Vaginal Squirting: Experiences, Discoveries, and Strategies in a U.S. Probability Sample of Women Ages 18-93.

Vaginal squirting is a phenomenon in which women expel fluid during the sexual response process, but it remains poorly understood in the extant literature. The study purpose was to use nationally representative data to investigate adult women's experiences with vaginal squirting. We assessed the prevalence of women who have ever squirted in their lifetime, the level of pleasure and concurrency of orgasm women reported during squirting, the ways in which women discovered squirting, and the challenges and/or concerns women experience with squirting. Forty percent of U.S. adult women (M = 47.6 years, SD = 16.8; Md = 24 years) had ever squirted in their lifetime (Md frequency = three to five times). Two thirds of women reported unintentional discovery of squirting, and most (75%) used specific techniques to promote build up and release of squirting versus squirting spontaneously. About 60% of participants reported squirting to be very or somewhat pleasurable, but only 20% "always" experienced squirting and orgasm together. Women reported different challenges with squirting, such as the time required to reach squirting or the experience being too emotionally intense. Our findings contribute to the growth of much needed, detailed literature on the ways in which women discover and enjoy squirting as part of their sexual lives. Knowledge of these techniques can enable women to better identify their own preferences, communicate about them with their partners, and advocate for their sexual pleasure.

Adopting e-government to monitor public infrastructure projects execution in Nigeria: The public perspective.

Public infrastructure projects (PIPs) are critical to the socioeconomic development of any country and similar to most public activities, their governance requires effective public participation to be successful. Information and communication technology adoption in government-public engagements (i.e., e-government) has improved public participation in governance in developed countries. This study utilizes the unified theory of acceptance and use of technology to investigate determining factors for the Nigerian public to adopt e-government tools to promote public participation in monitoring PIPs execution. It adopts questionnaire survey and structural equation modelling techniques to show that performance expectancy, facilitating conditions, social influence, and effort expectancy significantly and positively affect behavioral intention to adopt e-government tools to monitor PIPs execution in Nigeria. This study provides scholars with an exploratory baseline for extension of e-government adoption to public infrastructure project management. This study also provides recommendations to policy makers, government technocrats, and project engineers on the need for policy changes, creation of interactive and up-to-date project websites for PIPs in Nigeria.

Children's health insurance coverage and adequacy from 2016 to 2018: Racial/ethnic disparities under the ACA.

Background: This study advances health disparities research by documenting the racial/ethnic disparities in children's health insurance coverage and health insurance adequacy under the implementation and revisions of the Affordable Care Act between 2016 and 2018 in America. Design and methods: Combining the nation-wide repeated cross-sectional data from 2016 to 2018 Children's Health National Survey (NSCH), we examined the changes and trends of health insurance coverage and health insurance adequacy among children age 0-17 across different racial/ethnic groups from 2016 to 2018. Multivariate logistic regression models stratified by race-ethnicity were further analyzed to examine the association between children's health insurance adequacy, their health insurance coverage, and their socio-demographic background factors. Results: Our analyses indicate that generally children's enrollment in Medicaid or other government aided health care programs had been increasing whereas children's enrollment in the employer-based had been decreasing from 2016 to 2018. At the same time, the number of children who said that they always had adequate health insurance to meet their health care needs has slightly dropped from 2016 to 2018, except for AIAN children. Our analyses further revealed that the risk of inadequate health insurance appears to be stronger for children in disadvantaged situation, socially and economically. Conclusions: The ACA has contributed to expanding childhood health insurance coverage. But racial/ethnic disparities continue to exist in children's health insurance coverage and health insurance adequacy. To achieve equity in childhood health care, more outreach and appropriate programs are needed for children who are socially and economically disadvantaged.

Essential strategies and tactics for managing sickle cell disease.

Key to patients' well-being is the family physician's watchfulness-through periodic lab testing and health checks and diligent application of preventive measures.

Women's techniques for pleasure from anal touch: Results from a U.S. probability sample of women ages 18-93.

The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to experience pleasure from anal touch. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified three previously unnamed, but distinct, anal touch techniques that many women find pleasurable and that expand the anal sexual repertoire beyond the more commonly studied anal intercourse behaviors: Anal Surfacing, Anal Shallowing, and Anal Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report-a cross-sectional, online, national probability survey of 3017 American women's (age 18-93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel®. Data suggest that 40% of women find 'Anal Surfacing' pleasurable: sexual touch by a finger, penis, or sex toy on and around the anus. Approximately 35% of women have experienced pleasure using 'Anal Shallowing': penetrative touch by a finger, penis, or sex toy just inside the anal opening, no deeper than a fingertip/knuckle. Finally, 40% of women make other forms of sexual touch more pleasurable using 'Anal Pairing': touch on or inside the anus that happens at the same time as other kinds of sexual touch such as vaginal penetration or clitoral touching. These data provide techniques that women can and do use to explore the anus as a pleasurable region for touch-which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.

"OMG, Yes!": Feasibility, Acceptability, and Preliminary Efficacy of an Online Intervention for Female Sexual Pleasure.

The purpose of this study was to evaluate the acceptability, feasibility, and preliminary efficacy of using an online educational resource that presents research-informed strategies for women's pleasure, OMGyes.com, as a resource to empower women to broaden the ways in which they understand, advocate for, and enjoy sexual pleasure. A cohort of 870 adult women was given access to OMGyes.com and asked to explore the resource over a four-week period and complete online pre/post questionnaires. Participants reported a high level of satisfaction with the relatability, usefulness, and functionality of OMGyes.com. We observed statistically significant, large effect size increases in participants' knowledge about their own pleasure preferences, their confidence and positivity about that knowledge, as well as how pleasurable their sexual experiences were during both masturbation and partner sex. Many participants reported that after using OMGyes.com they felt more motivated to explore their preferences and more confident to explain their preferences to their partners. Our data suggest that OMGyes.com may be useful for positively impacting how women think about sexual pleasure, how they understand their own specific preferences, how they advocate for what they enjoy with partners, and how they actually experience pleasure.

Women's techniques for making vaginal penetration more pleasurable: Results from a nationally representative study of adult women in the United States.

The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to make vaginal penetration more pleasurable. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified four previously unnamed, but distinct, techniques women use to make vaginal penetration more pleasurable: Angling, Rocking, Shallowing and Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report-a cross-sectional, online, national probability survey of 3017 American women's (age 18-93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel®. Data suggest that 87.5% of women make vaginal penetration more pleasurable using 'Angling': rotating, raising, or lowering the pelvis/hips during penetration to adjust where inside the vagina the toy or penis rubs and what it feels like. Approximately 76% of women make vaginal penetration more pleasurable using 'Rocking': the base of a penis or sex toy rubbing against the clitoris constantly during penetration, by staying all the way inside the vagina rather than thrusting in and out. About 84% of women make vaginal penetration more pleasurable using 'Shallowing': penetrative touch just inside of the entrance of the vagina-not on the outside, but also not deep inside-with a fingertip, sex toy, penis tip, tongue, or lips. Finally, 69.7% of women orgasm more often or make vaginal penetration more pleasurable using 'Pairing': when a woman herself (Solo Pairing) or her partner (Partner Pairing) reaches down to stimulate her clitoris with a finger or sex toy at the same time as her vagina is being penetrated. These data provide techniques that are at women's disposal to make penetration more pleasurable-which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.

Does childhood victimization predict specific adolescent offending? An analysis of generality versus specificity in the victim-offender overlap.

BACKGROUND: A large body of research has examined the relationship between victimization and future offending, with results suggesting that crime victims are at higher risk of future criminal behavior-known as the victim-offender overlap. Prior studies have primarily examined the relationship between general victimization (e.g., violent victimization, sexual abuse, and more) and general offending (e.g., violence, sexual offending, and drug use), and focused on adult populations. OBJECTIVE: The goal of the present study is to expand on prior literature by examining if specific forms of childhood victimization increase the risk of specific and analogous forms of offending among delinquent youth. METHOD: Based upon a population of 64,329 high-risk youth offenders in Florida, this study evaluates the specificity of the overlap among youth who were physically abused, sexually abused, or witnessed illegal substance use at home during childhood to determine if these forms of victimization increased the risk of violence, sexual offending, and drug use, respectively, when assessed in multivariate logistic regression models. RESULTS: Results provide considerable support for specificity in the victim-offender overlap, as hypothesized. Specifically, experiencing physical abuse (OR = 1.55, p < .001), sexual abuse (OR = 3.58, p < .001) and witnessing household substance abuse (OR = 1.66, p < .001) in childhood each significantly and substantially increased the risk of analogous criminal behavior in adolescence, even when controlling for other risk factors and forms of victimization. CONCLUSION: This study provided novel evidence for specificity in the victim-offender overlap, even after controlling for confounding variables. Practical implications for early intervention and crime prevention are discussed, as well as implications for future research. Highlighting the importance of specificity in the victimization and adverse childhood experience (ACE) paradigms.

Experiences in the Gulf of Mexico: Overcoming Obstacles for Commercial Fishing Occupational Safety and Health Research.

Researchers involved in community-based participatory research often face challenges due to numerous dynamic factors, including the physical location of the study population, willingness to participate, language barriers, cultural norms, social stigmas, and unpredictable weather and other disasters. Investigators who work with commercial fishermen are all too familiar with these potential obstacles and barriers to performing occupational safety and health research. Such has been the case along the Texas and Louisiana gulf coasts, where the burden of occupational fatalities in the shrimp fishery remains high. Moreover, the need for strategic community, regulatory agency, and research partnerships in order to explore solutions that can help to reduce this burden is ongoing. The IFISH 5 conference and the panel session described in this brief report offered a venue to acknowledge and create awareness of these barriers and opportunities for developing sustainable solutions that can have an impact on this loss of life. The approach taken was to explore the perspectives of a panel of regional collaborators including two researchers, an outreach community liaison, and a marine safety and health official from the U. S. Coast Guard. Key barriers emerging from the panel fell into four themes, each emphasized by one of the four panel members, allowing for discussion of potential solutions. The themes included: (1) language gap; (2) cultural influences and use of personal flotation devices; (3) relationships with the community; and (4) enforcement agency role as a trusted opinion leader. This panel session can readily serve as a model to promote similar exploration of barriers and solutions in commercial fishing across other regions of the US and internationally as well.

In-situ burning with chemical herders for Arctic oil spill response: Meta-analysis and review.

With increased oil exploration and marine activity in the warming Arctic, there is an increased risk of future oil spills in the Arctic region. In-situ burning (ISB), along with the use of chemical herders (to thicken the slick of spilled oil) has emerged as a potentially viable oil-spill response technique for various Arctic scenarios. The purpose of this research review is to document the field use, research, and analysis regarding the use of ISB to address an offshore oil spill response in the Arctic, with a specific focus on the use of chemical herders to aid ISB in Arctic waters. The compilation of this work involved a systematic review of available experimental data, studies on actual spill-response events, and resulting recommendations on this topic. Both peer-reviewed and available gray literature from the early 1970s through 2018 were evaluated. Selection criteria centered on herders for use with ISBs, Arctic conditions as they relate to ISB, and operational windows of opportunity and environmental risk for this type of oil spill response. From the available literature, more than a hundred articles are referenced herein, and annotated summaries provided. There is general agreement that ISB should be classified as a viable response option for the Arctic offshore to be implemented as part of a multi-layered approach (ASTM 2014; Fritt-Rasmussen et al. 2017; NRC 2014; Rolandsen 2018). In addition, there continue to be gaps noted concerning the availability of monitoring/surveillance personnel and equipment, and logistical/safety considerations for working in the Arctic, as well as specific information on the fate and potential impact of herders and burn residue on Arctic receptors (NRC 2014; Nuka 2016; US-DOI and USGS 2011). This review provides background information for researchers, responders, decision-makers, communities, and is a resource when developing and approving an oil spill response plan or planning future research which includes the use of ISB and herders.

The Influence of Police Related Media, Victimization, and Satisfaction on African American College Students' Perceptions of Police.

This study explored the roles of police related television programming, and satisfaction with most recent police contact in predicting perceptions of law enforcement performance and treatment of minorities for students with no police victimization experiences. The current study also explored the role of personal and familial police victimization experiences impact on perceptions of police. A convenience sample of 246 African American students (168 females and 78 males) ranging in age from 17 to 59 (Mage = 21.73), attending a historically Black university completed a questionnaire assessing demographic information, satisfaction with most recent contact with police, personal, and familial police victimization experiences, and law enforcement related television programming. Results showed that African American students with personal and familial police victimization experiences had significantly different perceptions of law enforcement than individuals with no victimization experiences or just familial victimization experiences. Results also highlighted the predictive power of crime reality shows, police excessive force media consumption, and satisfaction with police in influencing perceptions of police. These significant relationships and causal models may be salient for understanding pertinent factors that influence perceptions of law enforcement in African American college students.

Using Problem-solving Therapy to Improve Problem-solving Orientation, Problem-solving Skills and Quality of Life in Older Hemodialysis Patients.

OBJECTIVES: To determine the effectiveness of Problem-Solving Therapy (PST) in older hemodialysis (HD) patients by assessing changes in health-related quality of life and problem-solving skills. METHODS: 33 HD patients in an outpatient hemodialysis center without active medical and psychiatric illness were enrolled. The intervention group (n = 15) received PST from a licensed social worker for 6 weeks, whereas the control group (n = 18) received usual care treatment. RESULTS: In comparison to the control group, patients receiving PST intervention reported improved perceptions of mental health, were more likely to view their problems with a positive orientation and were more likely to use functional problem-solving methods. Furthermore, this group was also more likely to view their overall health, activity limits, social activities and ability to accomplish desired tasks with a more positive mindset. CONCLUSIONS: The results demonstrate that PST may positively impact mental health components of quality of life and problem-solving coping among older HD patients. CLINICAL IMPLICATIONS: PST is an effective, efficient, and easy to implement intervention that can benefit problem-solving abilities and mental health-related quality of life in older HD patients. In turn, this will help patients manage their daily living activities related to their medical condition and reduce daily stressors.

From declared asset retirement obligations to a decommissioning cost estimate for onshore crude oil fields in Nigeria.

As in most mature crude oil producing regions, asset divestment has commenced in Nigeria. Decommissioning and associated environmental liabilities are expected to become important problems requiring attention. Public and government engagement on decommissioning will be ineffective without information on cost of decommissioning liabilities, which are held confidential by oil companies. This study demonstrates a method to determine generic aggregate cost of decommissioning liabilities for Nigeria onshore fields, using non-proprietary data from annual financial reports of operating companies in Nigeria. The results can be used as basis for negotiation with operators and to help government in preparation for decommissioning risk.

Electrochemical Nickel Catalysis for Sp2-Sp3 Cross-Electrophile Coupling Reactions of Unactivated Alkyl Halides.

A constant-current electrochemical method for reducing catalytic nickel complexes in sp2-sp3 cross-electrophile coupling reactions has been developed. The electrochemical reduction provides reliable nickel catalyst activation and turnover and offers a tunable parameter for reaction optimization, in contrast to more standard activated metal powder reductants. The electrochemical reactions give yields (i.e., 51-86%) and selectivities as high or superior to those using metal powder reductants and provide access to a wider substrate scope.

Scale-up considerations for surface collecting agent assisted in-situ burn crude oil spill response experiments in the Arctic: Laboratory to field-scale investigations.

In the event of a marine oil spill in the Arctic, government agencies, industry, and the public have a stake in the successful implementation of oil spill response. Because large spills are rare events, oil spill response techniques are often evaluated with laboratory and meso-scale experiments. The experiments must yield scalable information sufficient to understand the operability and effectiveness of a response technique under actual field conditions. Since in-situ burning augmented with surface collecting agents ("herders") is one of the few viable response options in ice infested waters, a series of oil spill response experiments were conducted in Fairbanks, Alaska, in 2014 and 2015 to evaluate the use of herders to assist in-situ burning and the role of experimental scale. This study compares burn efficiency and herder application for three experimental designs for in-situ burning of Alaska North Slope crude oil in cold, fresh waters with ∼10% ice cover. The experiments were conducted in three project-specific constructed venues with varying scales (surface areas of approximately 0.09 square meters, 9 square meters and 8100 square meters). The results from the herder assisted in-situ burn experiments performed at these three different scales showed good experimental scale correlation and no negative impact due to the presence of ice cover on burn efficiency. Experimental conclusions are predominantly associated with application of the herder material and usability for a given experiment scale to make response decisions.

Using pharmacists to improve risk stratification and management of stage 3A chronic kidney disease: a feasibility study.

BACKGROUND: Measurement of albuminuria to stratify risk in chronic kidney disease (CKD) is not done universally in the primary care setting despite recommendation in KDIGO (Kidney Disease Improving Global Outcomes) guidelines. Pharmacist medication therapy management (MTM) may be helpful in improving CKD risk stratification and management. METHODS: We conducted a pragmatic, cluster-randomized trial using seven primary care clinic sites in the Geisinger Health System to evaluate the feasibility of pharmacist MTM in patients with estimated glomerular filtration rate (eGFR) 45-59 ml/min/1.73 m2 and uncontrolled blood pressure (≥150/85 mmHg). In the three pharmacist MTM sites, pharmacists were instructed to follow a protocol aimed to improve adherence to KDIGO guidelines on testing for proteinuria and lipids, and statin and blood pressure medical therapy. In the four control clinics, patients received usual care. The primary outcome was proteinuria screening over a follow-up of 1 year. A telephone survey was administered to physicians, pharmacists, and patients in the pharmacist MTM arm at the end of the trial. RESULTS: Baseline characteristics were similar between pharmacist MTM (n = 24) and control (n = 23) patients, although pharmacist MTM patients tended to be younger (64 vs. 71 y; p = 0.06) and less likely to have diabetes (17 % vs. 35 %; p = 0.2) or baseline proteinuria screening (41.7 % vs. 60.9 %, p = 0.2). Mean eGFR was 54 ml/min/1.73 m2 in both groups. The pharmacist MTM intervention did not significantly improve total proteinuria screening at the population level (OR 2.6, 95 % CI: 0.5-14.0; p = 0.3). However, it tended to increase screening of previously unscreened patients (78.6 % in the pharmacist MTM group compared to 33.3 % in the control group; OR 7.3, 95 % CI: 0.96-56.3; p = 0.05). In general, the intervention was well-received by patients, pharmacists, and providers, who agreed that pharmacists could play an important role in CKD management. A few patients contacted the research team to express anxiety about having a CKD diagnosis without prior knowledge. CONCLUSIONS: Pharmacist MTM may be useful in improving risk stratification and management of CKD in the primary care setting, although implementation requires ongoing education and multidisciplinary collaboration and careful communication regarding CKD diagnosis. Future studies are needed to establish the effectiveness of pharmacist MTM on slowing CKD progression and improvement in cardiovascular outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02208674 Registered August 1, 2014, first patient enrolled September 30, 2014.

Incident chronic kidney disease: trends in management and outcomes.

BACKGROUND: Management trends in early chronic kidney disease (CKD) and their associations with clinical outcomes have not previously been reported. METHODS: We evaluated incident (Stage G3A) CKD patients from an integrated health care system in 2004-06, 2007-09 and 2010-12 to determine adjusted trends in screening (urinary protein quantification), treatment [prescription for angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), and statin] and nephrology referral. For the same time periods, adjusted rates for mortality, progression to Stage G4 CKD and hospitalization for myocardial infarction or heart failure were calculated and compared across time periods. RESULTS: There were 728, 788 and 956 patients with incident CKD in 2004-06, 2007-09 and 2010-12, respectively. Adjusted rates of proteinuria quantification (31, 39 and 51 screens/100 person-years), statin prescription (53, 63 and 64 prescriptions/100 person-years) and nephrology referral (2, 3 and 5 referrals/100 person-years) all increased over time (P for trend <0.001 in all cases). ACEI/ARB prescription rates did not change (88, 83 and 80 prescriptions/100 person-years, P = 0.68). Adjusted death rates (7, 5 and 6 deaths/100 person-years), CKD progression (9, 10 and 7 progressors/100 person-years) and cardiovascular hospitalization (10, 8 and 9 hospitalizations per 100/person-years) did not change (P for trend >0.4 in all cases). CONCLUSION: In this integrated health care system, management of incident CKD over the past decade has intensified.

Solvolysis, Electrochemistry, and Development of Synthetic Building Blocks from Sawdust.

Either aldehyde or cinnamyl ether products can be selectively extracted from raw sawdust by controlling the temperature and pressure of a solvolysis reaction. These materials have been used as platform chemicals for the synthesis of 15 different synthetic substrates. The conversion of the initial sawdust-derived materials into electron-rich aryl substrates often requires the use of oxidation and reduction chemistry, and the role electrochemistry can play as a sustainable method for these transformations has been defined.

Photovoltaic-driven organic electrosynthesis and efforts toward more sustainable oxidation reactions.

The combination of visible light, photovoltaics, and electrochemistry provides a convenient, inexpensive platform for conducting a wide variety of sustainable oxidation reactions. The approach presented in this article is compatible with both direct and indirect oxidation reactions, avoids the need for a stoichiometric oxidant, and leads to hydrogen gas as the only byproduct from the corresponding reduction reaction.

Impact of chronic kidney disease stage on lower-extremity arthroplasty.

End-stage renal disease and dialysis is commonly associated with poor outcomes after joint replacement surgery. The goal of this study was to evaluate postoperative complications in patients with less advanced chronic kidney disease undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients who underwent THA or TKA between 2004 and 2011 with stage 1, 2, or 3 chronic kidney disease were retrospectively reviewed via an electronic medical record. The authors compared 377 patients who had stage 1 to 2 chronic kidney disease with 402 patients who had stage 3 chronic kidney disease. No significant differences in 90-day readmission or revision rates were found between the stage 1 to 2 and stage 3 patient groups. For patients with stage 3 chronic kidney disease, the overall mortality rate was greater than that in patients with stage 1 to 2 chronic kidney disease. However, when adjusted for comorbid disease, no significant increases were seen in joint infection, readmission, or early revision between patients with stage 1 to 2 chronic kidney disease vs patients with stage 3 chronic kidney disease. The overall incidence of infection was high (3.5%) but far less than reported for patients with end-stage renal disease, dialysis, and kidney transplant. In conclusion, patients with stage 1, 2, or 3 chronic kidney disease may have a higher than expected rate of prosthetic joint infection (3.5%) after total joint arthroplasty. Patients with stage 3 chronic kidney disease are at higher risk for postoperative mortality compared with those with lesser stages of kidney disease.