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Community evidenced-based diabetes self-management education (DSME) models have not been examined for feasibility, acceptability, or effectiveness among persons transitioning from prison to the community to independent diabetes self-management (DSM). In a non-equivalent control group design with repeated measures, we examined the feasibility, acceptability, and preliminary effect of a 6-week, 1-h per week Diabetes Survival Skills (DSS) intervention on diabetes knowledge, distress, self-efficacy, and outcome expectancy for transitioning incarcerated males. Of the 92 participants (84% T2D, 83% using insulin, 40% Black, 20% White, 30% Latino, 66% high school or less, mean age 47.3 years, 84% length of incarceration ≤4 years ), 41 completed the study (22 control/19 intervention [TX]). One-way repeated measures ANOVAs revealed significant changes in diabetes knowledge within each group (C, p= .002; TX, p= .027) at all time points; however, a two-way repeated measures ANOVA showed no differences between groups. Additionally, both groups showed improvement in diabetes-related distress and outcome expectancy with the treatment group experiencing greater and sustained improvement at the 12-week time point. Analysis of focus group data (Krippendorf) revealed acceptance of and enthusiasm for the DSS training and low literacy education materials, the need for skill demonstration, and ongoing support throughout incarceration and before release. Our results highlight the complexity of working with incarcerated populations. After most of the sessions, we observed some information sharing between the intervention and the control groups on what they did in their respective sessions. Due to high attrition, the power to detect effects was limited. Yet, results suggest that the intervention is feasible and acceptable with an increased sample size and refined recruitment procedure. NCT05510531, 8/19/2022, retrospectively, registered

At the 2022 Clinical Ethics Unconference, the authors perceived a significant lack of racial and ethnic diversity, which was consistent with their experiences in other clinical ethics settings. As a result, they convened a working group to address the pervasive lack of diversity present in the field of clinical ethics and to propose strategies to increase the representation of people from racial and ethnic minority populations. This article identifies the harms associated with the lack of diversity in the healthcare setting and translates these to the field of clinical ethics. The article then proposes a framework that may be used to help diversify the field of clinical ethics. Specifically, the authors identify existing barriers to appropriate diversity, actionable steps to increase diversity, and tools the field can utilize to systematically assess its progress with respect to achieving diversity.

Supplemental Digital Content is available in the text.Patients on left ventricular assist device (LVAD) support may be susceptible to severe disease and complications from coronavirus disease-19 (COVID-19). The purpose of this study was to describe the clinical course of COVID-19 in LVAD patients. A retrospective review was performed at our center; 28 LVAD patients who developed COVID-19 between March 2020 and March 2021, and six patients with a prior COVID-19 infection who underwent LVAD implantation, were identified and examined. Of the 28 patients, nine (32%) died during the study period, five (18%) during their index hospitalization for COVID-19. Two patients (7%) presented with suspected pump thrombosis. In a nonadjusted binary regression logistic analysis, admission to the intensive care unit (unadjusted odds ratio, 7.6 [CI, 1.2–48], P= 0.03), and the need for mechanical ventilation (unadjusted odds ratio 14 [CI, 1.3–159], P= 0.03) were associated with mortality. The six patients who previously had COVID-19 and subsequently received a LVAD were on intra-aortic balloon pump and inotropic support at time of surgery. All six experienced a complicated and prolonged postoperative course. Three patients (50%) suffered from ischemic stroke, and there was one (17%) 30 day mortality. We observed an increased risk of morbidity and mortality in LVAD patients with COVID-19.

Despite modifications and a procedure to externally replace the distal portion of the percutaneous lead, damage to the wiring insulation causing an electrical short to ground, referred to as a short to shield (STS), has become an important factor in the longevity of the HeartMate II left ventricular assist device (LVAD). Device exchange has been the suggested treatment option. The aim of this study was to evaluate the long-term clinical outcomes of patients with an STS supported on an ungrounded cable. A retrospective review of all patients (n = 479) implanted with a HeartMate II at our center between January 2008 and December 2017 was performed. Patients with a documented STS maintained on an ungrounded cable were examined. Patient characteristics, time from device implantation to STS, treatment strategies, and duration of support on an ungrounded cable were summarized. The association between support with an ungrounded cable and clinical outcomes was evaluated. A total of 53 (11% of 479) patients (83% males and 81% destination therapy) with an STS were supported on an ungrounded cable for a median duration of 195 days (range 2 days to 3.3 years). Patients were more active (New York Heart Association [NYHA] p< 0.001, 6 minute walk test [6MWT] p= 0.003) and had a trend toward increased weight gain (p= 0.055) from time of implant to STS. Duration of support before the STS was 1.9 years (range 165 days to 8.6 years). Twenty-two patients were treated directly with an ungrounded cable and 31 patients underwent an external driveline repair and still required an ungrounded cable within 2 days (range 0 days to 1.3 years). During the study period, 38 patients were maintained on an ungrounded cable: 21 patients were ongoing for 299 days (range 114 days to 2.8 years), 11 patients transplanted after 79 days (range 7–295 days), four patients died because of comorbid conditions after 1.6 years (range 141 days to 3.2 years), one patient exchanged for thrombosis after 229 days, and one patient explanted after 279 days. The other 15 patients developed a phase-to-phase electrical short after 51 days (range 2 days to 3.3 years): 14 patients underwent a successful pump exchange and one patient transplanted within 2 days. No patients died because of support with an ungrounded cable or worsening lead damage necessitating device exchange. With extended durations of support, some patients with a HeartMate II LVAD will experience device failure in the form of an STS. Select patients with an STS can be safely supported on an ungrounded cable for several years with close monitoring. This treatment approach should be considered before a device exchange.

People transitioning from prisons or jails have high mortality, but data are scarce for people with HIV and no studies have integrated data from both criminal justice and community settings. We aimed to assess all-cause mortality in people with HIV released from an integrated system of prisons and jails in Connecticut, USA.

Internationalization trends worldwide have brought more multilingual students into English‐medium university classrooms in the United States and elsewhere. Faculty across the disciplines increasingly have the dual challenge of developing both content and advanced academic language. Ample precedent in P–12 education suggests developing instructors’ knowledge of (a) students as language learners, (b) instructional techniques grounded in second language acquisition theory, and (c) contextual factors necessary for helping instructors implement linguistically responsive instruction (LRI). This study probes the extent to which prior work transfers to the tertiary setting, focusing on participating faculty members’ beliefs about multilingual students, LRI, and context. The authors collected survey data from 197 faculty at a mid‐size comprehensive university in the midwestern United States and analyzed written comments provided by participants. They found that, on the whole, faculty participants displayed deficit views regarding students’ linguistic and academic abilities and questioned the appropriateness and feasibility of several of the LRItechniques. Many rejected the notion that language instruction was within the scope of their responsibilities and expressed a strong preference for support provided outside of class time. The authors discuss the results in terms of the notions of rigor, college readiness, and faculty development in LRI.

Incarceration provides an opportunity for engagement in HIV care but is associated with poor HIV treatment outcomes after release. We aimed to assess post-release linkage to HIV care (LTC) and the effect of transitional case management services.

AbstractRecognizing the importance of academic language for students’ success in schools, this article reports on an investigation of how narrative-focused literacy events in the classroom provide opportunities for academic language socialization. Data were collected from one public elementary school in a major metropolitan area in the Mid-Atlantic region of the United States. Participants include an intact kindergarten class of 16 students from culturally and linguistically diverse backgrounds and their teacher. The results of the investigation revealed that sharing time provides opportunities for socialization to academic register through: (1) requiring that students successfully navigate the academic language demands of the interaction, (2) providing differentiated teacher scaffolding that supports students in meeting these demands, and (3) building a linguistic third space. The author discusses how the data and results demonstrate that the roots of mature academic language register are in the emergent academic language used in early childhood classrooms.

When flowers start to bloom it's time to bring out the broom Spring is near, Spring is near When the sun comes out nice and bright it takes away all […]

Blood stream infections (BSIs) are an important cause of morbidity and mortality in patients with left ventricular assist devices (LVADs). The aim of this study was to examine the correlation between hemorrhagic cerebrovascular accident (CVA) and BSI after implantation of LVAD for advanced heart failure (HF). This was a retrospective descriptive review of 87 patients with end-stage HF, who underwent implantation of HeartMate II continuous-flow LVAD over a 4 year period. Blood stream infections were diagnosed by serial blood cultures, and suspected neurological complications including CVAs were confirmed by neuroimaging. Extensive patient chart review was performed, and descriptive characteristics were analyzed using SPSS statistical software. The mean age of our study population was 62.3 ± 12.8 years, and the majority of our patients were males (n = 75, 86.2). The baseline characteristics were comparable in the patients with and without CVAs. Patients with BSI had a much greater incidence of CVA compared to patients without BSI (n = 13, 43.3 vs.n = 5, 10.0; p< 0.0001). There was an increased mortality in patients with BSI than those without (n = 57, 65.5 vs.n = 30, 34.5; p= 0.003). The risk of all CVAs (hemorrhagicischemic) was eightfold (odds ratio OR = 7.9; 95 confidence interval CI = 2.4–25.5; p= 0.001 in patients with BSI. Patients with BSI had a >20-fold risk of hemorrhagic CVA (OR = 24; 95 CI = 2.8–201.1; p= 0.03). Advanced HF patients with LVAD support who developed BSI need urgent evaluation and close monitoring for suspected neurological complications, particularly hemorrhagic CVA.

Background Improving the survival and quality of life of patients with end-stage heart failure is the primary goal of using a ventricular assist device, generally known as mechanical circulatory support. Ventricular assist devices are a practical long-term surgical option for a select group of patients with end-stage heart failure.Method A case study is used to demonstrate the process of selection and evaluation of patients with end-stage heart failure for ventricular assist device therapy. Also, a detailed description of all aspects of care of patients before, during, and after implantation of a ventricular assist device is presented.Conclusion A ventricular assist device is a superior therapeutic option for patients with end-stage heart failure who have become intolerant to medical therapy or in whom medical therapy has been unsuccessful. Advances in device technology through the development of nonpulsatile continuous flow devices are showing favorable long-term outcomes for patients with a ventricular assist device by minimizing complications and enhancing quality of life.

Results for Destination Therapy (DT) continue to improve with advanced technology, better patient selection, and experienced clinical management. Quality of life for these patients is an important component of the overall success of DT, and traveling is becoming more common. We reviewed our experience with long-distance travel in our DT population. All patients implanted with a left ventricular assist device for DT were followed prospectively. Long-distance travel was considered to be >200 miles, one way from their homes. There were 15 patients (14 men) with an average age of 66 years (range, 30–82) who traveled a combined total of 40 long-distance trips. Four trips were international (Spain, Canada (2), and Puerto Rico), 35 within the continental U.S., and one to Hawaii. The average one way distance traveled was 925 miles with a range of 218–4256 miles. The average time away from home was 8.3 days (range, 2–30). Patients traveled by airplane (17), car (23), and one trip included a 5 day cruise. Five complications occurred: driveline trauma, delay of reentry into the United States, missed flight, red heart alarm from bearing wear, and dehydration. All patients returned home safely for routine follow-up. Long-distance travel is possible for DT patients. Anticipating potential problems and careful planning is necessary for safe national and international travel.

Purpose:To determine whether stereoacuity is an objective indicator of functional improvement following unilateral cataract surgery.

With increasingly mobile and global populations in universities worldwide, it is important that faculty and students share common expectations for student and instructor behaviors. This study focused on international student and faculty perceptions of student language performance and faculty instructional techniques in one U.S. university with recent growth in the international student population. Using responses from two questionnaires administered to faculty and matriculated international students at the university, the authors found a mismatch between faculty and student perceptions. Faculty rated students’ linguistic performance poorly, whereas students saw their language skills as adequate for the demands of their classes. In terms of instructional supports for international students, both students and faculty reported using or appreciating visuals, but other strategies such as advance provision of instructional materials or invitations to office hours were appreciated by students but less often used by faculty. The authors discuss the results in terms of developing shared expectations between students and faculty and engaging in intentional language acquisition planning at the institutional level.