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Pasteurised donor human milk is recommended for very low birthweight infants who do not have access to their mother's milk. Although the use of donor milk continues to increase, little is known about the donation experiences of milk bank donors. We aimed to describe and compare enablers, barriers and patterns of human milk donation and identify factors predicting donation volume in a convenience sample of approved milk bank donors in the United Kingdom and the United States. A cross‐sectional online survey was conducted from August 2022 to December 2022. Approved milk bank donors (n = 556) from three milk banks in the United States (n = 369, Mothers' Milk Bank of Florida, Mother's Milk Bank of North Texas and Northwest Mothers Milk Bank) and one milk bank in the United Kingdom (n = 187, Hearts Milk Bank) completed the survey. A substantial portion of donors in both settings reported participating in other forms of milk exchange (51% of U.S. donors vs. 39% of UK donors, p = 0.009). Top donation barriers reported in both settings were completing the serological screening and having enough space to store collected milk. Most donors started donating when their infant was 3 months old or older and reported donating mature milk. The most common source of information related to milk banking in each setting was the internet (United Kingdom–70% vs. United States ‐ 63%, p = 0.112). Variables that predicted lifetime donation volume differed between the United States and the United Kingdom, highlighting the importance of setting‐specific milk banking research. Key messages: Milk bank donors in the United Kingdom and the United States reported primarily receiving milk banking information from the internet and not their health care provider.A substantial portion of human milk bank donors in the United Kingdom and the United States participate in other forms of milk exchange, including sharing with a peer.Participating in other forms of milk exchange did not predict lower milk bank donation volumes.Barriers to donation and predictors of donation volume differed between donors in the United Kingdom and the United States, suggesting setting‐specific research is warranted to improve the donation process globally. [ABSTRACT FROM AUTHOR]

Simple Summary: Immune checkpoint inhibitors (ICIs) are a type of immunotherapy used to treat a variety of cancers by helping a patient's own immune system to kill cancer cells. ICIs received their regulatory approval based on the results of large, randomized clinical trials. However, certain patient groups were excluded from these trials, so their outcomes are unknown. We performed a multicenter, retrospective study of real-world data in the United States in patients who had received at least one cycle of ICI treatment to evaluate the efficacy and safety of ICIs in patient groups underrepresented in clinical trials. Unique patient groups included age > 75 years, non-White race, positive smoking history, poor performance status, obesity, autoimmune diseases, chronic viral infections, multiple previous cancer therapies, or >three metastatic sites. Overall, ICIs were safe and efficacious in these patient groups. We noted that poor performance status and a history of multiple cancer therapies were associated with poor ICI efficacy, and Black patients, compared to White patients, experienced fewer immune-related adverse events. Regulatory approval of immune checkpoint inhibitors (ICIs) was based on results of large, randomized clinical trials, resulting in limited outcomes data in patient cohorts typically underrepresented in such trials. The objective of this study was to evaluate the efficacy and safety of ICIs in these unique patient cohorts. This is a multicenter, retrospective analysis of real-world data at six academic and community clinics in the United States from 1 January 2011 to 1 April 2018. Patients were included if they had received at least one cycle of ICI treatment. Unique patient cohorts included age > 75 years, non-White race, positive smoking history, ECOG performance status (PS) ≥ 2, BMI ≥ 30 kg/m2, autoimmune diseases (AIDs), chronic viral infections (CVI), extensive prior lines of therapy (LOTs), or >three metastatic sites. Immune-related adverse events (irAEs), overall survival (OS), and time to treatment failure were evaluated in the entire cohort and in NSCLC patients treated with PD-(L)1 monotherapy. Outcomes and their association with unique patient cohorts were compared on univariate analysis and multivariate analysis to those without a particular characteristic in the entire NSCLC PD-(L)1 monotherapy cohorts. In total, 1453 patients were included: 56.5%—smokers, 30.4%—non-White, 22.8%—elderly, 20.8%—ECOG PS ≥ 2, 15.7%—history of AIDs, and 4.7%—history of CVI. The common ICIs were nivolumab (37.1%) and pembrolizumab (22.2%). Black patients, compared to White patients, experienced fewer irAEs (OR 0.54, p < 0.001). An ECOG PS of ≥2 (HR = 2.01, p < 0.001) and an increased number of previous LOTs were associated with poor OS (the median OS of 26.2 vs. 16.2 vs. 9.6 months for one vs. two vs. three prior LOTs, p < 0.001). The above results were confirmed in anti-PD-(L)1 monotherapy non-small cell lung cancer patients (n = 384). Overall, ICIs were safe and efficacious in these typically underrepresented patient cohorts. We noted ECOG PS ≥ 2 and an increased prior LOTs were associated with poor ICI efficacy, and Black patients, compared to White patients, experienced fewer irAEs. [ABSTRACT FROM AUTHOR]

Disparities in health outcomes between Black and White Americans are well-documented, including sleep quality, and disparities in sleep may lead to disparities in health over the life course. A meta-model indicates that cognitive processes may underly the connection between race and poor sleep quality, and ultimately, health disparities. That is, there are race-specific stressors that disproportionately affect Black Americans, which are associated with poor health through biological, cognitive, and behavioral mechanisms (e.g., sleep). Among these race-specific stressors is discrimination, which has been linked to poor sleep quality, and there is a body of literature connecting perseverative cognition (e.g., rumination and worry or vigilance) to poor sleep. Microaggressions, a more subtle but pervasive form of discrimination, are another race-specific stressor. Although less research has considered the connection of microaggressions to perseverative cognition, there are some studies linking microaggressions to health outcomes and sleep. Therefore, using a cross-sectional survey, we tested the following hypotheses: racism-related vigilance and rumination would mediate the relationship between discrimination and poor sleep as well as between microaggressions and poor sleep among Black Americans (N = 223; mean age = 35.77 years, 53.8% men, 86% employed, 66.8% with college degree or higher education). Results of seven parallel mediation models showed that neither rumination nor racism-related vigilance mediated a relationship between discrimination and poor sleep quality. However, rumination partially mediated relationships between the six microaggression sub-scales and poor sleep quality: there were significant indirect effects for Foreigner/Not Belonging (β =.13, SE = 0.03, 95% CI 0.08, 0.20), Criminality (β =.11, SE = 0.03, 95% CI 0.05, 0.17), Sexualization (β =.10, SE = 0.03, 95% CI 0.05, 0.17), Low-Achieving/Undesirable (β =.10, SE = 0.03, 95% CI 0.05, 0.15), Invisibility (β =.15, SE = 0.04, 95% CI 0.08, 0.23), and Environmental Invalidations (β =.15, SE = 0.04, 95% CI 0.08, 0.23). Overall, these findings indicate support for the meta-model, demonstrating a specific pathway from racial microstressors to poor sleep quality. Furthermore, these results suggest the importance of developing clinical and community approaches to address the impact of microaggressions on Black Americans' sleep quality. [ABSTRACT FROM AUTHOR]

Bone-stress injury (BSI) is common in collegiate athletes. Injury rates and health care use in running athletes are not well documented. To describe the rate and classification of injury and associated health care use in collegiate cross-country runners with BSI. Descriptive epidemiology study. Sports medicine facilities participating in the Pac-12 Health Analytics Program. Pac-12 Conference collegiate cross-country athletes. Counts of injury and health care resources used for each injury. Injury rates were calculated based on athlete-seasons. A total of 168 BSIs were reported over 4 seasons from 80 team-seasons (34 men's and 46 women's team-seasons) and 1220 athlete-seasons, resulting in 1764 athletic training services and 117 physician encounters. Bone-stress injuries represented 20% of all injuries reported by cross-country athletes. The average BSI rate was 0.14 per athlete-season. Injury rates were higher in female (0.16) than male (0.10) athletes and higher in the 2019–2020 season (0.20) than the 2020–2021 (0.14), 2018–2019 (0.12), and 2021–2022 (0.10) seasons. Most BSIs occurred in the lower leg (23.8%) and the foot (23.8%). The majority of injuries were classified as overuse and time loss (72.6%) and accounted for most of the athletic training services (75.3%) and physician encounters (72.6%). We found a mean of 10.89 athletic training services per overuse and time-loss injury and 12.20 athletic training services per overuse and non–time-loss injury. Mean occurrence was lower for physician encounters (0.70), prescription medications (0.04), tests (0.75), procedures (0.01), and surgery (0.02) than for athletic training services (10.50). Bone-stress injuries are common in collegiate cross-country runners and require considerable athletic training resources. Athletic trainers should be appropriately staffed for this population, and suspected BSIs should be confirmed with a medical diagnosis. Future investigators should track treatment codes associated with BSI to determine best-practice patterns. [ABSTRACT FROM AUTHOR]

Lower extremity injuries are prevalent in military trainees, especially in female and older trainees. Modifiable factors that lead to higher injury risk in these subgroups are not clear. The purpose of this study was to identify whether external loading variables during military‐relevant tasks differ by age and sex in U.S. Army trainees. Data was collected on 915 trainees in the first week of Basic Combat Training. Participants performed running and ruck marching (walking with 18.1 kg pack) on a treadmill, as well as double‐/single‐leg drop landings. Variables included: vertical force loading rates, vertical stiffness, first peak vertical forces, peak vertical and resultant tibial accelerations. Comparisons were made between sexes and age groups (young, ≤19 years; middle, 20–24 years; older, ≥25 years). Significant main effects of sex were found, with females showing higher vertical loading rates during ruck marching, and peak tibial accelerations during running and ruck marching (p ≤ 0.03). Males showed higher vertical stiffness during running and peak vertical tibial accelerations during drop landings (p < 0.01). A main effect of age was found for vertical loading rates during running (p = 0.03), however no significant pairwise differences were found between age groups. These findings suggest that higher external loading may contribute to higher overall injury rates in female trainees. Further, higher stiffness during running may contribute to specific injuries, such as Achilles Tendinopathy, that are more prevalent in males. The lack of differences between age groups suggests that other factors contribute more to higher injury rates in older trainees. Highlights: Female trainees showed higher lower extremity loading during running and ruck marching that may predispose them to higher rates of musculoskeletal injury during initial‐entry training.Male trainees showed higher stiffness during running, which may relate to an increased risk of specific musculoskeletal injuries that are more prevalent in males, such as Achilles tendinopathy.Overall, older trainees did not show different lower extremity loading patterns compared to younger, suggesting that these factors are not related to the increased risk for musculoskeletal injury in older trainees. [ABSTRACT FROM AUTHOR]

Background: Paid parental leave policies may promote breastfeeding, which can have short- and long-term health benefits for both members of the birthing person-infant dyad. In the United States, where 56% of the workforce qualifies for unpaid federal medical leave, certain states have recently enacted paid parental and family leave policies. We aimed to assess the extent to which living in states with versus without paid family leave was associated with feeding regimens that included breastfeeding. Methods: In this cross-sectional analysis of the 2021 National Immunization Survey-Child, we assessed feeding outcomes: (1) exclusively breastfed (only fed breastmilk—never infant formula—both before and after six months of age), (2) late mixed breastfeeding (formula after six months), (3) early mixed breastfeeding (breastfed, formula before six months), and (4) never breastfed. We conducted Pearson χ2 to compare social-demographic characteristics and multivariable nominal regression to assess extent to paid family leave was associated with breastfeeding regimens, compared with never breastfeeding. Results: Of the 35,995 respondents, 5,806 (25% of weighted respondents) were from states with paid family leave policies. Compared with never breastfeeding, all feeding that incorporated breastfeeding—exclusive breastfeeding, late mixed feeding (breastfed, formula introduced after six months), and early mixed feeding (breastfed, formula introduced before six months)—were more prevalent in states with paid family leave policies. The adjusted prevalence ratio (aPR) and differences in adjusted prevalence compared with never breastfeeding in states with versus without paid family leave policies were: aPR 1.41 (95% CI 1.15, 1.73), 5.36% difference for exclusive breastfeeding; aPR 1.25 (95% CI 1.01, 1.53), 3.19% difference for late mixed feeding, aPR 1.32 (95% CI 1.32, 1.97), 5.42% difference for early mixed feeding. Conclusion: States with paid family leave policies have higher rates of any breastfeeding and of exclusive breastfeeding than states without such policies. Because all feeding types that incorporate breastfeeding were higher in states with paid family leave policies, expansion of paid family leave may improve breastfeeding rates. [ABSTRACT FROM AUTHOR]

Background: Cough is one of the most common presenting problems for patients in primary care and is largely managed in primary care clinical settings. Family physicians' familiarity with chronic cough guidelines and the extent to which these guidelines translate into everyday practice have not been well described. The objective of this study was to characterize current diagnosis, treatment, and referral practices among family physicians and to identify potentially impactful strategies to optimize chronic cough management in primary care. Methods: We conducted a cross-sectional survey of 5,000 family physicians to explore diagnosis, treatment, and referral practices related to chronic cough management in adults in primary care. Respondents completed the survey via paper or online. The outcome measures were self-reported numeric ratings and responses related to the survey elements. Results: 588 surveys were completed (11.8% response rate). About half (49.6%) of respondents defined chronic cough in a manner consistent with the American College of Chest Physicians (ACCP) chronic cough guidelines, with the rest differing in opinion primarily regarding duration of symptom presentation. Respondents reported trying to rule out most common causes of chronic cough themselves before referring (mean 3.41 on a 4-point scale where 4 is "describes me completely") and indicated a desire for more resources to help them manage and treat chronic cough. Years in practice and rural/urban setting influenced diagnosis and referral practices. Conclusions: Family physicians see chronic cough as a complicated condition that can be and is often diagnosed and treated entirely in a primary care setting. They also value the ability to refer in complex cases. Our results support that family physicians provide evidence-based management of chronic cough. [ABSTRACT FROM AUTHOR]

Background: Technological burden and medical complexity are significant drivers of clinician burnout. Electronic health record(EHR)-based population health management tools can be used to identify high-risk patient populations and implement prophylactic health practices. Their impact on clinician burnout, however, is not well understood. Our objective was to assess the relationship between ratings of EHR-based population health management tools and clinician burnout. Methods: We conducted cross-sectional analyses of 2018 national Veterans Health Administration(VA) primary care personnel survey, administered as an online survey to all VA primary care personnel (n = 4257, response rate = 17.7%), using bivariate and multivariate logistic regressions. Our analytical sample included providers (medical doctors, nurse practitioners, physicians' assistants) and nurses (registered nurses, licensed practical nurses). The outcomes included two items measuring high burnout. Primary predictors included importance ratings of 10 population health management tools (eg. VA risk prediction algorithm, recent hospitalizations and emergency department visits, etc.). Results: High ratings of 9 tools were associated with lower odds of high burnout, independent of covariates including VA tenure, team role, gender, ethnicity, staffing, and training. For example, clinicians who rated the risk prediction algorithm as important were less likely to report high burnout levels than those who did not use or did not know about the tool (OR 0.73; CI 0.61-0.87), and they were less likely to report frequent burnout (once per week or more) (OR 0.71; CI 0.60-0.84). Conclusions: Burned-out clinicians may not consider the EHR-based tools important and may not be using them to perform care management. Tools that create additional technological burden may need adaptation to become more accessible, more intuitive, and less burdensome to use. Finding ways to improve the use of tools that streamline the work of population health management and/or result in less workload due to patients with poorly managed chronic conditions may alleviate burnout. More research is needed to understand the causal directional of the association between burnout and ratings of population health management tools. [ABSTRACT FROM AUTHOR]

Purpose. Recently, the association between ATRX and a more aggressive sarcoma phenotype has been shown. We performed a retrospective study of sarcomas from an individual institution to evaluate ATRX as a prognosticator in soft tissue sarcoma. Experimental Design. 128 sarcomas were collected from a single institution and stained for ATRX. The prognostic significance of these markers was evaluated in a smaller cohort of primary soft tissue sarcomas (n = 68). Kaplan–Meier curves were created for univariate analysis, and Cox regression was utilized for multivariate analysis. Results. High expression of ATRX was found to be a positive prognostic indicator for overall survival and metastasis-free survival in our group of soft tissue sarcomas both in univariate analysis and multivariate analysis (HR: 0.38 (0.17–0.85), P = 0.02 and HR: 0.49 (0.24–0.99), P = 0.05 , respectively). Conclusions. High expression of ATRX is a positive prognostic indicator of overall survival and metastasis-free survival in patients with STS. This is consistent with studies in osteosarcoma, which indicate possible mechanisms through which loss of ATRX leads to more aggressive phenotypes. Future prospective clinical studies are required to validate the prognostic significance of these findings. [ABSTRACT FROM AUTHOR]

For gender-diverse (GD) college marching band (MB) artists, the risks for anxiety and depression may be higher as they navigate the demands and stressors associated with MB, college, and their gender identity. To examine the risks of anxiety and depression across GD MB artists and to explore their barriers and attitudes toward seeking mental health (MH) care. Cross-sectional study. Online survey. Seventy-eight GD individuals (transgender = 12, nonbinary = 66, age = 19 ± 1 years). A survey was used to assess demographics, anxiety risk using the State-Trait Anxiety Inventory, depression risk using the Center for Epidemiologic Studies Depression Scale, and barriers and attitudes using the Barriers Towards Seeking Help Checklist, the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form, and the Mental Help Seeking Attitudes Scale. We calculated descriptive statistics and univariate analyses to evaluate scores, risks, and differences between MH and receiving assistance. Participants had high state anxiety (mean = 52.0 ± 112.1), trait anxiety (mean = 55.2 ± 10.0), and symptoms of depression (mean = 30.4 ± 12.0) based on the State-Trait Anxiety Inventory and the Center for Epidemiologic Studies Depression Scale. Overall, 78.2% (n = 61 of 78) of GD MB artists were considered at risk for both state and trait anxiety and depression, and 18% (n = 11 of 61) did not seek help from an MH professional. These GD MB artists cited a lack of time (82.1%; n = 64 of 78) as the primary barrier to seeking professional help. The mean score on the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form for all GD artists was 19.5 ± 5.0, and the total score for the Mental Help Seeking Attitudes Scale was 47.8 ± 9.2, which indicated more favorable attitudes toward seeking professional help. We identified high rates of clinical symptoms for depression and anxiety among GD MB artists. The data are consistent with those from other minority populations and above the normative values for cisgender students. The lack of help-seeking behaviors in nearly 15% of at-risk participants highlights the need for specialized resources for GD patients and those participating in MB. [ABSTRACT FROM AUTHOR]

Metabolic syndrome is associated with increased risk for negative health events, decrements in quality of life, and greater health costs. The current study sought to identify whether the ratio of social support to social demands across multiple relationship types (spouse, friends, children, or other family members) were associated with concurrent metabolic syndrome in a nationally representative sample of US adults ages 32–40. Results indicate that the ratio of total social support to social demands was associated with a greater likelihood of meeting criteria for metabolic syndrome, even after statistically controlling for the effects of race, ethnicity, sex, age, income, and prior metabolic syndrome. When considering the relative contributions of each relationship type, greater support relative to demands from friends was the only relationship type that was significantly independently associated with lower likelihood of metabolic syndrome. Although not statistically significant, a trend-level negative association with spousal support/demands emerged, as did a trend-level positive association with support/demands from children. Taken together, the current study reaffirms the relevance of considering social support and demands with regards to metabolic syndrome and highlights the ways in which specific relationships may differentially relate to health risk. [ABSTRACT FROM AUTHOR]

Baicalin has been acknowledged for its anti-inflammatory properties. However, its potential impact on osteoarthritis (OA) has not yet been explored. Therefore, our study aimed to examine the effects of Baicalin on OA, both in laboratory and animal models. To evaluate its efficacy, human chondrocytes affected by OA were treated with interleukin-1β and/or Baicalin. The effects were then assessed through viability tests using the cell counting kit-8 (CCK-8) method and flow cytometry. In addition, we analyzed the expressions of various factors such as FOXO1, autophagy, apoptosis, and cartilage synthesis and breakdown to corroborate the effects of Baicalin. We also assessed the severity of OA through analysis of tissue samples. Our findings demonstrate that Baicalin effectively suppresses inflammatory cytokines and MMP-13 levels caused by collagenase-induced osteoarthritis, while simultaneously preserving the levels of Aggrecan and Col2. Furthermore, Baicalin has been shown to enhance autophagy. Through the use of FOXO1 inhibitors, lentivirus-mediated knockdown, and chromatin immunoprecipitation, we verified that Baicalin exerts its protective effects by activating FOXO1, which binds to the Beclin-1 promoter, thereby promoting autophagy. In conclusion, our results show that Baicalin has potential as a therapeutic agent for treating OA (Clinical Trial Registration number: 2023-61). [ABSTRACT FROM AUTHOR]

INTRODUCTION The majority of decisions on electronic nicotine delivery system (ENDS) premarket tobacco product applications (PMTAs) were made from October 2020 to February 2023; 99% (>25 million) had determinations by March 2023 and just twenty-three received marketing granted orders. We examined the unique devices and liquids used among US adults frequently using ENDS before, during, and after a majority of PMTA decisions were made. METHODS Data are from waves 1-5 (W1: May-Oct 2020, n=1179; W5: Feb-Apr 2023, n=1290) of a longitudinal survey of US adults (≥21 years) using ENDS ≥5 days/week. User-submitted photos of participants' most used devices and liquids were coded. Descriptive analyses and Wilcoxon signed-rank tests were used to understand the number and types of unique devices and liquids used in W1-W5, and the top brands in each wave. RESULTS From W1-W5, the number of unique ENDS device models and liquid products used by participants increased from 279 to 357 (p<0.001) and 546 to 695 (p<0.001), respectively. More unique devices in W5 versus W1 were disposable (W1: 16.5%; W5: 36.1%); fewer were disposable pod (W1: 6.5%; W5: 3.1%) or tank (W1: 53.8%; W5: 30.8%) devices. Liquids were primarily sweetflavored (W1: 81.1%; W5: 82.0%). The median liquid nicotine concentration increased from 12 to 50 mg/mL. In W5, few participants used FDA-approved devices (n=17; 1.3%) or liquids (n=6; 0.5%), and Elf Bar was the most commonly used device and liquid brand. Results for all waves are reported. CONCLUSIONS Despite PMTA decisions, an increase in the number of unique device models and liquid products used among adults who frequently use ENDS was observed from 2020 to 2023. Few participants in 2023 were using FDA-approved devices or liquids. Further research and monitoring are needed to inform how FDA prioritizes enforcement actions and what types of enforcement actions are effective. [ABSTRACT FROM AUTHOR]

Simple Summary: Previous studies have noted a significant increase in the incidence of pancreatic cancer among younger women (15–54 years) compared to men in the United States, yet the specific histopathologic types remained unexplored. This study aimed to elucidate whether the disproportionate rise in the incidence of pancreatic cancer in younger women was predominantly attributed to pancreatic ductal adenocarcinoma (PDAC) or pancreatic neuroendocrine tumors (PanNET). Our analysis revealed that the age-adjusted incidence rates (aIRs) of PDAC in younger women increased at a greater rate than counterpart men, whereas PanNET did not demonstrate a statistically significant sex-specific average annual percentage change difference. These discoveries provide crucial insights for guiding future investigations and informing healthcare policy. In previous studies, a significant increase in the incidence of pancreatic cancer among younger women compared to men in the United States was noted. However, the specific histopathologic characteristics were not delineated. This population-based study aimed to assess whether this disproportionate rise in pancreatic cancer in younger women was contributed by pancreatic ductal adenocarcinoma (PDAC) or pancreatic neuroendocrine tumors (PanNET). The United States Cancer Statistics (USCS) database was used to identify patients with pancreatic cancer between 2001 and 2018. The results showed that, in younger adults, the incidence of PDAC has increased in women [average annual percentage change (AAPC) = 0.62%], while it has remained stable in men (AAPC = −0.09%). The PDAC incidence rate among women increased at a greater rate compared to men with a statistically significant difference in AAPC (p < 0.001), with neither identical nor parallel trends. In contrast, cases of PanNET did not demonstrate a statistically significant sex-specific AAPC difference. In conclusion, this study demonstrated that the dramatic increase in the incidence rate of PDAC explains the disproportionate rise in pancreatic cancer incidence in younger women. This prompts further prospective studies to investigate the underlying reasons for these sex-specific disparities in PDAC. [ABSTRACT FROM AUTHOR]

Simple Summary: Given the rarity of choroid plexus tumors (CPTs), there is a need for large cohort analyses to provide a better understanding of prognostication and optimal diagnosis. Using the National Cancer Institute's Surveillance, Epidemiology, and End Result (NCI SEER) database, here we present one of the largest retrospective cohort analyses studying patients with CPT. This study provides a better understanding of prognostication and optimal treatment, especially the role that neoadjuvant therapies play. Background: Choroid plexus tumors (CPTs) are rare neoplasms found in the central nervous system, comprising 1% of all brain tumors. These tumors include choroid plexus papilloma (CPP), atypical choroid plexus papilloma (aCPP), and choroid plexus carcinoma (CPC). Although gross total resection for choroid plexus papillomas (CPPs) is associated with long-term survival, there is a scarcity of prospective data concerning the role and sequence of neoadjuvant therapy in treating aCPP and CPC. Methods: From the years 2000 to 2019, 679 patients with CPT were identified from the Surveillance, Epidemiology, and End Result (SEER) database. Among these patients, 456 patients had CPP, 75 patients had aCPP, and 142 patients had CPC. Univariate and multivariable Cox proportional hazard models were run to identify variables that had a significant impact on the primary endpoint of overall survival (OS). A predictive nomogram was built for patients with CPC to predict 5-year and 10-year survival probability. Results: Histology was a significant predictor of OS, with 5-year OS rates of 90, 79, and 61% for CPP, aCPP, and CPC, respectively. Older age and African American race were prognostic for worse OS for patients with CPP. Older age was also associated with reduced OS for patients with aCPP. American Indian/Alaskan Native race was linked to poorer OS for patients with CPC. Overall, treatment with gross total resection or subtotal resection had no difference in OS in patients with CPP or aCPP. Meanwhile, in patients with CPC, gross total resection (GTR) was associated with significantly better OS than subtotal resection (STR) only. However, there is no difference in OS between patients that receive GTR and patients that receive STR with adjuvant therapy. The nomogram for CPC considers types of treatments received. It demonstrates acceptable accuracy in estimating survival probability at 5-year and 10-year intervals, with a C-index of 0.608 (95% CI of 0.446 to 0.77). Conclusions: This is the largest study on CPT to date and highlights the optimal treatment strategies for these rare tumors. Overall, there is no difference in OS with GTR vs. STR in CPP or aCPP. Furthermore, OS is equivalent for CPC with GTR and STR plus adjuvant therapy. [ABSTRACT FROM AUTHOR]

* Context.--Unsatisfactory Papanicolaou (Pap) tests pose a unique set of challenges to the laboratory with regard to their processing, review, reporting, and performance of human papillomavirus (HPV) testing. There are no standardized guidelines for the review process and handling of unsatisfactory Pap tests. Objective.--To assess the current practice patterns regarding various aspects of the unsatisfactory Pap test, from processing to reporting, across laboratories worldwide. Design.--A supplemental questionnaire was mailed to laboratories participating in the 2020 College of American Pathologists (CAP) Gynecologic Cytopathology (PAP Education) Program, requesting data regarding the unsatisfactory Pap test. Results.--Of 1520 participating laboratories, 619 (40.7%) responded, and the responses of 577 laboratories were included for further analysis. Only 64.6% (373 of 577) laboratories used the unsatisfactory Pap test criteria as specified by the 2014 Bethesda System. About threequarters of the respondents (433 of 576; 75.2%) routinely rescreened unsatisfactory Pap tests. Routine repreparation of such Pap tests was performed by 54.9% (316 of 576) of laboratories, and 52.0% (293 of 563) used glacial acetic acid for repreparing excessively bloody specimens. HPV test results were reported for unsatisfactory Pap tests, always or sometimes, by 62.4% (353 of 566) of respondents. Conclusions.--This CAP survey reveals important information regarding the practice patterns pertaining to several aspects of the unsatisfactory Pap test. It also provides valuable insight into the quality assurance measures that can be implemented for such tests. Future studies can further aid in the standardization of all components of the handling of unsatisfactory Pap tests for overall quality improvement. [ABSTRACT FROM AUTHOR]

Advocates and researchers have made many recommendations for forensic science improvement in the United States. These proposals are often motivated by wrongful convictions related to false or misleading forensic evidence. In many cases, the connection between the proposals and the actual experience of wrongful convictions has not been well defined. Further, recommendations may not have been realizable given the structure of the criminal justice system in the United States and the practical realities of forensic science laboratories. Finally, limited attempts have been made to assess recommendations over time to determine the progress of forensic science improvement and elucidate continuing gaps. Reports from the Department of Justice, the National Academy of Sciences, and the President's Council of Advisors on Science and Technology are assessed to determine the extent to which their recommendations have been implemented, whether the recommendations align with the actual experience of wrongful convictions, and how the American forensic science community has implemented forensic science improvement. The most successful proposals reflect a broad movement toward quality assurance, improved standards, and organizational improvement in the forensic sciences. Less successful proposals are associated with calls for large federal investments, difficulties in community-wide implementation, or uncertain linkage to foundations in science and practice. Significant progress has been made in the standardization of reporting and testimony, assessment of the foundational reliability of the disciplines, and DNA mixture interpretation. Significant gaps remain to improve medicolegal death investigation, governance, and the implementation of standards. Improved allocation and use of resources will be required to meet continuing challenges in capacity building, training, and proficiency testing, although past experience indicates that both federal and non-federal funding will be required to address these issues. Continued improvement is needed to address the issues associated with wrongful convictions, although forensic science leaders have demonstrated the ability to prioritize improvement initiatives. [ABSTRACT FROM AUTHOR]

Objective: Acute promyelocytic leukemia (APL) is associated with an elevated risk of developing disseminated intravascular coagulation (DIC). The purpose of this study was to assess the outcomes of hospitalizations related to DIC in APL and their impact on healthcare. Materials and Methods: This study entailed a cross-sectional and retrospective analysis of the US National Inpatient Sample database. We identified adults with APL and categorized them into groups of patients with and without DIC. Our focus areas included in-hospital mortality, length of stay, charges, and complications associated with DIC. Unadjusted odds ratios/coefficients were computed in univariate analysis, followed by adjusted odds ratios (aOR)/coefficients from multivariate analysis that accounted for confounding factors. Results: Our analysis revealed that APL patients with DIC had a substantially higher aOR for mortality (aOR: 6.68, 95% confidence interval [CI]: 4.76-9.37, p<0.001) and a prolonged length of stay (coefficient: 10.28 days, 95% CI: 8.48-12.09, p<0.001) accompanied by notably elevated total hospital charges (coefficient: $215,512 [95% CI: 177,368-253,656], p<0.001), thereby emphasizing the reality of extended medical care and economic burden. The presence of DIC was associated with increased odds of sepsis, vasopressor support, pneumonia, acute respiratory failure, intubation/mechanical ventilation, and acute kidney injury, reflecting heightened vulnerability to these complications. Patients with DIC demonstrated significantly higher odds ratios for major bleeding, intracranial hemorrhage, gastrointestinal bleeding, red blood cell transfusion, platelet transfusion, fresh frozen plasma transfusion, and cryoprecipitate transfusion, highlighting the pronounced hematological risks posed by DIC. Conclusion: This study has revealed the significant associations between DIC in APL and various outcomes, underscoring the clinical and economic implications of these conditions. The hematological risks further increase patients' vulnerability to bleeding events and the need for transfusions. [ABSTRACT FROM AUTHOR]

Objective: To describe associations between patients' demographic characteristics and access to telemedicine services in an urban tertiary academic medical system across the COVID-19 pandemic, and to identify potential barriers to access. Methods: This was a retrospective cohort study conducted at a single-center tertiary academic medical center. The study included adult patients undergoing outpatient otolaryngologic care in person or via telemedicine during 8 week timeframes: before the pandemic, at the onset of the pandemic, and during later parts of the pandemic. Patients were characterized by age, sex, race, insurance type, primary language, portal activation status, income estimate, and visit type. Where appropriate, chi-squared tests, Wilcoxon signed-rank tests, and logistic regression were used to compare demographic factors between the cohorts. Results: A total of 14,240 unique patients [median age, 58 years (range, 18-107 years); 56.5% were female] resulting in a total of 29,457 visits (94.8% in-person and 5.2% telemedicine) were analyzed. Patients seen in person were older than those using telemedicine. Telemedicine visits included a higher proportion of patients with private insurance, and fewer patients with government or no insurance compared to in-person visits. Race, income, and English as primary language were not found to have a significant effect on telemedicine use. Conclusion: In an urban tertiary medical center, we found significant differences in sociodemographic characteristics between patients who accessed otolaryngologic care in person versus via telemedicine through different phases of the COVID pandemic, reflecting possible barriers to care associated with telemedicine. Further studies are needed to develop interventions to improve access. [ABSTRACT FROM AUTHOR]

Negative health impacts exist for individuals who identify as lesbian, gay, bisexual, transgender, or something other than heterosexual are critical. Nurses are on the front lines of delivering holistic patient care to everyone, and their potential biases regarding this vulnerable population may negatively affect care. The study used scores from two tests designed to measure implicit bias in individuals towards sexual and gender minorities (SGM). A retrospective design with secondary data from Project Implicit was conducted using the Transgender (2020) and Sexuality (2006 to 2020) Implicit Association Tests (IATs). We compared mean Transgender IAT scores of nurses to other health-related professions (n = 53,586) and investigated differences between nurses' Transgender IAT scores and self-identified explicit attitudes (n = 1558). A time-series of nurses' Sexuality IAT scores was also explored (N = 25,791). Our study findings demonstrated that nurses held the strongest implicit preference for cisgender people compared to other occupational groups. No significant difference was found between nurses' implicit and explicit preferences. Nurses' implicit attitudes about sexual orientation have trended toward less biased scores. Comprehensive nursing education and implementation of nursing practices that promote health and well-being for sexual and gender minority patients are needed to reduce biases and continue this trend. [ABSTRACT FROM AUTHOR]