US Commonwealth Research Articles

Delayed Diagnoses in Patients With Dizziness in the US Commonwealth of Virginia and the Tidewater Region.

In a region of approximately 1.7 million people (Tidewater, coastal Virginia), identify secondary diagnoses in persons with dizziness. This cross-sectional study utilizing TriNetX included individuals in the region of interest diagnosed with dizziness between 2010 and 2020. Subsequent diagnoses of vestibular disease or medical conditions possibly associated with dizziness in the same subjects were catalogued. During the study period, 31,670 subjects were identified with diagnoses of dizziness as a symptom; 18,390 subjects were subsequently given a dizziness-related nonvestibular diagnosis, and 930 were given a subsequent vestibular disease diagnosis. The proportion of subjects diagnosed with vestibular disease (3%) after the dizziness diagnosis is far below expected norms (25%-34%) in the general population. There were greater proportions of delayed diagnoses of labyrinth dysfunction (odds ratio [OR], 4.8; P < 0.0001), superior semicircular canal dehiscence (OR, 3.1; P = 0.0023), otolith disease (OR, 3.1; P = 0.0023), among others, and a decreased proportion of delayed diagnosis of benign paroxysmal positional vertigo (OR, 0.56; P < 0.0001). The discrepancy between expected and observed prevalence in our region indicates that vestibular disease is likely underdiagnosed.

Community Pharmacy Operations in Puerto Rico During the 2017 Hurricane Season: A Descriptive Analysis of Rx Open Data.

This article aims to: (1) describe the 'Return to Open Pharmacy Operations' in Puerto Rico following the hurricanes Irma and Maria in the 2017 hurricane season, and (2) compare the recovery rate (Return to Open Pharmacy Operations) during the 2017 hurricane season between the US Commonwealth of Puerto Rico and the state of Florida. We performed a cross-sectional study of pharmacy operations in Puerto Rico utilizing Rx Open data for pharmacies in Puerto Rico during the 2017 hurricane season. To compare open rates of pharmacy operations over time in different contexts, we also analyzed Rx Open data for the state of Florida for Hurricane Irma. Only 11.1% of pharmacies remained open in Puerto Rico 3 days after Hurricane Maria made landfall, and Puerto Rico pharmacy operations recovered slowly, at an average daily rate of 3.9% before reaching pre-landfall baseline operations. Puerto Rico pharmacy operations after Hurricane Maria recovered 10 times slower on average, compared to pharmacy operations in Florida after Hurricane Irma which reached baseline operations less than 1 week following Hurricane Irma's landfall. Our results demonstrate the unique severity of Hurricane Maria's impacts on Puerto Rico's health system.

Submarine Groundwater Discharge (SGD) to Coastal Waters of Saipan (Commonwealth of the Northern Mariana Islands, USA): Implications for Nitrogen Sources, Transport and Ecological Effects

Seagrass meadows and coral reefs along the coast of Saipan, a US commonwealth in the Northern Pacific, have been declining since the 1940s, possibly due to nutrient loading. This study investigated whether submarine groundwater discharge (SGD) contributes to nutrient loading and supports primary production on Saipan’s coast. SGD can be an important source of freshwater, nutrients, and other pollutants to coastal waters, especially in oceanic islands without well-developed stream systems. Ra and Rn isotopes were used as natural tracers of SGD. Nitrate, phosphate, and ammonium concentrations, ancillary water quality parameters, δ15N and δ18O of dissolved nitrate, and δ15N of primary producer tissue were measured. Our results pointed to discharge of low-salinity groundwater containing elevated concentrations of sewage-derived N at specific locations along Saipan’s coast. High SGD areas had lower salinity and pH, higher dissolved inorganic nitrogen concentrations, and elevated primary producer δ15N, indicative of sewage nitrogen inputs. We estimated that SGD could support 730–6400 and 3000–15,000 mol C d−1 of primary production in Tanapag and Garapan Lagoons, respectively, or up to approximately 60% of primary production in Garapan Lagoon. Efforts to improve water quality, reduce nutrient loading, and preserve coastal ecosystems must account for groundwater, since our results demonstrate that it is an important pathway of nitrogen delivery.

When Governments Promise to Prioritize Public Debt: Do Markets Care?

Abstract During the European sovereign debt crisis of 2011–13, some nations faced with rising borrowing costs adopted commitments to treat bondholders as priority claimants. That is, if there were a shortage of funds, bondholders would be paid first. In this article, we analyse the prevalence and variety of these types of commitments and ask whether they impact borrowing costs. We examine a reform that was widely touted at the height of the Euro sovereign debt crisis in 2011, in which Spain enshrined in its constitution a strong commitment to give absolute priority to public debt claimants. We find no evidence that this reform had any impact on Spanish sovereign bond yields. By contrast, our examination of the US Commonwealth of Puerto Rico suggests that constitutional priority promises can have an impact, at least where the borrower government is subject to supervening law and legal institutions.

Of Internet born: idolatry, the Slender Man meme, and the feminization of digital spaces

This paper examines 96 US and British Commonwealth articles on the 2014 Wisconsin Slender Man stabbing. Using critical textual analysis, this study examined how media took a horror-themed meme from the underbelly of the Internet and curated a moral panic, once the meme was thrust into the international limelight. Because memes are a particular intersection of images and technology, media made sense of this meme-inspired attack in three ways: (1) through an idolatrous tone that played on long-standing Western anxieties over images; (2) by hyper-sensationalizing women’s so-called frivolous uses of technology; and (3) by removing blame from the assailants and, in turn, finding the Internet and the Slender Man meme guilty in the court of public opinion. Through this tripartite rhetoric, this study suggests that when media set out to curate a moral panic surrounding images and technology, together, the discourse that emerges is one that feminizes the Internet, turning it into technology-as-mother and image-as-child. This study also suggests this is the case because when women receive macro-level structure equality, micro-level inequities and attempts of control against them increase. Digital and image rhetoric are not exceptions.

Legitimizing Empire: Filipino American and U.S. Puerto Rican Cultural Critique by Faye Caronan

Reviewed by: Legitimizing Empire: Filipino American and U.S. Puerto Rican Cultural Critique by Faye Caronan Charlie Samuya Veric Faye Caronan Legitimizing Empire: Filipino American and U.S. Puerto Rican Cultural Critique Urbana: University of Illinois Press, 2015. 208 pages. Why compare? And why now? In the wake of the transnational turn in area studies wherein borders that constrain knowledge are opened up, such questions may appear outdated. Their implications, however, remain robust especially for the future of comparison in the Global South. Faye Caronan's Legitimizing Empire: Filipino American and U.S. Puerto Rican Cultural Critique shows us why. In the West the comparative imagination has a relatively long history. The discipline of comparative literature, for example, flourished in the US after the Second World War, a development that coincided with the escalation of the Cold War, during which the culture of others became an integral part of statecraft and international diplomacy. More recently, American studies—the larger field within which Caronan's work is situated—has seen the rise of transnationalism, expanding the investigation of US history and culture to include those of other state formations in the age of globalization. The literature embodying such developments that put comparison front and center is too broad to be enumerated here. But such breadth cannot be said about Philippine studies, a field that Legitimizing Empire also addresses, whose emergence as an academic domain corresponded with the rise of comparative literature on US shores after the Second World War. It is not unfair to say that comparison has yet to find its rightful place in the study of Philippine society, history, and culture. The late Benedict Anderson, himself a comparatist, gestured toward this possibility in The Spectre of Comparisons: Nationalism, Southeast Asia, and the World (Verso, 2001). The title of his book comes from no less than José Rizal, a point that may suggest the deep roots of comparative imagination in Filipino consciousness. But comparative scholarly studies done by local scholars are still hard to come by in the Philippines. This lack is ironic given the ecological and cultural diversity of the archipelago, a condition that suggests quite the opposite. Given such a diverse ecology and culture, the lay of the Filipino mind should be comparative, so to speak. The reality, however, could not be more untrue. Consider the lack of comparison in literary studies, which is rather bizarre given the fact [End Page 395] that Filipino scholars—Bienvenido Lumbera comes to mind—had been formally trained in comparative literature at American universities as early as the 1960s. Indeed, comparative literary studies remains marginal in Filipino scholarship, especially those that tackle American themes alongside Filipino questions. Since the publication of Lucilla Hosillos's Philippine–American Literary Relations, 1898–1941 (University of the Philippines Press) in 1969, for example, nothing similar has been done by a Filipino scholar on this side of the Pacific. Such a lack is a scandal given the prominence of American influence on Philippine history in the last hundred or so years. Caronan's work is accordingly significant in that it throws open the underlying principles that define cultural relations between the Philippines and the US. What is more, she includes another dimension that expands the scope of comparison—the case of Puerto Rico, a US Commonwealth. The origins of Legitimizing Empire go back to Caronan's undergraduate years at Cornell University, when she heard fellow students in the Latino Studies Resource Center talking about US colonialism in Puerto Rico while she was poring over an article by E. San Juan Jr in the nearby Asian American Resource Center. Caronan would later pursue the connections between the Philippines and Puerto Rico while completing her dissertation at the University of California, San Diego. The final product is Legitimizing Empire, Caronan's first book. Legitimizing Empire argues that US exceptionalism has delegitimized, and therefore neutralized, the critiques that are expressed in cultural texts produced by people of color, primarily Filipino American and US Puerto Rican. Looking comparatively at novels, documentary films, performance poetry, travelogues, and travel guides, Caronan illuminates the workings of US exceptionalism and highlights the deep but concealed connections that not only bind the two diasporic communities with...

An Assessment of State Board of Pharmacy Legal Documents for Public Health Emergency Preparedness

Objective. To estimate pharmaceutical emergency preparedness of US states and commonwealth territories. Methods. A quantitative content analysis was performed to evaluate board of pharmacy legal documents (ie, statutes, rules, and regulations) for the presence of the 2006 Rules for Public Health Emergencies (RPHE) from the National Association of Boards of Pharmacy's (NABP) Model Pharmacy Practice Act. Results. The median number of state-adopted RPHE was one, which was significantly less than the hypothesized value of four. Rule Two, which recommended policies and procedures for reporting disasters, was adopted significantly more than other RPHE. Ten states incorporated language specific to public health emergency refill dispensing, and among these, only six allowed 30-day refill quantities. Conclusion. Based on the 2006 NABP model rules, it does not appear that states are prepared to expedite an effective pharmaceutical response during a public health emergency. Boards of pharmacy should consider adding the eight RPHE to their state pharmacy practice acts.

Community Engagement in the Revised Chamorro–English Dictionary

Chamorro, an Austronesian language spoken in the Mariana Islands, is both the language of Micronesia with the largest number of speakers and one of Micronesia’s two most endangered languages. This note describes the community effort in progress in the US Commonwealth of the Northern Mariana Islands (CNMI) to preserve the language by revising the 1975 Chamorro–English Dictionary .

The Health Status of Youth in Puerto Rico

Few population-based studies have assessed health outcomes and health care access and use among youth in the US Commonwealth of Puerto Rico. Data are from an island population-based sample of 337 youth, 10 to 17 years old, who participated in the Asthma, Depression, and Anxiety in Puerto Rican Youth Study. In-person interviews with youth and caregivers assessed self-rated physical and mental health, weight status, diagnosed health conditions, and health care access and use. Island Puerto Rican youth report slightly worse physical and mental health than mainland youth. Puerto Rican youth have high rates of asthma, headaches, and stomachaches. Also, 6 in 10 island youth use public health insurance, and 1 in 3 regularly receive care at the emergency department. Island Puerto Rican youth are at a health disadvantage compared with mainland youth. Public health research is needed to fully understand and combat health challenges among Puerto Rican youth.

Can “Monkey Business” Resolve the Most Contentious Issue in the Convention on Biological Diversity?

Access to genetic resources and “fair and equitable” sharing of benefits (ABS) is the elusive objective of the 1992 United Nations Convention on Biological Diversity. At the tenth Conference of the Parties, long-standing differences were immortalized through the capacious language of the “Nagoya Protocol [NP] on the Fair and Equitable Sharing of Benefits Arising from the Utilization of Genetic Resources.” Although the NP does not resolve any contentious issue, the opposing narratives of scientist-as-hero and scientist-as-villain are reconciled through “mutually agreed terms” (MAT). The uncontested concept appears twenty-five times and transparency, thrice. An alternative narrative from the economics of information explains how “confidential business information,” subsumed in MAT, frustrates any “fair and equitable” royalty rate. Insights from psychology facilitate the brokerage of a fair and equitable rate and the US Commonwealth of Puerto Rico lends itself to a pilot project on the International Regime on ABS.

The grass isn't always greener

The grass isn't always greener

Childhood Obesity Prevention: An Intervention Targeting Primary Caregivers of School Children

Community-based participatory research (CBPR) was used to design and evaluate the effectiveness of a culturally relevant, science-based intervention for the prevention of childhood obesity in the Commonwealth of the Northern Mariana Islands (CNMI), a US Commonwealth in the western Pacific. This cognitive behavioral lifestyle intervention, Project Familia Giya Marianas (PFGM), was offered during the 2005-2007 school years in all CNMI public elementary schools over eight sessions to primary caregivers of 3rd grade children (N = 407). A crossover design was utilized with half of the schools offering the intervention in the Fall term, while the other half delivered the sessions in the Spring term. The primary outcome measure was change in BMI z-score. There was an intervention-dependent effect on BMI z-score, with program impact being a function of baseline BMI and the number of lessons attended. This effect was most apparent in students whose baseline BMI z-score was in healthy range (>/=5 to <85 percentile). In both Asian and Pacific Island groups, children whose caregivers completed 5-8 lessons experienced a significant change in BMI z-score as compared to those with 0 lessons (P < 0.05). Research that integrates multidisciplinary and multimethod approaches is effective in identifying and/or devising solutions to address a complex condition such as childhood obesity. PFGM demonstrated that community participation can be successfully utilized in the development and implementation of childhood obesity prevention programs.

Cost-related prescription nonadherence in the united states and Canada: A system-level comparison using the 2007 international health policy survey in seven countries

Background: Prior research indicates that residents of the United States are nearly twice as likely as Canadian residents to report cost-related nonadherence (CRNA) (ie, being unable to fill ≥1 prescription due to cost). However, these kinds of national comparisons obscure important within-country differences in insurance coverage. Objective: This study was designed to compare rates of CRNA across major financing systems for prescription drugs in the United States and Canada. Methods: This study used the 2007 International Health Policy Survey in Seven Countries (supported by the US Commonwealth Fund) to estimate rates of CRNA in the following health systems: Canadian compulsory coverage (Quebec), Canadian senior and social assistance coverage (Ontario), Canadian income-based coverage (British Columbia, Manitoba, and Saskatchewan), Canadian mixed coverage (all other provinces), US private coverage (employer-based or individual insurance), US senior and social assistance coverage (Medicare and/or Medicaid), and US no coverage (uninsured). Results: Adults in the United States were far more likely than adults in Canada to report CRNA (23.1% vs 8.0%; χ 2 = 147.4; P < 0.001). Seniors (≥65 years of age) were less likely than younger adults (<65 years) to report CRNA in both the United States (9.2% vs 25.8%; χ 2 = 64.3; P < 0.001) and Canada (4.6% vs 8.7%; χ 2 = 14.9; P < 0.001), presumably due to categorical eligibility for prescription drug insurance. Comparative analyses therefore focused on working-age adults (<65 years). Adults in Quebec (who have compulsory drug coverage) were only half as likely as those in Ontario to report CRNA (odds ratio [OR] = 0.5; 95% CI, 0.3–0.8). Uninsured adults in the United States were >7 times as likely to report CRNA (OR =7.2; 95% CI, 5.0–10.5), and adults with public insurance (OR = 2.2; 95% CI, 1.4–3.5) and private insurance (OR = 2.2; 95% CI, 1.6–3.0) were >2 times as likely to report CRNA. Conclusions: After stratifying by age and simultaneously adjusting for sex, household income, and chronic illness, large differences in CRNA were found between and within countries. Even in a compulsory prescription insurance system like that in Quebec, 4.4% of working-age adults reported CRNA. However, these rates were low compared with CRNA rates for working-age adults in the United States who lack any health insurance (43.3%).

Form and substance: the Cayman Islands perspective in the debate about offshore trusts. Presentation to the trusts and estates litigation forum in Provence, France, February 2008

Offshore legislation seeks to keep pace with demand in many of the key jurisdictions by a clear and deliberate policy of adapting the structure to fit the need. As a result, the legitimate uses of offshore trusts for estate preservation and planning, led to a legislative agenda which was designed to ensure that each jurisdiction offered the most attractive options for meeting those objectives.Most offshore commentators have argued that this innovation was essential for the survival of the industry after the tax authorities in the US, UK and other commonwealth countries introduced changes effectively closing the doors on offshore trust. However, some onshore detractors criticise the offshore trust as a triumph of form over substance. From the Cayman Islands' perspective, the chorus of criticism, on close examination, will be found to be baseless. The central proposition of this article is that the trust, in the Cayman Islands, has been a triumph of form and substance; that the cutting edge legislative developments find a solid foundation in the jurisprudence of the Islands.The article begins by reviewing some of the ways in which this onshore scepticism has recently manifested itself and then turns to exploring the case law, focusing in particular on decisions of the Cayman Islands courts, which reveal the doubters to be entirely misguided, with particular reference to the approach to disclosure of information, and the likely judicial approach to assessing the validity of the trust.

Vaccination Coverage in the US Commonwealth of the Northern Mariana Islands, 2005

In July 2005, a house-to-house survey was conducted to determine vaccination coverage achieved through routine health services on the three inhabited islands (Saipan, Rota, and Tinian) of the US Commonwealth of the Northern Mariana Islands (CNMI). A population-based cluster survey was conducted on Saipan; clusters and households were selected by systematic random sampling. On the smaller islands of Rota and Tinian, all households were visited. Vaccination histories and demographic information were obtained during household interview for all children aged 19-35 months, children aged 6 years, and adults aged 65 years and older. Vaccination histories for children were supplemented by hospital/clinic records and an electronic vaccination registry. Among 295 children aged 19-35 months, estimated coverage with the primary vaccination series was 80 percent; coverage with individual vaccines was generally higher. Among 193 children aged 6 years, coverage for vaccines required at school-aged was 83 percent. Among 226 adults aged 65 years and older, 52 percent received influenza vaccine during the previous season while 21 percent had ever received pneumococcal vaccine. The CNMI has achieved the US Healthy People 2010 objective of 80 percent coverage for the standard vaccination series among children aged 19-35 months. High coverage levels among 6-year-old children may reflect the benefit of school entry requirements. Influenza and pneumococcal vaccination among older adults remains low. Efforts to ensure that children and older adults throughout the CNMI are equally well-protected should continue. Strategies to address parental awareness of vaccinations that are due should be explored and may be facilitated by upgrading the electronic vaccination registry.

Identifying population vulnerable to hydrological hazards in San Juan, Puerto Rico

The hazards of place framework developed by Cutter (1996) has been applied to several areas across the United States. This article tests the applicability of that model for analysis of hydrological disasters in the municipio of San Juan, Puerto Rico. San Juan is chosen because it combines many socioeconomic attributes of a developing area while offering data availability befitting its status as a US commonwealth. The interoperability of principal components and arithmetically based methods for producing a social vulnerability layer are examined. For both methods, a basket of commonly cited demographic variables representing social and economic vulnerability is extracted from Census 2000 sample (SF-3) data at the census block-group level of analysis. These results provide insight on the strengths and weaknesses of the methods both methodologically and regarding policy implementation. A look at the neighborhood of La Perla suggests complex local positive and negative effects of local processes on vulnerability not captured by demographic analysis. These effects relate to possible census undercounts in peripheral areas and uncaptured coping ability provided by social networks.

Phylogeography illuminates maternal origins of exotic Coptotermes gestroi (Isoptera: Rhinotermitidae)

Coptotermes gestroi, the Asian subterranean termite (AST), is an economically important structural and agricultural pest that has become established in many areas of the world. For the first time, phylogeography was used to illuminate the origins of new found C. gestroi in the US Commonwealth of Puerto Rico; Ohio, USA; Florida, USA; and Brisbane, Australia. Phylogenetic relationships of C. gestroi collected in indigenous locations within Malaysia, Thailand, and Singapore as well as from the four areas of introduction were investigated using three genes (16S rRNA, COII, and ITS) under three optimality criteria encompassing phenetic and cladistic assumptions (maximum parsimony, maximum likelihood, and neighbor-joining). All three genes showed consistent support for a close genetic relationship between C. gestroi samples from Singapore and Ohio, whereas termite samples from Australia, Puerto Rico, and Key West, FL were more closely related to those from Malaysia. Shipping records further substantiated that Singapore and Malaysia were the likely origin of the Ohio and Australia C. gestroi, respectively. These data provide support for using phylogeography to understand the dispersal history of exotic termites. Serendipitously, we also gained insights into concerted evolution in an ITS cluster from rhinotermitid species in two genera.

Parental Mental Health, Childhood Psychiatric Disorders, and Asthma Attacks in Island Puerto Rican Youth

Previous research documents an association of poor parental mental health with asthma in children. This study aims to determine whether the associations between parental mental health problems and childhood asthma attacks persist after controlling for childhood anxiety and depression and other confounding factors. A community household sample of youth ages 4 to 17 years and their primary caregivers from the US Commonwealth of Puerto Rico was studied to determine the associations between parental mental health and childhood asthma attacks. Regression models that predicted asthma attacks in youth controlled for parental mental health problems, childhood anxiety and depression, zone of residence, and parents' age, education, and perception of poverty. After adjusting for children's depressive and anxiety disorders as well as other important confounders, associations between parental depression, suicide attempts, ataque de nervios, and history of mental health treatment and asthma attacks in offspring, by parental report, persisted. Additionally, the frequency of parental mental health problems was associated with children's asthma attacks. Parents with mental health problems were more likely to report histories of asthma attacks in their children compared with parents without mental health problems in Puerto Rico. These associations were not attributable to internalizing disorders in youth but persisted independent of childhood psychopathology and other confounding factors. Clinicians and researchers should recognize the relations between poor parental mental health and childhood asthma and explore the potential role of family psychosocial and behavioral factors related to the manifestation of the disease.

Message

Early this year Mr. Takizawa contacted the CNMI Assistive Technology Project with the desire to share information, research and invention of the experts of the Biophilia Rehabilitation Academy of Japan and with the intent of helping people with disabilities in the Commonwealth. Since November is celebrated annually in the CNMI. As Assistive Technology Awareness Month, one thing led to another and the idea of an International Conference was born. This conference will be the first ever International Conference on Assistive Technology and Biophilia Rehabilitation here in the US Commonwealth of the Northern Mariana Islands.

Tracking the axis enemy: the triumph of Anglo-American naval intelligence

The 1942-43 naval campaign against German U-boats known as the Battle of the Atlantic was a major victory not only for Allied warships but also for naval intelligence. Thanks to the co-ordinated efforts of submarine tracking rooms in London, Washington and Ottawa, the antisubmarine forces' search-and-destroy missions helped preserve the safety of the seaways. Naval intelligence has been an aspect of World War II that has received scant attention. Now former naval intelligence officer Alan Harris Bath traces the co-ordination of Anglo-American efforts before and during the war, identifying the political, military, technological and human factors that aided and sometimes hindered co-operation. He compares the two nations' different and often conflicting styles of intelligence gathering and reveals ways in which interagency and interservice rivalries complicated an already complex process. Drawing on archives in the US, UK and British Commonwealth, Bath describes how co-operation took place at all levels of decision-making, in all theatres of war and at all points in the intelligence cycle, from gathering through analysis to dissemination. He tells how the US learned from Britain's longer experience in the war and how intelligence co-operation was always subordinated to Anglo-American political relations - and how in the final months of fighting intelligence co-operation was impeded by the governments' postwar agendas. Although victory in the Atlantic was the capstone of this co-operative endeavour, Bath also describes how intelligence relationships fared in the South Pacific, not only between the forces of Admiral Nimitz and General MacArthur but also with those of Australia and New Zealand. Throughout the book, he emphasizes the contributions of Australian, New Zealand and Canadian naval intelligence to this co-operative effort. As an in-depth study of the nature, evolution and impact of information sharing by Allied navies, Tracking the Axis Enemy aims to be informative reading for historians and buffs alike. By showing how the Anglo-American political and cultural bonds shaped intelligence operations and how those operations shaped campaigns, it contributes a new perspective on the Allied victory.