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The medical savings account model of health insurance in the United States combines a high-deductible health insurance plan‹ A high-deductible health plan is an insurance plan under which the beneficiary is responsible for a substantial amount of expense (the deductible) before the insurer begins paying benefits. US federal law as of 2015 requires a deductible of at least US$1300 for single coverage and US$2600 for family coverage for health saving account-qualified high-deductible health plans ().› with a dedicated savings account used to pay expenses incurred below the deductible. Savings in the plan can roll over from one year to the next and, after some predefined period during which they are dedicated to health spending, can be used for non-health-related expenses.‹ Use of savings for non-health expenses before this predefined period (age 65 under current law), incurs a tax and 20% penalty.› In principle, this model combines the incentives for frugal use of health services that exist in high-deductible health insurance with assurance that the funds required in the event of true medical need will be available.
Radiocarbon (14C) ages cannot provide absolutely dated chronologies for archaeological or paleoenvironmental studies directly but must be converted to calendar age equivalents using a calibration curve compensating for fluctuations in atmospheric 14C concentration. Although calibration curves are constructed from independently dated archives, they invariably require revision as new data become available and our understanding of the Earth system improves. In this volume the international 14C calibration curves for both the Northern and Southern Hemispheres, as well as for the ocean surface layer, have been updated to include a wealth of new data and extended to 55,000 cal BP. Based on tree rings, IntCal20 now extends as a fully atmospheric record to ca. 13,900 cal BP. For the older part of the timescale, IntCal20 comprises statistically integrated evidence from floating tree-ring chronologies, lacustrine and marine sediments, speleothems, and corals. We utilized improved evaluation of the timescales and location variable 14C offsets from the atmosphere (reservoir age, dead carbon fraction) for each dataset. New statistical methods have refined the structure of the calibration curves while maintaining a robust treatment of uncertainties in the 14C ages, the calendar ages and other corrections. The inclusion of modeled marine reservoir ages derived from a three-dimensional ocean circulation model has allowed us to apply more appropriate reservoir corrections to the marine 14C data rather than the previous use of constant regional offsets from the atmosphere. Here we provide an overview of the new and revised datasets and the associated methods used for the construction of the IntCal20 curve and explore potential regional offsets for tree-ring data. We discuss the main differences with respect to the previous calibration curve, IntCal13, and some of the implications for archaeology and geosciences ranging from the recent past to the time of the extinction of the Neanderthals.
Although neuroimaging studies suggest brain regional abnormalities in depressive disorders, it remains unclear whether abnormalities are present at illness onset or reflect disease progression.
We hypothesized that cerebral variations were present in adolescents with subthreshold depression known to be at high risk for later full-blown depression.
We examined brain structural and diffusion-weighted magnetic resonance images of adolescents with subthreshold depression.
The participants were extracted from the European IMAGEN study cohort of healthy adolescents recruited at age 14. Subthreshold depression was defined as a distinct period of abnormally depressed or irritable mood, or loss of interest, plus two or more depressive symptoms but without diagnosis of Major Depressive Episode. Comparisons were performed between adolescents meeting these criteria and control adolescents within the T1-weighted imaging modality (118 and 475 adolescents respectively) using voxel-based morphometry and the diffusion tensor imaging modality (89 ad 422 adolescents respectively) using tract-based spatial statistics. Whole brain analyses were performed with a statistical threshold set to p< 0.05 corrected for multiple comparisons.
Compared with controls, adolescents with subthreshold depression had smaller gray matter volume in caudate nuclei, medial frontal and cingulate cortices; smaller white matter volume in anterior limb of internal capsules, left forceps minor and right cingulum; and lower fractional anisotropy and higher radial diffusivity in the genu of corpus callosum.
The findings suggest that adolescents with subthreshold depression have volumetric and microstructural gray and white matter changes in the emotion regulation frontal-striatal-limbic network.
Brine beneath Taylor Glacier has been proposed to enter the proglacial west lobe of Lake Bonney (WLB) as well as from Blood Falls, a surface discharge point at the Taylor Glacier terminus. The brine strongly influences the geochemistry of the water column of WLB. Year-round measurements from this study are the first to definitively identify brine intrusions from a subglacial entry point into WLB. Furthermore, we excluded input from Blood Falls by focusing on winter dynamics when the absence of an open water moat prevents surface brine entry. Due to the extremely high salinities below the chemocline in WLB, density stratification is dominated by salinity, and temperature can be used as a passive tracer. Cold brine intrusions enter WLB at the glacier face and intrude into the water column at the depth of neutral buoyancy, where they can be identified by anomalously cold temperatures at that depth. High-resolution measurements also reveal under-ice internal waves associated with katabatic wind events, a novel finding that challenges long-held assumptions about the stability of the WLB water column.
Optimism is associated with reduced cardiovascular disease risk; however, few prospective studies have considered optimism in relation to hypertension risk specifically. We investigated whether optimism was associated with a lower risk of developing hypertension in U.S. service members, who are more likely to develop high blood pressure early in life. We also evaluated race/ethnicity, sex and age as potential effect modifiers of these associations.
Participants were 103 486 hypertension-free U.S. Army active-duty soldiers (mean age 28.96 years, 61.76% White, 20.04% Black, 11.01% Hispanic, 4.09% Asian, and 3.10% others). We assessed optimism, sociodemographic characteristics, health conditions, health behaviours and depression status at baseline (2009–2010) via self-report and administrative records, and ascertained incident hypertension over follow-up (2010–2014) from electronic health records and health assessments. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and adjusted models for a broad range of relevant covariates.
Over a mean follow-up of 3.51 years, 15 052 incident hypertension cases occurred. The highest v. lowest optimism levels were associated with a 22% reduced risk of developing hypertension, after adjusting for all covariates including baseline blood pressure (HR = 0.78; 95% CI = 0.74–0.83). The difference in hypertension risk between the highest v. lowest optimism was also maintained when we excluded soldiers with hypertension in the first two years of follow-up and, separately, when we excluded soldiers with prehypertension at baseline. A dose–response relationship was evident with higher optimism associated with a lower relative risk (p < 0.001). Higher optimism was consistently associated with a lower risk of developing hypertension across sex, age and most race/ethnicity categories.
In a diverse cohort of initially healthy male and female service members particularly vulnerable to developing hypertension, higher optimism levels were associated with reduced hypertension risk independently of sociodemographic and health factors, a particularly notable finding given the young and healthy population. Results suggest optimism is a health asset and a potential target for public health interventions.
Porphyrinic compounds are of increasing interest to the materials science community, yet little attention has been paid to crystallographically controlled voids and channels in these materials. We have conducted an initial survey of the voids and channels in a random subset of 1000 porphyrinic compounds with known crystal structures. From calculations using a rolling-probe subroutine, we have found that about 5% of these compounds have line-of-sight channels, which differ in their topology depending on the crystallography. A small but significant number of porphyrinic compounds have calculated void contents of >25 volume %. We discuss in detail the void and channel characteristics, including pore-size distribution, of four representative compounds, with technological implications.
Mental disorders cause high burden in adolescents, but adolescents often underutilise potentially beneficial treatments. Perceived need for and barriers to care may influence whether adolescents utilise services and which treatments they receive. Adolescents and parents are stakeholders in adolescent mental health care, but their perceptions regarding need for and barriers to care might differ. Understanding patterns of adolescent-parent agreement might help identify gaps in adolescent mental health care.
A nationally representative sample of Australian adolescents aged 13–17 and their parents (N = 2310), recruited between 2013–2014, were asked about perceived need for four types of adolescent mental health care (counselling, medication, information and skill training) and barriers to care. Perceived need was categorised as fully met, partially met, unmet, or no need. Cohen's kappa was used to assess adolescent-parent agreement. Multinomial logistic regressions were used to model variables associated with patterns of agreement.
Almost half (46.5% (s.e. = 1.21)) of either adolescents or parents reported a perceived need for any type of care. For both groups, perceived need was greatest for counselling and lowest for medication. Identified needs were fully met for a third of adolescents. Adolescent-parent agreement on perceived need was fair (kappa = 0.25 (s.e. = 0.01)), but poor regarding the extent to which needs were met (kappa = −0.10 (s.e. = 0.02)). The lack of parental knowledge about adolescents' feelings was positively associated with adolescent-parent agreement that needs were partially met or unmet and disagreement about perceived need, compared to agreement that needs were fully met (relative risk ratio (RRR) = 1.91 (95% CI = 1.19–3.04) to RRR = 4.69 (95% CI = 2.38–9.28)). Having a probable disorder was positively associated with adolescent-parent agreement that needs were partially met or unmet (RRR = 2.86 (95% CI = 1.46–5.61)), and negatively with adolescent-parent disagreement on perceived need (RRR = 0.50 (95% CI = 0.30–0.82)). Adolescents reported most frequently attitudinal barriers to care (e.g. self-reliance: 55.1% (s.e. = 2.39)); parents most frequently reported that their child refused help (38.7% (s.e. = 2.69)). Adolescent-parent agreement was poor for attitudinal (kappa = −0.03 (s.e. = 0.06)) and slight for structural barriers (kappa = 0.02 (s.e. = 0.09)).
There are gaps in the extent to which adolescent mental health care is meeting the needs of adolescents and their parents. It seems important to align adolescents' and parents' needs at the beginning and throughout treatment and to improve communication between adolescents and their parents. Both might provide opportunities to increase the likelihood that needs will be fully met. Campaigns directed towards adolescents and parents need to address different barriers to care. For adolescents, attitudinal barriers such as stigma and mental health literacy require attention.
Experiments were performed within Sandia National Labs’ Multiphase Shock Tube to measure and quantify the shock-induced dispersal of a shock/dense particle curtain interaction. Following interaction with a planar travelling shock wave, schlieren imaging at 75 kHz was used to track the upstream and downstream edges of the curtain. Data were obtained for two particle diameter ranges (
) across Mach numbers ranging from 1.24 to 2.02. Using these data, along with data compiled from the literature, the dispersion of a dense curtain was studied for multiple Mach numbers (1.2–2.6), particle sizes (
) and volume fractions (9–32 %). Data were non-dimensionalized according to two different scaling methods found within the literature, with time scales defined based on either particle propagation time or pressure ratio across a reflected shock. The data show that spreading of the particle curtain is a function of the volume fraction, with the effectiveness of each time scale based on the proximity of a given curtain’s volume fraction to the dilute mixture regime. It is seen that volume fraction corrections applied to a traditional particle propagation time scale result in the best collapse of the data between the two time scales tested here. In addition, a constant-thickness regime has been identified, which has not been noted within previous literature.
Research was conducted from 2013 to 2015 across three sites in Mississippi to evaluate corn response to sublethal paraquat or fomesafen (105 and 35 g ai ha−1, respectively) applied PRE, or to corn at the V1, V3, V5, V7, or V9 growth stages. Fomesafen injury to corn at three d after treatment (DAT) ranged from 0% to 38%, and declined over time. Compared with the nontreated control (NTC), corn height 14 DAT was reduced approximately 15% due to fomesafen exposure at V5 or V7. Exposure at V1 or V7 resulted in 1,220 and 1,110 kg ha−1 yield losses, respectively, compared with the NTC, but yield losses were not observed at any other growth stage. Fomesafen exposure at any growth stage did not affect corn ear length or number of kernel rows relative to the NTC. Paraquat injury to corn ranged from 26% to 65%, depending on growth stage and evaluation interval. Corn exposure to paraquat at V3 or V5 consistently caused greater injury across evaluation intervals, compared with other growth stages. POST timings of paraquat exposure resulted in corn height reductions of 13% to 50%, except at V7, which was most likely due to rapid internode elongation at that stage. Likewise, yield loss occurred after all exposure times of paraquat except PRE, compared with the NTC. Corn yield was reduced 1,740 to 5,120 kg ha−1 compared with the NTC, generally worsening as exposure time was delayed. Paraquat exposure did not reduce corn ear length, compared with the NTC, at any growth stage. However, paraquat exposure at V3 or V5 was associated with reduction of kernel rows by 1.1 and 1.7, respectively, relative to the NTC. Paraquat and fomesafen applications near corn should be avoided if conditions are conducive for off-target movement, because significant injury and yield loss can result.
In recent years, the use of cover crops has increased in U.S. crop production systems. An important aspect of successful cover crop establishment is the preceding crop and herbicide program, because some herbicides have the potential to persist in the soil for several months. Few studies have been conducted to evaluate the sensitivity of cover crops to common residual herbicides used in soybean production. The same field experiment was conducted in 2016 in Arkansas, Illinois, Indiana, Missouri, Tennessee, and Wisconsin, and repeated in Arkansas, Illinois, Indiana, Mississippi, and Missouri in 2017 to evaluate the potential of residual soybean herbicides to carryover and reduce cover crop establishment. Herbicides applied during the soybean growing season included acetochlor; acetochlor plus fomesafen; chlorimuron plus thifensulfuron; fomesafen; fomesafen plus S-metolachlor followed by acetochlor; imazethapyr; pyroxasulfone; S-metolachlor; S-metolachlor plus fomesafen; sulfentrazone plus S-metolachlor; sulfentrazone plus S-metolachlor followed by fomesafen plus S-metolachlor; and sulfentrazone plus S-metolachlor followed by fomesafen plus S-metolachlor followed by acetochlor. Across all herbicide treatments, the sensitivity of cover crops to herbicide residues in the fall, from greatest to least, was forage radish = turnip > annual ryegrass = winter oat = triticale > cereal rye = Austrian winter pea = hairy vetch = wheat > crimson clover. Fomesafen (applied 21 and 42 days after planting [(DAP]); chlorimuron plus thifensulfuron and pyroxasulfone applied 42 DAP; sulfentrazone plus S-metolachlor followed by fomesafen plus S-metolachlor; and sulfentrazone plus S-metolachlor followed by fomesafen plus S-metolachlor followed by acetochlor caused the highest visual ground cover reduction to cover crop species at the fall rating. Study results indicate cover crops are most at risk when following herbicide applications in soybean containing certain active ingredients such as fomesafen, but overall there is a fairly low risk of cover crop injury from residual soybean herbicides applied in the previous soybean crop.
Salmonella enterica serovar Wangata (S. Wangata) is an important cause of endemic salmonellosis in Australia, with human infections occurring from undefined sources. This investigation sought to examine possible environmental and zoonotic sources for human infections with S. Wangata in north-eastern New South Wales (NSW), Australia. The investigation adopted a One Health approach and was comprised of three complimentary components: a case–control study examining human risk factors; environmental and animal sampling; and genomic analysis of human, animal and environmental isolates. Forty-eight human S. Wangata cases were interviewed during a 6-month period from November 2016 to April 2017, together with 55 Salmonella Typhimurium (S. Typhimurium) controls and 130 neighbourhood controls. Indirect contact with bats/flying foxes (S. Typhimurium controls (adjusted odds ratio (aOR) 2.63, 95% confidence interval (CI) 1.06–6.48)) (neighbourhood controls (aOR 8.33, 95% CI 2.58–26.83)), wild frogs (aOR 3.65, 95% CI 1.32–10.07) and wild birds (aOR 6.93, 95% CI 2.29–21.00) were statistically associated with illness in multivariable analyses. S. Wangata was detected in dog faeces, wildlife scats and a compost specimen collected from the outdoor environments of cases’ residences. In addition, S. Wangata was detected in the faeces of wild birds and sea turtles in the investigation area. Genomic analysis revealed that S. Wangata isolates were relatively clonal. Our findings suggest that S. Wangata is present in the environment and may have a reservoir in wildlife populations in north-eastern NSW. Further investigation is required to better understand the occurrence of Salmonella in wildlife groups and to identify possible transmission pathways for human infections.
Hereditary hemorrhagic telangiectasia (HHT) is a disease of abnormal vasculature where patients are predisposed to strokes of multiple etiologies. We assessed yearly stroke incidence among Albertans with HHT and compared with the general population. Given the tendency for stroke in HHT patients, we expected HHT patients to have higher stroke incidence, in particular at younger ages.
Population-based administrative health data on inpatient and ambulatory admissions were extracted over a 16-year period using International Classification of Diseases (ICD)-9 and ICD-10, Canada codes. We analyzed overall occurrence of strokes in Alberta by age, gender, stroke subtype, and diagnosis of HHT.
The age-standardized incidence rate of stroke in HHT was 450 per 100,000 compared with 260 per 100,000 in the general population with a rate ratio of 1.73 (95% confidence interval (CI) [1.046-2.842]). This study found a higher HHT prevalence in Alberta (1 in 3800) compared to the world average of 1 in 5000. Women were also more likely to be diagnosed with HHT, with a 3.25:1 female gender preponderance in the yearly incidence.
This study not only shows that HHT patients are at higher risk of having a stroke but also quantifies that risk using an age-adjusted metric in Alberta. This province has a higher than expected disease burden of HHT, with the majority of cases affecting women. Our study found that acute ischemic strokes and transient ischemic attacks are far more common than hemorrhage in HHT. As HHT is a rare, multi-system, chronic disease, these patients should be referred to an HHT Centre of Excellence.
Understanding control of glyphosate-resistant (GR) Palmer amaranth with multiple herbicide sites of action, including synthetic auxins, is crucial for growers to minimize GR Palmer amaranth interference with crops. Field studies in 2013 and 2014 and a greenhouse study in 2014 were conducted in Stoneville, MS, to evaluate POST control of GR Palmer amaranth with 2,4-D alone and in mixtures with glyphosate and/or glufosinate. In the greenhouse study, control of 5- and 10-cm GR Palmer amaranth was 87% with 2,4-D at 0.84 kg ae ha−1. Dry weight reduction of GR Palmer amaranth was ≥81% with 2,4-D at 0.84 kg ha−1. In field studies, mixtures of glufosinate at 0.59 kg ai ha−1 and 2,4-D at 0.56 or 1.12 kg ae ha−1 controlled 5- to 10-cm GR Palmer amaranth 87% at 28 d after treatment (DAT). Averaged across glyphosate treatments, glufosinate applied alone applied to 5- to 10-cm GR Palmer amaranth reduced dry weight at 28 DAT to 20 g m−2 from 82 g m−2 and was comparable with that following 2,4-D applied alone at 1.12 kg ae ha−1 and mixtures of glufosinate plus 2,4-D at 0.56 and 1.12 kg ae ha−1. Mixtures of 2,4-D plus glufosinate provided ≥92% control of 15- to 20-cm GR Palmer amaranth at 28 DAT. When applied to 15- to 20-cm plants, mixtures of 2,4-D plus glufosinate reduced GR Palmer amaranth density to ≤5 plants m−2 compared with 65 plants m−2 where no 2,4-D or glufosinate was applied. Glufosinate and 2,4-D are viable control options for 5- to 10-cm or 15- to 20-cm GR Palmer amaranth. However, 2,4-D did not improve GR Palmer amaranth control when added to any herbicide mixture except glyphosate and glufosinate applied to 15- to 20-cm plants at the 28 DAT evaluation.
Prenatal adversity shapes child neurodevelopment and risk for later mental health problems. The quality of the early care environment can buffer some of the negative effects of prenatal adversity on child development. Retrospective studies, in adult samples, highlight epigenetic modifications as sentinel markers of the quality of the early care environment; however, comparable data from pediatric cohorts are lacking. Participants were drawn from the Maternal Adversity Vulnerability and Neurodevelopment (MAVAN) study, a longitudinal cohort with measures of infant attachment, infant development, and child mental health. Children provided buccal epithelial samples (mean age = 6.99, SD = 1.33 years, n = 226), which were used for analyses of genome-wide DNA methylation and genetic variation. We used a series of linear models to describe the association between infant attachment and (a) measures of child outcome and (b) DNA methylation across the genome. Paired genetic data was used to determine the genetic contribution to DNA methylation at attachment-associated sites. Infant attachment style was associated with infant cognitive development (Mental Development Index) and behavior (Behavior Rating Scale) assessed with the Bayley Scales of Infant Development at 36 months. Infant attachment style moderated the effects of prenatal adversity on Behavior Rating Scale scores at 36 months. Infant attachment was also significantly associated with a principal component that accounted for 11.9% of the variation in genome-wide DNA methylation. These effects were most apparent when comparing children with a secure versus a disorganized attachment style and most pronounced in females. The availability of paired genetic data revealed that DNA methylation at approximately half of all infant attachment-associated sites was best explained by considering both infant attachment and child genetic variation. This study provides further evidence that infant attachment can buffer some of the negative effects of early adversity on measures of infant behavior. We also highlight the interplay between infant attachment and child genotype in shaping variation in DNA methylation. Such findings provide preliminary evidence for a molecular signature of infant attachment and may help inform attachment-focused early intervention programs.