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Aug 18, 2012
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“Very diverse, rapid presentations. It was fantastic to be able to get massive exposure to the research being conducted in such a short amount of time.” – Nate Storey, Plenty
“Short and to the point – excellent format for first introduction.” – Keith Wheeler, BASF
“Cornell has unique strength and diversity in DA.” – Kevin Kephart, Indigo Ag
“Cornell is uniquely positioned to bring all key disciplines together to tackle and transform DA.” – Marcos Castro, Syngenta
The Cornell Initiative for Digital Agriculture (CIDA) hosted its inaugural Digital Ag Workshop for 200 people at the Carrier Ballroom in the Statler Hotel on October 9, 2018. The event was titled “Transforming Agriculture and Food Systems,” acknowledging the need for breakthrough interdisciplinary solutions for the problems facing farms of all types and sizes globally, as well as the entire food manufacturing and supply chain.
At the outset of the event, Kathryn Boor, the Ronald P. Lynch Dean of the College of Agriculture and Life Sciences (CALS) introduced the newly named faculty director of CIDA, Susan McCouch, the Barbara McClintock Professor of Plant Breeding and Genetics. McCouch is joined by two associate directors Hakim Weatherspoon, associate professor of computer science and Abe Stroock, professor and director of the Smith School of Biomolecular Engineering. Dean Boor also announced gifts totaling approximately $500,000 from donors to support CIDA, as well as five faculty positions in CALS, to be filled in fiscal year 2019 in DA-related fields.
McCouch, Stroock and Weatherspoon were joined by Steven Wolf, associate professor, department of Natural Resources, and Cornell alum Ranveer Chandra (Ph.D. 2005), principal researcher at Microsoft, in morning keynotes that described research opportunities in DA. The keynotes were followed by a series of talks by Cornell researchers and external stakeholders, and the introduction of Working Groups led by faculty – all highlighting the interdisciplinary nature of DA.
The Working Groups met in breakout sessions and addressed five questions regarding how CIDA and its collaborators can advance agricultural and food systems:
– What are the research or intellectual questions/challenges should be addressed by CIDA
– Are there “signature” (i.e., interdisciplinary and transformative) projects in which CIDA should invest in this coming year?
– What new opportunities does CIDA provide for teaching/ curriculum development and outreach?
– What kinds of interactions/ partnerships should be nurtured or leveraged by CIDA?
– How can we extend our DA network to connect with people doing interesting things in other areas of DA and new sources of funding?
The Working Groups are continuing to meet on an ongoing basis, and welcome others to participate.
8:15am to 9:00am – Badge Pick-up and Continental Breakfast
9:10am to 9:20am –DA Opportunities at Cornell (.pdf) – Susan McCouch, CIDA Director, College of Agriculture and Life Sciences, Barbara McClintock Professor of Plant Breeding and Genetics (with introductory remarks by Lance Collins, Dean of the College of Engineering) video
9:20am to 9:30am – DA Opportunities in Computing and Information Science (.pdf) – Hakim Weatherspoon, CIDA Associate Director, Computing and Information Science, Associate Professor of Computer Science video
9:30am to 9:40am – DA Opportunities in Engineering (.pdf) – Abe Stroock, CIDA Associate Director, College of Engineering, Gordon L. Dibble Professor of Chemical and Biomolecular Engineering, William C. Hooey Director of the School of Chemical and Biomolecular Engineering video
9:50am to 10:00am – DA Opportunities for Cornell-Private Sector Collaboration (.ppt) – Dr. Ranveer Chandra, Principal Researcher, Microsoft Research video
10:00am to 10:30am – Q/A Panel – Boor, McCouch, Weatherspoon, Stroock, Wolf, Chandra video
10:30am to 11:00am – Networking Break
Foundations of DA at Cornell – Systems Analytics, Digital Innovations, Discovery and Design: Session Chaired by José Martínez, Professor of Electrical and Computer Engineering, Computer Systems Laboratory, College of Engineering
Systems Analytics Watch video of 11:00-11:20am here
11:00-11:05am – Computer-Aided Food Manufacturing (.ppt) – Ashim Datta, College of Agriculture and Life Sciences, Professor, Department of Biological and Environmental Engineering.
11:05-11:10am – Computational Sustainability – Carla Gomes, Professor of Computer Science and Director of the Institute for Computational Sustainability, Joint Appointment College of Agriculture and Life Sciences and Computing and Information Science
11:10-11:15am -– Blockchains for the Farm, Food Manufacturers and the Supply Chain (.ppt)– Robbert van Renesse, Computing and Information Science, Professor of Computer Science
11:15-11:20 am – Applying High Resolution Weather and Climate Forecasts to Agricultural Decisions (.ppt) – Art DeGaetano, College of Agriculture and Life Sciences. Professor, Department of Earth and Atmospheric Sciences, Director of the Northeast Regional Climate Center (NRCC)
Digital Innovations Watch video of 11:20-11:35am here
11:20-11:25am – Energy Modeling for Controlled Environment Agriculture (CEA) (.ppt) – Kale Harbick, College of Agriculture and Life Sciences, Department of Horticulture, Cornell CEA
11:25-11:30 am – DA Solutions for Livestock (.ppt) – Julio Giordano, College of Agriculture and Life Sciences, Assistant Professor, Department of Animal Science
11:30-11:35am — Soft Robots for Monitoring High Value Horticulture (.ppt) – Kirstin Hagelskjær Petersen, College of Engineering, Assistant Professor of Electrical and Computer Engineering
Discovery and Design Watch video of 11:35-11:50am here
11:35-11:40 am – Cornell’s Support for Smallholders in the Developing World (.ppt) – Maricelis Acevedo, Associate Director for Science, Delivering Genetic Gain in Wheat (DGGW)
11:40-11:45 am – High Resolution Imaging and Single Cell Genomic Analyses of the Maize Shoot Apex (.ppt) – Mike Scanlon, Professor of Plant Biology, School of Integrative Plant Science, College of Agriculture and Life Sciences
11:45- 11:50 am – Genetic control networks for provitamin A levels in maize grain (.ppt) – Mike Gore. College of Agriculture and Life Sciences, Associate Professor of Molecular Breeding and Genetics for Nutritional Quality, Liberty Hyde Bailey Professor, International Professor of Plant Breeding and Genetics
11:50am-12:00pm — Q/A Panel – Datta, Gomes, van Rennesse, DeGaetano video
12:00am-12:15pm — Q/A Panel – Acevedo, Harbick, Giordano, Petersen, Scanlon video
12:15pm to 1:15pm – Networking Lunch
1:15-2:00 pm –Introductions to Interdisciplinary DA Working Groups
- Rapid Phenotyping: Mike Gore, College of Agriculture and Life Sciences, Associate Professor of Molecular Breeding and Genetics for Nutritional Quality, Liberty Hyde Bailey Professor, International Professor of Plant Breeding and Genetics This group explores the limits of DA (new sensors, models and computational techniques) to reliably bridge the genome-phenome gap on a wide variety of dimensions (environment, management and microbe).
- Socioeconomic Analysis for Digital Agriculture: Steven Wolf, College of Agriculture and Life Sciences, Associate Professor, Department of Natural Resources We address the social and economic coordination challenges that structure the potential of digital technologies. This work addresses strategic behavior attached to hoarding and pooling of data, and we analyze a variety of models for structuring data access, privacy, and oversight. We are interested in interactions between farmers and off-farm service providers in the application and continuing development of digital tools for agricultural production and environmental protection. Based on engagement with relevant histories, we aim to advance analysis and dialogue around questions of whose vision and problem definitions inform technological designs, how benefits are distributed, and which people and places are disrupted by digital technologies in agriculture.
- Weather, Climate and Agriculture: Abe Stroock, College of Engineering, Gordon L. Dibble Professor of Chemical and Biomolecular Engineering, William C. Hooey Director of the School of Chemical and Biomolecular Engineering In the lab and in the field, this group seeks to discover new paradigms for sustainable agricultural management enabled by the integration of newly available and anticipated data streams (via novel in situ and remote sensors and methodologies) with emerging multi-scale hybrid models of crop and climate.
- The Software-defined FarmTM: Hakim Weatherspoon, Computing and Information Science, Associate Professor of Computer Science The SDF is being designed to work for large and small-scale farms; for farms with significant, limited, or even absent internet connectivity; and for farms with varying types of digitally controlled infrastructure, such as sensors, autonomous vehicles, or robots. SDF supports a systems engineering framework to enable data-driven machine learning and artificial intelligence (AI). The SDF actively manages a hybridization of cloud, edge and local compute resources.
3-min intro by WG leader, plus three 2-min Lightning Talks per group
1:15pm to 1:25pm – Working Group 1: Socioeconomic Analysis for Digital Agriculture (.pdf) – Steven Wolf
WG 1 Lightning Talks: David Schimmelpfennig (USDA-ERS), Prof. Karen Levy (Cornell), Marcos Castro (Syngenta)
1:25pm to 1:35pm – Working Group 2: Next Gen Phenotyping (.ppt) – Mike Gore
WG 2 Lightning Talks: Prof. Margaret Frank (Cornell), Dani Martinez (Cornell), Margaret Krause (Cornell)
1:35pm to 1:45pm – Working Group 3: Weather, Climate and Agriculture (.ppt) – Abe Stroock
WG 3 Lightning Talks: Prof. Ying Sun (Cornell), Prof. Jan van Aardt (RIT), Dr. Terry Bates (Cornell Lake Erie Research and Extension Lab)
1:45pm to 2:00pm – Working Group 4: The Software-defined FarmTM (.ppt) – Hakim Weatherspoon
WG 4 Lightning Talks: Nicholas Kaczmar (Cornell), Chris Layer (Moog), Prof. Mike Van Amburg (Cornell), Prof. Fengqi You (Cornell), Natalia Nelyubina (IBM), Prof. Kristan Reed (Cornell)
2:00 to 5:00pm – Working Group Breakout Session
2:00pm to 3:00pm – Working Group Breakouts (Discussion)
3:00pm to 3:30pm — Networking Break
3:30pm to 4:00pm – Working Group Breakouts (Prepare Readouts)
4:00pm to 5:00pm – Working Group Readouts to Entire Audience, Wrap Up and Next Steps video
5:15pm to 8:00pm – Networking Reception


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CONSENSUS WORKSHOP SESSIONS
Alcohol, Tobacco, and Other Drugs: Future Directions for Screening and Intervention in the Emergency Department Rebecca M. Cunningham, MD, Steven L. Bernstein, MD, Maureen Walton, PhD, Kerry Broderick, MD, Federico E. Vaca, MD, Robert Woolard, MD, Edward Bernstein, MD, Fred Blow, PhD, and Gail D’Onofrio, MD
Abstract This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on ‘‘Public Health in the ED: Screening, Surveillance, and Intervention.’’ The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening—develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention—conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups—conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies— a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and followup; and d) examine alternatives to specialized treatment referral. 5) Translation—conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice. ACADEMIC EMERGENCY MEDICINE 2009; 16:1078–1088 ª 2009 by the Society for Academic Emergency Medicine Keywords: substance abuse, emergency department, screening, intervention, public health
From the Department of Emergency Medicine, University of Michigan, and the Department of Health Behavior and Health Education, School of Public Health Injury Research Center (RMC), Ann Arbor, MI; the Department of Emergency Medicine, Yale University, School of Medicine (SLB, GD), New Haven, CT; the Department of Psychiatry, University of Michigan (MW, FB), Ann Arbor, MI; Denver Health Medical Center ⁄ University of Colorado at Denver (KB), Denver, CO; the University of California, and the Center for Trauma and Injury Prevention Research (FV), Irvine, CA; Texas Tech University, Health Sciences Center, School of Medicine (RW), El Paso, TX; and the Department of Emergency Medicine, Boston University School of Medicine (EB), Boston, MA. Received June 15, 2009; revisions received June 25, June 30, and July 7, 2009; accepted July 9, 2009. Address for correspondence and reprints: Rebecca M. Cunningham, MD; e-mail: [email protected]
This work is the output from a consensus workshop conducted during the May 2009 AEM consensus conference in New Orleans, LA: ‘‘Public Health in the ED: Surveillance, Screening, and Intervention.’’
ISSN 1069-6563 PII ISSN 1069-6563583
ª 2009 by the Society for Academic Emergency Medicine doi: 10.1111/j.1553-2712.2009.00552.x
ACAD EMERG MED • November 2009, Vol. 16, No. 11
his paper is a product of a breakout session on screening and brief intervention (SBI) for alcohol, tobacco, and other drugs from the 2009 Academic Emergency Medicine consensus conference on ‘‘Public Health in the ED: Screening, Surveillance, and Intervention.’’ The U.S. Preventive Services Task Force (USPSTF) has given tobacco SBI a grade A recommendation1 and strongly recommends that clinicians provide this service to eligible patients in primary care. They found good evidence that tobacco screening, brief intervention, and referral to treatment (SBIRT) improves important health outcomes and conclude that benefits substantially outweigh harms. The USPSTF found at least fair evidence that alcohol SBI improves important health outcomes. They conclude that benefits outweigh harms, giving it a grade B recommendation, but add that the evidence is insufficient to recommend for or against screening and behavioral counseling interventions to prevent or reduce alcohol misuse by adolescents in primary care settings.2 Building on this knowledge, the current working group and breakout session participants developed recommendations and future research questions for alcohol, tobacco, and other drugs: screening and intervention in the emergency department (ED). BACKGROUND Over 2 million ED visits in 2006 (2.3%) were related to either the patient’s use of alcohol, another person’s use of alcohol, or both according to the National Hospital Ambulatory Medical Care Survey.3 The Drug Abuse Warning Network4 notes more specifically that among 1.7 million ED visits in 2006 related to drug misuse ⁄ abuse, illicit drugs accounted for 31%, and nonmedical use of prescription drugs accounted for another 28%; 7% were related to consumption of alcohol alone by a minor, and 34% were a combination of illicit drugs, alcohol, and ⁄ or nonmedical use of prescription drugs. ED patients are more likely than primary care patients or the general population to report misuse of alcohol,5–7 drugs,8 and tobacco.9,10 Prior research notes at least 25% of all adult ED patients screen positive for hazardous or harmful drinking.11,12 The prevalence of tobacco use among ED patients is as high as 48%.9,10 In one study, 4.9% of all adult visits, 6.8% of all admissions, and 10.0% of all ED charges were smoking-attributable.13,14 Rockett et al.8 found that rates of current substance use disorders were 14.7%, and they are systematically underreported by patients. Overall, rates of substance use in the ED range from 4% to 47%, depending on the definitions and methodology used.8,15 Many patients seen in EDs have at-risk or problem alcohol use.16,17 However, alcohol screening is limited, and even fewer patients undergoing routine care receive interventions to cut back or stop drinking.8 Recently, in response to increased awareness and research on the ‘‘teachable moment,’’18 the American College of Surgeons mandated alcohol screening among admitted trauma patients for Level 1 and 2 trauma centers.19 Despite this progress, when screening does occur in routine clinical ED settings, it often consists of obtaining a biomarker, such as blood
alcohol level, from a subset of patients based on clinical concern. However, blood alcohol concentrations and biomarkers fail to detect the majority of patients with alcohol problems.20,21 There is currently little or no routine screening for drug use in the ED setting, likely resulting from the lack of brief drug-screening tools available and a lack of evidence-based data regarding the efficacy of ED-based drug interventions.22 In addition, despite strong evidence in favor of routine tobacco screening, rates of actual screening are low: from 32.5% to 56%.23,24 The ED is an important entry portal into the medical care system, especially for underinsured and uninsured patients who may have decreased access to other sources of medical care.23,25 Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. CURRENT STATE OF KNOWLEDGE: RESEARCH ON ED-BASED BIs FOR SUBSTANCE USE Alcohol To address the need to identify patients with unhealthy alcohol use, and to narrow the gap between patients in need of treatment and those actually receiving services, a comprehensive integrated public health approach for the delivery of alcohol BIs has been developed: SBIRT. This model has been recommended for use in EDs,26 inpatient trauma units,19 primary care settings,27–30 and other health care settings.27–31 It has been endorsed by the National Institute of Alcohol Abuse and Alcoholism (NIAAA), the Centers for Disease Control and Prevention (CDC), the National Highway Traffic Safety Administration, and the Committee on Trauma of the American College of Surgeons.32 Since 2003, the Substance Abuse and Mental Health Service Administration (SAMHSA) has provided funding to 11 states, six residency training programs, and 12 campuses. The recommended BI consists of a short interactive session, ranging from 5 to 60 minutes, and incorporates feedback, advice, and motivational enhancement to assist the patient in reducing substance use to lower risk of future illness and injury. These interventions have been found to be feasible to perform in the ED setting by routine ED clinical staff.33 With these recommendations in place, SAMHSA has funded multiple state efforts to incorporate SBIRT for unhealthy alcohol use more widely into EDs and to develop practical protocols for best practices.34 Despite the enthusiasm around SBIRT, evidence regarding the efficacy of BIs in the ED has been mixed.35–42 Several studies demonstrated a beneficial effect on negative consequences.35,38,42,43 While the Academic SBIRT trial, using a quasi-experimental methodology, found reduced consumption at 3 months,12 effects on decreasing alcohol consumption have not been consistent in other studies.35 Further confounding interpretation of the evidence is that the published studies include a wide variety of patient populations: some only young adults,44 many only with injured patients.45
Cunningham et al.
FUTURE DIRECTIONS FOR SCREENING AND INTERVENTION IN THE ED
Tobacco Few rigorously conducted randomized trials of EDbased tobacco control interventions have been published. A recent study of 543 smokers in an ED chest pain unit found that a tailored motivational interview (MI) with follow-up telephone BI sessions, coupled with initiation of nicotine replacement therapy (NRT) patch, found positive intervention effects on cessation rates at 1 month,46 but no difference between groups at the primary 6-month end point. Bernstein et al.23,47 found that an intervention consisting of a 1-hour lecture to providers, and placement of wallet cards in the ED promoting smokers’ quit lines, increased screening rates from 32.5% to 46.0% (p < 0.001) at eight EDs among 1,168 patients treated by 207 physicians. Finally, a study of 90 patients at a single urban ED showed no difference in self-reported abstinence rates at 3 months, although the study was underpowered.48 Data from these studies suggest that even low-intensity SBIRT may prompt quit attempts, decreased cigarette use, and quitting, if offered routinely to ED smokers. Bernstein et al.49 randomized 338 adult smokers being discharged from the ED to usual care or a multicomponent intervention consisting of a MI, 6 weeks of NRT, and a booster telephone call. Both arms showed similar cessation rates at 3 months, proportions of patients making a quit attempt, and decreases in daily cigarette use. In multivariate logistic modeling, factors associated with quitting included any tobacco-related ICD9 code for the ED visit or patient belief that the ED visit was tobacco-related. The negative primary end point reflected a higher-than-expected quit rate in the control group, perhaps because the control arm’s assessment and brochure still provided a stronger intervention than what ED smokers normally receive. Drugs A number of studies recommend BIs for illicit drug use;50–55 however, there are few published randomized controlled BI trials with illicit substance users in any clinical setting. Promising treatment results have been shown in studies investigating the effectiveness of BIs among cocaine, heroin, and amphetamine users in non– ED-based settings.56–59 Stotts et al.58 found positive results from a brief MI delivered to cocaine users in a BI outpatient detoxification treatment program. Bashir et al.60 found positive results from a BI delivered by a primary care provider. Similarly, positive results have been reported from brief motivational interventions in cannabis-dependent adults.54,61–63 Bernstein et al.64 reported that a BI for heroin and ⁄ or cocaine users recruited from several nonemergent clinics led to a reduction in heroin and cocaine use and an increased likelihood of abstinence from these drugs at the 6-month follow-up visit. The BI included a motivational intervention session delivered by trained peer educators and a subsequent BI booster call. The only ED-based study on drug BI,57 which included an active referral process, resulted in a 45% reduction in severity of drug problems among patients who kept their follow-up treatment appointments. However, this study’s conclusions are limited by the lack of a control group and a 22% follow-up rate.
It is important to understand the methodologic issues of both positive and negative studies of alcohol, tobacco, and drug SBIRT in the ED, as well as in other settings, to assist future researchers in developing efficacious interventions that can be optimally delivered and generalizable to all EDs. Many methodologic challenges remain in SBIRT research in the ED, such as assessment reactivity and the creation of procedures in obtaining credible and ethical control groups. Institutional review boards are becoming increasingly concerned regarding traditional ‘‘standard care’’ control groups, particularly for sensitive issues such as illicit drug use or with special populations, such as adolescents or pregnant women. Another workshop at the consensus conference dealt specifically with study designs for public health research.65 In summary, to date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed. As a result, there are more questions remaining than answered. RECOMMENDATIONS AND UNANSWERED QUESTIONS FOR SBIRT IN THE ED Recommendation 1: Screening Develop and validate brief and practical (feasible, efficient) screening instruments (particularly for illicit and prescription drug use, tobacco use, polysubstance use, and other risky health behaviors) for ED patients and determine the optimal method (technology-assisted; physician ⁄ nurse ⁄ social worker, peer educator, behavioral specialist, etc.) for administration of screening instruments. A large body of literature exists on screening for alcohol misuse in the ED across many different populations.66,67 Two tools have been validated in ED research settings: the 10-item Alcohol Use Disorders Identification Test (AUDIT),68 which assesses alcohol consumption and presence of at-risk drinking, and the three-item AUDIT-C,69,70 which assesses alcohol consumption only. Recent literature71,72 supports the internal consistency, test–retest reliability, and validity of the AUDIT-C in identifying at-risk or hazardous alcohol use. Several studies suggest that it is the optimal instrument for medical settings,69,73–75 but this is not without controversy in the literature.69,76,77 Although there are a variety of efficacious screening instruments,39,42,56,78,79 their effectiveness when implemented in the clinical setting varies, not only in light of their test characteristics, but also because of factors such as ease of administration in routine clinical care. For example, the AUDIT is long and needs to be scored. Therefore, its implementation is difficult when administered by clinical staff, but it has utility in the ED when self-administered via computer.80,81 The NIAAA Physicians’ Guide, developed for use by primary care physicians, recommends using the CAGE questions followed by questions concerning both quantity and frequency as a brief assessment for clinical use.82 This screen also has been integrated into a tool kit on the American College of Emergency Physicians’ website.83
ACAD EMERG MED • November 2009, Vol. 16, No. 11
There is no standard tool for screening for tobacco use in clinical settings. Current screening practices include simple queries such as, ‘‘Do you smoke?,’’ or ‘‘How much do you smoke?,’’ which may be adequate for the ED setting. In clinical trials, patients are often screened with two items from the CDC’s Behavioral Risk Factor Surveillance System (http://www.cdc.gov/ BRFSS/) and National Health Interview Survey (http:// www.cdc.gov/nchs/nhis.htm) endorsing lifetime use of ‡100 cigarettes and being an every- or some-day smoker. Routine screening for tobacco use is not standard of care in the ED and can be improved. No studies have adequately evaluated screening tools for drug use in an ED setting. Often a single question such as, ‘‘Do you use illicit drugs?’’ followed by a litany of specific drugs, is used. The National Survey on Drug Use and Health asks if one has used ‘‘a prescription drug that was not prescribed for you or that you took only for the experience or feeling it caused?’’ Recently, the World Health Organization sponsored a seven-country study that developed an eight-item screening instrument for at-risk use of psychoactive substances: the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST 3.0).84 The ASSIST assesses substancerelated problems for multiple substances. Although the ASSIST may have utility in ED substance use research, this is a multipage instrument requiring scoring, and it is not ideal for translation into the ED clinical practice setting. Recently, the National Institute on Drug Abuse (NIDA) has modified the ASSIST85 for clinical applicability entitled NIDAMED. This shorter version integrates drug, tobacco, and the NIAAA alcohol quantity and frequency screen and needs to be evaluated in the ED.85 Finally, there is a need to develop and validate a single instrument that assesses multiple risk behaviors that often co-occur, including polysubstance use. Emergency department–based screening practices vary considerably in how they are delivered, including 1) ED clinical care provider performing screening during the course of routine duties (nurse, physician assistant, physician, etc.); 2) research staff; 3) paid or volunteer peer educator; or 4) computer. Which method is most effective at screening patients in the ED has not been determined. More information is needed on the barriers associated with these different methods, as well as their validity among special populations, including youth. Recommendation 2: Key Components and Delivery Methods for Intervention Conduct research on the effectiveness of SBIRT in the ED, including strategies for addressing polysubstance use, on outcomes such as consumption, associated risk behaviors, and medical and psychosocial consequences (criminal justice, education), including: • Minimum effective dose (length of session, booster sessions); • Key components (motivational interviewing, feedback, adjunct pharmacotherapy, role of parents ⁄ caregivers ⁄ significant others ⁄ spouse);
• Optimal delivery method (technology assisted; physician ⁄ nurse ⁄ social worker, peer educator, behavioral specialist, etc.), as well as measurement of fidelity of intervention; • Interventions focused on multiple risk behaviors, as well as the effect of interventions tailored, based on assessment; • Strategies for addressing polysubstance use. Alcohol. While some recent ED-based alcohol BIs can be delivered in only 5 to 10 minutes,42 others are as long as 30 to 45 minutes.42,43 Some studies have utilized supplemental patient contact (booster sessions) in the hope of enhancing the intended effect.26,36,38 For example, Longabaugh et al.38 provided a booster session for participants ages 18 years and older within 7–10 days post–ED-based BI; 69% returned for the booster. Using an intent-to-treat analysis, the BI plus booster group significantly reduced their alcohol-related consequences compared to the control group. Post hoc analyses indicated that attendance at two sessions (compared to one) resulted in better outcomes and that therapists’ emotional support increased compliance with the booster.86 Among adult substance use treatment samples, findings for brief treatment (e.g., two to four sessions) compared to extended treatment (seven to eight sessions) show insignificant to very small effect sizes for extended treatment.87 Intervention deliveries that take place after (via telephone, computer, or in person) rather than during the target ED visit may not be taking advantage of the teachable moment, although it is unclear if the teachable moment can be extended to a post-ED intervention. Further, these booster BIs are limited by lack of compliance. Nonetheless, augmenting ED-based BIs with postdischarge additional brief treatments (e.g., case management) may be appropriate for patients with substance use disorders and ⁄ or concurrent mental health and social service needs and has shown promise.88 Tobacco. The dose of an intervention (number of sessions, efficacy of booster sessions, etc.) needed to prompt a quit attempt versus a successful quit is not clear. What is the expected efficacy of one-time ED interventions, particularly when a recent Cochrane review of tobacco treatment for hospitalized smokers determined that at least 1 month of outpatient booster intervention is needed to produce sustained quitting? The feasibility of NRT in the ED remains to be determined. A better understanding of what key components of the BI are most efficacious in ED patients across all substances is needed. Recent theory and empirical findings have highlighted the mechanisms by which motivational interviewing–based interventions facilitate behavioral change.89–93 Specifically, there is evidence that use of specific MI-adherent behaviors (e.g., Openended questions, Affirmations, Reflections, Summary statements [OARS]) tends to reduce resistance and increase participant change talk; that change talk leads to commitment talk (e.g., ‘‘I’m going to reduce my
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drinking’’); and that commitment talk predicts clinical outcomes.27–29 However, in their review of ED-based alcohol BI, Havard et al.35 found that only 8 of 13 studies incorporated principles of motivational interviewing. Finally, research and theories on mechanisms for behavior change in other settings illustrate that the likelihood of change can be enhanced by increasing motivation, coupled with elicitation of commitment ⁄ intentions to change and developing a specific behavioral change plan.28,89 Consistent with these notions, provision of a ‘‘full’’ BI (those that incorporate MIadherent behaviors) results in significantly greater reductions in average alcohol consumption and binge drinking compared to provision of feedback only.93 Research on combining BI strategies with pharmacologic treatment to patients in the ED, or including parents ⁄ caregivers or significant others ⁄ spouse, in the BI have not been evaluated and may improve outcomes. The optimal method of intervention delivery (face–face or technology assisted) as well as the most effective messenger type (physician, nurse, behavioral specialist, social worker), and whether effectiveness varies by patient subgroup, has yet to be determined and requires further study. With the exception of computer-based BIs, personnel have a variable level of baseline skill, training, belief in efficacy of BI, and interest in delivering all the components of BI. These inherent differences in operationalizing intervention delivery may contribute to mixed study results. Future research efforts must incorporate measures of fidelity to the intervention. Tools such as the use of workbooks94,95 may foster content adherence and should be investigated for further use as an aid to maintaining fidelity. In the past decade, growing time constraints in the ED have prompted integration of other communication technologies (telephones, computers) to facilitate ED SBIRT delivery.80,96–98 Evidence supports the efficacy in some settings of computer-based motivational interventions for smoking cessation in adults99 and for the prevention of alcohol and ⁄ or drug use in young adults.100–108 Computers have the potential to bridge the gap between the evidence base for brief alcohol interventions and the widespread use of these best practices in clinical care. Computerized SBIRT may not only help relieve time and resource challenges, but may also facilitate SBIRT program fidelity and integrity. At the same time, computerized solutions will need to overcome obstacles such as securing personnel to oversee the hardware and preventing patients from subverting programs to use the Internet. Although it is not yet clear which SBIRT delivery method will yield the greatest effect, using computers, Web-based programs,109 and other technology holds considerable promise in other settings and should be rapidly evaluated both for primary efficacy and as an aid for translation in the ED. BIs are often developed to change a single behavior. However, risk-taking behaviors tend to cluster in predictable ways in an individual (e.g., substance misuse, lack of seatbelt use, violence).110 Therefore, there is a need to develop, test, and implement ED-based BIs that focus on multiple risk behaviors. Furthermore, as ED-based BIs expand to include multiple
risk behaviors such as polysubstance use, injury, sexually transmitted infections, and mental health screening, there is an increased need to look at costeffective and theoretically sound approaches to tailoring intervention content to be the most salient for an individual patient or the most likely to improve health outcomes. Recommendation 3: Effectiveness Among Patient Subgroups 1) Conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness (e.g., age, sex, readiness to change, self-efficacy, level of substance use problem severity, how substance use was implicated in reason for ED visit, and factors related to resiliency). 2) Conduct SBIRT research among special populations: examine culturally and developmentally appropriate interventions (adolescents, college students and young adults, vulnerable racial ⁄ ethnic groups, pregnant women, and older adults). Alcohol. Research on potential moderators of alcohol BIs among ED patients is nearly absent in the literature. There is some evidence that age moderates BI effectiveness in non-ED settings.29 A recent study determined that the motivational interviewing component of BI was more effective than personalized feedback only among young adults (ages 18–24 years) in the ED.93 The outcome of ED-based BI may also vary by sex.111 Although readiness to change and self-efficacy have been conceptualized as important factors in predicting response to a BI,90 few studies have focused on this issue. ED studies demonstrate a positive relationship between self-efficacy or stage of change and alcohol use over time.80,112,113 When examined as moderators of outcome in ED-based studies, however, stage of change and self-efficacy have had little impact on the effectiveness of BIs.44,114 ED-based studies have included participants with a wide spectrum of baseline consumption, from presenting to the ED with an injury and a positive blood alcohol level, without other criteria for misuse, to dependent drinkers. Several studies have limited the inclusion criteria to patients with relatively low levels of consumption, excluding the most severe drinkers. The emphasis on lower-level consumption (i.e. at-risk ⁄ hazardous drinkers) may diminish the ability to detect intervention effects.29 Some studies suggest that baseline drinking status may moderate the effect of an ED BI: those with greater quantity and frequency of alcohol consumption at baseline had larger reductions in their alcohol use at 12 months if they received a BI.39,114,115 Heavy drinkers are those most likely to have experienced negative consequences and, as a result, represent a group that may be particularly responsive to BIs. Expert consensus groups have called for the inclusion of alcohol-dependent patients in the spectrum of future ED SBIRT research.37 A key next step is determining the minimum, maximum, and moderating effects of the patient’s consumption level.
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Another potential moderator is the extent to which alcohol prompted the ED visit116,117 and whether injury severity moderates intervention effectiveness. In one study among patients with a history of heavy or harmful drinking, drinking at the time of the current injury did not affect the effectiveness of the intervention.38 The ED SBIRT research collaborative study did not show differential effects of the BI among those with and without injury.56 Yet in another study, attributing the current injury to alcohol appeared to improve BI outcomes for those patients who related their ED visit to their alcohol use.113 This finding is consistent with Barnett et al.,116 who found that an alcohol-related incident was associated with greater motivation to change. Tobacco. Should interventions be targeted toward patients presenting with a tobacco-related problem, like chest pain or asthma? Studies to date show that ED patients with negative consequences of tobacco use are more likely to be asked about their tobacco use than those presenting with non–tobacco-related problems.23,24 There are some preliminary data to support the idea of targeting interventions toward smokers with negative consequences of smoking: a clinical trial found that patients with a tobacco-related ICD9 code or who believed that their ED visit was related to tobacco were more likely to quit.49 Drugs. To our knowledge, there is no research on moderators of drug BI among ED patients. Research is needed to identify if principles of BI can be applied successfully to drug use, which type of drugs, and how to address the issue of polysubstance use in intervention and outcome measurement. Across all substances there is a need for research among special populations. Adolescence is a critical period for the initiation of alcohol use,118–120 with earlier age of onset increasing the risk for development of an alcohol use disorder.121,122 There is a need for research targeted at adolescents and young adults, as results of BI studies among adults should not be generalized to underage drinkers who have a unique developmental trajectory.123 Although recent studies have validated measures for alcohol screening,124 screening measures for illicit drug use among adolescents are needed. Studies also are needed to assess the interrelationship among problem behaviors (i.e., alcohol, illicit drug use, prescription drug use, violence, sexual risk behaviors) and how such multiple risk behaviors impact trajectories over key developmental transitions (e.g., entering high school, high school graduation rates, and the transition to college ⁄ work force). It is important to determine the optimal timing of BIs (ED visit only, ED visit plus postdischarge BI) to maximize effectiveness in terms of decreased alcohol use and improved health behaviors in adolescents and young adults. There remain questions as to whether the positive effects noted in some studies with SBIRT will generalize effectively to EDs that treat predominantly vulnerable racial ⁄ ethnic groups. Currently, there is a paucity of ED SBIRT published work in this area. Finally, it can be assumed that the success of an SBIRT program will weigh heavily on the commitment of referral resources
offered to follow ED-based activities. Therefore, for the full SBIRT model, including the referral component, to be efficacious culturally and linguistically sound, ED and community resources are needed. Recommendation 4: Referral Strategies 1) Promote prospective cohort and comparative effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment. 2) Examine the impact of available community services and whether they are culturally appropriate. 3) Examine the role of stigma of referral and follow-up. 4) Examine alternatives to specialized treatment referral (i.e., ED-based pharmacotherapy or multisession intervention strategies or colocating services in the ED, post–acute care). Additional studies are needed to determine which intervention components and at which location (ED visit and ⁄ or post–ED visit) are most effective. As noted by Havard et al.,35 among 13 ED studies reviewed, none fully tested all SBIRT components, and only one provided a second session. Another study found that rates of attendance to a post–ED BI were 69% when a BI was offered during the ED visit.125 Research should focus on what strategies facilitate completion of linkage to post-ED services and how the availability of culturally appropriate community services, and the role of patient-perceived stigma, affect successful completion of the referral process. Finally, research is needed to determine possible effective alternatives to specialized treatment referral (i.e., ED-based pharmacotherapy multisession post-ED sessions, or colocating services in the ED with an addiction specialist post–acute care). Recommendation 5: Translation Conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, barriers to successful implementation, additional training needed, and cost-effectiveness, to move ED SBIRT from research to practice. In light of the promising results of BIs for alcohol and the critical need to address substance use in the ED, national organizations such as the American College of Emergency Physicians (ACEP) and the American Medical Association have called for routine screening and intervention for alcohol problems among ED patients. To encourage this, in 2008 the Centers for Medicare and Medicaid Services created new reimbursement codes for substance use SBIs for Medicaid and Medicare recipients. This will enhance the potential for more widespread use of SBIRT techniques in the future, particularly in high-volume ED settings. Despite this laudable progress and incentive structure, as well as research demonstrating that it is feasible for ED practitioners to perform BI during the course of the ED visit,33 SBI among ED patients during routine clinical care is still far from widespread. More research is needed to understand possible barriers to widespread
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implementation, such as multiple demands on the time of providers and lack of skilled providers available. If clinical providers (physicians, physician assistants, nurse practitioners) are unwilling or unable to deliver SBIRT in a feasible manner, there is a need to identify and to train other personnel to deliver the intervention, such as nurses, social workers, etc. What is the best way to train these skills? Do health care workers providing substance use interventions need formal training in motivational interviewing? If so, how should this be accomplished? Research is needed on the feasibility of integrating motivational interviewing ⁄ brief negotiated interview techniques for alcohol use problems and other medical conditions in the core curriculum of emergency medicine residencies or in the undergraduate medical education curriculum. Training in motivational interviewing skills around substance use interventions may have beneficial value to other patient–physician discussions (e.g., explaining the need for taking meds, lifestyle modification following discharge instructions). Will incorporating other uses for motivational interviewing increase the acceptability of SBIRT by health care workers? Recent cost–benefit studies show that the average ED alcohol screening plus BI costs $632 per patient,126 with the majority of the cost attributed to the personnel needed to complete the screening process ($497), and identify those in need of intervention. Alcohol SBIs have the potential to reduce costs associated with injury and other alcohol-related health consequences, resulting in a savings of $3.81 for every $1 spent in trauma settings,127 with similar findings for primary care samples ($4.30 for every $1 spent128). Unlike data regarding potential cost savings from alcohol SBIRT, approaches for illicit drug use and psychoactive prescription drug use are lacking, given the early phase of drug-related SBIRT. More research on drug SBIRT in the ED is needed prior to the cost analysis research that will be needed to guide future drug SBIRT implementation. Despite extensive data of the cost-effectiveness of tobacco dependence treatment in non-ED settings,129 costeffectiveness of ED-initiated tobacco dependence treatment needs to be evaluated. CONCLUSIONS Despite laudable progress over the past decades in ED-based substance use screening and intervention, studies show modest efficacy with some heterogeneity of results. Research in screening, brief intervention, and referral to treatment in the ED has advanced most quickly in the area of alcohol and tobacco, with recent increase in momentum in application to drug misuse and abuse. Additional challenges remain in elucidating the most effective timing, intensity, and delivery of BIs to ED patients with substance use disorders. There remains considerable opportunity not only to move relevant research efforts and activities forward, but also to translate findings in a manner that could positively influence the public’s health in an intentional and meaningful way.
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domain: medical


In a preliminary look at the Village of Lansing budget for the next fiscal year, Trustees overrode the tax cap in preparation for an estimated rise in its tax rate by 20 cents per thousand dollars of assessed property value. Mayor Donald Hartill told Village Trustees that major capital projects have spent down reserves to what will be unsustainable levels if an upward adjustment in property taxes is not implemented.
"We're spending down our capital reserve funds at a rate that is not sustainable over the long haul," Hartill said. "As a result I am proposing to increase the tax rate from $1.10 to $1.30 to partially offset that. In fairness, we've had several big projects in the last couple of years -- a new garage, the Village Hall, redoing Triphammer Road... this past year we made a fair amount of progress on Northwood Road... Bush Lane... several big projects."
Hartill said that other revenue sources such as sales and gross utilities taxes have flattened, and franchise fees have also remained stable. But with upcoming expenditures on improvements to Nothwood Road, a new park in the Northwood neighborhood, a sidewalk on Uptown Road, and equipment replacement costs, Hartill said Village reserves will be depleted even more than they have been.
"We're taking about $600,000 out of the capital reserve fund," he said. "That's not sustainable, so we're going to have to somehow spread out our projects to try to address that. I don't see raising the tax rate much more. We may have some increase in our assessment, but this year our assessment went down slightly."
For the owner of a $200,000 house the tax rise will mean an additional $40 for Village taxes if Hartill's initial estimates hold in final budget. On top of that Village officials expect the Village surcharge on water service will also rise from $1.11 per thousand gallons of water to $1.77 per quarter, adding $26.40 to Villagers' annual water expense for minimum water users.
While capital and water reserves need replenishing, Hartill noted that the sewer reserve has reached levels to which it has become necessary to plan ways to spend it. He outlined a two piece plan that will mean better sewer handling south of Route 13 plus a study to determine how best to expand the sewer district in the Village. The existing sewer fix would require a partnership with the Village of Cayuga heights to bypass an issue on the Lansing side by hooking into the Cayuga Heights sewer at a new location, bypassing the current problem area. The engineering study would determine how best to approach expanding unsewered areas of the Village.
"As part of that package would also be a change in the minimum lot size for the newly sewered areas," Hartill explained. "It would remain the same for the current sewer districts, but the newly sewered areas would change the minimum lot size from 30,000 square feet to 45,000 square feet, which is half way between the 30,000 and 60,000 for the unsewered district."
Trustee Ronny Hardaway said that unexpected expenditures on a Village park would mean budgeting $175,000 for parks, $25,000 more than originally expected. Replacing a dangerous child play structure in the Village Park on Uptown Road meant holding back on a portion of a plan for a new park near Northwood Road. Superintendent of Public Works John Courtney said that a parking area for the park and a barrier between the parking area and the park itself would most likely have to be postponed until the next building season.
"Looking at the future, I don't expect to see those big projects recurring any time soon," Hartill said. "But we have to be in a stable long term pattern, so increasing the tax rate is part of that. We stabilize that, and then we have to come to grips with the expenditure side also."
The Trustees are expected to begin a line by line analysis of the proposed budget at its March 20th meeting.


text:
The best rebuke to the Biden administration's inhumane border policies is for Republican governors to welcome migrants into their states.
The governor flew dozens of Venezuelans to Martha's Vineyard at taxpayer expense, even though they fled a regime he says "is responsible for countless atrocities."
A Psychiatric Facility Punishes Residents With Painful Electric Shocks. Now It's Trying To Sue Its Critics.
The Judge Rotenberg Center, which has been condemned by the UN Special Rapporteur on Torture, is suing a small nonprofit for defamation after they published a survey critical of the school's practices.
Brayton Point was a coal-fired plant that tried to clean up its act. Protesters and politicians demanded its closure. A new offshore wind project won't be sufficient to replace it.
But does not declare that it is a "national emergency."
Several states are retaining subjective criteria for carry permits or imposing new restrictions on gun possession.
State Reactions to the SCOTUS Ruling Against Discretionary Carry-Permit Laws Range From Compliance to Defiance
Some states promptly eliminated subjective standards, while others refused to recognize the decision's implications.
The fine print of the latest alcohol regulation proposal in Massachusetts is revealing.
On Wednesday, a Massachusetts judge will decide whether Joao DePina will face the possibility of a decade behind bars for publicly criticizing a district attorney.
Research on the effects of Oregon's loosening of its self-service gas ban finds that allowing adults to pump their own gas increases supply and lowers prices.
Legislators in New Jersey and Oregon keep failing to repeal their states' bans on self-service gas stations. Is Massachusetts' small town direct democracy the solution?
Rochelle Walensky says "now is not the moment" to stop forcing masks on children. Democratic politicians increasingly disagree.
Malinda Harris’ ordeal shows how easily the government can take innocent people’s property under civil forfeiture laws.
It's oppressively hard, if not impossible, to sell homemade food in the Bay State. One lawmaker proposes massive regulatory reform.
The city's solicitation of public input on the demolition of shacks, sheds, and boarded up homes is an invitation for NIMBYism.
Five men face "trafficking a person for sexual servitude" charges after meeting an undercover cop at a hotel.
A Massachusetts Commission Recommends Long-Overdue Reforms to the 'Worst Civil Forfeiture Laws in the Country'
The commission says the legislature should raise the standard of proof and remove the financial incentive that encourages cops and prosecutors to pursue profit instead of public safety.
The ban hasn't prevented deadly drunk driving incidents, but it is hamstringing bars and restaurants hurt by COVID shutdowns.
Defense lawyers say they were accused of smuggling drugs to clients based on tests so unreliable they're akin to "witchcraft, phrenology or simply picking a number out of a hat."
Much of what government does is tax people to try to fix problems that government caused.
Supreme Court Won't Hear Case Challenging Massachusetts' Income Tax on Telecommuters Who Don't Live or Work in Massachusetts
The Court left increasingly urgent questions about taxing remote workers up in the air.
After the Cops Seized Her Car, the Government Waited Five Years Before Giving Her a Chance To Get It Back
In Massachusetts, Malinda Harris argues, civil asset forfeiture routinely violates the right to due process.
A promising new law will give agricultural communities in Massachusetts more say in local public-health rules that apply to them and impact their property and livelihoods.
The Bay State finally creates a police certification system.
The most expensive ballot initiative campaign in Massachusetts history ended with a resounding victory for property rights.
Meanwhile a privately owned campground nearby works to bring in business
Two November ballot initiatives would introduce ranked-choice voting in two more states.
The costly fight over a “right to repair” proposal has led to a lot of cybersecurity fearmongering.
A week after being sued over his arbitrary COVID-19 policy, Gov. Charlie Baker says he will allow arcades to reopen.
A federal lawsuit argues that the distinction drawn by Massachusetts is unconstitutional.
To the extent that the accusations against Holyoke Mayor Alex Morse get into specifics, they're pretty dubious.
The report found it was "not uncommon for Narcotics Bureau officers to write false or incomplete narratives that justify their uses of force."
Bay State officials expect a new ban on flavored tobacco products to benefit illegal suppliers.
Trends in Massachusetts highlight the importance of voluntary changes in behavior.
But then, those stadiums weren't likely to bring the growth the cities wanted in the first place.
From doxxing people with the new coronavirus to making diagnosed and suspected patients wear ankle monitors, some states are taking all the wrong steps to slow the spread of COVID-19.
From relaxed TSA rules to speedy FDA approvals, the coronavirus is forcing authorities to admit many of their regulations are unnecessary.
Independent booze retailers are trying to stifle competition using arguments from Prohibition.
Don’t be afraid of the robopups, but make sure we leash law enforcement to keep officers from misusing them.

domain: law


text: One of the area’s hottest new polka bands, Isaak Klaus and the Lederhosen Junkies are up-and-coming stars. Polka fans young and old will enjoy their wide array of music ranging from traditional German, Czech, and Polish polkas and waltzes, to Russian folks songs, and Eastern European Gypsy tunes. The Junkies bring a fresh new take to old time classics and insert their own unique spin on traditional favorite tunes. Endearing fans find their irresistible charm, coupled with their unique comedic attitude and a can-do spirit very refreshing. Polka veterans enjoy the fact that young fans are drawn to the Junkies youthful, high energy shows. This young band, along with it’s diehard fans, will ensure that polka music will stick around for a long time to come. The 2020 Big Squeeze Polka State Champion, Isaak Klaus was born with a pretzel in one hand and a sausage-on-a-stick in the other. The Lederhosen Junkies have played at many festivals across Texas including the Tomball German Heritage Fest, the Fredericksburg Oktoberfest, the New Braunfels Christkindlmarkt, and the New Braunfels Wurstfest.

domain: artistic


text:
It is becoming more widely recognized that a pH balance diet can have a positive effect on people of all ages. Researchers have begun to study the way certain foods affect the body and not surprisingly they have discovered that alkaline foods are much better than those that are more acidic in nature. The body's normal pH level needs to be kept at a more alkaline level for optimal health which means you can influence and change your internal system by the food choices that you make each and every day.
Meats, sugary sodas, highly processed foods, coffee and sweetened fruit juices all contain more acid than a person needs if they want to stay healthy. With an alkaline dietary program you can learn how to choose the proper foods that can maintain your body's normal pH level.
Incorporating an alkaline diet is not going to be bland or boring because there are a number of delicious items that you can select to eat. Alkaline foods include almonds, kale, melons, potatoes, pineapple, wild rice, and sweet potatoes, which most people find satisfying, tasty and very filling.
There are a number of healthy benefits that an alkaline diet can provide. Here are 3 of the best reasons that you might want to consider making a pH diet part of your normal routine.
Create the Internal Environment Designed for Maximum Health
The human body functions best when the pH level is slightly alkaline and it is now known that as the body acidity level rises the unhealthier a person can become. When individuals eat foods that create a more acidic internal atmosphere then it allows opportunistic invaders to take charge and wreak havoc from within. Bacteria and yeast infections tend to thrive in acidic environments and if you are not utilizing the foods that are part of a pH balance diet you may unwittingly be cultivating diseases and illnesses by lowering your normal body pH level.
The pH Balance Diet can Save Your Teeth and Bones
Our normal cells are constantly reproducing and dividing and they need an alkaline environment in which to grow normally and survive. The body will try to combat the drop in pH by using any means possible and sometimes this will negatively affect our skeletal system and teeth. In severe cases your body will actually rob calcium from your bones and teeth to offset a highly acidic pH level. By choosing to follow an alkaline (or pH balance diet) you can boost your health and protect your teeth and bones from certain destruction.
Boost your Energy Levels Quickly
When you concentrate on following a pH balance diet regimen you are providing your body with the foods that naturally boost your energy levels. Many people have discovered that selecting foods that are alkaline is a quick and easy way to combat fatigue and raise their endurance.
There are additional healthy benefits that can be yours once you begin to use a pH balance diet. You might want to consider doing some more investigation to discover other ways that this alkaline dietary program can make a truly significant difference in your life and health.

domain: biology


text:
Shopping options abound in Louisiana’s Capital City—from stores you know and love to hidden gems where you’re sure to find original and unique items. In Baton Rouge, shoppers can travel back in time by browsing the local antiques and vintage stores or find current trends at one of the city’s locally owned boutiques.
Quirky Government Street Shops
Located in Baton Rouge’s eclectic Mid City neighborhood, Government Street’s recent refresh breathed new life into the walkable strip now lined with singular shops that carry antiques, vintage clothing, gifts, and artisan goods. Circa 1857 and The Pink Elephant are ideal for antiquing, and Time Warp Boutique is a must for vintage apparel.
A few other can’t-miss stops in Mid City include Red Stick Reads, Mimosa Handcrafted, Mid City Mercantile, Red Stick Spice Co., and The Hope Shop. Be sure to browse Local Leaf Gallery for a collection of art, stylish home goods, and products all sourced from Louisiana artists and makers.
Convenience and fun intersect at Perkins Rowe, which blends dining and entertainment with upscale, boutique shopping. Stroll the beautiful walkways and catch live music in the scenic courtyards on your way to well-known retailers like Anthropologie, Free People, and Orvis. Catch a movie at the Cinemark theater that serves as the heart of this picturesque location, and enjoy eateries like Rouj Creole or Bin 77 Bistro.
Head back towards downtown along Perkins Road and visit The Foyer, a one-stop shopping experience with more than 75 vendors across 8,000 square feet. As a multi-merchant design showroom and art gallery, The Foyer has many one-of-a-kind pieces to give your home that perfect touch.
Mall of Louisiana
The largest shopping mall in Louisiana is aptly located right in the center of the Capital City. You’ll find many familiar shops located on the two levels of the Mall of Louisiana, as well as a food court, carousel, and movie theater. Many interesting stores and dining options are conveniently located along Mall of Louisiana Boulevard.
Towne Center at Cedar Lodge is an expansive alfresco shopping complex with boutiques, salons, spas, gyms, home goods stores, and much more. From locally owned businesses to larger, national chains, the selection of merchants along the inviting walkways graced with fountains and traditional charm make the experience all the more pleasant.
Nearby shop The Queen Bee is filled with one-of-a-kind stationery and beautifully wrapped gifts. Choose a custom design for any occasion or browse their eclectic collection of home décor and entertaining essentials.
Baton Rouge is home to a lengthy list of independent boutiques, ranging from women’s fashion to home décor. Be sure to pop into stand-alone shops like The Royal Standard, fab’rik, and Herringstone’s on your next shopping trip to Baton Rouge.