Working on the railroad: coastal streams prioritization to inform restoration planning

Puget Sound’s nearshore has been substantially modified since the Industrial Revolution with extensive infrastructure developed along the shoreline. In Washington State, the BNSF railroad right-of-way runs along 52 miles of the shoreline, while another 73 miles of railroad is within 200 feet of the shoreline. In many places, the railroad forms a barrier between the coastal watershed and the shoreline preventing the delivery of water, sediment, wood and organic matter into the nearshore. This creates ongoing degradation of habitat quality in the nearshore, including small estuaries and coastal embayments, which provide important habitat to juvenile Chinook salmon. In addition, the modifications associated with the railroad also limit juvenile salmon movements in estuaries, including juvenile chinook who are documented using the estuaries and freshwater habitats of non-natal streams. Nearshore restoration along the railroad is expensive and requires extensive planning. To maximize environmental benefits, restoration efforts should be focused on those areas that provide substantial benefits to fish habitat and nearshore processes. Confluence Environmental is leading a project to prioritize and evaluate coastal embayments and streams along the 125 miles of railroad-impacted shoreline. The project is synthesizing existing data, as well as identifying and filling data gaps for use in the prioritization. This prioritization will be integrated with a list of known railroad maintenance and upgrade needs. An advisory team is guiding the development of the prioritization to ensure it can support identified local and regional restoration outcomes. The outcome of the project will include a prioritized list of coastal embayments and streams to support strategic restoration choices and potential matching of upgrades and maintenance along the railroad to mitigation projects that will benefit fisheries and shoreline processes. The list will also enable independent funders to evaluate the benefits among restoration projects

Physical function limitation among gay and bisexual men aged ≥55years with and without HIV: findings from the Australian Positive and Peers Longevity Evaluation Study (APPLES)

Background. As people living with HIV now have a life expectancy approaching that of the general population, clinical care focuses increasingly on the management and prevention of comorbidities and conditions associated with aging. We aimed to assess the prevalence of physical function (PF) limitation among gay and bisexual men (GBM) and determine whether HIV is associated with severe PF limitation in this population. Methods. We analysed cross-sectional data from GBM aged ≥55 years in the Australian Positive and Peers Longevity Evaluation Study who completed a self-administered survey on health and lifestyle factors. PF was measured using the Medical Outcomes Study–Physical Functioning scale. Factors associated with severe PF limitation were assessed using logistic regression. Results. The survey was completed by 381 men: 186 without HIV and 195 with HIV. Median age was 64.3 years for GBM without HIV and 62.1 years for GBM with HIV. Compared with men without HIV, those with HIV had higher proportions of severe (13.3% vs 8.1%) and moderate-to-severe (26.7% vs 24.2%) PF limitation. Severe PF limitation commonly involved difficulty with vigorous activity (95% with severe PF limitation described being limited a lot), climbing several flights of stairs (68.4% limited a lot), bending, kneeling or stooping (60.5% limited a lot), and walking 1 km (55.0% limited a lot). In a model adjusted for age, body mass index, typical duration of physical activity, psychological distress, and number of comorbidities, we found a significant association between HIV and severe PF limitation (adjusted odds ratio 3.3 vs not having HIV, 95% confidence interval 1.3–8.7). Conclusions. The biological mechanisms underlying this association require further investigation, particularly given the growing age of the HIV population and inevitable increase in the burden of PF limitation

Severe Illness Anxiety Treated by Integrating Inpatient Psychotherapy With Medical Care and Minimizing Reassurance

Illness anxiety disorder (IAD, formerly hypochondriasis) is characterized by preoccupation with fear of serious illness despite medical reassurance. IAD is common, debilitating, challenging to treat, and results in high healthcare utilization. Outpatient management of IAD is challenging because patients can compulsively seek reassurance from numerous providers, which interferes with learning more productive coping skills. We present the case of a woman with severe IAD who presented to the emergency room with increasing frequency over several months, despite regular outpatient medical visits and escalating psychiatric care. We made the unusual decision to hospitalize her for IAD for 1 month, in the absence of typical hospitalization criteria. This hospitalization allowed us to consolidate all medical and psychiatric care into a single provider team and train all staff and family to communicate with her in a consistent manner. We successfully treated her by integrating a general cognitive-behavioral therapy (CBT) protocol into medical care and decision-making. In response to her numerous health concerns, we minimized medical work-up, reassurance, and reactive medication changes, and instead used the concerns as opportunities to reinforce the psychotherapy. This approach allowed us to simplify her medication regimen and manage her co-morbid hypertension and vitamin deficiencies. Though inpatient hospitalization is likely infeasible in most cases of IAD, outpatient providers may create similar treatment plans based on the example of our case report, without needing highly specialized expertise. Such a plan would require a straightforward understanding of IAD psychology, which we review here, combined with readily accessible tools including a universal CBT protocol, online CBT courses, and clinical symptom scales. We discuss our approach for responding to health concerns, maintaining therapeutic alliance, integrating CBT principles into patient interactions, and managing medications. Since patients with IAD share health concerns with all providers, staff, and family, we also include our own IAD communication guide, appropriate for a general audience, that demonstrates how to respond in these conversations

Associations of cannabis use disorder with cognition, brain structure, and brain function in African Americans

Although previous studies have highlighted associations of cannabis use with cognition and brain morphometry, critical questions remain with regard to the association between cannabis use and brain structural and functional connectivity. In a cross-sectional community sample of 205 African Americans (age 18–70) we tested for associations of cannabis use disorder (CUD, n = 57) with multi-domain cognitive measures and structural, diffusion, and resting state brain-imaging phenotypes. Post hoc model evidence was computed with Bayes factors (BF) and posterior probabilities of association (PPA) to account for multiple testing. General cognitive functioning, verbal intelligence, verbal memory, working memory, and motor speed were lower in the CUD group compared with nonusers (p \u3c .011; 1.9 \u3c BF \u3c 3,217). CUD was associated with altered functional connectivity in a network comprising the motor-hand region in the superior parietal gyri and the anterior insula (p \u3c .04). These differences were not explained by alcohol, other drug use, or education. No associations with CUD were observed in cortical thickness, cortical surface area, subcortical or cerebellar volumes (0.12 \u3c BF \u3c 1.5), or graph-theoretical metrics of resting state connectivity (PPA \u3c 0.01). In a large sample collected irrespective of cannabis used to minimize recruitment bias, we confirm the literature on poorer cognitive functioning in CUD, and an absence of volumetric brain differences between CUD and non-CUD. We did not find evidence for or against a disruption of structural connectivity, whereas we did find localized resting state functional dysconnectivity in CUD. There was sufficient proof, however, that organization of functional connectivity as determined via graph metrics does not differ between CUD and non-user group

Estimating prevalence of overweight and obesity at the neighborhood level: the value of maternal height and weight data available on birth certificate records

<p>Abstract</p> <p>Objective</p> <p>To determine the value of maternal height and weight data on birth certificate records when estimating prevalence of overweight and obese adults at the neighborhood level.</p> <p>Research Design and Methods</p> <p>Regression analysis was used to determine how much variation in the percentage of the adult population with a body mass index (BMI) of ≥ 25 (based on survey data) could be accounted for by the percentage of mothers with BMI ≥ 25 (based on birth certificate data) -- alone and in combination with other sociodemographic characteristics of census tracts.</p> <p>Results</p> <p>Alone, the percentage of mothers with BMI ≥ 25 explained more than half (R²= .52) of the variation in the percentage of all residents in census tracts with BMI ≥ 25; in combination with several measures of the sociodemographic characteristics of the census tracts, 75% ( R²= 75.2) of the variation is explained.</p> <p>Conclusions</p> <p>Maternal height and weight data available from birth certificate records may be useful for identifying neighborhoods with relatively high or low prevalence of adult residents who are overweight or obese. This is especially true if used in combination with readily available census data.</p

Epidemiology of Nontuberculous Mycobacteria in Patients without HIV Infection, New York City

The incidence appears to be increasing

Expropriated from the hereafter: the fate of the landless in the Southern Highlands of Madagascar

During the period following the abolition of slavery by the French colonial government in 1896, the Southern Highlands of Madagascar was settled by ex-slaves. These early settlers constructed a foundation myth of themselves as tompon-tany, or 'masters of the land', a discourse not only equating land with tombs, kinship and ancestors, but also coupled with a skilful deployment of 'Malagasy customs'. In order to exclude later migrants who also wanted to settle, the 'masters of the land' attempted to establish control over holdings in the area. To this end, and to reinforce their own legitimacy as landholders, the tompon-tany labelled subsequent migrants andevo ('lave' or of 'slave descent') who - as a tombless people - have no rights to land. Because they have neither tombs nor ancestors, the landless andevo are socially ostracised and economically marginalised. As an 'impure people', they are not entitled to a place in the hereafter

Adenosine/A2B receptor signaling ameliorates the effects of ageing and counteracts obesity

The combination of aging populations with the obesity pandemic results in an alarming rise in non-communicable diseases. Here, we show that the enigmatic adenosine A2B receptor (A2B) is abundantly expressed in skeletal muscle (SKM) as well as brown adipose tissue (BAT) and might be targeted to counteract age-related muscle atrophy (sarcopenia) as well as obesity. Mice with SKM-specific deletion of A2B exhibited sarcopenia, diminished muscle strength, and reduced energy expenditure (EE), whereas pharmacological A2B activation counteracted these processes. Adipose tissue-specific ablation of A2B exacerbated age-related processes and reduced BAT EE, whereas A2B stimulation ameliorated obesity. In humans, A2B expression correlated with EE in SKM, BAT activity, and abundance of thermogenic adipocytes in white fat. Moreover, A2B agonist treatment increased EE from human adipocytes, myocytes, and muscle explants. Mechanistically, A2B forms heterodimers required for adenosine signaling. Overall, adenosine/A2B signaling links muscle and BAT and has both anti-aging and anti-obesity potential

Improving digital partner notification for sexually transmitted infections and HIV through a systematic review and application of the Behaviour Change Wheel approach

Background Partner notification (PN) is key to controlling sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Digital PN options (e.g. social media, short message service (SMS), emails) are promising in increasing PN behaviour. However, their implementation is often challenging and studies report varied levels of acceptability and uptake of PN, highlighting the need to optimise digital PN interventions. Methods A systematic review of barriers and facilitators to digital PN interventions for STIs, including HIV, across eight research databases (from 2010 to 2023) identified eight relevant studies, two of which addressed HIV. Data extraction identified 98 barriers and 54 facilitators to the use of digital PN interventions. These were synthesised into 18 key barriers and 17 key facilitators that were each deemed amenable to change. We then used the Behaviour Change Wheel approach, the Acceptability, Practicability, Effectiveness, Affordability, Side-effects and Equity criteria, and multidisciplinary expert input, to systematically develop practical recommendations to optimise digital PN. Results Thirty-two specific recommendations clustered around three themes. Digital PN interventions should: (1) empower and support the index patient by providing a range of notification options, accompanied by clear instructions; (2) integrate into users’ existing habits and the digital landscape, meeting contemporary standards and expectations of usability; and (3) address the social context of PN both online and offline through normalising the act of PN, combating STI-related stigma and stressing the altruistic aspects of PN through consistent messaging to service users and the public. Conclusions Our evidence-based recommendations should be used to optimise existing digital PN interventions and inform the co-production of new ones

Network Bads: How Bottlenecks Matter *

Abstract This paper examines a model where bads, such as water pollutants, infectious diseases, and liquidity shocks, arise at a source node and may be transmitted to a sink node as a flow through a network. Two players wish to decrease network bads, which is determined by the extent of bads at the source node and by the maximum transmission of bads through the network. One player can act to mitigate bads at the source node while the other player can act to reduce bads through the network. Each player incurs the cost of action but benefits from the decrease in network bads. The bottlenecks of the network affect the maximum transmission of bads and the behavior of the players. I characterize efficient profiles and equilibria in terms of the bottlenecks. Interestingly, the player who acts in an equilibrium may not be the player who must act in the efficient profile. Overall, strategic inaction leads to inefficiency. Unless there is an efficient equilibrium where neither player acts, no efficient profile is an equilibrium and no equilibrium is efficient. I study cooperative solutions where the players jointly choose an efficient profile and make transfers to each other. Such cooperative solutions always exist. JEL classification: C70; D85; H4