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Human papillomavirus (HPV) is a common sexually transmitted infection. Despite a safe and effective vaccine, uptake continues to be suboptimal. Recently, focus has moved to college campuses in an effort to increase vaccination rates. Little is known about the extent of efforts to reach graduate students on college campuses in the United States and the vaccination rates within this subpopulation. This scoping review assessed the literature on knowledge, attitudes, beliefs, and behaviors about HPV and HPV vaccination among graduate and post-baccalaureate professional students in the United States. This review also aims to identify areas for further research to improve institutions' abilities to create health programming to increase HPV awareness and HPV vaccination coverage on their campuses. Publications focusing on knowledge, attitudes, beliefs, and behaviors about HPV and HPV vaccination in post-baccalaureate students were included. The systematic review of PubMed, CINAHL, and Embase identified 2562 articles, and 56 articles met all inclusion criteria and were included in this scoping review. A majority of the reviewed studies investigated some combination of knowledge, attitudes, behaviors, and beliefs about HPV and the HPV vaccine in students in professional programs such as medicine. Study design approaches were primarily cross-sectional, utilizing web-based survey distribution methods. HPV vaccination status and HPV screening behaviors were primarily measured through participant self-report. There is limited research investigating post-baccalaureate student knowledge, attitudes, beliefs, and behaviors about HPV and HPV vaccination. There is a need for researchers to further investigate the needs of graduate students to create informative and effective HPV programming.

Voluntary event reporting (VER) systems underestimate the incidence of safety events and often capture only serious events. A limited amount of data is collected through these systems, and they may be inadequate to characterize disparities in reported safety events. We conducted a scoping review of the literature to summarize the state of the evidence as it relates to differences in safety events and safety event reporting by age, gender, and race. Using a broad-based query, a systematic search for published, peer-reviewed literature that discusses patient safety event reporting and differences by age, gender, race, and socioeconomic status was conducted. Based on modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 283 studies underwent title and abstract review, yielding 56 studies for full text review. After full text review, 23 studies were carefully reviewed individually, grouped thematically, and summarized to highlight the most pertinent findings. The studies reviewed yielded important insights, particularly with regard to race, gender, and the ways events are identified. Patients from minoritized groups may be less likely to have events reported and more likely to suffer serious events. Some studies found differences in rates of reporting safety events for female vs. male providers. The rate of VER is consistently lower than the rate of events identified through identified using automated detection. The current literature describing VER data shows disparities by race, language, age, and gender for patients and providers. Further research and systematic change are needed to specifically study these disparities to guide health care institutions on ways to mitigate bias and deliver more equitable care., (Copyright © 2023 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Objective: To assess if the antecedent statin use was associated with all-cause death among COVID-19 patients enrolled in Medicaid., Design: Cohort study., Setting: Mississippi Medicaid population., Participants: This study included 10 792 Mississippi Medicaid-enrolled patients between 18 and 64 years of age with a confirmed COVID-19 diagnosis from March 2020 to June 2021., Intervention: Antecedent statin use, which was determined by a record of statin prescription in the 90-day period prior to the COVID diagnosis., Main Outcome Measures: The outcomes of interest included mortality from all cause within 30 days, 60 days and 90 days after index., Results: A total of 10 792 patients with COVID-19 met the inclusion and exclusion criteria, with 13.1% of them being antecedent statin users. Statin users were matched 1:1 with non-users based on age, sex, race, comorbidities and medication use by propensity score matching. In total, the matched cohort consisted of 1107 beneficiaries in each group. Multivariable logistic regression showed that statin users were less likely to die within 30 days (adjusted OR: 0.51, 95% CI: 0.32 to 0.83), 60 days (OR: 0.56, 95% CI: 0.37 to 0.85) and 90 days (OR: 0.55, 95% CI: 0.37 to 0.82) after diagnosis of COVID-19. Those with low-intensity/moderate-intensity statin use had significantly lower mortality risk in the 60-day and the 90-day follow-up period, while the high intensity of statin use was only found to be significantly associated with a lower odd of mortality within 30 days post index., Conclusion: After COVID infection, Medicaid beneficiaries who had taken statins antecedently could be at lower risk for death. For patients with chronic conditions, continuity of care is crucial when interruptions occur in their medical care. Further research is required to further investigate the potential mechanisms and optimal use of statins in COVID-19 treatment., Competing Interests: Competing interests: TK and DS are Mississippi Division of Medicaid employees. The work reported was conducted by the MS-DUR program in the Center for Pharmaceutical Marketing and Management as part of the retrospective drug use analysis activities conducted under contract with the Mississippi Division of Medicaid. The views expressed are those of the authors and do not necessarily reflect those of the Mississippi Division of Medicaid or the University of Mississippi., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Dr. Fackler disclosed that he is a Board Member for Machine Learning for Healthcare, Scientific Advisor for ImmuneIQ, and founder of Rubicon Health LLC. The remaining authors have disclosed that they do not have any potential conflicts of interest.

To review the current literature evaluating the performance of the Surgical Apgar Score (SAS)., Background: The SAS is a simple metric calculated at the end of surgery that provides clinicians with information about a patient's postoperative risk of morbidity and mortality. The SAS differs from other prognostic models in that it is calculated from intraoperative rather than preoperative parameters. The SAS was originally derived and validated in a general and vascular surgery population. Since its inception, it has been evaluated in many other surgical disciplines, large heterogeneous surgical populations, and various countries., Methods: A database and gray literature search was performed on March 3, 2020. Identified articles were reviewed for applicability and study quality with prespecified inclusion criteria, exclusion criteria, and quality requirements. Thirty-six observational studies are included for review. Data were systematically extracted and tabulated independently and in duplicate by two investigators with differences resolved by consensus., Results: All 36 included studies reported metrics of discrimination. When using the SAS to correctly identify postoperative morbidity, the area under the receiver operating characteristic curve or concordance-statistic ranged from 0.59 in a general orthopedic surgery population to 0.872 in an orthopedic spine surgery population. When using the SAS to identify mortality, the area under the receiver operating characteristic curve or concordance-statistic ranged from 0.63 in a combined surgical population to 0.92 in a general and vascular surgery population., Conclusions: The SAS provides a moderate and consistent degree of discrimination for postoperative morbidity and mortality across multiple surgical disciplines., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: We aimed to test the safety of the CDK4/6 inhibitor palbociclib in combination with the EGFR inhibitor cetuximab and the PD-L1 inhibitor avelumab in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC)., Materials and Methods: This phase I study enrolled eligible adult patients with R/M HNSCC into three sequential single dose-escalation cohorts of palbociclib (75, 100, and 125 mg) PO daily on days 1 to 21 of a 28-day cycle in combination with avelumab 10 mg/kg IV every 2 weeks and cetuximab 400 mg/m 2 IV on day 1, then 250 mg/m 2 weekly thereafter. The study followed a 3 + 3 design with no intra-patient escalation. The primary objective was to identify the recommended phase II dose (RP2D); secondary objectives included overall response rate (ORR), duration of response (DOR), progression free survival (PFS), and overall survival (OS)., Results: Palbociclib in combination with avelumab and cetuximab was well tolerated, with rash and fatigue being the most common adverse events. A single dose-limiting toxicity was observed at the 125 mg dose of palbociclib: a grade 3 infusion reaction related to cetuximab. The RP2D of palbociclib is 125 mg, with avelumab and cetuximab at standard doses. The ORR by RECIST v1.1 was 42 %, the median DOR and OS have not been reached. Median PFS was 6.5 months., Conclusions: The combination of avelumab, cetuximab, and palbociclib was well tolerated and supports further evaluation in patients with R/M HNSCC., Clinical Trial Registration Number: NCT03498378., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Ltd.)

Objective: To describe some cardiorespiratory effects of an inspiratory-to-expiratory (IE) ratio of 1:1 compared with 1:3 in ventilated horses in dorsal recumbency., Study Design: Randomized crossover experimental study., Animals: A total of eight anesthetized horses, with 444 (330-485) kg body weight [median (range)]., Methods: Horses were ventilated in dorsal recumbency with a tidal volume of 15 mL kg -1 and a respiratory rate of 8 breaths minute -1 , and IE ratios of 1:1 (IE1:1) and 1:3 (IE1:3) in random order, each for 25 minutes after applying a recruitment maneuver. Spirometry, arterial blood gases and dobutamine requirements were recorded in all horses during each treatment. Electrical impedance tomography (EIT) data were recorded in four horses and used to generate functional EIT variables including regional ventilation delay index (RVD), a measure of speed of lung inflation, and end-expiratory lung impedance (EELI), an indicator of functional residual capacity (FRC). Results were assessed with linear and generalized linear mixed models., Results: Compared with treatment IE1:3, horses ventilated with treatment IE1:1 had higher mean airway pressures and respiratory system compliance (p < 0.014), while peak, end-inspiratory and driving airway pressures were lower (p < 0.001). No differences in arterial oxygenation or dobutamine requirements were observed. PaCO 2 was lower in treatment IE1:1 (p = 0.039). Treatment IE1:1 resulted in lower RVD (p < 0.002) and higher EELI (p = 0.023) than treatment IE1:3., Conclusions and Clinical Relevance: These results suggest that IE1:1 improved respiratory system mechanics and alveolar ventilation compared with IE1:3, whereas oxygenation and dobutamine requirements were unchanged, although differences were small. In the four horses where EIT was evaluated, IE1:1 led to a faster inflation rate of the lung, possibly the result of increased FRC. The clinical relevance of these findings needs to be further investigated., (Copyright © 2022 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Objectives: This study aims to estimate the burden of food affordability on diabetes-related preventable hospitalizations among Medicaid enrollees in the United States., Study Design: This study used a retrospective observational design with Medicaid administrative claims data from 17 states from 2014., Methods: Data were linked with county-level social determinants of health (SDOH) from the American Community Survey. The rate of diabetes-related preventable hospitalizations was measured using the Agency for Healthcare Research and Quality's Prevention Quality Diabetes Composite, which includes hospitalization for short-term complications, long-term complications, lower extremity amputations, and uncontrolled diabetes. Multivariable logistic regression was used to predict the occurrence of diabetes-related preventable hospitalization., Results: Among the 16 million eligible individuals, diabetes-related preventable hospitalizations were identified at the rate of 1.91 per 1000 individuals and contributed to more than $160 million in charges. Rates were higher among men compared with women (0.25% vs 0.15%; P  < .001) and among Black adults compared with White adults (0.29% vs 0.18%; P  < .001). Compared with individuals residing in counties with low food affordability, those residing in counties with high (odds ratio [OR], 0.84; 95% CI, 0.78-0.91; P  < .001) or medium (OR, 0.85; 95% CI, 0.81-0.90; P  < .001) food affordability had lower odds of hospitalization., Conclusions: This study provides real-world evidence about the impact of SDOH on diabetes-related preventable hospitalizations. Federal and state policies that can help improve accessibility of healthy foods are needed to ameliorate the burden of diabetes on society.

Background: Vaccinations are successful, cost-effective tools to prevent the spread of certain infectious diseases. Many colleges conduct vaccination campaigns on their campuses for various vaccine-preventable diseases, including measles, mumps, influenza, HPV, and most recently, for SARS-CoV-2, the virus responsible for COVID-19. Implementing these campaigns requires substantial effort and understanding their effectiveness is an important factor in justifying these programs., Aim: This scoping review aims to identify, review, and summarize existing evaluation methods for vaccination campaigns on college campuses in order to provide evaluation guidance for institutions planning future vaccination campaigns., Methods: Publications that focused on vaccination campaigns on college campuses for students and/or faculty and staff and described their evaluation methods were included in our analysis. A systematic search of the literature identified 2,101 articles. After duplicates were removed, titles and abstracts were screened, and references searched, 43 articles were identified for full-text review. Sixteen articles provided evaluation information and were systematically reviewed., Results: Interventions targeted a variety of vaccine-preventable diseases, with the majority either aiming to increase HPV vaccine uptake or vaccinate against meningococcal serogroups. Most studies reported on campaigns that included both educational activities and provided vaccinations. Evaluation methods varied widely. Some studies measured vaccine-related knowledge and attitudes. Vaccine uptake was most commonly measured as a simple count of doses administered., Conclusions: College campus vaccination campaigns are evaluated in multiple ways, with little consistency in how the effectiveness of campaigns are measured. There is a need to develop clear evaluation methods for college vaccination programs, especially how to calculate vaccination rates associated with these efforts., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Marie Barnard reports financial support was provided by Indiana Immunization Coalition., (© 2022 The Authors.)

After the emergency use authorization of coronavirus disease 2019 (COVID-19) vaccinations in the United States, existing pharmacy infrastructure was leveraged to disseminate vaccines. However, the national uptake of COVID-19 vaccines remains poor. This survey study of Mississippi pharmacists aimed to identify barriers to providing COVID-19 vaccination among pharmacists in practice settings that provided other vaccines. A thematic analysis was used to analyze open-ended survey responses. This study found that the greatest identified barrier to COVID-19 vaccination for pharmacists was patient willingness. The thematic analysis revealed logistical barriers, vaccine hesitancy, and rural pharmacy distribution concerns. These findings suggest that pharmacists require further training in overcoming vaccine hesitancy, and potentially indicate a need for the distribution of vaccination responsibilities to additional pharmacy staff members.

Introduction: Ketamine is a dissociative anesthetic increasingly used in the prehospital and battlefield environment. As an analgesic, it has been shown to have comparable effects to opioids. In 2012, the Defense Health Board advised the Joint Trauma System to update the Tactical Combat Casualty Care Guidelines to include ketamine as an acceptable first line agent for pain control on the battlefield. The goal of this study was to investigate trends in the use of ketamine during Operation Enduring Freedom (OEF) and Operation Freedom's Sentinel (OFS) during the years 2011-2016., Materials and Methods: A retrospective review of Department of Defense Trauma Registry (DoDTR) data was performed for all patients receiving ketamine during OEF/OFS in 2011-2016. Prevalence of ketamine use, absolute use, mechanism of injury, demographics, injury severity score, provider type, and co-administration rates of various medications and blood products were evaluated., Results: Total number of administrations during the study period was 866. Ketamine administration during OEF/OFS increased during the years 2011-2013 (28 patient administrations in 2011, 264 administrations in 2012, and 389 administrations in 2013). A decline in absolute use was noted from 2014 to 2016 (98 administrations in 2014, 41 administrations in 2015, and 46 administrations in 2016). The frequency of battlefield ketamine use increased from 0.4% to 11.3% for combat injuries sustained in OEF/OFS from 2011 to 2016. Explosives (51%) and penetrating trauma (39%) were the most common pattern of injury in which ketamine was administered. Ketamine was co-administered with fentanyl (34.4%), morphine (26.2%), midazolam (23.1%), tranexamic acid (12.3%), plasma (10.3%), and packed red blood cells (18.5%)., Conclusions: This study demonstrates increasing use of ketamine by the U.S. Military on the battlefield and effectiveness of clinical practice guidelines in influencing practice patterns., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: Pembrolizumab (PD-1 inhibitor) and cetuximab (EGFR inhibitor) are active as single agents and in combination with cytotoxic chemotherapy for recurrent or metastatic head and neck squamous cell carcinoma (HNSCC). Given each drug's single agent activity and unique mechanism of action, we aimed to evaluate the anti-tumour activity of PD-1 blockade with EGFR inhibition in recurrent or metastatic HNSCC., Methods: This study is an open-label, non-randomised, multi-arm, phase 2 trial done at four academic centres in the USA. Participants were required to have platinum-resistant or platinum-ineligible, recurrent or metastatic HNSCC, be at least 18 years old, have an Eastern Cooperative Oncology Group performance status 0-1, have measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, and to have received no previous immunotherapy or EGFR inhibition. All participants received pembrolizumab 200 mg intravenously every 3 weeks, combined with an initial loading dose of cetuximab 400 mg/m 2 intravenously followed by 250 mg/m 2 intravenously weekly (21 day cycle). The primary endpoint was overall response rate defined as the proportion of participants with a partial or complete responses (per RECIST version 1.1) by 6 months in the intention-to-treat population. The safety population included all participants who received at least one dose of pembrolizumab. Herein, the final analysis of cohort 1 (no previous PD-1, PD-L1, or EGFR inhibition for recurrent or metastatic HNSCC) is reported. Three additional cohorts (two for participants with a previous response to immunotherapy followed by relapse or progression, with or without previous cetuximab exposure, and one for cutaneous HNSCC) will be reported separately once fully accrued. This study is registered with ClinicalTrials.gov, NCT03082534, and remains open as the three additional cohorts are actively accruing participants., Findings: Between March 22, 2017, and July 16, 2019, 33 participants were enrolled to cohort 1. All 33 participants received at least one dose of pembrolizumab. Median follow-up duration was 7·3 months (IQR 3·9-10·9). By 6 months, the overall response rate was 45% (95% CI 28-62), with 15 of 33 participants achieving a partial response. The most common grade 3-4 treatment-related adverse event was oral mucositis (three [9%] of 33 participants), and serious treatment-related adverse events occurred in five (15%) participants. No treatment-related deaths occurred., Interpretation: Pembrolizumab combined with cetuximab shows promising clinical activity for recurrent or metastatic HNSCC, and merits further investigation., Funding: Merck Sharp & Dohme., Competing Interests: Declaration of interests AGS reports institutional research funding from Merck for the study presented in the article. FPW reports honoraria outside of the submitted work from Merck and Eli Lilly for advisory boards, and support for attending meetings or travel, or both, from Merck outside the submitted work. DJLW reports institutional research funding from Merck, Sharp & Dohme and Eli Lilly, outside the submitted work. DA reports institutional research funding from Merck for the study presented in the Article; institutional grants or contracts outside the submitted work from Aduro, Celgene (Bristol Myers Squibb), Novartis, AstraZeneca, Atara Biio, Blueprint Medicine, Celldex, Kura, Exelixis, Innate, Sensei, Matrix Biomed, Hookipa, CoFactor, Cue Biopharma, Medimmune, Shanghai Denovo, Eli Lilly, and Pfizer; and participation on a data safety monitoring board or advisory board outside the submitted work for Merck, Cue Biopharma, Pfizer, Celgene (Bristol Myers Squibb), and Eli Lilly. PS reports grants or contracts outside the submitted work from Pfizer and Ascentage Pharma, applications for provisional patents for companion diagnostics outside the submitted work, and participation on a data safety monitoring board or advisory board outside the submitted work for Prelude Therapeutics and Regeneron. PO reports honoraria for speaker bureaus in which he provided lectures from Merck and Bristol Myers Squibb for speaker bureaus outside the submitted work. KG reports institutional research funding from Pfizer and Pharmacyclics outside the submitted work, and personal consulting fees (advisory boards) from AstraZeneca, Takeda, Rakuten, and Regeneron outside the submitted work. EEWC reports personal consulting fees from Merck and Merck Sharp & Dohme outside the submitted work. All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: Long QT syndrome (LQTS) is an uncommon disorder that can lead to potentially life-threatening dysrhythmias. LQTS can be genetic, acquired, or both., Case Report: A 44-year-old female with well-controlled hypertension and asthma presented with chest tightness. An initial electrocardiogram yielded a normal corrected QT interval of 423 milliseconds (ms) (normal <480 ms in females). Albuterol was administered and induced agitation, tremulousness, and tachycardia. Follow-up electrocardiograms demonstrated extreme prolongation of the corrected QT interval to 633 ms and morphology change of the T wave. Lab values were later notable for hypokalemia and hypomagnesemia, attributable to a recently started thiazide diuretic. The patient was ultimately diagnosed with congenital LQTS after initial unmasking by albuterol in the emergency department., Conclusion: LQTS can be unmasked or exacerbated by electrolyte abnormalities and QT prolonging medications.