WAIVER AUTHORITY VS. FEDERAL PRESERVATION LAWS: A CASE STUDY ON THE U.S.-MEXICAN BORDER WALL

Because of federal law waivers, former President Donald J. Trump Administration’s border wall and border infrastructure project threatened the existence of the American Southwests’ natural, archaeological, and historical resources—including Native American cultural patrimony. Legislation such as the National Historic Preservation Act and the National Environmental Policy Act require lead federal agencies to consider the potential adverse impacts their project may have on cultural and environmental resources prior to project commencement. However, when waiver authority is declared by the Secretary of the Department of Homeland Security federal agencies are no longer obligated to comply with existing federal preservation laws. The U.S. Customs and Border Patrol voluntarily performs environmental reviews called Environmental Stewardship Plans and Environmental Stewardship Summary Reports when waiver authority is declared. Yet, these reviews are not as comprehensive as the existing federal environmental procedures. Through this thesis, I analyze existing surveys of the areas, federal preservation legislation, and interviews with federal and state professionals to understand the implications waiver authority has on the cultural landscapes of the border wall region. In the end, I make general recommendations to avoid, minimize, or mitigate adverse impacts on cultural landscapes when emergencies justifying waiver authority are declared

Urbanization Impacts on Campus Cypress Domes

Cypress domes are terrestrial freshwater ecosystems characterized by the presence of cypress trees (Taxodium spp.) growing in well-defined, dome-shaped clusters throughout the southeastern United States. These systems are one of many ecosystems in Florida facing increasing threats from human expansion and urbanization including fire suppression, logging, and hydrological alterations. This study sought to examine the impacts of urbanization on three cypress domes located on the University of Central Florida Orlando campus. To do this, we measured the defining traits, dendrochronology of Taxodium distichum var. imbricarium, and soil characteristics in each of the three selected domes. The cypress dome defined as most highly impacted had the largest trees compared to the moderate and low impacted domes. With increased urbanization, the soil pH increased while the soil moisture content decreased. Although these results alone are not indicative of the system’s overall health, they can be used in future studies to better explore the relationship between urban interface and the ecosystem. Understanding the impacts of urbanization on these valuable wetland ecosystems can help with long-term protection of these ecosystems, as well as improving natural resource management

Complex modeling with detailed temporal predictors does not improve health records-based suicide risk prediction

Suicide risk prediction models can identify individuals for targeted intervention. Discussions of transparency, explainability, and transportability in machine learning presume complex prediction models with many variables outperform simpler models. We compared random forest, artificial neural network, and ensemble models with 1500 temporally defined predictors to logistic regression models. Data from 25,800,888 mental health visits made by 3,081,420 individuals in 7 health systems were used to train and evaluate suicidal behavior prediction models. Model performance was compared across several measures. All models performed well (area under the receiver operating curve [AUC]: 0.794-0.858). Ensemble models performed best, but improvements over a regression model with 100 predictors were minimal (AUC improvements: 0.006-0.020). Results are consistent across performance metrics and subgroups defined by race, ethnicity, and sex. Our results suggest simpler parametric models, which are easier to implement as part of routine clinical practice, perform comparably to more complex machine learning methods

Pathways to Progress. Volume I: Community Development Challenges for San Angelo, Texas and Surrounding Communities

In 2011, we at Community Development Initiatives (CDI) met with Jack Cowan and Mike Kelly, editors of the San Angelo Standard Times newspaper. We sought approval to write a monthly article for the paper that would focus on stimulating thought and discussion about the social problems facing residents of San Angelo and the Concho Valley on a daily basis. We believe that such discussion is a key path to progress. The problems CDI deals with often focus on residents that seem most troublesome to many citizens. They concern the poor, the elderly, the disabled, the youth, the unemployed and the racial/ethnic minority members of the community. Jack and Mike were enthusiastic about our proposal and they have been staunch supporters ever since the publication of our initial article in August of 2011. Since that article, the Standard Times published monthly articles for more than five years. Those articles comprise our Pathways to Progress series.ACKNOWLEDGEMENTS (8) — SOCIAL HEALTH INDEX FOR THE CONCHO VALLEY (9) — Solving Our Problems Together (10) — Quality of Life Figures in Decline (13) — Vast Differences in Quality of Life across City (19) — Looking for Answers (23) — Taking a Balanced Approach (25) — Two Steps Forward, Two Steps Back in Measure (28) — Community Woes Linger (32) — Quality of Life (35) — CHILDREN OF THE CONCHO VALLEY (38) — Falling Through the Cracks (40) — The Well-Being of Children in Tom Green County (43) — Battle against Child Poverty Goes On (46) — Child Abuse in our Area (49) — It Takes a Village to Raise Kids Right (51) — Children Are All of Our Future (54) — How Are the Children? (57) — Local Domestic and Child Abuse Levels Too High (60) — Saying NO to Citizen Complacency (62) — Teen Births Cost us All (67) — No Reason for Complacency (70) — Disconnected Youth (73) — SENIORS OF THE CONCHO VALLEY (76) — Truly Grand Parents (77) — They worked, now it's Up to Us (80) — City Has High Levels of Elderly Abuse, Accidents (84) — Texas Should Get Atop the Coming Demographic Wave (88) — Not All Seniors Equal (92) — Isolation among the Elderly (95) — HEALTH CARE IN THE CONCHO VALLEY (98) — Caring About Care (101) — Not so well being (103) — Giving Thanks, Getting Checked (107) — Door to Reform (109) — West Texas' Wide Open Spaces a Challenge for Health Care (112) — Driven to Live a Healthier Lifestyle (115) — Ounces of Prevention (118) — Index Raises Red Flags (121) — The Gift of Health (124) — Getting With the ACA Program (127) — Kid's Health Index Reveals Disparities (130) — Standard of Safety (134) — Abortion Rate Declining (137) — White Midlife Despair (140) — Health Status of Poor (143) — THE ECONOMY OF THE CONCHO VALLEY (145) — Contributions of Immigrants Must Not be ignored (147) — US Needs to Commit to Paying a Living Wage (150) — GI Bill: A Success (153) — A Community Divided (156) — Let's Get Serious About Reducing Poverty (160) — HOUSEHOLDS OF THE CONCHO VALLEY (162) — College Education Crucial, Not Cheap (164) — Overcoming San Angelo's Housing Hurdles (168) — Avoiding Complacency (171) — Area Public Transportation Must Prepare for Future Needs (174) — Hunger in the Land of Plenty (177) — Seeing a Pattern Here (181) — Many Struggle to Keep a Roof over Their Heads (184) — Figures behind Tax Burden (188) — Solving Social Security (193) — Grading our Schools (196) — INEQUALITY IN THE CONCHO VALLEY (200) — Inequality Imperils Us (202) — Pay Roles (205) — Blaming the Poor for Being Poor (208) — Income Inequality by the Numbers (212) — Drifting Apart? (216) — Waking Up From the American Dream (220) — A Great Revolt? (223) — Different Kind of Segregation Occurring (226) — CONTRIBUTORS (231

Weighing the Association Between BMI Change and Suicide Mortality

OBJECTIVE: Suicide rates continue to rise, necessitating the identification of risk factors. Obesity and suicide mortality rates have been examined, but associations among weight change, death by suicide, and depression among adults in the United States remain unclear. METHODS: Data from 387 people who died by suicide in 2000-2015 with a recorded body mass index (BMI) in the first and second 6 months preceding their death ( index date ) were extracted from the Mental Health Research Network. Each person was matched with five people in a control group (comprising individuals who did not die by suicide) by age, sex, index year, and health care site (N=1,935). RESULTS: People who died by suicide were predominantly male (71%), White (69%), and middle aged (mean age=57 years) and had a depression diagnosis (55%) and chronic health issues (57%) (corresponding results for the control group: 71% male, 66% White, 14% with depression diagnosis, and 43% with chronic health issues; mean age=56 years). Change in BMI within the year before the index date statistically significantly differed between those who died by suicide (mean change=-0.72±2.42 kg/m(2)) and the control group (mean change=0.06±4.99 kg/m(2)) (p\u3c0.001, Cohen\u27s d=0.17). A one-unit BMI decrease was associated with increased risk for suicide after adjustment for demographic characteristics, mental disorders, and Charlson comorbidity score (adjusted odds ratio=1.11, 95% confidence interval=1.05-1.18, p\u3c0.001). For those without depression, a BMI change was significantly associated with suicide (p\u3c0.001). CONCLUSIONS: An increased suicide mortality rate was associated with weight loss in the year before a suicide after analyses accounted for general and mental health indicators

Study protocol for a type III hybrid effectiveness-implementation trial of strategies to implement firearm safety promotion as a universal suicide prevention strategy in pediatric primary care

BACKGROUND: Insights from behavioral economics, or how individuals\u27 decisions and behaviors are shaped by finite cognitive resources (e.g., time, attention) and mental heuristics, have been underutilized in efforts to increase the use of evidence-based practices in implementation science. Using the example of firearm safety promotion in pediatric primary care, which addresses an evidence-to-practice gap in universal suicide prevention, we aim to determine: is a less costly and more scalable behavioral economic-informed implementation strategy (i.e., Nudge ) powerful enough to change clinician behavior or is a more intensive and expensive facilitation strategy needed to overcome implementation barriers? METHODS: The Adolescent and child Suicide Prevention in Routine clinical Encounters (ASPIRE) hybrid type III effectiveness-implementation trial uses a longitudinal cluster randomized design. We will test the comparative effectiveness of two implementation strategies to support clinicians\u27 use of an evidence-based firearm safety practice, S.A.F.E. Firearm, in 32 pediatric practices across two health systems. All pediatric practices in the two health systems will receive S.A.F.E. Firearm materials, including training and cable locks. Half of the practices (k = 16) will be randomized to receive Nudge; the other half (k = 16) will be randomized to receive Nudge plus 1 year of facilitation to target additional practice and clinician implementation barriers (Nudge+). The primary implementation outcome is parent-reported clinician fidelity to the S.A.F.E Firearm program. Secondary implementation outcomes include reach and cost. To understand how the implementation strategies work, the primary mechanism to be tested is practice adaptive reserve, a self-report practice-level measure that includes relationship infrastructure, facilitative leadership, sense-making, teamwork, work environment, and culture of learning. DISCUSSION: The ASPIRE trial will integrate implementation science and behavioral economic approaches to advance our understanding of methods for implementing evidence-based firearm safety promotion practices in pediatric primary care. The study answers a question at the heart of many practice change efforts: which strategies are sufficient to support change, and why? Results of the trial will offer valuable insights into how best to implement evidence-based practices that address sensitive health matters in pediatric primary care. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04844021 . Registered 14 April 2021

Withdrawal rates as a consequence of disclosure of risk associated with manipulation of the cervical spine

<p>Abstract</p> <p>Background</p> <p>The risk associated with cervical manipulation is controversial. Research in this area is widely variable but as yet the risk is not easily quantifiable. This presents a problem when informing the patient of risks when seeking consent and information may be withheld due to the fear of patient withdrawal from care. As yet, there is a lack of research into the frequency of risk disclosure and consequent withdrawal from manipulative treatment as a result. This study seeks to investigate the reality of this and to obtain insight into the attitudes of chiropractors towards informed consent and disclosure.</p> <p>Methods</p> <p>Questionnaires were posted to 200 UK chiropractors randomly selected from the register of the General Chiropractic Council.</p> <p>Results</p> <p>A response rate of 46% (n = 92) was achieved. Thirty-three per cent (n = 30) respondents were female and the mean number of years in practice was 10. Eighty-eight per cent considered explanation of the risks associated with any recommended treatment important when obtaining informed consent. However, only 45% indicated they always discuss this with patients in need of cervical manipulation. When asked whether they believed discussing the possibility of a serious adverse reaction to cervical manipulation could increase patient anxiety to the extent there was a strong possibility the patient would refuse treatment, 46% said they believed this could happen. Nonetheless, 80% said they believed they had a moral/ethical obligation to disclose risk associated with cervical manipulation despite these concerns. The estimated number of withdrawals throughout respondents' time in practice was estimated at 1 patient withdrawal for every 2 years in practice.</p> <p>Conclusion</p> <p>The withdrawal rate from cervical manipulation as a direct consequence of the disclosure of associated serious risks appears unfounded. However, notwithstanding legal obligations, reluctance to disclose risk due to fear of increasing patient anxiety still remains, despite acknowledgement of moral and ethical responsibility.</p

Evolution from XIST-Independent to XIST-Controlled X-Chromosome Inactivation: Epigenetic Modifications in Distantly Related Mammals

X chromosome inactivation (XCI) is the transcriptional silencing of one X in female mammals, balancing expression of X genes between females (XX) and males (XY). In placental mammals non-coding XIST RNA triggers silencing of one X (Xi) and recruits a characteristic suite of epigenetic modifications, including the histone mark H3K27me3. In marsupials, where XIST is missing, H3K27me3 association seems to have different degrees of stability, depending on cell-types and species. However, the complete suite of histone marks associated with the Xi and their stability throughout cell cycle remain a mystery, as does the evolution of an ancient mammal XCI system. Our extensive immunofluorescence analysis (using antibodies against specific histone modifications) in nuclei of mammals distantly related to human and mouse, revealed a general absence from the mammalian Xi territory of transcription machinery and histone modifications associated with active chromatin. Specific repressive modifications associated with XCI in human and mouse were also observed in elephant (a distantly related placental mammal), as was accumulation of XIST RNA. However, in two marsupial species the Xi either lacked these modifications (H4K20me1), or they were restricted to specific windows of the cell cycle (H3K27me3, H3K9me2). Surprisingly, the marsupial Xi was stably enriched for modifications associated with constitutive heterochromatin in all eukaryotes (H4K20me3, H3K9me3). We propose that marsupial XCI is comparable to a system that evolved in the common therian (marsupial and placental) ancestor. Silent chromatin of the early inactive X was exapted from neighbouring constitutive heterochromatin and, in early placental evolution, was augmented by the rise of XIST and the stable recruitment of specific histone modifications now classically associated with XCI