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This study examines the associations between family and friend support and depressive and anxiety symptoms among adolescents, considering potential sex differences. Secondary data from a longitudinal cohort study of 1,348 adolescents ages 11–17 were analyzed using descriptive statistics and multiple linear regression, controlling for relevant factors. Interaction terms between sex and support were created to examine moderation by sex. Youth who reported higher family support reported lower depressive symptoms (b = −0.53, p <.001) and lower anxiety symptoms (b = −0.39, p <.001). Similarly, youth's higher reported friend support was associated with lower depressive symptoms (b = −0.52, p <.001) and lower anxiety symptoms (b = −0.44, p <.001). Effects were not modified by sex. Understanding modifiable factors such as supportive systems is important to mitigate mental health disorders. Further investigation of protective factors for promoting adolescent mental health is needed. [ABSTRACT FROM AUTHOR]

Background: Observational studies link high midlife systolic blood pressure to increased dementia risk. However, the synthesis of evidence from randomized controlled trials has not definitively demonstrated that antihypertensive medication use reduces dementia risk. Here, we emulate target trials of antihypertensive medication initiation on incident dementia using three cohort studies, with attention to potential violations of necessary assumptions. Methods: We emulated trials of antihypertensive medication initiation on incident dementia using data from the Atherosclerosis Risk in Communities study, Cardiovascular Health Study, and Health and Retirement Study. We used data-driven methods to restrict participants to initiators and noninitiators with overlap in propensity scores and positive control outcomes to look for violations of positivity and exchangeability assumptions. Results: Analyses were limited by the small number of cohort participants who met eligibility criteria. Associations between antihypertensive medication initiation and incident dementia were inconsistent and imprecise (Atherosclerosis Risk in Communities: HR = 0.30 [0.05, 1.93]; Cardiovascular Health Study: HR = 0.66 [0.27, 1.64]; Health and Retirement Study: HR = 1.09 [0.75, 1.59]). More stringent propensity score restrictions had little effect on findings. Sensitivity analyses using a positive control outcome unexpectedly suggested antihypertensive medication initiation increased the risk of coronary heart disease in all three samples. Conclusions: Positive control outcome analyses suggested substantial residual confounding in effect estimates from our target trials, precluding conclusions about the impact of antihypertensive medication initiation on dementia risk through target trial emulation. Formalized processes for identifying violations of necessary assumptions will strengthen confidence in target trial emulation and avoid inappropriate confidence in emulated trial results. [ABSTRACT FROM AUTHOR]

Purpose: This study explores how one novice teacher navigated his first-year teaching sixth-grade social studies. Design/methodology/approach: One-sixth grade novice teacher was observed during his unit on the Islamic Empire. The teacher was interviewed before the unit began to understand his approach to combating Islamophobia and interviewed again after the unit so he could reflect on the unit and discuss if he believed he had accomplished his original goal. Classroom artifacts (handouts, slide decks, etc.) were collected. Findings: The findings highlight the various forces that impacted the decisions the teacher made in the classroom. Lack of support from administration and various colleagues left the teacher feeling overwhelmed and unable to accomplish his goals. While the teacher started the unit with a clear purpose for teaching against Islamophobia, he ultimately taught a unit where students memorized discrete pieces of information. Originality/value: This study adds to previous research on the need for providing administrative support for novice teachers to be able to teach in ambitious ways by highlighting the numerous shortcomings. [ABSTRACT FROM AUTHOR]

• Unplanned 30-day hospital readmissions create a burden on the patient and an organization. • Close hospital discharge follow-up with a primary care provider (PCP) is associated with a lower risk of hospital readmission for non-surgical issues. • A transitional care clinic at the organization acts as a successful bridge for patients without a PCP. Background : The Centers for Medicare and Medicaid Services consider the 30-day hospital readmission rate an outcome of care measure; a high rate is associated with high-cost and bed utilization. Purpose : The Division of Vascular Surgery at a large academic medical center implemented a 15-week quality improvement project in the fall of 2022 to reduce readmissions among patients deemed high-risk for readmission and discharged to home. Methods : The discharging provider utilized the "HOSPITAL Score for Readmission" tool to identify patients at high-risk for unplanned 30-day readmission to receive the intervention, which included follow-up with a primary care provider (PCP) within two weeks of hospital discharge to address non-surgical medical conditions that may have been exacerbated during the hospital stay. A hospital based transitional care clinic bridged medical care for identified patients without an established PCP or whose PCP could not accommodate an appointment until PCP assumption of care. Discharging providers included 11 nurse practitioners and 2 surgery residents; each received a one-on-one educational teaching session and a weekly reminder e-mail through week 9. Results : A total of 158 vascular surgery patients (low and high-risk) were discharged home over 15 weeks with 30 patients (19%) having an unplanned readmission within 30-days from discharge. Adherence issues with the intervention among staff allowed for the high-risk group to be divided into those who did not receive the intervention versus those who did. The high-risk patients who did not receive the intervention had a higher readmission rate (30.4%) than the high-risk patients who did receive the intervention (21.4%). Conclusions : Numerous acute and chronic medical problems were treated at the PCP/transitional care clinic visits, which may have contributed to the reduction in rate of readmissions occurring within 30-days for those patients. Increased usage of the transitional care clinic identified a gap that patients continue to require assistance with establishing care with a PCP and further process change in the future is needed to ensure successful transition for all patients. [ABSTRACT FROM AUTHOR]

Differences in demographics, risk factors, and clinical characteristics may contribute to variations in men and women in terms of the prevalence, clinical setting, and outcomes associated with worsening heart failure (WHF) events. We sought to describe sex-based differences in the epidemiology, clinical characteristics, and outcomes associated with WHF events across clinical settings. We examined adults diagnosed with HF from 2010 to 2019 within a large, integrated health care delivery system. Electronic health record data were accessed for hospitalizations, emergency department (ED) visits and observation stays, and outpatient encounters. WHF was identified using validated natural language processing algorithms and defined as ≥1 symptom, ≥2 objective findings (including ≥1 sign), and ≥1 change in HF-related therapy. Incidence rates and associated outcomes for WHF were compared across care setting by sex. We identified 1,122,368 unique clinical encounters with a diagnosis code for HF, with 124,479 meeting WHF criteria. These WHF encounters existed among 102,116 patients, of whom 48,543 (47.5%) were women and 53,573 (52.5%) were men. Women experiencing WHF were older and more likely to have HF with preserved ejection fraction compared with men. The clinical settings of WHF were similar among women and men: hospitalizations (36.8% vs 37.7%), ED visits or observation stays (11.8% vs 13.4%), and outpatient encounters (4.4% vs 4.9%). Women had lower odds of 30-day mortality after an index hospitalization (adjusted odds ratio 0.88, 95% confidence interval 0.83–0.93) or ED visit or observation stay (adjusted odds ratio 0.86, 95% confidence interval 0.75–0.98) for WHF. Women and men contribute similarly to WHF events across diverse clinical settings despite marked differences in age and left ventricular ejection fraction. [Display omitted] [ABSTRACT FROM AUTHOR]

Increasing palliative care presence in the intensive care unit (ICU) improves symptom management, increases goals-of-care discussion, and reduces unnecessary procedures in ICU patients. An interdisciplinary study team developed a palliative care trigger program in a 17-bed surgical ICU (SICU). Surgical ICU patients who met 3 triggers (ICU length of stay > 10 days, repeat ICU admission, and metastatic cancer) automatically received a palliative care consult. The purpose of the current study was to survey SICU health care professionals before and after the institution of the palliative care trigger program. Overall, the palliative care trigger program was viewed positively by interdisciplinary team members with increased team communication and decreased resistance for the inclusion of palliative care in the SICU plan of care. The palliative care trigger program was successfully developed and implemented in a SICU and was accepted by the interdisciplinary team members caring for SICU patients. Team member feedback is being used to expand the palliative care trigger program to improve care for SICU patients. [ABSTRACT FROM AUTHOR]

Every practicing hand surgeon has had the challenging experience of treating a patient who demonstrates difficulty with, or inability to comply with medical advice. Patient noncompliance can lead to not only poor patient outcomes but also deterioration in the therapeutic relationship, physician burnout, high cost of care, and medical-legal risk. The guiding principles in the ethical practice of medicine render it important to consider noncompliance as a potentially modifiable risk factor, and every attempt should be made to work with these noncompliant patients to achieve the best possible outcomes. Data suggest that noncompliance may be affected by socioeconomic status and race; many of these patients are among the vulnerable. However, in some instances, treatment options may warrant alteration or adjustment to reflect the noncompliance of the patient. Rarely, it may be reasonable for a physician to discharge a patient from care once any urgent problems have been managed. Ethical and responsible management of a noncompliant patient requires a thoughtful and measured approach. [ABSTRACT FROM AUTHOR]

Engineering students require an education which facilitates the development not just of functional design of technological artefacts and processes, but they also need to be equipped to understand and engage with their wider implications and context. Consequently, as part of the formation of sustainability informed engineers, there is a clear necessity to integrate the socio-economic aspects of sustainability in order to posit technology in appropriate contextualised settings. The chemical engineering degree programme at University College Cork incorporates a strong emphasis on integrating the socio-economic dimension of sustainability within the programme. This paper focuses on ecological economics, and how it can connect with engineering and why it is important that engineering students receive a grounding in ecological economics. It outlines the content of a five-lecture series on ecological economics given to fifth-year chemical engineering students. This includes environmental aspects, such ecological limits analysis and the use of strategies, including economic, to move unsustainable natural resource use and emissions discharges to within their ecological limits. It explores social aspects and the critical barriers to transitioning to a sustainable economy, as well as the impact of ecological economics on engineering. Finally, three consecutive final year classes were surveyed to elicit their feedback on being taught ecological economics and to test the hypothesis that the inclusion of ecological economics appreciably enhances students' ability to engage productively with sustainability and the UN Sustainable Development Goals (SDGs); a key accreditation and professional requirement for contemporary engineering graduates. Overall, most students enjoyed the material, stating that is of value to engineering students, and they provided a useful qualitative assessment of the content. • Ecological economics education contributes to sustainability informed engineers. • Motivation for teaching ecological economics to engineering students is outlined. • Content of a lecture series in ecological economics is outlined. • Student survey showed that content is of value to engineering students. [ABSTRACT FROM AUTHOR]

As the proportion of women diagnosed with invasive breast cancer increases, the role of imaging for staging and surveillance purposes should be determined based on evidence-based guidelines. It is important to understand the indications for extent of disease evaluation and staging, as unnecessary imaging can delay care and even result in adverse outcomes. In asymptomatic patients that received treatment for curative intent, there is no role for imaging to screen for distant recurrence. Routine surveillance with an annual 2-D mammogram and/or tomosynthesis is recommended to detect an in-breast recurrence or a new primary breast cancer in women with a history of breast cancer, and MRI is increasingly used as an additional screening tool in this population, especially in women with dense breasts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Background: Patients who have recurrent atrial fibrillation (AF) following redo catheter ablation may eventually be managed with a pace-and-ablate approach, involving pacemaker implant followed by atrioventricular nodal ablation (AVNA). We sought to determine which factors would predict subsequent AVNA in patients undergoing redo AF ablation. Methods: We analyzed patients undergoing redo AF ablations between 2013 and 2019 at our institution. Follow-up was censored on December 31, 2021. Patients with no available follow- up data were excluded. Time-to-event analysis with Cox proportional hazard regression was used to compare those who underwent AVNA to those who did not. Results: A total of 467 patients were included, of whom 39 (8.4%) underwent AVNA. After multivariable adjustment, female sex (aHR 4.68 [95% CI 2.30-9.50]; p < 0.001), ischemic heart disease (aHR 2.99 [95% CI 1.25-7.16]; p = 0.014), presence of a preexisting pacemaker (aHR 3.25 [95% CI 1.10-9.60]; p = 0.033), and persistent AF (aHR 2.22 [95% CI 1.07-4.59]; p = 0.032) were associated with increased risk of subsequent AVNA requirement. Conclusion: Female sex, ischemic heart disease, and persistent AF may be useful clinical predictors of the requirement for subsequent AVNA and may be considered as part of shared clinical decision making. [ABSTRACT FROM AUTHOR]

Elizabeth Gaskell's protagonists are often categorized as redundant, particularly spinsters and widows. Such characters potentially complicate Gaskell's feminist status, seemingly embodying the repressive stereotypes of Victorian femininity. But rather than portraying them as unproductive, ridiculous, and marginal, Gaskell creates characters who directly counter the idea of redundancy. Her spinsters and widows are reformers who catalyze significant social change and redefine the power of elderly, unmarried women against patriarchal paradigms. The shift from redundancy to reform is especially evident in Cranford (1853) and My Lady Ludiow C 1858), which cast Miss Matty and Lady Ludlow as influential social figures who not only challenge tradition but reject its intolerance by working to rebuild their communities around a inore inclusive model based on morality and relationality. [ABSTRACT FROM AUTHOR]

Investigations of elite tennis match-play have highlighted the importance of serving and returning strategies. This study establishes the most common and effective strategies used by male and female players at Wimbledon, and identifies associated winner-loser differences. Hawk-Eye ball-tracking data from 302 men's and 139 women's singles matches contested between 2016 and 2018 were analysed using confidence intervals, Chi-square and Chi-square partitions. For both sexes, first serves to lateral areas (Zones A and D) of the service boxes were more common and more successful than first serves to central areas (Zones B and C). Second serves to lateral areas also tended to be more successful than those to central areas, but players typically prioritised safety, often executing second serves to Zone C (central, but towards the backhand of right-handed opponents). Men and women hit more serve-returns to central areas than lateral areas of the court, despite serve-returns to lateral areas being more successful. Furthermore, winning male players were more accurate than losing male players, executing a comparatively higher percentage of serves and returns to lateral areas; winning female players demonstrated this on first serves only. These findings can be used to improve the specificity and representativeness of players' grass court training. [ABSTRACT FROM AUTHOR]

Career opportunities for pharmacists beyond those commonly associated with the degree continue to emerge. A paucity of literature regarding evaluation of pharmacy graduate career paths over extended periods is apparent. Considering international pharmacy workforce capacity pressures, the primary study aim was to evaluate trends in career paths of pharmacy graduates. This study utilised a multimethod approach to access graduate career data using publicly accessible information from LinkedIn® profiles and an online survey. The survey was distributed to all pharmacy graduates of a university (2007–2022). Data from both methods was combined, cross-checked, coded and analysed quantitatively using descriptive and inferential statistics. Data from 69.7% of the university's pharmacy graduates was collected. Community pharmacy was the most prevalent employment sector (47.7%), followed by industry (21.5%) and hospital (17.7%). A higher proportion of more recent graduates (≤5 years post-graduation) work in a community or hospital pharmacy role versus those who graduated greater than five years ago (χ2 = 8.44, df = 2, p < 0.05). Post-graduate education was undertaken by 41.3% of graduates. Career satisfaction was high (88.2%) but was lower (χ2 = 11.31, df = 1, p < 0.05) for those in community and hospital (82%) versus other sectors (97.5%). This study provides the first analysis of graduate career paths over an extended period, highlighting a novel approach to track pharmacist workforce. While almost two thirds of pharmacy graduates occupy community or hospital roles, a trend of leaving these settings five years post-graduation was evident. Accordingly, this work represents a springboard for additional research to inform future pharmacist workforce planning worldwide. [ABSTRACT FROM AUTHOR]

Background: Conversations around disease conducted through social media provide a means for capturing public perspectives that may be useful in considering public health approaches. Syphilis is a sexually transmitted disease that is re-emerging. We sought to characterise online discourse on syphilis using data collected from the social media platform, Twitter. Methods: We extracted English-language tweets containing the word 'syphilis' posted on Twitter in 2019. Tweet identification number and URL, date and time of posting, number of retweets and likes, and the author's screen name, username and biographical statement were included in the dataset. A systematically sampled 10% subset of the data was subjected to qualitative analysis, involving categorisation on content. All tweets assigned to the category of medical resource were assessed for clinical accuracy. The engagement ratio for each category was calculated as (retweets + likes):tweets. Results: In 2019, 111,388 tweets mentioning syphilis were posted by 69,921 authors. The most frequent content category – totalling 5370 tweets (48%) – was a joke. Of 1762 tweets (16%) categorised as a medical resource, 1484 (84%) were medically correct and 240 (14%) were medically incorrect; for 38 (2%), medical accuracy could not be judged from the information posted. Tweets categorised as personal experiences had the highest engagement ratio at approximately 19:1. Medical resource tweets had an engagement ratio of approximately 7:1. Conclusions: We found medical information about syphilis was limited on Twitter. As tweets about personal experiences generate high engagement, coupling an experience with information may provide opportunity for public health education. This study used data sourced from Twitter to characterise social media conversations about syphilis. Accurate medical information was limited, whereas tweets about personal experience generated the most engagement. Coupling medical resources and personal experiences may support public health education on social media. [ABSTRACT FROM AUTHOR]

Objective: Although emerging studies examine the inverse relationship between body satisfaction and disordered eating for Black women, it has not been established how racially salient aspects of body satisfactionmay have implications for eating behaviors and longitudinal health outcomes. Method: In a longitudinal sample of 455 Blackwomen, we examined whether skin color satisfaction across ages 10-15was directly related to adult health outcomes at age 40 (e.g., disordered eating, self-esteem, self-reported health, depressive symptoms, and cardiovascular risk). We also investigated the indirect impact of skin color satisfaction on adult health, mediated by body satisfaction, and binge eating. Results: No significant direct or indirect effects of adolescent skin color satisfaction were observed for depressive symptoms or cardiovascular health outcomes. At ages 10 and 12, skin color satisfaction had negative and positive direct effects, respectively, on self-esteem. At age 15, greater skin color satisfaction was directly associated with greater self-reported health. Post hoc analyses revealed that when additionally accounting for adolescent body satisfaction, greater skin color satisfaction was indirectly associated with greater self-esteem and self-reported health, alongside lower cardiovascular risk. Conclusions: Although previous research suggests that in adolescence, Black girls' skin color satisfaction affects both body satisfaction and disordered eating behaviors, this association does not hold into midlife. Rather, post hoc analyses suggest that the lasting effects of adolescent skin color satisfaction are mediated by the longitudinal stability of body satisfaction, which in turn, is associated with adult health outcomes. [ABSTRACT FROM AUTHOR]