Sexually Transmitted Diseases: Trends in Maine and the US

Sexually transmitted diseases (STDs) are a significant public health concern and can cause lasting health problems if left untreated. Recognizing changes in STD prevalence is important to ensuring that appropriate resources are allocated for screening and prevention efforts. This study looked at trends in reported STD rates in Maine and the US over a 10 year period (2007-2017) that has seen rising prevalence nationwide. Methods: Data from Maine and national data on the rates of reported cases of chlamydia, gonorrhea, and syphilis were analyzed and compared. Percent changes were calculated for each STD over the time period. Data came from the Centers for Disease Control and Prevention STD Surveillance reports, which present data on nationally notifiable STDs. Results: Maine and the US saw increases in reported cases per 100,000 population of all three STDs from 2007 to 2017. In Maine, cases of chlamydia rose from 192.3 to 342.1 (+77.9%); gonorrhea from 8.9 to 46.6 (+423.6%); and primary and secondary syphilis from 0.7 to 4.9 (+600.0%). Nationally, chlamydia increased from 370.2 to 528.8 (+42.8%); gonorrhea from 118.9 to 171.9 (+44.6%); and syphilis from 3.8 to 9.5 (+150.0%). Conclusion: Reported STD rates in Maine are lower than national averages, but percent increases in Maine have outpaced national trends, underscoring the need for adequate screening and education. Maine should make every effort to fund these services and strengthen prevention efforts among vulnerable populations

Expanding the Scope of the Federal Arbitration Act: An Examination of the Seventh Circuit\u27s Opinion in Green v. U.S. Cash Advance, Illinois, LLC

The Roberts Court\u27s expansive interpretation of the Federal Arbitration Act (FAA) has ushered in a new era of pro-arbitration jurisprudence, allowing lower courts to categorically enforce arbitration agreements. Underlying this zealous application is Section 2 of the FAA, which states that arbitration agreements are valid, irrevocable, and enforceable, save upon such grounds as exist at law or in equity for the revocation of a contract. In Green v. U.S. Cash Advance, Illinois, LLC, the Seventh Circuit enforced an arbitration agreement between a consumer and payday lender, despite the fact that the named arbitration forum had been unavailable since the inception of the agreement. In reaching their conclusion, the majority rejected the integral part test, used by the Third, Fifth and Eleventh Circuits, which bars the judicial appointment of a substitute arbitrator when the named arbitration forum was an integral part of the agreement. The dissent also rejected this test but passionately argued that the arbitration clause was unenforceable based on principles of contract law. This Comment chronicles the passage of the FAA and the Supreme Court\u27s recent arbitration decisions. It discusses the Green case at the district court and appellate levels, and it addresses other circuit court decisions in similar fact situations. This Comment argues that the Seventh Circuit majority made the wrong decision in Green. It also argues that the majority and dissent wrongly rejected the integral part test implemented by other circuits when determining whether Section 5 of the FAA can be invoked

A Century Later: Rural Public Health\u27s Enduring Challenges and Opportunities.

The US public health community has demonstrated increasing awareness of rural health disparities in the past several years. Although current interest is high, the topic is not new, and some of the earliest public health literature includes reports on infectious disease and sanitation in rural places. Continuing through the first third of the 20th century, dozens of articles documented rural disparities in infant and maternal mortality, sanitation and water safety, health care access, and among Black, Indigenous, and People of Color communities. Current rural research reveals similar challenges, and strategies suggested for addressing rural-urban health disparities 100 years ago resonate today. This article examines rural public health literature from a century ago and its connections to contemporary rural health disparities. We describe parallels between current and historical rural public health challenges and discuss how strategies proposed in the early 20th century may inform current policy and practice. As we explore the new frontier of rural public health, it is critical to consider enduring rural challenges and how to ensure that proposed solutions translate into actual health improvements

Sinapate ester metabolism in Brassica and Arabidopsis

The accumulation of sinapate esters (SE) in organ- and tissue-specific patterns is considered a hallmark of Brassicaceae plants. Seeds of Arabidopsis and Brassica napus contain sinapine (sinapoylcholine) as major phenolic compound whereas the UV-shielding sinapoylmalate accumulates in epidermal cells. The accumulation kinetics of SE is based on transcriptional regulation of the enzymes UDP glucose:sinapate glucosyltransferase (SGT), sinapoylglucose:choline sinapoyltransferase (SCT), sinapoylglucose:malate sinapoyltransferase (SMT) and sinapine esterase (SCE). Enzymatic SGT activity is mediated by UDP glucosyltransferases of the UGT84A clade. In B. napus, the enzyme UGT84A9 is limiting for SE biosynthesis during seed development. Arabidopsis employs, besides the SGT homolog UGT84A2, three other hydroxycinnamate UGTs (UGT84A1, -A3, -A4) without pronounced specificity. In the allotetraploid genome of B. napus, UGT84A9 is represented by four loci of which UGT84A9a and -b are involved in SE biosynthesis. The sinapoyltransferases SMT and SCT were derived from hydrolases of the serine carboxypeptidase type (SCPs). Arabidopsis SMT adopted the functional elements of SCPs - catalytic triad, oxyanion hole and hydrogen bond network for substrate recognition - to catalyze glucose ester-dependent acyltransfer reactions. Sinapine esterase evolved by recruitment of lipase-like ancestors. To decrease the amount of antinutritive SE compounds in seeds of B. napus, targeted metabolic engineering was proven as the most efficient strategy. Silencing of UGT84A9 suppresses the biosyntheses of sinapine and related SE. Seed-specific overexpression of sinapine esterase BnSCE3 prevents sinapine accumulation by synchronization of biosynthesis and degradation. Combination of biosynthesis suppression with induced degradation of accumulating SE bears the potential to generate low sinapine B. napus lines

When weak modularity is robust enough?

In this paper, I suggest that the notion of module explicitly defined by Peter Carruthers in The Architecture of The Mind (Carruthers 2006) is not really In use in the book. Instead, a more robust notion seems to be actually in play. The more robust notion, albeit implicitly assumed, seems to be far more useful for making claims about the modularity of mind. Otherwise, the claims would become trivial. This robust notion will be reconstructed and improved upon by putting it into a more general framework of mental architecture. I defend the view that modules are the outcome of structural rather than functional decomposition and that they should be conceived as near decomposable systems.En este trabajo, sugiero que la noción de módulo explícitamente definida por Peter Carruthers en La Arquitectura de la Mente (Carruthers 2006) no se usa realmente en el libro. En su lugar parece adoptarse una noción más robusta. Esta noción más robusta, aunque asumida implícitamente, resulta mucho más útil para poder formular afirmaciones sobre la modularidad de la mente. De otro modo, las firmaciones resultarían triviales. Esta noción robusta será reconstruida y mejorada por medio de su ubicación en un marco más general de la arquitectura mental. Defiendo la idea de que los módulos son el resultado de una descomposición estructural y no funcional, y que deben ser concebidos como sistemas casi descomponibles

Юридический статус Суверенного Мальтийского ордена – ключевые вопросы, связанные с функциональной субъектностью

Zagadnienia związane z podmiotowością międzynarodową należą do najżywiej dyskutowanych w doktrynie. O ile w systemach prawnych poszczególnych państw kwestia podmiotowości rozstrzygana jest przez ustawodawców, o tyle w prawie międzynarodowym brakuje analogicznej normy traktatowej. Wobec tego pojęcie i rozumienie podmiotowości jest zagadnieniem rozpatrywanym przede wszystkim przez przedstawicieli doktryny prawa międzynarodowego. Przyjmuje się zatem, że podmiot prawa międzynarodowego musi legitymować się zdolnością prawną, czyli inaczej zdolnością do posiadania praw i obowiązków, oraz zdolnością do czynności prawnych – możliwością bezpośredniego zaciągania praw i obowiązków, co związane jest ze zdolnością występowania w stosunkach międzynarodowych. W doktrynie przyjmuje się, że specyficznym podmiotem prawa międzynarodowego jest Suwerenny Zakon Kawalerów Maltańskich. Celem niniejszej publikacji jest omówienie zagadnienia podmiotowości prawnomiędzynarodowej Zakonu Kawalerów Maltańskich. Wobec tego autor publikacji dokonuje analizy podmiotowości jednostki pod kątem jej zdolności do działania w sferze prawa międzynarodowego, tj. zdolności utrzymywania stosunków dyplomatycznych i konsularnych, uczestniczenia w organizacjach międzynarodowych, zawierania umów, występowania z roszczeniami i ich dochodzeniem poprzez odwołanie się do pokojowych sposobów załatwiania sporów międzynarodowych, ponoszenia odpowiedzialności międzynarodowej, posiadania własnego obywatelstwa oraz terytorium. Weryfikacja założeń nastąpiła poprzez dwa podejścia metodologiczne: dogmatyczno-prawne oraz formalno-dogmatyczne.Issues related to international subjectivity are among the most widely discussed in the doctrine. While the issue of subjectivity is resolved by legislators in the legal systems of individual states, there is no similar treaty norm in international law. Hence, the concept and understanding of subjectivity is an issue considered primarily by representatives of the doctrine of international law. Therefore, it was stated that the subject of international law should have legal capacity, in other words, the ability to have rights and obligations and the ability to perform legal acts – the possibility of direct contracting of rights and obligations, which is associated with the ability to appear in international relations. The doctrine assumes that the specific subject of international law is the Sovereign Order of the Knights of Malta. Thus, the author of the publication analyses the entity’s subjectivity in terms of its ability to act in the field of international law, i.e. the ability to maintain diplomatic and consular relations, participate in international organisations, conclude agreements, submit claims and pursue them by referring to peaceful ways of settling international disputes, taking international responsibility, owning citizenship and territory

Rural Working-Age Adults Report More Cost Barriers to Health Care

Using the 2019-2020 National Health Insurance Survey, researchers at the Maine Rural Health Research Center examined rural-urban differences in affordability of care and cost-saving strategies among working-age adults. Rural adults (18-64) were more likely than their urban counterparts to report problems paying, or being unable to pay, their medical bills. They were also more likely to delay or go without needed care because of the cost. Compared with urban adults, those in rural areas were more likely to engage in prescription drug cost-saving measures such as skipping doses, delaying refills, or taking less medication than prescribed. For all affordability measures, adjusted analyses showed that rural adults who were uninsured, lower income, or in fair or poor health were more likely to experience affordability problems compared with other rural adults. Given that individuals in fair or poor health are more likely to report affordability problems, these barriers may also translate into worse outcomes by exacerbating poor health. More research is needed to understand how affordability problems may be affecting the longer-term health of rural adults and what policy strategies may be optimal for addressing these concerns

Use of Electronic Health Records to Manage Tobacco Screening and Treatment in Rural Primary Care

Researchers at the Maine Rural Health Research Center, University of Southern Maine examined whether the use of electronic health records by rural primary care physicians facilitates their use of best practices in addressing tobacco dependence. The study used the National Ambulatory Medicare Care Survey (2012-2015) to explore how rurality and use of tobacco-related electronic health record functions were related to smoking status documentation and cessation treatment at adult primary care visits. Rural-urban comparisons were also examined. The authors conclude that rural primary care physicians were at least as successful as their urban counterparts in leveraging electronic health records to enhance tobacco-related services, and that opportunities exist to expand cessation treatment in rural primary care. FMI: Jean Talbot, [email protected]

Ambulance Deserts: Geographic Disparities in the Provision of Ambulance Services [Chartbook]

This chartbook begins with a broad overview of ambulance services including common types of organizational structure(s) and workforce and reimbursement issues. The methods section provides our definition of ambulance deserts and describes how ambulance deserts are illustrated in the national and state maps. The results section begins with an overall description of the prevalence of ambulance deserts in rural and urban counties across the 41 states for which data were available at the time, and the variation in the percent of people living in ambulance deserts across the four census regions. States are ranked in terms of the percent of counties in each state with ambulance deserts, the number of ambulance stations per 100,000 residents, and the number and percent of people living in ambulance deserts. National level maps illustrating the number and percent of people living in ambulance deserts at the county level are presented overall, as well as by rural and urban counties. State level maps illustrating the location of ambulance stations, health care facilities, and ambulance deserts at the census block level are presented in Appendix A. Finally, the discussion and conclusions section summarizes the findings and sets the stage for future analyses of populations most at risk for adverse health outcomes associated with poor access to ambulance services. For more information, please contact Dr. Yvonne Jonk, [email protected]