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Acute care nurses continue to rely on personally created paper-based tools—their “paper brains”—to support work during a shift, although standardized handoff tools are recommended. This interpretive descriptive study examines the functions these paper brains serve beyond handoff in the medical oncology unit at a cancer specialty hospital. Thirteen medical oncology nurses were each shadowed for a single shift and interviewed afterward using a semistructured technique. Field notes, transcribed interviews, images of nurses’ paper brains, and analytic memos were inductively coded, and analysis revealed paper brains are symbols of patient and nurse identity. Caution is necessary when attempting to standardize nurses’ paper brains as nurses may be resistant to such changes due to their pride in constructing personal artifacts to support themselves and their patients. [ABSTRACT FROM AUTHOR]

Abstract: Comparative effectiveness reviews (CERs) are systematic reviews that evaluate evidence on alternative interventions to help clinicians, policy makers, and patients make informed treatment choices. Reviews should assess harms and benefits to provide balanced assessments of alternative interventions. Identifying important harms of treatment and quantifying the magnitude of any risks require CER authors to consider a broad range of data sources, including randomized controlled trials (RCTs) and observational studies. This may require evaluation of unpublished data in addition to published reports. Appropriate synthesis of harms data must also consider issues related to evaluation of rare or uncommon events, assessments of equivalence or noninferiority, and use of indirect comparisons. This article presents guidance for evaluating harms when conducting and reporting CERs. We include suggestions for prioritizing harms to be evaluated, use of terminology related to reporting of harms, selection of sources of evidence on harms, assessment of risk of bias (quality) of harms reporting, synthesis of evidence on harms, and reporting of evidence on harms. [Copyright &y& Elsevier]

This paper explores the concept of "community-engaged research" (CEnR) within the context of Veteran health care delivery and reintegration programs. A multi-sector expert panel (msExP) was formed to evaluate and make recommendations on Veteran community reintegration research and programs. The panel consisted of Veterans, care partners, clinical providers, researchers, community stakeholders, and subject matter experts. The paper examines the composition and lifecycle of the panel, highlighting the characteristics and experiences of the participants. Shifts in the panel's purpose and engagement levels occurred in response to unanticipated disruptions, particularly the COVID-19 pandemic. The transformation of the panel emphasizes the importance of aligning individual and group needs and deepening intrapersonal relationships Findings based on observations, surveys, and interviews with panel members contribute to the field of community-engaged research by demonstrating the utility of catalytic validity that balances group and individual development. As part of a broader study on Veteran reintegration, the panel and its development over time allowed for various perspectives on Veteran experiences and reintegration within the community that shaped the overall project. Despite the challenges of developing and maintaining a panel alongside a research study, feedback from the panel members on their participation provides insight into the potential for future working alliances in community-engaged health research. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper is to systematically and critically appraise the available scientific evidence concerning the prevalence of edentulism among diabetic patients compared to non‐diabetic people. Methods: MEDLINE‐PubMed and Cochrane‐CENTRAL databases were comprehensively searched up to April 2023 to identify appropriate studies. The inclusion criteria were observational studies conducted in human subjects ≥18 years of age with the primary aim of investigating the prevalence of edentulism among diabetic patients. Based on the extracted data, a meta‐analysis was performed. Recommendations based on the body of evidence were formulated using the GRADE approach. Results: Independent screening of 2085 unique titles and abstracts revealed seven publications that met the eligibility criteria. Study size ranged from 293 to 15,943 participants. Data from all seven studies were suitable for meta‐analysis. Overall, 8.3% of the studied population was edentulous. The weighted mean prevalence of edentulism among diabetic and non‐diabetics was 14.0% and 7.1%, respectively. The overall odds ratio for diabetic patients to be edentulous as compared to non‐diabetics was 2.39 (95% CI [1.73, 3.28], p < 0.00001). Conclusion: There appears to be moderate certainty that the risk of being edentulous for diabetic patients compared to non‐diabetic people is significant, but the odds ratio is estimated to be small. [ABSTRACT FROM AUTHOR]

Background: The sudden growth in online instruction due to COVID‐19 restrictions has given renewed urgency to questions about remote learning that have remained unresolved. Web‐based assessment software provides instructors an array of options for varying testing parameters, but the pedagogical impacts of some of these variations has yet to be examined. Objectives: The current study examines whether question order affects student performance on online college math assessments. Drawing on the literature of testing and math anxiety, we hypothesized that difficult questions near the beginning of an assessment would have a destructive effect on student confidence, which would in turn have a deleterious effect on their performance. Methods: We employed an observational 'big data' methodology, analysing 23,468 final exams completed by students in 10 different courses over eight semesters at a Math Emporium in a large technical university in the eastern United States. Students were freshmen and sophomores enrolled in non‐engineering math courses. We regressed the final score on the difficulty level of the first and second questions, controlling for several other factors. Results and Conclusions: We found that several factors—day of the week, amount of time before the deadline, number of minutes spent on the exam—have more of an impact on score than question order. This pattern was consistent across sexes. Takeaways: Our findings contradict some previous studies, which have found that difficult early questions degrade student performance, and that this affect is more pronounced in females. This work enriches our understanding of how students respond to online assessment. Lay Description: What is already known about this topic: Previous studies have had mixed results about the effect of question difficulty ordering on student performance.Furthermore, few studies have examined this issue for computer assessments. What this paper adds: We employ a novel methodology with a uniquely large data set.Our findings indicate that difficulty ordering has no effect on student performance. Implications for practice: Math instructors can use the random ordering feature of computer assessment generating tools because question order does not affect performance. [ABSTRACT FROM AUTHOR]

Background: The United States is increasingly recognizing period product insecurity, insufficient access to menstrual products and limited private spaces for managing menstruation due to financial constraints, as an issue impacting the well-being and dignity of Americans. One strategy to address period product insecurity has been distributing free period products via period supply banks. The outcomes of period product distribution outside the school setting are absent from the literature. Objectives: This study, a formative evaluation of the free period product distribution efforts of the Alliance for Period Supplies, aims to identify (1) characteristics of individuals receiving products from period supply banks and their experiences of period product insecurity and (2) health and social outcomes experienced by recipients of free period products. Design: Survey data collection occurred at two points: baseline and one-year follow-up. All study participants provided verbal consent. Methods: Between Fall 2018 and Spring 2020, 1863 baseline and 80 follow-up surveys were administered. Participants received free period products for themselves and/or a household member from one of 20 participating Alliance for Period Supplies period supply banks directly or from one of their 64 partner agencies. Results: At baseline, 72.4% of participants had to choose between buying period products and another basic need. One year after accessing a period supply bank, 36.3% of participants reported this experience (p = 0.018). Participants reported at baseline, on average, 7.8 days in the past year of avoiding seeing others, canceling appointments, or skipping work or school because they did not have access to period products. At follow-up, this was reduced to 1.2 days, on average, t (68) = 2.214, p < 0.05. Conclusion: Period supply banks play an essential role in facilitating access to period products and the resulting benefits. Our study highlights the need for sustainable, well-funded policies and interventions to address period product insecurity effectively in society. Plain Language Summary: How people in the United States benefit when they get free period products from a period supply bank Why we did this study: In the United States, many individuals cannot afford to buy period supplies and the other stuff they need to live. Period supply banks want to help by giving them free period products. Researchers do not know if getting free period products is helpful for individuals. What we wanted to learn: The Alliance for Period Supplies is a membership program for period supply banks. We wanted to learn about the individuals who get free period products and whether getting them was helpful. What we did: For a year, starting in Fall 2018, we asked 1863 individuals to fill out paper surveys. A year later, we asked 80 of those same individuals to fill out a second survey. We asked participants to take the survey if they got free period products from a period supply bank for themselves or someone they live with. Individuals only participated in the study if they told us they wanted to. What we learned: Individuals who cannot afford period products must navigate difficult decisions between purchasing products or choosing other basic needs. Providing free products through a period supply bank has lessened the burden on these individuals, reducing the number who had to choose. Individuals unable to afford period products may sometimes opt out of going places they want to go for pleasure or miss important events, like work or school, because they do not have period products. Getting free period products has eased these challenges, letting individuals participate more fully in activities and engagements without worry about period products. Why is this important: Period supply banks are essential places where individuals receive free period products. The period supply banks need more individuals, including our government, to donate period supplies or money to buy them so they can help more individuals. [ABSTRACT FROM AUTHOR]

BACKGROUND: This paper presents the process taken by a nonprofit educational organization to create authentic evaluation tools for Food Education in K‐12 schools. Development was a collaborative effort between organization staff and teachers during an Evaluation Summit. The program background, development of the Summit, and plans for post‐Summit work continuation are described. The Summit included 14 teacher participants (3‐4 per grade band in preK‐1, 2‐5, 6‐8, 9‐12). METHODS: The process of tool development was captured via direct observations and analysis of artifacts (eg, participants' brainstorming chart paper, online development documents) to identify themes in successful approaches and challenges. Additional post‐Summit activities were also captured via surveys and artifacts. Outcomes of this work are outlined, including the challenges in carrying out the creation of authentic assessments that accurately reflect the classroom teaching experience, and the value of in‐person community building in the Food Education space. RESULTS: Key findings relate to the importance of in‐person collaboration amongst teachers, centering students in evaluation, and equity and accessibility in tool development. CONCLUSIONS: Although outlining challenges and outcomes was not an a priori goal of this work, it provides important information for others working in the education nonprofit space—especially as it pertains to new approaches to classroom evaluation. [ABSTRACT FROM AUTHOR]

Background: International guidelines recommend preoperative multidisciplinary team (MDT) assessment for high-risk surgical patients. Preoperative MDT meetings can help to improve surgical care, but there is little evidence on whether they improve patient outcomes. Methods: This paper aims to share our experience of MDT meetings for high-risk surgical patients to underline their added value to the current standard of care. An observational study of a retrospective cohort of preoperative high-risk MDT meetings of a tertiary referral hospital between January 2015 and December 2020. For 249 patients the outcomes preoperative data, MDT decisions, and patient outcomes were collected from electronic health records. Main results: A total of 249 patients were discussed at high-risk MDT meetings. Most of the patients (97%) were assessed as having an American Society of Anesthesiology score ≥ 3, and 219 (88%) had a European Society of Cardiology and European Society of Anaesthesiology risk score of intermediate or high. After MDT assessment, 154 (62%) were directly approved for surgery, and 39 (16%) were considered ineligible for surgery. The remaining 56 (23%) patients underwent additional assessments before reconsideration at a high-risk MDT meeting. The main reason for patients being discussed at the high-risk MDT meeting was to assess the risk-benefit ratio of surgery. Ultimately, 184 (74%) patients underwent surgery. Of the operated patients, 122 (66%) did not have a major complication in the postoperative period, and 149 patients (81%) were alive after one year. Conclusions: This cohort study shows the vulnerability and complexity of high-risk patients but also shows that the use of an MDT assessment contributes too improved peri- and postoperative treatment strategies in high-risk patients. Most patients underwent surgery after careful risk assessment and, if deemed necessary, preoperative and perioperative treatment optimization to reduce their risk. [ABSTRACT FROM AUTHOR]

Background: Chinese American immigrants have been underrepresented in health research partly due to challenges in recruitment. Objectives: This study aims to describe recruitment and retention strategies and report adherence in a 7-day observational physical activity study of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic. Methods: Foreign-born Chinese women aged 18--45 years, with a gestational diabetes index pregnancy of 0.5--5 years, who were not pregnant and had no current diabetes diagnosis were recruited. They wore an accelerometer for 7 consecutive days and completed an online survey. Multiple recruitment strategies were used: (a) culturally and linguistically tailored flyers, (b) social media platforms (e.g., WeChat [a popular Chinese platform] and Facebook), (c) near-peer recruitment and snowball sampling, and (d) a study website. Retention strategies included flexible scheduling and accommodation, rapid communications, and incentives. Adherence strategies included a paper diary and/or automated daily text reminders with a daily log for device wearing, daily email reminders for the online survey, close monitoring, and timely problem-solving. Results: Participants were recruited from 17 states; 108 were enrolled from August 2020 to August 2021. There were 2,479 visits to the study webpage, 194 screening entries, and 149 inquiries about the study. Their mean age was 34.3 years, and the mean length of U.S. stay was 9.2 years. Despite community outreach, participants weremainly recruited fromsocialmedia (e.g., WeChat). The majority were recruited via near-peer recruitment and snowball sampling. The retention rate was 96.3%; about 99% had valid actigraphy data, and 81.7% wore the device for 7 days. The majority of devices were successfully returned, and the majority completed the online survey on time. Discussion: We demonstrated the feasibility of recruiting and retaining a geographically diverse sample of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic. Recruiting Chinese immigrants via social media (e.g., WeChat) is a viable approach. Nonetheless, more inclusive recruitment strategies are needed to ensure broad representation from diverse socioeconomic groups of immigrants. [ABSTRACT FROM AUTHOR]

This study summarises research- and practice-based evidence on home-based chemotherapy, and explores existing delivery models. A three-pronged investigation was conducted consisting of a literature review and synthesis of 54 papers, a review of seven home-based chemotherapy programmes spanning four countries, and two case studies within the Canadian province of Ontario. The results support the provision of home-based chemotherapy as a safe and patient-centred alternative to hospital- and outpatient-based service. This paper consolidates information on home-based chemotherapy programmes including services and drugs offered, patient eligibility criteria, patient views and experiences, delivery structures and processes, and common challenges. Fourteen recommendations are also provided for improving the delivery of chemotherapy in patients' homes by prioritising patient-centredness, provider training and teamwork, safety and quality of care, and programme management. The results of this study can be used to inform the development of an evidence-informed model for the delivery of chemotherapy and related care, such as symptom management, in patients' homes. [ABSTRACT FROM AUTHOR]

Changes in life expectancy (LE) across metropolitan areas in the United States have been associated with substantial differential reductions in fine particulate matter (aerodynamic diameter <2.5 μm; PM2.5) air pollution that occurred during the 1980s and 1990s. It has been suggested that a single influential observation was largely responsible for the statistically significant LE-PM2.5associations. In this paper, the role of influential observations is further explored. Stable and statistically significant LE-PM2.5associations are observed in analyses that control for available socioeconomic, demographic, and proxy smoking variables and that use robust regression procedures that are relatively resistant to influential observations. These associations are not dependent upon the inclusion or exclusion of any single observation. [ABSTRACT FROM AUTHOR]

Research has been and will continue to be important to the music therapy profession, as evidenced by the number of studies examining the evolution of research in the field. Despite its seeming importance, no recent studies have investigated the extent to which music therapists find research relevant to practice and very few studies have examined this topic outside of the United States. The purposes of this study were to (a) examine the extent to which music therapists around the world view research as relevant to clinical practice and (b) among those who read research, identify which sections from scientific papers are read. This nonexperimental study involved an online survey of music therapists from 51 countries. Of the 1586 initially responding to the participant invitation, 1272 music therapists completed the survey (a completion rate of 80%). Findings suggest that music therapists find research to be relevant to clinical practice and perceptions differ as a function of educational attainment and occupational role. Results also evidenced similar educational and occupational differences with regard to reading scientific papers. These findings parallel those from earlier studies indicating those with higher educational attainment and working in academic/research-related positions tend to find research more relevant. These findings are important because they suggest there may be a disconnection between the extant research and the end consumer, the clinician. [ABSTRACT FROM PUBLISHER]

Introduction: COVID-19 pandemic negatively influenced the entire life globally including various aspects of patients' care. Its effect on medical research production is not known. The aim of this study is to assess the impact of COVID-19 pandemic on medical research reporting trend. Methods: Advanced search on PubMed was performed over 2011- August, 2021. Monthly comparison was done for the years 2019, 2020, and 2021. Kruskal Wallis test was used to compare continuous distributions. Results: The total publication count showed constant increment over the study period. Faster rise was noticed on 2020 (15.7%). A steady growth in publications over the years and through the pandemic was also seen in seven studied countries with variable, both in total and also after exclusion of COVID-19 related papers. Italy and India have the highest proportions of COVID-19 related publications in comparison to the total papers in 2020, but USA has the highest quantity. Statistically significant differences exist between the first eight months of the last three years with and without counting COVID-19 related publications (p-values=0.0003907 and 0.001084, respectively). Conclusion: Our results reflect that investigators world-wide succeeded to reconfigure their work style and utilize the spared time induced by the lockdown to enrich the medical research platform. [ABSTRACT FROM AUTHOR]

Background and Aims: The pathways model is a highly cited etiological model of problem gambling. In the past two decades, a number of studies have found support for the model's utility in classifying gambling subtypes. The aims of this paper were to refine empirically the model subtypes and to revise and update the model based on those findings. Design and Measurement: Observational study using data collected from treatment‐seeking problem gamblers using the Problem Gambling Severity Index (PGSI) and the Gambling Pathways Questionnaire (GPQ). Setting: Treatment clinics in Canada, Australia and the United States. Participants: A convenience sample of 1168 treatment‐seeking problem gamblers, aged 18 years or older. Findings Empirically validated risk factors were analyzed using latent class analyses, identifying a three‐class solution as the best‐fitting model. Those in the largest class (class 1: 44.3%, n = 517) reported the lowest levels of all etiological risk factors. Participants in class 2 (39.5%, n = 461) reported the highest rates of anxiety and depression, both before and after gambling became a problem, as well as childhood maltreatment, and a high level of gambling for stress‐coping. Those in class 3 (16.3%, n = 190) reported high levels of impulsivity; risk‐taking, including sexual risk‐taking; antisocial traits; and coping to provide meaning in life and to alleviate stress. Conclusions: The revised pathways model of problem gambling includes three classes of gamblers similar to the three subtypes in the original pathways model, but class 3 in the revised pathways model is distinct from class 2, showing higher levels of risk‐taking and antisocial traits and gambling motivated by a desire for meaning/purpose and/or to alleviate stress. Class 2 in the revised pathways model demonstrates high levels of childhood maltreatment as well as gambling for stress‐coping. [ABSTRACT FROM AUTHOR]

INTRODUCTION Electronic cigarette (e-cigarette) use is gaining popularity among adults. Monitoring e-cigarette-induced respiratory symptoms is crucial for both clinical and regulatory purposes. We systematically reviewed the current literature to understand the prevalence of respiratory symptoms among exclusive e-cigarette users, dual users, and former smokers. METHODS Databases searched included PubMed, CINAHL, Cochrane Library, Embase, and Scopus. We included all English-language, empirical quantitative articles that explored the prevalence of e-cigarette-related respiratory symptoms. Random-effects models were utilized in conducting the meta-analyses. The quality of identified studies was evaluated using the NIH Study Quality Assessment Tools. This study is registered with PROSPERO(#CRD42020165973). RESULTS The literature search identified 1240 references. After removing duplicates and screening for eligibility, 168 studies were included in the final review. The majority of included studies reported a wide range of adverse respiratory symptoms. The respiratory symptoms were prevalent among the exclusive e-cigarette users, dual users, and those who switched from combustible cigarettes to e-cigarettes. Further, out of the RCT studies, 5 were rated as good quality, while 3 were rated as fair. Among the observational studies, 24 were rated as good quality, and 9 were rated as fair. The two experimental studies were both rated as fair quality. CONCLUSIONS Continued monitoring of respiratory symptoms among e-cigarette users is warranted. Due to the heterogeneity and inconsistencies among studies, which limit result interpretation and highlight the need for studies assessing causal inference, further research using robust study designs is essential. This will provide clinicians with comprehensive knowledge about the potential respiratory risks of e-cigarette use. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is already known about this topic?: Individuals with severe mental illness (SMI) have elevated risks for physical health problems and low screening rates.No previous studies have compared the physical health promotion needs of people with SMI using the same screening tool across different international settings. What this paper adds to existing knowledge?: It appears feasible to use the HIP to profile and compare physical health‐related risks in people with SMI across different international settings.The HIP tool identified significant differences in areas of risk across the four countries. What are the implications for practice?: The HIP could be used to identify unique clusters of health promotion needs in different countries.Use of HIP health checks may support implementation of individualized interventions. Introduction: To date, no studies have contrasted physical health profiles of people with severe mental illness (SMI) in different countries. Aim: To evaluate feasibility of using the Health Improvement Profile (HIP) to compare and contrast physical health and health behaviours of people with SMI from four countries. Method: An observational feasibility study using secondary analysis of pooled health state and lifestyle data. Physical health checks using modified versions of HIP were administered in four countries. Results: Findings suggest feasibility of HIP screening to profile and compare physical health and health behaviours of people with SMI across international settings. High overall numbers of risk items (red flags) were identified in all but the Thailand sample. Despite some commonalities, there were important differences in health profiles across countries. Discussion: This is the first study to demonstrate feasibility of the HIP to compare health risks in individuals with SMI across countries. Future multi‐national HIP studies should recruit a fully powered stratified random sample of people with SMI that is representative of each setting. Implications for practice: It appears feasible to utilize the HIP to identify specific areas of health risk in different countries, which may help to better focus nursing interventions and use of resources. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aimed to measure the frequency of spiritual needs, identify the factors associated with these needs among Korean and American persons living with an advance chronic illness and compare them from a cross‐cultural perspective. Background: Persons with serious or life‐limiting illnesses often have spiritual needs. Unmet spiritual needs are associated with poor well‐being and threaten psychological health. Little is known about how specific spiritual needs vary across cultures. Design: A quantitative, cross‐sectional, observational cross‐cultural comparison was undertaken. Methods: The study has been prepared in accordance with the STROBE guidelines. Convenience sampling was used to recruit participants from outpatient clinics in South Korea and Southern California (N = 202). Spiritual needs were measured using the Spiritual Interests Related to Illness Tool (SpIRIT); demographic and illness‐related variables were also assessed using paper‐and‐pencil questionnaires. Data were analysed using various parametric statistical tests, including multiple regression analysis. Results: The findings quantify the intensity and types of spiritual needs that persons living with an advanced chronic illness experience. Furthermore, they show how the spiritual needs of religiously diverse samples of South Koreans and Americans differ. The findings also indicate that self‐reported spirituality and religiosity independently explain a substantial amount of the variance in spiritual needs. Conclusions: In both the samples, spiritual needs were reported and associated with spirituality and religiosity. Although all the eight domains of spiritual needs assessed by the SpIRIT were pertinent to the Korean and American samples, they were prioritised differently. Relevance to clinical practice: Screening patients to ascertain how important spirituality or religiosity is to them may help clinicians focus their in‐depth assessments on those who report high levels of spirituality or religiosity because these patients may experience the strongest spiritual needs. The SpIRIT shows promise as a measure of diverse spiritual needs. [ABSTRACT FROM AUTHOR]

Background: While the high prevalence of preterm births and its impact on infant mortality in the US have been widely acknowledged, recent data suggest that even full-term births in the US face substantially higher mortality risks compared to European countries with low infant mortality rates. In this paper, we use the most recent birth records in the US to more closely analyze the primary causes underlying mortality rates among full-term births.Methods and Findings: Linked birth and death records for the period 2010-2012 were used to identify the state- and cause-specific burden of infant mortality among full-term infants (born at 37-42 weeks of gestation). Multivariable logistic models were used to assess the extent to which state-level differences in full-term infant mortality (FTIM) were attributable to observed differences in maternal and birth characteristics. Random effects models were used to assess the relative contribution of state-level variation to FTIM. Hypothetical mortality outcomes were computed under the assumption that all states could achieve the survival rates of the best-performing states. A total of 10,175,481 infants born full-term in the US between January 1, 2010, and December 31, 2012, were analyzed. FTIM rate (FTIMR) was 2.2 per 1,000 live births overall, and ranged between 1.29 (Connecticut, 95% CI 1.08, 1.53) and 3.77 (Mississippi, 95% CI 3.39, 4.19) at the state level. Zero states reached the rates reported in the 6 low-mortality European countries analyzed (FTIMR < 1.25), and 13 states had FTIMR > 2.75. Sudden unexpected death in infancy (SUDI) accounted for 43% of FTIM; congenital malformations and perinatal conditions accounted for 31% and 11.3% of FTIM, respectively. The largest mortality differentials between states with good and states with poor FTIMR were found for SUDI, with particularly large risk differentials for deaths due to sudden infant death syndrome (SIDS) (odds ratio [OR] 2.52, 95% CI 1.86, 3.42) and suffocation (OR 4.40, 95% CI 3.71, 5.21). Even though these mortality differences were partially explained by state-level differences in maternal education, race, and maternal health, substantial state-level variation in infant mortality remained in fully adjusted models (SIDS OR 1.45, suffocation OR 2.92). The extent to which these state differentials are due to differential antenatal care standards as well as differential access to health services could not be determined due to data limitations. Overall, our estimates suggest that infant mortality could be reduced by 4,003 deaths (95% CI 2,284, 5,587) annually if all states were to achieve the mortality levels of the best-performing state in each cause-of-death category. Key limitations of the analysis are that information on termination rates at the state level was not available, and that causes of deaths may have been coded differentially across states.Conclusions: More than 7,000 full-term infants die in the US each year. The results presented in this paper suggest that a substantial share of these deaths may be preventable. Potential improvements seem particularly large for SUDI, where very low rates have been achieved in a few states while average mortality rates remain high in most other areas. Given the high mortality burden due to SIDS and suffocation, policy efforts to promote compliance with recommended sleeping arrangements could be an effective first step in this direction. [ABSTRACT FROM AUTHOR]

In 2019, the National Institutes of Health combined the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS) into the MACS/WIHS Combined Cohort Study (MWCCS). In this paper, participants who made a study visit during October 2018–September 2019 (targeted for MWCCS enrollment) are described by human immunodeficiency virus (HIV) serostatus and compared with people living with HIV (PLWH) in the United States. Participants include 2,115 women and 1,901 men with a median age of 56 years (interquartile range, 48–63); 62% are PLWH. Study sites encompass the South (18%), the Mid-Atlantic/Northeast (45%), the West Coast (22%), and the Midwest (15%). Participant race/ethnicity approximates that of PLWH throughout the United States. Longitudinal data and specimens collected for 35 years (men) and 25 years (women) were combined. Differences in data collection and coding were reviewed, and key risk factor and comorbidity data were harmonized. For example, recent use of alcohol (62%) and tobacco (28%) are common, as are dyslipidemia (64%), hypertension (56%), obesity (42%), mildly or severely impaired daily activities (31%), depressive symptoms (28%), and diabetes (22%). The MWCCS repository includes serum, plasma, peripheral blood mononuclear cells, cell pellets, urine, cervicovaginal lavage samples, oral samples, B-cell lines, stool, and semen specimens. Demographic differences between the MACS and WIHS can confound analyses by sex. The merged MWCCS is both an ongoing observational cohort study and a valuable resource for harmonized longitudinal data and specimens for HIV-related research. [ABSTRACT FROM AUTHOR]

Are the clean intermittent catheterization (CIC)‐cgQ and the CIC‐childQ feasible and generate valid measures of success performing CIC? CIC is the primary treatment for neurogenic bladder. However, instituting CIC with children can be challenging. Currently there are no validated instruments to measure the abilities of paediatric patients and their caregivers to perform CIC. The purpose of this study was to evaluate the validity and reliability of a modified version of the Intermittent Self Catheterization Questionnaire (ISC‐Q) in children with neurogenic bladder and their caregivers performing CIC. Children with spinal dysraphism, such as myelomeningocele (MMC) may face urologic challenges related to neurogenic bladder including renal compromise, recurrent urinary tract infections, and urinary incontinence due to bladder deterioration. CIC is an important intervention in the management of patients with neurogenic bladder. There are no valid tools currently available to measure the success of CIC in paediatric patients or their caregivers. A non‐experimental, psychometric research design was employed for this pilot study. Data collection was performed using online and paper surveys. The ISC‐Q was modified into two versions for use in the United States, one for caregivers of children on CIC (CIC‐cgQ) and one for paediatric patients on CIC (CIC‐childQ). A convenience sample of subjects was recruited from Spinal Differences Clinic and the local spina bifida support group. Informed consent was embedded in the invitation letter/email with survey completion indicating consent to participate. Criterion related validity was described using known group sum scores along with Cronbach's α for internal reliability. The tools were pilot tested on 15 caregivers and four children. Cronbach's alphas were.84 and.83 for the caregivers and children, respectively. Subjects identified a priori as successful with CIC scored higher than those identified as unsuccessful. The CIC‐cgQ and the CIC‐childQ are valid and reliable measures of the impact of CIC on the lives of caregivers and children. Future studies with larger sample sizes will allow further psychometric testing. This instrument gives researchers the ability to measure the impact of CIC on the lives of children and caregivers. [ABSTRACT FROM AUTHOR]

Despite extensive anecdotal evidence on US long-haul truckers' risk interactions on the road, links between their sexual mixing and drug exchanges and their potential risk for STI/BBI acquisition and dissemination remain insufficiently documented. Grounded in social ecological theories and multi method ethnographic data, this paper examines the sexual transactions and drug exchanges of key members of US trucker risk networks within diverse trucking milieux. Research has uncovered four key trucker-centered populations and their diverse risk exchanges: (a) straight male truckers who engage in casual sex with women; (b) female sexworkers (known as 'lot lizards') who solicit truckers; (c) intermediaries who broker sex and drug exchanges between truckers, drug dealers and sexworkers; and (d) male truckchasers who cruise for truckers in physical and virtual milieux to engage in sex. Concurrent sexual partnerships of truckers have the potential to amplify initial infections by linking individuals of disparate epidemiological settings, thereby enabling pathogens to travel rapidly and efficiently to disparate regions. The comprehensive delineation of the role of long-haul trucking in potential disease spread is required for the development of effective STI/HIV prevention programs for populations of interest. [ABSTRACT FROM AUTHOR]

Coordinating care for hospitalized patients requires the use of multiple sources of information. Using a macroergonomic framework (i.e. the work system model), we conducted interviews and observations of care managers involved in care coordination across transitions of care. When information is distributed across multiple health IT applications, care managers experience a range of challenges, including organizational barriers, technology design problems, skills and knowledge issues, and task performance demands (i.e. issues related to individual information processing and management and sharing of information). These challenges can be used as a checklist to evaluate the proposed IT infrastructure that will allow the integration of multiple health IT applications and, therefore, support coordination across transitions of care. [ABSTRACT FROM AUTHOR]

This paper examines the grid of sentiment that structures medical travel to India. In contrast to studies that render emotion as ancillary, the paper argues that affect is fundamental to medical travel's ability to ease the linked somatic, emotional, financial, and political injuries of being ill 'back home'. The ethnographic approach follows the scenes of medical travel within the Indian corporate hospital room, based on observations and interviews among foreign patients, caregivers, and hospital staff in Mumbai, New Delhi, Chennai, and Bangalore. Foreign patients conveyed diverse sentiments about their journey to India ranging from betrayal to gratitude, and their expressions of risk, healthcare costs, and cultural difference help sustain India's popularity as a medical travel destination. However, although the affective dimensions of medical travel promise a remedy for foreign patients, they also reveal the fault lines of market medicine in India. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate executive function measures as they relate to clinical and academic performance outcomes of graduate speechlanguage pathology students. Method: An observational design incorporating correlations and stepwise multiple regressions was used to determine the strength of the relationships between clinical outcomes that occurred at various time points throughout the graduate program (clinical coursework grades throughout the program and case study paper scores at the end of the program), academic outcomes (graduate grade point average and Praxis II exam in speech-language pathology scores), and executive function (EF) scores (EF assessment scores, self-reported EF scores). Participants were 37 students (36 women, Mage = 24.1) in a master's degree program in speech-language pathology at a southeastern U.S. university during the 2017-2018 academic year. Results: Findings of this preliminary study indicated that a limited number of objective EF scores and self-reported EF scores were related to clinical and academic outcomes of graduate speech-language pathology students. Conclusion: As results of this preliminary study suggest that EF tests may be related to clinical and academic outcomes, future research can move to study the potential role of EF measures in the graduate admissions process in clinical graduate programs such as speech-language pathology. [ABSTRACT FROM AUTHOR]

Objective: In this paper, we examine client perspectives of health coaching programs and differences by insurance type. Methods: We used descriptive coding and directed content analysis to analyze semi-structured qualitative in-person interviews that assessed preferred health coach qualifications and experience, desirable attributes for coaches, and interest in having a coach. We recruited participants (N = 140 adults: 61 commercial insurance, 79 Medicaid) without consideration of prior health coaching experience. Results: Participants viewed physicians as the experts on health and valued coaches as supporters of behavior-change efforts that could take a patient's life context into account. Empathetic coaches were expected to motivate and hold patients accountable without taking too much time or being too "pushy." Participants preferred some in-person interaction and differed in preferences for program referral and enrollment approaches. Medicaid beneficiaries had less prior exposure to health coaching, more interest in having a coach, and preferred coaches to provide medical education. Conclusions: Irrespective of prior coaching experience or insurance type, participants agreed on many preferred characteristics of coaches and coaching programs. Understanding client preferences and expectations can help refine the role of health coaches, making them more effective and shaping the way they are presented to potential participants to enhance their appeal and use. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to analyze research trends and hotspots in the field of food and nutrition literacy to inform evidence-based policymaking, and promote the health and well-being of the general population. Design/methodology/approach: The Scopus database was used to retrieve relevant research articles using specific keywords related to food or nutritional literacy. Findings: The analysis included 341 research articles, predominantly authored by scholars from the USA. Growth pattern of publications indicated recent evolution of the food and nutrition literacy concepts. The research hotspots identified included the development of tools to assess literacy, assessing food and nutritional literacy competencies among school children and adolescents and finally, cross-sectional survey studies on various international cultures to assess food and nutritional literacy. The top cited articles in the field focused on the operational definition and difference between nutrition literacy and food literacy. Research limitations/implications: The findings underscore the need for comparative studies across countries, and advocacy for policy change to advance food and nutrition literacy among school students and vulnerable populations. Practical implications: Policymakers, public health officials and practitioners can use the research findings to inform the development of evidence-based policy frameworks and interventions aimed at addressing the gaps in food and nutrition literacy. Social implications: By promoting and advocating for policy reforms, and addressing gaps in food and nutrition literacy, the study contributes to fostering global future public health. Originality/value: The study provides insights into the evolving research landscape on food and nutrition literacy, emphasizing the growing scholarly interest in understanding the concept and its public health impact. [ABSTRACT FROM AUTHOR]

Background: There is a critical gap in understanding the symptom experience and health outcomes of older adults with and without Alzheimer's Disease and related dementias (ADRD) and polypharmacy (PPY). The primary aim of the study was to compare the number of symptoms experienced over time in older adults with and without ADRD by polypharmacy status. The secondary aim was to examine the trajectory of physical function and health outcomes over time in each group. Methods: This study utilized longitudinal data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries from 2016–2019. The sample was separated into four groups (N = 2,052): neither ADRD or PPY (n = 1,048), PPY only (n = 761), ADRD only (n = 116), and both ADRD and PPY(n = 127). Results: The overall sample was predominately female (57.9%), White (70.9%), aged 84 or younger (75%), married (46%), and had some college or a college degree (50%). Participants with both ADRD and PPY experienced more symptoms on average, had higher odds of falls, hospitalizations, and mortality than all other groups. Older adults with both ADRD and PPY had lower physical function, needed more assistance with activities of daily living and higher assistive device utilization compared to the other three groups. Conclusions: Findings indicate that older adults with both ADRD and PPY experience more symptoms, negative health outcomes and physical function decline that can negatively impact their quality of life. Further research is needed to identify strategies for reducing PPY in people with ADRD. [ABSTRACT FROM AUTHOR]

Background: Robust and well-defined data collection is important when using electronic patient-reported outcome measures (ePROMs) in clinical studies. Questions have been raised as to whether older age may be a barrier to data collection due to patients' unfamiliarity with electronic devices. Older adults may also have underlying health conditions that affect their ability to fill out patient-reported outcome measures (PROMs) on electronic devices. The aim of this observational, qualitative research study was to evaluate the usability of electronic PROMs (ePROMs) on a tablet and smartphone in older participants with and without bullous pemphigoid (BP). Methods: Older people with and without BP were recruited in the US and France. They participated in 60-min in-person interviews, with moderators observing their completion of various tasks, including ePROMs, using a tablet and smartphone. Participants were scored on ease of task completion using a scale from 1 to 5. Results: A total of 12 participants were recruited (≥65 years old; six each with and without BP [all participants without BP were ≥75 years old]). Most participants (83%) could easily and confidently perform most assigned tasks on both the tablet and smartphone. Although select tasks required assistance, all participants were eventually able to complete all tasks. Overall, ePROM usability did not correlate with age, sex, country, or disease state. Feedback on the general usability of both electronic devices was largely positive, and most participants (n = 11; 92%) were willing to use them. Participants were generally pleased with the training modules offered on both devices, describing the training as sufficient, straightforward, and helpful. In total, 25 usability issues were identified, which fell into three categories: incomplete instructions, unclear language, and insufficient technical/visual design. Participants provided feedback on how to enhance device usability. Conclusions: The results suggest that older people can confidently use a tablet or smartphone for ePROM completion, particularly with appropriate training. ePROMs should be designed with the needs of the target patient population in mind. These results can be leveraged to improve clinical data recording, optimize device usability, and enhance the user experience for older people and those with functional or physical limitations. [ABSTRACT FROM AUTHOR]

Background: Oral diseases remain a significant public health problem worldwide, with growing gaps in oral health status among various socioeconomic groups. The objective of the current study is to analyze the impact of different social determinants of health (SDOH) on oral health outcomes (frequency of dental visits, self-reported oral health status, embarrassment because of oral health status, and tooth loss) among a representative sample of United States (U.S.) adults. Methods: Cross-sectional data for this observational study came from adults aged 18 and above (N = 5,320) participating in the nationally representative 2021 State of Oral Health Equity in America survey. Bivariate and multivariable analyses were conducted to examine the associations between oral health outcomes (dependent variables) and SDOH independent variables: structural (race/ethnicity, income, education); and intermediary (lack of transportation, food insecurity, racial discrimination, and housing instability), controlling for the confounding variables of age, gender, employment status, dental insurance, self-rated mental/emotional health, self-rated physical health, presence of one or more chronic conditions, and having had a routine physical examination in the past year. Results: When controlling for confounding variables, Black adults were less likely than White adults to have had a dental visit in the last year (odds ratio (OR) = 0.72 (95% confidence interval (CI) = 0.57–0.92, p < 0.05), more likely to report feeling self-conscious or embarrassed due to their oral health (OR = 1.67 (95% CI = 1.31–2.12, p < 0.05), and more likely to have at least one permanent tooth removed (OR = 1.67 (95% CI = 1.31–2.13, p < 0.05). Higher income and more education were significantly associated with greater odds of rating one's oral health positively and having had a dental visit in the past year and lesser odds of feeling self-conscious or having at least one tooth removed (p's < 0.05). All four intermediary determinants were associated with significant (p < 0.05) and negative odds of having a dental visit in the past year and reporting positive oral health, and with positive odds of having at least one permanent tooth removed. The odds of feeling self-conscious or embarrassed due to their oral health were significantly and positive associated with all intermediary determinants except for racial discrimination (OR = 1.21, 95% CI = 1.00–1.46). Conclusions: Significant inequities still exist in the U.S. regarding SDOH and their relationship to oral health. Improving oral health will involve addressing SDOH. Successful policy and public health interventions must address not only structural factors but also intermediary SDOH. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is increasing in the United States, and awareness is needed for prevention. Hypertension is the leading cause of HF, and adherence to antihypertensive medication is critical for reducing HF risk. Self-efficacy positively influences health-promoting behaviors. Objectives: Assess HF awareness, test associations with antihypertensive medication adherence, and self-efficacy for managing chronic conditions. Design: We conducted a cross-sectional, observational survey research study. Methods: We leveraged data from participants enrolled in the American Heart Association's Research Goes Red™ registry, an online platform powered by Verily. Three surveys ascertained HF awareness, blood pressure management, and self-efficacy. Chi-squared and Wilcoxon rank sum determined associations between survey domains and participant characteristics. Results: Two thousand three hundred twenty women took the HF awareness survey, 678 the blood pressure management survey, and 755 the self-efficacy survey (response rates: 12%, 78%, and 76%, respectively). Participants were predominantly non-Hispanic White (78%), with a median age of 51 (interquartile range (IQR): 39, 62). Median HF awareness score was 4/5 (IQR: 4, 5). Participants with high HF awareness versus low were more likely to be older (p < 0.001), non-Hispanic White (p < 0.001), and less likely to smoke (p < 0.001) or have depression (p = 0.004). Nearly 90% of hypertensive participants reported medication adherence, which was not associated with HF awareness or self-efficacy. Participants with greater self-efficacy versus less were more likely to have higher HF awareness (p = 0.01), be older (p = 0.01), and less likely to have depression (p < 0.001). Conclusion: Women's awareness of HF and adherence to antihypertensive medication in this cohort was high. Depression and younger age may be important factors affecting women's HF awareness and confidence in managing chronic disease medication plans. Plain language summary: Awareness of heart failure, blood pressure management and self-efficacy in the Research Goes Red for Women Registry The following study investigated heart failure (HF) awareness, antihypertensive medication adherence, and self-efficacy among women from the American Heart Association's Research Goes Red for Women Registry. We found high levels of HF awareness and medication adherence among these women. However, younger age and depression were associated with lower HF awareness and self-efficacy. These findings emphasize the importance of targeting education and support interventions, especially for younger women and those dealing with depression, to improve HF prevention strategies and medication management. [ABSTRACT FROM AUTHOR]

To examine the association between clinical personnel's general attitudes towards new interventions and implementation outcomes related to an evidence-based individualized, culturally tailored, computerized decision aid (DA) for the management of lupus. To assess attitudes, the validated Evidence-Based Practice Attitudes Scale (EBPAS) survey was emailed to personnel in 15 rheumatology clinics across the U.S. The survey also included questions related to three validated implementation outcomes: lupus DA acceptability, appropriateness and feasibility. The baseline round of the survey was fielded from August 2019 to January 2020 and yielded a 56.8% response rate (n = 76 respondents). We also collected organizational characteristics from each clinic and personnel-level control variables. Overall, respondents reported modest levels of lupus DA acceptability, appropriateness and feasibility (3.54, 3.45 and 3.40, respectively, on a scale of 1–5). Multilevel regression analyses demonstrated statistically significant positive relationships between a respondent's openness to new practices/interventions and perceived lupus DA acceptability (β = 0.31, p <.01) and feasibility (β = 0.28, p <.05). Divergence (a respondent's perceived difference between current and new practices) was not associated with clinic personnel perceptions of the DA. These findings suggest that understanding clinic personnel general attitudes toward new interventions is an important precursor to implementing evidence-based practices and may provide important diagnostic information about places to intervene in preparation for implementation and improving shared decision-making with patients. [ABSTRACT FROM AUTHOR]

Introduction: Over the past 30 years, the use of implanted vascular access devices (IVAD) for long-term administration of vesicants, parenteral nutrition, blood products, and antimicrobials has grown exponentially. IVADs are a vital part of patient care, improve quality of life, and help with body image. Despite the positive aspects of IVAD, complications can still occur, one of which is device occlusion as a result of blood reflux. Methods: This observational experiment was conducted in the United Kingdom and the United States. The investigators in each country tested six Huber needles and measured the fluid reflux in the IVAD catheter upon removal of each Huber. This simple experiment was done using an in vitro port with a six French catheter secured to a ruler to measure fluid reflux into the port catheter upon removal of the six available Huber needles. Six commercially available Huber needles were each tested unclamped and clamped three times upon removal; the average was then calculated. Results: The findings demonstrated fluid reflux volumes with the six Hubers ranging from 0.0 to 0.6 cm unclamped and 0.0 to 0.7 cm of fluid reflux with the Hubers clamped. Only one Huber had no fluid reflux during needle withdrawal from the IVAD without clamping the tubing and with the tubing clamped. Five of the Hubers had fluid reflux during removal when unclamped and clamped. Conclusions: This experiment confirmed and revealed the differences in fluid reflux when removing a Huber needle from a port unclamped and clamped. Highlighted was the need for further research on fluid reflux and the potential impact it has on port occlusions. This experiment demonstrated that positive pressure needle withdrawal reduced reflux, compared to positive pressure flushing. Understanding the reflux associated with each Huber needle when de-accessing a port can potentially reduce port occlusions subsequently, improving patient outcomes. [ABSTRACT FROM AUTHOR]

The materiality of information environments, and its role in information behavior, has received little attention. We present an ethnographic study involving 156 hours of observation and 28 patient interviews in outpatient hemodialysis facilities. Using an extended "Semiotic Framework for Information Systems Research," the findings show that objects, spaces, and bodies were integral to 6 sociomaterial layers of facility information environments: the physical, empiric, syntactic, semantic, pragmatic, and social world. Objects of importance in the information environments included dialysis machines, instruments, records, paper documents, televisions, furniture, thermostats, lighting, and personal possessions. Spatial features, including compartmentalization, displays, distance, proximity, and spatially‐grounded routines, also constituted information environments. The information environments were also shaped by patient immobility, bodily discomforts, and orientation to bodily states. Each sociomaterial layer introduced enablers and constraints to information access, flow, and acceptance; these combined to construct patients primarily as passive recipients of information rather than active seekers and producers of information. A sociomaterial perspective and related focus on objects, spaces, and bodies offers a lens for professional information practice. We contribute information environment design guidance to facilitate such practice and stress that the value of certain sources and types of information can be materially encoded in an environment. [ABSTRACT FROM AUTHOR]

This paper focuses on the methods of a single study, incorporating data from chiropractic clinics into an evidenced-based investigation of the appropriateness of manipulation for chronic back pain. A cluster sample of clinics (125) from 6 sites across the United States was chosen for this observation study. Patients with chronic low-back and neck pain were recruited using iPads, completed a series of online questionnaires, and gave permission for their patient records to be scanned. Patient records for a random sample were also obtained. The RAND staff and clinic personnel collected record data. We obtained survey data from 2024 patients with chronic low back pain, chronic neck pain, or both. We obtained patient record data from 114 of 125 clinics. These included the records of 1475 of the individuals who had completed surveys (prospective sample), and a random sample of 2128 patients. Across 114 clinics, 22% of clinics had patient records that were fully electronic, 32% had paper files, and 46% used a combination. Of the 114 clinics, about 47% scanned the records themselves with training from RAND. We obtained a total of 3603 scanned records. The patient survey data were collected from June 2016 to February 2017, the provider surveys from June 2016 to March 2017, and the chart pull from April 2017 to December 2017. Clinics can be successfully recruited for practice-based studies, and patients can be recruited using iPads. Obtaining patient records presents considerable challenges, and clinics varied in whether they had electronic files, nonelectronic records, or a mixture. Clinic staff can be trained to select and scan samples of charts to comply with randomization and data protection protocols in transferring records for research purposes. [ABSTRACT FROM AUTHOR]

In the past, physical barriers such as geography and distance limited global communication. In this paper, we explore how young children in immigrant families engage in transnational literacy practices. Specifically, we explore the transnational funds of knowledge that result from those experiences. This three-year longitudinal collective case study involves ten children from immigrant families who have come to the United States from around the world. The students entered the study in four-year-old kindergarten, grade 1 or grade 2. Each year, we collected observations, spoken data and student-created artefacts (e.g. writing samples, maps, photographs). Data sources were designed to highlight the various spaces that the immigrant families occupy or have occupied over time (i.e. home/neighbourhood/ school; native country/country of residence). Our reading and rereading of coded data across the sample led us to focus on families' digital transnational practices and children's transnational awareness. We argue that these funds of knowledge should be recognized in classrooms and schools and that they have the potential to contribute to the nurturing of cosmopolitan perspectives for all children. [ABSTRACT FROM AUTHOR]

When a randomized controlled trial is not feasible, a key strategy in observational studies is to ensure that intervention and control groups are comparable on observed characteristics and assume that the remaining unmeasured characteristics will not bias the results. In the past few years, propensity score-based techniques such as matching, stratification and weighting have become increasingly popular for evaluating health care interventions. Recently, marginal mean weighting through stratification ( MMWS) has been introduced as a flexible pre-processing approach that combines the salient features of propensity score stratification and weighting to remove imbalances of pre-intervention characteristics between two or more groups under study. The weight is then used within the appropriate outcome model to provide unbiased estimates of treatment effects. In this paper, the MMWS technique is introduced by illustrating its implementation in three typical experimental conditions: a binary treatment (treatment versus control), an ordinal level treatment (varying doses) and nominal treatments (multiple independent arms). These methods are demonstrated in the context of health care evaluations by examining the pre-post difference in hospitalizations following the implementation of a disease management program for patients with congestive heart failure. Because of the flexibility and wide application of MMWS, it should be considered as an alternative procedure for use with observational data to evaluate the effectiveness of health care interventions. [ABSTRACT FROM AUTHOR]

Background: Bowel urgency, the sudden and immediate need to have a bowel movement, is common in patients with ulcerative colitis (UC) and Crohn's disease (CD). While its impact in UC is well established, less is known about its importance in CD. Further, what level of bowel urgency control patients with UC or CD would consider to be acceptable or in remission has not been established. This qualitative study aimed to understand perceptions of bowel urgency and remission in these patients. Methods: Semi-structured combined concept elicitation and cognitive interviews were conducted to explore how adults with moderate-to-severe UC or CD and current or recent bowel urgency think about the concept of bowel urgency and its remission. The Urgency Numeric Rating Scale (UNRS) was used to examine different levels of bowel urgency severity and to investigate what level of bowel urgency patients would consider as representing remission. Results: Forty adults (n = 19 UC, n = 21 CD) recruited from six US sites completed the study. Sociodemographic and clinical characteristics were similar in both groups. Both groups reported impacts of bowel urgency on physical, social, professional, and emotional aspects of their lives. Most participants (n = 15 UC, n = 18 CD) reported having experienced one or more incidents of urgency-related fecal incontinence. Most participants considered remission to be a state with a normal or reduced number of bowel movements and no or less frequent bowel urgency, and they noted that remission would increase their ability to engage in daily activities without fear of fecal incontinence. Participants were able to map different levels of severity of bowel urgency to UNRS score ranges (scale: 0–10), and they indicated that a mean UNRS score of 5 (UC) or 4 (CD) would be the highest point on the NRS at which they would still consider their bowel urgency to be in remission. Conclusions: Bowel urgency is an important issue for patients with either moderate-to-severe UC or CD, and its remission would improve their lives. Further, these patients may still consider bowel urgency to be in remission even at UNRS scores as high as 4 or 5. Plain English summary: Bowel urgency is the sudden need to rush to the bathroom to have a bowel movement, which is common in people with ulcerative colitis and Crohn's disease. We interviewed adults with moderate or severe ulcerative colitis or Crohn's disease to better understand their experiences. They said that bowel urgency often made them feel anxious, depressed, or embarrassed and interfered with their social lives, work, and chores. Most felt that they would be in "remission" if the bowel urgency stopped or happened less often. They added that this would help them feel more relaxed and be more active. Interestingly, they would consider even a moderate amount of bowel urgency as being in "remission." This information can help healthcare providers better understand the toll that bowel urgency takes on patients with ulcerative colitis or Crohn's disease and better manage their treatment. [ABSTRACT FROM AUTHOR]

Introduction: Digital health technologies (DHTs) have the potential to alleviate challenges experienced in clinical trials through more objective, naturalistic, and frequent assessments of functioning. However, implementation of DHTs come with their own challenges, including acceptability and ease of use for study participants. In addition to acceptability, it is also important to understand device proficiency in the general population and within patient populations who may be asked to use DHTs for extended periods of time. We thus aimed to provide an overview of participant feedback on acceptability of DHTs, including body-worn sensors used in the clinic and a mobile application used at-home, used throughout the duration of the Wearable Assessments in the Clinic and at Home in Parkinson's Disease (WATCH-PD) study, an observational, longitudinal study looking at disease progression in early Parkinson's Disease (PD). Methods: 82 participants with PD and 50 control participants were enrolled at 17 sites throughout the United States and followed for 12 months. We assessed participants' general device proficiency at baseline, using the Mobile Device Proficiency Questionnaire (MDPQ). The mean MDPQ score at Baseline did not significantly differ between PD patients and healthy controls (20.6 [2.91] vs 21.5 [2.94], p = .10). Results: Questionnaire results demonstrated that participants had generally positive views on the comfort and use of the digital technologies throughout the duration of the study, regardless of group. Discussion: This is the first study to evaluate patient feedback and impressions of using technology in a longitudinal observational study in early Parkinson's Disease. Results demonstrate device proficiency and acceptability of various DHTs in people with Parkinson's does not differ from that of neurologically healthy older adults, and, overall, participants had a favorable view of the DHTs deployed in the WATCH-PD study. [ABSTRACT FROM AUTHOR]

In pandemic mitigation, strategies such as social distancing and mask-wearing are vital to prevent disease resurgence. Yet, monitoring adherence is challenging, as individuals might be reluctant to share behavioral data with public health authorities. To address this challenge and demonstrate a framework for conducting observational research with sensitive data in a privacy-conscious manner, we employ a privacy-centric epidemiological study design: the federated cohort. This approach leverages recent computational advances to allow for distributed participants to contribute to a prospective, observational research study while maintaining full control of their data. We apply this strategy here to explore pandemic intervention adherence patterns. Participants (n = 3808) were enrolled in our federated cohort via the "Google Health Studies" mobile application. Participants completed weekly surveys and contributed empirically measured mobility data from their Android devices between November 2020 to August 2021. Using federated analytics, differential privacy, and secure aggregation, we analyzed data in five 6-week periods, encompassing the pre- and post-vaccination phases. Our results showed that participants largely utilized non-pharmaceutical intervention strategies until they were fully vaccinated against COVID-19, except for individuals without plans to become vaccinated. Furthermore, this project offers a blueprint for conducting a federated cohort study and engaging in privacy-preserving research during a public health emergency. [ABSTRACT FROM AUTHOR]

Objective: Our goal was to compare data collected from 3- and 7-day Infant with Clefts Observation Outcomes (iCOO) diaries. Design: Secondary data analysis of an observational longitudinal cohort study. Caregivers completed the daily iCOO for 7 days before cleft lip surgery (T0) and for 7 days after cleft lip repair (T1). We compared 3- and 7-day diaries collected at T0 and 3- and 7-day diaries collected at T1. Setting: United States. Participants: Primary caregivers of infants with cleft lip with and without cleft palate (N = 131) planning lip repair and enrolled in original iCOO study. Main Outcomes Measure(s): Mean differences and Pearson correlation coefficients. Results: Correlation coefficients were high for global impressions (>0.90) and scaled scores (0.80–0.98). Mean differences were small across iCOO domains at T0. T1 comparisons reflected the same pattern. Conclusions: Three-day diary data is comparable to 7-day diaries for measuring caregiver observations using iCOO across T0 and T1. [ABSTRACT FROM AUTHOR]

Background and Purpose. Internationalization is expanding its presence in higher education in the United States. Reflecting this trend that includes incorporating global perspectives in the curricula, physical therapist education programmes increasingly offer international opportunities such as International Service-Learning (ISL) to their students. Service-learning, a teaching strategy that integrates community service with structured learning activities, has gained broad acceptance in health professions education including physical therapy, and is therefore the focus of this paper. The specific purposes of this paper were to identify and analyse the commonalities that existed among established ISL programmes within physical therapist education programmes in terms of structures and processes, and to consider its broader implications for physical therapist education. Methods. A descriptive, exploratory study was performed using grounded theory. Snowball and purposive, theoretical sampling yielded 14 faculty members with experience in international service, international learning or ISL in physical therapist education programmes. Faculty were interviewed by phone. Interview transcriptions and course documents were analysed applying grounded theory methodology. Data from eight programmes which met the operational definition of established ISL were used to address the purposes of this paper. Results. Five phases of establishing an ISL programme were identified: development, design, implementation, evaluation, and enhancement. Although no single model exists for ISL in physical therapist education; commonalities in structures and processes were identified in each phase. However, attention to service objectives and outcomes is lacking. Conclusions. While analysis revealed that each programme shared commonalities and demonstrated differences in structures and processes compared with the other programmes, the study demonstrated a general lack of focus on formal community outcomes which raises ethical concerns. Future research and dialogue is warranted to explore ethics and good practice in ISL and other global health initiatives in physical therapy. This study may facilitate reflections and creative solutions by individual faculty and the profession. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Behavioral support may be effective in increasing physical activity (PA) in school settings. However, there are no data collection systems to concurrently record PA and behavioral support. This paper describes the development and validation of the System for Observing Behavioral Ecology for Youth in Schools (SOBEYS)-an instrument used with existing observation systems to record PA within a behavioral ecological context. METHODS In 2013, experts created a set of behavioral categories to record prompting and reinforcement of PA during a recreational school activity program. The school provided supervision and equipment for lunchtime PA, making it possible to assess both PA and behavioral support. The system was implemented in spring semester 2014 at 1 suburban junior high school (N = 1452; 48% girls, 74% Caucasian) in the western Unites States. RESULTS Following multiple field trials, the SOBEYS instrument recorded behavioral categories of visual and verbal prompting, verbal, and nonreinforcement by adults and peers, and token reinforcement. Construct validity and acceptable interobserver agreement (>90%; kappa between 0.22 and 0.94) resulted. CONCLUSION Trained SOBEYS users can accurately and reliably record the presence of behavioral support aimed at prompting and reinforcing PA in conjunction with established systematic observation instruments to record PA context and quantity. [ABSTRACT FROM AUTHOR]

Purpose: Technological advances are changing how students approach learning. The traditional note-taking methods of longhand writing have been supplemented and replaced by tablets, smartphones, and laptop note-taking. It has been theorized that writing notes by hand requires more complex cognitive processes and may lead to better retention. However, few studies have investigated the use of tablet-based note-taking, which allows the incorporation of typing, drawing, highlights, and media. We therefore sought to confirm the hypothesis that tablet-based note-taking would lead to equivalent or better recall as compared to written note-taking. Methods: We allocated 68 students into longhand, laptop, or tablet note-taking groups, and they watched and took notes on a presentation on which they were assessed for factual and conceptual recall. A second short distractor video was shown, followed by a 30-minute assessment at the University of California, Irvine campus, over a single day period in August 2018. Notes were analyzed for content, supplemental drawings, and other media sources. Results: No significant difference was found in the factual or conceptual recall scores for tablet, laptop, and handwritten note-taking (P=0.61). The median word count was 131.5 for tablets, 121.0 for handwriting, and 297.0 for laptops (P=0.01). The tablet group had the highest presence of drawing, highlighting, and other media/tools. Conclusion: In light of conflicting research regarding the best note-taking method, our study showed that longhand note-taking is not superior to tablet or laptop note-taking. This suggests students should be encouraged to pick the note-taking method that appeals most to them. In the future, traditional note-taking may be replaced or supplemented with digital technologies that provide similar efficacy with more convenience. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe the diagnoses and chiropractic services performed by doctors of chiropractic operating within 3 military treatment facilities for patients with low back pain (LBP). This was a descriptive secondary analysis of a pragmatic clinical trial comparing usual medical care (UMC) plus chiropractic care to UMC alone for U.S. active-duty military personnel with LBP. Participants who were allocated to receive UMC plus 6 weeks of chiropractic care and who attended at least 1 chiropractic visit (n = 350; 1547 unique visits) were included in this analysis. International Classification of Diseases and Current Procedural Terminology codes were transcribed from chiropractic treatment paper forms. The number of participants receiving each diagnosis and service and the number of each service on unique visits was tabulated. Low back pain and co-occurring diagnoses were grouped into neuropathic, nociceptive, bone and/or joint, general pain, and nonallopathic lesions categories. Services were categorized as evaluation, active interventions, and passive interventions. The most reported pain diagnoses were lumbalgia (66.1%) and thoracic pain (6.6%). Most reported neuropathic pain diagnoses were sciatica (4.9%) and lumbosacral neuritis or radiculitis (2.9%). For the nociceptive pain, low back sprain and/or strain (15.8%) and lumbar facet syndrome (9.2%) were most common. Most reported diagnoses in the bone and/or joint category were intervertebral disc degeneration (8.6%) and spondylosis (6.0%). Tobacco use disorder (5.7%) was the most common in the other category. Chiropractic care was compromised of passive interventions (94%), with spinal manipulative therapy being the most common, active interventions (77%), with therapeutic exercise being most common, and a combination of passive and active interventions (72%). For the sample in this study, doctors of chiropractic within 3 military treatment facilities diagnosed, managed, and provided clinical evaluations for a range of LBP conditions. Although spinal manipulation was the most commonly used modality, chiropractic care included a multimodal approach, comprising of both active and passive interventions a majority of the time. [ABSTRACT FROM AUTHOR]

Objectives. This study aimed to report clinical outcomes of patients with vaginal melanoma (VaM) or vulvar melanoma (VuM) who were treated with immune checkpoint inhibitors (ICI) and discuss the development of immune‐related adverse events (irAE). Materials and Methods. This is a retrospective case series of patients diagnosed with VaM or VuM between July 2011 and September 2022 at the University of Virginia, Emily Couric Clinical Cancer Center. Patient demographics, disease characteristics, treatment outcomes, and adverse events were abstracted. The primary outcome was incidence of irAE. Results. Eight patients were included in this study, four with VaM and four with VuM. Most (n = 6) had local or regional disease at first presentation, and 25% (n = 2) presented with distant metastasis. All patients received a CTLA‐4 inhibitor and 75% (n = 6) received PD‐1 inhibitor alone or in combination with a CTLA‐4 inhibitor. Most (75%, n = 6) patients experienced irAE. Of those who had irAE, 83% (n = 5) required therapy interruption or discontinuation. Most (66%, n = 4) underwent ICI rechallenge of which 75% (n = 3) experienced subsequent irAE. Of all patients in the series, 75% of patients (n = 6) had partial or complete response to ICI. Conclusion. This series is the first to detail incidence of irAEs and ICI rechallenges in vulvovaginal melanoma. Our findings indicate that while ICIs are effective, their use is associated with significant irAE development. Rechallenge of ICI after irAE is feasible but associated with risk of recurrent/new irAE. Further studies are needed to better quantify this risk. [ABSTRACT FROM AUTHOR]

Objectives: To characterize the epidemiology of simultaneous traumatic brain injury (TBI) and ocular trauma. Materials and Methods: In this retrospective, observational study, de-identified data from patients admitted with ocular trauma and TBI was extracted from the National Trauma Data Bank (2008-2014) using International Classification of Diseases 9th Revision, Clinical Modification diagnostic codes and E-codes relating to injury circumstances. Mechanisms, types of ocular and head injuries, intention, and demographic distribution were determined. Association of variables was calculated with Student's t and chi-squared tests and logistic regression analysis. Results: Of 316,485 patients admitted with ocular trauma, 184,124 (58.2%) also had TBI. The mean (standard deviation [SD]) age was 41.8 (23) years. Most were males (69.8%). Race/ethnicity distribution was 68.5% white, 13.3% black, and 11.4% Hispanic patients. The mean (SD) Glasgow Coma Score (GCS) was 12.4 (4.4) and Injury Severity Score (ISS) was 17 (10.6). Frequent injuries were orbital fractures (49.3%) and eye/adnexa contusions (38.3%). Common mechanisms were falls (27.7%) and motor vehicle-occupant (22.6%). Firearm-related trauma (5.2%) had the greatest odds of very severe injury (ISS >24) (odds ratio [OR]: 4.29; p<0.001) and severe TBI (GCS <8) (OR: 5.38; p<0.001). Assault injuries were associated with the greatest odds of mild TBI (OR: 1.36; p<0.001) and self-inflicted injuries with severe TBI (OR: 8.06; p<0.001). Eye/adnexal contusions were most associated with mild TBI (OR: 1.25; p<0.001). Optic nerve/visual pathway injuries had greater odds of severe TBI (OR: 2.91; p<0.001) and mortality (OR: 2.27; p<0.001) than other injuries. Of associated head injuries, the odds of severe TBI were greatest with skull base fractures (OR: 4.07; p<0.001) and mortality with intracerebral hemorrhages (OR: 4.28; p<0.001). Mortality occurred in 5.9% of patients. Conclusion: TBI occurred in nearly two-thirds of ocular trauma admissions. The mortality rate was low with implications for challenging rehabilitation and long-term disability in survivors. [ABSTRACT FROM AUTHOR]

Aim: To investigate the feasibility and acceptability of the training process, procedures, measures and recruitment strategies necessary for a future investigation to test the reliability and validity of using positivity resonance measures in health care encounters. Background: Although the measurement of positivity resonance is promising, and non‐participant observation is considered effective, their approaches to studying nurse–patient relationships have not been fully explored. Design: A mixed‐methods observational study. Methods: Video recordings of 30 nurse–patient dyads completing telehealth video visit encounters were edited and coded using behavioural indicators of positivity resonance. A post‐visit survey gathered data on the participants' perceptions of positivity resonance and the study procedures. The research team completed memos and procedural logs to provide narrative data on the study's training, coding, recruitment and operational procedures. The study included 33 persons with cancer and 13 oncology nurses engaging in telehealth video visit encounters at an academic oncology ambulatory care center located in the southeastern United States. Results: Study procedures were found to be feasible and acceptable to participants. An adequate sample of participants (N = 46) were enrolled and retained in the study. Interrater reliability, as evidenced by Cohen's weighted kappa, ranged from.575 to.752 and interclass correlation coefficients >.8 were attainable within a reasonable amount of time and with adequate training. Behavioural indicators of positivity resonance were observed in all telehealth visits and reported by the participants in the perceived positivity resonance survey. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided reporting. Conclusions: Designing research around the concept of positivity resonance is an innovative and feasible approach to exploring how rapport is cultivated within nurse–patient relationships. Relevance to Professional Practice: Measuring positivity resonance may hold promise for exploring patient and nurse outcomes including trust, responsiveness, health‐related behaviours, well‐being, resilience and satisfaction. Reporting Method: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided the reporting of results to ensure that adequate details of the study were provided to ensure an accurate and complete report. Patient or Public Contribution: Planning of the research design and study procedures was done in consultation with nurse clinicians with experience with telehealth and managers responsible within the practice setting where the study was conducted. This ensured the study procedures were ethical, safe, secure and did not create unnecessary burden to the study participants. The study included collecting data from nurse and patient participants about the acceptability of the study procedures. [ABSTRACT FROM AUTHOR]

Aims: To apply videoconferencing as a new verification method prior to enrollment for an online survey‐based study. Design: A prospective‐observational, mixed methods, three group, repeated measures study involved recruiting a population‐based sample of breastfeeding mothers and infants (N = 81). Twenty‐seven mothers were recruited for each group: mothers returning to work outside of the home, mothers returning to work from home and mothers staying home with their infants full‐time. Methods: Data were collected at four time points, infant age 4, 12, 20 and 24 weeks, via online survey. Participating mothers received a $10 gift card for completing each survey. Social media, word of mouth and brochures promoted United States‐based recruitment nationwide. A publicly available direct link to the survey was initially provided to interested mothers. After the suspicion of online fraud, videoconferencing was instituted for self‐referrals and phone calls for professional referrals. Results: The survey was invaded by response fraud 3 weeks after the initial survey deployment. Out of 109 respondents who visited the survey site during that timeframe, only eight mothers (10%) were eligible (22 June 2022 to 14 July 2022). After recruitment modification, 313 individuals emailed the study team with 65 self‐referred mothers (80%) enrolled in the study via videoconferencing while eight mothers (10%) had a professional referral and enrolled via phone call (23 August 2022 to 30 March 2023). Conclusion: Providing a direct survey link, even with CAPTCHA‐protection, evoked fraudulent responses. Videoconferencing is an emerging verification method that can be readily applied to the enrollment of breastfeeding dyads for an online study. Impact: The emergence of fraudulent respondents and internet bots threatens data quality. This study addressed the strategy of videoconferencing as a new verification method for recruitment and enrollment of breastfeeding dyads. This knowledge can be applied by researchers to secure sample validity and data integrity. [ABSTRACT FROM AUTHOR]

The untapped potential of field study science is not being fully recognized or explored within the United States despite the recorded benefits of outdoor learning within K-12 settings. This research study contributes to the broader understanding of the affordances of field study science as an essential component of science education by investigating the approaches teachers adopt when facilitating scientific observations in an outdoor setting as well as specific strategies that support implementation. Engaging in qualitative content analysis allowed us to consider the descriptive concepts represented within K-12 teachers' narratives as we determined patterns within the transcript documents. Seven themes were developed from the analysis of participants' interviews, highlighting teachers' approaches and specific strategies for supporting students as they participated in field study science observations. Understanding these effective practices can shed light on both the theoretical and practical ways that teachers can implement outdoor science observations within a formal school setting. [ABSTRACT FROM AUTHOR]

Introduction: The relationship between obstructive sleep apnea (OSA), obesity, various metabolic variables, and psychosocial outcomes is complex. No studies have examined the association between these predictors and disease-specific distress related to heart disease (cardiac distress). We aimed to study the association between OSA and cardiac distress using a network analysis framework. Methods: This secondary analysis of an observational cross-sectional study conducted in 2021 consisted of 405 hospital- and community-sourced adults from Australia and the United States who reported an acute coronary event (such as a myocardial infarction, or procedures such as coronary artery bypass graft surgery, or percutaneous coronary intervention) in the previous 12 months. Participants were surveyed in relation to sociodemographic variables, clinical risk factors, comorbidities (including time since event, OSA, obesity, diabetes, hypertension, and hyperlipidemia), and cardiac distress (reported by the Cardiac Distress Inventory Short-Form). These data were subjected to bootstrapped exploratory graph analysis (EGA), which identifies the dimensions of variables that cluster together. Variables that contributed to the EGA dimensions were used to predict cardiac distress using multivariable logistic regression. Results: Three distinct dimensions were identified by the EGA: Dimension 1 – clinical risk factors and conditions including OSA, Dimension 2 – variables related to the heart event, and Dimension 3 – variables closely related to cardiac distress. For Dimension 1, only OSA was a significant predictor of cardiac distress in the fully adjusted model (adjusted odds ratio = 2.08, 95% confidence interval = 1.02–4.25, P = 0.044). Further analysis indicated that OSA was associated with physical challenges and changes in roles and relationships. Conclusions: This study identified that self-reported OSA is associated with cardiac distress, particularly distress that was associated with physical challenges and changes to roles and relationships. These findings imply that OSA could potentially increase stress in a relationship; however, distress was only assessed from the perspective of the participant with OSA in this study. EGA is a useful method for describing complex associations between diverse predictor variables such as OSA and cardiac distress. Owing to the self-reported aspect of the data, further investigation to confirm study outcomes is warranted. [ABSTRACT FROM AUTHOR]