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INTRODUCTION In recent decades, more Americans have enrolled in college to pursue the American dream. It is a widely held view in many countries that college degrees serve as catalysts [...], This paper analyses potential links between extreme optimism and student loan debt. Prior work finds extreme optimism to be associated with imprudent household savings and investment decisions. This paper explores whether these findings are relevant to student loan decisions. Using the most recent administration of the Survey of Consumer Finances (SCF), we present evidence that extreme optimists tend to be over-indebted with higher student loan balances, in absolute terms and relative to income. They are less likely to make payments on their student loan debt or reduce their loan balance. Extreme optimists are also more likely to take out loans for a degree they do not obtain and to enroll in income-based repayment plans.

The Food and Drug Administration Food Code is a set of science-based food safety guidelines that serve as the basis for jurisdictional food codes that regulate retail food service in the U.S. Uniform adoption of the Food Code has benefits for government, industry, and the public. Compliance with code provisions helps reduce risk of foodborne illness in retail establishments. Only 18 states, however, have adopted the most recent edition of the Food Code (Food and Drug Administration, 2023). The Retail Food Safety Regulatory Association Collaborative (Collaborative) has undertaken a multipronged approach that leverages the resources and strengths of its six organizations to support adoption of the Food Code. Through these approaches, the Collaborative aims to provide the tools, resources, and support needed to navigate the sometimes complex nature of adoption. This special report provides a summary of the different activities and approaches of the Collaborative to support national Food Code adoption., Introduction The vital work of retail food safety professionals happens in a rapidly evolving landscape of technological advancement, emerging trends, and globalization--a dynamic terrain that requires up-to-date, evidence-based regulations to [...]

Hepatitis C virus (HCV) can be transmitted perinatally (1). Rates of acute HCV infection have increased recently (2), but few children perinatally exposed to HCV are tested and referred to [...]

: Introduction: Adolescent girls and young women (AGYW), a priority population for HIV prevention in Africa, show high interest but difficulty in sustained effective use of pre‐exposure prophylaxis (PrEP). With ongoing PrEP scale‐up focused on increasing access, it is important to understand what influences AGYW's choice of PrEP delivery platforms. Methods: The POWER implementation study in Cape Town provided PrEP between 2017 and 2020 to AGYW (16−25 years) from four differentiated delivery platforms: mobile clinic, government facility, courier delivery or community‐based youth club. Healthcare providers at government and mobile clinics provided PrEP (initiation and refills) as part of comprehensive, integrated sexual and reproductive health services. Courier and youth club platforms provided light‐touch PrEP refill services incorporating rapid HIV self‐testing. We conducted in‐depth interviews with a purposive sample of AGYW who had ≥3 months of PrEP‐use and accessed ≥2 PrEP delivery platforms. The thematic analysis explored AGYW's preferences, decision‐making and habits related to PrEP access to inform market segmentation. Results: We interviewed 26 AGYW (median age 20) PrEP‐users between November 2020 and March 2021. AGYW PrEP‐users reported accessing different services with, 24 accessing mobile clinics, 17 courier delivery, 9 government health facilities and 6 youth clubs for their PrEP refills. Qualitative findings highlighted four potential behavioural profiles. The “Social PrEP‐user” preferred PrEP delivery in peer spaces, such as youth clubs or adolescent‐friendly mobile clinics, seeking affirmation and social support for continued PrEP use. The “Convenient PrEP‐user” favoured PrEP delivery at easily accessible locations, providing quick (courier) or integrated contraception‐PrEP refill visits (mobile and government clinic). The “Independent PrEP‐user” preferred PrEP delivery that offered control over delivery times that fit into their schedule, such as the courier service. The “Discreet PrEP‐user” highly valued privacy regarding their PrEP use (courier delivery) and avoided delivery options where unintentional disclosure was evident (youth club). Comfort with HIV self‐testing had minimal influence on PrEP delivery choice. Conclusions: Market segmentation of AGYW characterizes different types of PrEP‐users and has the potential to enhance tailored messaging and campaigns to reach specific segments, with the aim of improving sustained PrEP use and HIV prevention benefits., INTRODUCTION The past 5 years have seen the global inclusion of oral pre‐exposure prophylaxis (PrEP) into national guidelines as a key biomedical HIV prevention method, with many countries planning to [...]

Few have studied the COVID-19 pandemic's impact on tobacco use status assessment and cessation counseling. Electronic health record data from 217 primary care clinics were examined from January 1, 2019 to July 31, 2021. Data included telehealth and in-person visits for 759,138 adult patients (aged >18 years). Monthly rates of tobacco assessment per 1,000 patients were calculated. From March 2020 to May 2020, tobacco assessment monthly rates declined by 50% and increased from June 2020 to May 2021 but remained 33.5% lower than pre-pandemic levels. Rates of tobacco cessation assistance changed less, but remain low. These findings are significant given the relevance of tobacco use to increased severity of COVID-19. Key words: community health center; COVID-19; primary care; smoking status assessment; tobacco https://doi.org/10.1370/afm.2948, INTRODUCTION The COVID-19 pandemic dramatically altered patterns of primary health care-seeking and delivery. This was reflected in a dramatic increase in telehealth visits (ie, video and telephone visits) (1,2) and [...]

Wives Not Slaves: Patriarchy and Modernity in the Age of Revolutions KIRSTEN SWORD University of Chicago Press, 2021 408 pp. Kirsten Sword's Wives Not Slaves: Patriarchy and Modernity in the [...]

BACKGROUND Urinary tract infection (UTI) symptoms are common in primary care, but antibiotics are appropriate only when an infection is present. Urine culture is the reference standard test for infection, but results take >1 day. A machine learning predictor of urine cultures showed high accuracy for an emergency department (ED) population but required urine microscopy features that are not routinely available in primary care (the NeedMicro classifier). METHODS We redesigned a classifier (NoMicro) that does not depend on urine microscopy and retrospectively validated it internally (ED data set) and externally (on a newly curated primary care [PC] data set) using a multicenter approach including 80,387 (ED) and 472 (PC) adults. We constructed machine learning models using extreme gradient boosting (XGBoost), artificial neural networks, and random forests (RFs). The primary outcome was pathogenic urine culture growing >100,000 colony forming units. Predictor variables included age; gender; dipstick urinalysis nitrites, leukocytes, clarity, glucose, protein, and blood; dysuria; abdominal pain; and history of UTI. RESULTS Removal of microscopy features did not severely compromise performance under internal validation: NoMicro/XGBoost receiver operating characteristic area under the curve (ROC-AUC) 0.86 (95% CI, 0.86-0.87) vs NeedMicro 0.88 (95% CI, 0.87-0.88). Excellent performance in external (PC) validation was also observed: NoMicro/RF ROC-AUC 0.85 (95% CI, 0.81-0.89). Retrospective simulation suggested that NoMicro/RF can be used to safely withhold antibiotics for low-risk patients, thereby avoiding antibiotic overuse. CONCLUSIONS The NoMicro classifier appears appropriate for PC. Prospective trials to adjudicate the balance of benefits and harms of using the NoMicro classifier are appropriate. Key words: urinary tract infection; machine learning; antibiotic overuse; decision rule; prediction model; primary care, INTRODUCTION Urinary tract infections (UTIs) are the most common type of infections managed in the outpatient setting, accounting for 1% to 3% of all consultations, 15% of all community prescriptions [...]

A survey conducted with data from 2008 found that physicians often do not communicate with each other at the time of referral or after consultation. Communication between physicians might have improved since then, with the dissemination of electronic health records (EHRs), but this is not known. We used 2019 survey data to measure primary care physicians' perceptions of communication at the time of referral and after consultation. We found that large gaps in communication persist. The similarity between these survey results suggests that despite the dissemination of EHRs, physicians still do not consistently communicate with each other about the patients they share. Key words: physician communication; primary and specialty care; referral and consultation communication, INTRODUCTION Using 2008 data, O'Malley and Reschovsky found sizeable gaps in communication among physicians caring for mutual patients. (1) Poor communication has been linked to delayed diagnoses, unnecessary testing, and [...]

Net Promoter Score (NPS) has been widely adopted by managers as a measure of customer mindset and predictor of sales growth. Over time, practitioners have evolved the use of NPS from its original purpose as a transaction-based customer loyalty metric, towards a metric for tracking overall brand health which includes responses from non-customers. Despite enduring managerial popularity, academics remain skeptical of NPS, citing methodological issues and ongoing concerns with NPS measurement. This study re-visits the use of NPS as a predictor of sales growth by analyzing data from seven brands operating in the U.S. sportswear industry, measured over five years. Our results confirm-within the context of our study-that while the original premise of NPS is reasonable, the methodological concerns raised by academics are valid, and only the more recently developed brand health measure of NPS (using an all potential customer sample) is effective at predicting future sales growth., Author(s): Sven Baehre [sup.1] , Michele O'Dwyer [sup.1] , Lisa O'Malley [sup.1] , Nick Lee [sup.2] Author Affiliations: (1) grid.10049.3c, 0000 0004 1936 9692, Kemmy Business School, University of Limerick, [...]

Research on physical activity programming for children with autism spectrum disorder (ASD) is scant. The aim of this study was to assess the nature of physical activity programming conducted in ASD units in Irish primary schools, in addition to assessing the perceived benefits and challenges among teachers. An online questionnaire was sent to every primary school with an ASD unit in Ireland (n = 380). Questions pertained to the amount and type of physical activity being conducted, in addition to questions on physical activity facilities, training, and the teachers' perceived challenges and benefits. Data were gathered on 69 ASD units. In the majority of units (74.24%), physical education classes were held daily, with the most frequent duration (45.45%) being 10-20 minutes. The most common types of activities performed included walking (92.42%), running (81.82%), and jogging (60.61%). This study gives an insight into the nature of physical activity for children in ASD units in Irish primary schools. Keywords: Autism spectrum disorder; physical activity programming; physical education; school, Introduction The recommended guidelines for physical activity for children between the ages of two to 18 in Ireland, and indeed internationally, is at least 60 minutes of moderate to vigorous [...]

Introduction: In public clinics in Kenya, separate, sequential delivery of the component services of pre-exposure prophylaxis (PrEP) (e.g. HIV testing, counselling, and dispensing) creates long wait times that hinder clients' ability and desire to access and continue PrEP. We conducted a mixed methods study in four public clinics in western Kenya to identify strategies for operationalizing a one-stop shop (OSS) model and evaluate whether this model could improve client wait time and care accept-ability among clients and providers without negatively impacting uptake or continuation. Methods: From January 2020 through November 2020, we collected and analysed 47 time-and-motion observations using Mann-Whitney U tests, 29 provider and client interviews, 68 technical assistance reports, and clinic flow maps from inter-vention clinics. We used controlled interrupted time series (cITS) to compare trends in PrEP initiation and on-time returns from a 12-month pre-intervention period (January-December 2019) to an 8-month post-period (January-November 2020, excluding a 3-month COVID-19 wash-out period) at intervention and controlclinics. Results: From the pre- to post-period, median client wait time at intervention clinics dropped significantly from 31 to 6 minutes (p = 0.02), while median provider contact time remained around 23 minutes (p = 0.4). Intervention clinics achieved efficiency gains by moving PrEP delivery to lower volume departments, moving steps closer together (e.g. relocating supplies; cross-training and task-shifting), and differentiating clients based on the subset of services needed. Clients and providers found the OSS model highly acceptable and additionally identified increased privacy, reduced stigma, and higher quality client-provider interactions as benefits of the model. From the pre- to post-period, average monthly initiations at intervention and control clinics increased by 6 and 2.3, respectively, and percent of expected follow-up visits occurring on time decreased by 18% and 26%, respectively; cITS analysis of PrEP initiations (n = 1227) and follow-up visits (n = 2696) revealed no significant difference between intervention and control clinics in terms of trends in PrEP initiation and on-time returns (all p>0.05). Conclusions: An OSS model significantly improved client wait time and care acceptability without negatively impacting initiations or continuations, thus highlighting opportunities to improve the efficiency of PrEP delivery efficiency and client-centredness. Keywords: HIV prevention; implementation science; Kenya; organizational efficiency; pre-exposure prophylaxis; quality improvement, 1 | INTRODUCTION In the 6 years since the World Health Organization released guidelines recommending daily oral tenofovir-based pre-exposure prophylaxis (PrEP) for populations at substantial risk of HIV infection [1], [...]

Introduction: In Africa, oral pre-exposure prophylaxis (PrEP) is largely provided via over-burdened public HIV care clinics. Successfully incorporating PrEP services into these clinics may require adaptations to practices outlined in national implementation guidelines and modifications to routine existing service delivery. We aimed to describe adaptations made by public HIV clinics in Kenya to integrate PrEP delivery into existing services. Methods: The Partners Scale-Up Project aimed to catalyse integration of PrEP in 25 public HIV care clinics. Between May and December 2018, we conducted qualitative interviews with health providers and documented clinic observations in technical assistance (TA) reports to understand the process of PrEP service integration. We analysed 36 health provider interview transcripts and 25 TA reports to identify clinic-level adaptations to activities outlined in Kenyan Ministry of Health PrEP guidelines and modifications made to existing service delivery practices to successfully incorporate PrEP services. Identified adaptations were reported using the expanded framework for reporting adaptations and modifications (FRAME). Results: Allclinics (n = 25) performed HIV testing, HIV risk assessment, PrEP education and adherence counselling as stipulated in the guidelines. Most clinics initiated clients on PrEP without creatinine testing if otherwise healthy. While monthly refill appointments are recommended, a majority of clinics issued PrEP users two to three months of pills at a time. Clinics also implemented practices that had not been specified in the guidelines including incorporating PrEP-related topics into routine health talks, calling clients with missed PrEP appointments, discussing PrEP service delivery in regular staff meetings, 'fast-tracking' PrEP clients and dispensing PrEP in clinic rooms rather than at clinic-based pharmacies. PrEP initiation numbers were highest among clinics that did not require creatinine testing, conducted peer on-the-job PrEP training and those that discussed PrEP delivery in their routine meetings. Above-average continuation was observed among clinics that discussed PrEP in their routine meetings, dispensed PrEP in clinic rooms and offered PrEP at nonregular hours. Conclusions: Health providers in public HIV care clinics instituted practices and made innovative adaptations to PrEP delivery to reduce barriers for clients and staff. Encouraging clinic level adaptations to national implementation guidelines will facilitate scale-up of PrEP delivery. Keywords: adaptation; PrEP continuation; PrEP implementation; PrEP initiation; PrEP integration; public HIV care clinics, 1 | INTRODUCTION The World Health Organization issued a strong recommendation for use of oral pre-exposure prophylaxis (PrEP), a highly potent HIV prevention intervention that has the potential to reduce [...]