Decreasing Dirty Dumping? A Reevaluation of Toxic Waste Colonialism and the Global Management of Transboundary Hazardous Waste

Even though the phrase “toxic waste colonialism” has fallen outof usage in the past ten years, the effective global management of transboundaryhazardous waste has yet to become an out-of-date topic. Startingin the early 1980s, the international community sought to develop internationalagreements governing the transboundary movement of hazardouswaste in order to protect developing countries from illegal “dirty dumping”practices. Over twenty years have passed since the adoption of the BaselConvention formed the foundation for other subsequent global protocols.However, the ever-increasing global quantities of hazardous waste, includingthe growing electronic waste issue, only exacerbate the disproportionaterisks faced by developing countries in current efforts of implementationand policy of global hazardous waste management. The persistence ofthese issues indicates that the transboundary movement of hazardouswaste and the international methods introduced to correct these problemsare ripe for reevaluation. Hopefully, by considering the loopholes in thecurrent international system and suggesting possible recommendationsfor future global agreements, this area of international law can be moreeffectively addressed

Measures of cognitive functioning in the 1994-2000 Second Longitudinal Study of Aging

OBJECTIVES: This report describes in detail the measures of cognitive functioning administered in the Second Longitudinal Study of Aging (LSOA II) and proposes a three-category cognitive impairment variable for analysts' use that is derived from the individual measures. METHODS: LSOA II self-respondents completed an 11-question cognitive functioning measure based on the Telephone Interview of Cognitive Status (TICS) instrument. Proxy respondents answered nine questions drawn from the short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Using cut points provided in the literature as a guide, a single three-level categorical measure of cognitive impairment was created: probable, possible, and no cognitive impairment. RESULTS: The cognitive functioning measures administered in LSOA II retain many of the favorable psychometric properties of the original TICS and IQCODE. The constructed cognitive impairment (CI) variable demonstrates good construct validity, and prevalence rates are generally consistent with those from other published studies. CONCLUSIONS: The categorical CI variable is easy to use and interpret and allows analysts the option of combining self- and proxy-respondent data in investigations of associations between CI and health outcomes, including continuing independence, progressive impairment, health care utilization patterns, and mortality.by Laura A. Pratt, Julie D. Weeks, and Margie R. Goulding.Title from title screen (viewed on Feb. 3, 2009)."July 7, 2008."Chiefly tables."CS118539.""T31484 (07-2008)."Mode of access: Internet from the CDC web site. Address as of 2/3/09: http://www.cdc.gov/nchs/data/nhsr/nhsr002.pdf; current access available via PURL

Depression and smoking in the U.S. household population aged 20 and over, 2005-2008

"About 7% of adults aged 20 and over had depression in 2005-2008, based on National Health and Nutrition Examination Survey (NHANES) data. Persons with depression were more likely to be current smokers than persons without depression. Almost one-half of adults under age 55 with current depression were current smokers, while less than one-quarter of people in this age group without depression were smokers. The proportion of adults who were current smokers tended to increase with an increase in depression severity. Even persons with mild depressive symptoms below the threshold for the diagnosis of depression were more likely to be smokers than people with no depressive symptoms. Adults with depression were more likely to smoke over a pack a day and smoke their first cigarette within 5 minutes of waking up than were adults without depression. Both of these are indicators of heavy smoking. Heavy smoking is highly correlated with inability to quit (6,7). Those with depression had a higher rate of smoking initiation (ever smoking) as well as a lower quit rate. They were also heavier smokers than persons without depression. Individuals with other mental illnesses have similar smoking patterns (8,9). Studies have shown that persons with depression and other mental illnesses smoke a disproportionate share of all the cigarettes consumed in the United States (8).The few studies that have examined ability to quit smoking in persons with depression have shown that with intensive treatment, persons with depression can quit smoking and remain abstinent. These intensive cessation services often use treatments that are also used for depression, including cognitive-behavioral therapy or antidepressant medications (5). Adults with depression and other mental illnesses are an important subgroup to target for tobacco cessation programs."Laura A. Pratt and Debra J. Brody.Caption title."April 2010."Includes bibliographical references (p. 7-[8])

Uptake of Direct Acting Antivirals for Hepatitis C Virus in a New England Medicaid Population, 2014-2017

Introduction Introduction of the direct acting antiviral (DAA) sofosbuvir (SOV) in 2013 offered significant improvement over previous options for hepatitis C virus (HCV) treatment. Initial uptake was low in Medicaid and other populations, perhaps in part due to high drug cost and prior authorization (PA) restrictions related to fibrosis stage, prescribing provider specialty, and sobriety. Both the subsequent introduction of ledipasvir/sofosbuvir (LDV/SOV), an all-oral regimen for most genotypes, and lifting of PA restrictions were expected to increase overall uptake, but little is known about recent prescribing patterns. We examined trends in DAA uptake in a Medicaid population and identified the effect of these two events on treatment initiation. Study Design An interrupted time series (ITS) design utilized enrollment, medical, and pharmacy claims from Medicaid enrollees in three New England states, 12/2013-12/2017. Trends in treatment uptake, defined as 1+ pharmacy claim for a DAA, were examined overall, by demographic characteristics, and prior to and after two time points: 10/2014 (LDV/SOV approval date) and 7/2016 (date PA restrictions affecting two-thirds of members were lifted). Chi-square evaluated demographic differences, segmented regression models examined trends. Study Population The population included members ages 18-64 years with HCV (2+ claims with ICD-9/10 code for HCV or 1+ claim for chronic HCV). Eligible individuals remained in the sample until treatment initiation or Medicaid disenrollment. Findings The analytic sample averaged 30,433 members with HCV per month, mean age 42.9 years, 60% male. In 2014 3.3% of eligible members initiated treatment, increasing to 7.7% in 2017 (p = Conclusion While initial uptake of DAAs was low in this multi-state Medicaid population, treatment initiation among eligible members increased through 2017. Introduction of new medications and lifting of PA restrictions led to an immediate increase in uptake followed by relatively flat monthly utilization. Policy implications Sharp increases in uptake after LDV/SOV introduction may indicate warehousing of members in anticipation of LDV/SOV approval; increases after PA restrictions were lifted indicates demand for treatment among those affected by restrictions. As a large percentage of the Medicaid HCV population remains untreated, planned provider interviews will help to understand barriers and facilitators of treatment for HCV

Effects of Feeding a Novel Alfalfa Leaf Pellet Product (ProLEAF MAX) and Alfalfa Stems (ProFiber Plus) on Performance in the Feedlot and Carcass Quality of Beef Steers

Alfalfa is often included in the diets of beef animals; however, the nutrient content of alfalfa is variable depending on the region in which it is grown, climate, soil, and many other factors. The leaf portion of alfalfa has a less variable nutrient composition than the stem portion of the plant. The variability that is present in the alfalfa plant can make the development of total mixed rations of consistent nutrient content difficult. As such, the purpose of this study was to determine how the inclusion of fractionated alfalfa leaves and alfalfa stems impacts performance and carcass quality of finishing beef steers. Twenty-four steers were allocated to one of three treatments: a control group fed a typical finishing diet with alfalfa as the forage (CON; n = 8), a typical diet that replaced alfalfa with fractionated alfalfa leaf pellets and alfalfa stems (ProLEAF MAX™ + ProFiber Plus™; PLM+PFP; n = 8), or a typical diet that replaced alfalfa with alfalfa stems (PFP; n = 8) for 63 days. Steers were fed individually once daily, weighed every 14 days and ultrasound images were collected every 28 days. At the end of the feeding trial, steers were harvested at a commercial facility and carcass data was obtained. Analysis of dry matter intake demonstrated that steers receiving the PFP and CON diets consumed more feed (P \u3c 0.001) than steers consuming the PLM+PFP diet. Steers receiving the PLM+PFP diet gained less (P \u3c 0.001) weight than the steers receiving the other two dietary treatments. No differences (P \u3e 0.10) in feed efficiency or carcass characteristics were observed. Steers receiving the PFP diet had improved (P = 0.016) cost of gain ($0.93 per kg) when compared with steers receiving PLM+PFP ($1.08 per kg) diet. Overall, our findings demonstrate that the inclusion of PFP in place of alfalfa hay in a finishing diet has the potential to improve cost of gain, without negatively affecting growth, performance, or carcass characteristics of finishing feedlot steers

Weight perceptions in older adults: findings from the English Longitudinal Study of Ageing

Objectives: To explore weight perceptions in a large, nationally-representative sample of older adults, and the extent to which they differ according to age and perceived health status. Setting: England. Participants: 5,240 men and women (≥50y) participating in the English Longitudinal Study of Ageing (2016/17). Main outcome measures: Weight perception was self-reported as too heavy, too light, or about right. Results: The majority of older adults endorsed a weight perception that matched their (objectively measured) BMI classification. However, one in ten (9.9%) older adults classified by BMI as normal-weight (18.5-24.9kg/m2) felt too light, with women at the upper end of the older age spectrum (OR=1.04, 95%CI=1.01-1.09), and men (OR=3.70, 95%CI=1.88-7.28) and women (OR=2.61, 95%CI=1.27-5.35) in poorer health more likely to do so. Almost half (44.8%) of older adults classified as overweight (25-29.9kg/m2) and one in ten (10.3%) classified as obese (≥30kg/m2) felt about the right weight, with this observed more frequently among men and women at the upper end of the older age spectrum (OR range 1.04-1.06). Conclusion: Older adults’ perceptions of their own weight generally correspond with traditional BMI cut-offs for normal-weight, overweight, and obesity. However, a substantial minority ‘underestimate’ their weight status, with those at the upper end of the age spectrum and those in poorer health more likely to do so

Multi-site investigation of strategies for the clinical implementation of CYP2D6 genotyping to guide drug prescribing

PURPOSE: A number of institutions have clinically implemented CYP2D6 genotyping to guide drug prescribing. We compared implementation strategies of early adopters of CYP2D6 testing, barriers faced by both early adopters and institutions in the process of implementing CYP2D6 testing, and approaches taken to overcome these barriers. METHODS: We surveyed eight early adopters of CYP2D6 genotyping and eight institutions in the process of adoption. Data were collected on testing approaches, return of results procedures, applications of genotype results, challenges faced, and lessons learned. RESULTS: Among early adopters, CYP2D6 testing was most commonly ordered to assist with opioid and antidepressant prescribing. Key differences among programs included test ordering and genotyping approaches, result reporting, and clinical decision support. However, all sites tested for copy-number variation and nine common variants, and reported results in the medical record. Most sites provided automatic consultation and had designated personnel to assist with genotype-informed therapy recommendations. Primary challenges were related to stakeholder support, CYP2D6 gene complexity, phenotype assignment, and sustainability. CONCLUSION: There are specific challenges unique to CYP2D6 testing given the complexity of the gene and its relevance to multiple medications. Consensus lessons learned may guide those interested in pursuing similar clinical pharmacogenetic programs

'From mosh pit to posh pit': Festival imagery in the context of the boutique festival

This paper addresses market-based cultural production in the context of the UK festival field, with a focus on the framing of the festival experience through anticipation. In particular, boutique festivals are discussed as examples of a contemporary cultural ?product category? which has emerged and proliferated in the last decade. Through discourse analysis of media representations of boutique festivals, we situate the boutique festival in a broader sociocultural discourse of agency and choice, which makes it meaningful and desirable, and outline the type of consumer it is meant to attract. For the contemporary consumer, the boutique festival is presented as an anticipated experience based on countercultural festival imagery, while simultaneously framing cultural participation through consumption. The paper contributes to a wider debate on the construction of the consumer in the cultural economy

Are Racial and Ethnic Minorities Less Willing to Participate in Health Research?

BACKGROUND: It is widely claimed that racial and ethnic minorities, especially in the US, are less willing than non-minority individuals to participate in health research. Yet, there is a paucity of empirical data to substantiate this claim. METHODS AND FINDINGS: We performed a comprehensive literature search to identify all published health research studies that report consent rates by race or ethnicity. We found 20 health research studies that reported consent rates by race or ethnicity. These 20 studies reported the enrollment decisions of over 70,000 individuals for a broad range of research, from interviews to drug treatment to surgical trials. Eighteen of the twenty studies were single-site studies conducted exclusively in the US or multi-site studies where the majority of sites (i.e., at least 2/3) were in the US. Of the remaining two studies, the Concorde study was conducted at 74 sites in the United Kingdom, Ireland, and France, while the Delta study was conducted at 152 sites in Europe and 23 sites in Australia and New Zealand. For the three interview or non-intervention studies, African-Americans had a nonsignificantly lower overall consent rate than non-Hispanic whites (82.2% versus 83.5%; odds ratio [OR] = 0.92; 95% confidence interval [CI] 0.84–1.02). For these same three studies, Hispanics had a nonsignificantly higher overall consent rate than non-Hispanic whites (86.1% versus 83.5%; OR = 1.37; 95% CI 0.94–1.98). For the ten clinical intervention studies, African-Americans' overall consent rate was nonsignificantly higher than that of non-Hispanic whites (45.3% versus 41.8%; OR = 1.06; 95% CI 0.78–1.45). For these same ten studies, Hispanics had a statistically significant higher overall consent rate than non-Hispanic whites (55.9% versus 41.8%; OR = 1.33; 95% CI 1.08–1.65). For the seven surgery trials, which report all minority groups together, minorities as a group had a nonsignificantly higher overall consent rate than non-Hispanic whites (65.8% versus 47.8%; OR = 1.26; 95% CI 0.89–1.77). Given the preponderance of US sites, the vast majority of these individuals from minority groups were African-Americans or Hispanics from the US. CONCLUSIONS: We found very small differences in the willingness of minorities, most of whom were African-Americans and Hispanics in the US, to participate in health research compared to non-Hispanic whites. These findings, based on the research enrollment decisions of over 70,000 individuals, the vast majority from the US, suggest that racial and ethnic minorities in the US are as willing as non-Hispanic whites to participate in health research. Hence, efforts to increase minority participation in health research should focus on ensuring access to health research for all groups, rather than changing minority attitudes

RNA-seq of newly diagnosed patients in the PADIMAC study leads to a bortezomib/lenalidomide decision signature.

Improving outcomes in multiple myeloma will involve not only development of new therapies but also better use of existing treatments. We performed RNA sequencing on samples from newly diagnosed patients enrolled in the phase 2 PADIMAC (Bortezomib, Adriamycin, and Dexamethasone Therapy for Previously Untreated Patients with Multiple Myeloma: Impact of Minimal Residual Disease in Patients with Deferred ASCT) study. Using synthetic annealing and the large margin nearest neighbor algorithm, we developed and trained a 7-gene signature to predict treatment outcome. We tested the signature in independent cohorts treated with bortezomib- and lenalidomide-based therapies. The signature was capable of distinguishing which patients would respond better to which regimen. In the CoMMpass data set, patients who were treated correctly according to the signature had a better progression-free survival (median, 20.1 months vs not reached; hazard ratio [HR], 0.40; confidence interval [CI], 0.23-0.72; P = .0012) and overall survival (median, 30.7 months vs not reached; HR, 0.41; CI, 0.21-0.80; P = .0049) than those who were not. Indeed, the outcome for these correctly treated patients was noninferior to that for those treated with combined bortezomib, lenalidomide, and dexamethasone, arguably the standard of care in the United States but not widely available elsewhere. The small size of the signature will facilitate clinical translation, thus enabling more targeted drug regimens to be delivered in myeloma.Wellcome Trust, Bloodwise, Cancer Research UK