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In the seven years since the HIV Organ Policy Equity (HOPE) Act made HIV-positive organ donation to HIV-positive recipients legally permissible in the United States, there have been fewer HIV-positive organ donations than expected. Organ procurement organizations (OPOs) play a key role in the transplant system and barriers at OPOs may be partly responsible for the relatively low number of HIV-positive donors. To understand potential OPO barriers, we conducted semi-structured interviews with 20 OPO staff members. Interviews were recorded, transcribed, and analyzed using a conventional content analytic approach with two coders. OPO staff had high levels of knowledge about HOPE. Many had evaluated referrals of HIV-positive donors and approached families for authorization. Barriers to HIV-positive organ recovery identified included obtaining authorization for donation, potentially disclosing HIV status to next-of-kin, and fear of HIV infection among those engaged in organ recovery. Strategies to overcome these barriers include providing continuing education about the specific tasks required to procure organs from HIV-positive donors, implementing targeted interventions to reduce fear of infection, and developing partnerships with HIV advocacy and care organizations. Given the central role OPOs play, HIV-positive donations are unlikely to occur in significant numbers unless these barriers can be overcome.

The study used qualitative research method to gather non-numerical data about ideas, or experiences related to a reading gap of Grade-3 learners in the public elementary schools. Data was collected through individual interviews. The participants were public grade 3 elementary teachers, learners and parents from different schools in Cluster VIII of the Schools Division Office of Urdaneta City. The study presents the results of the Functional Literacy Assessment Tool (FLAT) report for Grade 3 learners in three elementary schools during the first quarter of School Year 2022-2023. The data suggests that learners need to focus on improving their performance in the Below Letter Level and Local Material Level + Comprehension categories, which are crucial for developing foundational reading skills. Regular assessments of students' literacy levels can help identify areas of strengths and weaknesses and provide an opportunity to develop effective interventions that can help students overcome reading difficulties and achieve better academic outcomes. Various factors contribute to reading gaps, including lack of familiarity with letters and words, shyness, and slow reading. Parental involvement in promoting reading proficiency is crucial. The study proposes a program of activities in reading that aims to develop effective reading strategies, foster positive attitudes towards reading, and encourage family engagement in reading and learning. The study emphasizes the need for targeted interventions and collaboration among teachers, learners, parents, and peers to improve reading skills.

BACKGROUND: Reintubation and prolonged intubation after cardiac surgery are associated with significant complications. Despite these competing risks, providers frequently extubate patients with limited insight into the risk of reintubation at the time of extubation. Achieving timely, successful extubation remains a significant clinical challenge. METHODS: Based on an analysis of 2835 patients undergoing cardiac surgery at our institution between November 2017 and July 2020, we developed a model for an individual’s risk of reintubation at the time of extubation. Predictors were screened for inclusion in the model based on clinical plausibility and availability at the time of extubation. Rigorous data reduction methods were used to create a model that could be easily integrated into clinical workflow at the time of extubation. RESULTS: In total, 90 patients (3.2%) were reintubated within 48 hours of initial extubation. Number of inotropes [1 (adjusted odds ratio (OR), 15.4; 95% confidence interval (CI) 6.5–47.6; p

Background: Reports of post-discharge admissions for surgical site infection (SSI) in African settings are lacking. This information could assist with allocating resources within hospitals, as well as developing targeted interventions aimed at reducing post-discharge SSI. The primary objective of this study was to determine trends in admissions for post-discharge SSI at a South African quaternary/teaching hospital. The secondary objective was to determine trends in mortality rates for these admissions. Methods: This was a retrospective review of adult admissions for post-discharge SSI at a quaternary/teaching South African hospital between 2006 and 2015. Admissions for post-discharge SSI were identified using the hospital administrative database and appropriate International Classification of Disease, 10th Revision codes. Mortality was determined from the discharge disposition for each admission. Data were analysed with simple regression and trend line statistics. The geospatial distribution of post-discharge SSI, based on the residential postal codes recorded on the hospital administrative database for each admission, was determined using the Power Map® software program. Results: There was no change in admissions for post-discharge SSI over the study period (p = 0.17). Mortality in elderly admissions declined during the study period (p = 0.03). Most admissions for post-discharge SSIs originated from urban areas. Conclusion: Despite the implementation of universal SSI prevention methods, admissions for post-discharge SSI remained consistent during the study period. Urban areas appeared to be more severely affected by post-discharge SSI than rural areas. Additional prevention methods for post-discharge SSI are required.&nbsp

INTRODUCTION Self-determination theory proposes that autonomy-supportive environments produce better health outcomes, and evidence demonstrating the importance of autonomy support for health behavior change has become increasingly clear. The bulk of the previous research has focused on the effects of receiving autonomy support, whereas the present study focuses on the potential impact of providing autonomy support for improving the weight loss and relationship satisfaction of the support provider. METHOD Sixty-four couples were randomized to a standard weight loss intervention or to an intervention that included training to enhance autonomy support behavior (e.g., empathic responding, accepting personal choices, etc.). Groups met weekly for 6 months, with assessments at baseline, 3, 6, and 12 months. The assessment of provided autonomy support was based on ratings of videotaped interactions of the couple discussing weight loss issues and on partner report of the autonomy support they received. RESULTS The results did not show any condition effects; however, the results for both conditions indicated that beyond receiving autonomy support, providing autonomy support was associated with greater sustained weight loss for the support provider, and for men greater relationship satisfaction over time. DISCUSSION The results confirm the importance of couples-based interventions and autonomy support for behavior change. In addition, it appears that providing autonomy support is useful for both the recipient and the provider. These results point to the need for developing targeted interventions to facilitate the provision of autonomy support. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The physical and mental health benefits of physical activity in all populations are well established. In 2019, incarcerated women at a Southwest county jail were observed during “recreation time,” a time when physical activity is encouraged, to identify the proportion of women who participated in recreation time and their physical activity levels. During observed recreation times, 28% of women attended; 56% were sedentary, 4% engaged in vigorous physical activity, and approximately 40% walked or performed similarly moderate physical activity. Future research should identify barriers to being physically active while incarcerated, leading to targeted interventions to promote physical activity.

BACKGROUND: Timely development of early motor skills is essential for later skill development in multiple domains. Infants with severe bronchopulmonary dysplasia (BPD) have significant risk for developmental delays. Early motor skill development in this population has not been described. The aim of the present study was to characterize motor skill acquisition at 3 and 6 months corrected age (CA) and assess trajectories of skill development over this time period in infants with severe BPD. METHODS: We performed a single-center, retrospective descriptive study. Motor skills were categorized as present and normal, present but atypical, or absent at 3 and 6 months CA. Logistic regression was used to identify clinical characteristics associated with negative trajectories of skill acquisition. RESULTS: Data were available for 232 infants and 187 infants at 3 and 6 months CA, respectively. Ten motor skills were present and normal in 5–44%(range) of subjects at 3 months. Nineteen motor skills were present and normal in 1–63%(range) of subjects at 6 months. Significant postural asymmetry was noted throughout the study period. Loss of skills and worsening asymmetries over time were common. Exposure to sedating medications was significantly associated with poor development. CONCLUSION: We report delays in motor skill acquisition and postural asymmetries in infants with severe BPD at both 3 and 6 months CA. The association between sedating medications and poor development suggests that efforts to limit these exposures may lead to improved development. Targeted interventions to facilitate early motor development may improve outcomes of this high-risk population.

Youthful offending is a complex behavior that develops from an interaction between social experiences and individual differences in thinking patterns and emotional reactions favoring antisociality. The combination of factors associated with offending varies across individuals and influences the ways in which youth perceive, interpret, and respond to a wide range of experiences. Programs must consider the specific environmental (e.g., community), institutional (e.g., schools, parents, peers), and individual factors impacting youth as essential targets for intervention. We synthesize research on family-focused, school-focused, peer- and community-focused, trauma-focused, cognitive-behavioral, and multisystem interventions in terms of their targets and note variability in their effectiveness. Furthermore, we highlight the continued need for developmentally appropriate interventions that accurately target the mechanisms of action, do no harm, are delivered with fidelity, and encourage active engagement by both interveners and youth.

Objective To explore critical care clinicians’ knowledge, attitudes and perceptions toward early mobilization of critically ill patients in ICUs. Design A cross-sectional national survey was conducted. From January to August 2020, ICU nurses in 11 hospitals were surveyed by using a questionnaire on the knowledge, attitudes and perceptions of ICU early mobilization. Results Totally 512 nurses completed the questionnaire. The respondents’ mean score for knowledge of early mobilization was 6.89 ± 2.91. The level of knowledge was good in 2.5% (13/512), fair in 52.3% (268/512). The attitudes toward early mobilization were positive in 31.4% (161/512). In terms of perceived implementation of ICU early mobilization, 42.9% (220/512) of nurses did not believe that this should be a top priority in intensive care. The attitudes of nurses from different ICUs were significantly different (F = 3.58, P

Для обеспечения эффективного инклюзивного образовательного процесса необходимы специалисты, изначально принимающие новую систему ценностей; владеющие современными методиками инклюзивного обучения, воспитания и социализации обучающихся с различными образовательными потребностями. В данной статье представлены основные факторы обеспечения эффективного инклюзивного образования: выявление образовательных потребностей учащихся, обеспечение качественного обучения с учетом образовательных потребностей посредством применения различных стратегий и подходов; осуществление эффективного руководства образовательной организацией с учетом понимания и принятия педагогическим коллективом концептуальных основ инклюзии. В статье делается вывод о том, что для предоставления качественного образования учащимся преподавателям необходимо выявлять образовательные потребности всех обучающихся, моделировать компоненты и организационно-содержательное обеспечение инклюзивной образовательной среды, разрабатывать и внедрять практико-ориентированные инклюзивные технологии., To ensure an effective inclusive educational process, specialists are needed who initially accept a new system of values; who possess modern methods of inclusive education, upbringing and socialization of students with different educational needs. The article presents the main factors for ensuring effective inclusive education: identifying the educational needs of students, providing quality education taking into account educational needs through the use of various strategies and approaches; implementing effective management of an educational organization taking into account the understanding and acceptance by the teaching staff of the conceptual foundations of inclusion. The article concludes that in order to provide quality education to students, teachers have to identify the educational needs of all students, model the components and organizational and substantive support of an inclusive educational environment, develop and implement practice-oriented inclusive technologies.

The focus of the present work is directed at developing and examining the effectiveness of various psychological interventions - aimed at improving intergroup relations amongst individuals differing in their attitudes, personalities, and emotions. While examining a theoretical framework for developing and matching distinct psychological interventions with individual-level factors by comparing the effectiveness of widely established interventions in promoting social equality and mitigating intergroup conflict - amongst different types of audiences (differing in ideology, personal values and traits).

This research explores the impact of effective leadership and targeted interventions in closing the achievement gap of disadvantaged pupils in primary schools. Findings suggest that the case study schools use effective school leaders and a range of targeted interventions including early intervention, small group additional teaching, one-to-one tuition, peer tutoring, parental involvement, booster class, mastery learning, pastoral care, and enrichment programmes. Each of the above success factors and intervention strategies was explored in detail in the paper. The overall conclusions of this study are that the case study schools have closed the achievement gap between disadvantaged pupils and their peers through providing effective school leaders and the use of a range of effective intervention strategies. We would suggest that the case study schools’ stories of how they have closed the achievement gap through providing strong school leaders and the use of targeted interventions are of local and national significance. Our research also suggests the possibilities for further research. The recommendations from the study are that there is a need to replicate and expand this research with a larger sample of the study, in order to explore in detail what works in schools.

Studies have suggested that body image is associated with dating anxiety, but are limited by small sample sizes, singular operationalisations of body image, and a lack of consideration of the concurrent effects of social physique anxiety. To overcome these gaps in the literature, we asked an online sample of 501 heterosexual emerging adults from the United Kingdom (age M = 21.16, 50.3% women) to complete measures of multidimensional body image, social physique anxiety, and dating anxiety. Correlational analyses indicated that more negative body image and social physique anxiety were both significantly associated with greater dating anxiety. However, in hierarchical regressions, the variance accounted for by body image variables was largely non-significant and weak after accounting for the effects of social physique anxiety. In exploratory analyses, we found that social physique anxiety mediated the relationship between the body image facet of appearance orientation and dating anxiety. These results highlight the importance of developing targeted interventions to reduce social physique anxiety and unhealthy appearance orientation in heterosocial dating contexts.

PURPOSE Acute care use (ACU) is a major driver of oncologic costs and is penalized by a Centers for Medicare & Medicaid Services quality measure, OP-35. Targeted interventions reduce preventable ACU; however, identifying which patients might benefit remains challenging. Prior predictive models have made use of a limited subset of the data in the electronic health record (EHR). We aimed to predict risk of preventable ACU after starting chemotherapy using machine learning (ML) algorithms trained on comprehensive EHR data. METHODS Chemotherapy patients treated at an academic institution and affiliated community care sites between January 2013 and July 2019 who met inclusion criteria for OP-35 were identified. Preventable ACU was defined using OP-35 criteria. Structured EHR data generated before chemotherapy treatment were obtained. ML models were trained to predict risk for ACU after starting chemotherapy using 80% of the cohort. The remaining 20% were used to test model performance by the area under the receiver operator curve. RESULTS Eight thousand four hundred thirty-nine patients were included, of whom 35% had preventable ACU within 180 days of starting chemotherapy. Our primary model classified patients at risk for preventable ACU with an area under the receiver operator curve of 0.783 (95% CI, 0.761 to 0.806). Performance was better for identifying admissions than emergency department visits. Key variables included prior hospitalizations, cancer stage, race, laboratory values, and a diagnosis of depression. Analyses showed limited benefit from including patient-reported outcome data and indicated inequities in outcomes and risk modeling for Black and Medicaid patients. CONCLUSION Dense EHR data can identify patients at risk for ACU using ML with promising accuracy. These models have potential to improve cancer care outcomes, patient experience, and costs by allowing for targeted, preventative interventions.

PURPOSE Breast cancer risk prediction models are used to identify high-risk women for early detection, targeted interventions, and enrollment into prevention trials. We sought to develop and evaluate a risk prediction model for breast cancer in US Black women, suitable for use in primary care settings. METHODS Breast cancer relative risks and attributable risks were estimated using data from Black women in three US population-based case-control studies (3,468 breast cancer cases; 3,578 controls age 30-69 years) and combined with SEER age- and race-specific incidence rates, with incorporation of competing mortality, to develop an absolute risk model. The model was validated in prospective data among 51,798 participants of the Black Women's Health Study, including 1,515 who developed invasive breast cancer. A second risk prediction model was developed on the basis of estrogen receptor (ER)–specific relative risks and attributable risks. Model performance was assessed by calibration (expected/observed cases) and discriminatory accuracy (C-statistic). RESULTS The expected/observed ratio was 1.01 (95% CI, 0.95 to 1.07). Age-adjusted C-statistics were 0.58 (95% CI, 0.56 to 0.59) overall and 0.63 (95% CI, 0.58 to 0.68) among women younger than 40 years. These measures were almost identical in the model based on estrogen receptor–specific relative risks and attributable risks. CONCLUSION Discriminatory accuracy of the new model was similar to that of the most frequently used questionnaire-based breast cancer risk prediction models in White women, suggesting that effective risk stratification for Black women is now possible. This model may be especially valuable for risk stratification of young Black women, who are below the ages at which breast cancer screening is typically begun.

Body image issues and disordered eating are relatively under-researched areas within midlife populations. Accordingly, this study investigated the applicability of the Tripartite Influence Model (TIM) to midlife women. In an online survey, predominately Australian female participants (N = 206) aged 40–55 years (M = 46.75, SD = 4.54) completed measures related to sociocultural pressures, thin-ideal internalisation, appearance comparison, body dissatisfaction, bulimic symptoms, restrained eating, and psychological distress. Path analysis was used to evaluate the model. Greater peer and media pressure were associated with greater appearance comparison, which in turn was associated with greater thin-ideal internalisation, and through this greater body dissatisfaction. Similarly, greater body dissatisfaction was associated with greater restrained eating and bulimic symptoms, which in turn were associated with greater psychological distress. Unexpectedly, family pressure also emerged as an important direct predictor of outcomes, while sociocultural influences were not associated with thin-ideal internalisation, nor was family pressure associated with appearance comparison. Furthermore, appearance comparison was not associated with body dissatisfaction. Overall, the findings provide partial support for applicability of the TIM for midlife women and suggest practical implications such as targeted interventions that may assist body image disturbance and associated outcomes for midlife women.

PURPOSE: To assess the level of knowledge and attitudes of nurses and midwives in Cyprus toward vaccinations and provide new insights into the determinants that influence them. METHODS: An online cross-sectional study was carried out during the period between December 08 and 28 2020. Participants included registered nurses and midwives working in public or private service provision. A self-administered questionnaire was used with questions about sociodemographic characteristics, questions assessing attitudes and beliefs toward vaccination, and participants' general vaccine knowledge. FINDINGS: A total of 437 responders answered the survey, with 93% being nurses and 7% midwives. Around two-thirds (67.3%) of the participants had a high vaccination knowledge, while the remaining have moderate (30.7%), and low (2.1%), respectively. Most of the participants agreed that by vaccinating they protect themselves and those around them (80.5%) and that when most people are not vaccinated, epidemics can easily initiate (74%). Oppositely, many participants disagreed with vaccination and avoided it due to a fear of injections (95.4%) or the belief that it is better to get sick rather than be vaccinated (69.1%). Neutral attitudes toward vaccine-mediated side effects (43.1%) and vaccination safety (41.7%) were observed. Sociodemographic factors such as age, educational status, and work setting significantly affected the nurses' and midwives' knowledge and attitudes toward vaccination (p < 0.05). CONCLUSIONS: The findings indicate that the overall vaccination knowledge of participants was high, however, gaps in vaccination knowledge were observed. Individuals who adopted a neutral stance toward vaccination can be prone to changes either toward positive or negative attitudes. IMPLICATIONS FOR NURSING PRACTICE: The survey findings suggest implementing educational strategies and targeted interventions in clinical settings to enhance nurses' and midwives' vaccination knowledge and awareness.

Objective: Understand the relationship between risk factors (eg, different sexual assault types - coercive, physical, incapacitation by alcohol/drugs) and protective factors (eg, strong maternal ties) with depressive symptoms and post-traumatic stress disorder (PTSD) symptoms among college students. Participants: Six hundred twenty-five undergraduate students. Methods: Students completed paper and pencil surveys in fall 2019 at a large public university. Results: Risk factors of child physical and sexual abuse, all three sexual assault types, and combined sexual assault were associated with greater PTSD symptoms while maternal relationship quality and religious influence served as protective factors. Risk factors of child physical and sexual abuse, coercive sexual assault, and combined sexual assault were associated with depressive symptoms while maternal relationship quality served as a protective factor. Males who identified as sexual minority (SM) had more PTSD symptoms compared to females who identified as SM. Conclusions: Findings have implications for targeted interventions to improve mental health outcomes.

Numerous studies have indicated an association between parental corporal punishment and aggressive adolescent behavior. However, there is a significant gap in the knowledge of the underlying processes responsible for this association. This study aimed to examine the potential mediators that connect parental corporal punishment with aggressive behavior and moderators that exacerbate or attenuate this direct/indirect association. A sample of 3180 Chinese students (52.52% males, mean age = 14.93 years) participated in this study and completed anonymous questionnaires on parental corporal punishment, aggressive behavior, peer victimization, and parent-adolescent relationship. We found that parental corporal punishment was positively associated with aggressive adolescent behavior. Mediation analyses revealed that peer victimization significantly mediated the association between parental corporal punishment and aggressive adolescent behavior. Further, the parent-adolescent relationship significantly moderated the mediating path of “parent corporal punishment → peer victimization → aggressive behavior.” Specifically, this mediating effect was notably stronger for adolescents with high-quality parent-adolescent relationships than adolescents with low-quality parent-adolescent relationships. The negative impact of parental corporal punishment on aggressive behavior was much more significant than that of the parent-adolescent relationship. Peer victimization and parent-adolescent relationships were the underlying mechanisms (mediator/moderator) of the relationship between parental corporal punishment and adolescent aggressive behavior. These findings provide a valuable reference for developing targeted interventions to prevent aggressive adolescent behavior in the Chinese context.

Background Both adolescent and young adult (AYA) and Black or African American (hereafter referred to as Black) cancer patients are historically under‐enrolled in cancer treatment trials (CTT). The purpose of this study was to quantify enrollment of Black AYAs in National Cancer Institute (NCI)‐sponsored CTTs overall and by age, sex, and cancer diagnosis during 2000–2015. Methods Utilizing data from NCI’s Cancer Therapy Evaluation Program and the Surveillance, Epidemiology and End Results (SEER) Program, we assessed CTT enrollment in Black patients with cancer and measured changes in enrollment over time between the study periods 2000–2007 and 2008–2015. Enrollment patterns were compared across age groups (≤14 years [y], 15–19y, 20–29y, 30–39y and 40+ years), sex, and cancer diagnosis. Results From 2000 through 2015, This study documents that compared with Black children, Black adolescent and young adult (AYA) patients were less likely to enroll in NCI‐sponsored CTTs from 2000 to 2015. Black AYA male enrollment decreased with increasing age, highlighting disparities among this specific population in CTT enrollment.

Introduction Routine adolescent physical activity is a well-established predictor of positive health across the lifespan, although wide disparities in youth physical activity engagement persist across sex and race/ethnicity. Transportation barriers may be related to adolescents’ ability to access physical activity opportunities. This study examines the association between neighborhood public transportation usage and adolescent physical activity using a national sample. Methods Cross-sectional data were drawn from the Family Life, Activity, Sun, Health, and Eating study (2014), a national sample of adolescents aged 12–17 years. Linear regression examined the association between neighborhood public transportation usage on the basis of neighborhood-level public transportation use and individual-level youth moderate-to-vigorous physical activity minutes per week. Models were developed for weekday, weekend, and combined moderate-to-vigorous physical activity for all youth and across sex and race/ethnicity subgroups. Analyses were run in 2020. Results The final analytic data set included 1,247 adolescents aged 12–17 years (71% non-Hispanic White, 49% male, mean age=14.52 [SD=1.59] years). Adjusted models showed a stronger magnitude of association between high neighborhood public transportation usage and both weekday (β=8.79, 95% CI=1.00, 16.59) and combined (β=13.74, 95% CI=1.14, 26.35) moderate-to-vigorous physical activity than between low/moderate neighborhood public transportation usage and moderate-to-vigorous physical activity. The magnitude of the neighborhood public transportation usage–moderate-to-vigorous physical activity association was strongest among non-Hispanic Black and Hispanic adolescent girls. Conclusions This study found an association between neighborhood public transportation usage and adolescent moderate-to-vigorous physical activity, particularly among non-Hispanic Black and Hispanic adolescent girls. Findings from this research have the potential to inform targeted interventions for promoting adolescent physical activity to ultimately reduce chronic health disparities across the lifespan.

IntroductionA significant proportion of ED attendances in children may be non-urgent attendances (NUAs), which could be better managed elsewhere. This study aimed to quantify NUAs and urgent attendances (UAs) in children to ED and determine which children present in this way and when.MethodsDataset extracted from the CUREd research database containing linked data on the provision of care in Yorkshire and Humber. Analysis focused on children’s ED attendances (April 2014–March 2017). Summary statistics and odds ratios (OR) comparing NUAs and UAs were examined by: age, mode and time of arrival and deprivation alongside comparing summary statistics for waiting, treatment and total department times.ResultsNUAs were more likely in younger children: OR for NUA in children aged 1–4 years, 0.82 (95% CI: 0.80 to 0.83), age 15 years, 0.39 (95% CI: 0.38 to 0.40), when compared with those under 1 year. NUAs were more likely to arrive out of hours (OOHs) compared with in hours: OR 1.19 (95% CI 1.18 to 1.20), and OOHs arrivals were less common in older children compared with those under 1 year: age 1–4 years, 0.87 (95% CI: 0.84 to 0.89) age 15 years, 0.66 (95% CI: 0.63 to 0.69). NUAs also spent less total time in the ED, with a median (IQR) of 98 min (60–147) compared with 127 min (80–185) for UAs.ConclusionA substantial proportion of ED attendances in children are NUAs. Our data suggest there are particular groups of children for whom targeted interventions would be most beneficial. Children under 5 years would be such a group, particularly in providing accessible, timely care outside of usual community care opening hours.

PurposeHybrid career has been discussed in the literature for some time but is still an emergent concept. The study investigated the careers of university professional staff working in universities in Australia and the UK to better understand the careers of this underresearched cohort of staff. The findings were used to extend the theory of the hybrid career.Design/methodology/approachA total of 139 career stories were collected via an open-ended question in an online survey. Inductive thematic analysis was used to create themes and theorise career pathways relevant to the participants' careers.FindingsIt was found that participants had a hybrid career orientation (HCO) based on their essential values and their reciprocal relationship with their employer. Four career pathways emerged from the data: intra-organisational advancement, inter-organisational advancement, work–life balance and dead end.Research limitations/implicationsThere is a need for future research to investigate the HCO, both to add depth to the understanding of careers for university professional staff in universities and to examine the hybrid concept in other settings.Practical implicationsIt is suggested that by grouping staff into career pathways, human resource practitioners could provide more targeted interventions to ensure that staff are motivated and productive for the benefit of the organisation.Originality/valueThe research has extended the concept of the hybrid career and discovered four career pathways relevant to university professional staff.

Prior work has identified the need for replication of psychological research; however, validation efforts are rare. The purpose of the current study was to confirm latent profiles of comorbid psychological symptoms in an urban adolescent sample and examine differences in gender and trait mindfulness across these profiles. Cross-sectional data from 201 eighth grade students (63% female; M(age) = 13.24; 86% Black) across nine Baltimore City public middle schools were analyzed. Confirmatory latent profile analyses showed that the previously-identified 3-profile solution with boundary constraints was the best fit for the data, and significant sex and trait mindfulness differences were identified. The current study supports the need for future replication studies using this methodology to improve theory and targeted interventions.

Background Point-of-care ultrasound (POCUS) devices are becoming more widely used in healthcare and have the potential to act as fomites. The objective of this project was to study the thoroughness of cleaning of POCUS machines before and after a quality improvement initiative. We designed a mixed-methods, pre/post study which took place over the course of one year at a university-affiliated health center. Cleaning rates of four ultrasound machines used by hospital medicine and critical care medicine services were evaluated using fluorescent marking. Interventions targeted physicians’ knowledge of best practices and improved access to cleaning supplies. Pre- and post-intervention cleaning rates were compared using a generalized linear model. The impact of the corona virus disease of 2019 (COVID-19) pandemic on baseline cleaning rates was also evaluated. Physicians’ attitudes and knowledge of cleaning practices were evaluated via unpaired pre/post surveys. Results There was significant improvement in thoroughness of cleaning following intervention (pre 0.62, SE 0.05; post 0.89, SE 0.07), p p = 0.78). Post-intervention surveying found improved understanding of guideline-based cleaning practice, better performance on knowledge-based questions, and fewer reported barriers to machine cleaning. Conclusion Thoroughness of cleaning of POCUS machines can be improved with practical interventions that target knowledge and access to cleaning supplies.

INTRODUCTION The electronic health record (EHR) has become an integral part of modern medical practice. The balance of benefit versus burden of a required EHR remains inconclusive, with many studies identifying increasing physician burnout and less face-to-face patient contact because of increasing documentation demands. Few studies have investigated EHR burden in orthopaedic surgery practice. This study aimed to characterize and compare EHR usage patterns and time allocation within EHR between orthopaedic surgeons, other surgeons, and medicine physicians at an academic medical center. METHODS EHR usage was digitally tracked within a large academic medical center. EHR usage data were compiled for all physicians seeing outpatients from April 2018 to June 2019. The tracking metrics included time spent answering messages, typing notes, reviewing laboratories and imaging, reading notes, and placing orders. Physicians were subdivided between orthopaedic surgeons, other surgeons, and nonsurgeon/medical specialties. Statistical comparisons using a two-sample t-test were done between orthopaedic surgeon EHR usage patterns and other surgeons, in addition to orthopaedic surgeons versus nonsurgeons. RESULTS One thousand sixty physicians including 28 full-time orthopaedic surgeons, 134 other surgeons, and 898 nonsurgical medicine physicians met inclusion criteria. Orthopaedic surgeons saw on average 31 patients per office day compared with other surgeons at 18 patients per office day (P < 0.01) and nonsurgeons at 12 patients per office day (P < 0.01). Orthopaedic surgeons received more EHR messages while also being more efficient at answering EHR messages compared with other surgeons and nonsurgeons (P < 0.01). EHR tasks, including answering messages, placing orders, chart review, writing notes, and reviewing imaging, consumed 58% of an orthopaedic surgeon's scheduled office day with the largest contribution from required note writing. DISCUSSION In academic orthopaedic practice, EHR use has surpassed face-to-face patient time, consuming 58% of orthopaedic surgeons' clinical days. With the previously shown correlation between EHR burden and physician burnout, targeted interventions to increase efficiency and off-load EHR burden are necessary to sustain a successful orthopaedic practice.

Background Laparoscopic adjustable gastric banding (LAGB) continues to be a valid surgical treatment option to address severe obesity. However, outcomes are varied and can be difficult to predict. Early prediction of suboptimal weight loss following LAGB may enable adjustments to postoperative care and consequently improve surgical outcomes. Therefore, our aim is to investigate the prognostic utility of using early weight loss following LAGB to predict long-term weight outcomes. Methods Clinical data from patients undergoing LAGB between 2001 and 2007 at a single institution were retrospectively collected and analysed. The data was used to inform a model for predicting long-term weight loss after LAGB surgery. Percent total weight loss (%TWL) greater than 20% 1 year after surgery was considered a measurement of success since it has been associated with the improvement of comorbidities and increased patient satisfaction. Results The average %TWL 1 year after LAGB surgery was 23.73% (n = 1524, SD = 8.68%). Weight loss of less than 10% in 1 year was a negative predictor of weight loss >20% in 8-12 years (OR = 0.449; p = 0.002; 95% CI = 0.272-0.742). Moreover, weight loss >20% in 1 year was a strong predictor of weight loss >20% in 8-12 years (OR = 5.33; p Conclusion Total body weight reduction of less than 10% 1 year after LAGB surgery suggests a lesser weight loss at 8-12 years. For these patients, targeted interventions would be appropriate to increase the chances of long-term success.

PURPOSE To understand what is known about sex and gender differences in quality of life (QoL) and related domains for individuals with an adult acquired lower limb amputation (LLA). METHODS A computer-assisted literature search of four online databases was completed. Articles were included if they incorporated sex or gender as part of their data analysis with a focus on QoL-related domains. Data were analyzed using descriptive numerical analysis and thematic analysis. RESULTS One hundred and eleven articles were included in this review. Women were under-represented across studies, with most of the participants being men. No articles described the inclusion of trans or non-binary persons. Differences by sex or gender were reported by 66 articles. Articles reporting on gender seldom provided descriptions of how gender was defined. Overall, women/females seemed to have worse outcomes in terms of prosthesis-related outcomes, mental health, and return to occupations. CONCLUSION Articles included in this review were not clear with how gender was defined. In order for more targeted interventions that account for sex and gender differences, studies need to be more forthcoming about how they use and define gender. Future research should seek to include gender non-conforming participants to identify additional needs.Implications for rehabilitationSex and gender are important constructs that influence outcomes following lower limb amputation.Rehabilitation professionals should consider sex and gender-specific outcomes when tailoring programs to ensure ethical clinical care.

BACKGROUND Even though onset of three-quarters of mental disorders occurs by age 25, few young adults seek help for their mental health needs. The objectives of this study are to examine the relationship of discrimination and stigma of mental illness on the help-seeking behavior for mental health among college students. METHOD Undergraduate students (N = 557) at a Midwestern university were surveyed online. Descriptive and logistic regression analysis was conducted using STATA15. RESULTS College students reporting higher discrimination were more likely to seek help for mental health services (OR = 1.04, CI = 1.01-1.06), after controlling for all covariates. Students with higher personal stigma reported lower odds of help-seeking behavior (OR = 89, CI = .80-.97). Students with higher perceived public stigma did not have an independent significant association on help-seeking behavior initially, but full model revealed a significantly association (OR = 1.02, CI = .99-1.05). CONCLUSION Developing targeted interventions addressing discrimination and stigma of mental illness is critical among college students.

Objective assessment of grit and its association with burnout in obstetrics and gynaecology (OG) training is underexplored.This study utilises the Short Grit Scale and the Oldenburg Burnout Inventory to investigate the association of grit with burnout, thriving and career progression among OG trainees and Fellows in Australia/New Zealand.A cross-sectional survey of the RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) members was conducted. Participants were categorised by seniority level (core trainees, advanced trainees and Fellows). Mean grit and burnout scores were compared with one-way analyses of variance. Correlation between grit and burnout was estimated using Pearson's correlation coefficient. Logistic regression models were used to determine factors associated with high vs low burnout. Grit was categorised as low/medium/high for regression models.A total of 751 (26%) participants completed the survey. Fellows reported higher mean grit than core (P = 0.02) and advanced trainees (P = 0.03), and lower mean burnout than core trainees (P 0.001). Moderate negative correlation was demonstrated between grit and burnout scores (r = -0.34). In the multivariable model, only seniority (adjusted adds ratio (OR): 0.40 for Fellows vs core trainees, P = 0.008) and grit levels (adjusted OR:4.52 for low versus high, P 0.001; 2.32 for low vs medium, P = 0.001) were significantly associated with burnout.This study demonstrates the protective role of grit in combating burnout among RANZCOG trainees and Fellows. While further well-designed studies are warranted, findings from our study are expected to help the College in developing targeted interventions and subsequently minimise burnout-related adverse outcomes in high-risk groups.

Background Presence in the neonatal intensive care unit (NICU) is a vital step for caregivers initiating involvement, such as skin-to-skin contact, holding or singing/reading to their newborn. Little is known about caregiver presence and involvement in Canadian NICU's context by caregiver type (mother, father, other), and the association between maternal presence and key maternal and newborn characteristics. Purpose The primary objective was to examine the presence and involvement of family caregivers in the NICU. The secondary objective was to examine the relationship between maternal presence and maternal and newborn characteristics. Design and methods A prospective observational cohort study in an open bay setting of an Eastern Canadian NICU. Presence (physically present at the newborn's bedside) and involvement (e.g., skin-to-skin, singing/reading) were tracked daily by families in the NICU until discharge. Demographic information was also collected. Results Participants included 142 mothers and their newborns. Mothers were present 8.7 h/day, fathers were present 4.1 h/day, and other caregivers were present 1.8 h/day in the NICU in the first 34 days. Mothers were involved in care activities 50% of the time they were present in the NICU, whereas fathers and other caregivers were spending 20% and 6% of their time respectively. Regression identified maternal age, distance to home, parity, birthweight, and length of stay to be statistically significant variables related to maternal presence. Conclusions There is variation in presence and involvement by caregiver type. Targeted interventions to maintain and increase mothers, fathers and other caregivers' presence and involvement in care throughout their stay in the NICU are recommended.

This study aimed to identify patient and appointment characteristics associated with no-shows to new patient appointments at a US academic ophthalmology department.Cross-sectional study.This was a study of all adult patients with new patient appointments scheduled with an attending ophthalmologist at Penn State Eye Center between January 1Of 4,628 patients, 759 (16.4%) were no-shows. From the multiple logistic regression model, characteristics associated with no-shows were age (Odds Ratio (OR) for 18-40 years vs.60 years: 3.41, 95% Confidence Interval (CI) 2.57, 4.51, p0.001 and OR for 41-60 years vs.60 years: 2.14, 95% CI 1.67, 2.74, p0.001), median household income (OR for$35,667 vs.$59,445: 1.59, 95% CI 1.08, 2.34, p0.001), insurance (OR for None vs. Medicare: 6.92, 95% CI 4.41, 10.86, p0.001 and OR for Medicaid vs. Medicare: 1.54, 95% CI 1.18, 2.01, p=0.002), race (OR for Black vs. White: 2.62, 95% CI 2.00, 3.43, p0.001 and OR for Other vs. White: 2.02, 95% CI 1.58, 2.59, p0.001), and commute distance (OR for 5-10 mi vs. ≤5 mi: 1.73, 95% CI 1.17, 2.55, p=0.006). Appointments with longer lead times and scheduled with glaucoma or retina specialists were also significantly associated with greater no-shows.Certain patient and appointment characteristics were associated with no-show status. These findings may assist in the development of targeted interventions at the patient, practice, and health system levels to improve appointment attendance.

Kentucky’s Targeted Interventions (TI) program is a statewide intervention intended to prepare non-college-ready high school students for college-level coursework. Using a difference-in-regression discontinuity design, we find that TI reduces the likelihood that students enroll in remedial courses by 8 to 10 percentage points in math. These effects are similar or stronger among students who are eligible for free/reduced-price lunch, students with remediation needs in multiple subjects, and students in lower performing schools. TI also increases the likelihood that students enroll in and pass college math before the end of the first year in 4-year universities by 4 percentage points and by 9 percentage points among free/reduced-price lunch eligible students. However, we do not find evidence of TI affecting credit accumulation or persistence.

Gestational diabetes mellitus (GDM) complicates pregnancies in Africa. Addressing the burden is contingent on early detection and management practices. This review aimed at identifying the barriers to diagnosing and managing GDM in Africa. We searched PUBMED, Web of Science, WHOLIS, Google Scholar, CINAHL and PsycINFO databases in May 2020 for studies that reported barriers to diagnosis and management of hyperglycaemia in pregnancy. We used a mixed method quality appraisal tool to assess the quality and risk of bias of the included studies. We adopted an integrated and narrative synthesis approach in the analysis and reporting. Of 548 articles identified, 14 met the eligibility criteria. Health system-related barriers to GDM management were the shortage of healthcare providers, relevant logistics, inadequate knowledge and skills, as well as limited opportunities for in-service training. Patient-related barriers were insufficient knowledge about GDM, limited support from families and health providers and acceptability of the diagnostic tests. Societal level barriers were concomitant use of consulting traditional healers, customs and taboos on food and body image perception. It was concluded that constraints to GDM detection and management are multidimensional. Targeted interventions must address these barriers from broader, systemic and social perspectives.

Infant Follow Up Programs (IFUPs) provide developmental surveillance for preterm infants after hospital discharge but participation is variable. We hypothesized that infants born to Black mothers, non-English speaking mothers, and mothers who live in “Very Low” Child Opportunity Index (COI) neighborhoods would have decreased odds of IFUP participation. There were 477 infants eligible for IFUP between 1/1/2015 and 6/6/2017 from a single large academic Level III NICU. Primary outcome was at least one visit to IFUP. We used multivariable logistic regression to identify factors associated with IFUP participation. Two hundred infants (41.9%) participated in IFUP. Odds of participation was lower for Black compared to white race (aOR 0.43, p = 0.03), “Very Low” COI compared to “Very High” (aOR 0.39, p = 0.02) and primary non-English speaking (aOR 0.29, p = 0.01). We identified disparities in IFUP participation. Further study is needed to understand underlying mechanisms to develop targeted interventions for reducing inequities.

We examined hypothalamic–pituitary–adrenal stress reactivity as an indicator of differential susceptibility in moderating the links between family socioeconomic status (SES) and executive function (EF) in three-year-old urban Chinese children. The participants included 77 children (36 girls) and their families. Family income, parents’ education, and level of occupation were reported by the mothers and aggregated into a composite index of family SES. We assessed the children’s biological reactivity by salivary cortisol responses to a mild stressor, which we calculated by the area under the curve with respect to increase. We measured EF skills with a series of laboratory tasks. The results revealed significant interactive effects of SES and cortisol reactivity on children’s cognitive inhibitory control. More specifically, SES was significantly related to cognitive inhibitory control for children with higher cortisol reactivity. Conversely, for children with lower cortisol reactivity, there were no significant correlations between SES and cognitive inhibitory control. Region of significance analyses indicated a moderating effect supporting the “bright side” of differential susceptibility, meaning that high cortisol reactive children were more likely to benefit from high levels of SES. The results also manifested a direct association between SES and children’s working memory, and this association was not dependent on the features of cortisol reactivity. SES did not relate to hot EF. The results highlight the SES disparity in different EF elements and may help in the development of targeted interventions.

The coparenting between grandparents and parents is increasingly prevalent in Chinese society. Based on the family system theory and the differential susceptibility model, the current study examined (a) the relative associations of maternal and grandparental psychological control with children’s behavioral problems; (b) the interactive effects of maternal and grandparental psychological control on children’s behavioral problems; and (c) the moderation role of children’s temperamental reactivity. The sample included 241 Chinese multigenerational families with preschool children (130 boys, Mage = 4.88 years, SD = 1.04). Mothers and grandparents reported their psychological control and children’s behavioral problems. Mothers also rated children’s temperamental reactivity. The results showed that only maternal psychological control was uniquely associated with more children’s behavioral problems. There was no interaction between maternal and grandparental psychological control. However, children’s temperamental reactivity moderated associations between grandparental psychological control and children’s behavioral problems. Specifically, grandparental psychological control was positively linked to children’s behavioral problems only for highly reactive children. This finding highlighted the susceptibility of children with high reactivity to grandparental psychological control, raising the possibility of targeted interventions to facilitate children’s development.

OBJECTIVE The purpose of the current study was to use network analysis techniques to parse relations between attention-deficit/hyperactivity disorder (ADHD) symptom domains, domains of executive function, and temperament traits. METHODS Participants were 420 children aged 6-17 years (55% boys). The majority of the participants were Caucasian (72.86%) and 50% of the sample met diagnostic criteria for ADHD. Both parents and teachers provided ratings of participants' ADHD symptom severity. Parents completed questionnaires pertaining to participants' temperament traits, and participants completed well-validated laboratory measures of executive function. RESULTS Results suggested effortful control as demonstrating the strongest relations with ADHD, particularly the parent-reported inattentive symptom domain. Additionally, negative effects appeared to demonstrate weaker but still notable relations primarily with the parent-reported hyperactive/impulsive symptom domain. Measures of executive function did not appear to demonstrate relations with any measures of ADHD symptoms or temperament traits. The results were generally replicated in a distinct sample (n = 732, 7-13 years, 63% boys, 81% White), although differences emerged pertaining to the role of surgency (i.e., related to the hyperactive/impulsive symptom domain in the replication but not the primary sample). CONCLUSIONS Overall, findings provided support for the primary role of effortful control, as well as secondary roles for negative affect and surgency, as key risk markers for the characterization of ADHD. Additional exploration of the overlap between temperament and executive function, as pertaining to ADHD, may help clarify heterogeneity in phenotypes and suggest priorities for targeted interventions outside of traditional symptoms.

Early diagnosis and treatment for autism spectrum disorder (ASD) pose challenges. The current diagnostic approach for ASD is mainly clinical assessment of patient behaviors. Biomarkers-based identification of ASD would be useful for pediatricians. Currently, there is no specific treatment for ASD, and evidence for the efficacy of alternative treatments remains inconclusive. The prevalence of ASD is increasing, and it is becoming more urgent to find the pathogenesis of such disorder. Metabolomic studies have been used to deeply investigate the alteration of metabolic pathways, including those associated with ASD. Metabolomics is a promising tool for identifying potential biomarkers and possible pathogenesis of ASD. This review comprehensively summarizes and discusses the abnormal metabolic pathways in ASD children, as indicated by evidence from metabolomic studies in urine and blood. In addition, the targeted interventions that could correct the metabolomic profiles relating to the improvement of autistic behaviors in affected animals and humans have been included. The results revealed that the possible underlying pathophysiology of ASD were alterations of amino acids, reactive oxidative stress, neurotransmitters, and microbiota-gut-brain axis. The potential common pathways shared by animal and human studies related to the improvement of ASD symptoms after pharmacological interventions were mammalian-microbial co-metabolite, purine metabolism, and fatty acid oxidation. The content of this review may contribute to novel biomarkers for the early diagnosis of ASD and possible therapeutic paradigms.

Among the histogenic subtypes of melanoma, nodular melanoma (NM) is the major contributor for thicker and fatal melanomas and it has been associated with melanoma-specific death in thin tumours, highlighting an important subgroup of 'aggressive thin' melanomas. This review provides a synthesis of the distinct characteristics of NM, with respect to epidemiology and risk factors, clinical presentation, histopathology, molecular and dermoscopic aspects, and screening practices. The real challenges are to find better biomarkers of aggressiveness and to know whether the control of such aggressive melanomas can be influenced by targeted interventions such as early detection, drug interventions and preventive strategies.

Introduction Depression and problem drinking are comorbid in emerging adulthood, yet the processes that link them are not well understood. Research has argued that shame has a unique influence on the experience of problematic drinking, but this has rarely been assessed at the state level. Using ecological momentary assessments (EMAs), we assessed whether shame, and not guilt, mediated the association between baseline depression and alcohol use and problems. Methods One hundred and eighty-four emerging adults (Mage= 19.27) completed a 12-day EMA study. Multilevel models were used to test hypotheses. Results In a model with alcohol use as the outcome, there were no significant associations between shame or guilt and alcohol use at the within- or between-subjects level. In a model with alcohol problems as the outcome, guilt was positively associated with alcohol problems but only at the daily level. At the between-subjects level and after controlling for guilt, there was a significant association between depression, shame, and alcohol problems; average levels of shame mediated the association between depression and alcohol problems. In post-hoc reverse directionality models, average alcohol problems mediated the relationship between depression and shame and guilt at the between-person level. No mediation was present for alcohol use. Conclusion After controlling for guilt, shame is an emotion that helps explain risk for alcohol problems among depressed emerging adults, which has implications for targeted interventions. Reciprocal associations between shame, guilt, and alcohol problems emerged highlighting the need for more fulsome assessments of shame and guilt in future EMA research.

Summary Background Universally, smoking cessation rates among established smokers are poor. Preventing young people from starting use of and becoming addicted to tobacco products remains a key strategy to end the tobacco epidemic. Previous country-specific studies have found that initiation of smoking tobacco use occurs predominantly among young people and have found mixed progress in reducing the prevalence of smoking tobacco use among young people. Current and comparable estimates for all countries are needed to inform targeted interventions and policies. Methods We modelled two indicators: prevalence of current smoking tobacco use among young adults aged 15–24 years, and the age at which current smokers aged 20–54 years in 2019 began smoking regularly. We synthesised data from 3625 nationally representative surveys on prevalence of smoking and 254 on age at initiation. We used spatiotemporal Gaussian process regression to produce estimates of the prevalence of smoking and age of initiation by sex, for 204 countries and territories for each year between 1990 and 2019. Findings Globally in 2019, an estimated 155 million (95% uncertainty interval 150–160) individuals aged 15–24 years were tobacco smokers, with a prevalence of 20·1% (19·4–20·8) among males and 4·95% (4·64–5·29) among females. We estimated that 82·6% (82·1–83·1) of current smokers initiated between ages 14 and 25 years, and that 18·5% (17·7–19·3) of smokers began smoking regularly by age 15 years. Although some countries have made substantial progress in reducing the prevalence of smoking tobacco use among young people, prevalence in 2019 still exceeds 20% among males aged 15–24 years in 120 countries and among females aged 15–24 years in 43 countries. Interpretation The fact that most smokers start smoking regularly before age 20 years highlights the unique window of opportunity to target prevention efforts among young people and save millions of lives and avert health-care costs in the future. Countries can substantially improve the health of their populations by implementing and enforcing evidence-based tobacco control policies that prevent the next generation from initiating smoking. Funding Bloomberg Philanthropies.

Objectives To evaluate patient, provider, and facility factors associated with variation in opioid prescribing after endoscopic procedures for benign prostatic hyperplasia across a large academic health system to drive improvement efforts. Methods Opioids prescribed at discharge for patients who underwent an endoscopic prostate procedure March 2018-November 2019 were analyzed. Multivariable logistic and linear regression were used to evaluate the relationship between patient, provider, and facility factors and the receipt of any opioid prescription and the quantity prescribed. Results We included 724 patients who had surgery with one of 26 urologists across five facilities. 222 (30.7%) received an opioid prescription, and the average morphine milligram equivalents (MMEs) prescribed was 97.9±33.5. We found wide variation in the proportion of patients who received an opioid prescription across surgeons (range 0%-88.9%) and facilities (range 19.9%-66.7%) and the average MMEs prescribed (range 25-188.5). Outpatient surgery (OR 2.32; 95% confidence interval [CI] 1.22-4.40, P = .010) and preoperative opioid use (OR 15.04; CI 9.65-23.45, P Conclusions Opioid prescribing following endoscopic prostate procedures varied widely. Targeted interventions tailored to younger patients, those taking opioids preoperatively, recipients of outpatient surgery and those undergoing surgery at satellite facilities may be particularly high yield given the association between these factors and increased postoperative prescribing.

Children with traumatic head injury are often transferred from community Emergency Departments (ED) to a Pediatric Emergency Department (PED). The primary objective of this study was to describe the outcomes of minor head injury (MHI) transfers to a PED. The secondary objective was to report Computed Tomography (CT) utilization rates for MHI.We conducted a retrospective study of children aged ≤18 years transferred to our PED for MHI from 2013 to 2018. Patients with Glasgow Coma Scale (GCS) 14, coagulopathies, history of brain mass/shunt and suspected non-accidental trauma were excluded. Data collected included demographics, interventions performed, and disposition. MHI risk stratification and clinically important traumatic brain injury (ciTBI) were defined per the Pediatric Emergency Care Applied Research Network (PECARN) head injury guidelines. Descriptive statistics were reported using general measures of frequency and central tendency.A total of 1078 children with MHI were analyzed based on eligibility criteria. The majority of patients were male (62%) and ≥ 2 years of age (69.3%). Subspecialist consultation (57.2%) and neuroimaging (27.4%) were the most commonly performed interventions in the PED. Only 14 children (1.3%) required neurosurgical intervention. One-third of the transferred patients required no additional work-up. Two-thirds of the patients (66.6%) were directly discharged from the PED. Though the total number of MHI transfers per year declined steadily during the study period (from 271/year to 119/year), CT head utilization remained relatively similar across the study years (60.3% to 70.8%). A higher proportion of children received CT in the ED when compared to the PED for low-risk (28.9% vs 15.8%) and intermediate-risk groups (42.8% vs 29.4%).The majority of pediatric MHI transfers are discharged home following a subspecialty consultation and/or neuroimaging. Despite guidelines and a low incidence of ciTBI, CT utilization remains high in the intermediate and low risk MHI groups, especially in the community settings. Targeted interventions are needed to reduce the potentially avoidable transfers and low-value performance of CT in children with MHI.

Background The current neonatal mortality rate in Nigeria (37/1000) is among the highest in the world and the major causes have consistently been reported as sepsis, perinatal asphyxia and prematurity. However, case-specific fatality which defines the risk of dying from these and other neonatal morbidities is rarely emphasized. Determination of case-specific fatality rates (CSFR) may inform a change in our current approach to neonatal care interventions which may eventually bring about the much-needed reduction in our neonatal mortality rate. Our aim was to determine the case-specific fatality rates for the common causes of mortality among hospitalized neonates at the National Hospital Abuja (NHA). Methods Relevant demographic and clinical data on all neonates admitted into the NICU at the NHA over a period of 13 months (January 2017 to February 2018) were extracted from the Neonatal Registry database and analyzed using appropriate statistical methods with the SPSS version 20 software. The case-specific fatality rates were computed for the predominant morbidities in addition to determination of the neonatal mortality rates and associated risk factors. Results and conclusion A total of 730 neonates were admitted, out of which 391 (53.6%) were females, 396 (54.5%) were inborn and 396 (54.2%) were term. The three most prevalent morbidities were prematurity 272(37.2%), neonatal Jaundice 208(28.4%) and perinatal asphyxia 91(12.5%) while the most common causes of mortality were prematurity 47/113(41.6%), congenital malformations 27/113(23.9%) and perinatal asphyxia 26/113(23%). Congenital malformations had the highest case-specific fatality 27/83(32.5%) followed by Perinatal Asphyxia 26/91(28.6%) and prematurity 47/272(20.7%). The mortality pattern differed between inborn and out born babies. Implications of these case-specific fatality rates for targeted interventions are discussed.

Background: There have been concerns about the increased use of helium and nitrogen gas as a suicide mechanism in Australia. Methods: National Coronial Information System data were used to investigate gas‐specific suicides in Australia over the period 2006–2017. Characteristics were compared between helium or nitrogen, carbon monoxide and seven other gases. Results: Gas inhalation accounted for 10% (3,103/31,002) of all suicide deaths in Australia between 2006 and 2017. The mean age of individuals who died by suicide was 47.6 years (SD 16.9, R 14‐97) and 83.3% were male. The number of gas suicides declined over the study period (IRR=0.96). The fall was associated with a 47% decline in carbon monoxide suicides (IRR=0.93). There was an increase in deaths due to argon (IRR=1.60) and nitrogen (IRR=1.27). Compared to individuals using other non‐carbon monoxide gases, individuals who died by suicide from helium or nitrogen were significantly more likely to be older, have a physical illness and/or disability, have contacted a euthanasia group and have accessed instructional material and purchased gas online. Conclusions: Suicides by carbon monoxide decreased between 2006 and 2017 alongside an increase in argon and nitrogen gas use – particularly among older adults. The ease of access to these gases points to new targets for means restriction. Implications for public health: Identifying the types of gases used in suicide deaths and emerging trends may enable targeted interventions that could potentially reduce access.

Healthcare workers (HCWs) from minoritized communities are a critical partner in moving vaccine-hesitant populations toward vaccination, yet a significant number of these HCWs are delaying or deciding against their own COVID-19 vaccinations. Our study aims to provide a more nuanced understanding of vaccine hesitancy among racially and ethnically minoritized HCWs and to describe factors associated with vaccine non-acceptance. Analysis of a sub-sample of racially and ethnically minoritized HCWs (N = 1131), who participated in a cross-sectional study at two large Southern California medical centers, was conducted. Participants completed an online survey consisting of demographics, work setting and clinical role, influenza vaccination history, COVID-19 knowledge, beliefs, personal COVID-19 exposure, diagnosis, and impact on those closest to them. While overall most HCWs were vaccinated (84%), 28% of Black, 19% of Hispanic, and 8% of Asian American HCWs were vaccine-hesitant. Age, education level, occupation, history of COVID-19, and COVID-19 related knowledge were predictive of vaccine hesitancy. We found significant variations in COVID-19 related knowledge and reasons for vaccine hesitancy among Black (governmental mistrust), Hispanic (preference for physiological immunity), and Asian-American HCWs (concern about side effects) who were vaccine-hesitant or not. Our findings highlight racial and ethnic differences in vaccine-hesitancy and barriers to vaccination among HCWs of color. This study indicates the necessity of targeted interventions to reduce vaccine hesitancy that are mindful of the disparities in knowledge and access and differences between and among racial and ethnic groups.

Aim To share our experience of implementing a programme of interventions aimed at building research capacity and capability of nurses and allied health professionals in a specialist children's hospital. Background Clinicians at the forefront of care are well positioned to lead on research to improve outcomes and experiences of patients but some professional groups continue to be underrepresented. Inequities persist alongside robust national infrastructures to support Clinical Academic Careers for non-medical health professionals, further highlighting the need to address local infrastructure and leadership to successfully build research capacity. Design An evolving programme of inquiry and analysis was established in one organisation, this included targeted interventions to mitigate barriers and enable research capacity and capability. Methods An all-staff survey was conducted in 2015 to understand the existing research culture. Interventions were put in place, evaluated through a second survey (2018), and focus group interviews with staff who had accessed interventions. Results Respondents demonstrated high levels of interest and commitment to research at the individual level which were not always harnessed at the organisational level. Inequities between professional groups existed in terms of training, time to undertake research and opportunities and outputs. Follow-up revealed continuing structural barriers at an organisational level, however at an individual level, interventions were reflected in >30 fellowship awards; major concerns were reported about sustaining these research ambitions. Conclusions Success in building a research-active clinical workforce is multifactorial and all professional groups report increasing challenges to undertake research alongside clinical responsibilities. Individuals report concerns about the depth and pace of cultural change to sustain Clinical Academic Careers and build a truly organisation-wide research hospital ethos to benefit patients. Relevance to clinical practice The achievements of individual nurses and allied health professionals indicate that with supportive infrastructure, capacity, cognisance and capability are not insurmountable barriers for determined clinicians. We use the standards for reporting organisational case studies to report our findings (Rodgers et al., 2016 Health Services and Delivery Research, 4 and 1).

Current debate has identified the factors emotion knowledge (EK) and attention as specific trajectories longitudinally influencing psychopathological development in childhood. The “Emotion Knowledge Hypothesis” assumes that children with great emotion skills have high self-regulating abilities that result in lower cognitive load and stronger attention capacities. Attention problems are thus perceived as a consequence of reduced EK. According to the competing “Attention Effect Hypothesis”, attention problems and EK deficits are associated because of impaired learning capacities due to attention problems. According to this hypothesis, attention problems are predictive of impaired EK. If those specific trajectories are disrupted, this might attenuate the development of later behavior problems. The present study tests those competing hypotheses replicating previous studies in this field to shed light on potential psychopathology trajectories. A total of 136 pre- and elementary school children as well as their teachers participated in this study. Children’s symptoms of inattention as well as their emotional competences were assessed 3 times over a 12-month period. We applied multilevel structural equation modelling and cross-lagged panel models for data analysis. Overall, we noted a drop in inattention scores and rise in emotional competences over the one-year course, indicating maturation effects. There was a significant but very small effect for attention scores predicting emotional competences. With respect to the question whether interventions should focus on the “Emotion Knowledge” or “Attention Effect” hypothesis, our findings imply that none of them has superiority over the other. Therefore, both emotion knowledge and attention are crucial for development, and that children with deficits in either domain should receive targeted interventions in order to disrupt potentially harmful developmental pathways.

Aims To investigate the status and influencing factors of illness uncertainty among patients with coronavirus disease 2019 (COVID‐19) in the mobile cabin hospital. Design A cross‐sectional study. Methods 114 patients with COVID‐19 admitted to a mobile cabin hospital in Wuhan, Hubei Province, in February 2020 were enrolled by a convenience sampling method. The Chinese version of the Mishel Illness Uncertainty Scale (MUIS) was used to assess patients’ degree of illness uncertainty, and multiple regression analysis was used to explore the influencing factors. Results The average total score of MUIS (Chinese version) was 52.22 ± 12.51, indicating a moderate level of illness uncertainty. The dimension unpredictability turned out to have the highest mean score: 2.88 ± 0.90. The multiple stepwise regression analysis showed that female (t = 2.462, p = .015), monthly family income not less than RMB 10,000 (t = −2.095, p = .039), and disease duration of 28 days or more (t = 2.249, p = .027) were independent influencing factors of illness uncertainty. Conclusion Patients with COVID‐19 are at a moderate level of illness uncertainty. Medical staffs should pay more attention to female patients, patients with lower monthly family income, patients with the prolonged disease, and take targeted interventions to help them reduce illness uncertainty. Impact Facing the brand new and unknown infectious disease, patients confirmed of COVID‐19 suffer from immense physical and psychological stress, where illness uncertainty is a major stressor that troubles patients. The present study surveys illness uncertainty among patients with COVID‐19 in the mobile cabin hospital with results revealing a moderate level. Study results will benefit nurses in any setting where care for patients with COVID‐19 is provided, public policymakers and future researchers.