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Purpose. To provide a bibliographical-historical perspective and main interest in the field of myopia. Methods. In this bibliographic study, the Web of Science Database was searched from 1999 to 2018. Recorded parameters included journal name, impact factor, year and language, number of authors, type and origin, methodology, number of subjects, funding, and topics. Results. Epidemiological assessments were the leading type of article (28%), and half of the papers were prospective studies. The number of citations for multicenter studies was significantly higher (P = 0.034). The articles were published in 27 journals, with the majority in Investigative Ophthalmology, Vision Sciences (28%), and Ophthalmology (26%). Etiology, signs and symptoms, and treatment equally encompassed the topics. Papers addressing etiology, specifically genetic and environmental factors (P = 0.029), signs and symptoms (P = 0.001), and prevention, specifically public awareness (47%, P = 0.005), received significantly more citations. Treatment to decrease myopia progression was a much more common topic (68%) than refractive surgery (32%). Optical treatment was the most popular modality (39%). Half of the publications came from 3 countries: the United States (US), Australia, and Singapore. The highest ranked and cited papers came from the US (P = 0.028) and Singapore (P = 0.028). Conclusions. To our knowledge, this is the first report of the top-cited articles on myopia. There is a predominance of epidemiological assessments and multicenter studies originating from the US, Australia, and Singapore, assessing etiology, signs and symptoms, and prevention. These are more frequently cited, emphasizing the great interest in mapping the increase in the incidence of myopia in different countries, public health awareness, and myopia control. [ABSTRACT FROM AUTHOR]

The research on mentorship in the professoriate is extensive and substantial. New faculty benefit from having sustained and focused interactions with a more knowledgeable other who is able to shepherd them through the induction phase of their academic career. Professional support, collaboration, and sponsorship have always been critical, but this need is even more pronounced in the isolating times of the pandemic. During the 2020-2022 academic years, junior faculty were asked to navigate new spaces which would be exceedingly trying under normal circumstances, but even more so while under severe restrictions. This paper will examine the usefulness of alternative ways of mentoring that can assist incoming faculty. Strategies for administrators and senior faculty responsible for facilitating these connections will be explored.

Introduction: This study presents a global research scenario in the broad domain of osteoarthritis (OA) research, using quantitative and qualitative publication and citation indicators. Methods: The study is based on 45,368 global publications, sourced from the Scopus bibliographical database, covering three decades (1994–2023). We studied the performance of the top 12 developed and top 12 developing countries. The key countries, organizations and authors at national and international levels were identified. The broad subject areas and key journals contributing to global OA research were delineated, besides identifying the broad characteristics of highly cited papers in the field. Results: The United States and China were the most productive countries, while the Netherlands and Canada made the largest citation impact. Harvard Medical School and the University of Sydney made the most contribution, while Boston University and Pfizer Inc., USA registered the highest citation impact. Hunter DJ and Guermazi A were the most productive authors, while Lohmander LS, and Hochberg MC registered the highest citation impact. Osteoarthritis and Cartilage (n = 4879) and Annals of the Rheumatic Diseases (n = 786) published the maximum papers, while Arthritis and Rheumatism and Nature Reviews Rheumatology registered the largest citation impact. The highly cited papers with 100 or more citations constituted 6.25% of the total publications. Conclusions: There has been a systematic growth of publications on OA. The research on OA was mainly done in developed countries, with the maximum publications coming from the United States of America, China and Canada. The most impactful publications on OA were from the Netherlands, Canada and the United States of America. [ABSTRACT FROM AUTHOR]

Background: Advances in health equity rely on representation of diverse groups in population health research samples. Despite progress in the diversification of research samples, continued expansion to include systematically excluded groups is needed to address health inequities. One such group that is infrequently represented in population health research are adults with intellectual disability. Individuals with intellectual disability experience pervasive health disparities. Representation in population health research is crucial to determine the root causes of inequity, understand the health of diverse populations, and address health disparities. The purpose of this paper was to develop recommendations for researchers to increase the accessibility of university health research and to support the inclusion of adults with intellectual disability as participants in health research. Methods: A comprehensive literature review, consultation with the university ethics review board, and review of United States federal regulations was completed to identify barriers to research participation for individuals with intellectual disability. A collaborative stakeholder working group developed recommendations and products to increase the accessibility of university research for participants with intellectual disability. Results: Eleven key barriers to research participation were identified including gaps in researchers' knowledge, lack of trust, accessibility and communication challenges, and systematic exclusion among others. Together the stakeholder working group compiled seven general recommendations for university health researchers to guide inclusion efforts. Recommendations included: 1) address the knowledge gap, 2) build community partnerships, 3) use plain language, 4) simplify consent and assent processes, 5) establish research capacity to consent, 6) offer universal supports and accommodations, and 7) practice accessible dissemination. In addition, four products were created as part of the stakeholder working group to be shared with researchers to support the inclusion of participants with intellectual disability. 1) Supports I Need Checklist, 2) Plain language glossary of health and research terms, 3) Understanding Consent and Assent in Plain Language, 4) Easy-Read Paper Template. Conclusion: Community members and individuals with intellectual disability want to be included in research and are eager to engage as research participants. It is the responsibility of the researcher to open the door to university health research. The recommendations discussed in this paper could increase accessibility for a broader range of research participants and, in particular, promote the inclusion of individuals with intellectual disability to advance health equity in population health research. [ABSTRACT FROM AUTHOR]

The paper describes the results of the wear test of innovative sets of piston rings intended, among others, to drive diesel locomotives operated in North America, including the USA. The main subject of research is an innovative set of piston rings, the first sealing ring containing a synthetic diamond embedded in a porous chrome coating. The developed multilayer coating is designed to reduce the wear of the piston rings and the combustion engine cylinder. This technology has been implemented at Piston Rings Manufactory "Prima" S.A. in Łódź. The tests were carried out using a two-stroke diesel engine of the EMD 645 type. This engine is manufactured by General Motors Corporation in the United States. The described research was carried out in the United States in San Antonio, Texas, at the Southwest Research Institute. The EMD 645 engine is widely used in power units of heavy diesel locomotives and inland waterway barges in the United States of America, India, and South Africa. [ABSTRACT FROM AUTHOR]

A large body of empirical research in accounting investigates the causes and consequences of accruals quality, reaching numerous influential conclusions. Yet little work has been done to systematically evaluate the validity of the underlying measures of accruals quality. We evaluate these measures using three criteria: (1) Is the measure unaffected by the underlying economic determinants of accruals? (2) Does the measure consistently reflect errors in accruals? (3) Does the measure facilitate tests with sufficient power to detect plausible variation in accrual errors? Using a combination of theoretical modeling and numerical simulations, we show that all measures fail at least one of these criteria. Our evaluation provides new interpretations of existing research and guides the choice of measures and the interpretation of results in future research. Data Availability: Data are available from the public sources identified in the paper. JEL Classifications: M41; C12. [ABSTRACT FROM AUTHOR]

International research and collaboration has been a part of the National Cancer Institute's (NCI) mission since its creation in 1937. Early on, efforts were limited to international exchange of information to ensure that US cancer patients could benefit from advances in other countries. As NCI's research grant portfolio grew in the 1950s, it included a modest number of grants to foreign institutions, primarily in the United Kingdom and Europe. In the 1960s, the development of geographic pathology, which aimed to study cancer etiology through variations in cancer incidence and risk factors, led to an increase in NCI-funded international research, including research in low- and middle-income countries. In this paper, we review key international research programs, focusing particularly on the first 50 years of NCI history. The first NCI-led overseas research programs, established in the 1960s in Ghana and Uganda, generated influential research but also struggled with logistical challenges and political instability. The 1971 National Cancer Act was followed by the creation of a number of bilateral agreements with foreign governments, including China, Japan, and Russia, to support cooperation in technology and medicine. Although these agreements were broad without specific scientific goals, they provided an important mechanism for sustained collaborations in specific areas. With the creation of the NCI Center for Global Health in 2011, NCI's global cancer research efforts gained sustained focus. Because the global cancer burden has evolved over time, increasingly impacting low- and middle-income countries, NCI's role in global cancer research remains more important than ever. [ABSTRACT FROM AUTHOR]

Each year, through population-based newborn screening (NBS), 1 in 294 newborns is identified with a condition leading to early treatment and, in some cases, life-saving interventions. Rapid advancements in genomic technologies to screen, diagnose, and treat newborns promise to significantly expand the number of diseases and individuals impacted by NBS. However, expansion of NBS occurs slowly in the United States (US) and almost always occurs condition by condition and state by state with the goal of screening for all conditions on a federally recommended uniform panel. The Newborn Screening Translational Research Network (NBSTRN) conducted the NBS Expansion Study to describe current practices, identify expansion challenges, outline areas for improvement in NBS, and suggest how models could be used to evaluate changes and improvements. The NBS Expansion Study included aworkshop of experts, a survey of clinicians, an analysis of data from online repositories of state NBS programs, reports and publications of completed pilots, federal committee reports, and proceedings, and the development of models to address the study findings. This manuscript (Part One) reports on the design, execution, and results of the NBS Expansion Study. The Study found that the capacity to expand NBS is variable across the US and that nationwide adoption of a new condition averages 9.5 years. Four factors that delay and/or complicate NBS expansion were identified. A companion paper (Part Two) presents a use case for each of the four factors and highlights how modeling could address these challenges to NBS expansion. [ABSTRACT FROM AUTHOR]

This paper explores the intersectionality of various analytical issues related to the trafficking of women from India, South Asia, to the United States. Addressing the oppressive pathways and their intersectionality, this conceptual framework provides a deeper understanding of the interrelationships of nationality, gender, ethnicity, religion, class, caste, immigration process, immigration status, social support in the United States, and language barriers that influence migrating women's vulnerability to human trafficking in the process of immigration from India, South Asia, to the United States. The primary purpose of this paper is to advocate for a binary perspective of intersectionality in conducting research in international human trafficking. [ABSTRACT FROM AUTHOR]

Background. Infection following orthopaedic trauma surgery is increasingly recognized as one of the major research priorities with as primary goal, improving patient care. This increased interest has been anecdotally recognized through published research, research grants, and, finally, with the development of the fracture-related infection (FRI) consensus group. In 2017, the accepted consensus definition of FRI was published, which has been followed by consensus recommendations from both a surgical and medical perspective. A bibliometric analysis was performed to objectively describe the trends in published clinical research related to FRI. Methods. The terms related to FRI were searched in the Web of Science database between 2000 and 2020. The characteristics of clinical research on FRI regarding the author, country, journal, institution, scientific output, top 100 most cited articles, and trend topics were analyzed using Bibliometrix and WPS Office. Results. A total of 2597 records were eligible for inclusion in this bibliometric approach, with studies originating from 89 countries, including eight languages. The United States of America (USA) published the highest number of articles and citations. International collaborations were present between 72 countries, with the most active country being the USA. The most contributive institution was the University of California. The highest number of papers and citations were from the Injury-International Journal of the Care of the Injured and the Journal of Orthopaedic Trauma. The top 100 most cited articles were published in 27 different journals, with the number of citations ranging between 97 and 1004. The latest trend topics were related to the diagnosis of FRI. Conclusion. The present bibliometric analysis shows the research characteristics and trends of FRI from multiple perspectives. The fact that there is an increasing number of studies being published on FRI shows the agreement among scientists and clinicians that standardization with respect to this topic is very important. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine modifiable mediators for socioeconomic disparities in childhood obesity in the United States.Methods: This study used the data of 1,211 mother-child dyads from a US national birth cohort from pregnancy to 6 years post partum. Socioeconomic status was indicated by maternal education (college graduate vs. less) and family income (>185% vs. ≤185% of the poverty line). Single- and multiple-factor mediation analyses were conducted for socioeconomic disparities in childhood obesity at 6 years, adjusting for demographics.Results: The confounder-adjusted relative risk of childhood obesity was 1.79 for low maternal education and 1.42 for low family income. Low-maternal-education-related obesity was individually mediated by maternal preconception BMI (percentage of indirect effect, 8.8%), smoking during pregnancy (7.0%), infant weight gain (14.4%), child sleep duration (11.4%), and TV viewing during weekdays at 6 years (4.9%). Low-family-income-related obesity was mediated by maternal preconception BMI (18.5%), smoking during pregnancy (6.3%), child sleep duration (12.8%), and the home learning environment at 6 years (26.2%). In multiple-mediator analysis, significant mediators together mediated 54.0% of maternal-education-related or 39.4% of family-income-related disparities.Conclusions: Maternal preconception BMI, smoking during pregnancy, infant weight gain, child sleep, TV viewing, and the home learning environment substantially mediated socioeconomic disparities in childhood obesity in the United States. [ABSTRACT FROM AUTHOR]

To mitigate COVID-19 exposure risks in methadone clinics, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary modification of regulations in March 2020 to permit, with state concurrence, extended take-home methadone doses. The modification allowed for up to 28 days of take-home methadone for stable patients and 14 days for those less stable. Using both interrupted time series and difference-in-differences methods, this study examined the association between the policy change and fatal methadone overdoses, comparing states that permitted the expansion of take-home doses with states that did not. The findings suggest the pandemic emergency take-home policy did not increase methadone-involved mortality. [ABSTRACT FROM AUTHOR]

Background: Clinical judgment is declining in new graduate nurses, which affects patient safety and is therefore tested on the Next Generation NCLEX. There is limited research describing barriers and facilitators impacting nursing faculty's experiences teaching clinical judgment. Aims: The purpose of this study was to explore barriers and facilitators affecting undergraduate nursing faculty's clinical judgment teaching methods. Methods: Sixteen qualitative interviews were conducted with full-time nursing faculty at seven universities in the Northeast and Southeast regions of the United States. Results: The findings revealed program, student, and faculty factors affecting clinical judgment teaching methods. Subthemes included time, class size, students' class preparation, critical thinking, task orientation, professional development, and faculty resistance. Conclusion: Minimizing barriers and strengthening facilitators based on participants' practices and previous research can support more effective clinical judgment pedagogy, which has the potential to achieve Next Generation NCLEX success and potentially increase patient safety. [ABSTRACT FROM AUTHOR]

Background: The American Society of Anesthesiologists (ASA) classification is the most used system to assess patient health status before surgery, ranging from I to V levels. This study aims to explore the impact of different ASA risk classes (ASA II [mild risk] and ASA III [severe risk]) on clinical outcomes following hip fracture surgery, including all-cause mortality and postoperative complications. Methods: A retrospective analysis from 2019 to 2021 across three Jordanian centers was conducted. The study included patients aged 65 and above who underwent hip fracture repair surgeries. Preoperative measures, intraoperative management protocols, and postoperative care were collected. Clinical data were extracted from electronic medical records, including demographics, fracture type, intraoperative data, and postoperative outcomes. Results: The analysis included 1033 patients, with 501 (48.5%) in the mild anesthetic risk group (ASA I-II) and 532 (51.5%) in the severe anesthetic risk group (ASA III-V). The mean age was 73 years, with a higher prevalence of males in the severe risk group. Patients in the severe risk group had more comorbidities, higher ICU admissions (15.23% vs. 6.18%), longer hospital stays (median 7 vs. 6 days), and higher rates of postoperative thromboembolic complications (3.39% vs. 1.39%) compared to the mild risk group. Additionally, the severe risk group showed higher mortality rates both in-hospital mortality (3.38% vs. 1.39%) and all-cause mortality (16.92% vs. 10.36%). Multivariate analysis identified higher ASA score as independent risk factors for increased all-cause mortality (HR = 1.64 95%CI 1.51–2.34) and thromboembolic complications (OR = 2.85 95%CI 1.16-7). Length of hospital stay was significantly associated with higher ASA score (OR = 1.04 95%CI 0.96–1.11). Conclusion: The study underscores the significant impact of anesthetic risk on the outcomes of hip fracture surgeries. Patients with higher ASA scores associated with severe systemic diseases may have at increased risk of adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Children with medical complexity (CMC) often face significant barriers to accessing care, obtaining appropriate insurance coverage for medical devices, technology, supplies, home nursing and social services. These challenges, when viewed through the lens of social determinants of health, highlight concerns about healthcare inequity. These inequities can impact CMC by limiting access to follow‐up appointments, leading to disproportionate use of emergency department services, restricting support services, reducing the quality of medical products and increasing the likelihood of adverse events. Addressing these concerns requires comprehensive policy changes at both state and federal levels. Achieving successful collaborations between states and federal agencies is particularly challenging and may take months or even years to accomplish. Objectives: Through an exploratory qualitative approach, this study facilitates a nuanced inquiry into the experiences and systemic challenges encountered by medical professionals and primary caregivers managing CMC who require a paediatric tracheostomy. Methods: Qualitative interviews were conducted with 17 health professionals and primary caregivers residing in the United States. A thematic analysis was used to analyse the transcribed interview data. Results: Using exploratory thematic analysis, we identified challenges and opportunities for improvement regarding (a) access to health insurance, (b) procurement of essential medical supplies, (c) logistical constraints and (d) identifying interim solutions. Conclusion: Building on our findings, we discuss how socioecological factors impact health and quality of life of CMC and families. Additionally, we address the growing gap in quality of care through a comprehensive approach that considers patient needs, regulatory frameworks and affordability. Patient or Public Contribution: Medical practitioners and healthcare professionals were actively involved in the development, production and implementation of the research project. These individuals were given the opportunity to review their statements and review the manuscript before publishing. While caregivers did not engage in member checking, each provided their consent before data collection. [ABSTRACT FROM AUTHOR]

Background: Physical agent modalities (PAMs) are used by occupational therapists to prepare for or facilitate participation in purposeful activities. However, little has been published in the last quarter century regarding how U.S. occupational therapists use and are prepared to use of PAMs in contemporary clinical practice. In this study, U.S.-based occupational therapists were surveyed regarding their use of PAMs, preparation for use, and perceptions of that preparation. Methods: Survey data was collected from a purposive sample of 141 U.S.-based occupational therapists and occupational therapy assistants as part of this exploratory-descriptive, mixed-methods study. Thematic and descriptive statistical analyses were completed using quantitative and qualitative data. Results: Quantitative data provided a current profile of types, frequency, and settings in which PAMs are used, along with sources and perceptions of training. Qualitative data yielded three themes, including (a) benefit of experiential learning, (b) benefit of continuing education, and (c) relative adequacy of entry-level training. Conclusions: Findings from this study serve as an initial step in understanding contemporary use of PAMs in clinical occupational therapy practice. Further study is needed to expand the knowledge base in the profession and support an evidence-informed approach to care. [ABSTRACT FROM AUTHOR]

Introduction: Consideration of the cost of care and value in healthcare is now a recognized element of physician training. Despite the urgency to educate trainees in high-value care (HVC), educational curricula and evaluation of these training paths remain limited, especially with respect to emergency medicine (EM) residents. We aimed to complete a needs assessment and evaluate curricular preferences for instruction on HVC among EM residents. Methods: This was a qualitative, exploratory study using content analysis of two focus groups including a total of eight EM residents from a single Midwestern EM residency training program. Participants also completed a survey questionnaire. Results: There were two themes. Within the overall theme of resident experience with and perception of HVC, we found five sub-themes: 1) understanding of HVC focuses on diagnosis and decision-making; 2) concern about patient costs, including the effects on patients’ lives and their ability to engage with recommended outpatient care; 3) conflict between internal beliefs and external expectations, including patients’ perceptions of value; 4) approach to HVC changes with increasing clinical experience; and 5) slow-moving, political discussion around HVC. Within the overall theme of desired education and curricular design, we identified four sub-themes: 1) limited prior education on HVC and health economics; 2) motivation to receive training on HVC and health economics; 3) desire for discussion-based format for HVC curriculum; and 4) curriculum targeted to level of training. Respondents indicated greatest acceptability of interactive, discussion-based formats. Discussion: We conducted a targeted needs assessment for HVC among EM residents. We identified broad interest in the topic and limited self-reported baseline knowledge. Curricular content may benefit from incorporating resident concerns about patient costs and conflict between external expectations and internal beliefs about HVC. Curricular design may benefit from a focus on interactive, discussion-based modalities and tailoring to the learner’s level of training. [ABSTRACT FROM AUTHOR]

Fructosamine is a measure of short-term glycemic control, which has been suggested as a useful complement to glycated hemoglobin (HbA1c) for the diagnosis and monitoring of diabetes. To date, a single genome-wide association study (GWAS) including 8,951 U.S. White and 2,712 U.S. Black individuals without a diabetes diagnosis has been published. Results in Whites and Blacks yielded different association loci, near RCN3 and CNTN5, respectively. In this study, we performed a GWAS on 20,731 European-ancestry blood donors and meta-analyzed our results with previous data from U.S. White participants from the Atherosclerosis Risk in Communities (ARIC) study (Nmeta = 29,685). We identified a novel association near GCK (rs3757840, βmeta = 0.0062; minor allele frequency [MAF] = 0.49; Pmeta = 3.66 × 10-8) and confirmed the association near RCN3 (rs113886122, βmeta = 0.0134; MAF = 0.17; Pmeta = 5.71 × 10-18). Colocalization analysis with whole-blood expression quantitative trait loci data suggested FCGRT as the effector transcript at the RCN3 locus. We further showed that fructosamine has low heritability (h2 = 7.7%), has no significant genetic correlation with HbA1c and other glycemic traits in individuals without a diabetes diagnosis (P > 0.05), but has evidence of shared genetic etiology with some anthropometric traits (Bonferroni-corrected P < 0.0012). Our results broaden knowledge of the genetic architecture of fructosamine and prioritize FCGRT for downstream functional studies at the established RCN3 locus. [ABSTRACT FROM AUTHOR]

This multi-center study examined the safety and effectiveness of cochlear implantation of children between 9 and 11 months of age. The intended impact was to support practice regarding candidacy assessment and prognostic counseling of pediatric cochlear implant candidates. Data in the clinical chart of children implanted at 9–11 months of age with Cochlear Ltd devices at five cochlear implant centers in the United States and Canada were included in analyses. The study included data from two cohorts implanted with one or two Nucleus devices during the periods of January 1, 2012–December 31, 2017 (Cohort 1, n = 83) or between January 1, 2018 and May 15, 2020 (Cohort 2, n = 50). Major adverse events (requiring another procedure/hospitalization) and minor adverse events (managed with medication alone or underwent an expected course of treatment that did not require surgery or hospitalization) out to 2 years post-implant were monitored and outcomes measured by audiometric thresholds and parent-reports on the IT-MAIS and LittlEARS questionnaires were collected. Results revealed 60 adverse events in 41 children and 227 ears implanted (26%) of which 14 major events occurred in 11 children; all were transitory and resolved. Improved hearing with cochlear implant use was shown in all outcome measures. Findings reveal that the procedure is safe for infants and that they show clear benefits of cochlear implantation including increased audibility and hearing development. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between the quality of YouTube videos on penile enlargement surgery and the scholarly profiles of surgeons. Materials and Methods: A YouTube search was conducted using the keyword "penile enlargement surgery". Of the first 200 videos from the search results, 66 that met the study criteria were included in the analyses. Two urologists scored each video using the DISCERN score, the Journal of the American Medical Association (JAMA) score, and the global quality scale (GQS) in a double-blind manner. After the video quality scores were determined, the number of publications and h-indexes of surgeons were obtained from Google Scholar. Results: Of the videos, 31 (46.9%) were uploaded by plastic surgeons and 35 (53.1%) by urologists. The median duration of the videos was 4.1 min (interquartile range: 1-8.5) minutes. Eighteen (27.2%) videos had low quality, 9 (13.6%) had medium quality, and 39 (59.1%) had high quality. A statistically significant correlation was found between the h-index of surgeons and video quality scores (DISCERN, r=0.678; JAMA, r=0.646; GQS, r=0.689; p<0.0001). There was also a statistically significant correlation between the total publication counts of surgeons and the video quality scores (DISCERN, r=0.614; JAMA, r=0.569; GQS, r=0.607; p<0.0001). Lastly, a weak, statistically significant correlation was detected between the DISCERN scores of the videos and the number of likes (r=0.278, p=0.029). Conclusion: This study revealed a significant correlation between the quality of YouTube videos on penile enlargement surgery and the h-indexes and total publication counts of surgeons. This study was the first to analyze the relationship between the quality of YouTube videos on penile enlargement surgery and the scholarly profiles of surgeons. [ABSTRACT FROM AUTHOR]

6–11-year-old children provide a critical window for physical activity (PA) interventions. The Virtual Fitness Buddy ecosystem is a precision health PA intervention for children integrating mixed reality technology to connect people and devices. A cluster randomized, controlled trial was conducted across 19 afterschool sites over two 6-month cohorts to test its efficacy in increasing PA and decreasing sedentary behavior. In the treatment group, a custom virtual dog via a mixed reality kiosk helped children set PA goals while sharing progress with parents to receive feedback and support. Children in the control group set PA goals using a computer without support from the virtual dog or parents. 303 children had 8+ hours of PA data on at least one day of each of the 3 intervention time intervals. Conversion of sedentary time was primarily to light-intensity PA and was strongest for children with low baseline moderate-to-vigorous PA than children above 45 min of baseline moderate-to-vigorous PA. Findings suggest that the VFB ecosystem can promote sustainable PA in children and may be rapidly diffused for widespread public health impact. [ABSTRACT FROM AUTHOR]

Background: There is an epidemic of firearm injuries in the United States since the mid-2000s. Thus, we sought to examine whether hospitalization from firearm injuries have increased over time, and to examine temporal changes in patient demographics, firearm injury intent, and injury severity. Methods: This was a multicenter, retrospective, observational cohort study of patients hospitalized with a traumatic injury to six US level I trauma centers between 1/1/2016 and 6/30/2022. ICD-10-CM cause codes were used to identify and describe firearm injuries. Temporal trends were compared for demographics (age, sex, race, insured status), intent (assault, unintentional, self-harm, legal intervention, and undetermined), and severity (death, ICU admission, severe injury (injury severity score ≥ 16), receipt of blood transfusion, mechanical ventilation, and hospital and ICU LOS (days). Temporal trends were examined over 13 six-month intervals (H1, January–June; H2, July–December) using joinpoint regression and reported as semi-annual percent change (SPC); significance was p < 0.05. Results: Firearm injuries accounted for 2.6% (1908 of 72,474) of trauma hospitalizations. The rate of firearm injuries initially declined from 2016-H1 to 2018-H2 (SPC = − 4.0%, p = 0.002), followed by increased rates from 2018-H2 to 2020-H1 (SPC = 9.0%, p = 0.005), before stabilizing from 2020-H1 to 2022-H1 (0.5%, p = 0.73). NH black patients had the greatest hospitalization rate from firearm injuries (14.0%) and were the only group to demonstrate a temporal increase (SPC = 6.3%, p < 0.001). The proportion of uninsured patients increased (SPC = 2.3%, p = 0.02) but there were no temporal changes by age or sex. ICU admission rates declined (SPC = − 2.2%, p < 0.001), but ICU LOS increased (SPC = 2.8%, p = 0.04). There were no significant changes over time in rates of death (SPC = 0.3%), severe injury (SPC = 1.6%), blood transfusion (SPC = 0.6%), and mechanical ventilation (SPC = 0.6%). When examined by intent, self-harm injuries declined over time (SPC = − 4.1%, p < 0.001), assaults declined through 2019-H2 (SPC = − 5.6%, p = 0.01) before increasing through 2022-H1 (SPC = 6.5%, p = 0.01), while undetermined injuries increased through 2019-H1 (SPC = 24.1%, p = 0.01) then stabilized (SPC = − 4.5%, p = 0.39); there were no temporal changes in unintentional injuries or legal intervention. Conclusions: Hospitalizations from firearm injuries are increasing following a period of declines, driven by increases among NH Black patients. Trauma systems need to consider these changing trends to best address the needs of the injured population. [ABSTRACT FROM AUTHOR]

Background: Smile esthetics can be subjective. This study aims to assess the effect of culture/geographic location on judging smile esthetics by comparing the perception of smile characteristics between American laypersons (Western culture) and Iranians (Eastern). Materials and Methods: One hundred residents from each country were recruited for this analytical cross-sectional study. A frontal picture of a posed smile with standard norms which are mentioned in the Contemporary Orthodontics textbook by William R. Proffit was selected. Adobe Photoshop 7 was used to alter midline diastema, gingival display (GD), maxillary midline-to-face discrepancy, buccal corridor (BC), and smile arc. Images were given to groups to determine the most attractive and acceptable smile. Data were analyzed by Chi-square, Mann-Whitney, and Spearman correlation coefficient in SPSS-22 (α = 0.05). Results: Americans were less critical in judging diastema (P < 0.001), GD (P = 0.013), and BC (P = 0.004) for smile attractiveness than Iranians. No difference was between the two groups in choosing the acceptability threshold and determining the most attractive smile except for BC (P = 0.002). Conclusion: Overall, Americans were more tolerant of variations in smile characteristics than Iranians. Both groups agreed on most smiles. Therefore, it seems that it is reasonable to use similar standards for smile characteristics while considering the small differences. [ABSTRACT FROM AUTHOR]

Background: Breakthrough cancer pain (BTCP) is primarily managed at home and can stem from physical exertion and emotional distress triggers. Beyond these triggers, the impact of ambient environment on pain occurrence and intensity has not been investigated. This study explores the impact of environmental factors on the frequency and severity of breakthrough cancer pain (BTCP) in the home context from the perspective of patients with advanced cancer and their primary family caregiver. Methods: A health monitoring system was deployed in the homes of patient and family caregiver dyads to collect self-reported pain events and contextual environmental data (light, temperature, humidity, barometric pressure, ambient noise.) Correlation analysis examined the relationship between environmental factors with: 1) individually reported pain episodes and 2) overall pain trends in a 24-hour time window. Machine learning models were developed to explore how environmental factors may predict BTCP episodes. Results: Variability in correlation strength between environmental variables and pain reports among dyads was found. Light and noise show moderate association (r = 0.50–0.70) in 66% of total deployments. The strongest correlation for individual pain events involved barometric pressure (r = 0.90); for pain trends over 24-hours the strongest correlations involved humidity (r = 0.84) and barometric pressure (r = 0.83). Machine learning achieved 70% BTCP prediction accuracy. Conclusion: Our study provides insights into the role of ambient environmental factors in BTCP and offers novel opportunities to inform personalized pain management strategies, remotely support patients and their caregivers in self-symptom management. This research provides preliminary evidence of the impact of ambient environmental factors on BTCP in the home setting. We utilized real-world data and correlation analysis to provide an understanding of the relationship between environmental factors and cancer pain which may be helpful to others engaged in similar work. [ABSTRACT FROM AUTHOR]

Introduction: Access to medication assisted treatment (MAT) for opioid use disorder (OUD) in the United States is a significant challenge for many individuals attempting to recover and improve their lives. Access to treatment is especially challenging in rural areas characterized by lack of programs, few prescribers, and transportation barriers. This study aims to better understand the roles that transportation, Medicaid-funded non-emergency medical transportation (NEMT), and telehealth play in facilitating access to MAT in West Virginia (WV). Methods: We developed this survey using an exploratory sequential mixed methods approach following a review of current peer-reviewed literature plus information gained from 3 semi-structured interviews and follow-up discussions with 5 individuals with lived experience in MAT. Survey results from 225 individuals provided rich context on the influence of transportation in enrolling and remaining in treatment, use of NEMT, and experiences using telehealth. Data were collected from February through August 2021. Results: We found that transportation is a significant factor in entering into and remaining in treatment, with 170 (75.9%) respondents agreeing or strongly agreeing that having transportation was a factor in deciding to go into a MAT program, and 176 (71.1%) agreeing or strongly agreeing that having transportation helps them stay in treatment. NEMT was used by one-quarter (n = 52, 25.7%) of respondents. Only 13 (27.1%) noted that they were picked up on time and only 14 (29.2%) noted that it got them to their appointment on time. Two thirds of respondents (n = 134, 66.3%) had participated in MAT services via telehealth video or telephone visits. More preferred in-person visits to telehealth visits but a substantial number either preferred telehealth or reported no preference. However, 18 (13.6%) reported various challenges in using telehealth. Conclusions: This study confirms that transportation plays a significant role in many people's decisions to enter and remain in treatment for OUD in WV. Additionally, for those who rely on NEMT, services can be unreliable. Finally, findings demonstrate the need for individualized care and options for accessing treatment for OUD in both in-person and telehealth-based modalities. Programs and payers should examine all possible options to ensure access to care and recovery. [ABSTRACT FROM AUTHOR]

Advocates and researchers have made many recommendations for forensic science improvement in the United States. These proposals are often motivated by wrongful convictions related to false or misleading forensic evidence. In many cases, the connection between the proposals and the actual experience of wrongful convictions has not been well defined. Further, recommendations may not have been realizable given the structure of the criminal justice system in the United States and the practical realities of forensic science laboratories. Finally, limited attempts have been made to assess recommendations over time to determine the progress of forensic science improvement and elucidate continuing gaps. Reports from the Department of Justice, the National Academy of Sciences, and the President's Council of Advisors on Science and Technology are assessed to determine the extent to which their recommendations have been implemented, whether the recommendations align with the actual experience of wrongful convictions, and how the American forensic science community has implemented forensic science improvement. The most successful proposals reflect a broad movement toward quality assurance, improved standards, and organizational improvement in the forensic sciences. Less successful proposals are associated with calls for large federal investments, difficulties in community-wide implementation, or uncertain linkage to foundations in science and practice. Significant progress has been made in the standardization of reporting and testimony, assessment of the foundational reliability of the disciplines, and DNA mixture interpretation. Significant gaps remain to improve medicolegal death investigation, governance, and the implementation of standards. Improved allocation and use of resources will be required to meet continuing challenges in capacity building, training, and proficiency testing, although past experience indicates that both federal and non-federal funding will be required to address these issues. Continued improvement is needed to address the issues associated with wrongful convictions, although forensic science leaders have demonstrated the ability to prioritize improvement initiatives. [ABSTRACT FROM AUTHOR]

Despite the benefits of continuous glucose monitoring (CGM), there is lower use of this technology among non-Hispanic Black and Hispanic people with type 1 diabetes compared with their non-Hispanic White counterparts. The T1D Exchange Quality Improvement Collaborative recruited five endocrinology centers to pilot an equity-focused quality improvement (QI) study to reduce racial inequities in CGM use. The centers used rapid QI cycles to test and expand interventions such as provider bias training, translation of CGM materials, provision of CGM education in multiple languages, screening for social determinants of health, and shared decision-making. After implementation of these interventions, median CGM use increased by 7% in non-Hispanic White, 12% in non-Hispanic Black, and 15% in Hispanic people with type 1 diabetes. The gap between non-Hispanic White and non-Hispanic Black patients decreased by 5%, and the gap between non-Hispanic White and Hispanic patients decreased by 8%. [ABSTRACT FROM AUTHOR]

In this research note, we demonstrate that trends in the likelihood of child support agreements differ by marital history (i.e., never-married vs. ever-married) and by whether measures rely on the stock of families (i.e., allthose in which children live apart from a parent) or the flow (i.e., those that include children who newly live apart from a parent) in a given year. While previous research has highlighted difference by marital history, the contrast between stock and flow is a new contribution. Trends are typically measured with reference to the stock of cases, even while the flow of cases, which more immediately reflects concurrent policy changes, is more relevant in many contexts. Interpretations of recent declines in child support agreements in the stock of cases--referenced as evidence for both mandating participation and the impracticality of requiring child support-- may be better informed by considering the flow of cases. We find the flow of previously married mothers increasingly likely to have child support agreements while the likelihood is relatively consistent over time for nevermarried mothers. For both groups, using the flow measure, we find notable increases in agreements without payments due in the most recent period. These findings underscore the importance of differentiating stock and flow, and by marital history, in considering the proportion with agreements as an indicator of the effectiveness of current policy. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. Despite the availability of multiple screening options, CRC screening is underutilized. We conducted a survey of patients (n = 2973) who were prescribed the multi-target stool DNA (mt-sDNA) screening test (commercialized as Cologuard® and manufactured by Exact Sciences Corporation) to understand attitudes and experiences that influence test completion and likelihood of future test completion. Using exploratory factor analyses, we developed three scales: Perceived Effectiveness, Perceived Ease of Use, and Perceived Comfort. [ABSTRACT FROM AUTHOR]

Background: Research in the form of poster and podium abstracts is disseminated at subspecialty society meetings. The quality of this research can be defined by exploring the ultimate publication rate of the presented abstracts. Purpose: To investigate (1) the manuscript publication rate of abstracts presented at the American Orthopaedic Society for Sports Medicine (AOSSM) annual meeting; (2) whether abstract format (poster vs podium) influences overall or 2-year publication rates and time to publication; (3) the abstract factors that are associated with increased publication rate; and (4) whether publication quality as measured by journal of publication, level of evidence (LOE), and number of citations differs between posters and podiums. Study Design: Cross-sectional study. Methods: Poster and podium abstracts that were presented at the AOSSM annual meetings between January 1, 2016, and December 31, 2019, were included. The PubMed and GoogleScholar databases were searched by abstract title and authors to determine whether the related manuscript had been published. For published manuscripts, the journal, journal impact factor (IF), time to publication, authors, and LOE were recorded. Results: The manuscripts of 664 abstracts (341 poster, 323 podium presentations) were published during the study period. The overall publication rate was 52.4%. Publication within 2 years of the meeting was found to be higher in podium abstracts (45.8%) compared with poster abstracts (37.8%) (P =.0366). Podium abstracts had a shorter time to publication (P <.001), higher LOE (P =.0166), more citations (P <.0001), and were published in higher IF journals (P =.0028). Poster presentations were more likely to undergo a change in first author between the time of the conference and future publication (P =.0300). The most common journal of publication was the American Journal of Sports Medicine (36.8%). Conclusion: Abstracts presented at the AOSSM annual meeting had a high rate of publication within 2 years. There was no difference in publication rates between podium and poster abstracts, but podium abstracts had a shorter time to publication and more future citations and were published in journals with higher IFs. [ABSTRACT FROM AUTHOR]

Background: Leigh Syndrome (LS) is a rare genetic neurometabolic disorder, that leads to the degeneration of the central nervous system and subsequently, early death. LS can be caused by over 80 mutations in mitochondrial or nuclear DNA. Patient registries are important for many reasons, such as studying the natural history of the disease, improving the quality of care, and understanding the healthcare burden. For rare diseases, patient registries are significantly important as patient numbers are small, and funding is limited. Cure Mito Foundation started a global patient registry for LS in September 2021 to identify and learn about the LS patient population, facilitate clinical trial recruitment, and unite international patients and researchers. Priorities were to allow researchers and industry partners to access data at no cost through a clear and transparent process, active patient engagement, and sharing of results back to the community. Results: Patient registry platform, survey design, data analysis process, and patient recruitment strategies are described. Reported results include demographics, diagnostic information, symptom history, loss of milestones, disease management, healthcare utilization, quality of life, and caregiver burden for 116 participants. Results show a high disease burden, but a relatively short time to diagnosis. Despite the challenges faced by families impacted by Leigh syndrome, participants, in general, are described as having a good quality of life and caregivers are overall resilient, while also reporting a significant amount of stress. Conclusion: This registry provides a straightforward, no-cost mechanism for data sharing and contacting patients for clinical trials or research participation, which is important given the recruitment challenges for clinical trials for rare diseases. This is the first publication to present results from a global patient registry for Leigh Syndrome, with details on a variety of patient-specific and caregiver outcomes reported for the first time. Additionally, this registry is the first for any mitochondrial disease with nearly 70% of participants residing outside of the United States. Future efforts include continued publication of results and further collaboration with patients, industry partners, and researchers. [ABSTRACT FROM AUTHOR]

Hemophilia is a bleeding disorder caused by a single absent/defective gene and characterized by a lack of functional clotting factors. People with hemophilia may experience joint damage, pain, and psychological impairments, all of which could contribute to reduced health-related quality of life (HRQoL). The current standard of care is clotting factor replacement, which is associated with regular infusions; therefore, alternative treatments such as gene therapy (GT) are in development. GT involves the delivery of a functional copy of the clotting factor 8/9 gene by a single infusion into the patient's cells, enabling them to produce their own clotting factor VIII/IX. The impact of treatment on patients' HRQoL can be assessed using hemophilia-specific patient-reported outcome (PRO) measures. Since these measures were designed before the advent of GT, there is a need for updated individualized PRO measures. Patient groups and regulatory authorities emphasize the need for increased patient engagement when considering clinical trial design. Here, we provide patients' perspective on undergoing GT and discuss how to capture the patient voice when measuring the therapy's transformative impact. [ABSTRACT FROM AUTHOR]

Background: There is an ongoing need for research to support the practice of high quality family medicine. The Family Medicine Discovers Rapid Cycle Scientific Discovery and Innovation (FMD RapSDI) program is designed to build capacity for family medicine scientific discovery and innovation in the United States. Our objective was to describe the applicants and research questions submitted to the RapSDI program in 2019 and 2020. Methods: Descriptive analysis for applicant characteristics and rapid qualitative analysis using principles of grounded theory and content analysis to examine the research questions and associated themes. We examined differences by year of application submission and the applicant's career stage. Results: Sixty-five family physicians submitted 70 applications to the RapSDI program; 45 in 2019 and 25 in 2020. 41% of applicants were in practice for five years or less (n = 27), 18% (n = 12) were in in practice 6–10 years, and 40% (n = 26) were ≥ 11 years in practice. With significant diversity in questions, the most common themes were studies of new innovations (n = 20, 28%), interventions to reduce cost (n = 20, 28%), improving screening or diagnosis (n = 19, 27%), ways to address mental or behavioral health (n = 18, 26%), and improving care for vulnerable populations (n = 18, 26%). Conclusion: Applicants proposed a range of research questions and described why family medicine is optimally suited to address the questions. Applicants had a desire to develop knowledge to help other family physicians, their patients, and their communities. Findings from this study can help inform other family medicine research capacity building initiatives. [ABSTRACT FROM AUTHOR]

Introduction: Medication assisted treatment (MAT) for opioid use disorder (OUD) saves lives and enhances quality of life for people in recovery. However, only a small percentage of people eligible for MAT in the United States receive treatment, and among those who do seek treatment, retention is a challenge. This study aims to understand factors that help individuals enter and stay in MAT from the perspective of those in recovery. The patient perspective is vital in efforts to improve care delivery and best support individuals in treatment. Methods: Survey development was driven by a review of current peer-reviewed literature plus information gained through 3 semi-structured interviews and follow-up discussions with 5 individuals who have lived experience in MAT, termed Participant Advisors. Survey questions focused in part on MAT participants' opinions relating to program policies such as drug testing, relapse protocols, duration of treatment, participant use of anti-anxiety medications and marijuana, and requirements for attendance in peer recovery groups such as Narcotics Anonymous and Alcoholics Anonymous. Responses were collected from West Virginia-based MAT programs from February through August 2021, with 1700 surveys distributed to 21 MAT programs. Results: At the close of data collection, 225 survey responses, including over 500 free-text comments, were received (13.2% response rate). Most (n = 207, 95%) were currently in a MAT program and most (n = 187, 88.6%) reported using buprenorphine/naloxone for MAT, though participants reported having used other medications for treatment of OUD as well. Questions about how long a person should have MAT prescribed, how long they should be able to stay in treatment, whether they can use marijuana or anti-anxiety drugs while in treatment, and whether they should use a 12-step program generated mixed opinions. Findings strongly support consideration of individual situations and shared decision-making with providers. [ABSTRACT FROM AUTHOR]

Introduction: In the aging process of the body, in addition to changes in fat and muscle content, there is also bone loss, implying the possibility of a strong muscle–bone–lipid link. In this study, we initially investigated the relationship between lumbar BMD and low muscle mass and the relationship between "muscle–bone–lipid." Methods: The datasets from the National Health and Nutrition Examination Survey (NHANES) 2011–2018 were used in a cross-sectional investigation. BMD and appendicular skeletal muscle (ASM) were measured by dual-energy X-ray absorptiometry (DXA), and appendicular skeletal muscle was adjusted by body mass index (BMI) as a marker of sarcopenia. Weighted multivariate regression and logistic regression analysis were used to explore the independent relationship between lumbar BMD and sarcopenia. Fitted smoothing curves and threshold effect analysis were used to describe the nonlinear relationship. Result: In 8386 participants with ages 20–59 years, there was a negative association between lumbar BMD and sarcopenia. In the fully adjusted model, the risk of developing sarcopenia decreased by 93% for each 1-unit increase in lumbar BMD (OR = 0.07, 95%CI 0.03–0.20). The risk of sarcopenia was 58% lower in participants in the highest quartile of lumbar BMD than in those in the lowest quartile (OR = 0.42, 95%CI 0.27–0.64). This negative association was more pronounced in the population of women with BMI ≥ 25. Conclusion: Our findings suggest that lumbar BMD is negatively associated with sarcopenia in US adults. The dynamic balance between "muscle–bone–lipid" is likely to be related to the pathogenesis of bone loss. [ABSTRACT FROM AUTHOR]

Objectives: Oxidative stress level takes part in the development of cognitive decline. However, the association between total antioxidant capacity (TAC) from diet and cognitive function is controversial. The aim of this study was to investigate the relationship between TAC and the cognitive function of older adults in the U.S. Design: A cross-sectional study. Setting: National Health and Nutrition Examination Surveys database. Participants: 2712 older adults aged over 60 years. Measurements: TAC was calculated from 8 antioxidative vitamins based on the reference values for vitamin C equivalent antioxidant capacity obtained from individuals' 24 h dietary recall. Four memory-related assessments were employed [Immediate Recall test (IRT), Delayed Recall test (DRT), Animal Fluency test (AFT), and Digit Symbol Substitution test (DSST)]. Results: Among the 2712 participants, the median age was 68 years, and 50.4% were women. Participants in the group with higher TAC levels had relatively higher IRT, AFT and DSST scores (P=0.025, P=0.008, P<0.001, respectively). In adjusted weighted linear regression, log-transformed TAC was positively associated with AFT (β=1.10, 95%CI: 0.51, 1.70) and DSST (β=2.81, 95%CI: 1.16, 4.45). Compared with the first quartile, the participants in the second (Q2 vs. Q1, OR=0.66, 95%CI: 0.43,1.02) and fourth quartile (Q4 vs. Q1, OR=0.47, 95%CI:0.28, 0.78) of log-transformed TAC showed a decreased risk of impaired cognitive function (ICF) after adjusting for confounders. The dose-response analysis indicated a gradual descent in the risk of ICF as TAC increases. Diabetes mellitus (DM) mediated part of the effect of TAC on ICF. The relationship between TAC and ICF was more pronounced in subjects with DM (Q4 vs Q1, OR=0.36, 95%CI:0.17, 0.74). Conclusion: Our findings support that higher dietary antioxidant potential was related to a decreased risk of cognitive dysfunction, particularly in the subjects with DM who may have oxidative injury. DM was one of the factors mediating the effect of TAC on ICF. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine sexual orientation-based disparities in six self-reported health outcomes among millennial aged military veterans. We collected data using The Millennial Veteran Health Study, a cross-sectional internet-based survey with extensive quality control measures. The survey was fielded April through December 2020 and targeted millennial aged veterans across the United States. A total of 680 eligible respondents completed the survey. We assessed six binary health outcomes: alcohol use, marijuana use, frequent chronic pain, opioid misuse, high psychological distress, and fair or poor health status. Using logistic regression adjusted for a range of demographic, socioeconomic, and military-based covariates, we find that bisexual veterans consistently report worse health than straight veterans for all six health outcomes tested. Results for gay or lesbian, compared to straight veterans, were less consistent. Sensitivity models with continuous outcomes, and stratified by gender, found similar results. These results have implications for improving the health of bisexual individuals, including addressing discrimination, belonging, and social identity, particularly in institutional settings that have traditionally heteronormative and masculine cultures such as the military. [ABSTRACT FROM AUTHOR]

Introduction: Chronic pain is one of the leading causes of disability that may accelerate biological aging and reduce physical function. Epigenetic clocks provide an estimate of how the system ages and can predict health outcomes such as physical function. Physical function declines may be attributed to decreases in muscle quality due to disuse that can be measured quickly and noninvasively using grip strength. The purpose of this study was to explore the associations among self-reported pain, grip strength, and epigenetic aging in those with chronic pain. Methods: Participants (57.91 ± 8.04 years) completed pain questionnaires, a blood draw and hand grip strength task. We used an epigenetic clock previously associated with knee pain (DNAmGrimAge), and used the subsequent difference of predicted epigenetic age from chronological age (DNAmGrimAge-Difference). Results: Exploratory pathway analyses revealed that pain intensity mediated the association between DNAmGrimAge-difference and handgrip strength in males only (β = −0.1115; CI [−0.2929, −0.0008]) and pain interference mediated the association between DNAmGrimAge-difference and handgrip strength in males β = −0.1401; CI [−0.3400, −0.0222]), and females (β = −0.024; CI [−0.2918, −0.0020]). Discussion: Chronic knee pain may accelerate epigenetic aging processes that may influence handgrip strength in older age adults. Chronic pain could be a symptom of the aging body thus contributing to declines in musculoskeletal function in later life. [ABSTRACT FROM AUTHOR]

The article focuses on the variation in firearm screening and access based on LGBT status among Veterans with the risk of firearm-related suicide in both LGBT individuals and Veterans. It mentions that the study aims to fill this gap by examining LGBTQI+ status, emergency department visits, and firearm screening and access using natural language processing and machine learning algorithms applied to clinical notes in the Veterans Affairs (VA) electronic health records.

BACKGROUND: COVID-19 placed a significant burden on the global healthcare system. Strain in critical care capacity has been associated with increased COVID-19-related ICU mortality. This study evaluates the impact of an early warning system and response team implemented on medical floors to safely triage and care for critically ill patients on the floor and preserve ICU capacity. METHODS: We conducted a multicenter, retrospective cohort study, comparing outcomes between intervention and control hospitals within a US eight-hospital urban network. Patients hospitalized with COVID-19 pneumonia between April 13th, 2020 and June 19th, 2020 were included in the study, which was a time of a regional surge of COVID-19 admissions. An automated, electronic early warning protocol to identify patients with moderate-severe hypoxemia on the medical floors and implement early interventions was implemented at one of the eight hospitals ("the intervention hospital"). RESULTS: Among 1024 patients, 403 (39%) were admitted to the intervention hospital and 621 (61%) were admitted to one of the control hospitals. Adjusted for potential confounders, patients at the intervention hospital were less likely to be admitted to the ICU (HR = 0.73, 95% CI 0.53, 1.000, P =.0499) compared to the control hospitals. Patients admitted from the floors to the ICU at the intervention hospital had shorter ICU stay (HR for ICU discharge: 1.74; 95% CI 1.21, 2.51, P =.003). There was no significant difference between intervention and control hospitals in need for mechanical ventilation (OR = 0.93; 95% CI 0.38, 2.31; P =.88) or hospital mortality (OR = 0.79; 95% CI 0.52, 1.18; P =.25). CONCLUSION: A protocol to conserve ICU beds by implementing an early warning system with a dedicated response team to manage respiratory distress on the floors reduced ICU admission and was not associated with worse outcomes compared to hospitals that managed similar levels of respiratory distress in the ICU. [ABSTRACT FROM AUTHOR]

Since December 2020, COVID-19 vaccines have become increasingly available to populations around the globe. A growing body of research has characterised inequalities in COVID-19 vaccination coverage. This scoping review aims to locate, select and assess research articles that report on within-country inequalities in COVID-19 vaccination coverage, and to provide a preliminary overview of inequality trends for selected dimensions of inequality. We applied a systematic search strategy across electronic databases with no language or date restrictions. Our inclusion criteria specified research articles or reports that analysed inequality in COVID-19 vaccination coverage according to one or more socioeconomic, demographic or geographic dimension of inequality. We developed a data extraction template to compile findings. The scoping review was carried out using the PRISMA-ScR checklist. A total of 167 articles met our inclusion criteria, of which half (n = 83) were conducted in the United States. Articles focused on vaccine initiation, full vaccination and/or receipt of booster. Diverse dimensions of inequality were explored, most frequently relating to age (n = 127 articles), race/ethnicity (n = 117 articles) and sex/gender (n = 103 articles). Preliminary assessments of inequality trends showed higher coverage among older population groups, with mixed findings for sex/gender. Global research efforts should be expanded across settings to understand patterns of inequality and strengthen equity in vaccine policies, planning and implementation. [ABSTRACT FROM AUTHOR]

The social work profession in the United States is striving to advance antiracism amidst increasing threats of white supremacist violence. However, tensions and paradoxes in the contexts of academic research and knowledge development, education and teaching, and service undermine the profession's efforts. Structural or institutional processes—in higher education broadly and in schools of social work specifically—shape who publishes research, educates, and serves, and how labor is evaluated and rewarded. We identify practical recommendations to advance antiracism while cautioning against overemphasizing the responsibility of individual actors. Recommendations include prioritizing and generously funding scholarship on white supremacy and antiracism, providing clinical and adjunct faculty with sufficient remuneration and supports to excel in teaching, joining with students in protest against oppressive conditions in higher education, and equalizing rewards for service in accordance with those for research. Social workers must work proactively across multiple contexts to realize our professional commitment to dismantling white supremacy and advancing antiracism. [ABSTRACT FROM AUTHOR]

Objective/ background: Chronic headaches and sports-related concussions are among the most common neurological morbidities in adolescents and young adults. Given that the two can overlap in presentation, studying the effects of one on another has proven difficult. In this longitudinal study, we sought to assess the relationship between chronic headaches and concussions, analyzing the role of historic concussions on chronic headaches, as well as that of premorbid headaches on future concussion incidence, severity, and recovery. Methods: This multi-center, longitudinal cohort study followed 7,453 youth athletes who were administered demographic and clinical surveys as well as a total of 25,815 Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) assessments between 2009 and 2019. ImPACT was administered at baseline. Throughout the season concussions were examined by physicians and athletic trainers, followed by re-administration of ImPACT post-injury (PI), and at follow-up (FU), a median of 7 days post-concussion. Concussion incidence was calculated as the total number of concussions per patient years. Concussion severity and recovery were calculated as standardized deviations from baseline to PI and then FU in Symptom Score and the four neurocognitive composite ImPACT scores: Verbal Memory, Visual Memory, Processing Speed, and Reaction Time. Data were collected prospectively in a well-organized electronic format supervised by a national research-oriented organization with rigorous quality assurance. Analysis was preformed retrospectively. Results: Of the eligible athletes, 1,147 reported chronic headaches (CH) at the start of the season and 6,306 reported no such history (NH). Median age of the cohort was 15.4 ± 1.6 years, and students were followed for an average of 1.3 ± 0.6 years. A history of concussions (OR 2.31, P < 0.0001) was associated with CH. Specifically, a greater number of past concussions (r2 = 0.95) as well as concussions characterized by a loss of consciousness (P < 0.0001) were associated with more severe headache burden. The CH cohort had a greater future incidence of concussion than the NH cohort (55.6 vs. 43.0 per 100 patient-years, P < 0.0001). However, multivariate analysis controlling for demographic, clinical, academic, and sports-related variables yielded no such effect (OR 0.99, P = 0.85). On multivariable analysis the CH cohort did have greater deviations from baseline to PI and FU in Symptom Score (PI OR per point 1.05, P = 0.01, FU OR per point 1.11, P = 0.04) and Processing Speed (OR per point 1.08, P = 0.04), suggesting greater concussion severity and impaired symptomatic recovery as compared to the NH cohort. Conclusion: A history of concussions was a significant contributor to headache burden among American adolescents and young adults. However, those with chronic headaches were not more likely to be diagnosed with a concussion, despite presenting with more severe concussions that had protracted recovery. Our findings not only suggest the need for conservative management among youth athletes with chronic headaches, they also indicate a potential health care gap in this population, in that those with chronic headaches may be referred for concussion diagnosis and management at lower rates than those with no such comorbidity. [ABSTRACT FROM AUTHOR]

Unpartnered mothers rely on formal and informal income sources to support their coresident minor children. Building on work focusing on selective populations and shorter time horizons, we describe the family income sources on which U.S. women and their minor children rely for up to 17 years following an unpartnered birth or union dissolution (Panel Study of Income Dynamics 2001–2017; N = 12,369 person-year records from 3,148 children). Using rich description and fixed-effect models, we treat family income as dynamic, mapping change in the share and amount of family income from multiple sources as children age and women gain employment experience; enter new unions; experience changes in eligibility for public support programs; and receive contributions from kin, friends, and other household members. A patchwork of income sources is the norm throughout childhood, with mothers' earnings nearly universal but insufficient as a sole source of family income. Maternal repartnering increases family income through new partner earnings but is accompanied by offsetting reductions in other income sources, particularly from outside the household. In the context of weak institutional support for U.S. families, families with nonresident fathers rely on a complex mix of income sources to make ends meet. [ABSTRACT FROM AUTHOR]

Across international healthcare, organisational culture and work environment have become central to all patient safety. However, there is a lack of comprehensive overview to assess and track the evolution of the literature on organisational culture in healthcare. This study aims to describe the current situation and global trends in organisational culture research in healthcare. The methodology is based on bibliometric mapping using scientific visualisation software (CiteSpace and VOSviewer). The big data were collected from the Web of Science core citation database. After applying the search criteria, we retrieved 1559 publications, which have steadily increased over the last two decades. In addition, 92 countries and regions have published studies on organisational culture in healthcare. The United States has made significant contributions to this field. In particular, organisational culture occupies an important position in the quality management of different types of care and caregiving. At the same time, organisational culture in healthcare may be inadequately researched in terms of theoretical underpinnings, which in turn leads to a lack of widespread dissemination of practice, and research on organisational culture in healthcare through evidence-based medicine may remain a significant focus and hot topic throughout the research field in the coming years. [ABSTRACT FROM AUTHOR]

Background: Diabetes impacts greater than 37 million people in the United States. Adults over 45 years, racial-ethnic minorities, and those who are overweight or obese are at increased risk for type 2 diabetes mellitus (T2DM). Digital health games offer one innovative opportunity to engage, educate, and motivate adults at risk for T2DM about healthy lifestyle changes. Objective: Describe the adaptation of an educational exergame for adults over 50 and examine feasibility, acceptability, and implementation within a health education intervention in African American adults at risk for T2DM. Method: Mixed methods were used: exploratory adaptation phase involving expert interviews and constituent focus groups; a randomized two-group (nutrition workshop alone vs workshop plus game) pilot exploring adherence and preliminary outcomes (i.e., eating habits, physical activity level, body mass index); and a post-gameplay explanatory component examining acceptability and feasibility. Results: Exploratory phase findings identified areas for game adaptation, such as modifying graphics and adjusting movement to user preferences and abilities. The pilot sample included 24 African American women with T2DM risk factors (Mean age = 63.1). Preliminary outcomes suggest pre-post intervention changes in the direction of improvement for both groups; however, there were no statistically significant differences between groups. Intervention adherence was slightly higher for the game-plus workshop group. Acceptability and feasibility feedback of the game was generally positive. Conclusion: Constituent and expert input helped inform game adaptation. Preliminary outcomes and acceptability/feasibility feedback of game implementation within a health education intervention showed promise in engaging adults over 50 with T2DM risk factors about topics of healthy eating and physical activity. Continued research is suggested to develop/adapt health games to promote healthy lifestyle change in diverse older adults (e.g., adults over 65; racial-ethnic minority groups;) and to conduct large-scale studies to evaluate the impact of health games in diverse groups and settings. [ABSTRACT FROM AUTHOR]

Objective: Despite the high prevalence of obesity and associated health risks in the United States adult population, few primary care providers (PCPs) have time and training to provide weight-management counseling to their patients. This study aims to compare the effect of referral to a comprehensive automated digital weight-loss program, with or without provider email feedback, with usual care on weight loss in patients with overweight or obesity.Methods: A total of 550 adults (mean [SD], 51.4 [11.2] years, BMI = 35.1 [5.5] kg/m2 , 72.0% female) were enrolled through their PCPs (n = 31). Providers were randomly assigned to refer their patients to a 12-month internet weight-loss intervention only (IWL), the intervention plus semiautomated feedback from the provider (IWL + PCP), or to usual care (EUC). Weight was measured at baseline and at 3, 6, and 12 months.Results: Weight changes (mean [SE]) at 12 months were -0.92 (0.46), -3.68 (0.46), and -3.58 (0.48) kg in the EUC, IWL, and IWL + PCP groups, respectively. Outcomes were significantly different in EUC versus IWL and EUC versus IWL + PCP (p < 0.001), but not in IWL versus IWL + PCP.Conclusions: Referral by PCPs to an automated weight-loss program holds promise for patients with obesity. Future research should explore ways to further promote accountability and adherence. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has taken a large toll on population health and well-being. We examine the consequences of prenatal exposure for infant health, through which the pandemic may have lasting intergenerational effects. We examine multiple pathways by which the pandemic shaped birth outcomes and socioeconomic disparities in these consequences. Analysis of more than 3.5 million birth records in California with universal information on COVID infection among persons giving birth at the time of delivery reveals deep inequalities in infection by education, race/ethnicity, and place-based socioeconomic disadvantage. COVID infection during pregnancy, in turn, predicts a large increase in the probability of preterm birth, by approximately one third. At the population level, a surprising reduction in preterm births during the first months of the pandemic was followed by an increase in preterm births during the surge in COVID infections in the winter of 2021. Whereas the early-pandemic reduction in preterm births benefited primarily highly educated mothers, the increase in preterm births during the winter infection surge was entirely concentrated among mothers with low levels of schooling. The COVID-19 pandemic is expected to exacerbate U.S. inequality in multiple ways. Our findings highlight a particularly enduring pathway: the long-term legacy of prenatal exposure to an unequal pandemic environment. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are few existing methods to quantify total exposure burden to chemical mixtures, independent of a health outcome. A summary metric could be advantageous for use in biomonitoring, risk assessment, health risk calculators, and mediation models. OBJECTIVE: We developed a novel exposure burden score method for chemical mixtures, applied it to estimate exposure burden to per- and polyfluoroalkyl substances (PFAS) mixtures, and estimated associations of PFAS burden scores with cardio-metabolic outcomes in the general U.S. population. METHODS: We applied item response theory (IRT) to biomonitoring data from 1,915 children and adults 12–80 years of age in the 2017–2018 National Health and Examination Survey to quantify a latent PFAS burden score, using serum concentrations of eight measured PFAS biomarkers, each considered an “item.” The premise of IRT is that through using both information about a participant’s concentration of an individual PFAS bio-marker, as well as their exposure patterns for the PFAS mixture, we can estimate the participant’s latent PFAS exposure burden, independent of a health outcome. We used linear regression to estimate associations of the PFAS burden score with cardio-metabolic outcomes and compared our findings to results using summed PFAS concentrations as the exposure metric. RESULTS: PFAS burden scores and summed PFAS concentrations had moderate-high correlation (ρ=0.75). Isomers of PFOS [푛-perfluorooctane sulfonic acid (푛-PFOS) and perfluoromethylheptane sulfonic acid isomers (Sm-PFOS)] were the most informative to the PFAS burden scores. PFAS burden scores and summed PFAS concentrations were both significantly associated with cardio-metabolic outcomes, but associations were generally closer to the null for summed PFAS concentrations vs. the PFAS burden score. Adjusted associations (95% CIs) with total cholesterol (in milligrams per deciliter) were 8.6 (95% CI: 5.2, 11.9) and 2.4 (95% CI: 0.5, 4.2) per interquartile range increase in the PFAS burden score and summed concentrations, respectively. Sensitivity analyses showed similar associations with cardio-metabolic outcomes when only a subset of PFAS biomarkers was used to estimate PFAS burden. In a validation study, associations between PFAS burden scores and cholesterol were consistent with primary analyses but null when using summed PFAS concentrations. DISCUSSION: IRT offers a straightforward way to include exposure biomarkers with low detection frequencies and can reduce exposure measurement error. Further, IRT enables comparisons of exposure burden to chemical mixtures across studies even if they did not measure the exact same set of chemicals, which supports harmonization across studies and consortia. We provide an accompanying PFAS burden calculator (https://pfasburden. shinyapps.io/app%5Fpfas%5Fburden/), enabling researchers to calculate PFAS burden scores based on U.S. population exposure reference ranges. [ABSTRACT FROM AUTHOR]