Comparison Sites Research Articles

Poor pulmonary health in Barataria Bay dolphins in the eight years following the Deepwater Horizon oil spill

TheDeepwater Horizon(DWH) disaster resulted in large-scale contamination of bays, sounds, and estuaries in the northern Gulf of Mexico, home to multiple stocks of common bottlenose dolphins (Tursiops truncatus). Inhalation, aspiration, ingestion, and dermal absorption of oil and its toxic components were all considered possible routes of exposure for dolphins living within the oil spill footprint. To determine if dolphins were adversely impacted, catch-and-release health assessments were performed in heavily-oiled Barataria Bay (BB), Louisiana, and in Sarasota Bay (SB), Florida, a comparison site with no DWH oil contamination. Initial studies were conducted as part of a Natural Resource Damage Assessment (2011-2014) and follow-on studies were performed between 2016-2018 with support from the Gulf of Mexico Research Initiative. Ultrasound was used to evaluate the dolphins’ pulmonary health, including the presence/absence of pleural effusion, nodules, masses, consolidation, and alveolar interstitial syndrome (AIS). When present, AIS was further graded by severity (mild, moderate, or severe) and distribution. Based on the presence and severity of abnormalities, each dolphin was given an overall lung disease score (normal, mild, moderate, or severe). Normal to mild scores were considered within expected limits for a wild population, therefore the prevalence of normal-mild versus moderate-severe scores was compared between the oiled and unoiled sites. Separate analyses were conducted for dolphins alive in 2010 (and in BB, presumably exposed to DWH oil), and those born after 2010. For the dolphins alive in 2010, temporal trends were also examined using generalized additive models (GAMs). Results showed a strong difference (p=0.000357) in moderate to severe lung disease between the two sites for dolphins alive in 2010, but no significant difference (p=0.6745) between the sites for dolphins born after 2010. In BB dolphins, the prevalence of moderate to severe lung disease did not decrease in the years after the spill, and in fact, potentially worsened (p=0.0644 for trend over years), with the highest prevalence (0.61) being in 2018. Moderate to severe AIS remained a persistent finding in BB dolphins, and several animals had a pattern of AIS that was more severe ventrally than dorsally, with evidence of chronic, progressive disease states.

Innovative tidal control successfully promotes saltmarsh restoration

The reduction of saltmarsh habitat at a global scale has seen a concomitant loss of associated ecosystem services. As such, there is a need and a push for habitat rehabilitation. This study examined an innovative saltmarsh restoration project in Australia which sought to address the threats of mangrove encroachment and sea level rise. The project was implemented in 2017, using automated hydraulic control gates, termed “SmartGates,” to lower the tidal regime over one site, effectively reversing sea level rise at a local level. Measured indicators of saltmarsh cover, number of species, seedling counts, and saltmarsh assemblages all showed significant positive development over time, with trends varying based on saltmarsh zone. The saltmarsh, predominantly Sarcocornia quinqueflora, developed from remnant supralittoral (previously high) marsh which remained at 45% cover to achieve over 15% coverage across the cleared habitat after 3 years. Slower development in the low marsh (<5%) compared to other zones contrasts with other saltmarsh restoration studies which may be due to the unique nature of the restoration method or the nature of Australian saltmarsh species which favor higher elevations and drier conditions. The development of saltmarsh at the treatment site was found to track toward that at comparison sites over time, becoming similar to some comparison sites by the studies end. This study highlights the usefulness of the novel restoration method used and of the measured indicators for assessing saltmarsh development. This innovative tidal control method could play an important role in the future of saltmarsh restoration worldwide.

Coastal bird community response to dredge‐spoil tidal marsh restoration at New Round Island, Mississippi, U.S.A.

The northern Gulf of Mexico has been the focus of many coastal habitat restoration projects in the wake of new funding streams stemming from the settlement of the 2010 Deepwater Horizon oil spill litigation. One such project was the creation of New Round Island (RNDI) in Mississippi, a 86 ha island created using dredge material in 2017. The island design incorporated a novel U‐shaped sand berm with multiple interconnected containment sells. In this study we sought to document changes in relative abundance of various coastal bird species. We conducted surveys for breeding and nonbreeding birds from June 2017 to May 2021, and we conducted nonbreeding surveys at two reference sites for comparison. Breeding bird numbers were dominated by colonial nesting species in years 1 and 2, which subsequently declined as vegetation cover increased. Solitary nesting species increased over time, with Wilson's Plover (Charadrius wilsonia) nest count increasing from zero in year 1 to 29 in year 5. Nonbreeding shorebird counts peaked in years 1–2 and subsequently declined, although shorebird counts also decreased at the reference sites. Relative abundance of waders (Ardeidae), rallids (Rallidae), and passerines (Passeriformes and allies) increased in comparison to reference sites. This study demonstrates the short‐term benefits of this U‐shaped island design to early‐succession breeding species and nonbreeding shorebirds shortly after construction, with longer‐term benefits to breeding Wilson's Plover and to marsh birds as vegetation fills in.

Stress-related disorders and subsequent cancer risk and mortality: a population-based and sibling-controlled cohort study in Sweden

Prior research has suggested a potential role of psychological stress on cancer development while the role of familial factors on this association is underexplored. We conducted a nationwide cohort study including 167,836 individuals with a first-onset stress-related disorder (including post-traumatic stress disorder, acute stress reaction, adjustment disorder and other stress reactions) diagnosed between 1981 and 2016 in Sweden (i.e., exposed patients), 1,631,801 birth year- and sex-matched unexposed individuals, and 179,209 unaffected full siblings of the exposed patients. Cox models were used to estimate the hazard ratios (HRs) of newly diagnosed cancer and cancer-related death, beyond 1 year after diagnosis of stress-related disorders. We further examined the potential mediation roles of behavior-related morbidities in the associations of stress-related disorders with smoking or alcohol-related cancer incidence and mortality. We found modestly elevated risks of cancer incidence and mortality among exposed patients compared with matched unexposed individuals (incidence: HR = 1.03, 95% CI 1.01–1.06; mortality: HR = 1.13, 95% CI 1.07–1.18), while not when comparing with full siblings (incidence: HR = 1.03, 95% CI 0.99–1.08; mortality: HR = 1.09, 95% CI 1.00-1.19). Similarly, the suggested elevations in incidence and mortality of individual cancer sites (or groups) in the population-based comparison attenuated towards null in the between-sibling comparison. The risk elevations for smoking or alcohol-related cancers in the population-based comparison (incidence: HR = 1.18, 95% CI 1.11–1.24; mortality: HR = 1.20, 95% CI 1.12–1.29) were partially mediated by alcohol-related morbidities during follow-up. Collectively, our findings suggest that the association between stress-related disorders and cancer risk and mortality is largely explained by familial factors, including shared behavioral hazards.

Disparities in Healthcare Utilization: Superfund Site vs. Neighboring Comparison Site.

Inequities in pollution-attributable health disparities are similar in most urban areas throughout the United States, and appear to encompass racial and socio-demographic differences, thereby suggesting increased health risks for those living in these areas. Individuals residing in close proximity to Superfund sites, predominantly people of color, are increasingly stricken with lung diseases. The prevalence of chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), asthma in children, and lower respiratory tract infections (LRTI), is significantly higher in the affected area compared to the neighboring control area, irrespective of smoking, socio-economic status, or demographics. We conducted a retrospective analysis using data collected from patients who obtained healthcare from the University of Alabama at Birmingham (UAB) Health System. The data were procured from the Enterprise Data Warehouse (UAB Informatics for Integrating Biology and the Bedside (i2b2)). We evaluated healthcare utilization and classification of disease (defined by ICD-10 codes) of patients residing in zip codes: affected (35207, 35217) and neighboring comparison (35214). The results of the analysis may provide evidence that can be used for risk mitigation strategies or outreach education campaign(s) for those who live in the affected area.

Analysis of an Antibiotic Stewardship Program for Asymptomatic Bacteriuria in the Veterans Affairs Health Care System

Antibiotic stewardship for asymptomatic bacteriuria (ASB) is an important quality improvement target. Understanding how to implement successful antibiotic stewardship interventions is limited. To evaluate the effectiveness of a quality improvement stewardship intervention on reducing unnecessary urine cultures and antibiotic use in patients with ASB. This interrupted time series quality improvement study was performed at the acute inpatient medical and long-term care units of 4 intervention sites and 4 comparison sites in the Veterans Affairs (VA) health care system from October 1, 2017, through April 30, 2020. Participants included the clinicians who order or collect urine cultures and who order, dispense, or administer antibiotics. Clinical outcomes were measured in all patients in a study unit during the study period. Data were analyzed from July 6, 2020, to May 24, 2021. Case-based teaching on how to apply an evidence-based algorithm to distinguish urinary tract infection and ASB. The intervention was implemented through external facilitation by a centralized coordinating center, with a site champion at each intervention site serving as an internal facilitator. Urine culture orders and days of antibiotic therapy (DOT) and length of antibiotic therapy in days (LOT) associated with urine cultures, standardized by 1000 bed-days, were obtained from the VA's Corporate Data Warehouse. Of 11 299 patients included, 10 703 (94.7%) were men, with a mean (SD) age of 72.6 (11.8) years. The decrease in urine cultures before and after the intervention was not significant in intervention sites per segmented regression analysis (-0.04 [95% CI, -0.17 to 0.09]; P = .56). However, difference-in-differences analysis comparing intervention with comparison sites found a significant reduction in the number of urine cultures ordered by 3.24 urine cultures per 1000 bed-days (P = .003). In the segmented regression analyses, the relative percentage decrease of DOT in the postintervention period at the intervention sites was 21.7% (P = .007), from 46.1 (95% CI, 28.8-63.4) to 37.0 (95% CI, 22.6-51.4) per 1000 bed-days. The relative percentage decrease of LOT in the postintervention period at the intervention sites was 21.0% (P = .001), from 36.7 (95% CI, 23.2-50.2) to 29.6 (95% CI, 18.2-41.0) per 1000 bed-days. The findings of this quality improvement study suggest that an individualized intervention for antibiotic stewardship for ASB was associated with a decrease in urine cultures and antibiotic use when implemented at multiple sites via external and internal facilitation. The electronic health record database-derived outcome measures and centralized facilitation approach are both suitable for dissemination.

Assessing the Impact of Client Knowledge and Demand on Service Provision from Antenatal to Postnatal Care - An Implementation Science Design

Background: In low resource countries suboptimal clinical care has been identified a contributor to maternal and infant mortality. This study aimed to test the impact of a community intervention promoting client demand on provision of care during ANC, labour and the first postnatal contact (PNC). Methods: This was implementation science research in Kasungu district of Malawi using a quasi-experimental design with an intervention site where mothers were exposed to a package of interventions aiming to improve knowledge and demand. The results were compared with a site where there was no intervention in the same district. The intervention included checklists for mothers, posters and a Radio Distance Learning (RDL) program. The study used mixed methods (qualitative and quantitative). A total of 1040 mothers participated in individual interviews. Sixteen Focus Group Discussions (FGDs) were conducted with 128 mothers and 8 Key Informant Interviews were conducted with health workers. Health passports were used to check service provision at both comparison and intervention sites. In addition, mothers’ checklists were used at the intervention site to verify service provision. Quantitative data were processed in Stata 16.0 using binomial regression and two-sample proportion tests. NVivo 12 was used to process qualitative data for thematic analysis through coding and merging or creation of new codes. Results: At the intervention site there a 21.9% mean increase in knowledge of demandable services in ANC (43.3% to 56.1%, p<0.001,), intrapartum services for the mother (20.6%, 41.8% to 62.6%, p=0.003,) and the neonatal services before discharge (17.5%, 47% to 64.5%, p=0.0039). For PNC, changes were non-significant. Overall, women at the intervention site were 50% more likely than women at the comparison site to demand a service in the continuum of care (RR = 1.5). Actual service provision was increased at the intervention sites across all elements of the continuum, including laboratory testing, clinical examination of mothers and newborns and provision of essential interventions such as oxytocin for prevention of postpartum haemorrhage, chlorhexidine for umbilical cord care and vitamin K. Conclusion: The intervention positively contributed to increased knowledge on care practices, attitudes towards demand, actual demand for care practices, services provision and service satisfaction.

Exploratory in vivo biophysical studies of stratum corneum lipid organization in human face and arm skin

The purpose of this in vivo exploratory study was to investigate human stratum corneum (SC) lipid conformational order and chain packing in healthy face (cheek) skin as a function of stratum corneum depth using a combination of tape-stripping and horizontal attenuated total reflection Fourier transform infrared (HATR-FTIR) spectroscopy. Equivalent data were also collected from volar forearm skin as we, and others, have previously characterized forearm SC lipid order as a function of depth, therefore these data served as a comparison site and an experimental internal standard for the previously unmeasured in vivo face skin data. An SC depth profile was achieved by using tape strips to sequentially remove “layers” of SC. Trans epidermal water loss (TEWL) measurements were recorded following each sequential tape strip. In vivo HATR-FTIR spectra were collected after each tape strip, providing a depth profile of spectral data through the SC of both faces and arms. Spectral data were analyzed at five discrete SC depths corresponding to baseline and SC depths at which the increase in TEWL was 25, 50, 75, and 100 percent (%) from the baseline measurement. Analysis of the SC in vivo HATR-FTIR spectroscopic data utilized mean spectra generated by averaging the spectra from all panelists (n = 10) at the five specific SC depths corresponding to when TEWL had increased by 25, 50, 75 and 100 % from baseline for each subject, respectively. While this is an exploratory study, and the data could be collated and processed in many ways, the average spectral data reveal clear trends in the face and arm SC. Increasing SC lipid order with depth is observed for face skin, as with arm skin, albeit with significant differences at all relative depths in the absolute lipid order between faces and arms. In vivo SC lipids are significantly more ordered at all depths in arms versus cheeks. The less ordered SC lipids of face skin can be in part attributed to the presence of a high amount of fluid sebaceous lipid species observed deep into the face SC. Interestingly, no evidence of orthorhombic packing is observed at any depth in face SC. This is consistent with the high degree of disorder indicated from the chain fluidity measurements. These in vivo HATR-FTIR depth studies of face skin highlight how different SC barrier organization is in the face compared to the more widely studied body sites such as arms and legs. Further studies of the SC lipid barrier in faces are needed to understand the significant differences in lipid organization and its implication for the penetration of drug and cosmetic actives through face skin.

Assessing Ecosystem Services of Rice–Fish Co-Culture and Rice Monoculture in Thailand

Increasing production costs for rice monoculture and concerns about farming households’ food security have motivated farmers to adopt integrated rice–fish farming. To date, there has been little research that comparatively assesses the ecosystem services (ESVs) of both rice–fish co-culture and the rice monoculture system in Thailand. Therefore, this study aims to estimate the ESV values of these systems based on the Millennium Ecosystem Assessment. A total of 19 rice–fish co-culture farms were investigated, covering three regions of Thailand (northern, northeastern, and central regions) and consisting of 13 sub-districts, 13 districts, and 11 provinces. For a fair comparison, 19 conventional rice farms were selected as comparison sites. Rice–fish co-culture had a higher net ESV value of 48,450,968.4 THB ha−1 year−1 than rice monoculture with a net ESV value of 42,422,598.5 THB ha−1 year−1. Rice–fish co-culture generated average economic values 25.40% higher than in rice monoculture farming. The most positive change in ESV was found in the regulation of temperature and humidity, with 3,160,862.9 THB ha−1 year−1. Moreover, agrotourism can generate revenue and increase the ESV in rice–fish co-culture. Our findings showed that rice–fish co-culture gives more economic and ecological benefits compared to the rice monoculture system. Further studies are recommended to explore and analyze the potential advantages of the rice–fish system in more detail.

Neighborhood Contexts and Alcohol Use Disorder Among Mexican Americans Living in the US-Mexico Border Region.

This study assessed contributions of exposure to neighborhood stressors (violent victimization, witnessing crime, greater alcohol and drug availability) to variation in alcohol use disorder (AUD) symptoms among drinkers in three cities in Texas, USA. We used data from interviews conducted from 2011 to 2013 with Mexican-origin adults (ages 16-65) in the US-Mexico Study of Alcohol and Related Conditions who were past-year drinkers (N = 1960; 55% male) living in two cities in the Texas-Mexico border region (Laredo, n = 751 and Brownsville/McAllen, n = 814) and one interior comparison site (San Antonio, n = 771). Analyses (conducted in 2018 and 2019) examined overall and gender-stratified multilevel mediated effects of each border site (versus San Antonio) on AUD symptoms through the neighborhood-level factors, adjusting for individual- and neighborhood-level covariates. Overall, drinkers in Laredo reported more AUD symptoms than drinkers in the other cities, and their neighborhoods had more witnessing of crime and greater perceived drug availability, as well as higher levels of disadvantage and a lower proportion non-Hispanic White residents, than neighborhoods in San Antonio. Witnessing neighborhood crime was associated with increased AUD symptoms, while neighborhood disadvantage and proportion non-Hispanic White residents each were negatively associated with AUD symptoms. Perceived neighborhood insecurity, crime victimization, perceived neighborhood drug availability and neighborhood alcohol availability (off- and on-premise) were not significantly associated with AUD symptoms. Stratified models suggested possible gender differences in indirect effects through witnessing neighborhood crime. Reducing witnessing of neighborhood crime may help reduce AUD symptoms among adults living in the US border region.

Impact of woodland agri-environment management on woodland structure and target bird species

Agri-environment incentives form a central mechanism supporting changes to land management to provide public benefits. This study assesses the medium-term effects of woodland management on 13 target, specialist woodland bird species, as well as other woodland birds in a single region of the UK. The abundance of breeding birds (using two methods: point counts and territory mapping) and metrics of woodland structure were recorded on sites with Woodland Improvement Grants (improvement sites) and nearby comparison sites (control sites). Initial measurements were made prior to management and repeated 7–9 years later. A separate comparison of changes in bird abundance was made between the managed woodland sites and woodland from similar landscapes surveyed as part of the national Breeding Bird Survey (BBS). There was an increase in abundance of target species on improvement sites compared to a decrease on both control sites and BBS sites, although this was only evident from point count data. The effects on target species were stronger than for other woodland specialists and there was no apparent effect on woodland generalists, suggesting that the management interventions were appropriate for the target species. Changes in woodland structure were generally consistent with the expected effect of management, with lower tree density and greater Bramble (Rubus sp.) cover. However, contrary to the aim of increasing understorey cover, a reduction was recorded within the 2–10 m height category in improvement sites. This contrast is due to the removal of young trees during thinning affecting this height band and the short time period since management to allow regrowth. Our findings show that bespoke management supported through government agri-environment incentives can have a positive impact on target woodland birds. For managed forests, identifying species requirements and how management can be adapted to improve their habitats can be an effective way of delivering biodiversity gains when financial incentives are provided to achieve policy goals.

Destratification of a Eutrophic Reservoir in South Korea Using a Novel Convectional Water Circulation System (CWCS)

Replication of natural mixing through artificial water circulation techniques, such as convectional water circulation systems (CWCS), can break thermal stratification in stagnant water and suppress algal blooms. Here, the field performance of a novel CWCS was evaluated in a eutrophic reservoir (Shingal reservoir, South Korea) for three seasons between September 2016 and September 2018. The CWCS was deployed in a corner of stagnated water in the reservoir. The changes in water temperature and dissolved oxygen (DO) concentrations at different water depths were examined at the deployment site and two control sites within the stagnant area during the 2016 and 2017 seasons. In 2018, the performance of the CWCS in replicating natural mixing was assessed by monitoring water temperature changes at different depths at the CWCS unit deployment site and a comparison site with natural water flow. The differences in water temperature and DO concentrations between the epilimnion and the hypolimnion were significantly smaller at the deployment site than at the control sites, demonstrating the effectiveness of the CWCS in vertical and horizontal mixing as well as in oxygen transfer. The findings of the field study revealed that the CWCS effectively induced natural-like mixing without disturbing the hypolimnion.

Impacts of enforcement cameras on pedestrians’ risk perception and drivers’ behaviors at non-signalized crosswalks

Introduction: Pedestrians are more vulnerable to traffic crashes than other road users, particularly at non-signalized crosswalks. Safety measures (such as law enforcement cameras) can be implemented to regulate road users’ behavior and traffic safety. This study evaluates the effects of such cameras on pedestrian-vehicle conflicts by investigating different interaction patterns of pedestrian risk perception and driving style. Data: Field investigations were conducted at four non-signalized crosswalks. Video data were collected using unmanned aerial vehicles and roadside cameras. Method: Two-step cluster analysis and k-means cluster analysis were employed to classify the pedestrian’s behavior and driving style, respectively. Surrogate safety measures were adopted to measure the pedestrian-vehicle conflicts. Results and conclusions: The results suggest that the implementation of cameras would decrease both the actual and perceived risks of pedestrians, while the heterogeneity between the actual and perceived risk is more obvious at camera sites. They also indicate that the cameras have a positive influence on reducing drivers’ aggressiveness and conflict severity. In terms of pedestrian-vehicle interaction patterns, the most severe conflicts occur when the pedestrian perceived risk level is low and the driving style is aggressive. Such dangerous interactions are observed more frequently at camera sites. In contrast, a safer interaction pattern is associated with a moderate driving style and cautious crossing behavior, which is more frequently observed at comparison sites. However, regardless of which interaction pattern is observed, the conflict severity is found to be lower at camera sites, indicating the effectiveness of the cameras. Practical Applications: Supplementary facilities, such as warning signs, flash lights, and speed control measures, should be implemented to maintain the effectiveness of the law enforcement cameras.

Inquiry-Based Activities and Games That Engage Students in Learning Atomic Orbitals.

Atomic orbitals represent an essential construct used to develop chemical bonding models, upon which other more advanced chemistry topics are built. In this article, we share a series of active-learning activities and a gamified approach to develop students' representational competence about atomic orbitals and to engage students in learning the properties of atomic orbitals. These properties are essential for understanding an array of fundamental concepts such as penetration and shielding, relationships such as periodic trends, and models used to describe chemical bonding. The activities employ an inquiry-based approach to engage students in exploring the relationship between atomic orbitals' spatial properties and quantum numbers. The activities guide students to collect data to verify periodic trends and construct electronic configurations. The activities utilize Orbital Explorer Web site for visualization, comparison and analysis of atomic orbitals. The Orbital Explorer Web site is described in a related Technology Report. The activities and the game are suitable to be conducted in both in-person and remote-teaching settings.

Evaluating implementation strategies to support documentation of veterans' care preferences.

To evaluate the effectiveness of feedback reports and feedback reports + external facilitation on completion of life-sustaining treatment (LST) note the template and durable medical orders. This quality improvement program supported the national roll-out of the Veterans Health Administration (VA) LST Decisions Initiative (LSTDI), which aims to ensure that seriously-ill veterans have care goals and LST decisions elicited and documented. Primary data from national databases for VA nursing homes (called Community Living Centers [CLCs]) from 2018 to 2020. In one project, we distributed monthly feedback reports summarizing LST template completion rates to 12 sites as the sole implementation strategy. In the second involving five sites, we distributed similar feedback reports and provided robust external facilitation, which included coaching, education, and learning collaboratives. For each project, principal component analyses matched intervention to comparison sites, and interrupted time series/segmented regression analyses evaluated the differences in LSTDI template completion rates between intervention and comparison sites. Data were extracted from national databases in addition to interviews and surveys in a mixed-methods process evaluation. LSTDI template completion rose from 0% to about 80% throughout the study period in both projects' intervention and comparison CLCs. There were small but statistically significant differences for feedback reports alone (comparison sites performed better, coefficient estimate 3.48, standard error 0.99 for the difference between groups in change in trend) and feedback reports + external facilitation (intervention sites performed better, coefficient estimate -2.38, standard error 0.72). Feedback reports + external facilitation was associated with a small but statistically significant improvement in outcomes compared with comparison sites. The large increases in completion rates are likely due to the well-planned national roll-out of the LSTDI. This finding suggests that when dissemination and support for widespread implementation are present and system-mandated, significant enhancements in the adoption of evidence-based practices may require more intensive support.

How to handle negative reviews of the practice

Online review and comparison sites, alongside increasing use of social media, has provided patients with many platforms to comment on the care or treatment they have received at the practice. How best to handle negative comments or reviews?

Impact of the Seattle Sweetened Beverage Tax on substitution to alcoholic beverages.

IntroductionTaxes are increasingly used as a policy tool aimed at reducing consumption of sugar-sweetened beverages (SSBs), given their association with adverse health outcomes including type 2 diabetes, obesity and cardiovascular disease. However, a potential unintended consequence of such a policy could be that the tax induces substitution to alcoholic beverages. The purpose of this study is to examine the impact of the $0.0175 per ounce Seattle, Washington, Sweetened Beverage Tax (SBT) on volume sold of alcoholic beverages.MethodsA difference-in-differences estimation approach was used drawing on universal product code-level food store scanner data on beer (N = 1059) and wine (N = 2655) products one-year pre-tax (February-November, 2017) and one and two-years post-tax (February-November, 2018 and 2019) with Portland, Oregon, as the comparison site.ResultsAt two-years post-tax implementation, volume sold of beer in Seattle relative to Portland increased by 7% (ratio of incidence rate ratios [RIRR] = 1.07, 95% CI:1.00,1.15), whereas volume sold of wine decreased by 3% (RIRR = 0.97, 95% CI:0.95,1.00). Overall alcohol (both beer and wine) volume sold increased in Seattle compared to Portland by 4% (RIRR = 1.04, 95% CI:1.01,1.07) at one-year post-tax and by 5% (RIRR = 1.05, 95% CI:1.00,1.10) at two-years post-tax. The implied SSB cross-price elasticities of demand for beer and wine, respectively, were calculated to be 0.35 and -0.15.ConclusionsThere was evidence of substitution to beer following the implementation of the Seattle SSB tax. Continued monitoring of potential unintended outcomes related to the implementation of SSB taxes is needed in future tax evaluations.

Advancing Interorganizational Crime and Violence Reduction Goals Through a Relational Change Intervention

Effective interorganizational collaboration is deemed essential to comprehensive crime and violence initiatives but rarely is it empirically assessed. An 18-month intervention to improve collaboration Comprehensive Gang Model (CGM) locations was used in this study to examine the impact on increasing community capacity to address gangs and violence and reducing gang and violence in the community. Relational coordination theory grounded the collaboration intervention. Results from the quasi-experimental design showed significant, increased collaboration and reduction in violent crime in one intervention site. Other crime reduction efforts were explored as counterfactuals. Matched comparison sites saw no change in the ability to work together or violence reduction. Study implications are that relational coordination interventions may facilitate the goal of working better together, but parallel evaluations for each of the five core CGM strategies are needed to understand the independent effects of each strategy on gang and violence reduction goals.

Influence of therapeutic grip exercises induced loading rates in distal radius fracture healing with volar locking plate fixation

Background and objectiveTherapeutic exercises could potentially enhance the healing of distal radius fractures (DRFs) treated with volar locking plate (VLP). However, the healing outcomes are highly dependant on the patient-specific fracture geometries (e.g., gap size) and the loading conditions at the fracture site (e.g., loading frequency) resulted from different types of therapeutic exercises. The purpose of this study is to investigate the effects of different loading frequencies induced by therapeutic exercises on the biomechanical microenvironment of the fracture site and the transport of cells and growth factors within the fracture callus, ultimately the healing outcomes. This is achieved through numerical modelling and mechanical testing. MethodsFive radius sawbones specimens (Pacific Research Laboratories, Vashon, USA) fixed with VLP (VRP2.0+, Austofix) were mechanically tested using dynamic test instrument (INSTRON E3000, Norwood, MA). The loading protocol used in mechanical testing involved a series of cyclic axial compression tests representing hand and finger therapeutic exercises. The relationship between the dynamic loading rate (i.e., loading frequency) and dynamic stiffness of the construct was established and used as inputs to a developed numerical model for studying the dynamic loading induced cells and growth factors in fracture site and biomechanical stimuli required for healing. ResultsThere is a strong positive linear relationship between the loading rate and axial stiffness of the construct fixed with VLP. The loading rates induced by the moderate frequencies (i.e., 1–2 Hz) could promote endochondral ossification, whereas relatively high loading frequencies (i.e., over 3 Hz) may hinder the healing outcomes or lead to non-union. In addition, a dynamic loading frequency of 2 Hz in combination of a fracture gap size of 3 mm could produce a better healing outcome by enhancing the transport of cells and growth factors at the fracture site in comparison to free diffusion (i.e. without loading), and thereby produces a biomechanical microenvironment which is favourable for healing. ConclusionThe experimentally validated numerical model presented in this study could potentially contribute to the design of effective patient-specific therapeutic exercises for better healing outcomes. Importantly, the model results demonstrate that therapeutic grip exercises induced dynamic loading could produce a better biomechanical microenvironment for healing without compromising the mechanical stability of the overall volar locking plate fixation construct.

Вертикальные ограничения на глобальных цифровых рынках

Vertical restraints applied by major operators of digital markets have become a serious challenge for international regulators and governments of leading world powers in recent years. Having new specific features in comparison with the restraints in force in traditional sales channels, they can lead to a rapid strengthening of the market power of dominant online platforms and to the subsequent monopolization of markets. The article is devoted to the study of business practices of applying various types of vertical restraints in global digital markets. Using the example of global leading companies (Apple Inc., Amazon, Booking.com., Microsoft, etc.), the market consequences of the introduction of exclusive and related contracts, cross-platform parity agreements, as well as a wide range of transaction bans are demonstrated. In particular, suppliers and dealers are significantly limited in their ability to sell competing products and brands and list them on major online marketplaces. Bans are introduced on the use of Internet sites for price aggregation and comparison, as well as certain e-commerce platforms and certain types of payment means. At the same time, there are significant penalties for non-compliance with the terms of vertical contracts. Buyers and users are limited by the possibilities of using software products of independent developers, connecting to competing online services. Technological solutions are being introduced that increase the costs of sharing hardware and software of competing operators. And such solutions are greatly simplified in the conditions of existing “closed” global digital ecosystems. It is shown that the norms of vertical contracts of major market players are able to effectively eliminate the cost advantages of both existing operators and new firms, significantly increasing the entry costs and reducing potential of entering firms to attract the target audience at the start of activity. The most vulnerable here are, first of all, small highly specialized companies using low-budget business models. The author proposes a theoretical model that reveals the mechanism that prevents new firms from achieving the minimum effective sales volume. Using the example of the distributor’s retail price control strategy, it is proved that the use of vertical contracts allows both increasing the profits of existing operators and successfully preventing potential competitors from entering the market. At the same time, it is noted that the use of vertical restraints contributes to solving a number of current business problems of large digital companies: effective protection of investments in the development of e-commerce channels, limiting the turnover of counterfeit products, deepening the differentiation of market supply, reducing the risks of price wars and leveling the actual “stowaway problem”. Therefore, the qualification of vertical restraints as good practices, or as abuses of market power, should be based on an analysis of the objectives of such restraints and a comprehensive assessment of their potential consequences. An important step towards solving this complex and very sensitive problem may be the adoption of the Digital Markets Act by the European Parliament in 2023.