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Objectives: We previously described derivation and validation of the emergency department trigger tool (EDTT) for adverse event (AE) detection. As the first step in our multicenter study of the tool, we validated our computerized screen for triggers against manual review, establishing our use of this automated process for selecting records to review for AEs. Methods: This is a retrospective observational study of visits to three urban, academic EDs over 18 months by patients ≥ 18 years old. We reviewed 912 records: 852 with at least one of 34 triggers found by the query and 60 records with none. Two first‐level reviewers per site each manually screened for triggers. After completion, computerized query results were revealed, and reviewers could revise their findings. Second‐level reviewers arbitrated discrepancies. We compare automated versus manual screening by positive and negative predictive values (PPVs, NPVs), present population trigger frequencies, proportions of records triggered, and how often manual ratings were changed to conform with the query. Results: Trigger frequencies ranged from common (>25%) to rare (1/1000) were comparable at U.S. sites and slightly lower at the Canadian site. Proportions of triggered records ranged from 31% to 49.4%. Overall query PPV was 95.4%; NPV was 99.2%. PPVs for individual trigger queries exceeded 90% for 28–31 triggers/site and NPVs were >90% for all but three triggers at one site. Inter‐rater reliability was excellent, with disagreement on manual screening results less than 5% of the time. Overall, reviewers amended their findings 1.5% of the time when discordant with query findings, more often when the query was positive than when negative (47% vs. 23%). Conclusions: The EDTT trigger query performed very well compared to manual review. With some expected variability, trigger frequencies were similar across sites and proportions of triggered records ranged 31%–49%. This demonstrates the feasibility and generalizability of implementing the EDTT query, providing a solid foundation for testing the triggers' utility in detecting AEs. [ABSTRACT FROM AUTHOR]

We evaluate the determinants of officer support for their agency participating in the 1033 Program: a program that facilitates the flow of military hardware to local law enforcement agencies. In doing so, we provide insight into why officers demand such equipment, which, in turn, may partially explain patterns of program participation and equipment usage. We utilize a series of random forest models to examine survey data collected from officers in a large police department, finding that being White and exhibiting animus toward minority communities are highly predictive of officer support across models. Our findings validate long‐held public concerns regarding the distributional patterns and consequences of 1033 transfers: concerns that have led to a number of proposed policy changes at the state and federal levels meant to restrict program usage (e.g., EO‐13688, HR‐1694, MO HB‐330). Policy makers should consider how out‐group animus may drive distributional patterns and usage when considering policy reform. [ABSTRACT FROM AUTHOR]

Barberry (Berberis thunbergii) is a widely established invasive shrub in temperate forests of the northeastern United States with the potential to alter soil arthropod communities through changes to soil nutrient cycling and acidity.We compared soil arthropod taxa and functional feeding groups between invaded and nearby control areas in a paired observational survey.Community ordination analysis suggested minimal differences between barberry and control samples. In contrast, pairwise differences revealed elevated densities of multiple taxa in barberry‐invaded soils.Among taxa that were able to be defined by functional feeding group and were collected at higher densities under barberry, all were detritivores. For example, barberry‐invaded soils harboured an average of 40% more Isopoda and more than twice as many Diplopoda per unit dry compared with control samples. Differences we observed between barberry and control samples despite the limited study spatiotemporal scope demonstrate the potential for invasions to restructure soil arthropod communities.Observed patterns potentially reflects elevated leaf litter decomposition rates associated with the invasion and results also highlight the need to integrate site‐specific environmental attributes when assessing the impact of invading plants on soil ecosystems. [ABSTRACT FROM AUTHOR]

The article focuses on analyzing the characteristics of motorcycle-involved crashes in the U.S. from 2011 to 2021, aiming to provide insights for injury prevention and policy changes. Topics discussed include demographic trends among motorcyclists, factors contributing to crashes such as alcohol involvement and helmet use, and regional variations in crash occurrence.

Background: Alcohol use disorder (AUD) is underdiagnosed and undertreated in medical settings, in part due to a lack of AUD assessment instruments that are reliable and practical for use in routine care. This study evaluates the test‐retest reliability of a patient‐report Alcohol Symptom Checklist questionnaire when it is used in routine care, including primary care and mental health specialty settings. Methods: We performed a pragmatic test‐retest reliability study using electronic health record (EHR) data from Kaiser Permanente Washington, an integrated health system in Washington state. The sample included 454 patients who reported high‐risk drinking on a behavioral health screen and completed two Alcohol Symptom Checklists 1 to 21 days apart. Subgroups of these patients who completed both checklists in primary care (n = 271) or mental health settings (n = 79) were also examined. The primary measure was an Alcohol Symptom Checklist on which patients self‐reported whether they experienced each of the 11 AUD criteria within the past year, as defined by the Diagnostic and Statistical Manual of Mental Disorders‐5th edition (DSM‐5). Results: Alcohol Symptom Checklists completed in routine care and documented in EHRs had excellent test‐retest reliability for measuring AUD criterion counts (ICC = 0.79, 95% CI: 0.76 to 0.82). Test‐retest reliability estimates were also high and not significantly different for the subsamples of patients who completed both checklists in primary care (ICC = 0.82, 95% CI: 0.77 to 0.85) or mental health settings (ICC = 0.74, 95% CI: 0.62 to 0.83). Test‐retest reliability was not moderated by having a past two‐year AUD diagnosis, nor by the age or sex of the patient completing it. Conclusions: Alcohol Symptom Checklists can reliably and pragmatically assess AUD criteria in routine care among patients who screen positive for high‐risk drinking. The Alcohol Symptom Checklist may be a valuable tool in supporting AUD‐related care and monitoring AUD criteria longitudinally in routine primary care and mental health settings. [ABSTRACT FROM AUTHOR]

This article explores the ways in which gendered processes play out through the professionalization of chaplains in healthcare settings. It describes how gender manifests within organizations, how literature addresses the role of gender in professionalization, and considerations for professional chaplaincy. Fifty interviews with U.S. chaplains were analyzed to explore the relationship between the professionalization of chaplaincy and male and female positionality. Although gender theory moves beyond binary conceptualizations of gender, all participants in this study self‐identified as male or female and our data were analyzed accordingly. The language and professionalization efforts used by male and female chaplains mirror the gendered cultural expectations associated with these groups. This article notes how the patriarchal structures of both religious and healthcare institutions are inextricably embedded in the chaplaincy profession; thus, female chaplains have found it necessary to challenge these systems from the beginning. [ABSTRACT FROM AUTHOR]

The article examines pedestrian fatalities in the United States between 2011 and 2021, underscoring the influence of speed on the severity of injuries. Utilizing the National Highway Transportation Safety Administration's Fatality and Injury Reporting System Tool (FIRST), the study analyzes data related to fatal and nonfatal pedestrian crashes, encompassing demographics, blood alcohol levels, impaired statuses of pedestrians and drivers and crash locations.

Volatile nitrogen oxides (N2O, NO, NO2, HONO, ...) can negatively impact climate, air quality, and human health. Using soils collected from temperate forests across the eastern United States, we show microbial communities involved in nitrogen (N) cycling are structured, in large part, by the composition of overstory trees, leading to predictable N‐cycling syndromes, with consequences for emissions of volatile nitrogen oxides to air. Trees associating with arbuscular mycorrhizal (AM) fungi promote soil microbial communities with higher N‐cycle potential and activity, relative to microbial communities in soils dominated by trees associating with ectomycorrhizal (ECM) fungi. Metagenomic analysis and gene expression studies reveal a 5 and 3.5 times greater estimated N‐cycle gene and transcript copy numbers, respectively, in AM relative to ECM soil. Furthermore, we observe a 60% linear decrease in volatile reactive nitrogen gas flux (NOy ≡ NO, NO2, HONO) as ECM tree abundance increases. Compared to oxic conditions, gas flux potential of N2O and NO increase significantly under anoxic conditions for AM soil (30‐ and 120‐fold increase), but not ECM soil—likely owing to small concentrations of available substrate (NO3‐) in ECM soil. Linear mixed effects modeling shows that ECM tree abundance, microbial process rates, and geographic location are primarily responsible for variation in peak potential NOy flux. Given that nearly all tree species associate with either AM or ECM fungi, our results indicate that the consequences of tree species shifts associated with global change may have predictable consequences for soil N cycling. [ABSTRACT FROM AUTHOR]

Over half of global rivers and streams lack perennial flow, and understanding the distribution and drivers of their flow regimes is critical for understanding their hydrologic, biogeochemical, and ecological functions. We analyzed nonperennial flow regimes using 540 U.S. Geological Survey watersheds across the contiguous United States from 1979 to 2018. Multivariate analyses revealed regional differences in no‐flow fraction, date of first no flow, and duration of the dry‐down period, with further divergence between natural and human‐altered watersheds. Aridity was a primary driver of no‐flow metrics at the continental scale, while unique combinations of climatic, physiographic and anthropogenic drivers emerged at regional scales. Dry‐down duration showed stronger associations with nonclimate drivers compared to no‐flow fraction and timing. Although the sparse distribution of nonperennial gages limits our understanding of such streams, the watersheds examined here suggest the important role of aridity and land cover change in modulating future stream drying. Plain Language Summary: A majority of global streams are nonperennial, flowing only part of the year, and are critical for sustaining flow downstream, providing habitat for many organisms, and regulating chemical and biological processes. Using long‐term U.S. Geological Survey measurements for 540 watersheds across the contiguous United States, we mapped patterns and examined the causes of no‐flow fraction, the fraction of each climate year with no flow, no‐flow timing, the date of the climate year on which the first recorded no flow takes place, and length of the dry‐down period, the average number of days from a local peak in daily flow to the first occurrence of no flow. We found differences in patterns of no‐flow characteristics between regions, with higher no‐flow fraction, earlier timing, and shorter dry‐down duration in the western United States. No‐flow fractions were greater and less variable in natural watersheds, while no‐flow timing was earlier and dry‐down duration was shorter in human‐modified watersheds. Aridity had the greatest effect on intermittence across the United States, but unique combinations of climate, biophysical, and human impacts were important in different regions. The number of gages measuring streamflow in nonperennial streams is small compared to perennial streams, and increased monitoring is needed to better understand drying behavior. Key Points: Three metrics reveal regional and human‐driven patterns of nonperennial flow: no‐flow fraction, day of first no flow, and dry‐down durationStreams with human modifications generally dry more quickly than unmodified streams, especially in California and the Southern Great PlainsClimate strongly influences no‐flow fraction and timing, but physiographic variables are more important for the duration of dry down [ABSTRACT FROM AUTHOR]

Rationale: Stable isotope analysis is used to understand the foraging habits and movements of a diverse set of organisms. Variability in stable isotope ratios among tissues derived from the same animal makes it difficult to compare data among study results in which different tissue types are evaluated. Isotopic relationships between two green turtle (Chelonia mydas) tissue types, skin and unhatched egg contents are unknown. Similarly, few data exist to evaluate the influence of time elapsed after oviposition (as a proxy for decomposition) on isotopic variability among unhatched eggs within the same nest. Methods: Skin and unhatched egg contents were collected from 69 adult female green turtles and associated nests at the Archie Carr National Wildlife Refuge in Florida, USA. Values of δ13C, δ15N, and δ34S were measured for both tissue types using a continuous flow isotope ratio mass spectrometer. Standardized major‐axis (SMA) regression was used to generate conversion equations of carbon, nitrogen, and sulfur isotope ratios between the two tissue types. Model selection frameworks consisting of single‐factor linear models were employed per isotope ratio to assess how egg time‐in‐nest affected intraclutch isotopic variability. Results: Conversion equations for all three isotope ratios indicated significant relationships between skin and unhatched egg values, although model fits were lower than found in some studies examining similar patterns in other marine turtle species. The probability of increased intraclutch variability was significantly higher among eggs collected at longer intervals after deposition. Conclusions: This study reports the first‐ever δ13C and δ15N conversion equations between skin and unhatched eggs for green turtles, and the first δ34S conversion equation for any marine turtle species. SMA regression was used to directly convert tissue values bidirectionally, unlike equations generated using ordinary least‐squares regression. Issues with increased intraclutch variability at later excavation dates highlight the importance of collecting unhatched eggs as soon as possible after hatchling emergence. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe the settings of care in which antipsychotics that nursing home (NH) residents received were likely to have been initiated. DESIGN: Cross‐sectional. SETTING: Iowa NHs. PARTICIPANTS: Fee‐for‐service Medicare beneficiaries who had NH stays between January 1, 2011, and December 31, 2014, and had new use of antipsychotics during their NH stays, defined as no antipsychotic use in NHs in the last 6 months. MEASUREMENTS: A linked dataset of Chronic Condition Data Warehouse Medicare claims and Long‐Term Care Minimum Data Set (MDS) 3.0 was used to determine care settings of antipsychotic initiations. RESULTS: Of 7,496 residents with new antipsychotic use in NHs, 4,794 (64.0%, 95% confidence interval (CI) = 62.9–65.0%) initiated them in NHs, 1,392 (18.6%, 95% CI 17.7–19.5%) appeared to have had them initiated in hospitals, and 1,310 (17.5%, 95% CI = 16.6–18.3%) had antipsychotics first dispensed as outpatients. Antipsychotics were commonly prescribed during the early NH stays, and 3,026 (40.4%, 95% CI = 39.3–41.5%) of the entire sample received antipsychotic therapy within the first 7 days after NH admissions. Fifty‐eight percent (n = 4,348) of the study residents initiating antipsychotics had potentially appropriate antipsychotic indications according toMDS records. CONCLUSION: Most residents initiated antipsychotic therapy in NHs, confirming that NH providers are appropriate primary target of interventions to reduce antipsychotic initiation in their residents. However, many antipsychotics were continued from other settings, indicating a need to evaluate the necessity of continued antipsychotic treatment after such transitions of care. J Am Geriatr Soc 66:1082–1088: 2018. [ABSTRACT FROM AUTHOR]

Much attention has been paid to government 'blunders' and 'policy disasters'. National political and administrative systems have been frequently blamed for being disproportionately prone to generating mishaps. However, little systematic evidence exists on the record of failures of policies and major public projects in other political systems. Based on a comparative perspective on blunders in government, this article suggests that constitutional features do not play a prominent role. In order to establish this finding, this article (a) develops theory-driven expectations as to the factors that are said to encourage blunders, (b) devises a systematic framework for the assessment of policy processes and outcomes, and (c) uses fuzzy-set qualitative comparative analysis to identify sets of causal conditions associated with particular outcomes (i.e., blunders). The article applies this novel approach to a set of particular policy domains, finding that constitutional features are not a contributory factor to blunders in contrast to instrument choice, administrative capacity and hyper-excited politics. [ABSTRACT FROM AUTHOR]

Patient-reported outcomes (PROs) measure quality of life, symptoms, patient functioning, and patient perceptions of care; they are essential for gaining a full understanding of cancer care and the impact of cancer on people's lives. Repeatedly captured facility-level and/or population-level PROs (PRO surveillance) could play an important role in quality monitoring and improvement, benchmarking, advocacy, policy making, and research. This article describes the rationale for PRO surveillance and the methods of the Patient Reported Outcomes Symptoms and Side Effects Study (PROSSES), which is the first PRO study to use the American College of Surgeons Commission on Cancer's Rapid Quality Reporting System to identify patients and manage study data flow. The American Cancer Society, the National Cancer Institute, the Commission on Cancer, and RTI International collaborated on PROSSES. PROSSES was conducted at 17 cancer programs that participated in the National Cancer Institute Community Cancer Centers Program among patients diagnosed with locoregional breast or colon cancer. The methods piloted in PROSSES were successful as demonstrated by high eligibility (93%) and response (61%) rates. Differences in clinical and demographic characteristics between respondents and nonrespondents were mostly negligible, with the exception that non-white individuals were somewhat less likely to respond. These methods were consistent across cancer centers and reproducible over time. If repeated and expanded, they could provide PRO surveillance data from patients with cancer on a national scale. [ABSTRACT FROM AUTHOR]

BACKGROUND: Blood transfusion after traumatic injury can result in microchimerism (MC) of donor white cells (WBCs) in the recipient as late as 2 to 3 years postinjury, the longest prospective follow-up to date. The purpose of this study was to determine how long transfusion-associated MC lasts after traumatic injury. STUDY DESIGN AND METHODS: A group of US combat veterans who received transfusions who responded to a recruitment notice was retrospectively evaluated. Their blood was sampled, and MC was assessed by quantitative allele-specific polymerase chain reaction detection of differences at the HLA-DR locus or a panel of insertion-deletion polymorphism loci. Results of veterans were compared to those from an age- and gender-matched blood donor control group, from whom WBCs were retrieved from leukoreduction filters. RESULTS: Among 163 combat veterans who received transfusion and 150 control subjects who did not receive transfusions, 16 (9.8%) of the veterans and 1 (0.7%) control subject had evidence of MC (relative risk, 14.7; 95% confidence interval, 2.0-110). The veterans with MC included 3 who served in WWII (7% of subjects from that conflict), 5 in Korea (18%), and 6 in Vietnam (7%). CONCLUSIONS: Transfusion for combat-related injury can result in MC that lasts for 60 years, suggesting that it may involve permanent engraftment. MC is rare among male blood donors who did not receive transfusions, who are probably representative of individuals who have not had postnatal allogeneic exposures. [ABSTRACT FROM AUTHOR]

Context: Appalachia has been characterized by its poverty, a factor associated with tuberculosis, yet little is known about the disease in this region. Purpose: To determine whether Appalachian tuberculosis risk factors, trends, and rates differ from the rest of the United States. Methods: Analysis of tuberculosis cases reported to the Centers for Disease Control and Prevention's National Tuberculosis Surveillance System (NTSS) within the 50 states and the District of Columbia from 1993 through 2005. Results: The 2005 rate of tuberculosis in rural Appalachia was 2.1/100,000, compared to 2.7/100,000 in urban Appalachia. Urban non-Appalachia had a 2005 tuberculosis rate of 5.4/100,000. Over the 13-year period, tuberculosis rates fell in Appalachia at an annual rate of 7.8%. In one age group (15- to 24-year-olds) the rates increased at an annual rate of 2.8%. Foreign-born Hispanics were the largest racial/ethnic group in this age group. When private providers gave exclusive care for tuberculosis disease, Appalachians were less likely to complete therapy in a timely manner when compared to non-Appalachians (OR 0.6, 95% CI 0.5-0.7). Conclusions: Tuberculosis rates and trends are similar in urban and rural Appalachia. It is crucial for public health officials in Appalachia to address the escalating TB rate among 15- to 24-year-olds by focusing prevention efforts on the growing numbers of foreign-born cases. Due to the increased risk of treatment failure among Appalachians who do not seek care from the health department, public health authorities must ensure completion of treatment for patients who seek private providers. [ABSTRACT FROM AUTHOR]

The concept of the relational self suggests that simply imagining significant others produces shifts in self-assessments consistent with one’s roles and experiences with those others. To test relevant hypotheses, college women (from the United States) imagined a significant other as part of a visualization task. After imagining parents as compared to peers, participants described themselves as less sensual, dominant, and adventurous (Experiment 1), a pattern consistent with other women’s ratings of how they actually felt with those others. Supporting the idea that self-esteem differences emerge in more evaluative contexts, self-esteem moderated self-assessments on key dimensions (Experiment 2). After imagining a romantic other but not a best friend, self-esteem was directly related to women’s self-ratings of sensuality, physical attractiveness, and being at ease. [ABSTRACT FROM AUTHOR]

Researchers have suggested golden eagle (Aquila chrysaetos) populations may be declining in portions of their range. However, there are few baseline data describing golden eagle populations across their range in the western United States. We used aerial line transect distance methodology with a double-observer modification to estimate golden eagle population numbers in 4 bird conservation regions of the western United States. We conducted surveys from 16 August to 8 September 2003, after most golden eagles had fledged and before fall migration. The goal of our sampling strategy was to provide ≥80% power (α = 0.1) to detect an annual rate of total population change ≥3% per year over a 20-year period. We observed 172 golden eagles across 148 transects and estimated 27,392 golden eagles (90% CI: 21,352-35,140) occurred in the study area during the late summer and early fall of 2003. Following the surveys, we used Monte Carlo simulation to determine the statistical power to detect trends in the golden eagle populations if yearly surveys were continued over a 20-year monitoring period. The simulation indicated the desired power could be achieved under the current methodology and sample size. The methods utilized in this study can be implemented for other raptor species when population estimates that include nonbreeding members of a population are needed. The results of this study can be utilized by professionals to help manage golden eagle populations and to develop conservation strategies. [ABSTRACT FROM AUTHOR]

Buprenorphine-naloxone is an office-based opioid agonist released in 2003 in the United States for the maintenance of heroin- and other opioid-dependent patients. Concern has been raised that the medication will distract or otherwise inhibit patients from participating in a holistic recovery program or abstinence-based counseling. Using a retrospective chart review, the first thirty opioid-dependent patients induced on buprenorphine maintenance therapy in an inpatient detoxification unit were compared to thirty age- and gender-matched patients who underwent detoxification (with a tramadol taper) and referral to intensive outpatient treatment. The clinical outcomes were a comparison of completion rates for an intensive outpatient program (IOP) and retention in treatment after twelve weeks of aftercare therapy. Patients induced on buprenorphine maintenance over three days had similar relief of withdrawal symptoms to patients detoxified from opioids over five days with tramadol. Patients maintained on buprenorphine had a markedly increased initiation of IOP and remained in outpatient treatment longer than patients who were detoxified (8.5 wks vs. 0.4 wks, p < 0.001). This study indicates that induction and maintenance on buprenorphine may be more effective than detoxification for engaging and retaining patients in abstinence-based comprehensive outpatient addiction treatment. [ABSTRACT FROM AUTHOR]

Evaluates the causes of differential skeletal preservation in the human skeletal series of Windover Pond in Florida. Evaluation of relationship between bone preservation and individual age and sex; Relation between the presence of preserved brain material and skeletal preservation; Effects of burial location on bone preservation.

Past experiments on sand-based putting greens have frequently used randomized complete blocked designs (RCBD), even though these experimental areas are relatively uniform with regard to external variables. Consequently, completely randomized designs (CRD) may have had better precision with which to estimate treatment effects compared with RCBD. The objective of this study was to estimate the relative efficiency (ERE) of a RCBD compared with a CRD when evaluating common parameters on sand-based putting greens. Uniformity trials were conducted in Arkansas and Nebraska on sandbased putting greens established with creeping bentgrass (Agrostis palustris Huds.). Estimated relative efficiency values were calculated for varying blocking schemes when measuring canopy temperature, soil temperature, soil moisture, clipping yield, and macronutrient content in plant tissues. Since canopy temperatures were time dependent, when those measurements were collected by a blocking scheme, the associated RCBD was approximately nine times more efficient than a CRD. For the remaining parameter and blocking scheme combinations, ERE values indicated that the precision between RCBD and CRD was similar. Therefore, it is likely that the precision with which treatment effects are estimated is not compromised from the use of RCBD on sand-based putting green trials. [ABSTRACT FROM AUTHOR]

Background: The treatment of severe aortic stenosis has evolved considerably since the introduction of transcatheter aortic valve replacement (TAVR), yet trends in complications for patients undergoing TAVR or surgical aortic valve replacement (SAVR) at a national level have yet to be evaluated., Methods and Results: We performed a retrospective cohort study using Medicare data to evaluate temporal trends in complications among beneficiaries, aged ≥65 years, treated with elective isolated transfemoral TAVR or SAVR between 2012 and 2019. The study end point was the occurrence of a major complication (composite outcome) during index and up to 30 days after. Multivariable logistic regression was used to assess odds of complications for TAVR and SAVR, individually over time, and for TAVR versus SAVR, over time. The cohort included 211 212 patients (mean±SD age, 78.6±7.3 years; 45.0% women). Complication rates during index following elective isolated aortic valve replacement decreased from 49% in 2012 to 22% in 2019. These reductions were more pronounced for TAVR (41% to >19%, Δ=22%) than SAVR (51% to >47%, Δ=4%). After risk adjustment, the risk of any complication with TAVR was 47% ( P <0.0001) lower compared with SAVR in 2012, and 78% ( P <0.0001) lower in 2019. TAVR was independently associated with reduced odds of complications each year compared with 2012, with the magnitude of benefit increasing over time (2013 versus 2012: odds ratio [OR], 0.89 [95% CI, 0.81-0.97]; 2019 versus 2012: OR, 0.35 [95% CI, 0.33-0.38]). These findings are consistent for complications up to 30 days from index., Conclusions: Between 2012 and 2019, the risk of complications after aortic valve replacement among Medicare beneficiaries decreased significantly, with larger absolute and relative changes among patients treated with TAVR than SAVR.

Background: Aortic regurgitation is distinguished by the backflow of blood from the aorta into the left ventricle. American College of Cardiology/American Heart Association guidelines recommend surgical aortic valve replacement (SAVR) for patients with symptomatic aortic regurgitation (sAR). This study estimates the difference in mortality, health care use, and costs between patients with sAR who receive SAVR within 12 months of diagnosis versus those who do not., Methods and Results: We used the Optum United Healthcare database to identify 132 317 patients diagnosed with sAR from 2016 to 2021 who had at least 6 months of enrollment before sAR and 12 months of enrollment after. Criteria were no history of aortic stenosis or transcatheter aortic valve replacement and ≥2 visits for heart failure, angina, dyspnea, or syncope. Outcomes were all-cause mortality, health care use, and annualized cost. Baseline differences in demographics and comorbidities were adjusted with inverse propensity score weighting. We modeled survival and estimated health care use and costs using Cox proportional hazards and general linear models, respectively. Of the 132 317 patients, 400 underwent SAVR within 12 months of diagnosis. They were on average younger, more often men, and with a slightly higher Elixhauser Comorbidity Index score. After inverse propensity score weighting, patients with sAR who had SAVR had lower mortality, fewer inpatient and emergency department visits, fewer hospital days, and lower annualized cost., Conclusions: SAVR performed within 12 months of an sAR diagnosis is associated with improved mortality and lower annualized health care use and costs. These clinical and economic benefits should be considered when managing patients with sAR.

Objective: Undergoing surgery and adjuvant radiotherapy (aRT) at the same facility has been associated with higher overall survival (OS) in head and neck squamous cell carcinoma. Our study investigates whether undergoing surgery and aRT at the same academic facility is associated with higher OS in major salivary gland cancer (MSGC)., Methods: The 2006-2018 National Cancer Database was queried for patients with MSGC undergoing surgery at an academic facility and then aRT. Multivariable binary logistic and Cox proportional hazards regression models were implemented., Results: Of 2801 patients satisfying inclusion criteria, 2130 (76.0%) underwent surgery and aRT at the same academic facility. Residence in a less populated area (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.16-2.45), treatment without adjuvant chemotherapy (aOR 1.97, 95% CI 1.41-2.76), and aRT duration (aOR 1.02, 95% CI 1.01-1.04) were associated with undergoing surgery and aRT at different facilities on multivariable logistic regression adjusting for patient demographics, clinicopathologic features, and adjuvant therapy (p < 0.01). Five-year OS was higher in patients undergoing surgery and aRT at the same academic facility (68.8% vs. 61.9%, p < 0.001). Undergoing surgery and aRT at different facilities remained associated with worse OS on multivariable Cox regression (aHR 1.41, 95% CI 1.10-1.81, p = 0.007)., Conclusion: Undergoing surgery and aRT at the same academic facility is associated with higher OS in MSGC. Although undergoing surgery and aRT at the same academic facility is impractical for all patients, academic physicians should consider same-facility treatment for complex patients who would most benefit from clear multidisciplinary communication., Level of Evidence: 4 Laryngoscope, 134:3620-3632, 2024., (© 2024 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Background We compared cardiac outcomes for surgery-eligible patients with stage III non-small-cell lung cancer treated adjuvantly or neoadjuvantly with chemotherapy versus chemo-radiation therapy in the Surveillance, Epidemiology and End Results-Medicare database. Methods and Results Patients were age 66+, had stage IIIA/B resectable non-small-cell lung cancer diagnosed between 2007 and 2015, and received adjuvant or neoadjuvant chemotherapy or chemo-radiation within 121 days of diagnosis. Patients having chemo-radiation and chemotherapy only were propensity-score matched and followed from day 121 to first cardiac outcome, noncardiac death, radiation initiation by patients who received chemotherapy only, fee-for-service enrollment interruption, or December 31, 2016. Cause-specific hazard ratios (HRs) and competing risks subdistribution HRs were estimated. The primary outcome was the first of these severe cardiac events: acute myocardial infarction, other hospitalized ischemic heart disease, hospitalized heart failure, percutaneous coronary intervention/coronary artery bypass graft, cardiac death, or urgent/inpatient care for pericardial disease, conduction abnormality, valve disorder, or ischemic heart disease. With median follow-up of 13 months, 70 of 682 patients who received chemo-radiation (10.26%) and 43 of 682 matched patients who received chemotherapy only (6.30%) developed a severe cardiac event ( P =0.008) with median time to first event 5.45 months. Chemo-radiation increased the rate of severe cardiac events (cause-specific HR: 1.62 [95% CI, 1.11-2.37] and subdistribution HR: 1.41 [95% CI, 0.97-2.04]). Cancer severity appeared greater among patients who received chemo-radiation (noncardiac death cause-specific HR, 2.53 [95% CI, 1.93-3.33] and subdistribution HR, 2.52 [95% CI, 1.90-3.33]). Conclusions Adding radiation therapy to chemotherapy is associated with an increased risk of severe cardiac events among patients with resectable stage III non-small-cell lung cancer for whom survival benefit of radiation therapy is unclear.

Background and Aim of the Study: Congenital heart disease is the most common congenital defect among infants born in the United States. Within the first year of life, 1 in 4 of these infants will need surgery. Only one generation removed from an overall mortality of 14%, many changes have been introduced into the field. Have these changes measurably improved outcomes?, Methods: The literature search was conducted through PubMed MEDLINE and Google Scholar from inception to October 31, 2021. Ultimately, 78 publications were chosen for inclusion., Results: The outcome of overall mortality has experienced continuous improvements in the modern era of the specialty despite the performance of more technically demanding surgeries on patients with complex comorbidities. This modality does not account for case-mix, however. In turn, clinical outcomes have not been consistent from center to center. Furthermore, variation in practice between institutions has also been documented. A recurring theme in the literature is a movement toward standardization and universalization. Examples include mortality risk-stratification that has allowed direct comparison of outcomes between programs and improved definitions of morbidities which provide an enhanced framework for diagnosis and management., Conclusions: Overall mortality is now below 3%, which suggests that more patients are surviving their interventions than in any previous era in congenital cardiac surgery. Focus has transitioned from survival to improving the quality of life in the survivors by decreasing the incidence of morbidity and associated long-term effects. With the transformation toward standardization and interinstitutional collaboration, future advancements are expected., (© 2022 Wiley Periodicals LLC.)

Objectives: Primary orbital melanoma (POM) is a rare disease with limited data on survival and best treatment practices. Here we utilize the National Cancer Database (NCDB) to determine the overall survival (OS) and covariates that influence mortality., Study Design: Retrospective cohort study., Methods: All patients diagnosed with POM from 2004 to 2016 were identified in the NCDB. Patient and oncologic data were analyzed using the Kaplan-Meier method and multivariate models for the primary outcome of OS., Results: A total of 129 patients were identified. Median OS was 36.9 months (95% confidence interval [CI] 24.1-78.7 months) with mean 5-year survival of 42.0% (CI 33.2%-53.2%). Treatments received included surgery alone (43.4%), radiation alone (23.3%), and surgery followed by radiation (20.2%). The multivariate model demonstrated an increased risk of death associated with age over 80 years (hazard ratio [HR] 3.41, CI 1.31-8.86, P = .012), a Charlson-Deyo comorbidity score of 2 or greater (HR 5.30, CI 1.87-15.03, P = .002), and no treatment (HR 2.28, CI 1.03-5.06, P = .042). For every 1 cm increase in tumor size, there was an increased risk of death (HR 1.06, CI 1.00-1.13, P = .039). When compared to surgery alone, no other treatment modality had an effect on OS., Conclusions: This study leveraged multiyear data from the NCDB to provide prognostic and demographic information on the largest known cohort of POM cases. Increased age, increased comorbidities, not receiving treatment, and larger tumor size were associated with increased mortality. There was no clear survival advantage for specific treatments., Level of Evidence: 4 Laryngoscope, 131:1790-1797, 2021., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: Postoperative hemorrhage is a serious complication of tonsillectomy, with secondary bleeding rates affecting up to 0.8% to 3% of patients. Although these bleeds are anecdotally perceived as occurring more frequently at night, the occurrence of hemorrhage relative to the time of day has not been investigated. We measured the frequency of post-tonsillectomy hemorrhage onset relative to the time of day., Methods: We reviewed electronic medical records of all patients who experienced postprocedural hemorrhage (International Classification of Disease, Ninth Edition [ICD-9] 998.11, ICD-10 J95.830 at two hospitals within a tertiary academic health system in a 10-year period). Patient demographics, time of bleed onset, emergency room [ED] arrival time, and management (operating room vs. observation) were abstracted. Patients without a recorded bleeding time were excluded. Time of bleed onset was categorized as morning (6:01 am-12 pm), afternoon (12:01 pm-6 pm), evening (6:01 pm-12 am), or overnight (12:01 am-6 am). Chi-square goodness of fit test was used to assess the distribution of hemorrhage timing (P ≤ 0.05)., Results: A total of 7,396 patients underwent tonsillectomy May 2008 through May 2018, among whom 121 (2%) post-tonsillectomy hemorrhage patients were identified. Among the 104 patients with ED arrival times, 29 (28%) arrived in the morning; 15 (14%) arrived in the afternoon; 40 (38%) arrived in the evening; and 20 (19%) arrived overnight (P = 0.003). Sixty patients (mean age 17.1 years, standard deviation 16.6) had a recorded timing of bleed onset. Bleed onset occurred most commonly overnight (24, 40%), followed by evening (21, 35%), afternoon (11, 18%), and morning (4, 7%) (P = 0.0007)., Conclusion: In this cohort, post-tonsillectomy hemorrhage occurred most frequently between midnight and 6 am. Our findings confirm anecdotal experience and provide data in setting caregiver expectations., Level of Evidence: 4 Laryngoscope, 130:1823-1827, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: To examine sociodemographic, hospital-specific, and disease-related characteristics in relation to outcomes in sinonasal squamous cell carcinoma (SCC)., Study Design: The National Cancer Database was queried for location codes corresponding to the nasal cavity and paranasal sinuses and histology codes representing SCC malignancy. Multivariate analyses were performed against short- and long-term outcomes (overall survival, days to discharge, 30-day readmission, and 30- and 90-day mortality)., Results: The database included 5,584 sinonasal SCC patients with an overall median survival of 53.5 months (95% confidence interval [CI]: 49.7-57.8). On multivariate analysis, uninsured, Medicaid, and Medicare were independently associated with worse overall survival compared to private insurance (hazard ratio [HR]: 1.49, 95% CI: 1.22-1.82, P < .001; HR: 1.57, 95% CI: 1.34-1.85, P < .001; and HR: 1.14, 95% CI: 1.01-1.29, P = .03, respectively). Both Medicaid and Medicare were also associated with increased 30-day mortality (HR: 1.36, 95% CI: 1.76-143.29, P = .02; HR: 8.27, 95% CI: 1.66-70.88, P = .02, respectively), and Medicaid patients spent more time in the hospital following surgery (difference in days to discharge: HR: 2.09, 95% CI: 0.57-3.61, P < .01). Compared to white race, other race was associated with improved overall survival (HR: 0.79, 95% CI: 0.63-0.99, P = .04) but increased 30-day readmissions (HR: 3.85, 95% CI: 1.58-8.38, P < .01). Hispanic ethnicity was associated with increased 30-day readmissions (HR: 2.35, 95% CI: 1.08-4.75, P = .02]. The highest income bracket (≥$63,000) was associated with fewer hospital readmissions (HR: 0.33, 95% CI: 0.13-0.79, P = .01)., Conclusions: Sociodemographic and economic differences in outcomes of patients with sinonasal SCC cancer exist. An understanding of these differences may help minimize disparities in oncologic treatment., Level of Evidence: 2c. Laryngoscope, 128:560-567, 2018., (© 2017 The American Laryngological, Rhinological and Otological Society, Inc.)

Board certification of pharmacists has been a reality in the United States since 1976, when the Board of Pharmaceutical Specialties (BPS) was founded. Little has been reported about the effects of board certification of pharmacists, particularly pharmacy practice faculty, since 1992, when the BPS administered its first certification examination. We developed and pretested a survey to describe and measure the effect of BPS certification on the realm of academia as perceived by deans of colleges of pharmacy in the United States. Deans or other appropriate officials at all 84 colleges of pharmacy in the United States were asked to complete and submit this 13-question survey, which was administered through the Web and maintained respondents' anonymity. Officials from 35 of the 84 colleges completed the survey, for a response rate of 42%. No college reported that board certification was a condition for employment. Eight schools (23%) anticipated a certification requirement in the future. The most commonly reimbursed items associated with certification were fees for the American College of Clinical Pharmacy preparatory course and the BPS examination. Twelve schools (34%) provided no reimbursement toward certification. The most common incentive for faculty to obtain certification was consideration in promotion and tenure (66%). We believe that this information will facilitate efforts to gauge the effects of BPS certification on colleges of pharmacy. We also anticipate that it will assist colleges as they attempt to recruit and retain the most qualified faculty members possible, particularly in light of the national pharmacist shortage.