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Introduction: Individuals living with sickle cell disease experience high levels of morbidity that result in frequent utilization of the emergency department. The objective of this study was to provide updated national estimates of emergency department utilization associated with sickle cell disease in the U.S. Methods: Data from the National Hospital Ambulatory Medical Care Survey for the years 1999–2020 were analyzed. Complex survey analysis was utilized to produce national estimates overall and by patient age groups. Results: On average, approximately 222,612 emergency department visits occurred annually among individuals with sickle cell disease, a nearly 13% increase from prior estimates. The annual volume of emergency department visits steadily increased over time, and pain remains the most common patient-cited reason for visiting the emergency department. Patient-reported pain levels for individuals with sickle cell disease were high, with 64% of visits associated with severe pain and 21% associated with moderate pain. Public insurance sources continue to cover most visits, with Medicaid paying for 60% of visits and Medicare paying for 12% of visits. The average time spent in the emergency department increased from previous estimates by about an hour, rising to approximately 6 hours. The average wait time to see a provider was 53 minutes. Conclusions: Utilization of the emergency department by individuals living with sickle cell disease remains high, especially for pain. With more than half of patients with sickle cell disease reporting severe pain levels, emergency department staff should be prepared to assess and treat sickle cell disease–related pain following evidence-based guidelines and recommendations. The findings of this study can help improve care in this population.

Although the isolated threat of disease often motivates people to avoid others, people need the help and cooperation of others to protect themselves against pandemic disease threats. Therefore, the fear of contracting a highly contagious virus like COVID-19 should motivate people to believe that they can in fact count on the help and cooperation of others for protection. Trusting in others provides the basis to anticipate their cooperation. Therefore, we expected a greater daily threat of contracting COVID-19 to motivate people to trust more in others, providing needed assurance that others would keep them safe from harm. We obtained 4 daily diary samples involving 2794 participants who provided in excess of 18,000 daily observations within the first three months of the COVID-19 pandemic. Each day, we tracked (1) disease threat, captured daily by personal concerns about COVID-19 and infection totals in the nearest most populous city, and (2) trust in others, captured daily by expressions of trust in intimates, collective caregivers (e.g., President, Congress), and strangers. Participants in two samples completed 2-month follow-ups. Integrative analyses of the daily diaries revealed that people trusted more in intimates and collective caregivers on days they had greater (vs. less) reason to be concerned about COVID-19. Further integrative analyses of the follow-up data revealed that participants who were initially more likely to trust in others on days when COVID-19 cases in nearby communities spread more rapidly later reported greater confidence that others would keep them safe from harm. That is, they evidenced greater physical, interpersonal, and collective security in social connection than participants who were initially less likely to defensively trust in others on such occasions. The present findings suggest that ecological threats may dynamically motivate people to trust others more than they otherwise would, providing optimism that collectively-faced crises may motivate social cooperation when it is most needed.

Acute appendicitis is an extremely common cause for pediatric admissions, most notably presenting with right lower quadrant pain. There are few other etiologies for a young male to have pain aside from appendicitis. We present a young boy who presented with right lower quadrant abdominal pain and fevers, but was found to have funiculitis. Funiculitis, or inflammation of the spermatic cord, is a very rare condition in the pediatric population, almost always occurring in the elderly with urinary flow conditions. We share our case to remind providers the importance of a full differential diagnosis.

Objectives: To implement the Cardiovascular Practice Transformation (CPT) program and evaluate its impact on blood pressure, and to assess the feasibility of implementing the CPT program by identifying obstacles and facilitators. Methods: Twenty-three Iowa pharmacies participated in the program, each monitoring approximately 10 hypertensive patients for 6 months. Pharmacists assessed blood pressure, medication adherence and addressed medication-related problems during patient visits. Pharmacists used a JotForm application to report patient demographics and care provided during visits. Also, blood pressure readings were collected or measured and reported. After six months, an online Qualtrics survey was sent to participating pharmacies to assess obstacles and facilitators to CPT program implementation. Descriptive statistics were calculated for the patient sample and paired t-tests compared baseline and final blood pressure readings. Frequencies were calculated for obstacles and facilitators. Results: A total of 232 patients participated, with 138 patients having both baseline and follow-up blood pressure data. Systolic blood pressure decreased from 144.2 to 133.6 mmHg, and diastolic blood pressure decreased from 84.4 to 78.3 mmHg, with p

Background: Complications occurring during the first postoperative year after lung transplantation increase the risk of long-term mortality. These events often lead to prolonged and repeated hospitalizations. We sought to assess the relationship between days outside the hospital or hospital-free days (HFD) during the first post-transplant year among 1-year survivors and subsequent retransplant-free survival. Methods: In a single-center study, we derived total inpatient days (initial transplant episode, readmission, and emergency room/observation) from the electronic medical record of lung transplant recipients who survived 1 year. The cohort was divided into HFD quartiles and Kaplan-Meier curves of subsequent transplant-free survival were compared with log-rank analysis. A Cox proportional hazards model was used to test the association of HFD with outcome and adjusted for selected variables. Results: Among 238 patients, 42 deaths and 2 retransplants occurred after a median of 3.6 years post-transplant. The median HFD was 341 (interquartile range: 324, 348). Estimated transplant-free survival at 3 and 5 years post-transplant in the lowest quartile of HFD (79% and 56%, respectively) was considerably worse compared with the first quartile (98% and 94%; p

Background: Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse response to heparin therapy, characterized by decreased platelet count and increased risk of thrombosis. HIT, without the tell-tale sign of thrombocytopenia, has rarely been described. Key Clinical Question: Can HIT be diagnosed in the presence of thrombocytosis? What clinical clues and diagnostic tools facilitate accurate diagnosis in such cases? Clinical Approach: We report a case of HIT with thrombocytosis in a young male who initially presented after traumatic knee dislocation. HIT was diagnosed clinically through the discovery of a white thrombus during a vascular surgery procedure and corroborated by a positive latex immunoturbidimetric immunoassay (HemosIL HIT-Ab (platelet-factor 4(PF4)-heparin)), a rapid immunoassay. Conclusion: With its high sensitivity, specificity, and rapid results, the latex immunoturbidimetric immunoassay is a valuable diagnostic tool, even among patients with a seemingly low pretest probability. This case underscores the guidance imparted by Dr Andreas Greinacher: “[HIT] must be considered if thrombosis occurs or progresses despite effective heparinization even in the absence of thrombocytopenia.” Access to rapid and effective laboratory testing reduces the probability of diagnostic error.

Purpose: To compare tensile fatigue and strength measures of biocomposite and all-suture anchors in an ovine humerus-infraspinatus tendon model of rotator cuff repair. Methods: Infraspinatus tendons on adult ovine humeri were sharply transected at the insertion. One of each pair was assigned randomly for fixation with 2 biocomposite or all-suture anchors. Constructs were tested with 200 cycles of 20 to 70 N tensile load, and gap formation was measured at the incised tendon end every 50 cycles. They were subsequently tested to failure. Outcome measures including fatigue stiffness, hysteresis, creep, and gap formation and tensile stiffness, and yield and failure displacement, load, and energy were compared between anchors. Results: Biocomposite anchors had greater yield load (134.1 ± 6.5 N, P < .01) and energy (228.6 ± 85.7 J, P < .03) than all-suture anchors (104.7 ± 6.5 N, 169.8 ± 85.7 J). Fatigue properties were not different between anchors, but stiffness and gap formation increased and hysteresis and creep decreased significantly with increasing cycle number. Conclusions: Although the yield displacement of both anchors was within the range of clinical failure, the tensile yield load and energy of ovine infraspinatus tendons secured to the humerus with 2 single-loaded all-suture anchors in a single row were significantly lower than those secured with 2 biocomposite anchors in the same configuration. Clinical Relevance: It is important to understand the biomechanical properties for selecting anchors for rotator cuff repair. A direct comparison of fatigue testing followed by failure strength of infraspinatus tendon fixation with all-suture and biocomposite anchors could help guide anchor selection and postoperative mobility recommendations.

Summary: Existing medical treatments for endometriosis-related pain are often ineffective, underscoring the need for new therapeutic strategies. In this study, we applied a computational drug repurposing pipeline to stratified and unstratified disease signatures based on endometrial gene expression data to identify potential therapeutics from existing drugs, based on expression reversal. Of 3,131 unique genes differentially expressed by at least one of six endometriosis signatures, only 308 (9.8%) were in common; however, 221 out of 299 drugs identified, (73.9%) were shared. We selected fenoprofen, an uncommonly prescribed NSAID that was the top therapeutic candidate for further investigation. When testing fenoprofen in an established rat model of endometriosis, fenoprofen successfully alleviated endometriosis-associated vaginal hyperalgesia, a surrogate marker for endometriosis-related pain. These findings validate fenoprofen as a therapeutic that could be utilized more frequently for endometriosis and suggest the utility of the aforementioned computational drug repurposing approach for endometriosis.

Objective: To report 2 cases of women with vertebral defects, anal atresia, cardiac defects, tracheaesophageal fistula, renal anomalies, and/or limb anomalies (VACTERL association) and the outcomes of their in vitro fertilization (IVF) cycles. Design: A case report. We obtained informed consent from both the patients for this case report. Setting: Outpatient clinic at an academic hospital. Patient(s): Patient 1 was a 23-year-old woman with scoliosis, tethered spinal cord, tracheaesophageal fistula, duodenal atresia, and a common cloaca at birth. Patient 2 was a 36-year-old woman with dextrocardia, congenital heart disease, scoliosis, and an imperforate anus at birth. Intervention(s): Both the patients underwent IVF. Main Outcome Measure(s): Oocyte yield, oocyte quality, and number of embryos. Result(s): Patient 1 underwent 1 IVF cycle, with 16 oocytes retrieved, of which 6 were mature. However, during intracytoplasmic sperm injection, the oocytes were noted to be extremely fragile and degenerated immediately after sperm injection. No oocyte was fertilized. Patient 2 underwent 3 IVF cycles, and 2 oocyte retrievals, with a total of 7 oocytes under cryopreservation. Conclusion(s): Both the patients’ cases presented challenges due to aberrations in pelvic anatomy and poor IVF outcomes. There is a paucity of data regarding fertility outcomes and, specifically, oocyte quality in patients with vertebral defects, anal atresia, cardiac defects, tracheaesophageal fistula, renal anomalies, and/or limb anomalies association. Their care requires a multidisciplinary assessment, an individualized approach, and continued investigation of their IVF and fertility outcomes.

Objective: To explore patterns of postconcussion care at a level 1 trauma center. Design: Retrospective cohort study. Setting: U.S. level 1 trauma center and local satellite units. Participants: Patients of any age with a concussion diagnosis that reported to level 1 trauma center and local satellite units between 2016 and 2018 (N=2417). Intervention: Not applicable. Main Outcome Measures: Age, sex, point of entry, rehabilitation referrals, and pre-existing comorbidity diagnosis. Results: Patient age (mean [SD]) significantly differed among points of entry, from youngest to oldest: 26.0 (14.0) years in sports medicine, 29.3 (23.0) years in the emergency department, 34.6 (23.6) years at primary care providers, and 46.0 (19.7) years at specialty care departments. Sex also significantly differed among points of entry; emergency departments reported more men (55.6%), whereas the other points of entry reported more women (59.3%-65.6%). Patients were more likely to receive a referral from sports medicine (odds ratio [OR]unadjusted=75.05, P

Introduction: Micronutrient supplementation is recommended in Ebola Virus Disease (EVD) care; however, there is limited data on its therapeutic effects. Methods: This retrospective cohort study included patients with EVD admitted to five Ebola Treatment Units (ETU) in Sierra Leone and Liberia during September 2014 to December 2015. A uniform protocol was used to guide ETU care, however, due to supply limitations, only a subset of patients received multivitamins. Data on demographics, clinical characteristics, and laboratory testing was collected. The outcome of interest was facility-based mortality and the primary predictor was multivitamin supplementation initiated within 48 h of admission. The multivitamin formulations included: thiamine, riboflavin, niacin and vitamins A, C, and D3. Propensity score models (PSM) were used to match patients based on covariates associated with multivitamin administration and mortality. Mortality between cases treated and untreated within 48 h of admission were compared using generalized estimating equations to calculate relative risk with bootstrap methods employed to assess statistical significance. Results: There were 424 patients with EVD who had sufficient treatment data for analysis, of which 261 (61.6%) had daily multivitamins initiated within 48 h of admission. The mean age of the cohort was 30.5 years and 59.4% were female. In the propensity score matched analysis, mortality was 53.5% among patients receiving multivitamins and 66.2% among patients not receiving multivitamins, resulting in a relative risk for mortality of 0.81 (p = 0.03) for patients receiving multivitamins. Conclusion: Early multivitamin supplementation was associated with lower overall mortality. Further research on the impact of micronutrient supplementation in EVD is warranted. Keywords: Ebola virus disease, Mortality, Multivitamins, Nutrition, Liberia, Sierra Leone

We study the form of the electrostatic potential created by a hemispherical surface with uniform surface charge density. We specifically consider a “northern” hemispherical surface and try to obtain analytical expressions for the electrostatic potential at an arbitrary point in space. Some compact analytical results are obtained for special cases and an interesting mathematical integral formula is derived as a by-product of the approach. The results suggest that a general expression for the electrostatic potential at an arbitrary point in space, if possible, would be very hard to obtain in compact analytical form.

Abstract: Venetoclax is approved for older untreated acute myeloid leukemia (AML) patients. Venetoclax was available prior to approval off-label. We assessed our single-institution off-label experience with venetoclax/azacitidine, comparing outcomes with a clinical trial cohort that administered this regimen at the same institution. Thirty-three untreated AML patients unfit or unwilling to receive induction chemotherapy and prescribed venetoclax/azacitidine off-trial were retrospectively analyzed and compared with 33 patients who received the same therapy on trial. Outcomes were compared, and comparisons were made to a theoretical scenario in which off-trial patients received induction. Digital droplet polymerase chain reaction evaluated measurable residual disease (MRD). Off-trial venetoclax was attainable in nearly all patients for whom this was desired. The complete remission (CR)/CR with incomplete blood count recovery rate was 63.3% for off-trial patients who received treatment and 84.9% for trial patients (P = .081). The median overall survival for off-trial patients who received treatment was 381 days (95% confidence interval [CI], 174, not reached) vs 880 days (95% CI, 384, not reached) for trial patients (P = .041). Prior exposure to hypomethylating agents was associated with worse outcomes. Response rates with venetoclax/azacitidine were not inferior to a theoretical scenario in which patients received induction, and early death rates were less than expected with induction. MRD negativity was achievable. Newly diagnosed AML patients treated in a “real-world” scenario with off-trial venetoclax/azacitidine had inferior outcomes compared with patients treated in the setting of a clinical trial. Additionally, this therapy may be as effective, and less toxic, when compared with induction chemotherapy.

Background: Cryptococcosis is one of the most common life-threatening opportunistic mycoses worldwide. Insidious presentation and slow onset of symptoms make it difficult to recognize, complicating the diagnostic process. Delays in diagnosis may lead to increased mortality. We aim to determine the frequency of missed opportunities for diagnosis of cryptococcosis and its effects on mortality. Methods: To estimate the proportion of individuals with a potentially missed diagnosis for cryptococcosis in hospitalized patients, we conducted a retrospective cohort study using the Healthcare Cost and Utilization Project State Inpatient Databases from 2005 to 2015 from eight states. All hospitalized adult patients diagnosed with cryptococcal infection or cryptococcal meningitis were included. Potentially missed diagnoses were defined as admissions coded for a procedure or diagnosis suggestive of cryptococcosis in the 90-days prior to the initial cryptococcosis admission. Generalized estimating equations models were used to evaluate the association between underlying comorbidities and potential missed diagnosis of cryptococcosis and 90-day all-cause in-hospital mortality. Findings: Of 5,354 patients with cryptococcosis, 2,445 (45·7%) were people living with HIV (PLWH). Among PLWH, 493/2,445 (20·2%) had a potentially missed diagnosis, of which 83/493 (16·8%) died while hospitalized compared with 265/1,952 (13·6%) of those without a potentially missed diagnosis (relative risk [RR] 1·04, 95% CI 0·99–1·09). Among HIV-negative patients, 977/2,909 (33·6%) had a potentially missed diagnosis, of which 236/977 (24·2%) died while hospitalized compared with 298/1,932 (15·4%) of those not missed (RR 1·12, 95% CI 1·07–1·16). Interpretation: Missed opportunities to diagnose cryptococcosis are common despite highly efficacious diagnostic tests and are associated with increased risk of 90-day mortality in HIV-negative patients. A high index of clinical suspicion is paramount to promptly diagnose, treat, and improve cryptococcosis-related mortality. Funding: National Center for Advancing Translational Sciences, Washington University Institute of Clinical and Translational Sciences, and the Agency for Healthcare Research and Quality.

Formation and accumulation of amyloid-beta (Aβ) plaques are associated with declined memory and other neurocognitive function in Alzheimer’s disease (AD) patients. However, the effects of Aβ plaques on neural progenitor cells (NPCs) and neurogenesis from NPCs remain largely unknown. The existing data on neurogenesis in AD patients and AD-like animal models remain controversial. For this reason, we utilized the nestin second-intron enhancer controlled LacZ (pNes-LacZ) reporter transgenic mice (pNes-Tg) and Bi-transgenic mice (Bi-Tg) containing both pPDGF-APPSw,Ind and pNes-LacZ transgenes to investigate the effects of Aβ plaques on neurogenesis in the hippocampus and other brain regions of the AD-like mice. We chose transgenic mice at 2, 8 and 12 months of age, corresponding to the stages of Aβ plaque free, plaque onset and plaque progression to analyze the effects of Aβ plaques on the distribution and de novo neurogenesis of (from) NPCs. We demonstrated a slight increase in the number of NPCs in the hippocampal regions at the Aβ plaque free stage, while a significant decrease in the number of NPCs at Aβ plaque onset and progression stages. On the other hand, we showed that Aβ plaques increase neurogenesis, but not gliogenesis from post-mitotic NPCs in the hippocampus of Bi-Tg mice compared with age-matched control pNes-Tg mice. The neurogenic responses of NPCs to Aβ plaques suggest that experimental approaches to promote de novo neurogenesis may potentially improve neurocognitive function and provide an effective therapy for AD.

Introduction: Accreditation Council for Pharmacy Education Standards require reasonable accommodation for students with disabilities in an educational setting. There is limited information regarding preceptor experiences and perspectives associated with accommodations in the pharmacy experiential learning environment. This study examined preceptor experiences and viewpoints and explored opportunities for schools/colleges of pharmacy (S/COP) to provide support and education for preceptors when meeting access needs., Methods: A collaborative team from seven S/COP experiential programs developed, pilot tested, and electronically distributed a questionnaire. The questionnaire collected information on preceptor demographics, experiences with disability-related accommodations, concerns and confidence in implementation, support from the academic institution, and additional needs. An open-ended question was analyzed using thematic analysis, and quantitative responses were described using descriptive statistics., Results: A total of 294 respondents consented to participate, met inclusion criteria, and submitted a questionnaire response (∼5 % response rate). Many respondents had not experienced requests for accommodation. The most common challenges related to implementation of accommodations were lack of clarity regarding the accommodation request (22 %) and uncertainty regarding how to apply the accommodation within the preceptor's practice (23 %). Most respondents (76 %) felt they would benefit from professional development in this area. Thematic analysis of free-text responses indicated a desire for resources, education, and for advanced notice when accommodation is needed., Conclusion: While many preceptors may not have received requests for accommodation, opportunities exist for S/COP related to preceptor education, provision of resources, and transparent and proactive communication between the academic institution and the preceptor to support students with disabilities., Contribution to the Literature: Requests for accommodations in the experiential education setting are an increasingly important topic for those involved in pharmacy experiential education, including directors, preceptors, and sites. The current body of literature published to date provides guidance, resources, strategies, and reviews of legal implications to consider when developing accommodations for experiential education. Additional literature provides insights from schools and colleges of pharmacy. However, there is limited information available regarding preceptor experiences and perspectives associated with accommodations in the pharmacy experiential learning environment. This manuscript outlines a study examining preceptor experiences and viewpoints. The results provide insight into preceptor perspectives as well as potential future opportunities for schools and colleges of pharmacy to support students with disabilities and implementation of accommodations., (Published by Elsevier Inc.)

Objective: We documented the nutritional quality of a weekend food backpack program with 5 bag types tailored for ethnic food preferences and reported participants' satisfaction and usage of the program., Methods: The Healthy Eating Index-2020 scores were calculated to assess the quality of the food items by bag type. We also recruited 49 caregivers of elementary school-aged children in Minnesota using multilingual flyers from December, 2022 to May, 2023. Caregivers' program satisfaction and usage were assessed through online surveys., Results: The Healthy Eating Index-2020 total scores ranged from 67 to 83 across the bag type. Participants liked 90% of the food items and used all or some of the items in 79% of the bags., Conclusion and Implications: A tailored weekend food backpack program can provide high-quality food with high satisfaction and usage. Further research is needed to determine whether such tailored programs can improve food security and diet quality., (Copyright © 2024 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: Households experiencing food insecurity may use dynamic strategies to meet food needs. Yet, the relationship between household food sourcing behaviors and food security, particularly in rural settings, is understudied., Objective: To identify food sourcing patterns and their associations with food insecurity among households in rural Appalachian Ohio during the COVID-19 pandemic., Design: Survey data were collected from a cohort of households in Athens County, OH, in July 2020, October 2020, January 2021, and April 2021., Participants/setting: The sample included 663 households with household food sourcing and food security information for ≥1 survey wave., Main Outcome Measures: Household food sourcing patterns. Households reported the frequency with which they obtained food from various retailers and charitable sources, classified as supercenters, supermarkets, convenience stores, farmers markets, or charitable sources., Statistical Analyses: Principal component analysis was used to identify food sourcing patterns. Linear mixed models were used to assess changes in food sourcing behaviors over the study period and to determine whether food sourcing behaviors differed according to food security status., Results: Two patterns were identified: Convenience Stores and Charitable Food and Supermarkets and Farmers Markets, not Supercenters. Relative to July 2020, alignment of households' food sourcing behaviors with the Supermarkets and Farmers Markets, not Supercenters pattern was higher in October 2020 (β .07, 95% CI .02 to .12) and alignment with the Convenience Stores and Charitable Food pattern was lower in April 2021 (β -.06, 95% CI -.11 to -.02). Compared with food-secure households, food sourcing behaviors of food-insecure households were more closely aligned with the Convenience Stores and Charitable Food pattern (β .07, 95% CI .00 to .13); no statistically significant difference in scores was observed for the Supermarkets and Farmers Markets, not Supercenters pattern (β -.07, 95% CI -.15 to .02)., Conclusions: These findings support efforts to increase access to healthy, affordable options at venues where food-insecure households may be likely to obtain food, such as convenience stores and charitable sources., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: We investigated factors associated with the longitudinal presence of neurodevelopmental delays in pediatric heart transplant recipients., Methods: The United Network for Organ Sharing Registry was queried for patients aged <18 years who received a first-time isolated heart transplant between March 2008 and December 2022. Two patient cohorts were developed, those with and without (1) definitive motor delay (MD) and (2) definitive cognitive delay (CD)., Results: The MD cohort was comprised of 3847 patients (n = 3267 [no MD], n = 580 [definitive MD]) and the CD cohort was comprised of 3446 patients (n = 2689 [no CD], n = 757 [definitive CD]). The MD cohort and the CD cohort shared 3189 patients. Compared with the intracohort nondelayed patients, definitive MD and CD cohorts each independently had higher rates of congenital heart disease, ventilator support at transplant, and stroke before discharge (P < .001 for all). Patients with a definitive delay at follow-up had worse longitudinal survival, with hazard ratios of 2.82 (95% CI, 2.32-3.44; P < .001) for the MD cohort and 1.67 (95% CI, 1.32-2.05; P < .001) for the CD cohort. Stroke before discharge and symptomatic cerebrovascular disease at listing were both predictors of CD and MD at follow-up. The definitive MD and CD cohorts each independently had higher rates of stroke before discharge (MD cohort, 57 of 580 [9.8%] vs 48 of 3267 [1.5%]; CD cohort, 53 of 757 [7.0%] vs 42 of 2689 [1.6%]; P < .001 for both), and symptomatic cerebrovascular disease at listing was a predictor of CD (odds ratio, 4.16; 95% CI, 2.62-6.58) and MD (odds ratio, 3.30; 95% CI, 2.06-5.22) at follow-up., Conclusions: Patients with MD and/or CD after receiving a heart transplant share several characteristics, including increased stroke before discharge, and have decreased longitudinal survival compared with their nondelayed counterparts., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: Studies of squamous cell carcinoma of the head and neck (HNSCC) have demonstrated the importance of nuclear receptors and their associated coregulators in the development and treatment of HNSCC. We sought to characterize members of the nuclear receptor super family through interrogation of RNA-Seq and microarray data., Materials and Methods: TCGA RNA-Seq data within the cBioportal platform comparing HNSCC samples (n = 515 patients with RNA-Seq data) to normal tissue (n = 82 patients) was interrogated for significant differences in nuclear receptor expression. Affymetrix microarray analysis of HNSCC tumors relative to normal oral mucosa (41 tumor, 13 normal) was analyzed., Results: Of the 48 NR genes and 19 NR cofactors examined, 99 % of tumor samples in the TCGA had some form of NR gene 'alteration' compared to normal tissue. These alterations predominantly encompass expression changes. NR genes (PPARG) and (RORC), and the NR cofactor, (NCOA1), were differentially expressed and downregulated in tumors compared to normal tissue., Conclusion: We have discovered significant decreases in PPARG expression with co-occurring changes in genes involved with lipid metabolism and cell cycle progression in HNSCC. We are targeting PPARγ with thiazolidinediones in a series of clinical trials to restore normal signaling via differentiation to hopefully reverse carcinogenesis. We also observed several receptors with differential expression associated with clinical factors that may become the focus of interest in future targeting efforts. These data provide evidence for nuclear receptors playing a role in the dysregulation of gene expression in HNSCC and illustrate the utility of current bioinformatic tools for interrogating complex, high throughput data sets., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Inc. All rights reserved.)

In the commercial table egg industry, avian pathogenic E. coli (APEC) can lead to significant economic loss and bird mortality. The Poulvac E. coli vaccine (PECV) (Zoetis, Parsippany, NJ) may be administered to poultry post hatch via coarse spray or in drinking water to protect against APEC infections. The purpose of this experiment was to in ovo vaccinate commercial layers with various doses of the PECV to evaluate hatchability and post hatch development of the chicks through 21 d of age. Eggs were either non-injected or vaccinated at 18 d of incubation with a diluent-injected control or one of the PECV treatments which included a full dose (2.65 × 10 7 E. coli CFU/egg) or dilutions of the full dose to produce 2.65 × 10 5 , 2.65 × 10 3 , or 2.65 × 10 1 CFU/egg. Mean hatch of injected eggs was significantly (P < 0.0001) affected by treatment, with all the PECV treatments significantly decreasing hatch. Mean chick BW was determined on d of hatch and at 1, 2, and 3 wk post hatch, and mean chick length was determined at 3 wk post hatch. Chick BW was significantly (all P < 0.0001) different between treatments at 1, 2, and 3 wk of age, with the chicks that had received diluent alone having the highest BW, and the chicks that had received the full dose having the lowest BW. Chick length was significantly (P = 0.045) different between treatments, with the chicks in the full dose treatment having a shorter body length than the chicks in the 2 control groups. Cumulative mortality from 0 to 21 d of growout was 5.41% in the full dose treatment, whereas no mortalities were observed in the other treatment groups. While layer chicken embryos were able to survive to 3 wk post hatch after having received the PECV by in ovo injection, the full dose of the vaccine increased cumulative chick mortality and decreased chick BW through 3 wk post hatch., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Katie Elliott reports equipment, drugs, or supplies was provided by Boehringer Ingelheim. Katie Elliott reports equipment, drugs, or supplies was provided by Zoetis Animal Health Co. If there are other authors, they 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 © 2024. Published by Elsevier Inc.)

Objectives: To determine the relationship between area deprivation index (ADI) and obtaining single-visit long-acting reversible contraception (LARC)., Study Design: We utilized Poisson regression to determine the association between area deprivation and single-visit LARC insertion within a state-wide healthcare system between 2019-2021., Results: Among our cohort (N = 4417), 68.60% of patients desiring LARC obtained single-visit LARC. Participants living in high deprivation areas were less likely to receive single-visit LARC (aRR 0.72, 95% CI 0.65-0.80)., Conclusions: Living in areas of high deprivation is independently negatively associated with obtaining a single-visit LARC., Implications: While access to single-visit LARC should be universally improved, reducing barriers for patientswith a higher ADI may help limit inequities in reproductive healthcare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Treatment plan quality is a crucial component for a successful outcome of radiation therapy treatments. As the complexity of radiation therapy planning and delivery techniques increases, the role of the medical physicist in assessing treatment plan quality becomes more critical. Integrating plan quality review throughout the treatment planning process allows improvements without delaying treatment or rushing to produce changes at the last minute. In this work, we aim to provide practical check items for physicists to reference when assessing treatment plan quality with a critical eye, asking questions such as "is this the best dose distribution feasible for this patient?," "could we change any planning parameters to improve plan quality?," and "could we change the planning strategy for this particular patient or for future patients?"; and to work with planners and physicians to create a multidisciplinary collaborative culture that achieves the best plan feasible for every patient. We tabulate the features that affect plan quality in each process step and check details for individual items. This report is aimed at medical physicists, planners, radiation oncologists, and other professionals who are involved in treatment planning., Competing Interests: Disclosures James A. Kavanaugh reports receiving honoraria from Varian Medical. Dustin Jacqmin reports receiving payment from ASTRO/Veteran's Health Administration and holds an unpaid leadership role as Chair of the Working Group on Treatment Planning at AAPM. Sean L. Berry reports received honoraria from RAMPS, the NYC chapter of the AAPM. The other authors have no conflicts of interest to declare., (Copyright © 2024 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)

Objectives: For individuals living with rare neurodevelopmental disorders, especially those who are at the most severe end of the spectrum, standardized outcome measures may lack the sensitivity to capture small but meaningful changes. Personalized endpoints such as Goal Attainment Scaling (GAS) allow the assessment of treatment response across variable baseline states and disease manifestations and thus provide a highly sensitive measure of efficacy. The current study tested the feasibility of using GAS in rare SCN2A-associated developmental and epileptic encephalopathy (SCN2A-DEE)., Methods: The caregivers of 10 individuals with SCN2A-DEE (M age =8.2 years, SD=5.62, range 3.4-20.4; N male =8) took part in in-person goal-setting and remote follow-up interviews facilitated by four clinical researchers. Implementation was standardized using clinician training, patient orientation, and an electronic data capture platform, GoalNav®; surveys were used to evaluate implementation., Results: All 10 caregivers completed the goal-setting interviews, were able to set, scale three goals, and assess attainment levels at follow-up interviews. The mean (SD) times to conduct the goal-setting and follow-up interviews were 59.4 (14.5) and 18.4 (10.5) minutes, respectively. Participants set a variety of goals relating to communication (n=10), feeding (n=4), gross and fine motor abilities (n=6), behavior (n=5), gastrointestinal function (n=3), sleep (n=1), and seizures (n=1). Data completeness, interview time, and the presence of high-quality goals (29/30) indicated the feasibility of using GAS in this population, while survey responses indicated its acceptability., Conclusions: This pilot project provided evidence supporting the feasibility of GAS as a method for assessing treatment outcomes for patients with rare neurodevelopmental disorders., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: To examine how risk of hospitalization among assisted living (AL) residents differs by dual enrollment in Medicare and Medicaid and by the percent of dually enrolled individuals in an AL community., Design: Retrospective cohort study., Setting and Participants: We used Medicare data from 2008 to 2018 and a national directory of licensed AL communities to identify Medicare beneficiaries with a change in their ZIP+4 code suggesting a new residence in an AL., Methods: We estimated linear regression models of hospitalization onto interactions of residents' dual enrollment status and categories of the AL community's percentage of dually enrolled residents. In the models, we adjusted for person-level clinical and demographic characteristics, year-fixed effects, and fixed effects for the AL residents' prior ZIP code., Results: Among 620,542 Medicare beneficiaries who moved to an AL community, the 1-year risk of hospitalization was higher for dually enrolled residents compared with Medicare-only residents. In adjusted models, dually enrolled residents in high-dual AL communities (>50% dually enrolled) had an 7.4% higher risk of hospital admission compared with dually enrolled residents in low-dual AL communities. Medicare-only beneficiaries in high-dual AL communities had a 9.4% higher risk of hospitalization than Medicare-only beneficiaries in low-dual ALs., Conclusions and Implications: The proportion of residents in an AL community who were dually enrolled was associated with residents' risk of hospitalization, regardless of their dual enrollment status. Additional research is needed to understand whether differences observed in residents' risk of hospitalization are due to differences in the types of services provided, unmeasured resident acuity, or the quality of care delivered in these settings., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Introduction: Bladder and bowel dysfunction (BBD) is a commonly experienced disorder that can cause adverse physical and psychological impacts on a child and their family., Objective: This study aimed to assess the yield of clinically significant sensitive genitourinary (GU) examination findings and whether findings influence BBD management., Methods: A cross-sectional, descriptive, correlational research design was used to study the relationship between GU examination findings and management of pediatric BBD. Data captured were baseline characteristics, urinary symptoms, GU examination findings, and required interventions. Clinically significant GU examination findings were defined as abnormalities requiring medical management such as prescription medications, in-office surgical procedures, or operating room surgical procedures. The primary outcome of interest included GU examination findings and treatments for additional diagnosis discovered during the physical examination. Clopper-Pearson 95 % confidence intervals (CI) were calculated for GU interventions needed for each exam outcome type. Fisher's Exact test was used to determine an association between GU examination findings and additional interventions., Results: Sixty-six patients met inclusion criteria. 91 % (n = 60) had GU examination findings within normal limits and no one (0 %, 95 % CI: 0.000, 0.059) required an additional intervention. 9 % (n = 6) returned with abnormal findings. Five (83 %0.95 % CI: 0.359, 0.996) of the patients with abnormal GU examination findings required an intervention such as a procedure, prescribed medication, or surgery., Discussion: The literature suggests normal anatomy in 98 % of children with BBD, while 91 % of our study cohort demonstrated normal exam findings. Patients with abnormal findings were offered interventions that are not considered standard BBD care. Nearly all patients with an abnormal examination chose to proceed with an intervention to address the abnormal finding. Previous BBD studies have not explicitly mentioned genital assessments or the significance of a GU examination. Current literature lacks standardization of physical exam components during BBD visits, however, many agree that a detailed clinical history is essential in diagnosing BBD. For patients with refractory BBD who are not improving with standard care, an in-person GU examination would be warranted. Additionally, radiologic imaging should be considered for patients who do not respond to initial therapies., Conclusion: Our study demonstrates that the rate of clinically significant examination findings during BBD visits is low. Omitting GU examinations does not appear to compromise the quality of care., Competing Interests: Conflict of interest No conflict of interest., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background and Objective: As most Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions on MRI harbor Gleason grade (GG) group ≥2 disease on biopsy, optimal management of patients with imaging-biopsy discordance remains unclear. To estimate grade misclassification, we evaluated the incidence of Gleason upgrading among patients with GG1 disease in the setting of a PI-RADS 5 lesion., Methods: We conducted a single-institution retrospective analysis to identify patients with GG1 prostate cancer on fusion biopsy with MRI demonstrating ≥1 PI-RADS 5 lesion. Primary study outcome was identification of ≥GG2 disease on subsequent active surveillance (AS) biopsy or radical prostatectomy (RP). We used multivariable models to examine factors associated with reclassification., Results: We identified 110 patients with GG1 disease on initial biopsy and ≥1 PI-RADS 5 lesion. There were 104 patients (94.6%) initially managed with AS and 6 (5.5%) received treatment. Sixty-one patients (58.7%) on AS underwent additional biopsies. Of these, 43 (70.5%) patients had tumor upgrading, with 32 (74.4%) upgraded on first surveillance biopsy. Forty-four (40%) patients ultimately received treatment, including prostatectomy in 15 (13.6%) and radiation in 25 (22.7%). Two patients (1.8%) developed metastases. In multivariable models, genomic classifier score was associated with upgrading. Limitations include a lack of multi-institutional data and long-term outcomes data., Conclusions: Most patients diagnosed with GG1 prostate cancer on MRI-Ultrasound fusion biopsy in the setting of a PI-RADS 5 lesion were found to have ≥GG2 disease on subsequent tissue sampling, suggesting substantial initial misclassification and reinforcing the need for confirmatory testing., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ML reports in-kind research collaboration with Verace Inc. CG has received research funding from NCCN Foundation (Astra-Zeneca) and Genentech, and funding from Johnson and Johnson through Yale University to help develop new approaches to sharing clinical trial data. TMS reports honoraria from Varian Medical Systems, GE Healthcare, Janssen, and WebMD; he has an equity interest in CorTechs Labs, Inc. and serves on its Scientific Advisory Board; he has received in-kind research support from GE Healthcare via a research agreement with the University of California San Diego. SL reports consulting with Astellas. If there are other authors, they 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 © 2024. Published by Elsevier Inc.)

Introduction: The purpose of this study was to determine whether the relationship between aggressive attitude and aggressive behavior is reciprocal or bidirectional in nature., Method: A sample of 845 early adolescent youth (406 boys, 439 girls) between the ages of 10 and 13 (mean = 11.21) served as participants in this study. Aggressive attitudes were assessed with 4 items from the Denver Youth Survey Neutralization scale and aggressive behavior was assessed with 5 items from the Self-Reported Offending scale., Results: A random intercepts cross-lagged panel model (RI-CLPM) analysis revealed that aggressive attitude predicted aggressive behavior from Wave 1 to Wave 2 and from Wave 2 to Wave 3, whereas aggressive behavior only predicted aggressive attitude from Wave 1 to Wave 2. These findings insinuate that while aggressive attitude consistently predicted within-person increases in aggressive behavior, aggressive behavior may have been less consistent in predicting within-person increases in aggressive behavior., Conclusion: A partial or restricted bidirectional relationship may link aggressive attitude to aggressive behavior such that the reciprocal effect between the two is only or most clearly evident during the transition from childhood to adolescence (i.e., the age 11-to-12-year transition). The theoretical and practical implications of these results are discussed., (© 2024 Foundation for Professionals in Services to Adolescents.)

Background: The COVID-19 pandemic focused national attention on food insecurity, equity, and the role of school meal programs in supporting children, families, and communities. In doing so, the pandemic created a rare policy window-an opportunity to advance a longstanding public health goal of guaranteed access to free school meals for all students. In July 2021, California and Maine became the first states to authorize school meal for all legislation (also known as universal free meals)., Objective: The aim of this study was to explore perspectives of policymakers, state agency officials, and advocates on the conditions and mechanisms that facilitated passage of school meal for all legislation in California and Maine., Design: A qualitative case study was conducted., Participants: Between December 2021 and June 2022, semistructured interviews were conducted with 30 policymakers, state agency officials, and advocates., Statistical Analysis Performed: Interviews were analyzed using principles of content analysis. Key themes are organized using Kingdon's multiple streams framework for public policy., Results: Eleven key themes were identified. Lessons are drawn from the policy and advocacy strategies used to advance laws in California and Maine. For instance, paving the way with incremental policy change, tailoring messaging to diverse audiences, and organizing at the grassroots and grasstops levels were critical to success of advocacy efforts., Conclusions: Promising practices can guide efforts to expand access to school meals and advance other child nutrition policies in other states and nationally. Moving forward, lessons learned from implementation of universal free school meal legislation in California, Maine, and other early adopters should be documented and shared., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Objective: A critical goal in the care of patients with peripheral artery disease (PAD) is to optimize their health status; that is, their symptoms, function, and quality of life. Social support has been proposed to be a predictor of disease-specific health status in patients with PAD. However, the prevalence of low perceived social support, the association with health status outcomes, and the interaction with other biopsychosocial variables, is unknown. Our aim was to assess the association of baseline perceived social support with health status at 12 months in patients with PAD., Methods: The Patient-Centered Outcomes Related Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) registry, which enrolled patients with PAD in the United States, the Netherlands, and Australia from 2011 to 2015, was used. Perceived social support was assessed at baseline with the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Social Support Inventory (ESSI), and disease-specific (Peripheral Artery Disease Questionnaire [PAQ]) and generic health status (Euro-Quality of Life Visual Analog Scale [VAS] and EQ-5D-3L Index) questionnaires were assessed at baseline and 12 months. Low social support was defined as a score of ≤3 on two items and an ESSI score of ≤18. A hierarchical mixed level linear regression model adjusting for biopsychosocial variables was used to assess the association between low perceived social support and the ESSI score with health status at 12 months., Results: A total of 949 patients were included (mean age, 67.64 ± 9.32 years; 37.9% female), with low social support being present in 18.2%. Patients with low social support were more likely to not be married or to be living alone (50.0% vs 77.5%; P < .001); have more financial constraints; have more depressive, stress, and anxiety symptoms; and have lower disease-specific and generic health status at baseline and at 12 months. In the unadjusted model, low social support was associated with a -7.02 (95% confidence interval [CI], -10.97 to -3.07) point reduction in the PAQ, -7.43 (95% CI, -10.33 to -4.54) in the VAS, and -0.06 (95% CI, -0.09 to -0.03) in the EQ-5D-3L Index. Adjusting for biopsychosocial factors minimally attenuated these associations (PAQ: -6.52; 95% CI, -10.55 to -2.49; P = .002; VAS: -5.39; 95% CI, 8.36 to -2.42; P < .001; EQ-5D-3L Index: -0.04; 95% CI, -0.07 to 0.01; P = .022). The ESSI per-point score was associated with a decrease of 0.51 (95% CI, 0.18-0.85; P = .003) in PAQ and 0.46 (95% CI, 0.12-0.61; P = .004) in the VAS., Conclusions: Among patients with PAD, low social support was frequent and associated with a lower health status at 1 year independent of other biopsychosocial variables. Improving social support could improve health status and outcomes in PAD., Competing Interests: Disclosures None., (Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

An integral part of understanding and then designing programs to reduce childhood cancer inequities includes adequate representation of people with cancer in research, including children. A scoping review was carried out to understand how cancer research is oriented toward inequities and to identify who has participated in childhood qualitative cancer research. A systematic search identified 119 qualitative studies that met inclusion criteria, with most studies taking place in high-income countries (n=84). Overall, data were lacking on social determinants of health at multiple levels-structural, household, child, and guardian. Only 29 studies reported on race and/or ethnicity, with the majority of those including predominantly or all white children. Six articles included socioeconomic information, and across most articles, attention was absent to the financial ramifications of cancer care. Limited reporting of sociodemographics highlights a broader issue of neglecting key demographics and social factors that contribute to inequities.

Introduction: Clinical trials play a pivotal role in advancing treatments for people with cancer, but often struggle with low enrollment. Unnecessarily including kidney function eligibility criteria when a trial's interventions do not have any potential kidney effects may contribute to this problem by needlessly limiting the pool of eligible patients, adding complexity to the patient screening process, and raising issues of inequitable access to trials. For these reasons, we applied custom natural language processing to assess renal function eligibility criteria, and the appropriateness of these exclusions, within phase 3 urologic oncology trials., Methods: We accessed all phase 3 urologic oncology trials registered on ClinicalTrials.gov from 2007 to 2021. We used a custom natural language processing script to extract kidney function requirements (e.g., creatinine, GFR) from trial free-text records. For each trial, we manually coded whether any trial intervention affected renal function or was renally excreted. Additionally, we recorded the formula used to calculate GFR in each trial., Results: Of 850 trials, 299 (35%) listed kidney function eligibility restrictions, and 432 (51%) tested an intervention with possible renal effects. Of the 299 trials with kidney function exclusions, 124 (41%) tested interventions with no kidney effects., Conclusion: There is a major disconnect in urologic oncology clinical trials between renal function exclusions and potential harm to the kidneys from the tested interventions. Standardizing eligibility criteria and restricting enrollment based on renal function only when necessary has the potential to increase the success, access, and applicability of clinical trials., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)

Broaching issues of identity and power with clients in the context of their mental health care is affirmed as an effective multicultural and social justice counseling skill by a growing evidence base. Considerations for broaching body size, including size difference and sizeism, with clients has not yet been studied, thus clinicians lack guidelines for facilitating these conversations. In this consensual qualitative research study, we present themes involved in broaching body topics based on our interviews with nine clinicians specialized in treating clients with eating disorders and body-related counseling concerns. Themes addressed counselor development, conceptualization of broaching, clinical-decision-making, practice, and impact of broaching body topics in session. Clinicians identified professional and personal developments they pursued and would advocate for training future clinicians to better serve clients. Descriptions of unique and shared aspects of broaching clients' intersectionality and body-size specifically depict avenues for tailoring broaching conversations. Specific examples of effective and ineffective broaching conversations, including language used and psychoeducational components, provide recommendations for practice and connect to observed impacts on the client, counselor, and counseling process., Competing Interests: Declaration of Competing Interest The authors do not have a competing financial interest or personal relationship that could have influenced the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Per- and polyfluoroalkyl substances (PFAS) are abundantly used in a plethora of products with applications in daily life. As a result, PFAS are widely distributed in the environment, thus providing a source of exposure to humans. The majority of human exposure to PFAS is attributed to the human diet, which encompasses drinking water. Their chemical nature grants persistent, accumulative and toxic properties, which are currently raising concerns. Over the past few years, adverse effects of PFAS on different organs have been repeatedly documented. Numerous epidemiological studies established a clear link between PFAS exposure and liver toxicity. Likewise, effects of PFAS on liver homeostasis, lipid metabolism, bile acid metabolism and hepatocarcinogenesis have been reported in various in vitro and in vivo studies. This review discusses the role of PFAS in liver toxicity with special attention paid to human relevance as well as to the mechanisms underlying the hepatotoxic effects of PFAS. Future perspectives and remaining knowledge gaps were identified to enhance future PFAS risk assessment., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: In response to the COVID-19 pandemic, the US Congress authorized the US Department of Agriculture to waive a variety of school meal regulations and funded school meals daily for all students at no charge regardless of family income. Because federal Universal Free School Meals (UFSM) ended with the 2021-2022 school year, several states, including California and Maine, adopted state-level UFSM policies., Objective: This study aimed to understand parent perceptions of school meals and the federal and new state UFSM policies in California and Maine, including potential challenges and benefits to students and households., Design: A mixed methods study design was used. A quantitative cross-sectional survey was administered, and semi-structured interviews were conducted in English and Spanish during the 2021-2022 school year., Participants/setting: The quantitative survey was administered to parents of students in elementary, middle, and high schools in rural, suburban, and urban communities in California (n = 1110) and Maine (n = 80). Qualitative interviews were then conducted with a subset of these parents in California (n = 46) and Maine (n = 20) using Zoom (Zoom Video Communications). Most survey participants (708 of 1190 [59.5%]) and interviewees (40 of 66 [60.6%]) were parents of students who were eligible for free or reduced-price meals., Main Outcome Measures: Parents' perceptions of UFSM, school meal quality, and experiences applying for free or reduced-price meals were examined., Analyses Performed: Tests of proportions were used to analyze survey data. Using grounded theory, interview transcripts were analyzed qualitatively by 2 trained research assistants, applying principles of content analysis to identify themes and domains. Inter-rater reliability was conducted., Results: Parents perceived that school meals and UFSM saved families money and time, as parents had fewer meals to purchase and prepare for their children. In addition, UFSM reduced parents' stress and reduced stigma for children and for parents, who described feelings of embarrassment when they previously filled out paperwork for free or reduced-price meals. Although parent perceptions of school meal quality and healthfulness were mixed, most parents reported feeling grateful for school meals., Conclusions: Parents had mixed opinions on the quality and healthfulness of school meals, but believed UFSM saved them money and time and reduced their stress. Parents also felt UFSM reduced stigma for families., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Abstract: The association between antimetabolite dose intensity (DI) and adverse events among children receiving maintenance therapy for acute lymphoblastic leukemia (ALL) remains unclear, especially in the context of antimetabolite adherence. Using Children's Oncology Group AALL03N1 data, we examined the association between high DI during the first 4 study months and (i) treatment-related toxicities during the subsequent 2 study months; and (ii) relapse risk. Patients were classified into a high DI phenotype (either 6-mercaptopurine [6-MP] or methotrexate [MTX] DI ≥110% during the first 4 study months, or 6-MPDI or MTXDI 100%-110% at study enrollment and ≥25% increase over the 4 study months) and normal DI phenotype (all others). Only patients with wild-type TPMT and NUDT15 were included. 6-MP adherence data were available for 63.7% of study participants and used to stratify as adherent (median adherence ≥85%) and nonadherent (median adherence <85%) participants. Multivariable analyses were adjusted for sociodemographic and clinical prognosticators. Of the 644 patients, 29.3% were exposed to high DI. High DI was associated with a 2.1-fold greater odds of hematologic toxicity (95% confidence interval [CI] = 1.4-3.1; reference: normal DI) in the entire cohort and 2.9-fold higher among adherers (95% CI = 1.6-5.1); odds were comparable among nonadherers (2.1-fold; 95% CI = 0.4-10.1). Although high DI was not associated with relapse in the entire cohort (adjusted hazard ratio [aHR] = 1.4; 95% CI = 0.8-2.4), it was associated with a greater hazard of relapse among adherent participants (aHR = 2.4; 95% CI = 1.0-5.5) but not among nonadherent participants (aHR = 0.9; 95% CI = 0.2-3.8). Dose escalation above protocol doses during maintenance therapy for ALL should be done cautiously after assessing adherence to prescribed therapy., (© 2024 American Society of Hematology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Background: Analgesics are one of the most commonly purchased and used over-the-counter (OTC) medication classes from pharmacies in the United States. Drug toxicity is a leading cause of injury death in the United States. Limited studies, if any, have examined the impact of specific OTC medication toxicities in the pediatric population., Objective: To examine the toxicity arising from the use of OTC analgesic medications in pediatric patients in Ohio., Methods: Data from National Poison Data System for Ohio were obtained for the past 5 years. This data were processed to focus on target populations; pediatrics defined as ages 0-17 years experiencing toxicities related to OTC analgesic medications. The data were categorized into 3 groups: 0-6 year old, 7-12 year old, and 13-17 year old, and reported toxicity was studied based on medications used/given, reasoning for toxicity, and medical outcomes., Results: Patients aged 0-6 years mainly experienced toxicities from acetaminophen (35%) and ibuprofen (52.7%), due to unintentional exposure (general misuse and therapeutic error; 74.2% and 25.4%, respectively), causing primarily minimal clinical effect (48.4%). Ages 7-12 experienced toxicities from acetaminophen (38.5%) and ibuprofen (44.9%) due to unintentional exposure therapeutic error (44.8%) and intentional suspected suicides (30.1%), causing mainly minimal clinical effects (35.5%) and no effect (23.4%). Pediatric ages 13-17 experienced toxicities due to ibuprofen (36.3%) and acetaminophen (38.9%), with primary reasoning of intentional suspected suicide (81.3%), causing medical outcomes of minor effect and no effect (38.2% and 31.2%, respectively). A chi-square test was performed to analyze correlation between case intention (unintentional or intentional) and age group. Proportion of intentional exposures differed by age [X 2 (2, N = 18,766) = 14,672, P < 0.0001]., Conclusion: Observations from this study underscore the importance of raising awareness about OTC analgesic toxicities which remain prominent in Ohio., Competing Interests: Disclosure The author declares no relevant conflicts of interest or financial relationships., (Copyright © 2024 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives: Police violence is a public health crisis that disproportionately impacts youth of color, particularly Black youth. These disparities may also compel Black youth to engage in police avoidance (ie, efforts to circumvent police contact and surveillance). Even so, research on Black youths' engagement in police avoidance is lacking. The present study is the first to investigate factors that may underpin police avoidance among Black youth., Methods: Data come from the Survey of Police-Adolescent Contact Experiences (SPACE), a recent, cross-sectional, non-probability survey of Black youth (around 52% male) aged 12-21 in Baltimore City, Maryland (n = 345)., Results: Findings indicate that youth 1) identifying as bisexual or queer, 2) perceiving lower safety at home and in their neighborhoods, 3) reporting more negative attitudes about police, and 4) engaging in delinquent behaviors reported significantly greater police avoidance. Furthermore, youth who reported a greater number of known persons stopped by the police (eg, family members, friends, neighbors) and had personally experienced officer intrusion during direct or witnessed stops (eg, harsh language, threats of force, use of force) also exhibited greater police avoidance., Conclusions: Lesbian, gay, bisexual, and queer (LGBQ) identity, reduced perceptions of environmental safety, negative attitudes about police, delinquent behaviors, and multiple types of police exposure may shape police avoidance among Black youth. Findings have the potential to inform targeted strategies to mitigate racial and LGBQ disparities in adolescent well-being., Clinical Trial Registration: None., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)