Confirmatory structural validation and refinement of the Recurrent Urinary Tract Infection Symptom Scale.

Objectives: To confirm the structural validity of the Recurrent Urinary Tract Infection Symptom Scale (RUTISS), determining whether a bifactor model appropriately fits the questionnaire's structure and identifying areas for refinement. Used in conjunction with established clinical testing methods, this patient-reported outcome measure addresses the urgent need to validate the patient perspective. Patients and methods: A clinically and demographically diverse sample of 389 people experiencing recurrent UTI across 37 countries (96.9% female biological sex, aged 18-87 years) completed the RUTISS online. A bifactor graded response model was fitted to the data, identifying potential items for deletion if they indicated significant differential item functioning (DIF) based on sociodemographic characteristics, contributed to local item dependence or demonstrated poor fit or discrimination capability. Results: The final RUTISS comprised a 3-item symptom frequency section, a 1-item global rating of change scale and an 11-item general 'rUTI symptom and pain severity' subscale with four sub-factor domains measuring 'urinary symptoms', 'urinary presentation', 'UTI pain and discomfort' and 'bodily sensations'. The bifactor model fit indices were excellent (root mean square error of approximation [RMSEA] = 0.041, comparative fit index [CFI] = 0.995, standardised root mean square residual [SRMSR] = 0.047), and the mean-square fit statistics indicated that all items were productive for measurement (mean square fit indices [MNSQ] = 0.64 - 1.29). Eighty-one per cent of the common model variance was accounted for by the general factor and sub-factors collectively, and all factor loadings were greater than 0.30 and communalities greater than 0.60. Items indicated high discrimination capability (slope parameters > 1.35). Conclusion: The 15-item RUTISS is a patient-generated, psychometrically robust questionnaire that dynamically assesses the patient experience of recurrent UTI symptoms and pain. This brief tool offers the unique opportunity to enhance patient-centred care by supporting shared decision-making and patient monitoring.

Evaluating the quality of life impact of recurrent urinary tract infection: Validation and refinement of the Recurrent UTI Impact Questionnaire (RUTIIQ).

BACKGROUND AND AIMS: Recurrent urinary tract infection (rUTI) has significant negative consequences for a wide variety of quality of life (QoL) domains. Without adequate validation and assessment of the unique insights of people living with rUTI, clinical results cannot be fully understood. The Recurrent UTI Impact Questionnaire (RUTIIQ), a novel patient-reported outcome measure of rUTI psychosocial impact, has been robustly developed with extensive patient and clinician input to facilitate enhanced rUTI management and research. This study aimed to confirm the structural validity of the RUTIIQ, assessing its strength and bifactor model fit. METHODS: A sample of 389 adults experiencing rUTI (96.9% female, aged 18-87 years) completed an online cross-sectional survey comprising a demographic questionnaire and the RUTIIQ. A bifactor graded response model was fitted to the data, optimizing the questionnaire structure based on item fit, discrimination capability, local dependence, and differential item functioning. RESULTS: The final RUTIIQ demonstrated excellent bifactor model fit (RMSEA = 0.054, CFI = 0.99, SRMSR = 0.052), and mean-square fit indices indicated that all included items were productive for measurement (MNSQ = 0.52-1.41). The final questionnaire comprised an 18-item general "rUTI QoL impact" factor, and five subfactor domains measuring "personal wellbeing" (three items), "social wellbeing" (four items), "work and activity interference" (four items), "patient satisfaction" (four items), and "sexual wellbeing" (three items). Together, the general factor and five subfactors explained 81.6% of the common model variance. All factor loadings were greater than 0.30 and communalities greater than 0.60, indicating good model fit and structural validity. CONCLUSIONS: The 18-item RUTIIQ is a robust, patient-tested questionnaire with excellent psychometric properties, which capably assesses the patient experience of rUTI-related impact to QoL and healthcare satisfaction. Facilitating standardized patient monitoring and improved shared decision-making, the RUTIIQ delivers the unique opportunity to improve patient-centered care.

The Recurrent Urinary Tract Infection Symptom Scale: Development and validation of a patient-reported outcome measure.

Objectives: This study aimed to develop and validate a tailored patient-reported outcome measure (PROM) evaluating the patient experience of recurrent urinary tract infection (rUTI) symptom severity. This measure was designed to supplement clinical testing methods, allowing full assessment of the patient experience of rUTI symptom burden, while enhancing patient-centred UTI management and monitoring. Subjects and Methods: The Recurrent Urinary Tract Infection Symptom Scale (RUTISS) was developed and validated using a three-stage methodology, in accordance with gold-standard recommendations. Firstly, a two-round Delphi study was conducted to gain insights from 15 international expert clinicians working in rUTI, developing an initial pool of novel questionnaire items, assessing content validity and making item refinements. Next, two phases of one-to-one semi-structured cognitive interviews were conducted with a diverse sample of 28 people experiencing rUTI to assess questionnaire comprehensiveness and comprehensibility, making refinements after each phase. Finally, a comprehensive pilot of the RUTISS was conducted with 240 people experiencing rUTI across 24 countries, providing data for psychometric testing and item reduction. Results: Exploratory factor analysis indicated a four-factor structure comprising: 'urinary pain and discomfort', 'urinary urgency', 'bodily sensations' and 'urinary presentation', together accounting for 75.4% of the total variance in data. Qualitative feedback from expert clinicians and patients indicated strong content validity for items, which was supported by high content validity indices in the Delphi study (I-CVI > 0.75). Internal consistency and test-retest reliability of the RUTISS subscales were excellent (Cronbach's α = 0.87-0.94 and ICC = 0.73-0.82, respectively), and construct validity was strong (Spearman's ρ = 0.60-0.82). Conclusion: The RUTISS is a 28-item questionnaire with excellent reliability and validity, which dynamically assesses patient-reported rUTI symptoms and pain. This new PROM offers a unique opportunity to critically inform and strategically enhance the quality of rUTI management, patient-clinician interactions, and shared-decision making by monitoring key patient-reported outcomes.

Development and psychometric validation of a patient-reported outcome measure of recurrent urinary tract infection impact: the Recurrent UTI Impact Questionnaire.

PURPOSE: Recurrent urinary tract infection (rUTI) is a highly prevalent condition associated with significant poor quality of life outcomes. A patient-reported outcome measure (PROM) of rUTI-associated psychosocial impact is urgently required to supplement clinical evaluation and validate the challenges experienced by patients. This study therefore developed and validated the Recurrent UTI Impact Questionnaire (RUTIIQ). METHODS: A rigorous four-stage methodology was followed: (I) concept elicitation through a qualitative survey of the experiences of people with rUTI (N = 1983); (II) Delphi expert screening of the RUTIIQ with expert rUTI clinicians (N = 15); (III) one-to-one cognitive interviews with people experiencing rUTI (N = 28) to evaluate the comprehensiveness and comprehensibility of the RUTIIQ, and (IV) full pilot testing of the RUTIIQ with people experiencing rUTI (N = 240) to perform final item reduction and psychometric analysis. RESULTS: Exploratory factor analysis demonstrated a five-factor structure comprising: 'patient satisfaction', 'work and activity interference', 'social wellbeing', 'personal wellbeing', and 'sexual wellbeing', collectively accounting for 73.8% of the total variance in pilot scores. Results from expert clinicians and patients indicated strong item content validity (I-CVI > .75). The internal consistency and test-retest reliability of the RUTIIQ subscales were excellent (Cronbach's α = .81-.96, ICC = .66-.91), and construct validity was strong (Spearman's ρ > .69). CONCLUSION: The RUTIIQ is a 30-item questionnaire with excellent psychometric properties, assessing the patient-reported psychosocial impact of living with rUTI symptoms and pain. This new instrument delivers the unique opportunity to enhance patient-centred care through standardised observation and monitoring of rUTI patient outcomes. TRIAL REGISTRATION: This study was pre-registered with ClinicalTrials.gov (identifier: NCT05086900).

A longitudinal analysis of PTSD and other mental health symptoms among people sentenced to drug treatment court.

OBJECTIVE: Drug treatment courts offer an alternative to incarceration for people who are facing criminal charges related to addiction. Because addiction commonly co-occurs with trauma exposure and associated mental illnesses, drug treatment courts likely serve people with these difficulties. Yet whether or how mental health symptoms change over drug treatment court participation has not been studied. METHOD: We sought to (1) describe the mental health symptom profiles, including PTSD, of recent drug court enrollees, (2) examine the course of these symptom profiles at baseline, 6-month follow-up, and 12-month follow-up, and (3) test posttraumatic stress symptoms (PTSS) and gender as potential moderators of any identified time effects. Participants were 983 adults sentenced to drug treatment court between 2009 and 2017. RESULTS: Generalized linear mixed models revealed a significant effect of time on PTSS as measured by the PTSD Checklist and on summary indices of mental health measured by the Brief Symptom Inventory (p < .05 for all the outcomes). Gender did not moderate the effect of time on either outcome. However, those with PTSS above the clinical cut-off at baseline experienced less improvement in mental health over time. CONCLUSION: Our findings suggest that drug treatment court participants' mental health, including PTSS, improved over time. However, the presence of elevated PTSS interfered with improvements in other facets of mental health. Additional work is needed to identify specific program components that may exert causal effects and to examine interventions for PTSS that can be readily integrated in drug treatment courts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Implementing and Sustaining SHARE: An Exposure-Based Psychotherapy Group for Incarcerated Women Survivors of Sexual Violence.

Although incarcerated women are a highly victimized population, therapy for sexual violence victimization (SVV) sequela is not routinely offered in prison. SHARE is a group therapy for SVV survivors that was successfully implemented and sustained in a women's correction center. Here, we aimed to identify implementation factors and strategies that led to SHARE's success and describe incarcerated women's perspectives on the program. We conducted a retrospective process evaluation using interviews structured according to EPIS, a well-established implementation science framework. Participants (N = 22) were incarcerated women, members of the SHARE treatment team, and members of the correction center's leadership, therapeutic team, and volunteer program. Factors that facilitated SHARE implementation varied by EPIS phase and organization. Positive inter-organizational and interpersonal relationships were key across phases, as were the synergies between both the strengths and needs of each organization involved in implementation. Incarcerated women reported a strong need for SHARE and did not report any concerns about receiving trauma therapy in a carceral setting. Therapy for SVV sequelae, including exposure-based therapy, is possible to implement and sustain in carceral settings. Community-academic partnerships may be a particularly feasible way to expand access to SVV therapy for incarcerated women.

Teacher Experience, Personal Health, and Dieting Status Is Associated With Classroom Health-Related Practices and Modeling.

BACKGROUND: Evidence suggests that schools play an important role in student health; however, little is known about variability in teachers' use of food-related classroom practices. In this study, we examined associations between teacher demographic and individual factors and their food-related practices and modeling in the classroom. METHODS: We had 239 teachers in the United States complete an online survey about their demographics (years of teaching experience, socioeconomic status of the school), personal health status, height and weight, and nutrition knowledge. Teachers also reported on the unhealthy food-related practices they use in their classroom (eg, candy as a reward) and modeling (ie, engaging in unhealthy and healthy eating practices in front of students). RESULTS: Hierarchical linear regressions were computed for each outcome separately. After controlling for socioeconomic status, fewer years of teaching experience and lower perception of personal health were associated with the use of unhealthy practices in the classroom. Teachers who were dieting were more likely to endorse healthy modeling. CONCLUSIONS: Teacher demographic and individual factors are associated with food-related classroom behavior. These findings have implications for interventions to promote the health of teachers and their students.

Seeds of change: A qualitative case study of a neighborhood youth program.

Even within economically disadvantaged neighborhoods, programs fostering protective factors can shape youth outcomes. One positive youth development (PYD) program- Seeds of Change-employs teenagers in an urban neighborhood in Ohio and uses goats and community gardens to promote adolescent development. The current study used semi-structured interviews with adolescents (N = 7, ages 16-20) to conduct a case study of the program. The case study describes youth's perceptions of the neighborhood, the program, and future directions; responses were analyzed using content analysis. Youth described that Seeds of Change enacts change on multiple levels of the social ecology by emphasizing individual growth, building a social support system with peers and adults, and increasing both tangible resources and positive relationships throughout the neighborhood. Seeds of Change promotes positive socialization, increases resources, and embodies multiple elements of effective PYD programming.

A look at the intergenerational associations between self-compassion, body esteem, and emotional eating within dyads of mothers and their adult daughters.

Research has demonstrated that mothers transmit body-related attitudes and eating behaviors to their daughters, but little is known about the role of self-compassion-treating oneself with kindness and being mindful about one's experiences-in this transmission. This research examined the intrapersonal and interpersonal associations between mothers' and daughters' self-compassion, body esteem (i.e., positive self-evaluations about one's appearance), and emotional eating (i.e., the tendency to eat in response to negative affect). Dyads (N = 191) of Canadian mothers (mean age: 57.37) and daughters (mean age: 28.76) completed self-report questionnaires. Dyadic, structural equation modeling and bootstrapping analyses were conducted to examine relationships among the study variables. Controlling for mothers' and daughters' body mass index, self-compassionate mothers and daughters reported higher body esteem. Additionally, daughters of self-compassionate mothers were more self-compassionate and had higher body esteem, which in turn predicted lower emotional eating. Adding to the literature on the intergenerational transmission of eating-related attitudes and behaviors, results suggest a relation between mother and daughter self-compassion, body esteem, and eating behaviors. Results also showed that attitudes toward oneself were related to eating behaviors. Mothers' self-compassion might provide a model for daughters, which in turn is associated with daughters' improved body esteem and eating behaviors.

Retrospective reports of childhood feeding in mother-daughter dyads.

Significant research has linked parents' feeding practices to children's eating habits. However, much less is known about how childhood feeding relates to longer-term outcomes such as eating in adulthood. The current study uses retrospective reports from mother-daughter dyads (N = 217) to compare childhood feeding practices and to examine how recalled feeding is related to current eating (emotional eating, intuitive eating, unrestrained eating) and body mass index (BMI) in adult daughters. Mothers and daughters completed the Comprehensive Feeding Practices Questionnaire (CFPQ), subscales from the Three Factor Eating Questionnaire, and the Intuitive Eating Scale. Results of an exploratory factor analysis indicated that mothers and daughters largely had similar factor structures on retrospective reports, with factor loadings varying on four of twelve original CFPQ subscales: monitoring, restriction for health, child control, and modelling. Paired samples t-tests examined mean differences between mother and daughter reports on each subscale; there was no significant difference between mother and daughter reports on six of the 11 scales. Daughters reported significantly higher levels of pressure to eat; mothers reported significantly higher levels of healthy practices, child control, involvement, and unhealthy environment than their daughters recalled. Hierarchical regressions revealed that daughters' reports of specific childhood feeding practices accounted for significant change in unadjusted variance for uncontrolled eating (18.8%), emotional eating (13.1%), intuitive eating (14.7%), and BMI (16.1%). Similarly, regressions revealed that mothers' reports of childhood feeding practices accounted for significant change in unadjusted variance for emotional eating (11.5%) and BMI (11.2%), but not uncontrolled or intuitive eating. Collectively, results lend strong support to the use of retrospective reports on childhood feeding and provide evidence that recalled childhood feeding practices have lasting relations with adult eating behaviors.

Mindful feeding: A pathway between parenting style and child eating behaviors.

Certain child eating behaviors (e.g., food fussiness, emotional overeating, and disruptive mealtime behaviors) can create challenges for caregivers and result in short- and long-term health consequences (e.g., lower fruit and vegetable intake, a deficiency of essential nutrients, greater intake of energy-dense foods and sugary beverages, and/or higher BMI) for the children. The role of mindful feeding-cultivating a present-centered awareness in the feeding context to increase parents' awareness of their own responsive (and non-responsive) feeding behaviors-has not been explored as it relates to parenting and children's problematic eating behaviors. The objective of this study was to understand whether the relations between parenting style and child eating behaviors often documented in the literature are mediated by mindful feeding. Using self-reports from Amazon's Mechanical Turk (MTurk) of 496 mothers and fathers of young children (age 2-7 years old), we explored whether mindful feeding mediates the relation between parenting style and child eating behaviors. As hypothesized, authoritative parenting was related to higher rates of mindful feeding (ß=.16, 95% C.I. [.05, .18]), while authoritarian (ß=-.34, 95% C.I. [-.32, -.17]) and permissive parenting (ß= -.15, 95% C.I. [-.18, -.05]) were related to lower rates of mindful feeding. Mindful feeding mediated the relation between each parenting style and each child eating behavior (i.e., food fussiness, problematic mealtime behaviors, and emotional overeating). These findings suggest that that mindful feeding may be a promising new construct, and its relation to feeding interventions aimed at improving problematic child eating behaviors should be further evaluated.

An examination of food parenting practices: structure, control and autonomy promotion.

OBJECTIVE: In recent years, researchers have been working towards creating a standard conceptual framework of food parenting. To understand how parents' reports correspond with the proposed model, the current study examined parents' reports of their feeding behaviours in the context of a newly established framework of food parenting. DESIGN: Cross-sectional, with a two-week follow-up for a subset of the sample. Participants completed a quantitative and qualitative survey to assess food parenting. The survey included items from common food parenting instruments to measure the constructs posited in the framework. Exploratory factor analyses were conducted to ascertain which items related most closely to one another and factors were mapped on to existing constructs. SETTING: Online. PARTICIPANTS: Parents of children aged 2·5-7 years (n 496). Of these, 122 completed a two-week follow-up. RESULTS: Analyses revealed eleven aspects of Structure (monitoring; distraction; family presence; meal/snack schedule; unstructured practices; healthy/unhealthy food availability; food preparation; healthy/unhealthy modelling; rules), ten aspects of Coercive Control (pressure to eat; using food to control emotions; food incentives to eat; food incentives to behave; non-food incentives to eat; restriction for health/weight; covert restriction; clean plate; harsh coercion) and seven aspects of Autonomy Promotion (praise; encouragement; nutrition education; child involvement; negotiation; responsive feeding; repeated offering). Content validity, assessed via parents' open-ended explanations of their responses, was high, and test-retest reliability was moderate to high. Structure and Autonomy Promoting food parenting were highly positively correlated. CONCLUSIONS: In general, parents' responses provided support for the model, but suggested some amendments and refinements.

Parental correlates of food parenting practices: socioeconomic status, weight, and dieting status.

Little research has considered how parents' socioeconomic indicators, body mass index (BMI), and dieting status relate to their food parenting. The current study used self-report data from parents of young children to examine group differences on three types of food parenting practices (Structure, Coercive Control, and Autonomy Promotion). Few group differences were found for socioeconomic indicators. However, parent dieting status moderated effects of parent BMI on structure and autonomy promotion. Obese, non-dieting parents reported lower scores on both variables. More research is needed to better understand how parents' dieting status moderates the effects of parent's weight.

Using food as a reward: An examination of parental reward practices.

Eating patterns and taste preferences are often established early in life. Many studies have examined how parental feeding practices may affect children's outcomes, including food intake and preference. The current study focused on a common food parenting practice, using food as a reward, and used Latent Profile Analysis (LPA) to examine whether mothers (n = 376) and fathers (n = 117) of children ages 2.8 to 7.5 (M = 4.7; SD = 1.1) grouped into profiles (i.e., subgroups) based on how they use of food as a reward. The 4-class model was the best-fitting LPA model, with resulting classes based on both the frequency and type of reward used. Classes were: infrequent reward (33%), tangible reward (21%), food reward (27%), and frequent reward (19%). The current study also explored whether children's eating styles (emotional overeating, rood fussiness, food responsiveness, and satiety responsiveness) and parenting style (Authoritative, Authoritarian, and Permissive) varied by reward profile. Analyses of Variance (ANOVA) revealed that the four profiles differed significantly for all outcome variables except satiety responsiveness. It appears that the use of tangible and food-based rewards have important implications in food parenting. More research is needed to better understand how the different rewarding practices affect additional child outcomes.

Medicine authentication technology as a counterfeit medicine-detection tool: a Delphi method study to establish expert opinion on manual medicine authentication technology in secondary care.

OBJECTIVES: This study aims to establish expert opinion and potential improvements for the Falsified Medicines Directive mandated medicines authentication technology. DESIGN AND INTERVENTION: A two-round Delphi method study using an online questionnaire. SETTING: Large National Health Service (NHS) foundation trust teaching hospital. PARTICIPANTS: Secondary care pharmacists and accredited checking technicians. PRIMARY OUTCOME MEASURES: Seven-point rating scale answers which reached a consensus of 70-80% with a standard deviation (SD) of <1.0. Likert scale questions which reached a consensus of 70-80%, a SD of <1.0 and classified as important according to study criteria. RESULTS: Consensus expert opinion has described database cross-checking technology as quick and user friendly and suggested the inclusion of an audio signal to further support the detection of counterfeit medicines in secondary care (70% consensus, 0.9 SD); other important consensus with a SD of <1.0 included reviewing the colour and information in warning pop up screens to ensure they were not mistaken for the 'already dispensed here' pop up, encouraging the dispenser/checker to act on the warnings and making it mandatory to complete an 'action taken' documentation process to improve the quarantine of potentially counterfeit, expired or recalled medicines. CONCLUSIONS: This paper informs key opinion leaders and decision makers as to the positives and negatives of medicines authentication technology from an operator's perspective and suggests the adjustments which may be required to improve operator compliance and the detection of counterfeit medicines in the secondary care sector.

The Effect of Body Mass on Outdoor Adult Human Decomposition.

Forensic taphonomy explores factors impacting human decomposition. This study investigated the effect of body mass on the rate and pattern of adult human decomposition. Nine males and three females aged 49-95 years ranging in mass from 73 to 159 kg who were donated to the Complex for Forensic Anthropology Research between December 2012 and September 2015 were included in this study. Kelvin accumulated degree days (KADD) were used to assess the thermal energy required for subjects to reach several total body score (TBS) thresholds: early decomposition (TBS ≥6.0), TBS ≥12.5, advanced decomposition (TBS ≥19.0), TBS ≥23.0, and skeletonization (TBS ≥27.0). Results indicate no significant correlation between body mass and KADD at any TBS threshold. Body mass accounted for up to 24.0% of variation in decomposition rate depending on stage, and minor differences in decomposition pattern were observed. Body mass likely has a minimal impact on postmortem interval estimation.

Effectiveness of medicines authentication technology to detect counterfeit, recalled and expired medicines: a two-stage quantitative secondary care study.

OBJECTIVES: To identify the authentication and detection rate of serialised medicines using medicines authentication technology. DESIGN AND INTERVENTION: 4192 serialised medicines were entered into a hospital dispensary over two separate 8-week stages in 2015. Medicines were authenticated using secure external database cross-checking, triggered by the scanning of a two-dimensional data matrix with a unit specific 12-digit serial code. 4% of medicines included were preprogrammed with a message to identify the product as either expired, pack recalled, product recalled or counterfeit. SETTING: A site within a large UK National Health Service teaching hospital trust. PARTICIPANTS: Accredited checking staff, pharmacists and dispensers in a pharmacy department. PRIMARY OUTCOME MEASURES: Authentication and detection rate of counterfeit expired and recalled medicines. RESULTS: The operational detection rate of counterfeit, recalled and expired medicines scanned as a combined group was 81.4% (stage 1 (S1)) and 87% (stage 2 (S2)). The technology's technical detection rate (TDR) was 100%; however, not all medicines were scanned and of those that were scanned not all that generated a warning message were quarantined. Owing to an operational authentication rate (OAR) of 66.3% (over both stages), only 31.8% of counterfeit medicines, 58% of recalled drugs and 64% of expired medicines were detected as a proportion of those entered into the study. Response times (RTs) of 152 ms (S1) and 165 ms (S2) were recorded, meeting the falsified medicines directive-mandated 300 ms limit. CONCLUSIONS: TDRs and RTs were not a limiting factor in this study. The suboptimal OAR poses significant quality and safety issues with this detection approach. Authentication at the checking stage, however, demonstrated higher OARs. There is a need for further qualitative research to establish the reasons for less than absolute authentication and detection rates in the hospital environment to improve this technology in preparation for the incumbent European Union regulative deadline.

The Stone Cold Truth: The Effect of Concrete Encasement on the Rate and Pattern of Soft Tissue Decomposition.

This study provides a descriptive analysis of taphonomic changes observed in the soft tissue of ten pigs (Sus scrofa) after being encased in Quickrete (®) concrete and excavated at monthly or bimonthly intervals over the course of 2 years. The best method of subject excavation was investigated. Rate and pattern of decomposition were compared to a nonencased control subject. Results demonstrate subjects interred in concrete decomposed significantly slower than the control subject (p < 0.01), the difference being observable after 1 month. After 1 year, the encased subject was in the early stage of decomposition with purging fluids and intact organs present, versus complete skeletonization of the control subject. Concrete subjects also display a unique decomposition pattern, exhibiting a chemically burned outer layer of skin and a common separation of the dermal and epidermal layers. Results suggest using traditional methods to estimate postmortem interval on concrete subjects may result in underestimation.

An Update on the Hazards and Risks of Forensic Anthropology, Part I: Human Remains.

This work reviews the hazards and risks of practicing forensic anthropology in North America, with a focus on pathogens encountered through contact with unpreserved human remains. Since the publication of Galloway and Snodgrass' seminal paper concerning the hazards of forensic anthropology, research has provided new information about known pathogen hazards, and regulating authorities have updated recommendations for the recognition and treatment of several infections. Additionally, forensic anthropology has gained popularity, exposing an increased number of students and practitioners to these hazards. Current data suggest many occupational exposures to blood or body fluids go unreported, especially among students, highlighting the need for this discussion. For each pathogen and associated disease, this work addresses important history, reviews routes of exposure, provides an overview of symptoms and treatments, lists decontamination procedures, and presents data on postmortem viability. Personal protection and laboratory guidelines should be established and enforced in conjunction with the consideration of these data.

An Update on the Hazards and Risks of Forensic Anthropology, Part II: Field and Laboratory Considerations.

This paper focuses on potential hazards and risks to forensic anthropologists while working in the field and laboratory in North America. Much has changed since Galloway and Snodgrass published their seminal article addressing these issues. The increased number of forensic practitioners combined with new information about potential hazards calls for an updated review of these pathogens and chemicals. Discussion of pathogen hazards (Brucella, Borrelia burgdorferi, Yersinia pestis, Clostridium tetani and West Nile virus) includes important history, exposure routes, environmental survivability, early symptoms, treatments with corresponding morbidity and mortality rates, and decontamination measures. Additionally, data pertaining to the use of formaldehyde in the laboratory environment have resulted in updated safety regulations, and these are highlighted. These data should inform field and laboratory protocols. The hazards of working directly with human remains are discussed in a companion article, "An Update on the Hazards and Risks of Forensic Anthropology, Part I: Human Remains."