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Introduction: Previous studies have shown that patients in the emergency department (ED) are frequently given incomplete discharge instructions that are written at least four grade levels above the recommended sixth-grade reading level, leading to poor understanding. Our aims in this study were to implement standardized discharge instructions containing six key components written at a more appropriate reading level for common emergency department (ED) diagnoses to improve patient understanding.Methods: We conducted this study in a 20-bed ED at an urban Veteran’s Administration hospital. Data was collected via in-person patient and clinician interviews. Patient interviews were conducted after patients received their discharge instructions. We compared patient responses to clinician responses and marked them as incorrect, partially correct, or correct with a score of 0, 0.5, or 1, respectively. The maximum possible score for each interview was six. Six key components of discharge instructions were asked about: diagnosis; new medications; at-home care; duration of illness; reasons to return; and follow-up. There were 25 patients in the pre-intervention group and 20 in the intervention group with the standardized set of instructions. We performed a Mann-Whitney U test on the total interview scores in the control and intervention groups and conducted a sub-analysis on the individual scores for each of the six key components.Results: The patients in the intervention demonstrated a statistically significant increase in patient-clinician correlation when compared to the patients in the pre-intervention group overall (P < 0.05), and two of the six key components of the discharge instructions individually showed statistically significant increase in patient-clinician correlation when standardized discharge instructions were used.Conclusion: Patients who received the standardized discharge instructions had improved understanding of their discharge instructions. Future opportunities extending off this pilot study include expanding the number of diagnoses for which standardized instructions are used and investigating patient-centered outcomes related to these instructions.

BackgroundRising overdose deaths globally and increased social isolation during the coronavirus disease 2019 (COVID-19) pandemic may have disproportionately impacted people with human immunodeficiency virus (PWH) with substance use disorders (SUD). We examined trends in SUD risk among PWH before and after the COVID-19 shelter-in-place (SIP) mandate.MethodsData were collected between 2018 and 2022 among PWH enrolled across 8 US sites in the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We evaluated changes in moderate/high SUD risk after SIP using interrupted time series analyses.ResultsThere were 7126 participants, including 21 741 SUD assessments. The median age was 51 (interquartile range, 39-58) years; 12% identified as Hispanic or Latino/Latina, 46% Black/African American, and 46% White. Moderate/high SUD risk increased continuously after the pandemic's onset, with 43% (95% confidence interval [CI], 40%-46%) endorsing moderate/high SUD risk post-SIP, compared to 24% (95% CI, 22%-26%) pre-SIP (P < .001). There were increases in the use of heroin, methamphetamine, and fentanyl, and decreases in prescription opioids and sedatives post-SIP. Further, there was a decrease in reported substance use treatment post-SIP compared to pre-SIP (P = .025).ConclusionsThe rising prevalence of SUD through late 2022 could be related to an increase in isolation and reduced access to substance use and HIV treatment caused by disruptions due to COVID-19. A renewed investment in integrated substance use treatment is vital to address the combined epidemics of substance use and HIV following the COVID-19 pandemic and to support resilience in the face of future disruptions.

OBJECTIVES: We aim to estimate geographic variability in total numbers of infections and infection fatality ratios (IFR; the number of deaths caused by an infection per 1,000 infected people) when the availability and quality of data on disease burden are limited during an epidemic. METHODS: We develop a noncentral hypergeometric framework that accounts for differential probabilities of positive tests and reflects the fact that symptomatic people are more likely to seek testing. We demonstrate the robustness, accuracy, and precision of this framework, and apply it to the United States (U.S.) COVID-19 pandemic to estimate county-level SARS-CoV-2 IFRs. RESULTS: The estimators for the numbers of infections and IFRs showed high accuracy and precision; for instance, when applied to simulated validation data sets, across counties, Pearson correlation coefficients between estimator means and true values were 0.996 and 0.928, respectively, and they showed strong robustness to model misspecification. Applying the county-level estimators to the real, unsimulated COVID-19 data spanning April 1, 2020 to September 30, 2020 from across the U.S., we found that IFRs varied from 0 to 44.69, with a standard deviation of 3.55 and a median of 2.14. CONCLUSIONS: The proposed estimation framework can be used to identify geographic variation in IFRs across settings.

Intercultural Perspectives on Information Literacy and Metaliteracy (IPILM) is a discourseoriented learning environment that engages students from diverse cultural backgrounds to participate in collaborative knowledge construction. The objective is to evolve a thematic approach to course design that includes elements of open pedagogy, information literacy, and metaliteracy. IPILM invites participation from educators and learners from around the world and has witnessed an increase in participating countries. This paper describes the concept of IPILM and demonstrates the implementation of this approach in practice. The initiative was well received by students and is both feasible and sustainable as an intercultural learning endeavor. IPILM is an ongoing project and a work in progress that is an adaptable model which may be transferred to disparate fields of teaching and learning or adopted by international communities of instructors.

This study analyzes seasonal and spatial patterns of column carbon dioxide (CO2) over North America, calculated from aircraft and tall tower measurements from the NOAA Global Greenhouse Gas Reference Network from 2004 to 2014. Consistent with expectations, gradients between the eight regions studied are larger below 2 km than above 5 km. The 11-year mean CO2 dry mole fraction (XCO2) in the column below ∼ 330 hPa ( ∼ 8 km above sea level) from NOAA's CO2 data assimilation model, CarbonTracker (CT2015), demonstrates good agreement with those calculated from calibrated measurements on aircraft and towers. Total column XCO2 was attained by combining modeled CO2 above 330 hPa from CT2015 with the measurements. We find large spatial gradients of total column XCO2 from June to August, with north and northeast regions having ∼ 3 ppm stronger summer drawdown (peak-to-valley amplitude in seasonal cycle) than the south and southwest regions. The long-term averaged spatial gradients of total column XCO2 across North America show a smooth pattern that mainly reflects the large-scale circulation. We have conducted a CarbonTracker experiment to investigate the impact of Eurasian long-range transport. The result suggests that the large summertime Eurasian boreal flux contributes about half of the north–south column XCO2 gradient across North America. Our results confirm that continental-scale total column XCO2 gradients simulated by CarbonTracker are realistic and can be used to evaluate the credibility of some spatial patterns from satellite retrievals, such as the long-term average of growing-season spatial patterns from satellite retrievals reported for Europe which show a larger spatial difference ( ∼ 6 ppm) and scattered hot spots.

INTRODUCTION: Brodalumab is a human interleukin-17 receptor A antagonist indicated for the treatment of moderate-to-severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy and have failed to respond or have lost response to other systemic therapies. Although the US prescribing information for brodalumab includes a boxed warning regarding suicidal ideation and behavior, no causal association has been demonstrated. Here, we summarize 5 years of pharmacovigilance data, from August 15, 2017, through August 14, 2022, reported to Ortho Dermatologics by US patients and healthcare providers. METHODS: Prevalence of the most common adverse events (AEs) listed in the brodalumab package insert (incidence ≥ 1%) and AEs of special interest are described. Brodalumab exposure was estimated as the time from the first to last prescription-dispensing authorization dates. Data were collected from 4744 patients in the USA, with an estimated exposure of 5815 patient-years. RESULTS: Over 5 years, 11 cases of adjudicated major adverse cardiovascular events were reported (0.23 events/100 patients), a rate lower than that experienced by patients in the international Psoriasis Longitudinal Assessment and Registry. There were 106 serious infections. No serious fungal infections were reported. There were 40 confirmed and 2 suspected COVID-19 cases, with no new COVID-19-related deaths. Of 49 reported malignancies among 42 patients, 3 were deemed possibly related to brodalumab. No completed suicides and no new suicidal attempts were reported. CONCLUSION: Five-year pharmacovigilance data are consistent with the established safety profile reported in long-term clinical trials and previous pharmacovigilance reports, with no new safety signals.

Bridging molecular information to ecosystem-level processes would provide the capacity to understand system vulnerability and, potentially, a means for assessing ecosystem health. Here, we present an integrated dataset containing environmental and metagenomic information from plant-associated microbial communities, plant transcriptomics, plant and soil metabolomics, and soil chemistry and activity characterization measurements derived from the model tree species Populus trichocarpa. Soil, rhizosphere, root endosphere, and leaf samples were collected from 27 different P. trichocarpa genotypes grown in two different environments leading to an integrated dataset of 318 metagenomes, 98 plant transcriptomes, and 314 metabolomic profiles that are supported by diverse soil measurements. This expansive dataset will provide insights into causal linkages that relate genomic features and molecular level events to system-level properties and their environmental influences.

Abstract: On seasonal time scales, vapor pressure deficit (VPD) is a known predictor of burned area in the southwestern United States (“the Southwest”). VPD increases with atmospheric warming due to the exponential relationship between temperature and saturation vapor pressure. Another control on VPD is specific humidity, such that increases in specific humidity can counteract temperature-driven increases in VPD. Unexpectedly, despite the increased capacity of a warmer atmosphere to hold water vapor, near-surface specific humidity decreased from 1970 to 2019 in much of the Southwest, particularly in spring, summer, and fall. Here, we identify declining near-surface humidity from 1970 to 2019 in the southwestern United States with both reanalysis and in situ station data. Focusing on the interior Southwest in the months preceding the summer forest fire season, we explain the decline in terms of changes in atmospheric circulation and moisture fluxes between the surface and the atmosphere. We find that an early spring decline in precipitation in the interior region induced a decline in soil moisture and evapotranspiration, drying the lower troposphere in summer. This prior season precipitation decline is in turn related to a trend toward a Northern Hemisphere stationary wave pattern. Finally, using fixed humidity scenarios and the observed exponential relationship between VPD and burned forest area, we estimate that with no increase in temperature at all, the humidity decline alone would still lead to nearly one-quarter of the observed VPD-induced increase in burned area over 1984–2019. Significance Statement: Burned forest area has increased significantly in the southwestern United States in recent decades, driven in part by an increase in atmospheric aridity [vapor pressure deficit (VPD)]. Increases in VPD can be caused by a combination of increasing temperature and decreasing specific humidity. As the atmosphere warms with climate change, its capacity to hold moisture increases. Despite this, there is a decrease in near-surface air humidity in the interior southwestern United States over 1970–2019, which during the summer is likely caused by a decline in early spring precipitation leading to limited soil moisture and evaporation in spring and summer. We estimate that this declining humidity alone, without an increase in temperature, would cause about one-quarter of the VPD-induced increase in burned forest area in this region over 1984–2019.

This article argues for a Deweyan "democratic design" approach to program leadership that builds programmatic ideals into leadership practices. To illustrate democratic design in practice, we draw from case studies of two partnership programs based in writing studies--a writing partnership between the University of Arizona and area high schools and a collaboration between Salt Lake City Community College and the University of Utah--that utilize community advisory boards and democratic processes to work toward stakeholder-oriented approaches to leadership. Through these case studies, we emphasize three core principles of democratic design, including stakeholder leadership, political vision, and epistemic equity, that can be applicable across a range of programmatic opportunities. For leaders in composition studies who see collaboration as central to their mission, democratic design can serve as a linchpin for aligning processes with values.

The COVID-19 pandemic has drastically affected how higher education operates, but relatively little is known about its effects on students enrolled in remote online classes. Across two data collection timepoints, we sought to examine college students' experiences, focusing particularly on their sense of belonging/loneliness, their course formats, and their experiences in the pandemic. Though some findings differed between data collected in fall 2020 and in spring 2021, we generally found that students' belonging/loneliness was linked with their class format, aspects of their virtual classes, social contact, and experiences in the pandemic. This research demonstrates the importance both of understanding students' experiences in general and of continuing to study students' experiences as we progress from one stage of the pandemic to the next.