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Background. The National Education Progression in Nursing's current goal is for one million incumbent nurses and 90% of new ADN nurses to achieve a BSN or higher by 2025 in the United States. To meet this goal, programs nationwide are exploring options to increase BSN graduates. One method is the concurrent enrollment ADN-BSN pathway. This review examines how nurse educators develop and implement concurrent enrollment ADN-BSN programs in the US and calls to expand access to this important approach to academic progression in nursing. Method. A PRISMA search strategy was used to identify articles that detailed the development and implementation of dual-admission nursing programs. Ten relevant works were analyzed in this review. Results. Dual enrollment programs vary in program type and implementation methods nationwide and offer an innovative, cost-effective, and time-efficient approach to obtaining the BSN. Conclusion. While employing dual or concurrent enrollment partnerships between community colleges and universities is a complex endeavor, these programs are a powerful and cost-effective way to increase the number of BSN nurses in the workforce and should be considered for expansion as we promote academic progression for all nurses. [ABSTRACT FROM AUTHOR]

Background: People with aphasia (PWA) report higher levels of stress in comparison to stroke survivors without aphasia. If untreated, chronic stress is known to have detrimental effects to the body and brain and can negatively impact health and well-being. According to extant literature, selfand proxy-report agreement on objective domains is higher than on subjective domains, like chronic stress. In addition, high levels of mutuality, also known as shared feelings between two people, have been strongly associated with low levels of stress in stroke survivors. Little is known, however, of the agreement between self-report and caregiver proxy-report on perceived chronic stress or mutuality in PWA. Purpose: The proposed study sought to examine (a) the degree of agreement between caregiver proxy-report and PWA self-report on perceived stress and (b) the relationship between perceived stress and mutuality between PWA and their caregivers. Method: The Modified Perceived Stress Scale and the Mutuality Scale were administered to 21 PWA/caregiver dyads. An independent-samples t test was conducted to determine if there were significant differences in perceived stress and mutuality as reported by PWA, their caregiver, and their caregiver's proxy-report. A Pearson correlation was performed to determine the level of agreement across questionnaires. Results: There was a moderate correlation between the proxyreport and self-report for perceived stress. On average, proxyreports for perceived stress were significantly higher than PWA self-reports. Overall, mutuality was high among the dyads. There was moderate agreement between caregiver's mutuality and proxy-report agreement on perceived stress. Lastly, our findings do not indicate that caregiver's perceived stress influenced their perception of the PWA's perceived stress. Conclusion: The results of this study provide support for the use of proxy-derived information in perceived stress with the use of a mutuality scale. [ABSTRACT FROM AUTHOR]

The article offers information on the use of magnetically retained overdentures in dental treatments. It is stated that magnetically retained overdentures are maintenance-free and inexpensive to fabricate, and average practitioners are well aware of this technique. One of the advantages of overdentures is that it distributes occlusal loads to the remaining periodontium of retained abutments. An attempt is made to eliminate possible misconceptions regarding the use of magnets in overdentures. It has also been used with good success in Europe and the U.S.

Objective: Little is known about mental health service use by adults with prior suicidal behavior and current mood or anxiety disorders. This study determined nationally representative prevalence estimates of current mental health service use by these adults, examining racial-ethnic, age, and gender differences.Methods: Service use across the life course was examined with Collaborative Psychiatric Epidemiology Survey data from 1,139 adults with a history of suicidal behavior and current mood or anxiety disorders.Results: Overall service use was 47.3%. Across the life course, African Americans showed increasing service use that paralleled use by non-Hispanic whites, Hispanics, and others, whereas use by these three groups decreased in the latter half of the life course (p interaction=.01).Conclusions: Adults with prior suicidal behavior and current mood or anxiety disorders have low mental health service use. Findings of racial-ethnic disparities in use can help identify those in need of care. [ABSTRACT FROM AUTHOR]

The article focuses on the issues of corporate form hardening in the U.S., and mentions protection for agents engaged in frauds that inflict harm on the public; development of a paper dragon analogy for focusing on importance of agents in corporate animation; and intracorporate conspiracy doctrine.

In the recent case of Commonwealth v. Lynn, Pennsylvania prosecuted a Roman Catholic priest who had not abused children himself but who, to protect the archdiocese that employed him, covered up information about priests who had abused children and reassigned the priests to new parishes. This case was the first of its kind to bring criminal charges against an official of the Church solely for how he supervised the careers of priests to protect his employer. Because the intracorporate conspiracy doctrine prohibits it, the state--as is now typical of both state and federal jurisdictions around the countrywas unable to prosecute Monsignor Lynn and the Archdiocese for their involvement in the conspiracy. This failure illustrates the misalignment of current conspiracy law with the way the law should be designed to incentivize employees and organizations to prevent harm from both the commission and the cover-up of crimes. The intracorporate conspiracy doctrine provides immunity from conspiracy suits to enterprises based on the legal fiction that an enterprise and its employees are a single actor incapable of the meeting of two minds to form a conspiracy. This Article argues that the un-checked growth of the intracorporate conspiracy doctrine from its proper place in antitrust and sovereign immunity cases to swallow criminal law and tort claims misplaces employee and employer incentives in contravention of agency law, criminal law, tort law, and public policy. Ultimately, the doctrine's uninhibited growth permits harmful behavior to be ordered and performed without consequences, and it leaves the victims of the behavior without appropriate remedy. As the Nuremberg trials famously taught the world, for human beings to operate responsibly in social groups, each individual in the group must be responsible for his own actions. This same moral hazard exists when the intracorporate conspiracy doctrine swallows the penalties that should otherwise be in place for the coordinated harms that employers and their employees inflict in tort and criminal law. [ABSTRACT FROM AUTHOR]

Aims Among people with diabetes, 10-25% will experience a foot ulcer. Research has shown that supplementation with arginine, glutamine and β-hydroxy-β-methylbutyrate may improve wound repair. This study tested whether such supplementation would improve healing of foot ulcers in persons with diabetes. Methods Along with standard of care, 270 subjects received, in a double-blinded fashion, (twice per day) either arginine, glutamine and β-hydroxy-β-methylbutyrate or a control drink for 16 weeks. The proportion of subjects with total wound closure and time to complete healing was assessed. In a post-hoc analysis, the interaction of serum albumin or limb perfusion, as measured by ankle-brachial index, and supplementation on healing was investigated. Results Overall, there were no group differences in wound closure or time to wound healing at week 16. However, in subjects with an albumin level of ≤ 40 g/l and/or an ankle-brachial index of < 1.0, a significantly greater proportion of subjects in the arginine, glutamine and β-hydroxy-β-methylbutyrate group healed at week 16 compared with control subjects ( P = 0.03 and 0.008, respectively). Those with low albumin or decreased limb perfusion in the supplementation group were 1.70 (95% CI 1.04-2.79) and 1.66 (95% CI 1.15-2.38) times more likely to heal. Conclusions While no differences in healing were identified with supplementation in non-ischaemic patients or those with normal albumin, addition of arginine, glutamine and β-hydroxy-β-methylbutyrate as an adjunct to standard of care may improve healing of diabetic foot ulcers in patients with risk of poor limb perfusion and/or low albumin levels. Further investigation involving arginine, glutamine and β-hydroxy-β-methylbutyrate in these high-risk subgroups might prove clinically valuable. [ABSTRACT FROM AUTHOR]

Mobile medical applications are increasingly taking center-stage in the health care industry and more importantly, in the patient-doctor relationship. Yet, as technological prevalence continues its upward trend, regulatory initiatives will also continue their march to the forefront of the discussion. This can lead to only one ultimate conclusion: an impasse between the potential for technological innovation and governmentally enforced restrictions. The first, of what will most likely prove to be many, federal regulation controlling mobile medical applications was recently enacted by the Food and Drug Administration. overbearing governmental regulations such as these stifle innovation in the health care field and operate to the detriment of the public as a whole by restricting society's ability to advance in the health care industry. Before implementing any governmental regulation, a cost-benefit analysis should always be performed to ensure that it is truly worth it. in the situation where health care is on one side of the equation, we simply can't afford to stifle our own future. This can be, quite literally, a matter of life or death. [ABSTRACT FROM AUTHOR]

Rice (Oryza sativa L.) milling yield is a key export and domestic grain quality trait whose genetic control is poorly understood. To identify genomic regions influencing grain quality, quantitative trait locus (QTL) mapping was performed for quality-related traits including head-rice yield (HR) in 205 recombinant inbred lines (RILs) derived from a cross of L-204, a high-HR long-grain cultivar, with 01Y110, a low-HR advanced breeding line with high yield potential in the temperate U.S. rice-growing region. In replicated trials planted in California during 2007-2008, four QTLs carrying the HR-increasing allele from L204 and three from 01Y110 were consistently expressed. Multi-QTL models accounted for 30% of genetic variation for HR and up to 58% for other quality-related traits. Measures of kernel damage, though correlated with HR, were poor predictors of HR. Heading time, kernel dimension, apparent amylose content, and other highly heritable traits showed no correlation with HR. Stable QTLs for HR are likely to be revealed best by multienvironment experiments employing larger population sizes or more direct measurement of kernel structure and development traits involved in kernel breakage. [ABSTRACT FROM AUTHOR]

The extreme physics of targets shocked by NIF's 192-beam laser is observed by a diverse suite of diagnostics. Many diagnostics are being developed by collaborators at other sites, but ad hoc controls could lead to unreliable and costly operations. A diagnostic control system (DCS) framework for both hardware and software facilitates development and eases integration. Each complex diagnostic typically uses an ensemble of electronic instruments attached to sensors, digitizers, cameras, and other devices. In the DCS architecture each instrument is interfaced to a low-cost WINDOWS XP processor and JAVA application. Each instrument is aggregated with others as needed in the supervisory system to form an integrated diagnostic. The JAVA framework provides data management, control services, and operator graphical user interface generation. DCS instruments are reusable by replication with reconfiguration for specific diagnostics in extensible markup language. Advantages include minimal application code, easy testing, and high reliability. Collaborators save costs by assembling diagnostics with existing DCS instruments. This talk discusses target diagnostic instrumentation used on NIF and presents the DCS architecture and framework. [ABSTRACT FROM AUTHOR]

The purpose of this cross-sectional study, conducted with a random sample of 166 students with emotional disturbance (ED), was to establish, with attention to age and gender differences, the extent to which students with ED served in public school settings experience language skill deficits. This study also examined particular types of problem behaviors related to language skills. Students with ED showed moderate to large language deficits, which appeared to be more pronounced in the expressive language domain. The language deficits of a majority of the students were clinically significant. These language deficits appeared to be relatively stable across age and gender. Furthermore, externalizing behaviors were related to receptive and expressive language skills, whereas internalizing ones were not. [ABSTRACT FROM AUTHOR]

Office discipline referrals are one approach that educators could use (a) as a guide in the development and/or selection of primary, secondary, and tertiary prevention programs; (b) as an outcome measure with which to assess the effectiveness of those programs; and (c) as an early screening procedure to identify children who might benefit from the secondary and tertiary programs. The purpose of this study was to examine the extent to which children who met the borderline and clinical cut-off scores on the Teacher Report Form (TRF; Achenbach, 1991b) received one or more office discipline referrals (the most liberal criteria possible) to determine the levels of false negatives (failure to detect a problem when one exists) that would occur if one used office discipline referrals as an early screening device. The relatively high levels of false negatives suggest that the use of office discipline referrals as an early screening device may fail to identify relatively large numbers of young children in need of interventions and supports. This issue appears to be even more pronounced in the case of students who are experiencing internalizing-related problems. Results, limitations, and future research needs are discussed. [ABSTRACT FROM AUTHOR]

The 1997 Individual with Disabilities Education Act Amendments require the use of functional behavioral assessment (FBA) and positive behavioral interventions and supports for students with disabilities who are the subject of formal disciplinary actions. FBA has been represented by different terms and associated procedures such as functional analysis, functional assessment, brief functional assessment, and descriptive analysis. However, much of the FBA research has focused on children with severe developmental disorders in clinical settings. In this article, we review the available FBA research conducted with students with high-incidence behavior problems in school settings to examine its utility (i.e., effectiveness), acceptability (i.e., social validity), and practicality (i.e., whether FBA can be conducted by direct service providers in a timely manner). The findings and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Offers an evaluation of a school-wide program designed to increase the institutional capacity of elementary schools to educate students who exhibit disruptive or externalizing behavior. School organizational practices; School-wide classroom management intervention; Individual behavioral programs; Advisory board.

Conducts a comparative analysis of the effects of direct instruction, cooperative learning, and independent learning instructional practices on the classroom behavior of students with behavior disorders in the United States. Aversive stimuli in educational environments explored; Instructional approaches used; Occurrence of non-task behavior; Teacher training.

Discusses the results of a study on the responses of rehabilitation counselor education programs to learning disabilities in the United States. Eligibility for vocational rehabilitation services through the state and federal vocational rehabilitation systems; Inclusion of curriculum content on learning disabilities.

Assesses the effects of learning strategy instruction on the completion of job applications by learning disabled students. Learning strategy instruction condition; Information omissions; Understanding of procedural text.

Presents the results of a semi-structured interview used to assess poor single-mother students' views of the factors that influence their academic success. Related studies; Social support factors; Psychological belief factors.

Analyzes the effects of a peer-mediated self-evaluation procedure on the recess behavior of students with behavior problems. Facilitation of the generalization of behavioral gains; Differences in the playground behavior of target students and peer partners; Improvements in the recess behavior.

In an efficient NFL betting market, point spreads incorporate all relevant information contained in past game outcomes. Efficiency implies that trading rules based on past game outcomes should not be able to produce a consistent pattern of winners over losers. This study identifies 15 trading rules based on historical game outcomes and, using simulated gambling, tests them over the 1984-1986 NFL seasons. The study's main finding indicates that the NFL betting market is efficient, but does identify a small set of profitable trading rules over this time period.
This study tests market efficiency in the National Football League (NFL) point spread betting market. In general, markets are said to be efficient if prices reflect all known relevant information.[1] The NFL betting market is weak-form efficient if trading rules based on past game outcomes are not able to produce a consistent pattern of winners over losers. Any discernible trend in game outcomes based on easily attainable at low cost information points to profitable betting opportunities and is evidence against market efficiency in the point spread betting market.
The NFL comprises 28 teams who play a season of 16 games from September to December. The market for NFL betting is made by licensed sports books in Nevada who, as intermediaries, facilitate wagering over each game in the NFL season.[2] Wagers are defined relative to the point spread at which the bet is made such that subsequent point spread moves do not effect already placed bets. [ABSTRACT FROM AUTHOR]

The article discusses the implications of bankruptcy filing for deals, transfers and, transactions which precede it. The drafted contractual default and provisions are raised against the Bankruptcy Code when a bankruptcy case is filed. The Bankruptcy Code has provisions which are aimed at avoiding and recapturing pre-bankruptcy transfers. Rejection of contracts and leases would agitate reasonable exercise of business judgment in bankruptcy. The lenders, bondholders, committees, the U.S. Trustee and lawyers would inspect the debtor's action for any pre-bankruptcy misconduct.

Abstract: An increase in cervical intraepithelial neoplasia (CIN) has been described in American Indian women in New Mexico. Differences in human leukocyte antigen (HLA) alleles have been reported in cervical intraepithelial neoplasia (CIN) compared with controls in other populations. We investigated HLA alleles and CIN in Southwest American Indian women. The case control study included 89 women with biopsy-proven CIN II/III (diagnosed November 1994 through October 1997) and 271 similar women with normal cervical epithelium from the same clinics. DRB1, DQB1, and DPB1 alleles were determined using DNA typing techniques. DQA1 and HLA-A allele typing was included for some subjects (randomly chosen n = 37 and n = 163 cases and controls, respectively). We found a decreased risk of CIN with DRB1*1402 (OR 0.5, 95% CI 0.3–0.9) and an increased risk with DRB1*1501 (OR 2.7, 95% CI 0.9–7.3). Additionally, DQA1*0102 was associated with increased risk (OR 4.5, 95% CI 1.3–5.3) and HLA-A*02 with decreased risk (OR 0.4, CI 0.2–0.9). Our findings are discussed along with studies in other populations. [Copyright &y& Elsevier]

Most reports of the decrease in age-adjusted coronary heart disease (CHD) are based on databases with upper age cut-offs that exclude approximately half of the events. We report changes in rates of acute myocardial infarction (AMI) and of out-of-hospital coronary death between 1986 and 1996 among New Jersey residents > or =15 years old. Data on patients discharged with the diagnosis of AMI from nonfederal acute care hospitals in the state (n = 270,091) and all records in the New Jersey death registration files with CHD (n = 172,175) listed as the cause of death from 1986 to 1996 (total study n = 442,266) were analyzed. The rate of hospitalized AMI cases in the state remained essentially unchanged during these 11 years, whereas in-hospital and 30-day case fatality among all age groups and both sexes declined. Age-adjusted CHD rates showed a decrease in fatal events, a smaller decrease in total events, and a slight increase in nonfatal events. The proportion of fatal CHD events occurring out-of-hospital decreased especially among men. The median age at occurrence of events increased by 1 year. Despite a decrease in CHD mortality, the rate of nonfatal events increased, especially among persons > or =75 years old. Thus, the decrease in age-adjusted CHD mortality is not all due to treatment and true prevention of CHD, but the disease simply occurs at an older age. [ABSTRACT FROM AUTHOR]

Discusses the role of hospitalists in medical education in the United States. Size of the hospitalist workforce; Hospitalist as educator; Components of hospitalist training; Role of the National Association of Inpatient Physicians in educating hospitalists.

Background: Hypertensive disorders of pregnancy are among the leading causes of maternal mortality and morbidity in the U.S., with rates highest among birthing people who are Black, rural residents, and/or have low-income. Severe hypertension, in particular, increases risk of stroke and other serious pregnancy complications. To promote early detection and treatment of severe hypertension, the Alliance for Innovation on Maternal Health developed the Severe Hypertension During Pregnancy and Postpartum Period Safety Bundle (HTN Bundle). Multiple studies have demonstrated the HTN Bundle's effectiveness in the inpatient setting. With funding from the National Heart, Lung, and Blood Institute, we engaged community partners to adapt the HTN Bundle for the outpatient setting (i.e., O-HTN Bundle) and planned for its implementation. In this paper, we describe the protocol for a study evaluating O-HTN Bundle implementation in 20 outpatient clinics serving Black, rural, and/or low-income populations., Methods: This study is a hybrid type 3 effectiveness-implementation trial with a multiple baseline design. We will implement the O-HTN Bundle in three successive cohorts of clinics using a multicomponent implementation strategy to engage community partners (coalition, patient workgroup) and support clinics (training, facilitation, education materials, and simulations of severe hypertension events). To test the strategy, we will compare clinic fidelity to evidence-based guidelines for (a) patient education on hypertension and (b) blood pressure measurement technique, with repeated measures occurring before and after strategy receipt. We will also observe strategy effects on community- and clinic-level intermediate outcomes (community engagement, organizational readiness), implementation outcomes (reach, adoption, fidelity, maintenance), and effectiveness outcomes (receipt of guideline concordant care). Analyses will address whether outcomes are equitable across Black, rural, and/or low-income subgroups. Guided by the Consolidated Framework for Implementation Research 2.0, we will use mixed methods to identify adaptations and other determinants of implementation success., Discussion: This study integrates community engagement and implementation science to promote equitable and timely response to severe HTN in the outpatient setting during pregnancy and postpartum. This is one of the first studies to implement an outpatient HTN Bundle and to use simulation as a strategy to reinforce team-based delivery of guideline concordant care., Trial Registration: This study was registered with ClinicalTrials.gov as "Testing Implementation Strategies to Support Clinic Fidelity to an Outpatient Hypertension Bundle (AC 3 HIEVE)." Registration number NCT06002165, August 21, 2023: https://clinicaltrials.gov/study/NCT06002165 ., (© 2024. The Author(s).)

Objective: Coronavirus disease 2019 (COVID-19) vaccination is recommended in pregnancy to reduce the risk of severe morbidity from COVID-19. However, vaccine hesitancy persists among pregnant people, with risk of stillbirth being a primary concern. Our objective was to examine the association between COVID-19 vaccination and stillbirth., Methods: We performed a matched case-control study in the Vaccine Safety Datalink (VSD). Stillbirths and live births were selected from singleton pregnancies among persons aged 16-49 years with at least one prenatal, delivery, or postpartum visit at eight participating VSD sites. Stillbirths identified through diagnostic codes were adjudicated to confirm the outcome, date, and gestational age at fetal death. Confirmed antepartum stillbirths that occurred between February 14, 2021, and February 27, 2022, then were matched 1:3 to live births by pregnancy start date, VSD site, and maternal age at delivery. Associations among antepartum stillbirth and COVID-19 vaccination in pregnancy, vaccine manufacturer, number of vaccine doses received, and vaccination within 6 weeks before stillbirth (or index date in live births) were evaluated using conditional logistic regression., Results: In the matched analysis of 276 confirmed antepartum stillbirths and 822 live births, we found no association between COVID-19 vaccination during pregnancy and stillbirth (38.4% stillbirths vs 39.3% live births in vaccinated individuals, adjusted odds ratio [aOR] 1.02, 95% CI, 0.76-1.37). Furthermore, no association between COVID-19 vaccination and stillbirth was detected by vaccine manufacturer (Moderna: aOR 1.00, 95% CI, 0.62-1.62; Pfizer-BioNTech: aOR 1.00, 95% CI, 0.69-1.43), number of vaccine doses received during pregnancy (1 vs 0: aOR 1.17, 95% CI, 0.75-1.83; 2 vs 0: aOR 0.98, 95% CI, 0.81-1.17), or COVID-19 vaccination within the 6 weeks before stillbirth or index date compared with no vaccination (aOR 1.16, 95% CI, 0.74-1.83)., Conclusion: No association was found between COVID-19 vaccination and stillbirth. These findings further support recommendations for COVID-19 vaccination in pregnancy., Competing Interests: Financial Disclosure Gabriela Vazquez-Benitez reports AbbVie and Sanofi Pasteur provided research-related funds unrelated to this work to her institution. Sangini Sheth's institution received payment from the NIH, and they received payment from Merck and ACOG. Malini DeSilva's institution received payments from Westat, Inc., and the Minnesota Department of Health. Darios Getahun's institution received payment from the NIH, Garfield Memorial Fund, and Hologic, Inc. Nicola Klein's institution received research support from Pfizer. Money was paid to her institution from Merck and Sanofi Pasteur. Joshua Williams has served as a content reviewer for Immunize 4 Good. Heather Lipkind subcontracted via Health Partners as a consultant for the Vaccine Safety Datalink. Money was paid to her institution from PCORI and Pfizer (external DMSV for COVID-19 vaccination). The other authors did not report any potential conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine endorse checklist use to improve obstetric care. However, there is limited research into development, implementation, and sustained use of perinatal emergency checklists to inform individual institutions. This study aimed to investigate the development and implementation of perinatal emergency checklists in diverse hospital settings in the United States., Study Design: A qualitative study was conducted individually with clinicians from three health care systems. The participants developed and implemented institution-tailored perinatal emergency checklists. Interview transcriptions were coded using the Consolidated Framework for Implementation Research., Results: The study sites included two health care systems and one individual hospital. Delivery volumes ranged from 3,500 to 48,000 deliveries a year. Interviews were conducted with all 10 participants approached. Checklists for 19 perinatal emergencies were developed at the three health care systems. Ten of the checklist topics were the same at all three institutions. Participants described the checklists as improving patient care during crises. The tools were viewed as opportunities to promote a shared mental model across clinical roles, to reduce redundancy and coordinate obstetric crisis management. Checklist were developed in small groups. Implementation was facilitated by those who developed the checklists. Participants agreed that simulation was essential for checklist refinement and effective use by response teams. Barriers to implementation included limited clinician availability. There was also an opportunity to strengthen integration of checklists workflow early in perinatal emergencies. Participants articulated that culture change took time, active practice, persistence, reinforcement, and process measurement., Conclusion: This study outlines processes to develop, implement, and sustain perinatal emergency checklists at three institutions. Participants agreed that multiple, parallel implementation tactics created the culture shift for integration. The overview and specific Consolidated Framework for Implementation Research components may be used to inform adaptation and sustainability for others considering implementing perinatal emergency checklists., Key Points: · Perinatal emergency checklists reduce redundancy and coordinate obstetric crisis management.. · Perinatal emergency simulation is essential for checklist refinement and effective team use.. · Integrations of perinatal emergency checklists requires culture change and process measurement.., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Compared to heterosexual and cisgender people, lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people are more likely to develop problems with high-risk polysubstance use. According to syndemic theory, this disparity in high-risk polysubstance use is produced by the LGBTQ+ community's increased vulnerability to experiencing psychosocial (e.g., discrimination, unwanted sex) and structural (e.g., food insecurity, homelessness) conditions, greater likelihood of coping with concurrent health problems (e.g., human immunodeficiency virus [HIV]), and decreased opportunities to develop protective factors (e.g., social support, resilience)., Methods: Data from 306 LGBTQ+ participants living in the United States (U.S.) with a lifetime history of alcohol and drug use were analyzed; 21.2% reported lifetime problems with 10 different drugs. Bootstrapped hierarchical multiple regression was used to test demographic correlates and syndemic predictors of high-risk polysubstance use. One-way ANOVA and post-hoc comparison tests were used to test subgroup differences by gender., Results: Results indicated that income, food insecurity, sexual orientation-based discrimination, and social support were associated with high-risk polysubstance use, explaining 43.9% of the variance of high-risk polysubstance use. Age, race, unwanted sex, gender identity-based discrimination, and resilience were not significant. Group comparison tests revealed that, compared to nonbinary people and cisgender sexual minority men and women, transgender individuals experienced significantly higher levels of high-risk polysubstance use and sexual orientation-based discrimination but significantly lower levels of homelessness and social support., Conclusion: This study provided further evidence for conceptualizing polysubstance use as an adverse outcome of syndemic conditions. Harm reduction strategies, anti-discrimination laws, and gender-affirming residential treatment options should be considered in U.S. drug policy. Clinical implications include targeting syndemic conditions to reduce high-risk polysubstance use among LGBTQ+ people who use drugs., Competing Interests: Declarations of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Importance: Anthracycline-containing regimens are highly effective for diffuse large B-cell lymphoma (DLBCL); however, patients with preexisting heart failure (HF) may be less likely to receive anthracyclines and may be at higher risk of lymphoma mortality., Objective: To assess the prevalence of preexisting HF in older patients with DLBCL and its association with treatment patterns and outcomes., Design, Setting, and Participants: This longitudinal cohort study used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare registry from 1999 to 2016. The SEER registry is a system of population-based cancer registries, capturing more than 25% of the US population. Linkage to Medicare offers additional information from billing claims. This study included individuals 65 years and older with newly diagnosed DLBCL from 2000 to 2015 with Medicare Part A or B continuously in the year prior to lymphoma diagnosis. Data were analyzed from September 2020 to December 2022., Exposures: Preexisting HF in the year prior to DLBCL diagnosis ascertained from billing codes required one of the following: (1) 1 primary inpatient discharge diagnosis, (2) 2 outpatient diagnoses, (3) 3 secondary inpatient discharge diagnoses, (4) 3 emergency department diagnoses, or (5) 2 secondary inpatient discharge diagnoses plus 1 outpatient diagnosis., Main Outcomes and Measures: The primary outcome was anthracycline-based treatment. The secondary outcomes were (1) cardioprotective medications and (2) cause-specific mortality. The associations between preexisting HF and cancer treatment were estimated using multivariable logistic regression. The associations between preexisting HF and cause-specific mortality were evaluated using cause-specific Cox proportional hazards models with adjustment for comorbidities and cancer treatment., Results: Of 30 728 included patients with DLBCL, 15 474 (50.4%) were female, and the mean (SD) age was 77.8 (7.2) years. Preexisting HF at lymphoma diagnosis was present in 4266 patients (13.9%). Patients with preexisting HF were less likely to be treated with an anthracycline (odds ratio, 0.55; 95% CI, 0.49-0.61). Among patients with preexisting HF who received an anthracycline, dexrazoxane or liposomal doxorubicin were used in 78 of 1119 patients (7.0%). One-year lymphoma mortality was 41.8% (95% CI, 40.5-43.2) with preexisting HF and 29.6% (95% CI, 29.0%-30.1%) without preexisting HF. Preexisting HF was associated with higher lymphoma mortality in models adjusting for baseline and time-varying treatment factors (hazard ratio, 1.24; 95% CI, 1.18-1.31)., Conclusions and Relevance: In this study, preexisting HF in patients with newly diagnosed DLBCL was common and was associated with lower use of anthracyclines and lower use of any chemotherapy. Trials are needed for this high-risk population.

Unacceptably high rates of severe maternal morbidity and mortality in the United States and stark racial disparities in outcomes are generating efforts to improve both research capacity and quality improvement in obstetrical care. Comprehensive, high-quality datasets on which to build these efforts are crucial to the success of obstetrical quality improvement efforts. However, existing data sources in obstetrics have notable limitations. Other medical and surgical specialties have addressed similar challenges through the creation of national registries, and we argue that obstetrics must take the same approach to improve outcomes. In this article, we summarized the current availability and limitations of large-scale data in obstetrics research and compared the data with registries developed in other specialties. Moreover, we have outlined the guiding principles for the development of a national obstetrics registry and have proposed future directions., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The total economic burden of cancer reflects direct and indirect costs, including productivity loss due to employment change, absenteeism, and presenteeism of patients and caregivers., Objective: This study estimated the magnitude of employment decrease, work absence (WA), short-term disability (STD), long-term disability (LTD), and associated indirect costs among employees newly diagnosed with metastatic versus non-metastatic cancer in the USA., Methods: IBM ® MarketScan ® Commercial Claims and Encounters and Health and Productivity Management databases were used to identify employees aged 18-64 years and newly diagnosed with any cancer from 2009 to 2019. Proportions of patients with employment decrease, WA, STD, and LTD claims, and number of days missing from work were summarized by metastatic status during the first 12 months after diagnosis and the entire follow-up period. Subgroup analyses were conducted by age (< 50 years, ≥ 50 years) and cancer type (breast, lung, colon, pancreatic, and liver cancer)., Results: During the first year after diagnosis, compared to patients without metastases, significantly higher proportions of patients with metastases had employment decrease and STD or LTD claims (p < 0.001). The mean total number of days missing from work for patients with versus without metastases was 33.39 versus 14.91 (ratio = 2.40), 64.05 versus 27.15 (ratio = 2.36), and 105.93 versus 46.29 (ratio = 2.29) days within 3, 6, and 12 months after diagnosis, respectively. Estimates of indirect cost differences between the two groups ranged from $6,877 to $22,283 in the first year., Conclusion: Earlier detection of cancer may reduce productivity loss of patients and indirect costs by initiating treatment before cancer progresses to late stage., (© 2022. The Author(s).)

Patients undergoing allogeneic (allo) and autologous (auto) hematopoietic cell transplantation (HCT) require extensive hospitalizations or daily clinic visits for the duration of their transplantation. Home HCT, wherein patients live at home and providers make daily trips to the patient's residence to perform assessments and deliver any necessary interventions, may enhance patient quality of life and improve outcomes. We conducted the first study of home HCT in the United States to evaluate this model in the US healthcare setting and to determine the effect on clinical outcomes and quality of life. This case-control study evaluated patients who received home HCT at Duke University in Durham, North Carolina, from November 2012 to March 2018. Each home HCT patient was matched with 2 controls from the same institution who had received standard treatment based on age, disease, and type of transplant for outcomes comparison. Clinical outcomes were abstracted from electronic health records, and quality of life was assessed via Functional Assessment of Cancer Therapy-Bone Marrow Transplant. Clinical outcomes were compared with Student's t-test or Fisher's exact test (continuous variables) or chi-square test (categorical variables). Quality of life scores were compared using the Student t-test. All analyses used a significance threshold of 0.05. Twenty-five patients received home HCT, including 8 allos and 17 autos. Clinical outcomes were not significantly different between the home HCT patients and their matched controls; home HCT patients had decreased incidence of relapse within 1 year of transplantation. Pre-HCT quality of life was well preserved for autologous home HCT patients. This Phase I study demonstrated that home HCT can be successfully implemented in the United States. There was no evidence that home HCT outcomes were inferior to standard-of-care treatment, and patients undergoing autologous home HCT were able to maintain their quality of life. A Phase II randomized trial of home versus standard HCT is currently underway to better compare outcomes and costs., (Copyright © 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

Prior evidence suggests an association among food insecurity, poor health, and increased health care spending. In this study, we are using a natural experiment to confirm if longer participation in the Supplemental Nutrition Assistance Program (SNAP) is associated with reduced Medicaid spending among a highly impoverished group of adults. In 2013, the mandatory work requirements associated with SNAP benefits were lifted for able-bodied adults without dependents (ABAWDs). Using 2013 to 2015 Medicaid and SNAP data of 24,181 Minnesotans aged 18-49, we examined if changes in SNAP enrollment duration affect health care expenditures. In fully adjusted within-participant regression models, for each additional month of SNAP, average annual health care spending was $98.8 lower (95% CI: -131.7, -66.0; p&lt;.001) per person. Our data suggests that allowing ABAWDs to receive SNAP even in months they are not working may be critical to their health as well as cost-effective.