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To understand the different Na menu labelling approaches that have been considered by state and local policymakers in the USA and to summarise the evidence on the relationship between Na menu labelling and Na content of menu items offered by restaurants or purchased by consumers.
Proposed and enacted Na menu labelling laws at the state and local levels were reviewed using legal databases and an online search, and a narrative review of peer-reviewed literature was conducted on the relationship between Na menu labelling and Na content of menu items offered by restaurants or purchased by consumers.
Local and state jurisdictions in the USA
Between 2000 and 2020, thirty-eight laws – eleven at the local level and twenty-seven at the state level – were proposed to require Na labelling of restaurant menu items. By 2020, eight laws were enacted requiring chain restaurants to label the Na content of menu items. Five studies were identified that evaluated the impact of Na menu labelling on Na content of menu items offered by restaurants or purchased by consumers in the USA. The studies had mixed results: two studies showed a statistically significant association between Na menu labelling and reduced Na content of menu items; three showed no effects.
Data suggest that Na menu labelling may reduce Na in restaurant menu items, but further rigorous research evaluating Na menu labelling effects on Na content of menu items, as well as on the Na content in menu items purchased by consumers, is needed.
In response to advancing clinical practice guidelines regarding concussion management, service members, like athletes, complete a baseline assessment prior to participating in high-risk activities. While several studies have established test stability in athletes, no investigation to date has examined the stability of baseline assessment scores in military cadets. The objective of this study was to assess the test–retest reliability of a baseline concussion test battery in cadets at U.S. Service Academies.
All cadets participating in the Concussion Assessment, Research, and Education (CARE) Consortium investigation completed a standard baseline battery that included memory, balance, symptom, and neurocognitive assessments. Annual baseline testing was completed during the first 3 years of the study. A two-way mixed-model analysis of variance (intraclass correlation coefficent (ICC)3,1) and Kappa statistics were used to assess the stability of the metrics at 1-year and 2-year time intervals.
ICC values for the 1-year test interval ranged from 0.28 to 0.67 and from 0.15 to 0.57 for the 2-year interval. Kappa values ranged from 0.16 to 0.21 for the 1-year interval and from 0.29 to 0.31 for the 2-year test interval. Across all measures, the observed effects were small, ranging from 0.01 to 0.44.
This investigation noted less than optimal reliability for the most common concussion baseline assessments. While none of the assessments met or exceeded the accepted clinical threshold, the effect sizes were relatively small suggesting an overlap in performance from year-to-year. As such, baseline assessments beyond the initial evaluation in cadets are not essential but could aid concussion diagnosis.
Herbicides have been a primary means of managing undesirable brush on grazing lands across the southwestern United States for decades. Continued encroachment of honey mesquite and huisache on grazing lands warrants evaluation of treatment life and economics of current and experimental treatments. Treatment life is defined as the time between treatment application and when canopy cover of undesirable brush returns to a competitive level with native forage grasses (i.e., 25% canopy cover for mesquite and 30% canopy cover for huisache). Treatment life of industry-standard herbicides was compared with that of aminocyclopyrachlor plus triclopyr amine (ACP+T) from 10 broadcast-applied honey mesquite and five broadcast-applied huisache trials established from 2007 through 2013 across Texas. On average, the treatment life of industry standard treatments (IST) for huisache was 3 yr. In comparison, huisache canopy cover was only 2.5% in plots treated with ACP+T 3 yr after treatment. The average treatment life of IST for honey mesquite was 8.6 yr, whereas plots treated with ACP+T had just 2% mesquite canopy cover at that time. Improved treatment life of ACP+T compared with IST life was due to higher mortality resulting in more consistent brush canopy reduction. The net present values (NPVs) of ACP+T and IST for both huisache and mesquite were similar until the treatment life of the IST application was reached (3 yr for huisache and 8.6 yr for honey mesquite). At that point, NPVs of the programs diverged as a result of brush competition with desirable forage grasses and additional input costs associated with theoretical follow-up IST necessary to maintain optimum livestock forage production. The ACP+T treatments did not warrant a sequential application over the 12-yr analysis for huisache or 20-yr analysis for honey mesquite that this research covered. These results indicate ACP+T provides cost-effective, long-term control of honey mesquite and huisache.
There is discontent and turnover among faculty at US academic health centers because of the challenges in balancing clinical, research, teaching, and work–life responsibilities in the current healthcare environment. One potential strategy to improve faculty satisfaction and limit turnover is through faculty mentoring programs.
A Mentor Leadership Council was formed to design and implement an institution-wide faculty mentoring program across all colleges at an academic health center. The authors conducted an experimental study of the impact of the mentoring program using pre-intervention (2011) and 6-year (2017) post-intervention faculty surveys that measured the long-term effectiveness of the program.
The percent of faculty who responded to the surveys was 45.9% (656/1428) in 2011 and 40.2% (706/1756) in 2017. For faculty below the rank of full professor, percent of faculty with a mentor (45.3% vs. 67.1%, P < 0.001), familiarity with promotion criteria (81.7% vs. 90.0%, P = 0.001), and satisfaction with department’s support of career (75.6% vs. 84.7%, P = 0.002) improved. The percent of full professors serving as mentors also increased from 50.3% in 2011 to 68.0% in 2017 (P = 0.002). However, the percent of non-retiring faculty considering leaving the institution over the next 2 years increased from 18.8% in 2011 to 24.3% in 2017 (P = 0.02).
Implementation of an institution-wide faculty mentoring program significantly improved metrics of career development and faculty satisfaction but was not associated with a reduction in the percent of faculty considering leaving the institution. This suggests the need for additional efforts to identify and limit factors driving faculty turnover.
We conducted a survey in the major row-crop production regions of Texas to determine the response of waterhemp to glyphosate (5-enolpyruvylshikimate-3-phosphate synthase [EPSPS] inhibitor), atrazine (photosystem II [PSII] inhibitor), pyrithiobac (acetolactate synthase [ALS] inhibitor), tembotrione (hydroxyphenylpyruvate dioxygenase [HPPD] inhibitor), fomesafen (protoporphyrinogen oxidase [PPO] inhibitor), and dicamba (synthetic auxin). We evaluated 127 accessions for these herbicides. Resistance was confirmed on the basis of plant survival within an accession, and the injury ratings of surviving plants were used to categorize each accession as resistant (<50% injury) or less sensitive (50% to 89% injury). For glyphosate, approximately 27% of all tested accessions were resistant and 20% were less sensitive. The Gulf Coast region had the most glyphosate-resistant accessions (46% of the accessions from this region), followed by the Blacklands region (9%). A dose-response assay of the most resistant waterhemp accession (TX-25) exhibited 17-fold resistance to glyphosate when compared with a susceptible standard. Waterhemp resistance to atrazine also was common in the Gulf Coast region. The accession with the greatest atrazine resistance (TX-31) exhibited 47- and 68-fold resistance to this herbicide when applied POST and PRE, respectively. Widespread resistance to pyrithiobac was observed in waterhemp accessions throughout the Blacklands and Gulf Coast regions. The most resistant accession identified in this study was 61-fold resistant compared with a susceptible standard. No high-level resistance was detected for tembotrione, dicamba, or fomesafen, but high variability in sensitivity to tembotrione and dicamba was observed. One waterhemp accession exhibited reduced sensitivity to fomesafen; the rest were sensitive. Overall, at least two accessions exhibited resistance or reduced sensitivity to herbicides with five different sites of action. The study illustrates the prevalence of multiple herbicide resistance in waterhemp accessions in Texas and emphasizes the need to implement diversified management tactics.
Vitamin D deficiency is a common occurrence globally, and particularly so in pregnancy. There is conflicting evidence regarding the role of vitamin D during pregnancy in non-skeletal health outcomes for both the mother and the neonate. The aim of this study was to investigate the associations of maternal total 25-hydroxy vitamin D (25OHD) with neonatal anthropometrics and markers of neonatal glycaemia in the Belfast centre of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. Serological samples (n 1585) were obtained from pregnant women in the Royal Jubilee Maternity Hospital, Belfast, Northern Ireland, between 24 and 32 weeks’ gestation as part of the HAPO study. 25OHD concentrations were measured by liquid chromatography tandem-MS. Cord blood and neonatal anthropometric measurements were obtained within 72 h of birth. Statistical analysis was performed. After adjustment for confounders, birth weight standard deviation scores (SDS) and birth length SDS were significantly associated with maternal total 25OHD. A doubling of maternal 25OHD at 28 weeks’ gestation was associated with mean birth weight SDS and mean birth length SDS higher by 0·05 and 0·07, respectively (both, P=0·03). There were no significant associations with maternal 25OHD and other measures of neonatal anthropometrics or markers of neonatal glycaemia. In conclusion, maternal total 25OHD during pregnancy was independently associated with several neonatal anthropometric measurements; however, this association was relatively weak.
The modest level and differing structure of compensation Japanese corporate executives receive has sparked recent interest in the determinants of executive pay in Japan. One factor that remains unexamined is the role played by Article 361 of the Companies Act which requires that director pay be set by the general shareholders’ meeting. To explore the question of whether this rule, by giving shareholders a veto over changes to compensation they disagree with, matters to pay in Japan, this article examines the results of the shareholders’ meetings of companies listed on the First Section of the Tokyo Stock Exchange that voted on compensation resolutions in 2014. We find that, while all resolutions were approved, there was significant variation in both what pay directors asked for and how shareholders responded that was correlated with differences in each. The results are consistent with the view that the relevance of the rule varies depending on the context of the company. While at most companies, shareholder voting on pay is relatively uncontroversial, the changing structure of ownership and governance at some provides an avenue through which the rule may now matter to pay.
Over the past two decades, all U.S. states have incorporated alcohol ignition interlock technology into sentencing laws for individuals convicted of driving while intoxicated (DWI). This article provides the first 50-state summary of these laws to include changes in the laws over time and their effective dates. This information is critical for policy makers to make informed decisions and for researchers to conduct quantitative evaluation of the laws.
Standard legal research and legislative history techniques were used, including full-text searches in the Westlaw legal database and identification of state session laws. Because ignition interlock device (IID) laws often change over time, we identified the date of each law's initial enactment as well as the effective date of each law in its current form.
Beginning with California and Washington in 1987, all 50 states have enacted IID laws as a sentencing option for DWI offenders. Initially, most of these laws were discretionary. Today, however, 48 states mandate IID installation for at least some types of DWI offenders to maintain lawful driving privileges. Of these, 27 mandate an IID for all offenders; seven mandate an IID for repeat offenders only; and 21 for some combination of specific groups of DWI offenders, including repeat offenders, offenders with a blood alcohol content above a legislatively-specified level, and aggravated offenders (including those who harm someone else or who are convicted of a DWI with a child in the vehicle).
States have wrestled with a number of IID policy issues, including for whom to mandate IIDs and whether to suspend a license for DWI prior to reinstating driving privileges with or without an IID. By understanding how state interlock laws differ, policy makers and researchers can ultimately better ascertain the impact of these laws.
During natural disasters, hospital evacuation may be necessary to ensure patient safety and care. We aimed to examine perceptions of stakeholders involved in these decisions throughout the Mid-Atlantic region of the United States during Hurricane Sandy in October 2012.
Semistructured interviews were conducted from March 2014 to February 2015 to characterize stakeholders’ perceptions about authority and responsibility for acute care hospital evacuation/shelter-in-place decision-making in Delaware, Maryland, New Jersey, and New York during Hurricane Sandy. Interviews were recorded, transcribed, and thematically analyzed using a framework approach.
We interviewed 42 individuals from 32 organizations. Hospital executives from all states reported having authority and responsibility for evacuation/shelter-in-place decision-making. In New York and Maryland, government officials stated that they could order hospital evacuation, whereas officials in Delaware and New Jersey said the government lacked enforcement capacity and therefore could not mandate evacuation.
Among government officials, perceived authority for hospital evacuation/shelter-in-place decision-making was viewed as a prerequisite to ordering evacuation. When both hospital executives and government officials perceive themselves to possess decision-making authority, there is the potential for inaction. Future work should examine whether a single entity bearing ultimate responsibility or regional emergency response coalitions would improve decision-making. (Disaster Med Public Health Preparedness. 2016;10:320–324)
Following the tragic shootings in Newtown (Connecticut), Aurora (Colorado), Isla Vista (California) and others, increased national attention has focused on the relationship between mental illness and gun violence. While some have called for enhanced regulation of firearm possession by persons with mental illness, others have argued that such actions would be ineffective and enhance stigma associated with mental illness while discouraging treatment seeking.
Physician trainees were surveyed to assess intention to perform hand hygiene (HH). Compared with preclinical medical students (MS), clinical MS and residents reported less confidence that HH prevents carrying home microorganisms (P = .006, P = .003) or protects oneself from antibiotic-resistant microorganisms (P = .01, P = .006). Clinical trainees may need targeted interventions focusing on intention to perform HH.
The hypocretins (HCRTs) are two hypothalamic peptides that have been implicated in a variety of functions including the regulation of behavioral arousal. In the brain, HCRT-expressing neurons are localized within the perifornical-lateral hypothalamic area, where they are intermingled with various other neuronal groups, including GABAergic, glutamatergic, and melanin-concentrating hormone containing neurons. Hypocretin neurons are active during behavioral arousal and are quiet during non-REM and REM sleep. Deficiency of HCRTergic signaling is linked to the symptoms of narcolepsy in humans, dogs, and rodents. Narcolepsy is a debilitating sleep disorder characterized by excessive daytime sleepiness, disrupted nighttime sleep, sleep-onset REM sleep, and sudden loss of muscle tone during waking (cataplexy). Hypocretin neurons project extensively to brain structures, especially to those that are involved in arousal and motor control as well as receive extensive inputs from areas regulating emotions, autonomic tone, appetite, circadian rhythms, and sleep–wake behavior. Therefore, HCRT neurons are well positioned to integrate a variety of interoceptive and homeostatic signals to increase behavioral arousal and suppress REM sleep and its atonia. This chapter provides a brief review of the HCRTergic system, its interactions with other neuronal systems involved in sleep–wake regulation, and the neuronal circuitry and the potential mechanism(s) by which the HCRTergic system promotes behavioral arousal and suppresses REM sleep and its muscle atonia.
The caudate putamen (CPu) has been implicated in habit learning and neuroadaptive changes that mediate the compulsive nature of drug-seeking following chronic cocaine self-administration. Re-exposure to an operant chamber previously associated with cocaine, but not yoked-saline, increases activity-regulated cytoskeleton-associated (Arc) gene mRNA expression within the dorsolateral (dl) CPu following prolonged abstinence. In this study, we tested the hypothesis that antisense gene knockdown of Arc within the dlCPu would alter cocaine-seeking. Initial studies showed that a single infusion of Arc antisense oligodeoxynucleotide (ODN) into the dlCPu significantly attenuated the induction of Arc mRNA and Arc protein by a single cocaine exposure (20 mg/kg i.p.) compared to scrambled-ODN-infused controls. In cocaine self-administering rats, infusion of Arc antisense ODN into the dlCPu 3 h prior to a test of context-driven drug-seeking significantly attenuated Arc protein induction, but failed to alter responding during testing, suggesting striatal Arc does not facilitate context-induced drug-seeking following prolonged abstinence. However, Arc antisense ODN infusion blunted the decrease in responding during subsequent 1-h extinction tests 24 and 48 h later. Following re-exposure to a cocaine-paired context, surface expression of the AMPA-type glutamate receptor GluR1 was significantly reduced whereas GluR2 was significantly increased in the dlCPu, independent of Arc antisense ODN infusion. Together, these findings indicate an important role for Arc in neuroadaptations within brain regions responsible for drug-seeking after abstinence and direct attention to changes occurring within striatal circuitry that are necessary to break down the habitual behaviour that leads to relapse.
The chapter will summarize our current understanding of the neuronal and neurochemical basis of hypnogenesis. The hypothesis of the localization of a hypnogenic mechanism in the mammalian hypothalamic preoptic area (POA) was first proposed by von Economo more than 70 years ago (von Economo, 1930). This hypothesis has been confirmed by findings that experimental POA lesions suppress sleep, and that electrical, chemical, and thermal POA stimulation induce sleep (reviewed by McGinty & Szymusiak, 2001). Unit recording studies have identified POA neurons that exhibit increased activity during NREM sleep, REM sleep, or both. These sleep-active neurons are hypothesized to be the substrate of the hypnogenic mechanism. The past decade has seen substantial progress in the further description of this hypnogenic system; we summarize this progress in this chapter.
Localization of sleep-active neurons within the POA
Studies of sleep-active neuronal discharge across the sleep–wake cycle in freely moving animals provide important information about the hypnogenic process (see below) but, because of sampling limitations, are not suitable for systematic mapping of the exact locations of putative hypnogenic neurons. The application of the c-Fos immunoreactivity (IR) method to map sleep-active neurons has stimulated several advances. C-Fos IR is a marker of neuronal activation in most brain sites; immunohistochemically labeled neurons can be mapped systematically.