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Racial residential segregation has been deemed a fundamental cause of health inequities. It is a result of historical and contemporary policies such as redlining that have created a geographic separation of races and corresponds with an inequitable distribution of health-promoting resources. Redlining and racial residential segregation may have contributed to racial inequities in COVID-19 vaccine administration in the early stages of public accessibility. We use data from the National Archives (historical redlining), Home Mortgage Disclosure Act (contemporary redlining), American Community Survey from 1940 (historical racial residential segregation) and 2015–2019 (contemporary racial residential segregation), and Washington D.C. government (COVID-19 vaccination administration) to assess the relationships between redlining, racial residential segregation, and COVID-19 vaccine administration during the early stages of vaccine distribution when a tiered system was in place due to limited supply. Pearson correlation was used to assess whether redlining and racial segregation, measured both historically and contemporarily, were correlated with each other in Washington D.C. Subsequently, linear regression was used to assess whether each of these measures associate with COVID-19 vaccine administration. In both historical and contemporary analyses, there was a positive correlation between redlining and racial residential segregation. Further, redlining and racial residential segregation were each positively associated with administration of the novel COVID-19 vaccine. This study highlights the ongoing ways in which redlining and segregation contribute to racial health inequities. Eliminating racial health inequities in American society requires addressing the root causes that affect access to health-promoting resources. [ABSTRACT FROM AUTHOR]

Background and Objective: Most evidence about difficult‐to‐treat and severe asthma (DTTA) comes from clinical trials and registries. We aimed to identify people with DTTA from a large nationally representative asthma population and describe their characteristics and healthcare utilization compared with people whose asthma was not 'difficult‐to‐treat'. Methods: We conducted a cross‐sectional survey of Australians aged ≥18 years with current asthma from large web‐based survey panels. Enrolment was stratified by gender, age‐group and state/territory based on national population data for people with asthma. Difficult‐to‐treat or severe asthma was defined by poor symptom control, exacerbations and/or oral corticosteroid/biologic use despite medium/high‐dose inhaled therapy. Outcomes included exacerbations, healthcare utilization, multimorbidity, quality of life and coronavirus disease of 2019 (COVID‐19)‐related behaviour. Weighted data were analysed using SAS version 9.4. Results: The survey was conducted in February–March 2021. The weighted sample comprised 6048 adults with current asthma (average age 47.3 ± SD 18.1 years, 59.9% female), with 1313 (21.7%) satisfying ≥1 DTTA criteria. Of these, 50.4% had very poorly controlled symptoms (Asthma Control Test ≤15), 36.2% were current smokers, and 85.4% had ≥1 additional chronic condition, most commonly anxiety/depression. More than twice as many participants with DTTA versus non‐DTTA had ≥1 urgent general practitioner (GP) visit (61.4% vs. 27.5%, OR 4.8 [4.2–5.5, p < 0.0001]), or ≥1 emergency room visit (41.9% vs. 17.9%, OR 3.8 [3.3–4.4, p < 0.0001]) in the previous 12 months. Conclusion: Our findings emphasize the burden of uncontrolled symptoms, current smoking, multimorbidity and healthcare utilization in people with DTTA in the community, who may be under‐represented in registries or clinical trials. In this cross‐sectional study of a nationally‐representative population of 6048 adults with current asthma, 21.7% had difficult‐to‐treat asthma. Burden for patients and health system was seen in poor general health status, poor asthma symptom control, frequent urgent GP and emergency department (ED)/hospital visits and high prevalence of multimorbidity, particularly anxiety and/or depression. See relatededitorial [ABSTRACT FROM AUTHOR]

Simple Summary: Congenital malformations of the equine caudal cervical vertebrae (C6 and C7) were first reported in the 1800s. However, by the 21st century these findings were no longer incidental, especially with studies reporting breed percentages as high as 38%. Therefore, this study examined the association between C6 osseous specimens (n = 85) demonstrating the congenital malformation of either a partial unilateral or bilateral absent ventral process and the transposition on the ventral surface of sequential C7s (44/85). The aim was to determine if the absent morphology on C6 corresponded to the transposition on C7 and in some cases replication of a transverse foramen (33/44). Findings revealed the larger morphological absence on C6 generated a stronger dependency for transposition on C7 that included the replication of a transverse foramen. The transposition on C7 was characterized by either a complete or incomplete likeness of the C6 ventral process. Complete transpositions on C7 appeared as a normal C6 ventral process, while incomplete transpositions appeared in most as a cranial ventral tubercle (CrVT). When complete bilateral transpositions were demonstrated, the morphology of C7 resembled C6. These findings are relevant to the reading of radiographic images and potential clinical findings. In recent years, equine complex vertebral malformation (ECVM) has been of concern in the equine community, with studies identifying numerous associative morphological variations. Here, we examine the morphological association between C6 and C7 for dependency in ECVM cases, where the partially absent ventral process of C6 transposes on the ventral surface of C7. A C6 ventral process presents two tubercles, one cranial (CrVT) and one caudal (CVT). In this study, the C6 osseous specimens (n = 85) demonstrated a partial or completely absent CVT (aCVT) graded 1–4 that often extended cranially creating a partially absent cranial ventral tubercle (aCrVT) graded 1–3. In the 85 C6 osseous specimens examined, the corresponding C7s demonstrated either a complete or incomplete transposition of the ventral process from C6 in 44/85, with 30/44 replicating a transverse foramen. A strong statistical dependency existed between C6 grade 4 aCVTs and grades 1–3 aCrVTs and C7 transpositions with replicated transverse foramen. Sidedness was also demonstrated, where a left sided absent C6 associated with transposition on the left ventral surface of C7. This likewise applied to right sidedness and most bilateral cases. These findings might benefit practitioners when radiographing the extent of the ECVM configuration in patients presenting caudal cervical pain. [ABSTRACT FROM AUTHOR]

Background As the enthusiasm for integrating artificial intelligence (AI) into clinical care grows, so has our understanding of the challenges associated with deploying impactful and sustainable clinical AI models. Complex dataset shifts resulting from evolving clinical environments strain the longevity of AI models as predictive accuracy and associated utility deteriorate over time. Objective Responsible practice thus necessitates the lifecycle of AI models be extended to include ongoing monitoring and maintenance strategies within health system algorithmovigilance programs. We describe a framework encompassing a 360 ° continuum of preventive, preemptive, responsive, and reactive approaches to address model monitoring and maintenance from critically different angles. Discussion We describe the complementary advantages and limitations of these four approaches and highlight the importance of such a coordinated strategy to help ensure the promise of clinical AI is not short-lived. [ABSTRACT FROM AUTHOR]

Mobile phone applications ("apps") are potentially an effective, low-burden method to collect patient-reported outcomes outside the clinical setting. Using such apps consistently and in a timely way is critical for complete and accurate data capture, but no studies of concurrent reporting by cancer patient–caregiver dyads have been published in the peer-reviewed literature. This study assessed app engagement, defined as adherence, timing, and attrition with two smartphone applications, one for adult cancer patients and one for their informal caregivers. This was a single-arm, pilot study in which adult cancer patients undergoing IV chemotherapy or immunotherapy used the DigiBioMarC app, and their caregivers used the TOGETHERCare app, for approximately one month to report weekly on the patients' symptoms and wellbeing. Using app timestamp metadata, we assessed user adherence, overall and by participant characteristics. Fifty patient–caregiver dyads completed the study. Within the one-month study period, both adult cancer patients and their informal caregivers were highly adherent, with app activity completion at 86% for cancer patients and 84% for caregivers. Caregivers completed 86% of symptom reports, while cancer patients completed 89% of symptom reports. Cancer patients and their caregivers completed most activities within 48 h of availability on the app. These results suggest that the DigiBioMarC and TOGETHERCare apps can be used to collect patient- and caregiver-reported outcomes data during intensive treatment. From our research, we conclude that metadata from mobile apps can be used to inform clinical teams about study participants' engagement and wellbeing outside the clinical setting. [ABSTRACT FROM AUTHOR]

Introduction The pitfalls of label leakage, contamination of model input features with outcome information, are well established. Unfortunately, avoiding label leakage in clinical prediction models requires more nuance than the common advice of applying "no time machine rule." Framework We provide a framework for contemplating whether and when model features pose leakage concerns by considering the cadence, perspective, and applicability of predictions. To ground these concepts, we use real-world clinical models to highlight examples of appropriate and inappropriate label leakage in practice. Recommendations Finally, we provide recommendations to support clinical and technical stakeholders as they evaluate the leakage tradeoffs associated with model design, development, and implementation decisions. By providing common language and dimensions to consider when designing models, we hope the clinical prediction community will be better prepared to develop statistically valid and clinically useful machine learning models. [ABSTRACT FROM AUTHOR]

Introduction: Pharmacovigilance programs protect patient health and safety by identifying adverse event signals through postmarketing surveillance of claims data and spontaneous reports. Electronic health records (EHRs) provide new opportunities to address limitations of traditional approaches and promote discovery-oriented pharmacovigilance. Methods: To evaluate the current state of EHR-based medication safety signal identification, we conducted a scoping literature review of studies aimed at identifying safety signals from routinely collected patient-level EHR data. We extracted information on study design, EHR data elements utilized, analytic methods employed, drugs and outcomes evaluated, and key statistical and data analysis choices. Results: We identified 81 eligible studies. Disproportionality methods were the predominant analytic approach, followed by data mining and regression. Variability in study design makes direct comparisons difficult. Studies varied widely in terms of data, confounding adjustment, and statistical considerations. Conclusion: Despite broad interest in utilizing EHRs for safety signal identification, current efforts fail to leverage the full breadth and depth of available data or to rigorously control for confounding. The development of best practices and application of common data models would promote the expansion of EHR-based pharmacovigilance. [ABSTRACT FROM AUTHOR]

Simple Summary: Specialized bony structures in the cervical spine are conservative traits in Equus ferus caballus with the ventral process of C6 being deemed one of the most significant structures relative to posture and locomotion. However, studies have identified an anomalous variation in the ventral process of C6 where its caudal ventral tubercle (CVT) is either unilaterally or bilaterally absent (aCVT). Consequently, the aim of this study is to describe the morphology and provide a grading system that identifies the extent of the absence in equal quarterly increments. Only osseous specimens with congenital variants of the ventral process were examined, totaling 76 (unilateral n = 47; bilateral n = 29). Observational grading identified four levels of absence—1/4, 2/4, and 3/4, with 4/4 representing complete absence of the CVT. Fifty-six osseous specimens with aCVTs had a grade 4/4 with 41/56 extending the absent morphology cranial, thus involving the caudal aspect of the cranial ventral tubercle (CrVT). This combined morphology effectively diminished the attachment sites for the cranial, and thoracal portions of the longus colli muscle, a primary fixator, flexor, rotator, and stabilizer of the cervical vertebrae. A study comparing radiographic images with gross specimens may provide information to facilitate accurate radiological descriptions of C6 variants. This study examined the anomalous variations of the ventral process of C6 in modern E. ferus caballus. The aim was to provide an incremental grading protocol measuring the absence of the caudal ventral tubercle (CVT) in this ventral process. The findings revealed the most prevalent absent CVT (aCVT) was left unilateral (n = 35), with bilateral (n = 29) and right unilateral (n = 12). Grading was determined in equal increments of absence 1/4, 2/4, 3/4, with 4/4 representing a complete aCVT in 56/76, with a significance of p = 0.0013. This also applied to bilateral specimens. In those C6 osseous specimens displaying a 4/4 grade aCVT, 41/56 had a partial absence of the caudal aspect of the cranial ventral tubercle (CrVT). Here, grading absent CrVTs (aCrVT) followed similarly to aCVTs, though 4/4 was not observed. The significance between 4/4 grade aCVTs and the presentation of an aCrVT was left p = 0.00001 and right p = 0.00018. In bilateral specimens, C6 morphologically resembled C5, implying a homeotic transformation that limited the attachment sites for the cranial and thoracal longus colli muscle. This potentially diminishes function and caudal cervical stability. Therefore, it is recommended that further studies examine the morphological extent of this equine complex vertebral malformation (ECVM) as well as its interrelationships and genetic code/blueprint. [ABSTRACT FROM AUTHOR]

Simple Summary: The mammalian body plan is like a 'blueprint' that supports the survival and procreation of a species. This plan includes specialized bony structures for muscle attachment such as the ventral process of C6, a two-part bony projection divided into cranial and caudal ventral tubercles (CVT). In modern horses, muscles such as the longus colli attach to the ventral process of C6 and aid in the flexion, stabilization, fixation, and force redirection of cervical vertebrae. Recent studies identified an anomalous variation where the CVT was either unilaterally or bilaterally absent. Therefore, the purpose of this study is to determine if anomalous variations of the CVTs, as described in modern horses, is a post-domestication congenital abnormality or a normal presentation throughout evolution. For this purpose, the ventral processes of C6 in extinct and extant Equus specimens in museums and research/educational facilities were examined. The findings revealed the CVT of C6 was present in those extinct and extant specimens examined, and that its absence was only evident in modern horses. This implies that the absent CVT manifested post-domestication. Although the clinical significance is unknown, the relevance might be considered when reporting on diagnostic images of C6, and especially, for potential buyers in pre-purchase cases. In this study, we examined the ventral process of C6 in extinct and extant Equus (sister taxa to Equus ferus caballus only) with the purpose of describing normal morphology and identifying anomalous variations relevant to recent studies describing a congenital malformation in E. ferus caballus. Overall, 83 specimens from 9 museums and 3 research/educational facilities were examined, totalling 71 extinct specimens from 12 species and 12 extant specimens from 5 species. The lateral view revealed that a large convexity exists in the ventral process between the cranial ventral tubercle (CrVT) and the caudal ventral tubercle (CVT) in the earliest ancestor, Hyracotherium grangeri, from 55 mya, which receded throughout the millennia to become a smaller convexity in E. ferus caballus and the sister taxa. The CrVT is visibly shorter and narrower than the CVT, with a constricted section directly ventral to the transverse process, essentially demarcating the CrVT and CVT. No congenital malformations were evident. As the ventral process of C6 is an integral component for muscle attachment in supporting the head/neck during posture and locomotion, this would indicate that the caudal module in the cervical column might be compromised when a partial or complete absence of the CVT is detected via radiographs in modern E. ferus caballus. [ABSTRACT FROM AUTHOR]

Background: Validating new algorithms, such as methods to disentangle intrinsic treatment risk from risk associated with experiential learning of novel treatments, often requires knowing the ground truth for data characteristics under investigation. Since the ground truth is inaccessible in real world data, simulation studies using synthetic datasets that mimic complex clinical environments are essential. We describe and evaluate a generalizable framework for injecting hierarchical learning effects within a robust data generation process that incorporates the magnitude of intrinsic risk and accounts for known critical elements in clinical data relationships. Methods: We present a multi-step data generating process with customizable options and flexible modules to support a variety of simulation requirements. Synthetic patients with nonlinear and correlated features are assigned to provider and institution case series. The probability of treatment and outcome assignment are associated with patient features based on user definitions. Risk due to experiential learning by providers and/or institutions when novel treatments are introduced is injected at various speeds and magnitudes. To further reflect real-world complexity, users can request missing values and omitted variables. We illustrate an implementation of our method in a case study using MIMIC-III data for reference patient feature distributions. Results: Realized data characteristics in the simulated data reflected specified values. Apparent deviations in treatment effects and feature distributions, though not statistically significant, were most common in small datasets (n < 3000) and attributable to random noise and variability in estimating realized values in small samples. When learning effects were specified, synthetic datasets exhibited changes in the probability of an adverse outcomes as cases accrued for the treatment group impacted by learning and stable probabilities as cases accrued for the treatment group not affected by learning. Conclusions: Our framework extends clinical data simulation techniques beyond generation of patient features to incorporate hierarchical learning effects. This enables the complex simulation studies required to develop and rigorously test algorithms developed to disentangle treatment safety signals from the effects of experiential learning. By supporting such efforts, this work can help identify training opportunities, avoid unwarranted restriction of access to medical advances, and hasten treatment improvements. [ABSTRACT FROM AUTHOR]

Background and Objective: Breathlessness is prevalent and associated with medical consequences. Obesity is related to breathlessness. However, the magnitude of its contribution has not been clearly documented. This investigation aimed to determine the contribution of obesity to breathlessness by estimating the population attributable fraction (PAF) in a representative sample of Australian adults. Methods: A cross‐sectional, nationally representative survey of Australian residents aged ≥18 years was conducted in October 2019. Breathlessness was defined as modified Medical Research Council (mMRC) dyspnoea scale grade ≥2. BMI was calculated from self‐reported height and weight. Adjusted relative risks (aRRs) were estimated using a generalized linear model with Poisson distribution, adjusted for age group and/or participant‐reported diagnosed illnesses. Adjusted PAFs were estimated using aRR and obesity prevalence in Australian adults. Results: Among those who completed the National Breathlessness Survey, 9769 participants (51.4% female) were included in the analysis; 28.1% of participants were obese. The prevalence of breathlessness was 9.54%. The aRR of obesity for breathlessness was 2.04, adjusted for age. Adjusting for various co‐morbid conditions, the aRR was slightly attenuated to around 1.85–1.98. The PAF, adjusted only for age, was 24.6% (95% CI 20.1–29.1) and after further adjustment for co‐morbid conditions, the PAF ranged from 21.1% to 23.6%. Obesity accounted for a higher proportion of breathlessness in women than in men. Conclusion: Our results demonstrate that obesity accounts for around a quarter of breathlessness symptoms in Australian adults. This has important implications for health policy in light of the global trend in increasing obesity. [ABSTRACT FROM AUTHOR]

This article reports findings from a study that examines the factors which influence early childhood and care (ECEC) early career teachers' confidence in teaching Religious Education (RE) and how it impacts their teaching of RE in Catholic primary schools in Western Australia. Teachers' confidence is a teacher's belief in their ability to accomplish a goal and refers to strength of belief. Research in this area has shown that confidence is correlated with the sense of teaching efficacy and responsibility for student learning. Whilst there has been some research into teacher confidence, there has been insufficient research into early childhood teachers' confidence to teach RE in Catholic schools in an Australian context. Literature supports the notion that if early childhood teachers have a strong teacher confidence for a subject, they are more motivated to teach the subject and this has a positive correlation with positive student outcomes. The epistemological approach underpinning the research is constructivist in nature; therefore, it is based on understanding the constructed realities of what humans know of the world and themselves as produced by communications and systems of meaning. Three case studies follow teachers from their early career to second-year experience in Catholic schools. This study investigates support structures and aspects that contribute to teacher confidence in the teaching of RE. The main themes identified by the data that contributed to confidence or lack of confidence included training, family and religious backgrounds, teaching and learning, mentoring and support in the first year of teaching. The implications of the results for pre-service teacher training and support for graduate teachers are discussed and some suggestions are offered about the courses provided by universities and what schools and education systems can do to support early career teachers to teach RE effectively in Catholic schools. [ABSTRACT FROM AUTHOR]

This research reports an exploratory study of 22 pre-service teachers involved in the Religious Education courses offered by The University of Notre Dame Australia, as part of the university's accreditation to teach religious education. The study examined the influence of key factors on how confident these pre-service teachers perceived themselves to be to engage with the necessary knowledge to effectively teach religious education in a Catholic school. The pre-service teachers were surveyed pre and post their final-year internship, and subsequently, six of these were interviewed at the end of their first term of employment. Results indicated that out of the five compulsory courses, the two teaching method courses were found to be most influential in developing confidence to teach. Family, religious background, schooling, and mentoring were found to be influential in confidence development. In addition, confidence improved across the timeframe. [ABSTRACT FROM AUTHOR]

There are three major social issues that are identified and discussed as major contributors to the new normal and the redefinition of deviance. They include: 1) the political rise of the extreme right; 2) the renewed urgency to address issues of social, political, and environmental justice, including and racial inequalities and inequities; and 3) COVID and its effects on society and culture. Sociologists must be key players in the identification and resolution of these issues. In so doing, we impact the reframing and redefinition of what is deviant and what constitutes the new normal. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Chronic pain is a global public health problem that negatively impacts individuals' quality of life and imposes a substantial economic burden on societies. The use of medicinal cannabis (MC) is often considered by patients to help manage chronic pain as an alternative or supplement to more conventional treatments, given enabling legalization in a number of countries. However, healthcare professionals involved in providing guidance for patients related to MC are often doing so in the absence of strong evidence and clinical guidelines. Therefore, it is crucial to understand their perspectives regarding the clinical use and relevance of MC for chronic pain. As little is known about attitudes of HCPs with regard to MC use for chronic pain specifically, the aim of this review was to identify and synthesize the published evidence on this topic. Methods: A systematic search was conducted across six databases: MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and PubMed from 2001 to March 26, 2021. Three authors independently performed the study selection and data extraction. Thematic analysis was undertaken to identify key themes. Results: A total of 26 studies were included, involving the United States, Israel, Canada, Australia, Ireland, and Norway, and the perspectives of physicians, nurses, and pharmacists. Seven key themes were identified: MC as a treatment option for chronic pain, and perceived indicated uses; willingness to prescribe MC; legal issues; low perceived knowledge and the need for education; comparative safety of MC versus opioids; addiction and abuse; and perceived adverse effects; Conclusion: To support best practice in the use of MC for chronic pain, healthcare professionals require education and training, as well as clinical guidelines that provide evidence‐based information about efficacy, safety, and appropriate dosage of products for this indication. Until these gaps are addressed, healthcare professionals will be limited in their capacity to make treatment recommendations about MC for people/patients with chronic pain. [ABSTRACT FROM AUTHOR]

Educational practices to reduce negative attitudes toward persons with substance use disorders (SUD) are urgently needed for undergraduate nursing students, but few studies have examined their long term effectiveness. In this pilot, consenting students completed the Drug and Drug Problems Perception Questionnaire (DDPPQ) anonymously online, before and 1 year after integrated curricular content about SUD. Pretest scores were significantly higher than posttest, indicating higher negative attitudes toward persons with SUD before the integrated content. Time main effect was statistically significant. To our knowledge, this is the first report examining long-term effects of an educational intervention with reinforcement in multiple courses over time upon the attitudes of undergraduate nursing students toward persons with SUD. [ABSTRACT FROM AUTHOR]

Background: Unfair treatment such as discrimination and racism contribute to depression and perceived stress in African Americans. Although studies have examined how responding to such treatment is associated with ameliorating depressive symptoms and levels of perceived stress, most do not focus on African Americans. The purpose of this study is to assess how talking to others in response to unfair treatment is associated with self-reported depressive symptoms and perceived stress levels in African Americans. Methods: A sample from the 2010–2013 Minority Health Genomics and Translational Research Bio-Repository Database was used and consisted of 376 African American adults aged 30–55 years old residing in the southern region of the United States. Linear regression models were used to assess the association between talking to others following unfair treatment, compared to keeping it to oneself, on self-reported depressive symptoms and perceived stress. The predictor variable was based on the question "If you have been treated unfairly, do you usually talk to people about it or keep it to yourself?". Results: Talking to someone after being treated unfairly was inversely associated with perceived stress (β : -3.62, SE: 1.14, p ≤ 0.05) and depressive symptoms (β : -3.62, SE: 1.14, p ≤ 0.05). Conclusions: African Americans who talked to others in response to unfair treatment had lower depressive symptoms and perceived stress than those who kept it to themselves. More outreach to African Americans regarding the importance of talk in response to exposure to unfair treatment is needed as a potential coping mechanism. [ABSTRACT FROM AUTHOR]

The historical evolution of the rehabilitation profession is addressed, and current issues facing rehabilitation educators and professionals are identified. Clearly, both our practice environments and our consumers are continuously evolving and becoming more diverse. Simultaneously, a need exists to be seen as a stable, unified profession. Specific issues including the continuing development of private rehabilitation licensure and accreditation, increasing consumer diversity, and movement toward evidence-based practices are identified as critical issues for rehabilitation educators and professionals. [ABSTRACT FROM AUTHOR]

Background: Approximately 6.1 million adults in the United States serve as care partners for cancer survivors. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management. Objective: We aimed to develop a mobile app incorporating user preferences to enable cancer survivors' care partners to monitor the survivors' health and to provide care partner resources. Methods: An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners. Results: Health professionals noted the importance of identifying early symptoms of adverse events. Survivors requested modules on medication, diet, self-care, reminders, and a version in Spanish. Care partners preferred to focus primarily on the patient's health and not their own. The app was developed incorporating quality-of-life surveys and symptom reporting, as well as resources on home survivor care. Early user testing demonstrated ease of use and app feasibility. Conclusions: TOGETHERCare, a novel mobile app, was developed with user input to track the care partner's health and report on survivor symptoms during home care. The following two clinical benefits emerged: (1) reduced anxiety among care partners who use the app and (2) the potential for identifying survivor symptoms noted by the care partner, which might prevent adverse events. [ABSTRACT FROM AUTHOR]

Objective: This pilot aimed to test the engagement, acceptability, and usefulness of a goal-setting smartphone app, Kiss myAsthma, in young people with asthma. Methods: Young people aged 15–24 years old were invited to trial a smartphone app for asthma management. A mixed-methods approach combined quantitative analysis of self-report questionnaires and app usage log data with qualitative thematic analysis of open-ended questions at baseline and six weeks after downloading the app. App log data (pages visited, frequency of use and content of participants interaction, e.g.goals set, symptoms recorded) were analyzed. Results: Nine of 12 participants completed both baseline and six-week questionnaires. Participants reported high satisfaction with app content and usability (median score 5 out of 6 [range 4–6]) and rated the app highly on "feeling confident in my ability to manage my asthma." At six weeks there was a clinically significant change in asthma quality of life (e.g. Emotional Function domain score baseline: 4.7 [2.7–6.3], follow-up: 5.7 [4.7–6.7]; p = 0.043). Participants logged information about asthma severity, flare-ups and mood and tracked their symptoms with the app's History functionality. Five participants (42%) nominated goals and strategies and 3 participants (25%) entered data in the Inspiration section, a tool to support intrinsic motivation to manage asthma. Qualitative data aligned with quantitative results. Conclusions: This six-week pilot of the Kiss myAsthma app showed its potential to support self-management, quality of life and health behavior change in young people with asthma. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the relationship between adiposity and telomere length in the United States population. The objective of our research was to examine this relationship in a representative, socioeconomically and sex-specific, diverse racial/ethnic population in the United States.Methods: Body mass index (BMI), % total body fat (TBF) and waist circumference (WC) with leukocyte telomere length (LTL) were examined according to sex-specific race/ethnicity using separate adjusted multivariate linear regressions on a sample of 4,919 respondents aged 20-84 years from the National Health and Nutrition Examination Survey's 1999-2002 data.Results: LTL was shortened .41%, .44%, and .16% in African American (AA) women and was associated with increasing BMI, %TBF, and WC, (β:-.0041, 95%CI: -.0070, -.0012; P=.007; β:-.0044, 95% CI: -.0081, -.0007; P=.02; β:-.0016, 95%CI: -.0031, -.0001; P=.04, respectively). LTL was shortened .29% in White women and was associated with increasing %TBF (β:-.0029, 95%CI: -.0048, -.0009; P=.006). There were no associations among AA men, White men or Mexican American men and women.Conclusions: LTL is associated with an obesity phenotype in AA women. Tailored intervention is needed to ameliorate the burden of excess adiposity and subsequent cellular aging. [ABSTRACT FROM AUTHOR]

Since its founding in 1929, the Pacific Sociological Association (PSA) has undergone a variety of changes as it has adapted to shifts in society, developments in the discipline, and an increasingly diverse membership. The panelists in this session highlighted several ways in which the PSA has evolved over time and discussed a number of attempts to address the challenges facing millennials and millennial sociologists (the theme of the 90th Annual Meeting). Suggestions regarding ways in which the PSA can continue to offer support to this generation in the future were also discussed. [ABSTRACT FROM AUTHOR]

Background: Early hospital readmission for patients with cirrhosis continues to challenge the healthcare system. Risk stratification may help tailor resources, but existing models were designed using small, single-institution cohorts or had modest performance.Aims: We leveraged a large clinical database from the Department of Veterans Affairs (VA) to design a readmission risk model for patients hospitalized with cirrhosis. Additionally, we analyzed potentially modifiable or unexplored readmission risk factors.Methods: A national VA retrospective cohort of patients with a history of cirrhosis hospitalized for any reason from January 1, 2006, to November 30, 2013, was developed from 123 centers. Using 174 candidate variables within demographics, laboratory results, vital signs, medications, diagnoses and procedures, and healthcare utilization, we built a 47-variable penalized logistic regression model with the outcome of all-cause 30-day readmission. We excluded patients who left against medical advice, transferred to a non-VA facility, or if the hospital length of stay was greater than 30 days. We evaluated calibration and discrimination across variable volume and compared the performance to recalibrated preexisting risk models for readmission.Results: We analyzed 67,749 patients and 179,298 index hospitalizations. The 30-day readmission rate was 23%. Ascites was the most common cirrhosis-related cause of index hospitalization and readmission. The AUC of the model was 0.670 compared to existing models (0.649, 0.566, 0.577). The Brier score of 0.165 showed good calibration.Conclusion: Our model achieved better discrimination and calibration compared to existing models, even after local recalibration. Assessment of calibration by variable parsimony revealed performance improvements for increasing variable inclusion well beyond those detectable for discrimination. [ABSTRACT FROM AUTHOR]

Background: Growing evidence suggests that leptin is critical for glycemic control. Impaired leptin signaling may also contribute to low adiponectin expression in obese individuals. We assessed the association of leptin and adiponectin with incident type 2 diabetes (T2D), their interactions with sex and obesity status, and mediation by insulin resistance. Methods: We included study participants from the Jackson Heart Study, a prospective cohort of adult African Americans in Jackson, Mississippi, that were free of T2D at the baseline Exam 1. Incident T2D was defined as new cases at Exam 2 or Exam 3. We created separate Cox regression models (hazard ratios per log-transformed ng/mL of leptin and adiponectin) with and without insulin resistance, HOMA-IR. Mediation by insulin resistance was analyzed. Several interactions were assessed, including by sex, HbA1c, and obesity. Results: Among our 3363 participants (mean age 53 years, 63% women), 584 developed incident T2D. Leptin was directly associated with incident T2D when modeled without HOMA-IR (HR = 1.29, 95% CI = 1.05–1.58). This direct association between leptin and T2D was significant among men (HR = 1.33, 95% CI = 1.05–1.69), but nonsignificant among women (HR = 1.24, 95% CI = 0.94–1.64); statistical interaction with sex was nonsignificant (p = 0.65). The associations in all participants and in men were nullified by HOMA-IR (HR = 0.99, 95% CI = 0.80–1.22; HR = 1.00, 95% CI = 0.78–1.28, respectively), indicating mediation through insulin resistance (proportion mediated: 1.04), and were not observed in abdominally obese participants. Adiponectin was inversely associated with T2D even after adjustment for HOMA-IR in women (HR = 0.68, 95% CI = 0.55–0.84), but not in men (HR = 0.80, 95% CI = 0.62–1.04). The inverse association was present only among abdominally obese participants, and persisted after adjustment for HOMA-IR. Conclusions: Among African Americans in the Jackson Heart Study the association of leptin with incident type 2 diabetes was mediated by insulin resistance. This association was present only among abdominally non-obese participants. Differences by sex appeared: men showed a significant association mediated by insulin resistance. Among abdominally obese participants, adiponectin was inversely associated with incident T2D even after adjustment for HOMA-IR. Our results should inform future clinical trials that aim to reduce the burden of type 2 diabetes through the modification of serum levels of leptin and adiponectin. [ABSTRACT FROM AUTHOR]

Objective: Clinical prediction models require updating as performance deteriorates over time. We developed a testing procedure to select updating methods that minimizes overfitting, incorporates uncertainty associated with updating sample sizes, and is applicable to both parametric and nonparametric models.Materials and Methods: We describe a procedure to select an updating method for dichotomous outcome models by balancing simplicity against accuracy. We illustrate the test's properties on simulated scenarios of population shift and 2 models based on Department of Veterans Affairs inpatient admissions.Results: In simulations, the test generally recommended no update under no population shift, no update or modest recalibration under case mix shifts, intercept correction under changing outcome rates, and refitting under shifted predictor-outcome associations. The recommended updates provided superior or similar calibration to that achieved with more complex updating. In the case study, however, small update sets lead the test to recommend simpler updates than may have been ideal based on subsequent performance.Discussion: Our test's recommendations highlighted the benefits of simple updating as opposed to systematic refitting in response to performance drift. The complexity of recommended updating methods reflected sample size and magnitude of performance drift, as anticipated. The case study highlights the conservative nature of our test.Conclusions: This new test supports data-driven updating of models developed with both biostatistical and machine learning approaches, promoting the transportability and maintenance of a wide array of clinical prediction models and, in turn, a variety of applications relying on modern prediction tools. [ABSTRACT FROM AUTHOR]

Background: Methods to increase treatment compliance in adolescents with cystic fibrosis (CF) is of utmost importance to improve outcomes and survival. Motivational interviewing (MI) has gained momentum as an effective strategy to address ambivalence to change in a variety of chronic health conditions and remains a promising strategy to facilitate treatment adherence in adolescents with CF. Methods: The project utilized the Plan-Do-Study-Act cycle of quality improvement (QI). A repeated measure pretest-posttest design was used to evaluate the effectiveness of a MI training. An interactive, 4-hour MI workshop was executed within a single CF center. CF care providers (N = 12) from a single CF team completed surveys evaluating knowledge, perceived importance, usage, and confidence in using MI with adolescents before and after the training. Following the MI training, care providers engaged high-risk adolescent patients using MI techniques. To determine the effect of MI on patient adherence (N = 32), markers of lung function and weight were measured before and after MI exposure. Results: Quantitative analysis of provider surveys indicated enhanced MI-related knowledge and confidence after the training. Provider usage, perception of the usefulness, and importance of using MI was unchanged. Patient-specific outcomes indicated no significant change in patient-forced expiratory volume in 1 second (FEV1), a marker of lung function, or body mass index (BMI), five months after exposure of MI in the CF clinic setting. Conclusions: This QI project demonstrates the effectiveness of a brief MI training on CF care providers' knowledge and confidence in engaging adolescents using MI techniques. Though no statistically significant differences were found in patient-specific outcomes during this brief intervention period, it is critical that longer-term exposure to MI be explored further in adolescents with CF. This study adds to a growing body of evidence supporting team-based MI trainings for CF providers. Future research focusing on patient experience and perceived benefit of MI counseling is warranted. [ABSTRACT FROM AUTHOR]

Purpose: Poor health-related quality of life (HRQOL) could lead to higher morbidity and mortality through telomere attrition or accelerated cellular aging. We conducted a cross-sectional analysis to examine the relationship between four dimensions of HRQOL and leukocyte telomere length (LTL) among a nationally representative sample of 3547 US adults (≥20 years) using the data from the 2001-2002 National Health and Nutrition Examination Survey.Method: We used HRQOL survey information collected on individuals' self-rated general health, recent physical health, recent mental health, and recent activity limitation. Telomere length was assessed using quantitative polymerase chain reaction. Multiple linear regressions were used to estimate the relationship between each dimension of HRQOL and log-transformed values of LTL with adjustment for sample weights and design effects.Results: HRQOL-race interactions were significant, and the results were stratified by race. After controlling for demographic factors, disease conditions, and lifestyle variables, worse general health was significantly associated with shorter LTL for Blacks (coefficient, β: -0.022, 95% Confidence Interval, 95% CI: -0.03 to -0.01), but not for Whites or Mexican Americans. Unwell physical health was associated with shorter telomere length for Whites (β: -0.005, 95% CI: -0.01 to -0.001) only. Unwell mental health showed no significant association with LTL in any race.Conclusions: Although longitudinal studies are needed to prove causality, our findings suggest that HRQOL could be associated with LTL shortening. We also found a possible racial difference in this association and recommend additional multiethnic studies to confirm this and to understand the reasons and consequences of this difference. [ABSTRACT FROM AUTHOR]

The article focuses on the Home Baking Association's celebration of 100 years of baking education, tracing its origins in 1923 and highlighting its continued collaboration with family and consumer sciences (FCS) professionals. Topics include the association's mission aligned with FCS standards, recognition of outstanding baking educators, and a leadership transition with the retirement of long-serving executives and the appointment of Christine Kirby as the new Executive Director.

Purpose: This study aimed to identify appropriate development and testing strategies for mobile health applications for cancer survivors.Methods: In January of 2016, we conducted a PubMed search for mobile applications for cancer survivors. A total of 32 articles were selected for inclusion, including 13 review articles, and 19 articles describing an mHealth application or intervention. We assessed mobile app development and testing strategies and standards as described in these articles.Results: We identified seven elements of patient empowerment applications for cancer survivors, strategies for application development that take advantage of smartphone capabilities, issues for consideration in developing new applications, and steps for creating user-centered mobile health applications that provide meaningful value for cancer survivors. However, few mobile health apps implemented empowerment elements, underwent rigorous design approaches, or included assessment of use in the cancer survivor population.Conclusions: There is tremendous potential for mobile health apps to benefit cancer survivors. However, there are specific issues for consideration in developing new applications and steps for creating user-centered applications which are not routinely used. This diminishes the value for the cancer survivor population but could be easily addressed through standardized development and testing procedures.Implications For Cancer Survivors: Smartphone applications have the potential to improve the cancer survivorship experience, but users should look for evidence that the application was appropriately developed and tested. [ABSTRACT FROM AUTHOR]

Opioid use during pregnancy is on the rise in the United States. Neonatal abstinence syndrome (NAS), also known as newborn drug withdrawal, is a public health epidemic. Between 2004 and 2014, Tennessee experienced a fivefold increase in NAS hospitalizations, from 1.5 to 8.0 per 1,000 live births. Soaring increases in the number of newborns with NAS nationwide have caught the attention of many federal and state lawmakers, especially given the unknown burdens associated with medical and social services needed by those affected over time. Tennessee opioid-related regulations and laws enacted between 2000 and 2018 were systematically reviewed and analyzed to identify each law's purpose; effects on families and individuals; pros and cons in terms of social, practical, and legal factors; and implications for nursing practice. Our findings were that Tennessee's laws are intended to decrease the number of opioids prescribed, ensure access to continued prenatal care and substance abuse management for mothers with substance use disorders, and reduce the ease of obtaining opioids. We also found that Tennessee lawmakers have enacted laws and regulations aimed at decreasing the abuse of opioids, but not reducing the incidence of NAS. As new laws are considered, it is critical that health care providers and lawmakers work together to ensure that the developed and enacted laws strike a balance between safely managing the care of both pregnant women and their newborns without producing negative outcomes. [ABSTRACT FROM AUTHOR]

Given the large body of evidence linking physical and mental health and the impetus provided by health care reform and the Affordable Care Act, the time is ripe to engage nurses in community based, integrated primary care teams to holistically address psychiatric, mental health and substance abuse needs. There is a compelling need for curricular redesign and clinical innovation to prepare an RN workforce for practice in community based integrated primary care teams. To that end, a faculty team of primary care, interprofessional education and content experts developed the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) program for BSN students in a large university in the southeastern United States. The primary goals of the TRIP program are to build/implement an innovative BSN curriculum and expand our academic practice partnership by enhancing student clinical experiences with the goal of preparing an RN workforce for practice in community based integrated care teams. The TRIP program incorporates didactic, simulation and clinical components. Our first student cohort began the TRIP program in the fall of 2018 and will complete the program in spring 2020. In this paper, we provide details about the background, content and activities of this 4-semester (2 year) program. [ABSTRACT FROM AUTHOR]

Purpose: Before performing a surgical procedure, informed consent (IC) is obtained. Parents may exhibit anxiety and/or a desire for more knowledge during the IC process for their child. The purpose of this study was to measure the impact of a multimedia intervention (MMI) versus conventional discussion on parental understanding and anxiety during the IC process for infants undergoing surgery for hypertrophic pyloric stenosis.Methods: A time-interrupted series design was employed over a 9-month period. In the first phase, conventional discussion for IC was performed. In the second phase, a MMI was utilized. In both phases, anxiety scores and post-consent knowledge tests were collected.Results: 31 participants were included in the study, 17 in the conventional consent and 14 in the MMI phase. Parental anxiety around the IC discussion was measured. There was a significant decrease in anxiety noted with use of the MMI (p = 0.046) but no significant difference in knowledge (p = 0.84).Conclusion: The MMI significantly reduced parental anxiety during the IC process. Providers may consider applying this type of MMI to other surgical procedures. Securing IC in a manner that improves knowledge and decreases anxiety may improve long-term understanding and parental satisfaction with the health care process. [ABSTRACT FROM AUTHOR]

It was noted with some concern by service providers in Limerick that women presenting to homeless, probation and drug treatment services in Limerick city significantly exceeded the number attending similar services in other geographical areas in Ireland. Different services were engaging with the same women simultaneously, sometimes for years, without any discernible positive outcomes for the women. Research was commissioned to facilitate a better understanding of the women's needs, with a view to enabling services to be more responsive. The findings profile a group of women with considerable resilience and capacity for survival, despite very challenging life experiences. An Adverse Childhood Experiences analysis showed that the women in this research cohort were more frequently affected by almost all forms of childhood adversity than people in the general population. The women proffered some practical advice that could help services to be designed and delivered in a trauma- and gender-informed manner. This paper presents a brief literature review of trauma and trauma-informed care, outlines the research findings and makes recommendations for future service design and delivery. [ABSTRACT FROM AUTHOR]

Background: Use of secure messaging through patient portals has risen substantially in recent years due to provider incentives and consumer demand. Secure messaging may increase patient satisfaction and improve outcomes, but also adds to physician workload. Most prior studies of secure messaging focused on primary care and medical specialties. We examined surgeons' use of secure messaging and the contribution of messaging to outpatient interactions in a broadly deployed patient portal.Methods: We determined the number of clinic visits and secure messages for surgical providers in the first 3 years (2008-2010) after patient portal deployment at an academic medical center. We calculated the proportion of outpatient interaction conducted through messaging for each specialty. Logistic regression models compared the likelihood of message-based versus clinic outpatient interaction across surgical specialties.Results: Over the study period, surgical providers delivered care in 648,200 clinic visits and received 83,912 messages, with more than 200% growth in monthly message volume. Surgical specialties receiving the most messages were orthopedics/podiatry (25.1%), otolaryngology (20.1%), urology (10.8%), and general surgery (9.6%); vascular surgery (0.8%) and pediatric general surgery (0.2%) received the fewest. The proportion of outpatient interactions conducted through secure messaging increased significantly from 5.4% in 2008 to 15.3% in 2010 (p < 0.001) with all specialties experiencing growth. Heart/lung transplantation (74.9%), liver/kidney/pancreas transplantation (69.5%), and general surgery (48.7%) had the highest proportion of message-based outpatient interaction by the end of the study.Conclusions: This study demonstrates rapid adoption of online secure messaging across surgical specialties with significant growth in its use for outpatient interaction. Some specialties, particularly those with long-term follow-up, interacted with patients more through secure messaging than in person. As surgeons devote more time to secure messaging, additional research will be needed to understand the care delivered through online interactions and to develop models for reimbursement. [ABSTRACT FROM AUTHOR]

Background: Fifteen percent of Australians with intellectual disability (ID) are reported to have asthma. People with ID are at risk of poor health knowledge due to deficits in intellectual and adaptive functioning, but their medication knowledge has largely been ignored in research to date.Objective: To explore the level of understanding of asthma medication use of people with ID who self-administer their inhaled medications, in order to inform future educational support. Setting The research was conducted in NSW, Australia, at the participants' homes, the point of health care access, or the offices of relevant support organisations.Method: In this qualitative study face-to-face interviews were conducted with people with ID using a semi-structured interview guide. The interviews were recorded, transcribed and thematically analysed. Main outcome Identification of barriers to asthma medication self-management by people with ID.Results: Seventeen people with ID who self-administer their asthma medications were interviewed. Factors influencing their asthma medication knowledge and use included understanding of their illness and the need for medication; aspects of self-management and autonomy versus dependence. This sample of people with ID had a good understanding of the importance of using their inhaled asthma medications, as well as asthma triggers, and the difference between use of preventer and reliever medications. Both enablers and barriers to asthma medication self-management were identified in the domains of managing attacks, adherence, knowledge of side effects and sources of information on correct use of inhalers. The level of autonomy for medication use varied, with motivation to self-manage asthma influenced by the level of support that was practically available to individual participants.Conclusion: This research investigated aspects of asthma medication self-management of people with ID. Based on the barriers identified, pharmacists should promote use of spacers and written asthma action plans as well as counsel people with ID about how to recognise and minimise side effects of asthma medications. Specific strategies for pharmacists when educating people with ID and their caregivers include active listening to determine understanding of concepts, exercising care with language, and working with the person's known routines to maximise adherence with preventer medications. [ABSTRACT FROM AUTHOR]

In the United States, youth involvement in delinquent and criminal acts remains persistent and increasingly violent. For at-risk youth, key demographics include poverty and distressed communities. Since traditional interventions have had limited success in addressing the needs of and issues experienced by these youths, millennials must seek new and creative techniques and programs to serve them. One such program that currently exists and provides inspiration for the future is Destiny Arts Youth Performance Company, a nonprofit, community dance group based in Oakland, CA, that offers competitive scholarships to deserving, at-risk youth in lower class, largely ethnic communities. In the ethnographic documentary, FREE: The Power of Performance, the lives of five at-risk youths are affected and transformed through the creative medium of dance. It shows that for at-risk, diverse teens, collaborative art can be a foundation for personal strength, liberation, and hope. [ABSTRACT FROM AUTHOR]

The Dutch Konik is valued from a genetic conservation perspective and also for its role in preservation of natural landscapes. The primary management objective for the captive breeding of this primitive horse is to maintain its genetic purity, whilst also maintaining the nature reserves on which they graze. Breeding selection has traditionally been based on phenotypic characteristics consistent with the breed description, and the selection of animals for removal from the breeding program is problematic at times due to high uniformity within the breed, particularly in height at the wither, colour (mouse to grey dun) and presence of primitive markings. With the objective of identifying an additional non-invasive selection criterion with potential uniqueness to the Dutch Konik, this study investigates the anatomic parameters of the distal equine limb, with a specific focus on the relative lengths of the individual splint bones. Post-mortem dissections performed on distal limbs of Dutch Konik (n = 47) and modern domesticated horses (n = 120) revealed significant differences in relation to the length and symmetry of the 2nd and 4th Metacarpals and Metatarsals. Distal limb characteristics with apparent uniqueness to the Dutch Konik are described which could be an important tool in the selection and preservation of the breed. [ABSTRACT FROM AUTHOR]

Background: The correlation between low socioeconomic status (SES) and poor health outcome or higher risk of disease has been consistently reported by many epidemiological studies across various race/ancestry groups. However, the biological mechanisms linking low SES to disease and/or disease risk factors are not well understood and remain relatively under-studied. The analysis of the blood transcriptome is a promising window for elucidating how social and environmental factors influence the molecular networks governing health and disease. To further define the mechanistic pathways between social determinants and health, this study examined the impact of SES on the blood transcriptome in a sample of African-Americans. Methods: An integrative approach leveraging three complementary methods (Weighted Gene Co-expression Network Analysis, Random Forest and Differential Expression) was adopted to identify the most predictive and robust transcriptome pathways associated with SES. We analyzed the expression of 15079 genes (RNA-seq) from whole blood across 36 samples. Results: The results revealed a cluster of 141 co-expressed genes over-expressed in the low SES group. Three pro-inflammatory pathways (IL-8 Signaling, NF-κB Signaling and Dendritic Cell Maturation) are activated in this module and over-expressed in low SES. Random Forest analysis revealed 55 of the 141 genes that, collectively, predict SES with an area under the curve of 0.85. One third of the 141 genes are significantly over-expressed in the low SES group. Conclusion: Lower SES has consistently been linked to many social and environmental conditions acting as stressors and known to be correlated with vulnerability to chronic illnesses (e.g. asthma, diabetes) associated with a chronic inflammatory state. Our unbiased analysis of the blood transcriptome in African-Americans revealed evidence of a robust molecular signature of increased inflammation associated with low SES. The results provide a plausible link between the social factors and chronic inflammation. [ABSTRACT FROM AUTHOR]

Objective: The underlying model of the genetic determinant of a trait is generally not known with certainty a priori. Hence, in genetic association studies, a dominant model might be erroneously modelled as additive, an error investigated previously. We explored this question, for candidate gene studies, by evaluating the sample size required to compensate for the misspecification and improve inference at the analysis stage. Power calculations were carried out with (1) the true dominant model and (2) the incorrect additive model. Empirical power, sample size and effect size were compared between scenarios (1) and (2). In each of the scenarios the estimates were evaluated for a rare (minor allele frequency < 0.01), low frequency (0.01 ≤ minor allele frequency < 0.05) and common (minor allele frequency ≥ 0.05) single nucleotide polymorphism. Results: The results confirm the detrimental effect of the misspecification error on power and effect size for any minor allele frequency. The implications of the error are not negligible; therefore, candidate gene studies should consider the more conservative sample size to compensate for the effect of error. When it is not possible to extend the sample size, methods that help mitigate the impact of the error should be systematically used. [ABSTRACT FROM AUTHOR]

Objective: Predictive analytics create opportunities to incorporate personalized risk estimates into clinical decision support. Models must be well calibrated to support decision-making, yet calibration deteriorates over time. This study explored the influence of modeling methods on performance drift and connected observed drift with data shifts in the patient population.Materials and Methods: Using 2003 admissions to Department of Veterans Affairs hospitals nationwide, we developed 7 parallel models for hospital-acquired acute kidney injury using common regression and machine learning methods, validating each over 9 subsequent years.Results: Discrimination was maintained for all models. Calibration declined as all models increasingly overpredicted risk. However, the random forest and neural network models maintained calibration across ranges of probability, capturing more admissions than did the regression models. The magnitude of overprediction increased over time for the regression models while remaining stable and small for the machine learning models. Changes in the rate of acute kidney injury were strongly linked to increasing overprediction, while changes in predictor-outcome associations corresponded with diverging patterns of calibration drift across methods.Conclusions: Efficient and effective updating protocols will be essential for maintaining accuracy of, user confidence in, and safety of personalized risk predictions to support decision-making. Model updating protocols should be tailored to account for variations in calibration drift across methods and respond to periods of rapid performance drift rather than be limited to regularly scheduled annual or biannual intervals. [ABSTRACT FROM AUTHOR]

BACKGROUND: Detecting volatile organic compounds (VOCs) could provide a rapid, noninvasive, and inexpensive screening tool for detecting cancer. OBJECTIVE: In this systematic review, we identified specific exhaled breath VOCs correlated with lung, colorectal, and breast cancer. METHODS:We identified relevant studies published in 2015 and 2016 by searching Pubmed andWeb of Science. The protocol for this systematic review was registered in PROSPERO and the PRISMA guidelines were used in reporting. VOCs and performance data were extracted. RESULTS: Three hundred and thirty three records were identified and 43 papers were included in the review, of which 20 were review articles themselves. We identified 17 studies that listed the VOCs with at least a subset of statistics on detection cutoff levels, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and gradient. CONCLUSIONS: Breath analysis for cancer screening and early detection shows promise, because samples can be collected easily, safely, and frequently. While gas chromatography-mass spectrometry is considered the gold standard for identifying specific VOCs, breath analysis has moved into analyzing patterns of VOCs using a variety of different multiple sensor techniques, such as eNoses and nanomaterials. Further development of VOCs for early cancer detection requires clinical trials with standardized breath sampling methods. [ABSTRACT FROM AUTHOR]

Purpose: Shorter telomere length and obstructive sleep apnea are associated with increased oxidative stress and chronic inflammation, which are both considered leading causes of age-related diseases. Different forms of sleep disordered breathing have been linked to telomere length although their relationship remains uncertain. The purpose of this study was to explore the associations between the risk of obstructive sleep apnea and telomere length in African Americans. Methods: The analysis included 184 women and 122 men aged 30-55 years from the Morehouse School of Medicine Study. Relative TL (T/S ratio) was measured from peripheral blood leukocytes using quantitative real-time polymerase chain reaction. The Berlin questionnaire was used for OSA risk assessments. Multivariable linear regression models were used to examine the associations between OSA risk and LTL. Results: We observed that LTL varied by OSA risk in women (0.532 ± 0.006 vs. 0.569 ± 0.008) ( p = 0.04). Multiple linear regression analysis confirmed that women at higher risk for OSA presented shorter LTL compared to those at lower risk, independent of age, income, education, obesity, smoking, alcohol consumption, and hypertension. These differences were not observed in men. Conclusions: Our findings suggest that OSA risk may contribute to the acceleration of cellular aging processes through telomere shortening. [ABSTRACT FROM AUTHOR]

Background: Circadian rhythms regulate key biological processes and the dysregulation of the intrinsic clock mechanism affects sleep patterns and obesity onset. The CLOCK (circadian locomotor output cycles protein kaput) gene encodes a core transcription factor of the molecular circadian clock influencing diverse metabolic pathways, including glucose and lipid homeostasis. The primary objective of this study was to evaluate the associations between CLOCK single nucleotide polymorphisms (SNPs) and body mass index (BMI). We also evaluated the association of SNPs with BMI related factors such as sleep duration and quality, adiponectin and leptin, in 2962 participants (1116 men and 1810 women) from the Jackson Heart Study. Genotype data for the selected 23 CLOCK gene SNPS was obtained by imputation with IMPUTE2 software and reference phase data from the 1000 genome project. Genetic analyses were conducted with PLINK Results: We found a significant association between the CLOCK SNP rs2070062 and sleep duration, participants carriers of the T allele showed significantly shorter sleep duration compared to non-carriers after the adjustment for individual proportions of European ancestry (PEA), socio economic status (SES), body mass index (BMI), alcohol consumption and smoking status that reach the significance threshold after multiple testing correction. In addition, we found nominal associations of the CLOCK SNP rs6853192 with longer sleep duration and the rs6820823, rs3792603 and rs11726609 with BMI. However, these associations did not reach the significance threshold after correction for multiple testing. Conclusions: In this work, CLOCK gene variants were associated with sleep duration and BMI suggesting that the effects of these polymorphisms on circadian rhythmicity may affect sleep duration and body weight regulation in Africans Americans. [ABSTRACT FROM AUTHOR]

The study examined potential psychosocial determinants of male condom use in steady heterosexual relationships among Somali and Ethiopian immigrants in Minnesota in two sequential phases: the elicitation (Phase I) and cross-sectional quantitative studies (Phase II). Information from Phase I was used to develop the instrument for Phase II. Study participants who self-identified as Somali and Ethiopian immigrants (n = 205) responded to questions on demographic characteristics, attitudes (affective and instrumental), norms (subject and descriptive), perceived behavioral control, self-efficacy, and intention to use male condoms. Hierarchical regression models were used to assess the relationship between the main independent variables (attitude norms, perceived behavioral control, and self-efficacy, and the dependent variable, the intention to use male condoms. Overall, participants showed low intention and slightly favorable (affective and instrumental) attitudes toward condom use; had experienced weak, but positive social influence as measured by injunctive and descriptive norms. Moreover, study participants had shown slight perceived behavioral control, but had fairly moderate positive self-efficacy. The Theory of Planned Behavior was moderately effective in predicting condom use; however, the Integrated Behavioral Model, explained nearly 40% of the variations in the intention to use male condoms. Among men, self-efficacy had the strongest influence (β = .44, p < .001) on behavioral intention. Among women, descriptive norms (β = .22,p < .05) exerted the strongest effect (model 3). Improving self-efficacy, specifically, among older men, and fostering desirable normative influence among women, are suggested as main components of public health interventions to promote condom use among Somali and Ethiopian immigrants. [ABSTRACT FROM PUBLISHER]