymphal tick abundance between the control and core treatment area were significant in 1999 (p = 0.042) and highly significant in 2001 (p < 0.001) and 2002 (p = 0.002). The passive topical application to deer of the acaricide amitraz resulted in a significant decrease in the population of free-living I. scapularis nymphs in the treated core in Connecticut.

Phosphorus-31 nuclear magnetic resonance spectroscopy transect study of poultry operations on the Delmarva Peninsula.

Nonpoint source phosphorus (P) pollution into the Chesapeake Bay watershed from poultry operations contributes to the algal blooms, hypoxia, anoxia, and fish kill events that occur there most years. A major source of soluble, bioavailable P species is poultry litter, which is used as a crop fertilizer on fields adjacent to the tributaries of the Bay. A potentially significant source of orthophosphate in the litter is the heavily phosphorylated compound myo-inositol hexakisphosphate (phytate), which is indigestible by poultry and thus becomes a major component of their excreta. Phytate evaluation in environmental samples is expensive; hence, its impact is not captured in standard farmer-friendly eutrophication potential guides, like Delaware's Phosphorus Site Index. In this transect study of two poultry operations on the Delmarva Peninsula, we measured the incidence of all P compounds using solution 31P nuclear magnetic resonance (NMR) spectroscopy and extracts, relating them to relevant geochemical properties. The contribution of phytate to the overall pool of P declined from around 50% in manures to between 2 and 13% in down-gradient soils and sediments, corresponding to a rise in the relative proportion of orthophosphate (increasing from 39% to 65-88%). The results show that the large pool of phytate P spread onto croplands during standard operating practice at poultry farms on the Delmarva Peninsula does not appear to accumulate; rather, phytate decreases in down-gradient locations, most likely due to transport off-site and/or through in situ biological activity.

Evaluating phosphorus release from biosolids and manure-amended soils under anoxic conditions.

The solubility of P in biosolids and manures has been shown to influence the potential for dissolved P losses in runoff and leachate when these materials are land applied. As a result, some Mid-Atlantic US states have developed P source coefficients (PSCs) to account for differences in P solubility between fertilizers, manures, and biosolids in P risk assessment tools. The reliability of these PSCs has not been evaluated under anoxic conditions, where environmental changes may affect the P solubility of biosolids or manures. The objective of this study was to assess the effects of anoxic conditions on the release of P from a range of Mid-Atlantic soils amended with manures and biosolids. The concentration of dissolved P released into solution (0.01 mol L(-1) NaCl) from the Pamunkey, Berks, and Manor soils was significantly lower under reducing conditions than under oxidized conditions (median DeltaP = -0.70, -0.49, and -0.07 mg L(-1), respectively; all significant at the 0.001 probability level). There was no significant P source effect on dissolved P released into solution after anoxic incubation of soils. Calculated solubility diagrams and increases in oxalate-extractable Fe and P sorption index under reducing conditions for all soils suggest the precipitation of (i) an Fe(II)-oxide that increased the P sorption capacity of the soils or (ii) an Fe(II)-phosphate that decreased the solubility of P. We propose that current PSCs do not need alteration to account for differences in P solubility of organic sources under reducing conditions under relatively static conditions (e.g., seasonable high water table, periodically submerged soils, stagnant drainage ditches).

Benefits, barriers, and cues to action of yoga practice: a focus group approach.

OBJECTIVES: To explore perceived benefits, barriers, and cues to action of yoga practice among adults. METHODS: Focus groups were conducted with persons who had never practiced yoga, practitioners of one year or less, and practitioners for more than one year. The Health Belief Model was the theoretical foundation of inquiry. RESULTS: All participants acknowledged a variety of benefits of yoga. Barriers outweighed benefits among persons who had never practiced despite knowledge of benefits. Positive experiences with yoga and yoga instructors facilitated practice. CONCLUSIONS: Newly identified benefits and barriers indicate the need for quantitative research and behavioral trials.

A health plan's integration of molecular diagnostics and the impact on treatment pathways for quality care.

This Mid-Atlantic area Blues plan views genetic biomarkers as an important advancement in predicting recurrence rates and response to chemotherapy in estrogen-receptor-positive, node-negative, HER2-negative women with early-stage breast cancer. Care-First's Pay for Quality oncology program strives to combine clinically sound treatment with stable outcomes and predictable costs.