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Introduction: Long-acting injectable (LAI) antipsychotic medications and clozapine are effective yet underutilized medical therapies in early intervention services. The purpose of this study was to conduct a pre-implementation evaluation of contextual determinants of early intervention programs to implement innovations optimizing LAI antipsychotic and clozapine use within a shared decision-making model., Methods: Semi-structured interviews explored barriers and facilitators to implementing LAI antipsychotics and clozapine in early intervention services. Participants were: prescribers ( n  = 2), non-prescribing clinicians ( n  = 5), administrators ( n  = 3), clients ( n  = 3), and caregivers ( n  = 3). Interviews were structured and analyzed using the Consolidated Framework for Implementation Research (CFIR 2.0)., Results: Participants were supportive of using LAI antipsychotics, despite barriers (e.g., transportation, insurance coverage), while most were unfamiliar with clozapine (Innovation). Critical incidents (e.g., COVID-19) did not interfere with implementation, while barriers included lack of performance measures; stigma affecting willingness to take medication; and clozapine considered to be a "last resort" (Outer Setting). Treatment culture was described as client-centered and collaborative, and most participants indicated LAI antipsychotic use was compatible with clinic workflows, but some were in need of resources (e.g., individuals trained to administer LAI antipsychotics; Inner Setting). Participants on the healthcare team expressed confidence in their roles. Family education and collaborative decision-making were recommended to improve client/family engagement (Individuals). Participants related the importance of tracking medication compliance, addressing client concerns, and providing prescribers with updated guidelines on evidence-based treatment (Implementation Process)., Discussion: Results may guide implementation strategy selection for future programs seeking to optimize the use of LAI antipsychotics and clozapine for early-phase schizophrenia, when appropriate., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Carroll, Robinson, Kane, Kordon, Bannon, Walunas and Brown.)

Background: The Ryan White Medical Case Management System, which serves more than half of people living with HIV (PLWH) in the USA, is an opportune setting for identifying and addressing depression among PLWH. A growing body of research suggests that interventions that promote positive emotion may lessen symptoms of depression and improve physical and psychological well-being among people experiencing a variety of health-related stress, including living with HIV. Research on how best to integrate standardized mental health screening and referral to evidence-based interventions in Ryan White Medical Case Management settings has the potential to improve the health and wellbeing of PLWH., Methods: This mixed-methods study will enroll up to N = 300 Ryan White clients who screen positive for depressive symptoms in ORCHID (Optimizing Resilience and Coping with HIV through Internet Delivery), a web-based, self-guided positive emotion regulation intervention. The study will be conducted in 16 Ryan White Medical Case Management clinics in Chicago, IL. Following pre-implementation surveys and interviews with Medical Case Managers (MCMs) and Supervisors to develop an implementation facilitation strategy, we will conduct a hybrid type 2 implementation-effectiveness stepped wedge cluster randomized trial to iteratively improve the screening and referral process via interviews with MCMs in each wedge. We will test the effectiveness of ORCHID on depression and HIV care outcomes for PLWH enrolled in the program. RE-AIM is the implementation outcomes framework and the Consolidated Framework for Implementation Research is the implementation determinants framework., Discussion: Study findings have the potential to improve mental health and substance use screening of Ryan White clients, decrease depression and improve HIV care outcomes, and inform the implementation of other evidence-based interventions in the Ryan White Medical Case Management System., Trial Registration: ClinicalTrials.gov NCT05123144. Trial registered 6/24/2021., (© 2024. The Author(s).)

Introduction: Burnout poses a substantial, ongoing threat to healthcare worker (HCW) wellbeing and to the delivery of safe, quality healthcare. While systemic and organization-level changes in healthcare are critically important, HCWs also need individual-level skills to promote resilience. The objective of this trial is to test feasibility, acceptability, and efficacy of PARK, an online self-guided positive affect regulation intervention, in a sample of healthcare workers during the COVID-19 pandemic., Design and Methods: In the context of the unprecedented rise in burnout during the COVID-19 pandemic, we conducted a randomized waitlist-controlled trial of the Positive Affect Regulation sKills (PARK) program-a five-week, online, self-guided coping skills intervention nested within an ongoing cohort of HCWs. N = 554 healthcare workers were randomly assigned to receive the intervention immediately or to receive the intervention after approximately 12 weeks. Outcomes included change in burnout, emotional wellbeing (positive affect, meaning and purpose, depression, anxiety) and sleep over approximately 12 weeks. Analyses included mixed-effects linear regression models comparing change over time in outcomes between intervention and control conditions., Results: One third (n = 554) of the participants in the cohort of HCWs consented to participate and enrolled in PARK in April 2022. Compared to those who did not enroll, participants in the trial reported higher burnout, poorer emotional wellbeing, and poorer sleep at baseline (April, 2022; all ps < .05). Intent-to-treat analyses showed that participants randomly assigned to the intervention immediately (PARK-Now) improved significantly on anxiety (within-group change on PROMIS T-score = -0.63; p = .003) whereas those in the waitlist (PARK-Later) did not (within group T-score change 0.04, p = 0.90). The between-group difference in change, however, was not statistically significant (B = -0.67 p = 0.10). None of the other wellbeing outcomes changed significantly in the intervention group compared to the waitlist. Additional as-treated analyses indicated that those participants who completed all 5 of the weekly online lessons (N = 52; 9.4%) improved significantly more on the primary outcome of positive affect compared to those who enrolled in PARK but completed zero lessons (n = 237; 42.8%; B = 2.85; p = .0001)., Conclusions: Online self-guided coping skills interventions like PARK can be effective in targeted samples and future work will focus on adaptations to increase engagement and tailor PARK for HCWs who could most benefit., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Moskowitz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Prediction during language processing has been hypothesized to lead to processing benefits. These possible benefits have led to several prominent theories that center around prediction as an essential mechanism in language processing. Such theories typically assume predicting is better than not predicting at all, but do not always account for the potential processing costs from failed predictions. Predicting wrongly can be costly, but the cost may depend on how wrong the prediction was. Across three experiments, we manipulate cloze probability, semantic relatedness, and language modality (production vs. comprehension) to determine whether predicting almost correctly is better than predicting completely incorrectly, and if so, if predicting almost correctly is better than not predicting at all. Results showed that when a predicted ending is replaced with a related term, it is processed faster than when it is replaced with an unrelated term, but that related term is not named more quickly than when it appears after a low constraint sentence. This pattern held regardless of whether participants were asked to produce the sentence-final term by naming a picture (Experiments 1 and 2), or if they were asked to perform a semantic classification of the sentence-final word (Experiment 3). Thus, predicting almost correctly is better than predicting completely incorrectly, but it's not better than not predicting at all. This carries implications for current accounts that argue for processing benefits of prediction during language processing, and suggests that prediction may be used to fine-tune the language system rather than to speed language processing. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Proper names are especially prone to retrieval failures and tip-of-the-tongue states (TOTs)-a phenomenon wherein a person has a strong feeling of knowing a word but cannot retrieve it. Current research provides mixed evidence regarding whether related names facilitate or compete with target-name retrieval. We examined this question in two experiments using a novel paradigm where participants either read a prime name aloud (Experiment 1) or classified a written prime name as famous or non-famous (Experiment 2) prior to naming a celebrity picture. Successful retrievals decreased with increasing trial number (and was dependent on the number of previously presented similar famous people) in both experiments, revealing a form of accumulating interference between multiple famous names. However, trial number had no effect on TOTs, and within each trial famous prime names increased TOTs only in Experiment 2. These results can be explained within a framework that assumes competition for selection at the point of lexical retrieval, such that successful retrievals decrease after successive retrievals of proper names of depicted faces of semantically similar people. By contrast, the effects of written prime words only occur when prime names are sufficiently processed, and do not provide evidence for competition but may reflect improved retrieval relative to a "don't know" response., (© 2023. The Psychonomic Society, Inc.)

Introduction: During the coronavirus disease 2019 pandemic, high levels of burnout were reported among healthcare workers. This study examines the association of work absenteeism and frequency of thoughts in leaving current job with burnout among a cohort of healthcare workers during the COVID-19 pandemic., Methods: A cross-sectional survey of healthcare workers was conducted from April-May, 2022 on healthcare workers from 10 hospitals, 18 immediate care centers, and 325 outpatient practices in the Chicago area and surrounding Illinois suburbs. Logistic regression models were used to assess the association of burnout scores (Oldenburg Burnout Inventory-OLBI) and its sub-scores (exhaustion and disengagement scores) with work absenteeism and thoughts of leaving work., Results: One-fifth and 60% of respondents ( n  = 1,825) reported unplanned absenteeism and thoughts of leaving their job, respectively. After adjusting for covariates, higher burnout scores, especially exhaustion scores, were associated with increased odds of unplanned absenteeism (OR = 1.04, 95% CI: 1.01-1.08). Burnout scores and both sub-scores were also positively associated with the frequency of thoughts of leaving work, e.g., each unit increase in the OLBI burnout score was associated with 1.39 (95% CI: 1.34-1.43) times higher odds of thinking about leaving work "a lot/constantly" vs. "never"., Discussion: Overall, this study cohort showed a positive association between burnout scores and unplanned work absenteeism (and frequency of thoughts in leaving job) during the COVID-19 pandemic. More research is needed to support healthcare worker well-being during times of stress and direct solutions to addressing unplanned absenteeism in the light of a pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Lee, Vu, Fuller, Freedman, Bannon, Wilkins, Moskowitz, Hirschhorn, Wallia and Evans.)

Background: During the COVID-19 pandemic, telemedicine was adopted to ensure continuity of HIV care. We examined how introducing televisits affected technical quality of care for people with HIV (PWH) during this time., Methods: PWH receiving HIV care at Howard Brown Health Centers and Northwestern University in Chicago, Illinois were included. HIV care quality indicators were calculated using data extracted from electronic medical records during 4 timepoints every 6 months from March, March 1, 2020 to September 1, 2021. Generalized linear mixed models estimated differences in indicators across timepoints within each site while controlling for multiple observations of individuals. Generalized linear mixed models were also used to compare differences in outcomes among PWH who attended all versus a combination of in-person and televisits versus no televisits across the study time periods., Results: 6447 PWH were included in the analysis. Compared with prepandemic levels, there were significant declines in care utilization and processes of care measures. Measures of HIV virologic suppression, blood pressure control, and HbA1C <7% (in both people with and without diabetes) were stable with no significant differences noted across the study timepoints. Similar trends were observed across all age, race, and sex subgroups. In multivariable models, televisits were not associated with decreased HIV viral suppression., Conclusions: During the COVID-19 pandemic and rapid implementation of televisits, indicators of care utilization and processes of care decreased compared with prepandemic levels. Among PWH who remained in care, televisits were not associated with worse virologic, blood pressure, and glycemic control in PWH., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The burden of cardiovascular disease (CVD) is particularly high in several US states, which include the state of Michigan. Hypertension and smoking are two major risk factors for mortality due to CVD. Rural Michigan is disproportionally affected by CVD and by primary care shortages. The Healthy Hearts for Michigan (HH4M) study aims to promote hypertension management and smoking cessation through practice facilitation and quality improvement efforts and is part of the multi-state EvidenceNOW: Building State Capacity initiative to provide external support to primary care practices to improve care delivery., Methods: Primary care practices in rural and underserved areas of Michigan were recruited to join HH4M, a pragmatic, single-arm hybrid Type 2 effectiveness-implementation study during which practice facilitation was delivered at the practice level for 12 months, followed by a 3-month maintenance period., Results: Fifty-four practices were enrolled over a 12-month recruitment period. At baseline, the mean proportion (standard deviation) of patients at the practice level meeting the clinical quality measures were: blood pressure, 0.72 (0.12); tobacco screening, 0.80 (0.30); tobacco cessation intervention, 0.57 (0.28); tobacco screening and cessation intervention: 0.78 (0.26)., Conclusion: This three-year research program will evaluate the ability of rural and medically underserved primary care practices to implement the quality improvement model by identifying drivers of and barriers to sustainable implementation, and test whether the model improves (a) blood pressure control and (b) tobacco use screening and cessation., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Burnout, depression, and anxiety are prevalent among healthcare workers (HCWs) during the COVID-19 pandemic and have been previously shown to contribute to poor health outcomes and reduced quality of care. Positive psychological constructs such as positive affect and meaning and purpose are related to resilience in the face of significant stress. No studies have examined these associations among a cohort of HCWs during this pandemic. The purpose of this study was to examine the association of depression, anxiety, positive affect, and meaning and purpose with burnout among HCWs during the COVID-19 pandemic. We utilized data from a cross-sectional survey conducted between September 29-December 8, 2021, among a cohort of 2,411 HCWs from a large, tertiary academic health care system in the Chicago area. We employed the Patient-Reported Outcomes Measurement Information System (PROMIS) measures for depression, anxiety, positive affect, and meaning and purpose and burnout was measured by the Oldenburg Burnout Inventory (OLBI). The majority (80.88%) of HCWs in this study identified as White, Non-Hispanic race/ethnicity, female sex (82.37%), and roughly one third were between ages 30-39 years old (30.98%). Registered nurses (26.96%) accounted for the largest single occupation group. The mean burnout score was 36.87 (SD = 7.65), with 53.38% of participants classified as having burnout, and registered nurses demonstrating the highest proportions of burnout (63.54%). Higher depression (coef = 0.15, SE = 0.03, p < 0.001) and anxiety (coef = 0.25, SE = 0.02, p < 0.001) scores were associated with higher burnout in multivariable linear regression models. Increased positive affect (coef= -0.19, SE= 0.02, p < 0.001) and meaning and purpose (coef= -0.12, SE= 0.01, p < 0.001) scores were significantly associated with reduced burnout. Positive affect and meaning and purpose were inversely associated with burnout among a cohort of HCWs during the COVID-19 pandemic. Previous studies of positive affect and meaning and purpose suggest the potential buffering effect that these indices may have on burnout. Future research is needed to examine the effect of positive affect and meaning and purpose on mitigating the negative impacts of burnout, depression, and anxiety among HCWs as they cope with the stress of the COVID-19 pandemic and beyond., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Bannon, Evans, Freedman, Lee, Vu, Wallia, Wilkins, Moskowitz and Hirschhorn.)

Background: To reduce the impact of depression on people living with HIV, we are implementing a clinic-based behavioral health screener and referral to Optimizing Resilience and Coping with HIV through Internet Delivery, an evidenced-based intervention. We used the Consolidated Framework for Implementation Research to identify contextual barriers and facilitators in advance of implementation., Setting: Sixteen Chicagoland area Ryan White Medical Case Management sites., Methods: We conducted a sequential mixed-methods study with medical case managers and supervisors. Participants completed an online survey assessing Consolidated Framework for Implementation Research domains, scored on a 1 (strongly disagree) to 5 (strongly agree) scale. Survey results informed a purposive sampling frame and interview protocol. Interviews were analyzed by rapid qualitative analysis., Results: On average, survey respondents (n = 58) slightly agreed with positive views of team culture, learning climate, and implementation readiness (mean = 3.80-3.87). Potential barriers included intervention complexity (mean = 3.47), needed human resources (mean = 2.71-3.33), and only slight agreement with relative advantage over existing screening/referral systems (mean = 3.09-3.71). Qualitative results (n = 15) identified low advantage for clinics with robust behavioral health systems but strong advantage in clinics without these services. Respondents identified system-wide training and monitoring strategies to facilitate implementation., Conclusions: Ryan White Medical Case Management sites are a generally favorable context for the implementation of the interventions. As illustrated in an implementation research logic model, barriers will be addressed through deploying strategies proposed to impact clinic- and individual-level outcomes, including electronic prompts (reduce complexity), training on Optimizing Resilience and Coping with HIV through Internet Delivery as a complement to other behavioral health services (increase relative advantage), and feedback during implementation (strengthen rewards/incentives)., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The past decade has seen increasing opportunities and efforts to integrate quality improvement into health care. Practice facilitation is a proven strategy to support redesign and improvement in primary care practices that focuses on building organizational capacity for continuous improvement. Practice leadership, staff, and practice facilitators all play important roles in supporting quality improvement in primary care. However, little is known about their perspectives on the context, enablers, barriers, and strategies that impact quality improvement initiatives., Objective: This study aimed to develop a framework to enable assessment of contextual factors, challenges, and strategies that impact practice facilitation, clinical measure performance, and the implementation of quality improvement interventions. We also illustrated the application of the framework using a real-world case study., Methods: We developed the TITO (task, individual, technology, and organization) framework by conducting participatory stakeholder workshops and incorporating their perspectives to identify enablers and barriers to quality improvement and practice facilitation. We conducted a case study using a mixed methods approach to demonstrate the use of the framework and describe practice facilitation and factors that impact quality improvement in a primary care practice that participated in the Healthy Hearts in the Heartland study., Results: The proposed framework was used to organize and analyze different stakeholders' perspectives and key factors based on framework domains. The case study showed that practice leaders, staff, and practice facilitators all influenced the success of the quality improvement program. However, these participants faced different challenges and used different strategies. The framework showed that barriers stemmed from patients' social determinants of health, a lack of staff and time, and unsystematic facilitation resources, while enablers included practice culture, staff buy-in, implementation of effective practice facilitation strategies, practice capacity for change, and shared complementary resources from similar, ongoing programs., Conclusions: Our framework provided a useful and generalizable structure to guide and support assessment of future practice facilitation projects, quality improvement initiatives, and health care intervention implementation studies. The practice leader, staff, and practice facilitator all saw value in the quality improvement program and practice facilitation. Practice facilitators are key liaisons to help the quality improvement program; they help all stakeholders work toward a shared target and leverage tailored strategies. Taking advantage of resources from competing, yet complementary, programs as additional support may accelerate the effective achievement of quality improvement goals. Practice facilitation-supported quality improvement programs may be opportunities to assist primary care practices in achieving improved quality of care through focused and targeted efforts. The case study demonstrated how our framework can support a better understanding of contextual factors for practice facilitation, which could enable well-prepared and more successful quality improvement programs for primary care practices. Combining implementation science and informatics thinking, our TITO framework may facilitate interdisciplinary research in both fields., (©Jiancheng Ye, Donna Woods, Jennifer Bannon, Lucy Bilaver, Gayle Kricke, Megan McHugh, Abel Kho, Theresa Walunas. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 24.06.2022.)

The underutilization of pre-exposure prophylaxis (PrEP) among cisgender women in the U.S. limits this population's ability to reduce their risk for HIV infection, especially within the unique individual, social and structural systems they navigate. There is a need to identify the relevant multi-level barriers and facilitators to PrEP use among cisgender women to inform theory-guided efforts that address HIV disparities by race/ethnicity among cisgender women. Guided by the Integrated Behavioral Model and the Behavioral Model of Vulnerble Populations we conducted 41 interviews with PrEP eligible cisgender women in New York City and Philadelphia. Directed content analysis identified 11 modal behavioral beliefs crucial to PrEP uptake, including anticipated negative social consequences, 5 normative beliefs centered on available social supports, and 9 control beliefs such as anticipated barriers such as cost. Awareness and knowledge of PrEP as a biobehavioral HIV prevention method is limited for this sample. Through conventional content analysis we identified interpersonal and structural barriers to PrEP uptake including lack of partner support, transportation, mental health challenges, and challenges in accessing PrEP care. Potential solutions to structural barriers were enumerated along with implications for future intervention work and public health programming.

Background: Multiple studies have linked obesity to an increased risk of cancer. The correlation is so strong that the national cancer prevention guidelines recommend weight loss for patients with obesity to reduce their risk of cancer. Bariatric surgery has been shown to be very effective in sustained weight loss. However, there have been mixed findings about bariatric surgery and its effects on the risk of colorectal cancer., Objective: This study sought to examine bariatric surgery patients and their risk of pre-cancerous or cancerous polyps to elucidate any risk factors or associations between bariatric surgery and colorectal cancer., Setting: A retrospective review of the academic medical center's bariatric surgery database was performed from January 2010 to January 2017. Patients who underwent medical or surgical weight loss and had a subsequent colonoscopy were included in the study. Positive colonoscopy findings were described as malignant or premalignant polyps., Methods: A total of 1777 patients were included, with 1360 in the medical group and 417 in the surgical group. Data analysis included patient demographics, co-morbidities, procedure performed, surgical approach, weight loss, and colonoscopy findings. A multivariate analysis was used to determine whether an association exists between weight loss and incidence of colorectal polyps, and if so, whether the association different for medical versus surgical weight loss., Results: A higher percentage of body mass index (BMI) reduction was seen in the surgical group. An overall comparison showed average reductions in BMI of 27.7% in the surgical group and 3.5% in the medical group (P < .0001). Patients with the greatest reduction in BMI, regardless of medical or surgical therapy, showed a lower incidence of precancerous and cancerous polyps (P = .041)., Conclusion: This study offers a unique approach in examining the incidence of colorectal polyps related to obesity. Patients with the greatest reduction in their BMI, more common in the surgical group, had a lower incidence of precancerous and cancerous polyps., (Copyright © 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Practice facilitation is a multicomponent implementation strategy used to improve the capacity for practices to address care quality and implementation gaps. We sought to assess whether practice facilitators use of coaching strategies aimed at improving self-sufficiency were associated with improved implementation of quality improvement (QI) interventions in the Healthy Hearts in the Heartland Study., Methods: We mapped 27 practice facilitation activities to a framework that classifies practice facilitation strategies by the degree to which the practice develops its own process expertise (Doing Tasks, Project Management, Consulting, Teaching, and Coaching) and then used regression tree analysis to group practices by facilitation strategies experienced. Kruskal-Wallis tests were used to assess whether practice groups identified by regression tree analysis were associated with successful implementation of QI interventions and practice and study context variables., Results: There was no association between number of strategies performed by practice facilitators and number of QI interventions implemented. Regression tree analysis identified 4 distinct practice groups based on the number of Project Management and Coaching strategies performed. The median number of interventions increased across the groups. Practices receiving > 4 project management and > 6 coaching activities implemented a median of 17 of 35 interventions. Groups did not differ significantly by practice size, association with a healthcare network, or practice type. Statistically significant differences in practice location, number and duration of facilitator visits, and early study termination emerged among the groups, compared to the overall practice population., Conclusions: Practices that engage in more coaching-based strategies with practice facilitators are more likely to implement more QI interventions, and practice receptivity to these strategies was not dependent on basic practice demographics.

Objectives . Survey current experience with Skin to Skin care (SSC) in Pennsylvania Maternity Centers. Study Design . The nursing director of each Maternity Center in PA (n = 95) was sent an on-line confidential survey querying SSC practices. Responses were compared by delivery size, location, and nature of affiliation. Statistics analyzed by chi-square and student t-test. Results. Of these 64/95 MCs (67%) responded. All allowed SSC after vaginal deliveries, 55% after C-section, 73% mother's room. Monitoring included delivery room nurse (94%) with support from other providers (61%), family members (37%), and electronic monitoring (5%). If SSC occurred in mother's room all reported family education on safe practices. 40% were aware of adverse SSC events, including falls and suffocation. About 80% educated staff about infant safety during SSC. Conclusions. Gaps in education and supervision during SSC were identified. Additional education and standardization of best practices are needed to reduce risks from falls and suffocation during SSC., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: Live kidney donors (LKDs) account for nearly a third of kidney transplants in the United States. While donor nephrectomy poses minimal post-surgical risk, LKDs face an elevated adjusted risk of developing chronic diseases such as hypertension, diabetes, and end-stage renal disease. Routine screening presents an opportunity for the early detection and management of chronic conditions. Transplant hospital reporting requirements mandate the submission of laboratory and clinical data at 6-months, 1-year, and 2-years after kidney donation, but less than 50% of hospitals are able to comply. Strategies to increase patient engagement in follow-up efforts while minimizing administrative burden are needed. We seek to evaluate the effectiveness of using small financial incentives to promote patient compliance with LKD follow-up., Methods/design: We are conducting a two-arm randomized controlled trial (RCT) of patients who undergo live donor nephrectomy at The Johns Hopkins Hospital Comprehensive Transplant Center (MDJH) and the University of Maryland Medical Center Transplant Center (MDUM). Eligible donors will be recruited in-person at their first post-surgical clinic visit or over the phone. We will use block randomization to assign LKDs to the intervention ($25 gift card at each follow-up visit) or control arm (current standard of care). Follow-up compliance will be tracked over time. The primary outcome will be complete (all components addressed) and timely (60 days before or after expected visit date), submission of LKD follow-up data at required 6-month, 1-year, and 2-year time points. The secondary outcome will be transplant hospital-level compliance with federal reporting requirements at each visit. Rates will be compared between the two arms following the intention-to-treat principle., Discussion: Small financial incentivization might increase patient compliance in the context of LKD follow-up, without placing undue administrative burden on transplant providers. The findings of this RCT will inform potential center- and national-level initiatives to provide all LKDs with small financial incentives to promote engagement with post-donation monitoring efforts., Trial Registration: ClinicalTrials.gov number: NCT03090646 Date of registration: March 2, 2017 Sponsors: Johns Hopkins University, University of Maryland Medical Center Funding: The Living Legacy Foundation of Maryland.

Mentorship is a vital component within general surgery residency that fosters success extending into future practices. Recognizing the need for formalized mentorship within our general surgery residency, a survey based match process was developed. The "Mentor Match" was developed by creating resident and faculty surveys using the six ACGME core competencies of patient care, medical knowledge, communication skills, practice based learning, system based practice and professionalism. Surveys focused on resident areas of weakness correlating to areas in which faculty expressed subjective strength. Survey results were used to match faculty mentors with resident mentees. One year after implementation, residents were surveyed to evaluate the perceived success of the match process and mentorship program. Resident participation was 100% with a survey response of 78%. Ninety-two percent of residents were satisfied with the program, 83% saw improvement in their areas of weakness and 75% felt the match process was effective in pairing mentors with mentees. In conclusion, the "Mentor Match" was an effective tool in developing a formalized mentorship program with positive results after one year of implementation., Competing Interests: Declaration of competing interest We have no conflict of interest to declare for this study., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Adolescents and young adults in the age range of 13-24 years are at the highest risk of developing HIV infections. As social media platforms are extremely popular among youths, researchers can utilize these platforms to curb the HIV epidemic by investigating the associations between the discourses on HIV infections and the epidemiological data of HIV infections., Objective: The goal of this study was to examine how Twitter activity among young men is related to the incidence of HIV infection in the population., Methods: We used integrated human-computer techniques to characterize the HIV-related tweets by male adolescents and young male adults (age range: 13-24 years). We identified tweets related to HIV risk and prevention by using natural language processing (NLP). Our NLP algorithm identified 89.1% (2243/2517) relevant tweets, which were manually coded by expert coders. We coded 1577 HIV-prevention tweets and 17.5% (940/5372) of general sex-related tweets (including emojis, gifs, and images), and we achieved reliability with intraclass correlation at 0.80 or higher on key constructs. Bivariate and multivariate analyses were performed to identify the spatial patterns in posting HIV-related tweets as well as the relationships between the tweets and local HIV infection rates., Results: We analyzed 2517 tweets that were identified as relevant to HIV risk and prevention tags; these tweets were geolocated in 109 counties throughout the United States. After adjusting for region, HIV prevalence, and social disadvantage index, our findings indicated that every 100-tweet increase in HIV-specific tweets per capita from noninstitutional accounts was associated with a multiplicative effect of 0.97 (95% CI [0.94-1.00]; P=.04) on the incidence of HIV infections in the following year in a given county., Conclusions: Twitter may serve as a proxy of public behavior related to HIV infections, and the association between the number of HIV-related tweets and HIV infection rates further supports the use of social media for HIV disease prevention., (©Robin Stevens, Stephen Bonett, Jacqueline Bannon, Deepti Chittamuru, Barry Slaff, Safa K Browne, Sarah Huang, José A Bauermeister. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 24.06.2020.)

Background: Prior studies have shown a better prognosis with medullary colon cancer (MCC) compared to nonmedullary colon carcinomas (NMC); however, data are inconsistent and lacking the evaluation of treatments received. As we did not see similar survival outcomes, we aimed to retrospectively examine survival and receipt of treatment differences between MCC and NMC within the Geisinger Health System., Methods: The Cancer Registry was retrospectively reviewed for MCC and NMC from 2006 to 2017. Demographics and treatments were compared using T -test and chi-squared analyses, also comparing MCC to poorly differentiated (PD) or undifferentiated (UD) NMC. Overall survival was analyzed using Kaplan-Meier curves and log-rank tests., Results: 33 MCC and 1775 NMC patients were identified and 31 (93.9%) MCC and 1433 (87.0%) NMC underwent resection. MCC were older ( p =0.0002), had a higher Charlson Comorbidity Index ( p =0.013) and were more likely right sided ( p =0.013). Seven patients (22.6%) with MCC vs. 149 (10.4%) NMC underwent resection of contiguous organs. Overall median survival was significantly worse for MCC as compared to NMC (19.6 vs. 60.5 months, p =0.0002). Only stage 3 patients had a significantly worse median survival when compared to PD/UD NMC (9.6 vs. 47.2 months, p < 0.001). Contiguous organ resection and failure to receive chemotherapy were not found as contributing factors to decreased survival., Conclusion: Multiple previous studies showed a better prognosis for MCC compared to PD/UD NMC. We, however, found stage 3 patients had a worse prognosis which may be secondary to higher comorbidities, increased stage, and higher rate of UD., Competing Interests: The authors declares that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 A. Gupta et al.)

Contemporary research on aging has provided mixed evidence for whether older adults are less effective than younger adults at designing and delivering spoken utterances. However, most of these studies have focused on only specific aspects of this process. In addition, they tend to vary significantly in terms of the degree of complexity in their chosen stimuli or task. The present study compares younger and older adults' performance using a referential production paradigm involving simple everyday objects. We varied referential context such that a target object was either unique in its category (e.g., one shirt), or was accompanied by a same-category object (e.g., two shirts). We evaluated whether speakers' descriptions provided listeners with sufficient information for identification, and whether speakers spontaneously adapt their speech for different addressee types (younger adult, older adult, automated dialogue system). A variety of measures were included to provide a comprehensive perspective on adults' performance. Interestingly, the results revealed few or no age differences in measures related to production performance (speech onset latency, speech rate, and fluency). In contrast, consistent differences were observed for measures related to descriptive content, both in terms of informativity and variability in lexical selection: Older adults not only provided more information than necessary for referential success (e.g., superfluous modifiers), but also exhibited greater variability in their selection of modifiers. The results show that, although certain aspects of the production process are well-preserved across the adult lifespan, meaningful age-related differences can still be found in simple referential tasks with everyday objects. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background: Every year, more than 5500 healthy people in the United States donate a kidney for the medical benefit of another person. The Organ Procurement and Transplantation Network (OPTN) requires transplant hospitals to monitor living kidney donors (LKDs) for 2 years postdonation. However, the majority (115/202, 57%) of transplant hospitals in the United States continue to fail to meet nationally mandated requirements for LKD follow-up. A novel method for collecting LKD follow-up is needed to ease both the transplant hospital-level and patient-level burden. We built mKidney-a mobile health (mHealth) system designed specifically to facilitate the collection and reporting of OPTN-required LKD follow-up data. The mKidney mobile app was developed on the basis of input elicited from LKDs, transplant providers, and thought leaders., Objective: The primary objective of this study is to evaluate the impact of the mKidney smartphone app on LKD follow-up rates., Methods: We will conduct a two-arm randomized controlled trial (RCT) with LKDs who undergo LKD transplantation at Methodist Specialty and Transplant Hospital in San Antonio, Texas. Eligible participants will be recruited in-person by a study team member at their 1-week postdonation clinical visit and randomly assigned to the intervention or control arm (1:1). Participants in the intervention arm will receive the mHealth intervention (mKidney), and participants in the control arm will receive the current standard of follow-up care. Our primary outcome will be policy-defined complete (all components addressed) and timely (60 days before or after the expected visit date) submission of LKD follow-up data at required 6-month, 1-year, and 2-year visits. Our secondary outcome will be hospital-level compliance with OPTN reporting requirements at each visit. Data analysis will follow the intention-to-treat principle. Additionally, we will collect quantitative and qualitative process data regarding the implementation of the mKidney system., Results: We began recruitment for this RCT in May 2018. We plan to enroll 400 LKDs over 2 years and follow participants for the 2-year mandated follow-up period., Conclusions: This pilot RCT will evaluate the impact of the mKidney system on rates of LKD and hospital compliance with OPTN-mandated LKD follow-up at a large LKD transplant hospital. It will provide valuable information on strategies for implementing such a system in a clinical setting and inform effect sizes for future RCT sample size calculations., International Registered Report Identifier (irrid): DERR1-10.2196/11000., (©Macey L Henderson, Alvin G Thomas, Ann K Eno, Madeleine M Waldram, Jaclyn Bannon, Allan B Massie, Michael A Levan, Dorry L Segev, Adam W Bingaman. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 15.01.2019.)

The present study provides normative measures for a new stimulus set of images consisting of 225 everyday objects, each depicted both as a photograph and a matched clipart image generated directly from the photograph (450 images total). The clipart images preserve the same scale, shape, orientation, and general color features as the corresponding photographs. Various norms (modal name and verb agreement measures, picture-name agreement, familiarity, visual complexity, and image agreement) were collected separately for each image type and in two different contexts: online (using Mechanical Turk) and in the laboratory. We discuss similarities and differences in the normative measures according to both image type and experimental context. The full set of norms is provided in the supplemental materials.

Titanocene compounds are a novel series of agents that exhibit cytotoxic effects in a variety of human cancer cells in vitro and in vivo. In this study, the antiproliferative activity of two titanocenes (Titanocenes X and Y) was evaluated in human epidermoid cancer cells in vitro. Titanocenes X and Y induce apoptotic cell death in epidermoid cancer cells, with IC50 values that are comparable to cisplatin. Characterisation of the cell death pathway induced by titanocene compounds in A431 cells revealed that apoptosis is preceded by cell cycle arrest and the inhibition of cell proliferation. The induction of apoptosis is dependent on the activation of caspase-3 and -7 but not caspase-8. Furthermore, the antitumour activity of Titanocene Y was tested in an A431 xenograft model of epidermoid cancer. Results indicate that Titanocene Y significantly reduced the growth of A431 xenografts with an antitumour effect similar to cisplatin. These results suggest that titanocenes represent a novel series of promising antitumour agents.

The behavioural changes initiated during Phase III cardiac rehabilitation programmes were recorded using Prochaska and Diclemente's "stages of change" model. This study aimed to ascertain if changes were initiated, maintained or further developed during Phase III programmes and 6 months after the programmes with a view to ascertaining the usefulness of this tool in providing stage matched individualised care. The risk factors examined were: exercise, diet and stress. The stages were recorded quantitatively and were numerically designated a value of 1-5. The results were analysed using SPSS. The sample number was one hundred and eighty seven patients. Significant improvements were made by the end of the programme (6 or 8 weeks) indicating that most patients had modified their behaviour during the programme. There was no significant additional improvement in the risk factors 6 months later. These results are a further indication of the need for support post Phase III programmes. Patients entered Phase III rehabilitation at different stages in their risk behaviours and with regard to exercise this stage at commencement influences the final stage achieved. "Stages of change" is a useful simple method of recording behavioural change and this type of routine monitoring of a patient could be used effectively as part of the individual care plan during the programme.

Routine anaerobic culture of urine identified the urinary tract as the primary focus of sepsis in a postoperative patient with Bacteroides fragilis septicaemia. Specimens of urine from six other symptomatic patients grew > 10(8) cfu/litre of a Bacteroides species in pure growth. The significance of these isolates is discussed. Multipoint technology and the availability of anaerobic work stations have facilitated anaerobic culture and reduced its cost. The incorporation of anaerobic culture of urine into routine laboratory practice may be clinically valuable and should be considered.

Background: Despite conventional attitudes that interdict sphincter-preservation surgery (SPS) for cancers arising in the terminal 3 cm of rectum, we have selectively employed high-dose preoperative external radiation (HDPER) and either radical or local excisional SPS techniques for rectal cancer arising between the 0.5 and 3 cm levels above the anorectal ring. We have reported a preliminary experience with HDPER and full-thickness local excision (FTLE) and three different methods of radical SPS. We now describe our experience with a single method of radical excision, transanal abdominal transanal proctosigmoidectomy with coloanal anastomosis (TATA) and FTLE in conjunction with HDPER for cancers of the distal 3 cm of rectum based on specific guidelines., Methods: Since 1984, 109 patients with cancers at or below the 3 cm level have been treated with HDPER in doses of 4,500-7,000 cGy and a sphincter-preserving radical or local excision method in a prospective rectal cancer management program. Sixty-five patients (group A) underwent transanal abdominal transanal radical proctosigmoidectomy with colonal anastomosis (TATA) and 44 patients (group B) underwent FTLE., Results: There was one death (1%). Mean follow-up was 40 months. Local recurrence rates for groups A and B were 9 and 14%, respectively. Kaplan-Meier 5-year actuarial survival was 85 and 90% for groups A and B, respectively, and 87% collectively., Conclusion: Experience with 109 patients with cancers of the distal 3 cm of rectum indicates that SPS can be accomplished by either radical or local excisional methods with acceptable local control and survival if HDPER and strict selection guidelines are employed.

Strongyloides stercoralis is an intestinal nematode that is widely distributed throughout the tropics and subtropics. Immigration patterns, travel, and poor hygiene can place patients in the United States at an increased risk. Endemic regions in the southeastern United States have been identified. The infected host may be asymptomatic or present with a wide variety of complaints. Abdominal findings may mimic an acute abdomen or intestinal obstruction, which may lead to an avoidable laparotomy. A massive infection of the gastrointestinal tract and lungs is termed hyperinfection syndrome. Disseminated strongyloides occurs when other organs are involved. This can be life-threatening. A prominent predisposing factor to severe infection is a patient's status as an immunocomprised host. Asymptomatic infected hosts can become symptomatic after the initiation of corticosteroid therapy or other immunosuppressive medications. Strongyloidiasis should be considered in patients with transient pulmonary infiltrates and gastrointestinal complaints. A recent travel history, poor hygiene, cutaneous manifestations, or blood eosinophilia may point to the diagnosis. Negative stool cultures do not rule out the diagnosis, and esphogogastroduodonoscopy with aspiration cultures and mucosal biopsy greatly increase the diagnostic yield. A high index of suspicion is necessary to establish the diagnosis, and unnecessary laparotomies can be avoided.

Purpose: To assess the efficacy of high-dose preoperative radiation and full thickness local excision as an option for the management of selected distal rectal cancers., Methods and Materials: Forty-eight patients with invasive distal rectal cancer have been treated with high-dose preoperative radiation (45-55 GY at 180 cGy/fx) followed 6 to 8 weeks later by full thickness local excision. Three groups of patients are included in this study. Group 1 (N = 15) Medically Compromised: patients with rectal cancers Stages T3 or > 3 cm in size and significant cardiorespiratory disease that precluded radical surgery. Group 2 (N = 18) Elective: patients suitable for local treatment by standard criteria (Stages < T2 and < 3 cm in size), and group 3 (N = 15) Staged: patients with Stages T3 or > 3 cm in size that postradiation were downstaged and met the criteria as in group 2. One patient in group 3 was found to be pathologically T3 following full thickness local excision and was converted to an abdominoperineal resection. Follow-up ranges from 6-96 months with a median of 40 months., Results: The overall 5-year actuarial survival for the whole group is 83.5% and local recurrence is 10%. The 5-year survival is 74%, 92%, and 88% for Groups 1, 2, and 3 and 90%, 89%, and 50% for postradiation pathologic stages T0/T1, T2, and T3, respectively. Local recurrence rate by treatment groups are 20%, 11%, and 0% for groups 1, 2, and 3 and 11%, 0%, and 67% for postradiation Stages T0/T1, T2, and T3, respectively. Surgical complications, primarily wound healing, were observed in five patients (10%). Four patients required a subsequent colostomy (three for recurrence and one for a rectovaginal fistula). Sphincter function as measured by Parks criteria was good/excellent in 88% of patients., Conclusion: High-dose preoperative radiation and full thickness local excision appear to be a promising new option for the management of selected patients with invasive distal rectal cancers. Selected patients with Stage T3 cancers that as a result of preoperative radiation are downstaged and met the criteria for primary local therapy (T2 or less) appear to have an excellent survival with retained normal sphincter function following full thickness local excision.

Successful long-term treatment of hypertension must include consideration of individual patients' life-style interfaced with the potential for adverse drug events. In a postmarketing surveillance study, 30,515 patients received captopril monotherapy and were evaluated by 7792 physicians. Mean systolic and diastolic blood pressures were reduced 17 and 11 mm Hg, respectively. Mean diastolic blood pressure was reduced 10% for patients with mild hypertension; larger mean reductions were noted for patients with moderate (16.5%) and severe (21.5%) hypertension. Captopril therapy was equally effective in all races (white, Hispanic, and black patients), age groups, and in isolated instances of systolic hypertension. Only 4.9% of patients reporting an adverse event required discontinuation of therapy. Headache (1.8%) and dizziness (1.6%) were the most frequently reported adverse events. Quality-of-life measures improved.

Beta-adrenergic blocking drugs are gaining acceptance as initial therapy for patients with mild to moderate hypertension. In a postmarketing surveillance study, 5,190 hypertensive patients received timolol maleate monotherapy and were evaluated by 1,355 physicians. A total of 1,057 patients did not complete the study: 28% of these patients experienced an adverse event. Mean systolic and diastolic blood pressure readings were reduced 20 and 13 mm Hg, respectively. Mean diastolic blood pressure was reduced 11% for patients with mild hypertension; larger mean reductions were noted for patients with moderate (17%) and severe hypertension (22%). The effect in black and elderly patients was less than in other groups. Although 22% of all patients experienced an adverse event, less than 2.2% of all patients experienced events related to beta-adrenergic blockade, ie, respiratory difficulty, heart failure, bradycardia, and cold extremities. Fatigue, dizziness, and nausea were the most frequently reported adverse events requiring discontinuation of therapy. Timolol monotherapy is a well-tolerated and effective treatment for a broad range of hypertensive patients.

A postmarketing surveillance study was conducted to determine the safety and efficacy of a fixed-ratio combination containing 10 mg of timolol maleate and 25 mg of hydrochlorothiazide, administered twice daily for one month to hypertensive patients. Data on 9,037 patients were collected by 1,455 participating physicians. Mean systolic blood pressure decreased 25 mmHg and mean diastolic blood pressure declined 15 mmHg after one month of timolol-hydrochlorothiazide therapy (P less than 0.01, both comparisons). Age, race, and sex appeared to have no influence on the decrease in blood pressure. The antihypertensive effect of the drug was greater in patients with more severe hypertension. Overall, 1,453 patients experienced a total of 2,658 adverse events, the most common being fatigue, dizziness, and weakness. Treatment in 590 patients was discontinued because of adverse events.