<p> A review of literature suggests that train derailments are a statistically relevant concern. While not all train derailments involve hazardous materials, those that do release chemicals pose a public health threat. This study challenges the decision-making mainstay tool of the hazardous materials response community &ndash; the <i>Emergency Response Guidebook</i> (ERG) &ndash; and its default strategy of evacuation through quantitative research that evaluates data from train derailments involving the release of hazardous materials. It explores whether there are correlations between a derailment&rsquo;s variables and evacuation, as well as correlations between the number evacuated and the number of those injured or killed. Secondary data on train derailments from the Pipeline Hazardous Material Safety Administration revealed 358 incidents involving the release of 876 substances between October 12, 1989 through August 10, 2016. The resulting data analysis confirms a certain level of predictability between causal factors and worsening outcomes supporting expansion of decision-making tools in the ERG.</p><p>

Records of 667 of 1242 Western Massachusetts Department of Mental Health clients, meeting age and diagnostic criteria established for the study, were analyzed for their use of inpatient and community mental health services. Clients from four geographic areas were compared on the dependent variables: admissions and inpatient days per year, before and after the initiation of community mental health services. Socio-demographic and clinical variables, as well as the utilization of community mental health services also were measured for each individual. Dramatic reductions in the utilization of inpatient care were demonstrated, with admissions per year decreasing by 56%, from 1.40 to.61; and inpatient days per year decreasing by 80% from 128 to 28. Increased admissions were related to increased use of outpatient care, medication services, diagnosis of Major Mood Disorders, shorter total duration in the mental health system, fewer inpatient days prior to community mental health services and increased inpatient days after community mental health services. Increased inpatient days were associated with increases in education, total years in the mental health system, years in community mental health services, admissions prior to community mental health services, and decreased use of outpatient therapy. Decreased admissions were related to increases in the use of inpatient days prior to community mental health services. Decreased inpatient days were associated with the use of staffed residential, day treatment, and other day programs, as well as increased admissions prior to community mental health services, and years in the mental health system. The use of community mental health services in predicting decreased inpatient utilization improved the R$\sp2$ by 16.7%. There were no differences in patterns of inpatient utilization among catchment areas after initiating community services, although differences existed in mix and availability of services, as well as resources. The availability of selective community services were related to inpatient utilization. It is suggested that there may be a threshold of service availability beyond which additional resources, although they may contribute to the quality or diversity of opportunities, do not impact inpatient utilization. These findings suggest that the paradigm for future research must included service variables in the predictive models.

<p> Individuals diagnosed with dementia make up the majority of the population in skilled nursing facilities (SNFs). Certified Nursing Assistants (CNAs) are the primary caretakers of older adults living in SNFs. The purpose of this grant project was to write a proposal for funding to provide Person-Centered Care (PCC) training to help CNAs enhance their skills to better enhance the quality of life of older adults living with dementia in SNFs. </p><p> The goal of PCC training is to help CNAs better understand the signs and symptoms of Alzheimer&rsquo;s and dementia, improve communication skills, and provide strategies to manage the behavioral and psychological symptoms of dementia. Previous research on PCC has found it to be effective in improving the quality of care of older adults who are affected by dementia and who are living in nursing homes. </p><p> Actual submission or funding of the grant was not required for the successful completion of this project.</p>

<p> This research explores the cultural, sociopolitical, biological, and psychological aspects of spanking. Utilizing a hermeneutic methodology, it reviews the language used around spanking, such as abuse, trauma, violence, corporal punishment, maltreatment, adverse childhood experiences, interpersonal victimization, and discipline; its history in indigenous and post-Columbian America; and empirical findings about its effects on mental health. It concludes with suggestions as to how to use this information clinically, noting perspectives on treating intergenerational transmission of trauma and the ethical duties of mental health practitioners to advocate against abuse.</p>

<p> Drug injection is an increasingly important risk factor in the transmission of blood-borne pathogens, including the hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The purpose of the study was to examine the influence of social network factors on HCV and HIV. The study was grounded in social network theory and sought to determine whether social network characteristics affect high-risk sexual and drug injection behavior as well as self-reported HIV and HCV status. The study design was a quantitative cross-sectional survey. A total of 181 participants in a needle exchange program completed a survey in Spanish assessing individual drug and sex risk practices as well as gathering information to describe the characteristics of participants&rsquo; personal networks from an egocentric perspective. General estimating equation techniques were used to analyze the data. Results showed that only social network size was related to risky sexual behavior. Injecting risk behaviors were only impacted by personal network exposures, measured by the average number of years network members had injected. HIV self-reported serum status was correlated with trust, closeness, and number of family members named among the closest 5 network members. Last, HCV self-reported serum status was only related to the years that network members had been injecting drugs. This study has implications for positive social change in that public health practitioners may gain a better understanding of the social network characteristics associated with high-risk behaviors of those infected with HCV and HIV in order to develop health promotion programs to lower infections and mortality.</p>

<p>Firefighters and asphalt pavers are exposed to polycyclic aromatic hydrocarbons (PAHs) during various work activities. The purpose of this study was to evaluate urinary PAH levels and compare these bio-monitoring levels among firefighters, asphalt pavers, and non-occupationally exposed individuals. The National Institute of Standards and Technology (NIST) urinary PAH levels were used for non-occupationally exposed controls. When compared to the NIST standard for smokers and non-smokers, firefighters demonstrated statistically significant differences in urinary concentration differences for the following metabolites: 2-OH-fluorene, 3-OH-fluorene and 1-OH-pyrene, which were lower in firefighters than the NIST mean for smokers. 1-OHphenanthrene, 2-OH-phenanthrene and 3-OH-phenanthrene were higher among world trade center exposed firefighters than the NIST mean for smokers. When firefighters were compared to the NIST non-smoker standard, firefighters demonstrated elevated levels in all tested PAH biomarkers due to a mixture of smokers and non-smokers in the firefighter cohort. </p><p> Asphalt workers had statistically significant higher urinary concentration elevations in 2OH-fluorene, 1-OH-phenanthrene and 3-OH-phenanthrene as compared to the NIST smoker mean. When asphalt pavers were compared to the NIST non-smoker mean, asphalt pavers had statistically significant increases in all tested PAH biomarkers, with the exception of 2-OHphenanthrene. While firefighters did not demonstrate a substantial change in urinary PAH metabolite levels compared to control populations of smokers and non-smokers, asphalt pavers experienced concentrations that were in some cases increased by orders of magnitude compare to NIST controls. Future research may be needed to evaluate any potential health risk posted to occupational exposed asphalt pavers. </p>

<p> Over the past two decades, development assistance for health and government health expenditure have both increased substantially. Despite the rise in public attention and funding levels internationally, there has been little empirical exploration of budgetary trends in global health funding. Through the use of public budgeting and finance theories, these three studies in aim to increase understanding of the flow of health funds between and within donor and recipient countries through time. Application of Punctuated Equilibrium Theory (PET) to multiple datasets of national health financing data illustrates a leptokurtic distribution for both own domestic health (government health expenditure) and other health (development assistance for health) spending. The distribution of change in government health expenditure by 15 OECD donor countries was found to be less punctuated that their development assistance for health to developing countries from 1990-2012, suggesting smoother, more constant pressures for &ldquo;own health&rdquo; spending versus spending for global health. Comparison of country-level annual changes in government spending on domestic health for 145 countries between 1995 and 2012 illustrated that overall, and when grouped by income, the distributions of countries&rsquo; pooled annual changes in government health spending were leptokurtic. There was a greater departure from the normal distribution as country income decreased across the highest and two lowest income groups, and the proportion of annual changes that were positive decreased. However, the high-income non-OECD and upper-middle income groups diverged from this trend in interesting ways. Empirical exploration of the changing organizational composition of the field through the lens of population ecology provides greater context for the funding trends in global health with a particular focus on the emergence of public private partnerships. Application of the Herfindahl-Hirschman Index (HHI) found a decrease in concentration in the organizational field of global health between 1990 and 2000, followed by stability in the field despite the introduction of a new organizational form. Over this period, there were increases in &lsquo;market&rsquo; shares for non-profit organizations and PPPs within the global health organizational population. The grant making-behavior directed through PPPs by a significant US bilateral agency was explored to identify patterns in decision-making related to PPP lifespan, disease focus, program type, regional focus, implementing partner categories and financial commitment, as well as recession impact. The limited empirical research concerning actors in global health funding emphasizes the need for further exploration of this phenomenon.</p>

<p> Waiters who serve alcoholic beverages at the majority of bars and restaurants in the United States are apt to serve alcohol to patrons who are visually intoxicated, notwithstanding laws prohibiting such service. Adverse effects of this practice include patron injuries, deaths, and law violations resulting in fines, incarceration, and lawsuits. Waiters not effectively trained to practice responsible alcohol retailing practices put patrons and others at risk of harm from alcohol related injuries or death. The problem is that the perceptions and attitudes of waiters who serve alcohol regarding self-learning as a strategy to prevent patron intoxication are not known; the purpose of this qualitative case study was to explore these perceptions. The study utilized in-depth semi-structured interviews with 23 waiters who utilized a self-learning tool about preventing patron intoxication. The waiters perceived that this self-learning tool was a good training solution, that it would be beneficial if implemented, that the tool could be used to improve public safety, and that its specific data on patron behavior and BAC levels were helpful. The participants also indicated that there would be challenges to implementing such a tool, including the waiters&rsquo; assertiveness and social aptness. As a whole, the researcher recommended that this tool be implemented across the country to improve waiter knowledge and patron safety. For future research, the researcher recommended that the study be expanded to include the perceptions of waiters across the country, the perceptions of those who underwent this training more than a year ago, and that the learning tool be adapted for different learning styles.</p>

<p> Instagram (IG) is a social media application that allows users to upload personal images in a public forum by including a searchable link (e.g. hashtag) along with a posted image. An IG community devoted to a pro-recovery (i.e., #anarecovery) perspective on eating disorders (EDs) stands alongside the pro-ana lifestyle IG community (i.e., #ana). Research has yet to examine the nature of visual representations associated with pro-ana and pro-recovery social media imagery and moreover, not much empirical attention has been given to the nature of this content on IG. Thus, the first aim of this qualitative content analysis was to examine how the underlying theoretical constructs of objectified body consciousness (OBC) and positive body image (PBI) were represented among #ana and #anarecovery content. A second aim was to compare the frequency of the themes present for #ana versus #anarecovery images. A coding guide was developed and high levels of interrater reliability were established for the primary codes (kappa &ge; .80). One hundred and fifty IG images each from #ana and #anarecovery were systematically coded. Within- and between-hashtag comparisons of images were performed using frequency counts and chi-square analyses. Within #ana images, the theme of body shame (62.7%) was more frequently depicted relative to body surveillance (22%) and appearance control (22%) themes. Within #anarecovery images, the theme of body protection was most prevalent (67.3%) followed by body functionality (38.7%) and body acceptance (11.3%) themes. All three OBC themes were more likely to be present in #ana images. Conversely, PBI themes of body protection and body functionality were more frequently represented in the #anarecovery images. The frequency of body acceptance themes did not differentiate the images sampled from both hashtags. This research calls for more expanded and distinguished definitions of the constructs that comprise the continuum of PBI. Findings also suggest how the lack of distinction in the frequency of body acceptance observed between the two hashtags may be clinically relevant for exploring potential risk factors that persist in the process of ED recovery.</p>

<p><b>Background</b>: Throughout the twentieth century, Brazil developed a Social Health Insurance, providing coverage to formal workers and their dependents. In 1988, the country implemented a health reform adopting a National Health Service model, based on three core principles, universal coverage, open-ended benefit package and striving for health equity. During this transition, formal workers recomposed their privileged access to healthcare through private health insurance, resulting in a two-tier system represented by those with dual coverage&mdash;public and private&mdash;and those who must rely exclusively on the public insurance. Private health insurance coverage has a positive correlation with income, however, between 1998 and 2008 private coverage expanded vigorously among the poor, while remained stable among the rich. The health equity literature in Brazil consistently reports the presence of relevant inequalities in utilization of health services favoring privately insured individuals. A gap in this literature, however, is to determine whether inequalities in utilization of health services remain among insured individuals, i.e., does private insurance improve access regardless of individuals&rsquo; income? </p><p> <b>Methods</b>: The study relies on Andersen&rsquo;s behavioral model as a theoretical framework to analyze data from two rounds (1998 &amp; 2008) of a national household survey, assessing levels of utilization of fourteen dependent variables across income quintiles and calculating concentration indexes as summary measures of inequality. Dependent variable distributions across income are standardized by need using the indirect method. Concentration curves compare the evolution of inequality during that time. Curve dominance is formally tested between survey years. Decomposition analysis identifies the most relevant contributors to inequality. Physician services are analyzed as the probability of having a physician visit and the number of physician visits. Hospital services are analyzed as the number of hospital admissions, the probability of having a hospitalization, and the number of hospital days during the last hospitalization. The latter two variables are broken down according to their financing source, either public (SUS) or private insurance. </p><p> <b>Results</b>: Physician services present very low inequalities, although a statistically significant positive gradient persists in both survey rounds. Poor PHI beneficiaries have an advantage compared to national levels. SUS financed hospitalizations are a rare phenomenon among privately insured individual but strongly concentrated on the poor. Poor PHI beneficiaries utilize private hospital at lower levels than the rich. Compared at a national level, they are at a disadvantage. In 1998, this was not the case, suggesting that insurers may be developing mechanisms to deter hospital utilization among the poor. Premium value and income are the most relevant contributors to inequality in physician and hospital services. </p><p> <b>Conclusions</b>: The Brazilian government (ANS) needs to monitor utilization levels across income and develop policies to increase accountability of PHI products particularly preventing insurers from purposefully pushing their beneficiaries to use SUS hospitals. Greater availability on insurance policies segmented as ambulatory care only and inpatient services only would increase the range of options for consumers that could sort more adequate coverage according to their capacity to pay and healthcare needs. </p>