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Purpose: To investigate the influence of acute normobaric hypoxia on standing balance under single and dual-task conditions, both with and without visual input. Methods: 20 participants (7 female, 20–31 years old) stood on a force plate for 16, 90-s trials across four balance conditions: single-task (quiet stance) or dual-task (auditory Stroop test), with eyes open or closed. Trials were divided into four oxygen conditions where the fraction of inspired oxygen (FIO2) was manipulated (normoxia: 0.21 and normobaric hypoxia: 0.16, 0.145 and 0.13 FIO2) to simulate altitudes of 1100, 3,400, 4300, and 5200 m. Participants breathed each FIO2 for ~ 3 min before testing, which lasted an additional 7–8 min per oxygen condition. Cardiorespiratory measures included heart rate, peripheral blood oxygen saturation, and pressure of end tidal (PET) CO2 and O2. Center of pressure measures included total path length, 95% ellipse area, and anteroposterior and mediolateral velocity. Auditory Stroop test performance was measured as response accuracy and latency. Results: Significant decreases in oxygen saturation and PETO2, and increased heart rate were observed between normoxia and normobaric hypoxia (P < 0.0001). Total path length was higher at 0.13 compared to 0.21 FIO2 for the eyes closed no Stoop test condition (P = 0.0197). No other significant differences were observed. Conclusion: These findings suggest that acute normobaric hypoxia has a minimal impact on standing balance and does not influence auditory Stroop test or dual-task performance. Further investigation with longer exposure is required to understand the impact and time course of normobaric hypoxia on standing balance. [ABSTRACT FROM AUTHOR]

Background: Two propensity score (PS) based balancing covariate methods, the overlap weighting method (OW) and the fine stratification method (FS), produce superb covariate balance. OW has been compared with various weighting methods while FS has been compared with the traditional stratification method and various matching methods. However, no study has yet compared OW and FS. In addition, OW has not yet been evaluated in large claims data with low prevalence exposure and with low frequency outcomes, a context in which optimal use of balancing methods is critical. In the study, we aimed to compare OW and FS using real-world data and simulations with low prevalence exposure and with low frequency outcomes. Methods: We used the Texas State Medicaid claims data on adult beneficiaries with diabetes in 2012 as an empirical example (N = 42,628). Based on its real-world research question, we estimated an average treatment effect of health center vs. non-health center attendance in the total population. We also performed simulations to evaluate their relative performance. To preserve associations between covariates, we used the plasmode approach to simulate outcomes and/or exposures with N = 4,000. We simulated both homogeneous and heterogeneous treatment effects with various outcome risks (1-30% or observed: 27.75%) and/or exposure prevalence (2.5-30% or observed:10.55%). We used a weighted generalized linear model to estimate the exposure effect and the cluster-robust standard error (SE) method to estimate its SE. Results: In the empirical example, we found that OW had smaller standardized mean differences in all covariates (range: OW: 0.0–0.02 vs. FS: 0.22–3.26) and Mahalanobis balance distance (MB) (< 0.001 vs. > 0.049) than FS. In simulations, OW also achieved smaller MB (homogeneity: <0.04 vs. > 0.04; heterogeneity: 0.0-0.11 vs. 0.07–0.29), relative bias (homogeneity: 4.04–56.20 vs. 20–61.63; heterogeneity: 7.85–57.6 vs. 15.0-60.4), square root of mean squared error (homogeneity: 0.332–1.308 vs. 0.385–1.365; heterogeneity: 0.263-0.526 vs 0.313-0.620), and coverage probability (homogeneity: 0.0–80.4% vs. 0.0-69.8%; heterogeneity: 0.0-97.6% vs. 0.0-92.8%), than FS, in most cases. Conclusions: These findings suggest that OW can yield nearly perfect covariate balance and therefore enhance the accuracy of average treatment effect estimation in the total population. [ABSTRACT FROM AUTHOR]

To achieve optimal, equitable health outcomes for all older adults, the United States desperately needs equity in access to, quality of, and cost of aging care. To illustrate these needs, we discuss the current inequitable state of frailty care. Frailty disproportionately affects marginalized populations, yet these populations struggle to access high-quality geriatrics care and long-term care services and supports (LTSS) that mitigate frailty, leading to accelerated frailty trajectories. Health services research can provide the data needed to document, elucidate, and address health inequities in frailty care, including early identification and referral of frail adults to specialized care and financing LTSS. [ABSTRACT FROM AUTHOR]

The article focuses on legal decisions in Minnesota concerning unemployment compensation, religious accommodation, and discrimination claims. It highlights cases where individuals were denied unemployment benefits due to non-compliance with job search requirements or lack of "good reason" to quit. It also discusses a challenge to Covid-19 vaccination policies at the Mayo Clinic, dismissal of race and gender discrimination claims.

Background: Limited research has explored the performance of health centers (HCs) compared to other primary care settings among children in the United States. We evaluated utilization, quality, and expenditures for pediatric Medicaid enrollees receiving care in HCs versus non-HCs. Methods: This national cross-sectional study utilized 2012 Medicaid Analytic eXtract (MAX) claims to examine children 0–17 years with a primary care visit, stratified by whether majority (> 50%) of primary care visits were at HCs or non-HCs. Outcome measures include utilization (primary care visits, non-primary care outpatient visits, prescription claims, Emergency Department (ED) visits, hospitalizations) and quality (well-child visits, avoidable ED visits, avoidable hospitalizations). For children enrolled in fee-for-service Medicaid, we also measured expenditures. Propensity score-based overlap weighting was used to balance covariates. Results: A total of 2,383,270 Medicaid-enrolled children received the majority of their primary care at HCs, while 18,540,743 did at non-HCs. In adjusted analyses, HC patients had 20% more primary care visits, 15% less non-primary care outpatient visits, and 21% less prescription claims than non-HC patients. ED visits were similar across the two groups, while HC patients had 7% lower chance of hospitalization than non-HC. Quality of care outcomes favored HC patients in main analyses, but results were less robust when excluding managed care beneficiaries. Total expenditures among the fee-for-service subpopulation were lower by $239 (8%) for HC patients. Conclusions: In this study of nationwide claims data to evaluate healthcare utilization, quality, and spending among Medicaid-enrolled children who receive primary care at HCs versus non-HCs, findings suggest primary care delivery in HCs may be associated with a more cost-effective model of healthcare for children. [ABSTRACT FROM AUTHOR]

The article discusses the series of legal cases, which includes the 8th Circuit Court of Appeals upheld dismissal of a lawsuit claiming racial and age discrimination in employment termination; a discharged Black man found no pretext for race bias in his termination; and the Minnesota Court of Appeals affirmed reinstatement of health insurance coverage for a duty-disabled first responder until age 65.

Cloud microphysical processes are an important facet of atmospheric modeling, as they can control the initiation and rates of snowfall. Thus, parameterizations of these processes have important implications for modeling seasonal snow accumulation. We conduct experiments with the Weather Research and Forecasting (WRF V4.3.3) Model using three different microphysics parameterizations, including a sophisticated new scheme (ISHMAEL). Simulations are conducted for two cold seasons (2018 and 2019) centered on the Colorado Rockies' ∼750-km2 East River watershed. Precipitation efficiencies are quantified using a drying-ratio mass budget approach and point evaluations are performed against three NRCS SNOTEL stations. Precipitation and meteorological outputs from each are used to force a land surface model (Noah-MP) so that peak snow accumulation can be compared against airborne snow lidar products. We find that microphysical parameterization choice alone has a modest impact on total precipitation on the order of ±3% watershed-wide, and as high as 15% for certain regions, similar to other studies comparing the same parameterizations. Precipitation biases evaluated against SNOTEL are 15% ± 13%. WRF Noah-MP configurations produced snow water equivalents with good correlations with airborne lidar products at a 1-km spatial resolution: Pearson's r values of 0.9, RMSEs between 8 and 17 cm, and percent biases of 3%–15%. Noah-MP with precipitation from the PRISM geostatistical precipitation product leads to a peak SWE underestimation of 32% in both years examined, and a weaker spatial correlation than the WRF configurations. We fall short of identifying a clearly superior microphysical parameterization but conclude that snow lidar is a valuable nontraditional indicator of model performance. [ABSTRACT FROM AUTHOR]

The article discusses the efforts of the Agency for Healthcare Research and Quality (AHRQ) to address health inequities in the United States. AHRQ has published a research and action agenda focused on advancing health equity, with a particular emphasis on five action domains: healthcare delivery system structure, payment, social determinants of health and social needs, implementation science, and access to care. The article highlights the importance of centering patients and communities in efforts to advance equity, emphasizing the need for authentic engagement and participation. It also emphasizes the importance of tailoring solutions to diverse populations, particularly those who are minoritized, and addresses the need to consider historical and present-day systems of oppression in research and interventions. The document discusses the importance of addressing structural racism and other systems of oppression in healthcare to achieve health equity. The authors emphasize the need to recognize and address racism and oppression in dissemination and implementation frameworks, as well as the need for social care and interventions to directly address these issues. The document also highlights the role of payment and financing in advancing health equity, the benefits of whole-person and whole-community approaches, and the need for evidence-based interventions across diverse contexts. Additionally, the authors stress the importance of a diverse and inclusive healthcare workforce in dismantling inequities. The document concludes by stating that the Agency for Healthcare Research and Quality (AHRQ) is committed to advancing health equity and will prioritize research and action based on the insights provided in the document. [Extracted from the article]

Studies across diverse taxa have revealed the importance of early life environment and parenting on characteristics later in life. While some have shown how early life experiences can impact cognitive abilities, very few have turned this around and looked at how the cognitive skills of parents or other carers during early life affect the fitness of young. In this study, we investigate how the characteristics of carers may affect proxies of fitness of pups in the cooperatively breeding banded mongoose (Mungos mungo). We gave adult mongooses a spatial memory test and compared the results to the success of the pups those individuals cared for. Our results show a tradeoff between speed and accuracy in the spatial memory task, with those individuals which were faster to move between cups in the test arena making more erroneous re-visits to cups that they had already checked for food. Furthermore, the accuracy of their carer predicted future survival, but not weight gain of the pups and the effect was contrary to expected, with pups that were cared for by less accurate individuals being more likely to survive to adulthood. Our research also provides evidence that while younger carers were less accurate during the test, the age of the carer did not have an impact on the chance of raising young that live to sexual maturity. Our findings suggest that banded mongoose carers' cognitive traits have fitness consequences for the young they care for, affecting the chance that these young live to maturity. [ABSTRACT FROM AUTHOR]

We present an X-ray spectro-polarimetric analysis of the bright Seyfert galaxy IC 4329A. The Imaging X-ray Polarimetry Explorer (IXPE) observed the source for ∼500 ks, supported by XMM–Newton (∼60 ks) and NuSTAR (∼80 ks) exposures. We detect polarization in the 2–8 keV band with 2.97σ confidence. We report a polarization degree of 3.3 ± 1.1 per cent and a polarization angle of 78° ± 10° (errors are 1σ confidence). The X-ray polarization is consistent with being aligned with the radio jet, albeit partially due to large uncertainties on the radio position angle. We jointly fit the spectra from the three observatories to constrain the presence of a relativistic reflection component. From this, we obtain constraints on the inclination angle to the inner disc (<39° at 99 per cent confidence) and the disc inner radius (<11 gravitational radii at 99 per cent confidence), although we note that modelling systematics in practice add to the quoted statistical error. Our spectropolarimetric modelling indicates that the 2–8 keV polarization is consistent with being dominated by emission directly observed from the X-ray corona, but the polarization of the reflection component is completely unconstrained. Our constraints on viewer inclination and polarization degree tentatively favour more asymmetric, possibly out-flowing, coronal geometries that produce more highly polarized emission, but the coronal geometry is unconstrained at the 3σ level. [ABSTRACT FROM AUTHOR]

Purpose: To report on the visual outcomes of the second-generation (ActivShieldTM) Light Adjustable Lens (LAL) used in cataract surgery for patients with a history of laser refractive surgery (LASIK and/or photorefractive keratectomy [PRK]) using a co-managed, open-access methodology.Patients and Methods: This retrospective case series of consecutive patients with history of laser refractive surgery implanted with the second-generation LAL with an emmetropic target were included in the study. Following surgery, all patients received their ultraviolet (UV) light treatments at a separate open-access facility through a co-managed arrangement. Uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and residual cylinder for eyes with an emmetropic refractive target were the primary outcome measures as documented at the patient's final, stable, refractive postoperative exam.Results: Thirty-three patients (34 eyes) with a history of laser refractive surgery were included in the study and implanted with the second-generation LAL with a postoperative emmetropic refractive target. Twenty-eight (82.4%) saw 20/20 or better and 9 (26.5%) saw 20/15 or better. The mean SE was 0.01 ± 0.31 D and 33 (97.1%) were within ± 0.50 D SE of plano. The mean residual cylinder was − 0.28 ± 0.32 D and 30 (88.2%) were within ± 0.50 D.Conclusion: Use of the second-generation LAL was efficacious in cataract surgical patients with a history of LASIK and/or PRK using a co-managed, open-access methodology. [ABSTRACT FROM AUTHOR]

We report on the second observation of the radio-quiet active galactic nucleus MCG-05-23-16 performed with the Imaging X-ray Polarimetry Explorer (IXPE). The observation started on 2022 November 6 for a net observing time of 640 ks, and was partly simultaneous with NuSTAR (86 ks). After combining these data with those obtained in the first IXPE pointing on 2022 May (simultaneous with XMM–Newton and NuSTAR) we find a 2–8 keV polarization degree Π = 1.6 ± 0.7 (at 68 per cent confidence level), which corresponds to an upper limit Π = 3.2 per cent (at 99 per cent confidence level). We then compare the polarization results with Monte Carlo simulations obtained with the monk code, with which different coronal geometries have been explored (spherical lamppost, conical, slab, and wedge). Furthermore, the allowed range of inclination angles is found for each geometry. If the best-fitting inclination value from a spectroscopic analysis is considered, a cone-shaped corona along the disc axis is disfavoured. [ABSTRACT FROM AUTHOR]

Studies across diverse taxa have revealed the importance of early life environment and parenting on characteristics later in life. While some have shown how early life experiences can impact cognitive abilities, very few have turned this around and looked at how the cognitive skills of parents or other carers during early life affect the fitness of young. In this study, we investigate how the characteristics of carers may affect proxies of fitness of pups in the cooperatively breeding banded mongoose (Mungos mungo). We gave adult mongooses a spatial memory test and compared the results to the success of the pups those individuals cared for. Our results show a tradeoff between speed and accuracy in the spatial memory task, with those individuals which were faster to move between cups in the test arena making more erroneous re-visits to cups that they had already checked for food. Furthermore, the accuracy of their carer predicted future survival, but not weight gain of the pups and the effect was contrary to expected, with pups that were cared for by less accurate individuals being more likely to survive to adulthood. Our research also provides evidence that while younger carers were less accurate during the test, the age of the carer did not have an impact on the chance of raising young that live to sexual maturity. Our findings suggest that banded mongoose carers' cognitive traits have fitness consequences for the young they care for, affecting the chance that these young live to maturity. [ABSTRACT FROM AUTHOR]

Research in medicine and evolutionary biology suggests that the sequencing of parental investment has a crucial impact on offspring life history and health. Here, we take advantage of the synchronous birth system of wild banded mongooses to test experimentally the lifetime consequences to offspring of receiving extra investment prenatally versus postnatally. We provided extra food to half of the breeding females in each group during pregnancy, leaving the other half as matched controls. This manipulation resulted in two categories of experimental offspring in synchronously born litters: (i) 'prenatal boost' offspring whose mothers had been fed during pregnancy, and (ii) 'postnatal boost' offspring whose mothers were not fed during pregnancy but who received extra alloparental care in the postnatal period. Prenatal boost offspring lived substantially longer as adults, but postnatal boost offspring had higher lifetime reproductive success (LRS) and higher glucocorticoid levels across the lifespan. Both types of experimental offspring had higher LRS than offspring from unmanipulated litters. We found no difference between the two experimental categories of offspring in adult weight, age at first reproduction, oxidative stress or telomere lengths. These findings are rare experimental evidence that prenatal and postnatal investments have distinct effects in moulding individual life history and fitness in wild mammals. This article is part of the theme issue 'Evolutionary ecology of inequality'. [ABSTRACT FROM AUTHOR]

The article offers information on several U.S. court cases related to criminal law; labor law; and family law. The cases discussed include State v. Beganovic related to state must prove a fire was started without authorization for arson; Hennepin HealthCare System, Inc. v. AFSCME on violation of collective bargaining agreements for arbitration award and Buckner v. Robichaud on award of attorneys' fees through the court's inherent authority.

The article summarizes recent judicial decisions in employment and labor law cases. It highlights rulings on wage payment claims, disability discrimination lawsuits, employment discrimination challenges, retaliation claims, and other related matters. It focuses on the legal issues addressed, such as the interpretation of statutory definitions, dismissal of claims for failure to state a cause of action, and the determination of discrimination or retaliation.

Rabies is a lethal zoonosis present in most parts of the world which can be transmitted to humans through the bite from an infected mammalian reservoir host. The Arctic rabies virus variant (ARVV) persists mainly in populations of Arctic foxes (Vulpes lagopus), and to a lesser extent in red fox populations (Vulpes vulpes). Red foxes are thought to be responsible for sporadic southward movement waves of the ARVV outside the enzootic area of northern Canada. In this study, we wanted to investigate whether red foxes displayed notable levels of genetic structure across the Quebec-Labrador Peninsula, which includes portions of the provinces of Quebec and Newfoundland-Labrador in Canada, and is a region with a history of southward ARVV movement waves. We combined two datasets that were collected and genotyped using different protocols, totalling 675 red fox individuals across the whole region and genotyped across 13 microsatellite markers. We found two genetic clusters across the region, reflecting a latitudinal gradient, and characterized by low genetic differentiation. We also observed weak but significant isolation by distance, which seems to be marginally more important for females than for males. These findings suggest a general lack of resistance to movement in red fox populations across the Quebec-Labrador Peninsula, regardless of sex. Implications of these findings include additional support for the hypothesis of long-distance southward ARVV propagation through its red fox reservoir host. [ABSTRACT FROM AUTHOR]

Background: The need for coronavirus 2019 (COVID-19) vaccination in different age groups and populations is a subject of great uncertainty and an ongoing global debate. Critical knowledge gaps regarding COVID-19 vaccination include the duration of protection offered by different priming and booster vaccination regimens in different populations, including homologous or heterologous schedules; how vaccination impacts key elements of the immune system; how this is modified by prior or subsequent exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and future variants; and how immune responses correlate with protection against infection and disease, including antibodies and effector and T cell central memory. Methods: The Platform Trial In COVID-19 priming and BOOsting (PICOBOO) is a multi-site, multi-arm, Bayesian, adaptive, randomised controlled platform trial. PICOBOO will expeditiously generate and translate high-quality evidence of the immunogenicity, reactogenicity and cross-protection of different COVID-19 priming and booster vaccination strategies against SARS-CoV-2 and its variants/subvariants, specific to the Australian context. While the platform is designed to be vaccine agnostic, participants will be randomised to one of three vaccines at trial commencement, including Pfizer's Comirnaty, Moderna's Spikevax or Novavax's Nuvaxovid COVID-19 vaccine. The protocol structure specifying PICOBOO is modular and hierarchical. Here, we describe the Core Protocol, which outlines the trial processes applicable to all study participants included in the platform trial. Discussion: PICOBOO is the first adaptive platform trial evaluating different COVID-19 priming and booster vaccination strategies in Australia, and one of the few established internationally, that is designed to generate high-quality evidence to inform immunisation practice and policy. The modular, hierarchical protocol structure is intended to standardise outcomes, endpoints, data collection and other study processes for nested substudies included in the trial platform and to minimise duplication. It is anticipated that this flexible trial structure will enable investigators to respond with agility to new research questions as they arise, such as the utility of new vaccines (such as bivalent, or SARS-CoV-2 variant-specific vaccines) as they become available for use. Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12622000238774. Registered on 10 February 2022. [ABSTRACT FROM AUTHOR]

Background: Rural populations are older, have higher diabetes prevalence, and have less improvement in diabetes-related mortality rates compared to urban counterparts. Rural communities have limited access to diabetes education and social support services. Objective: Determine if an innovative population health program that integrates medical and social care models improves clinical outcomes for patients with type 2 diabetes in a resource-constrained, frontier area. Design/Participants: Quality improvement cohort study of 1764 patients with diabetes (September 2017–December 2021) at St. Mary's Health and Clearwater Valley Health (SMHCVH), an integrated health care delivery system in frontier Idaho. The United States Department of Agriculture's Office of Rural Health defines frontier as sparsely populated areas that are geographically isolated from population centers and services. Intervention: SMHCVH integrated medical and social care through a population health team (PHT), where staff assess medical, behavioral, and social needs with annual health risk assessments and provide core interventions including diabetes self-management education, chronic care management, integrated behavioral health, medical nutritional therapy, and community health worker navigation. We categorized patients with diabetes into three groups: patients with two or more PHT encounters during the study (PHT intervention), one PHT encounter (minimal PHT), and no PHT encounters (no PHT). Main Measures: HbA1c, blood pressure, and LDL over time for each study group. Key Results: Of the 1764 patients with diabetes, mean age was 68.3 years, 57% were male, 98% were white, 33% had three or more chronic conditions, and 9% had at least one unmet social need. PHT intervention patients had more chronic conditions and higher medical complexity. Mean HbA1c of PHT intervention patients significantly decreased from baseline to 12 months (7.9 to 7.6%, p < 0.01) and sustained reductions at 18 months, 24 months, 30 months, and 36 months. Minimal PHT patients decreased HbA1c from baseline to 12 months (7.7 to 7.3%, p < 0.05). Conclusion: The SMHCVH PHT model was associated with improved hemoglobin A1c among less well-controlled patients with diabetes. [ABSTRACT FROM AUTHOR]

Background: Patients with type 2 diabetes frequently have both medical- and health-related social needs that must be addressed for optimal disease management. Growing evidence suggests that intersectoral partnerships between health systems and community-based organizations may effectively support improved health outcomes for patients with diabetes. Objective: The purpose of this study was to describe stakeholders' perceptions of the implementation factors associated with a diabetes management program, an intervention involving coordinated clinical and social services supports to address both medical- and health-related social needs. This intervention delivers proactive care alongside community partnerships, and leverages innovative financing mechanisms. Design: Qualitative study with semi-structured interviews. Participants: Study participants included adults (18 years or older) who were patients with diabetes and essential staff (e.g., members of a diabetes care team, health care administrators) and leaders of community-based organizations. Approach: We used the Consolidated Framework for Implementation Research (CFIR) to develop a semi-structured interview guide designed to elicit perspectives from patients and essential staff on their experiences within an outpatient center to support patients with chronic conditions (the CCR) as a part of an intervention to improve care for patients with diabetes. Key Results: Interviews illuminated three key takeaways: (1) team-based care held an important role in promoting accountability across stakeholders motivating patient engagement and positive perceptions, (2) mission-driven alignment across the health care and community sectors was needed to synergize a broad range of efforts, and (3) global payment models allowing for flexible resource allocation can invaluably support the appropriate care being directed where it is needed the most whether medical or social services. Conclusions: The views and experiences of patient and essential staff stakeholder groups reported here thematically according to CFIR domains may inform the development of other chronic disease interventions that address medical- and health-related social needs in additional settings. [ABSTRACT FROM AUTHOR]

Social drivers of health impact health outcomes for patients with diabetes, and are areas of interest to health systems, researchers, and policymakers. To improve population health and health outcomes, organizations are integrating medical and social care, collaborating with community partners, and seeking sustainable financing with payors. We summarize promising examples of integrated medical and social care from the Merck Foundation Bridging the Gap: Reducing Disparities in Diabetes Care initiative. The initiative funded eight organizations to implement and evaluate integrated medical and social care models, aiming to build a value case for services that are traditionally not eligible for reimbursement (e.g., community health workers, food prescriptions, patient navigation). This article summarizes promising examples and future opportunities for integrated medical and social care across three themes: (1) primary care transformation (e.g., social risk stratification) and workforce capacity (e.g., lay health worker interventions), (2) addressing individual social needs and structural changes, and (3) payment reform. Integrated medical and social care that advances health equity requires a significant paradigm shift in healthcare financing and delivery. [ABSTRACT FROM AUTHOR]

Background: Medical mistrust has had devastating consequences during the COVID-19 pandemic, particularly in rural communities. Community Health Workers (CHWs) have been shown to build trust, but there is little research on trust-building by CHWs in rural communities. Objective: This study aims to understand the strategies that CHWs use to build trust with participants of health screenings in frontier Idaho. Design: This is a qualitative study based on in-person, semi-structured interviews. Participants: We interviewed CHWs (N=6) and coordinators of food distribution sites (FDSs; e.g., food banks and pantries) where CHWs hosted a health screening (N=15). Approach: Interviews were conducted with CHWs and FDS coordinators during FDS-based health screenings. Interview guides were initially designed to assess facilitators and barriers to health screenings. Trust and mistrust emerged as dominant themes that determined nearly every aspect of the FDS-CHW collaboration, and thus became the focus of interviews. Key Results: CHWs encountered high levels of interpersonal trust, but low institutional and generalized trust, among the coordinators and clients of rural FDSs. When working to reach FDS clients, CHWs anticipated confronting mistrust due to their association with the healthcare system and government, especially if CHWs were perceived as "outsiders." Hosting health screenings at FDSs, which were trusted community organizations, was important for CHWs to begin building trust with FDS clients. CHWs also volunteered at FDS locations to build interpersonal trust before hosting health screenings. Interviewees agreed that trust building was a time- and resource-intensive process. Conclusions: CHWs build interpersonal trust with high-risk rural residents, and should be integral parts of trust building initiatives in rural areas. FDSs are vital partners in reaching low-trust populations, and may provide an especially promising environment to reach some rural community members. It is unclear whether trust in individual CHWs also extends to the broader healthcare system. [ABSTRACT FROM AUTHOR]

Background: Global budgets might incentivize healthcare systems to develop population health programs to prevent costly hospitalizations. In response to Maryland's all-payer global budget financing system, University of Pittsburgh Medical Center (UPMC) Western Maryland developed an outpatient care management center called the Center for Clinical Resources (CCR) to support high-risk patients with chronic disease. Objective: Evaluate the impact of the CCR on patient-reported, clinical, and resource utilization outcomes for high-risk rural patients with diabetes. Design: Observational cohort study. Participants: One hundred forty-one adult patients with uncontrolled diabetes (HbA1c > 7%) and one or more social needs who were enrolled between 2018 and 2021. Interventions: Team-based interventions that provided interdisciplinary care coordination (e.g., diabetes care coordinators), social needs support (e.g., food delivery, benefits assistance), and patient education (e.g., nutritional counseling, peer support). Main Measures: Patient-reported (e.g., quality of life, self-efficacy), clinical (e.g., HbA1c), and utilization outcomes (e.g., emergency department visits, hospitalizations). Key Results: Patient-reported outcomes improved significantly at 12 months, including confidence in self-management, quality of life, and patient experience (56% response rate). No significant demographic differences were detected between patients with or without the 12-month survey response. Baseline mean HbA1c was 10.0% and decreased on average by 1.2 percentage points at 6 months, 1.4 points at 12 months, 1.5 points at 18 months, and 0.9 points at 24 and 30 months (P<0.001 at all timepoints). No significant changes were observed in blood pressure, low-density lipoprotein cholesterol, or weight. The annual all-cause hospitalization rate decreased by 11 percentage points (34 to 23%, P=0.01) and diabetes-related emergency department visits also decreased by 11 percentage points (14 to 3%, P=0.002) at 12 months. Conclusions: CCR participation was associated with improved patient-reported outcomes, glycemic control, and hospital utilization for high-risk patients with diabetes. Payment arrangements like global budgets can support the development and sustainability of innovative diabetes care models. [ABSTRACT FROM AUTHOR]

We report on the Imaging X-ray Polarimetry Explorer (IXPE) observation of the closest and X-ray brightest Compton-thick active galactic nucleus (AGN), the Circinus galaxy. We find the source to be significantly polarized in the 2–6 keV band. From previous studies, the X-ray spectrum is known to be dominated by reflection components, both neutral (torus) and ionized (ionization cones). Our analysis indicates that the polarization degree is 28 ± 7 per cent (at 68 per cent confidence level) for the neutral reflector, with a polarization angle of 18° ± 5°, roughly perpendicular to the radio jet. The polarization of the ionized reflection is unconstrained. A comparison with Monte Carlo simulations of the polarization expected from the torus shows that the neutral reflector is consistent with being an equatorial torus with a half-opening angle of 45°–55°. This is the first X-ray polarization detection in a Seyfert galaxy, demonstrating the power of X-ray polarimetry in probing the geometry of the circumnuclear regions of AGNs, and confirming the basic predictions of standard Unification Models. [ABSTRACT FROM AUTHOR]

State-of-the-art health equity training for medical, nursing, social work students, and others must facilitate greater tactile understanding of patients' and clients' lived experiences. Medical, nursing, social work, and public health communities have special responsibilities to exercise such vigilance, given the severe health consequences of cruelty. Shklar understood that persistent cruelty more frequently results from the failure of bystanders to intervene, what Dr. King rightly called "the appalling silence of the good people", than it does from the outright evils committed by the few.[4],[7] To be serious about eradicating cruelty, we must all use our personal agency to address structural racism and other systems of oppression. [Extracted from the article]

The article discusses several legal cases related to various labor and employment issues. It encompasses cases related to the Fair Labor Standards Act, where nominal attorney's fees were awarded due to egregious attorney conduct. It further addresses cases involving misconduct in wage disputes, race discrimination claims, ERISA benefits, Social Security disability claims, and challenges to federal vaccination requirements.

The article focuses on legal decisions in Minnesota, U.S. involving workers' rights, health insurance entitlements, and claims of reprisal under state laws. Key cases discussed include a social worker's successful claim for workers' compensation due to PTSD from exposure to a client's murder details, disputes over police officers' health insurance coverage rights, and outcomes of reprisal claims where adverse actions were scrutinized under the Human Rights Act.

Racism reduces eligibility for health insurance and access to high-quality care for people of color in the United States, and current payment structures exacerbate the resultant de facto racial segregation. Payers and health plans do not adequately support and incentivize clinicians and health care delivery organizations to meet the health needs of minoritized communities. This article describes foundational work needed to create an antiracist culture of equity; the Roadmap to Advance Health Equity; and specific, actionable antiracist payment reform strategies, including increasing access to and the scope of health insurance coverage, antiracism accountability in managed-care contracts, support for the safety-net system, strengthened nonprofit hospital tax status requirements, and payment incentives to advance health equity. Antiracist payment reforms have great potential to desegregate health care systems and to ensure that everyone has a fair opportunity to receive good health services and optimize their health. [ABSTRACT FROM AUTHOR]

Objectives: To describe the Health Resources and Services Administration's Quality Improvement Award (QIA) program, award patterns, and early lessons learned. Study Setting: 1413 health centers were eligible for QIA from 2014 to 2018. Study Design: We assessed cumulative QIA funding earned and modified funding excluding payments for per‐patient bonuses, electronic health record (EHR) use, patient‐centered medical home (PCMH) accreditation, and health information technology. We compared health centers on rural/urban location, PCMH accreditation, EHR reporting, and size. Data Collection: Organizational and quality measures are reported in the Uniform Data System, QIA program data. Principal Findings: Average cumulative funding was higher for health centers that were not rural (USD 380,387 [± USD 233,467] vs. USD 303,526 [± USD 164,272]), had PCMH accreditation (USD 401,675 [± USD 218,246] vs. USD 250,784 [± USD 144,404]), used their EHR for quality reporting (USD 374,214 (± USD 222,866) vs. USD 331,150 (± USD 198,689)), and were large (USD 435,473 (± USD 238,193) vs. USD 270,681 (± USD 114,484) an USD 231,917 (± USD 97,847) for small and medium centers, respectively). There were similar patterns, with smaller differences, for average modified payments. Conclusions: QIA is an important feasible initiative to introduce value‐based payment principles to health centers. Early lessons for program design include announcing award criteria in advance and focusing on a smaller number of priority targets. [ABSTRACT FROM AUTHOR]

Predictive analytic models leveraging machine learning methods increasingly have become vital to health care organizations hoping to improve clinical outcomes and the efficiency of care delivery for all patients. Unfortunately, predictive models could harm populations that have experienced interpersonal, institutional, and structural biases. Models learn from historically collected data that could be biased. In addition, bias impacts a model's development, application, and interpretation. We present a strategy to evaluate for and mitigate biases in machine learning models that potentially could create harm. We recommend analyzing for disparities between less and more socially advantaged populations across model performance metrics (eg, accuracy, positive predictive value), patient outcomes, and resource allocation and then identify root causes of the disparities (eg, biased data, interpretation) and brainstorm solutions to address the disparities. This strategy follows the lifecycle of machine learning models in health care, namely, identifying the clinical problem, model design, data collection, model training, model validation, model deployment, and monitoring after deployment. To illustrate this approach, we use a hypothetical case of a health system developing and deploying a machine learning model to predict the risk of mortality in 6 months for patients admitted to the hospital to target a hospital's delivery of palliative care services to those with the highest mortality risk. The core ethical concepts of equity and transparency guide our proposed framework to help ensure the safe and effective use of predictive algorithms in health care to help everyone achieve their best possible health. [ABSTRACT FROM AUTHOR]

While a robust literature supports the role of community health workers in reducing health inequities, many health financing and reimbursement systems either do not pay for them or have regulatory language that makes it hard to access funding. [Extracted from the article]

The article offers information on several U.S. Court case related to criminal, labor and intellectual property laws. Topics discussed include State v. Modtland on parole eligibility determination which does not implicate a guilty plea's intelligence; Placzek v. Mayo Clinic on claims of whistleblower as independent contractor not covered and Gould v. Brown Cty. on mistakes of law in copyright registrations which are eligible for safe harbor.

Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient-clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers' work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities. [ABSTRACT FROM AUTHOR]

Background: Interpersonal biases between clinicians and patients contribute to disparities in health care and outcomes by race, ethnicity, and socioeconomic status. We used standup comedy principles and exercises to help medical students recognize how others perceive them and how they perceive others, and engage in difficult discussions around implicit biases and interpersonal racism. Methods: 90 min Zoom workshop with 40 first-year medical students in urban medical school. Intervention consisted of three exercises: Naming icebreaker, Rant and Rave (communicate strong perspective clearly), and Personal Monologue about how others perceive you and how you perceive yourself. Discussion debriefed the personal monologue exercise. Likert scale questions on post-session survey evaluated workshop overall, whether workshop increased skills, and safety of learning environment. Open-ended questions included what trainees liked about the module, what could be improved, and what impact the module had on them? Results: Seventeen (42.5%) students responded to survey. Six respondents identified as white, 4 as Asian, 1 as Black, 1 as multiracial, and 5 did not identify. Seventy-six percent rated the module as "very good" or "excellent", and 94% would recommend the module to others. Most respondents reported the workshop helped them become better listeners (75%) and more observant (82%). Eighty-three percent reported the training could help them take better care of patients with lived experiences different than their own. All respondents believed the learning environment was safe, and 94% reported that instructors created an atmosphere in which they could take risks. Thirty-six percent felt stressed. Students reported the workshop helped them recognize their own identities, others' perceptions, and bidirectional biases, and inspired them to strive for more accurate, authentic interactions with patients. Conclusions: Standup comedy principles show promise for engaging students in meaningful, safe discussions about perceptions and interpersonal biases rooted in their own personal experiences and those of their classmates. [ABSTRACT FROM AUTHOR]

The article identifies the ethical dimensions of pricing transparency including knowledge and action, autonomous informed consent, efficient decision-making and justice promotion, equitable access to high-quality care for marginalized populations and reform of payment and delivery streams.

Unacceptable healthcare disparities in endocrine disease have persisted for decades, and 2021 presents a difficult evolving environment. The COVID-19 pandemic has highlighted the gross structural inequities that drive health disparities, and antiracism demonstrations remind us that the struggle for human rights continues. Increased public awareness and discussion of disparities present an urgent opportunity to advance health equity. However, it is more complicated to change the behavior of individuals and reform systems because societies are polarized into different factions that increasingly believe, accept, and live different realities. To reduce health disparities, clinicians must (1) truly commit to advancing health equity and intentionally act to reduce health disparities; (2) create a culture of equity by looking inwards for personal bias and outwards for the systemic biases built into their everyday work processes; (3) implement practical individual, organizational, and community interventions that address the root causes of the disparities; and (4) consider their roles in addressing social determinants of health and influencing healthcare payment policy to advance health equity. To care for diverse populations in 2021, clinicians must have self-insight and true understanding of heterogeneous patients, knowledge of evidence-based interventions, ability to adapt messaging and approaches, and facility with systems change and advocacy. Advancing health equity requires both science and art; evidence-based roadmaps and stories that guide the journey to better outcomes, judgment that informs how to change the behavior of patients, providers, communities, organizations, and policymakers, and passion and a moral mission to serve humanity. [ABSTRACT FROM AUTHOR]

Policy PointsPopulation health efforts to improve diabetes care and outcomes should identify social needs, support social needs referrals and coordination, and partner health care organizations with community social service agencies and resources.Current payment mechanisms for health care services do not adequately support critical up‐front investments in infrastructure to address medical and social needs, nor provide sufficient incentives to make addressing social needs a priority.Alternative payment models and value‐based payment should provide up‐front funding for personnel and infrastructure to address social needs and should incentivize care that addresses social needs and outcomes sensitive to social risk. Context: Increasingly, health care organizations are implementing interventions to improve outcomes for patients with complex health and social needs, including diabetes, through cross‐sector partnerships with nonmedical organizations. However, fee‐for‐service and many value‐based payment systems constrain options to implement models of care that address social and medical needs in an integrated fashion. We present experiences of eight grantee organizations from the Bridging the Gap: Reducing Disparities in Diabetes Care initiative to improve diabetes outcomes by transforming primary care and addressing social needs within evolving payment models. Methods: Analysis of eight grantees through site visits, technical assistance calls, grant applications, and publicly available data from US census data (2017) and from Health Resources and Services Administration Uniform Data System Resources data (2018). Organizations represent a range of payment models, health care settings, market factors, geographies, populations, and community resources. Findings: Grantees are implementing strategies to address medical and social needs through augmented staffing models to support high‐risk patients with diabetes (e.g., community health workers, behavioral health specialists), information technology innovations (e.g., software for social needs referrals), and system‐wide protocols to identify high‐risk populations with gaps in care. Sites identify and address social needs (e.g., food insecurity, housing), invest in human capital to support social needs referrals and coordination (e.g., embedding social service employees in clinics), and work with organizations to connect to community resources. Sites encounter challenges accessing flexible up‐front funding to support infrastructure for interventions. Value‐based payment mechanisms usually reward clinical performance metrics rather than measures of population health or social needs interventions. Conclusions: Federal, state, and private payers should support critical infrastructure to address social needs and incentivize care that addresses social needs and outcomes sensitive to social risk. Population health strategies that address medical and social needs for populations living with diabetes will need to be tailored to a range of health care organizations, geographies, populations, community partners, and market factors. Payment models should support and incentivize these strategies for sustainability. [ABSTRACT FROM AUTHOR]

The article discusses a summary of legal cases related to employment issues. It cover various topics such as time rounding-off practices, union dues deductions, failure to promote, battery, harassment claims, retaliation and discrimination verdicts, veterans preference, and unemployment compensation disqualifications. It provide key details and outcomes of each case, showcasing legal decisions related to employment law.