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Introduction: Hemotoxicity is common following rattlesnake envenomation. Published experiences with equine-derived crotalidae immune F(ab')2 antivenom have characterized hemotoxicity as delayed, recurrent, or persistent. This study investigated recovery of hypofibrinogenemia following rattlesnake envenomation treated with equine-derived crotalidae immune F(ab')2 antivenom. Methods: This is a retrospective analysis of human rattlesnake envenomations reported to the Arizona Poison and Drug Information Center over four years. We included rattlesnake-envenomated patients who developed hypofibrinogenemia (<1,500 mg/L) and were treated with equine-derived crotalidae immune F(ab')2 antivenom. The primary outcomes were recovery period (h) and recovery rate (mg/L/h) of hypofibrinogenemia following equine-derived crotalidae immune F(ab')2 antivenom administration. Collected data included demographics, laboratory values, and antivenom administered. Statistics used were percentages, medians, and Kruskall-Wallis test. Results: There were 527 rattlesnake envenomations treated with antivenom, of which 80 met the inclusion criteria. Patients receiving treatment with F(ab')2 antivenom and had a median fibrinogen concentration recovery rate of 62.3 mg/L/h (IQR: 42.0–74.3 mg/L/h) and median recovery period of 19.2 h (IQR: 13.8–26.2 h). There were statistically significant differences between categories for time to antivenom for the median recovery period (P = 0.0154). Discussion: Hypofibrinogenemia is a common laboratory finding following rattlesnake envenomation in Arizona. This study investigated rattlesnake envenomated patients treated with F(ab')2 antivenom and monitored fibrinogen concentrations as a surrogate marker of venom toxicity. Additionally, time to administration of F(ab')2 antivenom was a statistical significant marker of the recovery period from hypofibrinogenemia. Limitations of this study included the geographic coverage of the poison center and exclusion of patients with insufficient laboratory monitoring or those who received another antivenom. Conclusions: Following rattlesnake envenomation in Arizona, recovery from hypofibrinogenemia was able characterized in a rate (mg/L/h) and period (h) with the quantity and time to administration of antivenom. More studies are needed to assess this finding with other antivenoms and its clinical significance. [ABSTRACT FROM AUTHOR]

The growing food waste phenomenon is recognised as a global issue with significant social, economic, and environmental burdens. This is a major concern in developed nations, where consumers are the largest contributors to the total volume of food waste production. As a leading cause of food and water insecurity, economic inequality, and environmental degradation, preventing and minimising consumer food waste is a key objective for policymakers and practitioners. Due to the complex consumer behaviours and practices associated with food waste generation, current understandings of why food waste occurs remain scattered. The purpose of this review is therefore to map the history and development of consumer food waste research over time, highlighting key themes and inconsistencies within the existing literature. Adopting a narrative approach, the literature is organised into three distinct themes to explore and identify the various internal and external determinants of consumer food waste. Our analysis highlights consumer food waste as a complex and multi-faceted challenge which cannot be attributed to one single variable, but rather a combination of behaviours determined by various societal, individual, and behavioural factors. While previous research tends to frame food waste as mainly a consumer issue, this review identifies several collective actors who are central to the problem. These findings call for a holistic view across the food supply chain to help identify opportunities for multi-stakeholder actions that prevent and reduce food waste at the consumer level. Drawing upon these new insights, we provide practical recommendations to assist policymakers, retailers, and consumers in mitigating consumer-related food waste. [ABSTRACT FROM AUTHOR]

This article discusses the use of SCINSEV measures in cochlear implant surgery to detect and correct electrode extrusion. The study presents three cases where SCINSEV was used to identify extrusion and make immediate surgical corrections, eliminating the need for revision surgery. The authors suggest that SCINSEV, along with other measures, can improve the efficiency and outcomes of cochlear implant surgery by reducing the reliance on x-rays and the need for revision surgery. The article provides detailed information on the methodology and results of the study, highlighting the potential of SCINSEV as an important tool in intraoperative decision-making and correction. [Extracted from the article]

Objective: To examine changes in hospitalization trends and healthcare utilization among Veterans following Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act implementation. Data Sources and Study Setting: VA Corporate Data Warehouse and Centers for Medicare and Medicaid Services datasets. Study Design: Retrospective cohort study to compare 7‐ and 30‐day rates for unplanned readmission and emergency department visits following index hospital stays based on payor type (VHA facility stay, VA‐funded stay in community facility [CC], or Medicare‐funded community stay [CMS]). Segmented regression models were used to compare payors and estimate changes in outcome levels and slopes following MISSION Act implementation. Data Collection/Extraction Methods: Veterans with active VA primary care utilization and ≥1 acute hospitalization between January 1, 2016 and December 31, 2021. Principal Findings: Monthly index stays increased for all payors until MISSION Act implementation, when VHA and CMS admissions declined while CC admissions accelerated and overtook VHA admissions. In December 2021, CC admissions accounted for 54% of index admissions, up from 25% in January 2016. From adjusted models, just prior to implementation (May 2019), Veterans with CC admissions had 47% greater risk of 7‐day readmission (risk ratio [RR]: 1.47, 95% confidence interval [CI]: 1.43, 1.51) and 20% greater risk of 30‐day readmission (RR: 1.20, 95% CI: 1.19, 1.22) compared with those with VHA admissions; both effects persisted post‐implementation. Pre‐implementation CC admissions were also associated with higher 7‐ and 30‐day ED visits, but both risks were substantially lower by study termination (RR: 0.90, 95% CI: 0.88, 0.91) and (RR: 0.89, 95% CI: 0.87, 0.90), respectively. Conclusions: MISSION Act implementation was associated with substantial shifts in treatment site and federal payor for Veteran hospitalizations. Post‐implementation readmission risk was estimated to be higher for those with CC and CMS index admissions, while post‐implementation risk of ED utilization following CC admissions was estimated to be lower compared with VHA index admissions. Reasons for this divergence require further investigation. [ABSTRACT FROM AUTHOR]

Shared decision-making (SDM) is an essential component of patient-centered healthcare and disease management. However, the association of SDM with healthcare resource utilization and patient-reported outcomes among multimorbid individuals is not well understood. This study sought to evaluate the association of SDM with healthcare resource utilization and patient-reported outcomes among United States (US) adults with multimorbidity. Data were collected from the 2020 Medical Expenditure Panel Survey (MEPS) for this cross-sectional study. Eligible participants were US adults with two or more comorbidities. The predictor variable was SDM (optimal versus not optimal). The outcome variables were healthcare resource utilization and patient-reported outcomes. Logistic regression models, adjusted for demographic characteristics, assessed associations with SDM for each healthcare resource utilization and patient-reported outcome variable. The analysis maintained the complex survey data and was weighted to produce nationally representative estimates. Individuals who reported optimal SDM in adjusted analyses utilized more healthcare resources compared to those who reported not optimal SDM. Individuals with optimal SDM had more than one outpatient visit (odds ratio OR = 1.23, 95% CI = 1.03–1.47), emergency room visit (OR = 1.55, 95% CI = 1.17–2.06), and inpatient discharge (OR = 1.44, 95% CI = 1.05–1.96). Additionally, these individuals had higher odds of reporting limitations in their ability to work or engage in other activities due to their physical health in the past four weeks (OR = 1.27, 95% CI = 1.01–1.60). This study indicated evidence of increased healthcare resource utilization among patients who participate in SDM with their providers, which should be explored in future studies. [ABSTRACT FROM AUTHOR]

Climate change is predicted to have severe impacts on coastal communities, including sea level rise, flooding, and coastal erosion, and is expected to reshape many coastlines. One further, and often overlooked, consequence of the climate crisis is the threat posed to cultural heritage sites in the coastal zone. The threat to coastal cultural heritage (CCH) will inevitably impact both tangible (physical and material) and intangible (socio-cultural) components of cultural, historical, and archaeological character along frontline coastal communities. This poses substantial sustainability challenges for stakeholders and decision-makers for the management of cultural heritage assets and for management practices to respond to increasing threats from climate change. This paper uses five illustrative examples based on maximum variation principles to evaluate different strategies (or 'steering' processes) for managing coastal heritage resources in the context of climate change. These include the traditional 'preservationist' perspective and trajectories based on discontinuity or transformation. We examine these issues with reference to five post-European heritage assets located along the East Coast of the USA. While a consideration of steering processes is important, we argue that it is necessary to also embrace the policies and strategies for adapting to and mitigating the impacts of climate change through which processes of managing CCH unfold. Adopting such a perspective can lead to more nuanced approaches for understanding how CCH can respond to the challenges of a changing climate. [ABSTRACT FROM AUTHOR]

Background/Objectives: Arthritis is a chronic, debilitating condition affecting millions of United States (US) adults. Regular physical exercise is particularly important for adults with arthritis. This study aimed to investigate the characteristics associated with regular physical exercise in US adults with arthritis. Methods: This cross-sectional database study used 2021 Medical Expenditure Panel Survey data and included US adults (age ≥ 18) alive with arthritis. A multivariable logistic regression model was developed to test the association of the following variables with regular physical exercise (defined as moderate-vigorous intensity exercise for ≥30 min ≥5 times weekly; yes, no): age, sex, Hispanic, race, census region, marriage status, schooling, employment, health insurance, household income, mental health, general health, smoking status, chronic conditions, pain, and functional limitations. Results: Overall, 5091 people (regular physical exercise n = 2331, no regular physical exercise n = 2760) were involved in this analysis. Most were female, non-Hispanic, white, married, had schooling beyond high school, were unemployed, had private health insurance, had mid-high household income, had good mental health, had good general health, were non-smokers, had two or more chronic conditions, had little/moderate pain, and did not have a functional limitation. In multivariable logistic regression analysis, male vs. female sex (odds ratio [OR] = 1.440, 95% confidence interval [CI] = 1.185–1.749), employed vs. unemployed (OR = 1.277, 95% CI = 1.005–1.624), good vs. poor general health (OR = 2.174, 95% CI = 1.673–2.824), little/moderate vs. quite a bit/extreme pain (OR = 1.418, 95% CI = 1.109–1.818), and no functional limitation (OR = 1.592, 95% CI = 1.282–1.980) were associated with higher odds of reporting regular physical exercise, while Midwest vs. West census region (OR = 0.698, 95% CI = 0.521–0.935) was associated with lower odds of reporting regular physical exercise. Conclusions: This study identified variables associated with regular physical exercise among US adults with arthritis. Further work is needed to develop interventions for characteristics that may help increase exercise and, subsequently, health outcomes in this population. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide a description and evaluation of a graduate-level Health Services Research Methods course offered at the University of Arizona R. Ken Coit College of Pharmacy. This three-credit, round-table discussion-style course introduces students to fundamental concepts in healthcare study design and teaches them how to design and critique example studies for a variety of commonly encountered study designs. The course is assessed through essay-style examinations, development of a research proposal, and low-stakes weekly assignments. Twenty-seven students have completed the course in the past five years. Feedback from student course surveys was almost unanimously positive, with few meaningful suggestions for improvement. The description and evaluation of a graduate-level Health Services Research Methods course at one institution indicates that students had a largely favorable experience with the course. Considerations for future revisions to the course are discussed alongside other lessons learned. [ABSTRACT FROM AUTHOR]

Introduction: Rattlesnake (Crotalus spp., Sistrurus spp.) bites in the southwestern United States are associated with significant morbidity. This study aims to describe 25 years of rattlesnake encounters reported to the Arizona Poison and Drug Information Center to identify vulnerable populations and circumstances where encounters occur to create public education to reduce future bites. Methods: Cases of suspected rattlesnake encounters in Arizona reported to the Arizona Poison and Drug Information Center between 1999 and 2023 were analyzed to identify populations and circumstances associated with encounters. Results: A total of 3,808 cases were analyzed overall and by age subgroups. Most encounters occurred in men (69.9%), during the evening (16:00–21:59; 49.2%), in summer (41.9%), and close to home (38.2%). Most bites occurred to the lower extremity (51%). Children 0 to 12-years-old have more encounters than those 13-years-old and older in rural zip codes (27.7% versus 14.8%; P = 0.005), during spring (31.8% versus 22.3%; P = 0.0005), and during the evening (64.4% versus 48.1%; P < 0.001). Discussion: Rattlesnakes are encountered when rattlesnake and human behavior patterns overlap. Many people spend time outside during evening hours in the summer, and valuable resources like food, water, and shelter can be found near houses where humans spend much of their time. Most age groups have similar encounter circumstances but encounters among children 0 to 12-years-old differ in time of day, season, and urbanization level than encounters of those 13-years-old and older. Limitations of this study include underreporting of encounters, incomplete case details, potential reporting bias, potential snake misidentification, and geographic coverage of the poison center. Conclusion: Prevention of rattlesnake bites by reducing encounters is the most effective way to reduce suffering and healthcare costs. Future steps include creating and disseminating targeted public health education using the data collected. [ABSTRACT FROM AUTHOR]

There is little published research on limited physical functioning in United States (US) adults with arthritis. The objective of this cross-sectional 2021 Medical Expenditure Panel Survey (MEPS) database study was to investigate the variables associated with limited physical functioning in US adults with arthritis. Logistic regression tested the associations of predisposing, enabling, and need variables with the dependent variable (limited physical functioning). This study included 5102 US adults with arthritis, reflecting an estimated weighted population of 64,136,870 US adults with arthritis. In the final multivariable logistic regression model, age ≥ 70 and ages 60–69 (vs. 18–49 years), female (vs. male) sex, having quite a bit/extreme or moderate (vs. little) pain, and having 6+ or 4–5 (vs. 0–1) comorbid conditions were all associated with higher odds of the person stating they had limited physical functioning. Whereas high school or less (vs. more than high school), being employed (vs. unemployed), being married (vs. not married), having excellent/very good or good (vs. poor) general health, and exercise (vs. no exercise) were each associated with lower odds of the person reporting they had limited physical functioning. Future work may be considered to explore these variables in greater detail. [ABSTRACT FROM AUTHOR]

Studies have explored the association of particular conditions, or combinations of conditions, and pain among specific populations. However, there is limited information regarding the association of the number of comorbid conditions, as well as other demographic, economic, health, and limitation variables, with pain among adults in the United States. This cross-sectional database study aimed to examine the relationships between number of comorbid conditions (including cancer, arthritis, joint pain, stroke, heart attack, angina, coronary heart disease, high cholesterol, high blood pressure, other heart diseases, diabetes, asthma, chronic bronchitis, and emphysema), demographic, economic, health, and limitation variables with pain among United States adults using 2021 Medical Expenditure Panel Survey data. A multivariable logistic model assessed the association between the number of comorbid conditions (≥6, 5, 4, 3, 2, 1, versus 0 conditions) and quite a bit/extreme (versus little/moderate) pain, adjusting for demographic, economic, health, and limitation variables. The study found that greater numbers of comorbid conditions were associated with higher odds of quite a bit or extreme pain. In addition, age, education, employment, income, overall health, regular physical activity, and three limitation variables were each associated with pain in the multivariable model. These findings offer insight into the association between number of comorbid conditions and other variables with pain and suggest areas where interventions may be helpful to help improve pain outcomes for United States adults. [ABSTRACT FROM AUTHOR]

This cross-sectional study included a nationally representative sample of U.S. adults aged ≥50 years with self-reported pain in the past 4 weeks from the 2018 Medical Expenditure Panel Survey. Adjusted linear regression analyses accounted for the complex survey design and assessed differences in several types of annual health care expenditures between individuals who reported frequent exercise (≥30 min of moderate–vigorous intensity physical activity ≥5 times per week) and those who did not. Approximately 23,940,144 of 56,979,267 older U.S. adults with pain reported frequent exercise. In adjusted analyses, individuals who reported frequent exercise had 15% lower annual prescription medication expenditures compared with those who did not report frequent exercise (p =.007). There were no statistical differences between frequent exercise status for other health care expenditure types (p >.05). In conclusion, adjusted annual prescription medication expenditures were 15% lower among older U.S. adults with pain who reported frequent exercise versus those who did not. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess degree of audiovestibular handicap in patients with vestibular schwannoma. Methods: Audiovestibular handicap was assessed using the Hearing Handicap Inventory, Tinnitus Handicap Inventory and Dizziness Handicap Inventory. Patients completed questionnaires at presentation and at least one year following treatment with microsurgery, stereotactic radiosurgery or observation. Changes in audiovestibular handicap and factors affecting audiovestibular handicap were assessed. Results: All handicap scores increased at follow up, but not significantly. The Tinnitus Handicap Inventory and Dizziness Handicap Inventory scores predicted tinnitus and dizziness respectively. The Hearing Handicap Inventory was not predictive of hearing loss. Age predicted Tinnitus Handicap Inventory score and microsurgery was associated with a deterioration in Dizziness Handicap Inventory score. Conclusion: Audiovestibular handicap is common in patients with vestibular schwannoma, with 75 per cent having some degree of handicap in at least one inventory. The overall burden of handicap was, however, low. The increased audiovestibular handicap over time was not statistically significant, irrespective of treatment modality. [ABSTRACT FROM AUTHOR]

Objective: Pure tone audiometry (PTA) is the gold standard for hearing assessment. However, it requires access to specialized equipment. Smartphone audiometry applications (apps) have been developed to perform automated threshold audiometry and could allow patients to perform self‐administered screening or monitoring. This study aimed to assess the validity and feasibility of patients using apps to self‐assess hearing thresholds at home, with comparison to PTA. Methods: A multi‐center, prospective randomized study was conducted amongst patients undergoing PTA in clinics. Participants were randomly allocated to one of four publicly‐available apps designed to measure pure tone thresholds. Participants used an app once in optimal sound‐treated conditions and a further three times at home. Ear‐specific frequency‐specific thresholds and pure tone average were compared using Pearson correlation coefficient. The percentage of app hearing tests with results within ±10 dB of PTA was calculated. Patient acceptability was assessed via an online survey. Results: One hundred thirty‐nine participants submitted data. The results of two at‐home automated smartphone apps correlated strongly/very strongly with PTA average and their frequency‐specific median was within ±10 dB accuracy. Smartphone audiometry performed in sound‐treated and home conditions were very strongly correlated. The apps were rated as easy/very easy to use by 90% of participants and 90% would be happy/very happy to use an app to monitor their hearing. Conclusion: Judicious use of self‐performed smartphone audiometry was both valid and feasible for two of four apps. It could provide frequency‐specific threshold estimates at home, potentially allowing assessments of patients remotely or monitoring of fluctuating hearing loss. Level of Evidence: 2 Laryngoscope, 134:2864–2870, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Identifying characteristics associated with patients’ confidence managing diabetes may aid the primary care provider in offering diabetes self‑management education and support to patients. This analysis assessed the relationship between demographic, health, economic, access to care, satisfaction with care, and healthcare utilization characteristics with patients’ confidence managing diabetes. Methods: United States adults with diabetes in the 2020 Medical Expenditure Panel Survey were included in this retrospective cross‑sectional analysis. Characteristics related statistically to patients’ confidence managing diabetes in multivariable logistic regression analysis were reported. Results: Among the 1,516 eligible individuals, 76.3% stated they were very confident/confident with their diabetes management. Adults who perceived their health positively (odds ratio 2.3, 95% confidence interval [CI] 1.3–3.9), completed ≥30 min moderate/vigorous exercise five times weekly (odds ratio 1.6, 95% CI 1.0–2.6), had at least one inpatient discharge in 2020 (odds ratio 3.5, 95% CI 1.5–8.1), said it was not difficult to telephone their usual provider (odds ratio 3.3, 95% CI 1.4–7.8), and had no emergency room visits in 2020 (odds ratio 2, 95% CI 1.1–3.3) had higher odds of stating they were very confident or confident with their diabetes management. Conclusion: The characteristics associated with being very confident/confident managing diabetes should be considered by primary healthcare physicians and other healthcare professionals when helping patients manage diabetes. [ABSTRACT FROM AUTHOR]

The purpose of this cross-sectional study was to investigate the relationship between Body Mass Index (BMI), cholesterol, and cancer in United States (US) adults. Data were collected from the 2020 Medical Expenditure Panel Survey (MEPS). Eligible participants were US adults (≥18 years) with data on BMI, cholesterol, and cancer status, who were alive at the end of the data collection period. An adjusted logistic regression model assessed associations between eight possible combinations of BMI and cholesterol status (independent variable) with cancer diagnosis (dependent variable). Among 27,805 individuals in the 2020 MEPS data, 20,818 met the eligibility criteria (weighted N = 252,340,615). Of these 2668 (weighted N = 29,770,359) had cancer and 18,150 (weighted N = 222,570,256) did not have cancer. In the adjusted logistic regression model, underweight and normal weight individuals with high cholesterol were associated with higher odds of cancer (odds ratio, OR = 2.002, and 95% confidence interval, CI = 1.032–3.885, and OR = 1.326 and 95% CI = 1.047–1.681, respectively), while obese individuals with normal cholesterol were associated with lower odds of cancer (OR = 0.681; 95% CI = 0.543–0.853) compared to normal weight individuals with normal cholesterol. This study offers insights into specific groups of individuals who may be prioritized for cancer prevention. Further research is required to investigate these findings in additional subpopulations. [ABSTRACT FROM AUTHOR]

While telemedicine infrastructure was in place within the Veterans Health Administration (VHA) healthcare system before the onset of the COVID-19 pandemic, geographically varying ordinances/closures disrupted vital care for chronic disease patients such as those with type 2 diabetes. We created a national cohort of 1,647,158 non-Hispanic White, non-Hispanic Black, and Hispanic veterans with diabetes including patients with at least one primary care visit and HbA1c lab result between 3.5% and 20% in the fiscal year (FY) 2018 or 2019. For each VAMC, the proportion of telehealth visits in FY 2019 was calculated. Two logistic Bayesian spatial models were employed for in-person primary care or telehealth primary care in the fourth quarter of the FY 2020, with spatial random effects incorporated at the VA medical center (MC) catchment area level. Finally, we computed and mapped the posterior probability of receipt of primary care for an "average" patient within each catchment area. Non-Hispanic Black veterans and Hispanic veterans were less likely to receive in-person primary care but more likely to receive tele-primary care than non-Hispanic white veterans during the study period. Veterans living in the most socially vulnerable areas were more likely to receive telehealth primary care in the fourth quarter of FY 2020 compared to the least socially vulnerable group but were less likely to receive in-person care. In summary, racial minorities and those in the most socially vulnerable areas were less likely to receive in-person primary care but more likely to receive telehealth primary care, potentially indicating a disparity in the impact of the pandemic across these groups. [ABSTRACT FROM AUTHOR]

The myriad and contested meanings of 'sustainability' and 'sustainable development' lead many to refer to both concepts as meaningless, oxymoronic, and paradoxical. Yet breaking down such terms to their key principles allows for introducing core concepts, constituent meanings, and associated practices that should enable greater understanding. Despite this, understandings of the interconnected nature of sustainability and sustainable development lack a holistic perspective among students. Exploring this area further, this paper presents findings from a 6-year longitudinal survey at Southern Connecticut State University which asked sustainability studies students (n = 150) for their perspectives on the Rio Declaration's principles of sustainability. Findings from this study elucidate the many disconnections students form predicated on limited real-world global awareness of sustainability projects alongside breaking down broad concepts to those accommodated by contemporary socio-environmental discourse. Conversely, sustainability students consider alternative concepts such as responsibility, cooperation, accountability, intersectionality, and new economic pathways to be of value and necessity as opposed to the sustainability principles encompassed in the Rio Declaration. Summarising the alternative concepts that are preferable to sustainability students, and exploring the principles and implications of related disconnections and terminological evolution, this article argues for increasing engagement from sustainability academics to explore this departure from some of the discipline's core foundations. [ABSTRACT FROM AUTHOR]

In this study, we aimed to identify the factors correlated with positive psychological health among United States older adults (≥50 years) with pain and documented opioid treatment. This retrospective cross-sectional study utilized a nationally representative dataset (Medical Expenditure Panel Survey). A multivariable logistic regression model was developed to assess the correlation of positive psychological health in the eligible population. The logistic regression model showed having excellent/very good/good (versus fair/poor) perceived health (adjusted odds ratio [AOR] = 9.062; 95% confidence interval [CI] = 5.383, 15.254) had a statistically significant correlation with positive psychological health among the eligible population. This finding offers important insights for clinicians and policymakers to consider when formulating approaches to better manage the psychological health of United States older adults with pain and documented opioid treatment. [ABSTRACT FROM AUTHOR]

On 28 May 2019, a tornadic supercell, observed as part of Targeted Observation by UAS and Radars of Supercells (TORUS) produced an EF-2 tornado near Tipton, Kansas. The supercell was observed to interact with multiple preexisting airmass boundaries. These boundaries and attendant air masses were examined using unoccupied aircraft system (UAS), mobile mesonets, radiosondes, and dual-Doppler analyses derived from TORUS mobile radars. The cool-side air mass of one of these boundaries was found to have higher equivalent potential temperature and backed winds relative to the warm-side air mass; features associated with mesoscale air masses with high theta-e (MAHTEs). It is hypothesized that these characteristics may have facilitated tornadogenesis. The two additional boundaries were produced by a nearby supercell and appeared to weaken the tornadic supercell. This work represents the first time that UAS have been used to examine the impact of preexisting airmass boundaries on a supercell, and it provides insights into the influence environmental heterogeneities can have on the evolution of a supercell. [ABSTRACT FROM AUTHOR]

Objective: ‒ The aim of this study was to assess the associations between the characteristics of United States (US) adults (≥50 years) who used opioids and self-reported pain severity using a nationally representative dataset. Methods: ‒ This retrospective cross-sectional database study used 2019 Medical Expenditure Panel Survey data to identify US adults aged ≥50 years with self-reported pain within the past 4 weeks and ≥1 opioid prescription within the calendar year (n = 1,077). Weighted multivariable logistic regression analysis modeled associations between various characteristics and self-reported pain severity (quite a bit/extreme vs less/moderate pain). Results: ‒ The adjusted logistic regression model indicated that greater odds of reporting quite a bit/extreme pain was associated with the following: age 50–64 vs ≥65 (adjusted odds ratio [AOR] = 1.76; 95% confidence interval [CI] = 1.22–2.54), non-Hispanic vs Hispanic (AOR = 2.0; CI = 1.18–3.39), unemployed vs employed (AOR = 2.01; CI = 1.33–3.05), no health insurance vs private insurance (AOR = 6.80; CI = 1.43–32.26), fair/poor vs excellent/very good/good health (AOR = 3.10; CI = 2.19–4.39), fair/poor vs excellent/very good/good mental health (AOR = 2.16; CI = 1.39–3.38), non-smoker vs smoker (AOR = 1.80; CI = 1.19–2.71), and instrumental activity of daily living, yes vs no (AOR = 2.27; CI = 1.30–3.96). Conclusion: ‒ Understanding the several characteristics associated with pain severity in US adults ≥50 years who used an opioid may help transform healthcare approaches to prevention, education, and management of pain severity in later life. [ABSTRACT FROM AUTHOR]

This retrospective, cross-sectional database study aimed to identify characteristics associated with self-reported frequent exercise (defined as moderate- to vigorous-intensity exercise for ≥30 min five times a week) in older U.S. (≥50 years) adults with pain in the past 4 weeks, using 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models. The variables significantly associated with frequent exercise included being male (adjusted odds ratio [AOR] = 1.507, 95% confidence interval [CI] [1.318, 1.724]); non-Hispanic (AOR = 1.282, 95% CI [1.021, 1.608]); employed (AOR = 1.274, 95% CI [1.040, 1.560]); having no chronic conditions versus ≥5 conditions (AOR = 1.576, 95% CI [1.094, 2.268]); having two chronic conditions versus ≥5 conditions (AOR = 1.547, 95% CI [1.226, 1.952]); having no limitation versus having a limitation (AOR = 1.209, 95% CI [1.015, 1.441]); having little/moderate versus quite/extreme pain (AOR = 1.358, 95% CI [1.137, 1.621]); having excellent/very good versus fair/poor physical health (AOR = 2.408, 95% CI [1.875, 3.093]); and having good versus fair/poor physical health (AOR = 1.337, 95% CI [1.087, 1.646]). These characteristics may be useful to create personalized pain management protocols that include exercise for older adults with pain. [ABSTRACT FROM AUTHOR]

The ocean and coasts are largely absent from the 'Green New Deal' proposal. In response to the limited attention paid to the sustainability and equitable governance approaches of the blue economy, a US 'Blue New Deal' has been proposed aiming to protect the health of the ocean and support coastal communities' adaptation to climate change. The Blue New Deal emerged as a central policy proposal from 2020 Democratic presidential candidate Elizabeth Warren to enhance the role of the blue economy while simultaneously addressing the climate crisis. Through a just transitions analysis, this article evaluates the proposal for a US Blue New Deal — as designed by Senator Elizabeth Warren — that would be applied towards enhancing socioeconomic resiliency, environmental justice, and addressing social inequities. As part of a critical policy analysis evaluating the areas of focus Warren's Blue New Deal presents, environmental justice and sustainability are central to the success of managing, and enhancing the role of, the blue economy. The challenges facing the Blue New Deal reflect a 'one size fits all' federal approach that has implications for addressing multifaceted obstacles in key sectors of the blue economy, its governance, and tackling interconnected crises that exacerbate socioeconomic inequities and vulnerabilities of marginalised coastal communities. This article proposes a blue justice framework for the Blue New Deal that seeks to address the tensions and contradictions that exist in its current form and indicates how a comprehensive policy framework can enhance the sustainability and equitable involvement of the blue economy. [ABSTRACT FROM AUTHOR]

The accelerated pace with which companies, governments, and institutions embrace digital transformation is creating opportunities for economic prosperity, but also increases the threat landscape. Recent orchestrated cyber-attacks have revealed the unpredictability of the harm they can cause in our society, rendering the creation of new models that capture systemic risk more critical than ever. In this article, we model the behaviour of one of the most prominent cyber-attacks: ransomware; in particular, ransomware that propagates between organisations via the Internet. We draw concepts from epidemiological models of viral propagation to reason about policies that can reduce the systemic cyber-risk to the community. To achieve this, we present a compartment-based epidemiological model of predator-prey interactions and run simulations to validate the importance of defensive controls that reduce the propagation of ransomware. Our model suggests that with specific defensive controls in place, other response policies may also become more effective. A prey policy to not pay the ransom may improve the ability of the victim population to recover; while information-sharing may reduce the number of organisations compromised if certain conditions on the speed of threat-intelligence sharing practices are met. These results indicate the validity of the approach, which we believe could be extended to explore the impacts of a broad range of attacker and defender behaviours and characteristics of the digital environment on systemic risk. [ABSTRACT FROM AUTHOR]

Demand Reduction is a strategy with the potential to make a significant contribution to the energy supply/demand balance. Its two major themes are improving the energy efficiency of devices (appliances and processes) and changing people's behaviour towards using less energy. In our analysis of a nation's energy security, we treat Demand Reduction as an additional fuel which delivers 'negafuel', allowing a particular level of energy services to be met at a lower volume of supply than would be possible in its absence. In common with other fuels, negafuel is delivered by a supply chain with linked stages, all encountering risks of various types. A comprehensive survey of these risks in a case study of the UK shows that Demand Reduction belongs to a middle-ranking group of fuels in terms of overall risk. High-level risks encountered include the difficulty of assessing and delivering potential energy savings, the rate of building construction at the highest energy efficiency standards, optimism bias, changing policy and regulation, and operational failure (both of technology and policy). Assessing the risk of Demand Reduction as a supplied negafuel focuses attention on specific risks requiring mitigation, facilitating design of better policy, and more effective commercial products. [ABSTRACT FROM AUTHOR]

Globally, gastric cancer is a major cause of cancer mortality, with a 5-year survival rate of 32% for locally advanced and metastatic gastric cancer (A/MCG). This systematic literature review summarized the clinical, safety, and humanistic outcomes associated with systemic regimens administered as a first-line therapy for A/MGC. The search included articles published in English in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and the American Society of Clinical Oncology meeting library, from inception to April 2022. Phase II and III randomized controlled trials (RCTs) conducted among western populations diagnosed with stage III and IV A/MGC were included. Two investigators independently reviewed the studies, conducted data extraction, and assessed risk of bias in accordance with PRISMA guidelines. Twenty-four randomized controlled trials totaling 8705 patients were included. Median overall survival ranged from 5.0 to 13.1 months, median progression-free survival ranged from 2.0 to 7.7 months, and objective response ranged from 13.0 to 64.1%. Two studies reported high quality-of-life outcomes. Grade 3 and 4 adverse events were reported in most studies. This review provides a comprehensive overview of first-line systemic therapy outcomes in western populations with A/MGC. With the evolving treatment landscape of A/MGC, an improvement in clinical outcomes can be seen in recently published RCTs with immunotherapies. The potential of new targeted treatments and immunotherapies may present more favorable forthcoming options for treating A/MGC. [ABSTRACT FROM AUTHOR]

The purpose of this scoping literature review was to assess available published literature/abstracts, and to examine described contributions by pharmacists and/or pharmacy technicians as part of the care of people with cystic fibrosis (pwCF). This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews (PRISMA‐ScR). Published abstracts and articles from inception through December 2022 were included if they described care of pwCF (all ages), with at least one group of participants receiving care/services from pharmacy staff, and were available in English. Data extractions were outcomes, study, and participant characteristics. From 756 abstracts and papers, 91 were included. The majority were published abstracts (n = 67), from the United States (n = 64), retrospective cohort study design (n = 47), involved pharmacist intervention (n = 75), with no comparison group (n = 48), and in an outpatient/ambulatory setting (n = 59). Most often, literature were descriptions of specific pharmacist services, evaluations of adding a pharmacist, or descriptions of overall pharmacist practice/role. Specific pharmacist services were defined as patient or caregiver education, adherence support, medication reconciliation, management of pulmonary exacerbations, and medication management (including monitoring, and telehealth). Pharmacists and pharmacy technicians have contributed to the care of pwCF in various ways; however, much of the available data are currently disseminated in the form of conference abstracts. Efforts to support author publication of data as full peer‐reviewed publications should be prioritized as this data can help support others' efforts to develop or support similar clinical pharmacy services. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the variables associated with multimorbidity status among older United States (US) adults with self-reported pain and opioid use. This study used a cross-sectional retrospective database design that included US adults aged ≥50 years with self-reported pain who used an opioid in 2019 in the Medical Expenditure Panel Survey data. Multivariable logistic regression models, weighted to produce nationally representative estimates, were used to determine variables significantly associated with multimorbidity status (≥2 versus <2 chronic conditions). Significance was determined using an a priori alpha level of 0.05. In the adjusted logistic regression analysis, those aged 50–64 (vs. ≥65 years), Hispanic (vs. non-Hispanic), employed (vs. unemployed), and who performed frequent exercise (vs. no frequent exercise) were associated with lower odds of having multimorbidity. In conclusion, these characteristics may be targets for pain management and opioid use interventions among older US adults. Further research is needed to investigate the variables associated with multimorbidity in greater detail. [ABSTRACT FROM AUTHOR]

Background: Vestibular schwannoma (VS) is the most common benign tumour arising in the lateral skull base. Reported incidence rates of VS vary across geographical locations and over time. There is scarce updated evidence over the past decade on the epidemiology and mode of presentation of VS. Objective: To describe the epidemiology and mode of presentation of VS in the East of England between 2013 and 2016. Methods: A retrospective epidemiological analysis of data from a national VS registry and electronic patient records was conducted, including all newly diagnosed adult patients in a UK tertiary referral centre, between April 1st, 2013, and March 31st, 2016. Results: There were 391 new cases identified resulting in an overall mean incidence of 2.2 VS cases per 100,000 person-year. The incidence rate for all patients in the <40 age group ranged between 0.3 and 0.7 per 100,000 person-year, increasing to a range of 5.7 to 6.1 per 100,000 person-year in the 60–69 age group. The top three combinations of symptoms on presentation per patient were hearing loss and tinnitus (97, 24.8%), hearing loss alone (79, 20.2%) and hearing loss, tinnitus, and balance symptoms (61, 15.6%). The median duration of symptoms was 12 months, with a wide range from 1.4 to 300 months. Age was negatively correlated with tumour size (r = -0.14 [-0.24 to -0.04], p=0.01) and positively correlated with symptom duration (r = 0.16 [0.03–0.29], p=0.02). Conclusions: The incidence of vestibular schwannoma has increased compared to previous studies in the UK and is similar to incidence rates reported in other countries during the past decade. It peaks in the seventh decade of life, mainly because of an increase in the diagnosis of small tumours with a long duration of audio-vestibular symptoms in older patients, compared to earlier studies. [ABSTRACT FROM AUTHOR]

Main statements: All endoscopic procedures are invasive and carry risk. Accordingly, all endoscopists should involve the patient in the decision-making process about the most appropriate endoscopic procedure for that individual, in keeping with a patient's right to self-determination and autonomy. Recognition of this has led to detailed guidelines on informed consent for endoscopy in some countries, but in many no such guidance exists; this may lead to variations in care and exposure to risk of litigation. In this document, the European Society of Gastrointestinal Endoscopy (ESGE) sets out a series of statements that cover best practice in informed consent for endoscopy. These statements should be seen as a minimum standard of practice, but practitioners must be aware of and adhere to the law in their own country. 1 Patients should give informed consent for all gastrointestinal endoscopic procedures for which they have capacity to do so. 2 The healthcare professional seeking consent for an endoscopic procedure should ensure that the patient has the capacity to consent to that procedure. 3 For patients who lack capacity, healthcare personnel should at all times try to engage with people close to the patient, such as family, friends, or caregivers, to achieve consensus on the appropriateness of performing the procedure. 4 Where a patient lacks capacity to provide informed consent, the best interest decision should be clearly documented in the medical record. This should include information about the capacity assessment, reason(s) that the decision cannot be delayed for capacity recovery (or if recovery is not expected), who has been consulted, and where relevant the form of authority for the decision. 5 There should be a systematic and transparent disclosure of the expected benefits and harms that may reasonably affect patient choice on whether or not to undergo any diagnostic or interventional endoscopic procedure. Information about possible alternatives, as well as the consequences of doing nothing, should also be provided when relevant. 6 The information provided on the benefit and harms of an endoscopic procedure should be adapted to the procedure and patient-specific risk factors, and the preferences of the patient should be central to the consent process. 7 The consent discussion should be undertaken by an individual who is familiar with the procedure and its risks, and is able to discuss these in the context of the individual patient. 8 Patients should confirm consent to an endoscopic procedure in a private, unrushed, and non-coercive environment. 9 If a patient requests that an endoscopic procedure be discontinued, the procedure should be paused and the patient's capacity for decision making assessed. If a competent patient continues to object to the procedure, or if a conclusive determination of capacity is not feasible, the examination should be terminated as soon as it is safe to do so. 10 Informed consent should be sufficiently detailed to cover all findings that can be reasonably anticipated during an endoscopic examination. The scope of this consent should not be expanded, nor a patient's implicit consent for additional interventions assumed, unless failure to proceed with such interventions would result in immediate and predictable harm to the patient. [ABSTRACT FROM AUTHOR]

Objective: This study aims to estimate the rate of postoperative meningitis (both immediate and long‐term) in patients following cochlear implants (CIs). It aims to do so through a systematic review and meta‐analysis of published studies tracking complications after CIs. Data Sources: MEDLINE, Embase, and Cochrane Library. Review Methods: This review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Studies tracking complications following CIs in patients were included. Exclusion criteria included non‐English language studies and case series reporting <10 patients. Bias risk was evaluated using the Newcastle‐Ottawa Scale. Meta‐analysis was performed through DerSimonian and Laird random‐effects models. Results: A total of 116/1931 studies met the inclusion criteria and were included in the meta‐analysis. Overall, there were 112 cases of meningitis in 58,940 patients after CIs. Meta‐analysis estimated an overall rate of postoperative meningitis of 0.07% (95% confidence interval [CIs], 0.03%‐0.1%; I2 = 55%). Subgroup meta‐analysis showed this rate had 95% CIs crossing 0% in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, those with postoperative acute otitis media (AOM), and those implanted less than 5 years. Conclusion: Meningitis is a rare complication following CIs. Our estimated rates of meningitis after CIs appear lower than prior estimates based on epidemiological studies in the early 2000s. However, the rate still appears higher than the baseline rate in the general population. The risk was very low in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, received unilateral or bilateral implantations, developed AOM, those implanted with a round window or cochleostomy techniques, and those under 5 years. [ABSTRACT FROM AUTHOR]

The Chronic Pain Profile (CPP) was developed as a tool for patients to document types and levels of use for all pain management strategies used. This pilot mixed-methods (quantitative and qualitative methods) study aimed to assess the perceived clinical usefulness of the CPP and identify potential areas of difficulty using the CPP among a sample of pharmacists. Data were obtained from an online survey of pharmacists licensed to practice in Arizona. Quantitative analysis included assessing the clinical usefulness of the CPP using 10 numerical items (scores ≥50% = useful), 5 ordinal items (scores ≥ 4 out of 5 = useful), and 11 open-response items. Qualitative analysis was conducted by two independent researchers who coded the comments and identified key themes through consensus. Data were collected for 33 individuals. Mean usefulness scores ranged from 66.6 ± 22.4 to 80.9 ± 23.5, and three of the five ordinal items had a median score ≥ 4. Three key themes (and subthemes) were identified: favorable features of the CPP, which included promoting patient advocacy and saving time when accessing pain information; using the CPP, which included evaluating of the effectiveness and appropriateness of the pain management approach and identifying gaps in patient knowledge; and limitations of the CPP, which included absence of customization, interpretation issues, complexity and wording issues, and concerns of internal consistency and reliability. This pilot study provides initial evidence of the CPP's clinical usefulness that could ultimately be used to help manage pain and improve health outcomes. Further analyses are needed to assess the CPP's validity and explore its use in wider populations of patients with pain. [ABSTRACT FROM AUTHOR]

Nivolumab, an immune checkpoint inhibitor, was approved by the United States (US) Food and Drug administration as a first-line systemic therapy for locally advanced/metastatic gastric cancer patients. The current study aimed to investigate the cost-effectiveness of nivolumab-chemotherapy combination versus chemotherapy alone as a first-line therapy from a US payer perspective. An economic evaluation was conducted using a partitioned survival model in Microsoft Excel® using data from the CheckMate 649 trial. Three discrete mutually exclusive health states (progression-free, post-progression, and death) were included in the model. The health state occupancy was calculated using the overall survival and progression-free survival curves derived from the CheckMate 649 trial. Cost, resource use, and health utility estimates were estimated from a US payer perspective. Deterministic and probabilistic sensitivity analyses assessed the uncertainty of the model parameters. Nivolumab-chemotherapy provided additional 0.25 life years compared to chemotherapy alone and the quality-adjusted life years (QALYs) were 0.701 and 0.561, respectively, producing a gain of 0.140 QALYs and an incremental cost-effectiveness ratio of $574,072/QALY. From the US payer perspective, at a willingness to pay threshold of $US150,000/QALY, nivolumab-chemotherapy was not found to be cost-effective as a first-line therapy for locally advanced/metastatic gastric cancer. [ABSTRACT FROM AUTHOR]

This report describes the adoption and integration of Western medicine in Cherán K'eri after the social changes in the 1940s which led to the transition from healer to pharmacist. There are various health models that rely heavily on community pharmacies. The place used as the basis for this report was a clinic managed by a Purépecha-speaking physician and pharmacist that served primarily monolingual indigenous Purépecha patients, whose population was around 9550 according to the 2010 census. Twelve major differences were observed between community pharmacies in the United States and the community pharmacies of Cherán. It was also observed that the modern approach to the health of the indigenous population used a combination of Western medicine together with traditional methods and only resorted to short-term therapies with Western medicines lasting five days or less. A formulary from the clinic's community pharmacy compiled in 2022 listed the 38 most common medications. Medications used included anti-infectives (n = 3), central nervous system (n = 2), endocrine/hormonal (n = 3), gastrointestinal (n = 3), musculoskeletal (n = 17), respiratory or allergy (n = 6), and genitourinary (n = 2). [ABSTRACT FROM AUTHOR]

Introduction: Opioid over-prescribing has led to changes in prescribing habits and a reduction in the amount of opioid prescriptions per patient. Deprescribing has proved to be an effective way of decreasing the number of opioids patients are receiving, and pharmacists are in the optimal position to provide these services for their patients. However, student pharmacists require additional education and training to be able to understand their role in deprescribing opioids upon entering the profession. Methods: Student pharmacists at three United States of America schools of pharmacy were invited to participate in virtual focus groups about deprescribing opioids in Fall 2021. A trained qualitative researcher conducted the focus groups, which were audio-recorded and later transcribed verbatim for thematic analysis. Two independent qualitative researchers coded the transcripts using both inductive and deductive approaches. The researchers then met to identify, discuss, and describe themes from the data. Results: Thematic analysis revealed two themes: (1) perceived obstacles and enablers to initiate deprescribing for opioid medications and (2) additional pharmacy curricula experiences are necessary to better equip student pharmacists to address deprescribing. These themes emphasize the challenges student pharmacists face as well as opportunities to enhance their knowledge to be practice-ready. Conclusion: Varying educational approaches to teaching deprescribing in the pharmacy curriculum, including objective structured clinical exams, interprofessional education, and motivational interviewing, should be further assessed. [ABSTRACT FROM AUTHOR]

(1) Background: The use of telehealth in the United States during the coronavirus disease 2019 pandemic was accelerated and there was a lack of telehealth training programs available to clinicians of all levels. At the onset of the pandemic, the American Association of Colleges of Pharmacy (AACP) had no educational outcomes or professional activity standards for the inclusion of telehealth in the didactic Doctor of Pharmacy curriculum. Yet, in November 2022, the AACP encouraged colleges of pharmacy to include digital health and telehealth. The purpose of this study was to assess faculty perceptions in preparation for a nation-wide survey regarding telehealth integration into pharmacy practice curricula. (2) Methods: An exploratory questionnaire was developed to describe faculty perceptions and opinions of telehealth integration into the pharmacy practice curriculum at a single college of pharmacy. The questionnaire was emailed to 76 faculty members over six weeks in Summer 2022. Data were summarized descriptively. (3) Results: A total of 18 faculty members completed the survey (24% response rate). The responding faculty were typically very aware (median = 4) of telehealth, its benefits, and barriers, and were very comfortable (median = 4) discussing telehealth communication, benefits of telehealth, and barriers of telehealth. Yet, they were less comfortable discussing telehealth applications (median = 2.5). The faculty had a positive perception of telehealth in general (mean = 8.1 ± 1.5), telehealth services (mean = 8.6 ± 1.6), and the incorporation of telehealth instruction into the pharmacy practice curriculum (mean = 7.7 ± 2.7). Most respondents (67%) could discuss telehealth in their course. Lack of time to teach (50%) was the most reported reason by those who did not have plans to incorporate telehealth instruction into their course. (5) Conclusions: This exploratory survey of faculty at one college of pharmacy indicated positive perceptions and opinions of telehealth integration into the Doctor of Pharmacy curriculum. Further efforts to incorporate telehealth into the curriculum at other pharmacy schools is warranted. [ABSTRACT FROM AUTHOR]

The number of older United States (US) adults is increasing, yet extra life years are not always spent in good health. This study explored the relationship between pain intensity and health status among US adults aged ≥50 with pain who used an opioid in the 2020 Medical Expenditure Panel Survey using multivariable logistic regression adjusting for demographic, economic, and health variables. Most (60.2%) older US adult opioid users with pain reported having good health (versus 39.8% poor health). In the fully adjusted analysis, those with extreme pain (odds ratio (OR) = 0.19, 95% confidence interval (CI) = 0.10, 0.35) and quite a bit of pain (OR = 0.34, 95% CI = 0.19, 0.60) had lower odds of reporting good health compared to those with little pain. There was no statistical relationship between health status for moderate versus little pain. In addition, males (versus females; OR = 0.61, 95% CI = 0.40, 0.91), white race (versus not white; OR = 0.43, 95% CI = 0.22, 0.84), education ≤high school (versus >high school; OR = 0.61, 95% CI = 0.41, 0.92), and current smoker (versus non-smoker; OR = 0.55, 95% CI = 0.32, 0.93) were associated with lower odds of reporting good health. Being employed (versus unemployed; OR = 1.88, 95% CI = 1.06, 3.33), having <2 chronic conditions (versus ≥2; OR = 4.38, 95% CI = 1.91, 10.02), and doing regular physical activity (versus not; OR = 2.69, 95% CI = 1.73, 4.19) were associated with higher odds of reporting good health. These variables should be considered when assessing the health needs and developing treatment plans for older US adult opioid users with pain. [ABSTRACT FROM AUTHOR]

Pain affects over 20% of United States adults, and less than 50% of United States adults participate in frequent physical exercise. This cross-sectional database study included 13,758 United States adults aged >18 years from the 2020 Medical Expenditure Panel Survey (MEPS) and analyzed the association between severity of pain (independent variable) and frequent physical exercise (dependent variable), adjusting for demographic, economic, limitation, and health variables using multivariable logistic regression. The study showed 50.3% of adults report frequently exercising. Only 37.1% of adults reported experiencing pain of any degree, with a majority of them experiencing little pain. In the adjusted model, extreme pain vs. none, quite a bit of pain vs. none, Hispanic vs. non-Hispanic ethnicity, having a functional limitation vs. no limitation, and being overweight/obese vs. not being obese/overweight were associated with lower odds of reporting doing frequent physical exercise. Meanwhile, being ≥65 or 40–64 vs. 18–39 years of age, male vs. female, white vs. not white race, private or public vs. no health coverage, and good vs. poor general health were associated with greater odds of reporting doing frequent physical exercise. These variables associated with frequent physical exercise should be considered in future work when designing health interventions. [ABSTRACT FROM AUTHOR]

Thematic analysis (TA) is a commonly used approach in qualitative research. TA has been widely applied in various disciplines such as psychology, sociology, and anthropology, and is now increasingly employed in pharmacy and healthcare research. However, pharmacy researchers may not be familiar with TA. The objectives of this manuscript are to succinctly describe the process for TA explained through the six steps of Braun and Clark as it applies to pharmacy or healthcare‐related research, discuss how rigor is achieved in qualitative studies, provide an overview of the qualitative software that is available to assist with TA, and offer comparisons to quantitative analysis where appropriate to demonstrate the contrast with qualitative techniques such as TA. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the prevalence of, and risk factors associated with electrode migration (EM) in cochlear implant (CI) recipients. Design: Historical cohort study of all CIs performed between 1 January 2018 and 1 August 2021 in a single tertiary adult and paediatric CI centre in the UK. Main Outcome Measures: The primary aim is to determine the prevalence of electrode migration, comparing intraoperative surgeon report and examination of a routine plain radiograph performed 2 weeks after surgery. EM is defined as the detection of movement of two or more electrodes out of the cochlea from the time of surgery. Multivariate analysis was performed to investigate preoperative and intraoperative risk factors that might predispose to migration. Results: Four hundred and sixty‐five patients, having 516 distinct surgeries, with 628 implants were analysed. EM occurred following 11.5% of implant operations. Pre‐existing cochlear abnormality was an independent associated risk factor for EM (OR: 3.40 ⟨1.20–9.62⟩ p =.021). Demographics, surgical technique, usage of a precurved electrode, CSF leak, surgeon seniority and intraoperative telemetry did not influence risk of migration. There were 5 implants (0.8%) which migrated later than 2 weeks, with a median date of imaging diagnosis (x‐ray or CT scan) of 263 days ⟨IQR:198⟩, for which head injury was a common precipitating factor. There were differences in the risk of migration between different lateral wall electrodes. Conclusion: EM in the early postoperative period is a common occurrence and is more likely in implant recipients with obstructed or malformed cochleae. [ABSTRACT FROM AUTHOR]

Objective: This study investigated factors associated with frequent moderate-to-vigorous intensity physical activity among United States (US) adults with asthma. Methods: This retrospective cross-sectional study included US adults (≥18 years) with asthma in the 2019 Medical Expenditure Panel Survey data. Logistic regression models that added sequential groups of variables were used to assess associations between predisposing (age, gender, race), enabling (marital status, poverty level, education level, insurance coverage, employment status), and need (smoking status, co-morbidities, mental health, physical health, functional limitations) factors and doing ≥30 min moderate-to-vigorous intensity physical activity ≥ five times per week. The alpha level was 0.05. Results: The study included 2,410 individuals, of which 46.9% (95% confidence interval [CI] = 44.2–49.6) reported doing frequent moderate-to-vigorous intensity physical activity. In fully adjusted analyses, the following variables were associated with a greater odds of reporting frequent moderate-to-vigorous intensity physical activity: men vs. women (adjusted odds ratio [AOR] = 1.4, 95% CI = 1.1–1.7), white vs. other races (AOR = 1.3, 95% CI = 1.0–1.6), excellent/very good/good vs. fair/poor physical health (AOR = 2.3, 95% CI = 1.7–3.0), and functional limitations no vs. yes (AOR = 1.7, 95% CI = 1.3–2.2). Conclusions: The factors identified in this study (gender, race, health status, and limitation status) may be helpful to target interventions to raise awareness and increase physical activity among US adults with asthma. Studies that can demonstrate a temporal relationship are needed to further our understanding of this topic. [ABSTRACT FROM AUTHOR]