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The objective was to evaluate a novel intervention that integrates a psychological, values-based approach with coordinated care management. This paper describes an integrated comprehensive health record system to enhance engagement with a subset of those with complex needs; those who are high-needs, high-cost (HNHC). Patients are selected after conducting data analysis on the most costly and complex patients of a payer system that works with HNHC patients. Specifically, the Patient Care Intervention Center in Houston TX, applies the values-based intervention to HNHC patients. This pilot study reports data from 18 HNHC patients over 6 months; specifically, outcomes related to daily functioning, depression, working alliance, stages of change, and overall well-being. Additionally, this paper reports preliminary findings from qualitative monitoring of provider experiences implementing the values-based approach and integrated evaluation. HNHC patients improved their daily functioning over 4 months but no other significant changes were found over time. Patients self-reported mild depression, strong working alliances with their provider, being in the contemplation phase of change, and moderate well-being. There also was variation when patients completed the assessments and data points were collected. Although this is a small sample and short time frame, preliminary results suggest that the intervention has a positive impact on HNHC patient daily functioning. Provider accounts of the implementation describe using the evaluation items to inform their interactions with patients, and also suggest that patient literacy level impacts when data can be collected. Other changes to the approach are suggested. [ABSTRACT FROM AUTHOR]

Objective: This meta-analysis of randomized controlled trials (RCTs) on the Transcendental Meditation® (TM) technique updates previous meta-analyses and assesses the effects of initial anxiety level, age, duration of practice, regularity of practice, research quality, author affiliation, and type of control group on effect sizes. Design: This systematic review of the literature used the Comprehensive Meta-Analysis (CMA) program for core analyses of effect sizes, bias analysis, meta-regression, and moderator variable analysis. Comprehensive literature searches included databases devoted to meditation research. Results: More than 600 TM research papers were identified; 14 of these addressed trait anxiety and reported on 16 studies among 1295 participants with diverse demographic characteristics. No adverse effects were reported. The standardized difference in mean, d, for the TM technique compared with controls receiving an active alternative treatment (10 studies) was d=−0.50 (95% CI, −.70 to −0.30; p=0.0000005). Compared with controls receiving treatment as usual (wait list or attention controls, 16 studies), d=−0.62 (95% CI, −0.82 to −0.43; p=1.37E-10). Meta-regression found that initial anxiety level, but not other variables, predicted the magnitude of reduction in anxiety ( p=0.00001). Populations with elevated initial anxiety levels in the 80th to 100th percentile range (e.g., patients with chronic anxiety, veterans with post-traumatic stress disorder, prison inmates) showed larger effects sizes (−0.74 to −1.2), with anxiety levels reduced to the 53rd to 62nd percentile range. Studies using repeated measures showed substantial reductions in the first 2 weeks and sustained effects at 3 years. Conclusion: Overall, TM practice is more effective than treatment as usual and most alternative treatments, with greatest effects observed in individuals with high anxiety. More research is needed in this area, especially with high-anxiety patients, conducted under medically supervised conditions. [ABSTRACT FROM AUTHOR]

Objectives: This study examines involvement with a range of complementary and alternative medicine (CAM) during pregnancy on the use of pharmacologic (PPMT) and nonpharmacologic (NPMT) pain management techniques for labor and birth. Design: Longitudinal analysis of survey data. Participants: A substudy ( n=2445) of the 'young' cohort of the nationally representative Australian Longitudinal Study on Women's Health was conducted. Outcome measures : Use of PPMT and NPMT during labor and birth. Results: The survey was completed by 1835 women (response rate, 79.2%). Most respondents used either intrapartum PPMT (81.9%) or NPMT (74.4%). Many (60.7%) used some form of CAM during pregnancy and also used PPMT during birth. More than two thirds of women (66.7%) who used NPMT used CAM during pregnancy. There was a general trend of increased likelihood of NPMT use by women who applied CAM during pregnancy. There was an inverse effect on use of epidural analgesia for women who consumed herbal teas during pregnancy (odds ratio, 0.60). Conclusions: Because of the study design, this paper does not confirm a causative relationship between the use of CAM during pregnancy and intrapartum pain management choices. It does, however, indicate that the use of CAM during pregnancy may not significantly affect the uptake of intrapartum PPMT, despite possible attempts to reduce PPMT by using NPMT. It also highlights the possibility of potential interactions between CAM and PPMT, given the high prevalence of concomitant use. [ABSTRACT FROM AUTHOR]

The theories of Traditional Chinese Medicine (TCM) originated from experiences doctors had with patients in ancient times. We ask the question whether aspects of TCM theories can be reconstructed through data analysis. To answer the question, we have developed a data analysis method called latent tree models and have used it to analyze several TCM data sets. This paper reports the results we obtained on one of the data sets and explains how they provide statistical validation to the relevant TCM theories. [ABSTRACT FROM AUTHOR]

This paper presents a new approach to estimating the indirect costs of health-related absenteeism. Productivity losses related to employee absenteeism have negative business implications for employers and these losses effectively deprive the business of an expected level of employee labor. The approach herein quantifies absenteeism cost using an output per labor hour-based method and extends employer-level results to the region. This new approach was applied to the employed population of 3 health insurance carriers. The economic cost of absenteeism was estimated to be $6.8 million, $0.8 million, and $0.7 million on average for the 3 employers; regional losses were roughly twice the magnitude of employer-specific losses. The new approach suggests that costs related to absenteeism for high output per labor hour industries exceed similar estimates derived from application of the human capital approach. The materially higher costs under the new approach emphasize the importance of accurately estimating productivity losses. ( Population Health Management 2015;18:47-53) [ABSTRACT FROM AUTHOR]

Background: The U.S. Centers for Disease Control and Prevention has set national goals to eliminate health disparities by race, sex, and socioeconomic status. Progress in meeting these goals has been mixed. This paper provides a different view on the evolving health of U.S. women by examining a sample of daughters and their mothers. Methods: The aim was to determine if the health risk profiles of daughters (born 1975-1992) were different from their mothers (born 1957-1964) measured when both were between the ages of 17 and 24 years. The U.S.-based National Longitudinal Survey of Youth 1979 and associated Children and Young Adult Surveys were used. The sample was 2411 non-Hispanic white and African American girls born to 1701 mothers. Outcomes were height, weight, body mass index (BMI), age of menarche, and self-reported health. Results: In both races, daughters were taller but entered adulthood at greater risk for the development of chronic illness than their mothers. Racial differences were greater in the daughters' generation than in the mothers'. Whites in both generations experienced educational differences in health based upon the mother's educational level, with fewer years of maternal education associated with poorer health. African Americans of both generations experienced differences by maternal education in self-reported health. However, when African American daughters were compared with their mothers, daughters born to college educated women gained more weight and had higher BMI and earlier menarche than did daughters born to high school dropouts. Conclusion: Health deterioration across generations in both races suggests that much work is needed to meet Healthy People 2020 goals of health equity. [ABSTRACT FROM AUTHOR]

Background: It is generally accepted that obesity and depression are positively related in women. Very little prior research, however, has examined potential variation in this relationship across different racial/ethnic groups. This paper examines the association between obesity and depression in non-Hispanic White, non-Hispanic Black, and Mexican American women. Methods: The sample included women aged 20 years and older in the 2005-2008 National Health and Nutrition Examination Surveys ( n=3666). Logistic regression was used to assess the relationship between obesity and depression syndrome (assessed using the Patient Health Questionnaire-9), after adjusting for covariates. We then investigated whether this association varied by race/ethnicity. Results: Overall, obese women showed a 73% greater odds of depression (odds ratio [OR]=1.73; 95% confidence interval [CI]=1.19, 2.53) compared with normal weight women. This association varied significantly, however, by race/ethnicity. The obesity-depression associations for both Black and Mexican American women were different from the positive association found for White women (ORBlack*obese=0.24; 95% CI=0.10,0.54; ORMexican American*obese=0.42; 95% CI=1.04). Among White women, obesity was associated with significantly greater likelihood of depression (OR=2.37; 95% CI=1.41, 4.00) compared to normal weight. Among Black women, although not statistically significant, results are suggestive that obesity was inversely associated with depression (OR=0.56; 95% CI=0.28, 1.12) relative to normal weight. Among Mexican American women, obesity was not associated with depression (OR=1.01; 95% CI=0.59, 1.72). Conclusions: The results reveal that the association between obesity and depression varies by racial/ethnic categorization. White, but not Black or Mexican American women showed a positive association. Next research steps could include examination of factors that vary by race/ethnicity that may link obesity to depression. [ABSTRACT FROM AUTHOR]

Background: The Australasian Chapter of the Palliative Medicine (AChPM) Curriculum Development Group identified communication as a core skill that trainees in palliative medicine need to acquire, and proposed the development of a communication skills workshop that should become a compulsory part of training to achieve accreditation as a palliative medicine specialist in Australia and New Zealand. This paper describes the development and subsequent evaluation of this module. Methods: A three-day communication workshop was developed in collaboration with expert communication skills facilitators from the United States and Australia. The teaching consists of: (1) brief plenary presentations providing an evidence-based framework for communication and a demonstration of suggested strategies; (2) small group experiential learning providing opportunities to practice communication skills with clinically relevant simulated patients, self-appraisal, constructive feedback, and reflective exercises; and (3) accompanying course-specific written material. Participants completed de-identified questionnaires before, after, and three months following completion of the workshop. Results: Forty-one participants completed the training in two workshops held in 2008 and 2009. Participants said in their questionnaire responses that the training was useful, would be helpful for their communication with patients, and that they would recommend the training to others. Qualitative feedback was highly positive. Self-assessed confidence in communication skills significantly increased following the workshop ( p<.001) and was sustained at three months ( p<.001). Conclusion: The training is highly valued by participants and increases confidence in communication skills. Facilitator training and capacity planning will be critical for the ongoing success of the communication workshop. [ABSTRACT FROM AUTHOR]

This paper describes Mexican American family members' descriptions of perceived discrimination by pediatric health care providers (HCPs) and the families' reactions to the HCPs' discriminatory conduct. A retrospective, grounded theory design guided the overall study. Content analysis of interviews with 13 participants from 11 families who were recruited from two children's hospitals in Northern California resulted in numerous codes and revealed that participants perceived discrimination when they were treated differently from other, usually white, families. They believed they were treated differently because they were Mexican, because they were poor, because of language barriers, or because of their physical appearance. Participants reported feeling hurt, saddened, and confused regarding the differential treatment they received from HCPs who parents perceived 'should care equally for all people.' They struggled to understand and searched for explanations. Few spoke up about unfair treatment or complained about poor quality of care. Most assumed a quiet, passive position, according to their cultural norms of respecting authority figures by being submissive and not questioning them. Participants did not perceive all HCPs as discriminatory; their stories of discrimination derived from encounters with individual nurses or physicians. However, participants were greatly affected by the encounters, which continue to be painful memories. Despite increasing efforts to provide culturally competent palliative care, there is still need for improvement. Providing opportunities for changing HCPs' beliefs and behaviors is essential to developing cultural competence. [ABSTRACT FROM AUTHOR]

Objective: In 2006, the Food and Drug Administration (FDA) approved the human papillomavirus (HPV) vaccine Gardasil® (Merck) for girls and women aged 9-26 years. Although the vaccine is ideally administered to 11 and 12 year olds, college-aged women may be uniquely at risk for HPV due to high rates of sexual activity and, thus, serve as an important catch-up population for the HPV vaccine. The purpose of this study is to examine factors associated with HPV vaccination status among college women. Methods: In fall 2008, a convenience sample of 256 undergraduate women enrolled in an introductory social science course at a large, public, urban university in the southeastern United States was surveyed. The 30-item paper-and-pencil questionnaire asked for demographic information, HPV knowledge, HPV vaccine beliefs, and HPV vaccination status. The overall survey response rate was 89.6%. Results: Most women were unmarried/single (91.7%), with a mean age of 18.9 years (range 17-42). Race/ethnicity status included 73.0% white, 17.5% Hispanic, and 7.7% black/African American. One hundred eleven (40.5%) women reported receiving the vaccine. Nonvaccinated women were less likely to have heard of the vaccine through a healthcare provider (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.04-0.35) or from a family member (OR 0.33, 95% CI 0.16-0.68) and more likely to consider a healthcare provider recommendation as being only somewhat important (OR 2.91, 95% CI 1.32-6.41) or not important at all (OR 5.61, 95% CI 0.44-71.87) vs. very important. Conclusions: Findings suggest that healthcare providers have an important role in encouraging HPV vaccination. Continuing education for providers who see preadolescent girls in conjunction with a parent or who treat women of college age may be a worthwhile endeavor. [ABSTRACT FROM AUTHOR]

This paper contains a description of several common normalization methods used in microarray analysis, and compares the effect of these methods on microarray data. The importance of background subtraction is also addressed. The research focuses on three parts. The first uses three statistical methods: t-test, Wilcoxon signed rank test, and sign test to measure the difference between background subtracted data and nonbackground subtracted data. The second part of the study uses the same three statistical methods to compare whether data normalized with different normalization methods yield similar results. The third part of the study focuses on whether these differently normalized data will influence the result of gene selection (dimension reduction). The comparisons are done for several data sets to help identify similarity patterns. The conclusion of this study is that background subtraction can make a difference, especially for some data sets with poorer quality data. The choice of normalization method, for the most part, makes little difference in the sense that the methods produce similarly normalized data. But, based on the third part of analysis, we found that when gene selection is performed on these differently normalized data, somewhat different gene sets are obtained. Thus, the choice of normalization method will likely have some effect on the final analysis. [ABSTRACT FROM AUTHOR]

Background: African Americans have the highest prevalence of high blood pressure (HBP) in the United States, but the lowest blood pressure control rates among all major racial/ethnic groups. This study examined the extent to which African Americans use home remedies to treat HBP and assessed their knowledge, beliefs, attitudes, and behaviors regarding such use. Materials and Methods: This study utilized a descriptive, exploratory, cross-sectional, and correlational research design. We determined the association between knowledge, beliefs, attitudes, and behaviors and use of home remedies among participants using a principal investigator-developed online questionnaire entitled the Beliefs about Hypertension Survey (BHS). Results: Reliability for the BHS representing all four dependent variables was good (Cronbach's α = 0.848). The study sample was 254 African Americans with and without HBP (79.9% females; 83% aged 30–59). Participants were more willing to use home remedies to treat rather than to prevent HBP, with 58% of participants with HBP reporting current use of home remedies as treatment. Results of the Multivariate Analysis of Variance test indicated statistical significance (P = 0.000) only for the behavior variable (α = 0.05), with no significant differences found between participants with and without HBP with respect to knowledge, beliefs, and attitudes. Conclusion: The results suggest that diagnosis of HBP increases African Americans' willingness to use home remedies, but this group needs more education about the effects and risk factors of HBP. Further evidence-based studies will help to increase knowledge and acceptance of home remedies as a viable treatment option for HBP. [ABSTRACT FROM AUTHOR]

Background: Hospitalized patients with cancer and their caregivers discharged to skilled nursing facilities (SNFs) have unmet palliative care needs. Objective: To determine feasibility and acceptability of Assessing and Listening to Individual Goals and Needs (ALIGN), a palliative care social worker (PCSW) intervention, for older adults and their caregivers in SNFs. Design: Single-arm, single-site pilot study. Predefined feasibility goals were >70% intervention completion and study retention rates (postintervention outcomes completed at one week). Setting/Subjects: Twenty-three patients with cancer and their 21 caregivers discharged to 12 SNFs posthospitalization. Measurements: Primary outcomes were feasibility and acceptability. Exploratory patient and caregiver-reported outcomes, including goals of care were collected at baseline and one week postintervention. Health care utilization, mortality, and hospice utilization was collected at the six-month follow-up. Results: Of 73 patients screened, 35 (48%) were eligible and 23 (66%) patients and 21 caregivers enrolled. Eighteen (78%) patients completed the intervention and 10 (44%) patients and 13 (62%) caregivers provided follow-up outcomes. Average age of patients was 73, and 19 (83%) had stage III or IV cancer. Average age of caregivers was 55. Eight (44%) patients' preferences changed to prefer less aggressive care. Nineteen (83%) patients died during or shortly after intervention completion. Qualitative feedback from participant and SNF staff interviews supported high acceptability. PCSW involvement increased illness understanding and patient engagement with advance care planning. SNF staff valued increased palliative support. Conclusions: Intervention completion was >70%, however, not study retention due to higher-than-expected mortality. Future study should account for high mortality and examine whether ALIGN can better prepare surrogate decision makers and enhance the ability of SNFs to address changing goals of care. Clinical Trial Registration Number NCT04882111. [ABSTRACT FROM AUTHOR]

Objectives: Pediatric acute-onset neuropsychiatric syndrome (PANS) and its subset, pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS), are emerging autoimmune encephalopathies of childhood. Management guidelines are needed. This article, from the PANS/PANDAS Consortium, presents a consensus management guideline for the infection components. Accompanying papers from the Consortium discuss psychiatric and immunomodulatory management. Methods: Literature was reviewed and integrated with the clinical experience of the authors to provide a set of practical guidelines. This article was submitted to all members of the PANS/PANDAS Consortium, and their additional comments were added. Results: The relationships between PANS and infections are reviewed. An approach to the retrospective diagnosis of group A streptococcal infection for an operational definition of PANDAS is proposed. An initial course of anti-streptococcal treatment is proposed for all newly diagnosed PANS cases. Chronic secondary antimicrobial prophylaxis is suggested for children with PANDAS who have severe neuropsychiatric symptoms or recurrent group A Streptococcus-associated exacerbations. Guidelines for children with non-streptococcal PANS include vigilance for streptococcal pharyngitis or dermatitis in the patient and close contacts. All patients with PANS or PANDAS should also be closely monitored for other intercurrent infections, including sinusitis and influenza. Intercurrent infections should be diagnosed and treated promptly according to current standard guidelines. A guideline for the assessment of infection at initial onset or during neuropsychiatric exacerbations is also presented. Standard immunizations and attention to vitamin D are encouraged. Data indicating limited utility of adenotonsillectomy and probiotics are presented. Conclusion: A working guideline for the management of infection issues in PANS and PANDAS, based on literature and expert opinion, is provided. [ABSTRACT FROM AUTHOR]

The objectives were to determine whether and by what amounts the US Department of Veterans Affairs (VA) use of Medical Foster Homes (MFH) rather than Community Living Centers (CLC) reduced budget impacts to the VA. This was a retrospective, matched, case-control study of veterans residing in MFH or CLC in the VA health care system from 2008 to 2012. Administrative data sets, nearest neighbor matching, generalized linear models, and a secondary analysis were used to capture and analyze budget impacts by veterans who used MFH or CLC exclusively in 2008-2012. Controls of 1483 veterans in CLC were matched to 203 cases of veterans in MFH. Use of MFH instead of CLC reduced budget impacts to the VA by at least $2645 per veteran per month. A secondary analysis of the data using different matching criteria and statistical methods produced similar results, demonstrating the robustness of the estimates of budget impact. When the average out-of-pocket payments made by MFH residents, not made by CLC residents, were included in the analysis, the net reduction of budget impact ranged from $145 to $2814 per veteran per month or a savings of $1740 to $33,768 per veteran per year. Even though outpatient costs of MFH are higher, much of the reduced budget impact of MFH use arises from lower inpatient or hospital costs. Reduced budget impacts on the VA system indicate that expansion of the MFH program may be cost-effective. Implications for further research are suggested. [ABSTRACT FROM AUTHOR]

Limited sample size, incomplete measures, and inadequate risk adjustment adversely influence accurate health care quality measurements, surgical quality measurements, and accurate comparisons among hospitals. Since these measures are linked to resources for quality improvement and reimbursement, improving the accuracy of measurement has substantial implications for patients, clinicians, hospital administrators, insurers, and purchasers. The team examined risk-adjusted differences of postoperative cardiac events among 20 geographically dispersed, community-based medical centers within an integrated health care system and compared it with the National Surgical Quality Improvement Program (NSQIP) hospital-specific differences. The exposure included the hospital at which patients received noncardiac surgical care, with stratification of patients by the acuity of surgery (elective vs. urgent/emergent). Among 157,075 surgery patients, the unadjusted risk of cardiac event per 1000 ranged among hospitals from 2.1 to 6.9 for elective surgery and from 10.3 to 44.5 for urgent/emergent surgery. Across the 20 hospitals, hospital rankings estimated in the present analysis differed significantly from ranking reported by NSQIP (P for difference: elective, P = 0.0001; urgent/emergent, P < 0.0001) with significantly and substantially lower variation after risk adjustment. Current surgical quality measures may not adequately account for limitations of sample size, data capture, adequate risk adjustment, and surgical acuity in a given hospital, particularly for rare outcomes. These differences have implications for quality reporting and may introduce bias into hospital comparisons, particularly for hospitals with incomplete capture of their patients' baseline risk and acuity. [ABSTRACT FROM AUTHOR]

We tested use of an online support group for women of color who had experienced stillbirth or early infant loss. We recruited recently bereaved mothers and asked them to participate in an existing online community for pregnancy and infant loss hosted on a commercial platform. Participants were asked to go online at least three times weekly for 6 weeks to read posts. Using a mixed-methods approach, we assessed attitudes toward online support, mental health, and experiences pre- and postintervention using written surveys and a brief phone interview. We used summary statistics for quantitative data and a deductive coding approach for qualitative data. Twenty participants completed the study. We found nonsignificant improvements in all four mental health domains (depression, post-traumatic stress disorder, moderate-severe generalized anxiety, and perinatal grief). Women reported the group allowed them to help others and feel less alone. They also reported that at times, posts could increase the intensity of their loss emotions. This study demonstrated feasibility to recruit, retain, and track participation in an online support group for perinatally-bereaved mothers of color. Although the study was not powered for outcome, all mental health measures showed nonsignificant improvements, suggesting value in further investigating online social support for improving women's mental health after perinatal loss. Clinical Trial Registration: Registered on clinicaltrials.gov [NCT04600076], October 19, 2020. [ABSTRACT FROM AUTHOR]

Introduction: Preoperative anxiety before cesarean section is a major issue. Nonpharmacologic anxiety control is believed to be more suitable in pregnant women. Auricular acupuncture (AA) is an inexpensive, easy-to-use, and validated intervention to reduce anxiety in different surgical settings. We evaluated the effect of AA on preoperative cesarean section anxiety. Methods: In a prospective, blind, controlled trial, pregnant women with a scheduled cesarean section under spinal anesthesia were randomized to receive AA with needle, AA without needle (sham), or usual care (no intervention). Anxiety level was assessed by using a visual analogue scale for anxiety (VAS-A; 0-minimal anxiety, 100-maximal anxiety) at three time points: inclusion (pre-induction room--T0), when entering the operating room (T1), and before incision (T2). The primary outcome was the VAS-A variation (percentage changes) between T0 and T1 in the AAe group compared with that in the sham AA group. The secondary outcomes were the VAS-A variation between T0 and T1 in the AA group compared with that in the control group, and the variation between T0 and T2 compared between the three groups, the effect of AA on parasympathetic tone, and the incidence of adverse effects. Results: In women immediately before anesthesia for cesarean section, the AA produced a 19% decrease of anxiety, compared with a 21% anxiety increase in sham AA, which is significantly different. The effect of AA was more present in women with low initial anxiety. The proportion of patients reaching clinically significant anxiety reduction (>33% from the initial level) was 2.5 times higher in the AA group ( p = 0.02) compared with the sham group. No differences in anxiety variations were found compared with the no-intervention group. No effect of AA was noted on parasympathetic tone. Conclusion:Comparedwith sham,AAdecreasedmaternal anxiety levelwhen arriving in the operation roomand just before the beginning of the cesarean section, with a trend toward improvement compared with usual care. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate a new-generation, single-incision transvaginal mesh (TVM) procedure on anatomical and functional outcomes and complication rates in women with symptomatic cystoceles. Materials and Methods: Sixty-five patients with symptomatic cystoceles (POP-Q stage ≥2) were included in a prospective, multicenter study in the Netherlands to evaluate the TVM procedure using the Nuvia® Anterior Device (Bard Medical, Crawley, UK). The primary endpoint was anatomical cure after 12 months (Pelvic Organ Prolapse Quantification [POP-Q] points Aa and Ba at −2 cm or higher). Secondary endpoints were subjective reduction of pelvic organ prolapse (POP) noted on 3 disease-specific quality-of-life (QoL) questionnaires (Urogenital Distress Inventory [UDI], Incontinence Impact Questionnaire [IIQ], and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire [PISQ-12]); complications; and serious adverse events during and after surgery up to 12 months later. Repeated-measurement analyses were used for POP-Q scores and QoL outcomes. Results: Anterior and apical measurements improved after surgery with anatomical success rates of 70.6% and 60.8% after 6 and 12 months, respectively. Four patients (7.7%) developed vaginal mesh exposure and 2 (3.8%) developed significant pain related to the mesh. Three (5.7%) needed reintervention due to these complications. The apical recurrence rate was 4%, and 2 patients underwent repeat POP surgery. Functional outcomes on UDI, IIQ, and PISQ-12 were satisfactory with significant improvements in QoL reported on all questionnaires. Conclusions: This study demonstrated significant improvement in anatomical and functional outcomes with low complication rates. The single-incision approach to TVM surgery can be a valid option for patients with complex recurrent prolapse. (J GYNECOL SURG 38:232) [ABSTRACT FROM AUTHOR]

Health care organizations are increasingly incorporating social care programs into medical care delivery models. Recent studies have identified burnout as a potential unintended consequence of this expansion. Successful implementation of these programs requires investment in the health care team, although understanding the impact of this expansion on nonphysician team members remains limited. Utilizing a theory-informed model for organizational behavior change, the authors aim to characterize the perceived elements of capacity to address patients' social needs within a heterogenous group of health care workers, and to examine the association of these behavioral conditions with burnout. A cross-sectional analysis was conducted of a survey of ∼1900 health care staff from 46 organizations in a large delivery system. Exploratory factor analysis identified factors contributing to the "Perceived Capacity to Address Social Needs" domain; Motivation, Organizational Reinforcement, and 3 task-specific capacities (Identification of social needs, Providing care for patients with social needs, and Linkage to social needs resources). Logistic regression found both a lower sense of motivation (OR 0.71, 95% CI 0.59–0.86), and organizational reinforcement (OR 0.51, 95% CI 0.42–0.62) associated with a higher rate of burnout. These associations with burnout differed by organizational role, suggesting role-specific relationships between these behavioral conditions. As health care has evolved into team-based interventions, staff across the care spectrum are now tasked with addressing larger social issues that affect their patients. A systems approach, aligning organizational priorities and staff motivations, in addition to task-specific skill sets is likely necessary to prevent burnout in this setting. [ABSTRACT FROM AUTHOR]

We designed an anonymous survey to identify knowledge gaps regarding correctional medicine and health disparities for justice-affected patients and distributed it to medical students. Fifty-six percent of the 140 students who responded (14% response rate) had some interaction with the criminal justice system and/or a justice-affected person. Most students somewhat agreed to having knowledge of health risks/disparities related to incarceration. Most were unaware of correctional medicine as a subspecialty. A majority felt comfortable providing care to justice-affected patients and on average agree this population should have equal access to health care. There was a statistically significant correlation between students who considered correctional medicine as a career and belief that these patients should have equal health care access, with the importance of including correctional health care in medical education. We agree with the growing body of literature that concludes there is a need for correctional health care curricula in medical education. [ABSTRACT FROM AUTHOR]

Greater investment in the social determinants of health (SDOH) is positively associated with improved health outcomes of both individuals and their communities, which in turn may help to bend the health care cost curve and reduce health care spending. The purpose of this study was to examine the relationship between local governments' spending on the SDOH and the health care costs of privately insured nonelderly adults. Annual spending by local governments on the SDOH for the years 2007–2017 was obtained from the Census of Governments. Annual health care costs for privately insured nonelderly adults for the years 2013–2017 was obtained from the Health Care Cost Institute. Bivariate and multivariate regression analyses were performed to examine the association between county-level local governments' per capita spending on the SDOH and the per member health care costs of privately insured adults living in these counties controlling for community characteristics. All analyses were conducted in 2021. For near-elderly adults ages 55–64, health care costs were significantly higher in counties with the lowest levels of local governmental spending on the SDOH. For adults ages 18–54, in contrast, health care costs were unrelated to local governmental spending. Investments of local governments in the SDOH may have rather limited potential to yield meaningful savings in health care costs for privately insured nonelderly adults at the population level, especially once such investments exceed a minimum threshold. [ABSTRACT FROM AUTHOR]

Melipona marginata is an endangered species of stingless bee from Brazil that produces honey with particular physicochemical features and a remarkable exotic flavor. To the best of our knowledge, this is the first report devoted to exploring the medicinal potential of this honey. Thus, the aim of this paper was to investigate the potential anti-inflammatory activity of honey extract from M. marginata on skin inflammation. The honey sample was classified as a monofloral honey of Mimosa scabrella. The presence of 11 phenolic compounds as kaempferol and caffeic acid was detected using the high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (HPLC-UV-ESI-MS) method. The anti-inflammatory activity was measured using a 12- O-tetradecanoylphorbol-13-acetate-induced ear edema model of inflammation in mice. The topical application of the M. marginata honey extract (1.0 mg/ear) was able to reduce ear edema with an inhibitory effect of 54±5%. This extract decreased the myeloperoxidase activity in 75±3%, which suggests a lower leucocyte infiltration that was confirmed by histological analysis. This extract also provided a reduction of 55±14% in the production of reactive oxygen species. This anti-inflammatory activity could be due to a synergic effect of the phenolic compounds identified in the honey sample. Taken together, these results open up new possibilities for the use of M. marginata honey extract in skin disorders. [ABSTRACT FROM AUTHOR]

In response to calls for greater integration of research on the effects of visual images in the emotional and cognitive processing of health-related posts on Facebook, this study examined the questions of how gain-and-loss framed images, the valence of emoticon responses, and level of personal relevance of health topics contribute toward intentional engagement (e.g., sharing the posts) on Facebook. This study conducted a 2 (visual framing: gain vs. loss) × 2 (personal relevance of health topic: high vs. low) × 2 (emoticon valence: positive vs. negative) mixed-factorial experiment. A total of 187 college students were recruited to assess the impact of visual framing, personal relevance, and emoticon valence on sharing intention. Results showed that negative emoticons led to a higher intention to share health news posts than positive emoticons. Moreover, two parallel mediation models showed that (a) gain-framed images with high-relevance topics positively predicted perceived susceptibility but negatively predicted perceived severity that both positively impacted sharing intention; (b) loss-framed images with low-relevance topics positively predicted perceived severity but negatively predicted perceived susceptibility that both positively impacted the sharing intention. The implications regarding the contribution to the literature of visual framing and emotion on social media engagement and health communication are discussed. [ABSTRACT FROM AUTHOR]

This study investigated whether the degree of cybersickness varies depending on different virtual reality experience modes (playing vs. watching) and whether specific eye movement parameters reflect changes in cybersickness. Simulator Sickness Questionnaire results from 20 participants (10 playing and 10 watching) showed that cybersickness was much more severe in the watching mode, particularly during the second of the three total trials. Moreover, cybersickness' changing pattern was reflected in the center gaze ratio and scan-path length. These findings imply the importance of physiological measurements for a deeper understanding of cybersickness in theoretical and practical respects. [ABSTRACT FROM AUTHOR]

Introduction: Personal development workshops are increasingly popular. This study evaluated the relationships between the measures of well-being, interconnectedness, and extended perception in various workshops and explored which kinds of workshops and individual characteristics predicted changes in these outcomes. Materials and Methods: In a prospective, uncontrolled, within-participant design study, adult participants completed questionnaires and online tasks before and after personal development workshops. Three analyses were conducted: (1) examining the relationships between measures by using only pre-workshop measures using Spearman correlations; (2) exploring change scores pre- to post-workshop and workshop using Wilcoxon signed-rank test; (3) assessing workshop format and content, and individual characteristics as predictors of those change scores multivariate nonparametric regression. The following outcomes were collected: Well-being--Arizona Integrative Outcomes Scale, positive and negative affect, Dispositional Positive Emotions Scale--Compassion subscale, Sleep Quality Scale, Numeric Pain Rating Scale; Interconnectedness--Cloninger Self-Transcendence Scale, Inclusion of Nature in Self and Inclusion of the Other in Self; and Extended perception tasks--Intuition Jar, Quick Remote Viewing, Psychokinesis Bubble, and Time Estimation. The following potential predictor variables were collected: demographic, mental health, psychiatric and meditation history, Single General Self-Rated Health Question, Brief Five-Factor Inventory-10, and the Noetic Experience and Belief Scale. Workshop leaders also selected which format and content characteristics applied to their workshop. Results: Interconnectedness measures were significantly and positively correlated with well-being (ρ: 0.27 to 0.33), positive affect (ρ: 0.20 to 0.27), and compassion (ρ: 0.21 to 0.32), and they were negatively correlated with sleep disturbance (ρ: -0.13 to -0.16) and pain (ρ: -0.11 to -0.16). Extended perception task performance was not correlated with interconnectedness or well-being. General personal development workshops improved subjective interconnectedness, well-being, positive emotion, and compassion, and they reduced sleep disturbances, negative emotion, and pain (all p's < 0.00005). The lecture (p = 0.03), small groups (p = 0.001), pairs (p = 0.01), and discussion (p = 0.03) workshop formats were significant predictors of well-being outcomes. The workshop content categories of meditation (p = 0.0002) and technology tools (p = 0.01) were also predictive of well-being outcomes, with meditation being the most consistent predictor of positive well-being changes. Conscientiousness was the only significant individual characteristic predictor (p = 0.002), although it was associated with increases in some well-being measures and decreases in others. Conclusions: This study provides preliminary evidence for the positive relationship between the subjective sense of interconnectedness and multiple well-being measures and the beneficial effects of some personal development workshops. [ABSTRACT FROM AUTHOR]

The estimation of species trees typically involves the estimation of trees and alignments on many different genes, so that the species tree can be based on many different parts of the genome. This kind of phylogenomic approach to species tree estimation has the potential to produce more accurate species tree estimates, especially when gene trees can differ from the species tree due to processes such as incomplete lineage sorting (ILS), gene duplication and loss, and horizontal gene transfer. Because ILS (also called 'deep coalescence') is a frequent problem in systematics, many methods have been developed to estimate species trees from gene trees or alignments that specifically take ILS into consideration. In this paper we consider the problem of estimating species trees from gene trees and alignments for the general case where the gene trees and alignments can be incomplete, which means that not all the genes contain sequences for all the species. We formalize optimization problems for this context and prove theoretical results for these problems. We also present the results of a simulation study evaluating existing methods for estimating species trees from incomplete gene trees. Our simulation study shows that *BEAST, a statistical method for estimating species trees from gene sequence alignments, produces by far the most accurate species trees. However, *BEAST can only be run on small datasets. The second most accurate method, MRP (a standard supertree method), can analyze very large datasets and produces very good trees, making MRP a potentially acceptable alternative to *BEAST for large datasets. [ABSTRACT FROM AUTHOR]

AbstractMicroarray technology for profiling gene expression levels is a popular tool in modern biological research. Applications range from tissue classification to the detection of metabolic networks, from drug discovery to time-critical personalized medicine. Given the increase in size and complexity of the data sets produced, their analysis is becoming problematic in terms of time/quality trade-offs. Clustering genes with similar expression profiles is a key initial step for subsequent manipulations and the increasing volumes of data to be analyzed requires methods that are at the same time efficient (completing an analysis in minutes rather than hours) and effective (identifying significant clusters with high biological correlations). In this paper, we propose K-Boost, a clustering algorithm based on a combination of the furthest-point-first (FPF) heuristic for solving the metric k-center problem, a stability-basedmethod for determining the number of clusters, and a k-means-like cluster refinement. K-Boostruns in O(|N| · k) time, where Nis the input matrix and kis the number of proposed clusters. Experiments show that this low complexity is usually coupled with a very good quality of the computed clusterings, which we measure using both internal and external criteria. Supporting data can be found as online Supplementary Material at www.liebertonline.com. [ABSTRACT FROM AUTHOR]

The Kolmogorov-Smirnov (K-S) test is a statistical method often used for comparing two distributions. In high-throughput screening (HTS) studies, such distributions usually arise from the phenotype of independent cell populations. However, the K-S test has been criticized for being overly sensitive in applications, and it often detects a statistically significant difference that is not biologically meaningful. One major reason is that there is a common phenomenon in HTS studies that systematic drifting exists among the distributions due to reasons such as instrument variation, plate edge effect, accidental difference in sample handling, etc. In particular, in high-content cellular imaging experiments, the location shift could be dramatic since some compounds themselves are fluorescent. This oversensitivity of the K-S test is particularly overpowered in cellular assays where the sample sizes are very big (usually several thousands). In this paper, a modified K-S test is proposed to deal with the nonspecific location-shift problem in HTS studies. Specifically, we propose that the distributions are “normalized” by density curve alignment before the K-S test is conducted. In applications to simulation data and real experimental data, the results show that the proposed method has improved specificity. [ABSTRACT FROM AUTHOR]

Health care organizations are increasingly assessing patients' social needs (eg, food, utilities, transportation) using various measures and methods. Prior studies have assessed social needs at the point of care and many studies have focused on correlates of 1 specific need (eg, food). This comprehensive study examined multiple social needs and medical and pharmacy claims data. Medicaid beneficiaries in Louisiana (n = 10,275) completed a self-report assessment of 10 social needs during July 2018 to June 2019. Chronic health conditions, unique medications, and health care utilization were coded from claims data. The sample was predominantly female (72%), Black (45%) or White (32%), had a mean age of 42 years, and at least 1 social need (55%). In bivariate analyses, having greater social needs was associated with greater comorbidity across conditions, and each social need was consistently associated with mental health and substance use disorders. In multivariable logistic analyses, having ≥2 social needs was positively associated with emergency department (ED) visits (OR = 1.39, CI = 1.23 – 1.57) and negatively associated with wellness visits (OR = 0.87, CI = 0.77 – 0.98), inpatient visits (OR = 0.87, CI = 0.76 – 0.99), and 30-day rehospitalization (OR = 0.66, CI = 0.50 – 0.87). Findings highlight the greater concomitant risk of social needs, mental health, and substance use. Admission policies may reduce the impact of social needs on hospitalization. Chronic disease management programs offered by health plans may benefit from systematically assessing and addressing social needs outside point-of-care interactions to impact health outcomes and ED utilization. Behavioral health care management programs would benefit from integrating interventions for multiple social needs. [ABSTRACT FROM AUTHOR]

Social needs screening in health care settings reveals that many low-income individuals have multiple unmet social needs at the same time. Having multiple simultaneous social needs greatly increases the odds of experiencing adverse health outcomes. To better understand how and which social needs cluster in these cases, the authors examined data from 14,749 low-income adults who completed a social needs assessment in one of 4 separate studies conducted between 2008 and 2019 in the United States. Participants were Medicaid beneficiaries, helpline callers, and daily smokers. Findings were strikingly consistent across the 4 studies. Participants with ≥2 social needs (n = 5621; 38% of total) experienced more stress, depressive symptoms, sleep problems, and chronic diseases and were more likely to rate their health as fair or poor. Social needs reflecting financial strain were highly correlated, such as needing help paying utility bills and needing money for necessities such as food, shelter, and clothing (r = .49 to.71 across studies). Participants experienced 351 distinct combinations of ≥2 social needs. The 10 most common combinations accounted for more than half of all participants with ≥2 needs. Clusters of social needs varied by subgroups. Women with children were more likely than others to need more space in their home and help paying utility bills; low-income men were more likely to be physically threatened and need a place to stay; older, sicker adults were more likely to need money for necessities and unexpected expenses, as well as transportation. Findings are discussed in the context of creating smarter, more efficient social needs interventions. [ABSTRACT FROM AUTHOR]

Background: Prior research has reported that integrative medicine (IM) therapies reduce pain in inpatients, but without controlling for important variables. Here, the authors extend prior research by assessing pain reduction while accounting for each patient's pain medication status and clinical population. Methods: The initial data set consisted of 7,106 inpatient admissions, aged ≥18 years, between July 16, 2012, and December 15, 2014. Patients' electronic health records were used to obtain data on demographic, clinical measures, and pain medication status during IM. Results: The final data set included first IM therapies delivered during 3,635 admissions. Unadjusted average pre-IM pain was 5.33 (95% confidence interval [CI]: 5.26 to 5.41) and post-IM pain was 3.31 (95% CI: 3.23 to 3.40) on a 0–10 scale. Pain change adjusted for severity of illness, clinical population, sex, treatment, and pain medication status during IM was significant and clinically meaningful with an average reduction of −1.97 points (95% CI: −2.06 to −1.86) following IM. Adjusted average pain was reduced in all clinical populations, with largest and smallest pain reductions in maternity care (−2.34 points [95% CI: −2.56 to −2.14]) and orthopedic (−1.71 points [95% CI: −1.98 to −1.44]) populations. Pain medication status did not have a statistically significant association on pain change. Decreases were observed regardless of whether patients were taking narcotic medications and/or nonsteroidal anti-inflammatory drugs versus no pain medications. Conclusions: For the first time, inpatients receiving IM reported significant and clinically meaningful pain reductions during a first IM session while accounting for pain medications and across clinical populations. Future implementation research should be conducted to optimize identification/referral/delivery of IM therapies within hospitals. Clinical Trials.gov #NCT02190240. [ABSTRACT FROM AUTHOR]

Background: Cancer patients often suffer from high levels of distress. Mobile health (mHealth) applications might be an innovative way to deliver mindfulness and relaxation interventions for cancer patients. However, data about the implementation of apps in health care are lacking. Adherence to mHealth interventions is an important indicator for a successful implementation and might be needed to maximize treatment effects. However, the decrease in distress might reduce the motivation of patients to engage in such self-care tools in the long run. Therefore, the aim of this analysis was to investigate the association between the course of distress over time and the adherence to a relaxation self-care app in cancer patients. Methods: We developed an app for cancer patients (CanRelax) and 83 patients who participated in the prospective observational study used the app at least once. The evaluation was guided by the RE-AIM framework, and this analysis focused on the implementation of the app. Patients were grouped into five subgroups according to their course of distress over 10 weeks (Distress Thermometer). These subgroups of patients were compared with each other to identify different user groups. Findings: About half of the patients were adherent over 10 weeks. However, a decrease in distress was associated with lower adherence to the app intervention, whereas patients with moderate distress or an increase in distress showed more adherence. Conclusion: Adherence to an app intervention might be also driven by patients' distress level. A decrease in distress might reduce patients' motivation to continue with a self-care intervention. The interplay between adherence and treatment outcomes should be explored in upcoming mHealth trials to get a better understanding for the implementation of such interventions. Encouraging patients to continue self-care interventions is a major challenge in integrative medicine if they are delivered digitally. The Clinical Trial Registration number: DRKS00010481. [ABSTRACT FROM AUTHOR]

In recent years, smartphone and social networking services (SNS) use have received a great amount of scholarly attention regarding their potentially addictive effects. Conceptualized as smartphone or SNS use disorder, research has consistently demonstrated relations with daily-life impairments. However, Smartphone Use Disorder (SmUD), WhatsApp Use Disorder (WAUD), Facebook Use Disorder (FBUD), Instagram Use Disorder (IGUD), or Snapchat Use Disorder (SCUD) scores have not been compared with each other. This comparison could provide insight into which device/platform could be most related to daily-life impairments. The effective sample of this study comprised 439 German-speaking individuals (age M = 25.08, SD = 9.74; 271 women) who reported actively using a smartphone, as well as WhatsApp, Facebook, Instagram, and Snapchat, and responded to the respective use disorder scales. Within-subjects analysis of variance and post hoc tests (p values adjusted with the Holm method) were used to compare smartphone and SNS use disorder scale scores. The results suggest that SmUD scores are highest in comparison with other SNS platforms. Although WAUD and IGUD scores did not differ from each other, these scores were higher than for FBUD and SCUD. SCUD scores were higher than FBUD scores. These results provide novel insight into how the smartphone and different SNSs may relate to engagement in problematic digital technology use. [ABSTRACT FROM AUTHOR]

Objectives: Acute coronary syndrome (ACS) is an acute disease with high mortality. Although early percutaneous coronary intervention (PCI) is proved to be the practical approach in treating ACS, the incidence of cardiovascular events is still far from satisfactory. The combination of Suxiao Jiuxin Pill (SJP) and Western medicine is one conventional approach in the treatment of ACS. Many elementary and clinical trials have proved the efficacy and safety in the improvement of cardiocerebral vascular conditions. The aim of this project is to evaluate the safety and efficacy of SJP on ACS with early PCI patients. Trial Design: This is a multicenter randomized, double-blind placebo-controlled trial. Trial registration: ChiCTR-TRC-13003053. Settings: Hospitals. Subjects: A total of 200 ACS with early PCI patients were randomly divided into SJP group (n = 100) and placebo group (n = 100). Interventions: The SJP group was treated with routine treatment and SJP (taking eight SJP pills orally each time, three times per day). The placebo group was treated with routine treatment along with equal amounts of SJP placebo. The course of treatment was 6 months and a follow-up visit at 12 months. Outcome Measures: Assessments of major adverse cardiovascular events (MACE), safety assessments, adverse events, left ventricular systolic function (LVEF), Seattle angina questionnaire (SAQ), troponin C (cTNI), C-reactive protein (CRP), fibrinogen (Fib), and cystatin C (cysC). Results: The SJP group had a relatively low incidence of MACE than the placebo (p < 0.05, odds ratio: 1.916, 95% confidence interval [0.999–3.674]). LVEF was significantly higher in the SJP group than the placebo group on the 360-day follow-up (p < 0.01). SJP had a significant increase score in the SAQ subscale of physical limitation, angina frequency, and treatment satisfaction (p < 0.05). There is no significant difference in the cTNI and CRP level between the two groups. The serum concentration of Fib and cysC in the SJP was significantly decreased compared with the placebo (p < 0.05). The numbers of adverse events between the two groups were not statistically different (p > 0.05). Conclusions: SJP is associated with a reduction in MACE, and an improvement of heart function and quality of life in ACS patients with early PCI, and is probably safe to use. [ABSTRACT FROM AUTHOR]

Instead of traditional free movement, node-based movement can be used in virtual reality (VR) games. In node-based movement systems, players navigate by jumping to set locations. Node-based movement is similar to hypertext navigation. We show that the hypertext lostness measure can be used as a game analytic to evaluate navigational efficiency. In a randomized controlled trial with 25 adolescent participants, an immersive desktop game environment and a VR game environment were compared on the transmission of in-game educational content and navigational efficiency. Results show that the hypertext lostness measure is also valuable outside its original hypertext domain: in VR. VR did not improve players' retention of factual knowledge, but did significantly improve players' spatial knowledge and navigational efficiency. We conclude (a) the hypertext lostness measure is also valuable for node-based VR games and (b) VR games add to spatial learning, even when compared with already immersive desktop games. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the effects of Ayurvedic treatment on deceleration of the disease progress of nondialysis patients with stage IV or V chronic renal failure (CRF). Materials and Methods: A complex oral and proctocolonic Ayurvedic multiherbal medication was administered daily for 1 month to inpatients. Thereafter, patients were treated as outpatients with oral medication for additional 5 months. Four renal function tests (RFTs) were evaluated at various time points (TPs): (1) 6 months before baseline (TP −6), (2) at baseline (TP 0), and (3) after completion of 6 months of treatment (TP +6). Repeated-measures analysis of variance (ANOVA) with Greenhouse–Geisser correction and Friedman's ANOVA by ranks were used to analyze the RFTs. For post hoc tests, the Bonferroni correction was applied. Bias-corrected effect sizes (Hedges) for the treatment were calculated. Results: Sixty-four nondialysis CRF patients with laboratory investigations of the preceding 6 months were included; 12 patients discontinued the treatment. Fifty-two patients with stage IV or V at baseline completed the study. Mean concentrations of estimated glomerular filtration rate (eGFR), serum creatinine, and hemoglobin differed significantly between TPs (eGFR: F = 15.3, p < 0.001; serum creatinine: F = 29.3, p < 0.001; blood urea: F = 2.0, p = 0.159; hemoglobin: F = 53.9, p < 0.001). Pairwise comparisons of the mean differences between TPs are significant for eGFR, creatinine, and hemoglobin. For blood urea, a significant decrease was observed for the treatment period [15.9(↓) mg/dL, standard error 4.0; n = 52], but a nonsignificant increase was observed for the pretreatment period [16.2(↑) mg/dL, standard error 9.8] due to insufficient data for TP −6 (n = 26). The effect sizes for eGFR, creatinine, blood urea, and hemoglobin were medium (0.45, 0.53, 0.44, and 0.30). Conclusions: After 6 months of treatment, statistically and clinically significant improvements of eGFR, creatinine, blood urea, and hemoglobin and a significant shift to better CRF stages were observed. Several cardinal symptoms were also significantly reduced. Randomized controlled trials are warranted to evaluate the effects in comparison to usual care. [ABSTRACT FROM AUTHOR]

Objective: Midlife women are at risk of obesity. Poor sleep outcomes including inadequate sleep duration and variable sleep timing are risk factors for obesity, but there is a lack of understanding on how specific sleep constructs uniquely or concurrently are associated with weight outcomes in this population. This study examined the unique association of sleep timing with weight outcomes and how sleep timing works in conjunction with sleep duration to influence weight in midlife women. Materials and Methods: An archival analysis was performed using the Midlife in the United States-II study (MIDUS-II). The sample consisted of 132 midlife women (40–64; M = 52.9, standard deviation = 6.94). Sleep timing (mean sleep time, variability) and duration were measured through actigraphy and daily sleep diaries. Weight was assessed using body mass index (BMI) and waist circumference measures. Results: PROCESS mediation and moderation analyses assessed direct, indirect, and moderating pathways. Sleep duration emerged as an indirect link between sleep timing (mean and variability) and weight outcomes (95% CI = 0.0001–0.0123; 95% CI = 0.0007–0.0378; 95% CI = 0.0079–0.1006). Sleep timing (95% CI = −0.0144 to 0.0076; 95% CI = −0.0358 to 0.0219) and sleep time variability (95% CI = −0.0124 to 0.0438; 95% CI = −0.0533 to 0.0939) were not directly associated with BMI or waist circumference. Also, sleep timing and duration did not interact to influence weight outcomes. Conclusions: Sleep duration, rather than sleep timing, is associated with weight outcomes, and is an indirect link in the sleep timing and weight outcomes association. Future work is needed to further disentangle the impact of sleep on weight in midlife women using prospective studies, implementing daily assessments of sleep behavior. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents and young adults (AYAs) with cancer need self-management strategies to cope with multiple symptoms. Self-efficacy, self-regulation, and negotiated collaboration are key theoretical components of the self-management process and have not been fully explored with AYAs with cancer. This study examined the effects of a heuristic symptom assessment tool on AYAs' self-efficacy for symptom management, AYAs' self-regulation abilities related to their symptoms, and communication with their providers about symptoms. Methods: AYAs (15–29 years of age) receiving chemotherapy used the Computerized Symptom Capture Assessment Tool (C-SCAT) to illustrate their symptom experience and discuss their symptoms with providers during two clinic visits. Participants completed the PROMIS Self-efficacy for Managing Symptoms Scale, a measure of satisfaction with provider communication, and a short interview about self-regulation and communication behaviors at baseline and after each provider visit. Results: Eighty-five AYAs who used the C-SCAT showed improved self-efficacy for managing symptoms. Qualitative data suggest that the C-SCAT was useful for enhancing a number of AYAs' self-regulation abilities related to symptom management, such as awareness and recall of symptoms, how symptoms were related, and how they planned to talk about their symptoms to providers. AYAs reported C-SCAT facilitated communication with providers about symptoms and symptom management because it was a visual prompt showing priority and related symptoms. Conclusions: Because AYAs continue to experience multiple distressing symptoms, symptom self-management remains an important area for practice and research. Use of heuristic tools, such as the C-SCAT, may help AYAs more effectively self-manage their symptoms for better health outcomes. [ABSTRACT FROM AUTHOR]

Introduction:Burn care requires multiple disciplines to collaborate to achieve best patient care. Because of this, rounds involve a very large burn team to assess patients' wounds and formulate plans. To decrease the amount of team members on rounds, our burn center implemented a new budding technology: telemedicine. We created "Zoom Rounds," aHealth Insurance Portability and Accountability Act (HIPAA)-compliant, secure videoconferencing system to relay patient wound evaluations to a remote conference room where team members can participate digitally. We sought to evaluate this new rounding process by querying the burn team, patients, and families regarding their experience. Methods:Surveys were developed for each group and were distributed over a 2-month period. Respondents were asked to rate the videoconferencing rounding experience and comment on the educational experience (staff/providers) and one's personal experience (patient/family). We analyzed both the quantitative data with the qualitative responses. Qualitative data analysis for content was used to independently code and analyze responses to the open-ended survey questions by two authors and verified by adjudication review. Results:Thirty-three patients/families and 69 burn staff members completed the confidential survey (response rate of 90% and 83%, respectively). Coded responses identified several themes: inconsistent technology, improved visualization and communication regarding the wounds, better learning experience, and improved patient experience by decreased crowds in the room. Conclusions:There was strong support for the use of videoconferencing for patient wound rounds among providers, burn center staff, and patients/families. Telemedicine is a promising technology to improve inpatient burn rounds. [ABSTRACT FROM AUTHOR]

Objectives: The study investigates measurable effects of cabbage leaf wraps on post-traumatic knee injury exudate absorption in men. Design: Case–control experiment on the same group of patients (before and after treatment). Settings/Location: One academic center and two hospitals. Subjects: The study was carried out on a group of patients with different degrees of injury severity in the acute stage of the knee injury who were divided into three groups based on the width of suprapatellar recess gap (3–5 mm in group 1, 6–10 mm in group 2, and 11 mm or more in group 3) as assessed by ultrasonography. Interventions: Each group of patients was divided into two subgroups, one of which comprised patients whose knees were treated with wraps containing cabbage leaves with ice (cases) and the others comprised patients treated with wraps without cabbage leaves, with cooling dressing only (controls). Results: Significant progression in knee fluid uptake was observed in the acute stage of the knee injuries treated with cabbage wraps compared with control groups (p < 0.05). It was shown that the time, type of wraps, and a degree of severity of post-traumatic exudative knee inflammation affect the process of knee recovery (Friedman test for repeated measures p < 0.05). The most significant results were observed within first 24 h after the injury. Further decrease in the width of the recess gap after 5 days was observed. Conclusions: Application of cabbage wraps with ice to the knee in men may promote a reduction of swelling (by accelerating absorption of knee exudates) if applied during the acute stage of the knee injury. [ABSTRACT FROM AUTHOR]

Objective: To assess whether a self-care toolkit (SCT) provided to breast cancer patients undergoing surgery could mitigate distress and lessen symptoms associated with surgery. Design: One hundred women with breast cancer, planning to undergo initial surgery, were randomly assigned to either one of two groups: treatment as usual (TAU; n = 49) or TAU with the addition of an SCT (n = 51). The SCT contained an MP3 player with audio-files of guided mind–body techniques (breathing, progressive muscle relaxation, meditation, guided imagery, and self-hypnosis) and acupressure antinausea wristbands. Anxiety, pain, nausea, sleep, fatigue, global health, and quality of life (QOL) were assessed using validated outcome measures. Two inflammatory blood markers (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) were measured serially. Data were collected at baseline (T1), immediately before surgery (T2), within 10 h postoperatively (T3), and ∼2 weeks postsurgery (T4). Settings: Numerous studies have shown that psychological distress associated with a cancer diagnosis can affect pain perception and QOL. Results: Between T1 and T4, there were significant between-group differences in Patient-Reported Outcomes Measurement Information System (PROMIS)-57 scores of Pain Interference, Fatigue, and Satisfaction with Social Roles, favoring the SCT group compared with TAU (p = 0.005, p = 0.023, and p = 0.021, respectively). There was a significant mean change in Defense and Veterans Pain Rating Scale (DVPRS) scores from T2 to T3, with the SCT group having significantly smaller increases in postoperative pain (p = 0.008) and in postoperative ESR (p = 0.0197) compared with the TAU group. Clinically significant reductions in anxiety occurred in the SCT group during the main intervention period. Conclusion: These results suggest that using the SCT in the perioperative period decreased pain perceptions, fatigue, and inflammatory cytokine secretion. [ABSTRACT FROM AUTHOR]

Building capacity in implementation science within health programs is dependent on training in theory and practice of epidemiology, statistics, and research in addition to high self-efficacy toward application of training. This article describes a training program providing technical assistance to more than 300 health facilities in Kenya and Tanzania, its evaluation results, and its ability to improve participants' knowledge, competencies, and self-efficacy on data management, analysis, and dissemination among health care professionals. Two months prior to the training, participants (n = 98) were emailed a pre-course survey including 19 questions using a Likert-type response for planning the content of the workshop. Six to 12 weeks after the training, a post-course survey was emailed to all participants. Five different trainings were conducted indicating 5 participant cohorts. The questions posed involved course satisfaction, course impact on knowledge and skills, and self-efficacy in data analysis and utilization. Post-course survey results revealed that the participants had confidence in data analysis, which was significantly different from the pre-test results (0.05 α). Qualitative commentary complemented the findings of the impact of the workshop. Four manuscripts and 13 abstracts have been submitted post training. Results suggest that a short-term training program can achieve immediate gains in data and research self-efficacy among health care professionals. Although increasing self-efficacy is a necessary first step in developing skills, educators should engage in continuing education for sustainable dissemination practices. There is an urgent need to determine the current infrastructure to promote scientific dissemination. This will assist countries to produce better evidence to support their programs, policies, and overall health programs. [ABSTRACT FROM AUTHOR]

Although many impacts of the Affordable Care Act (ACA) have been well studied, less attention has been paid to whether use of contraceptives (especially those covered by health insurance) changed in young adults. The ACA did several things that might influence contraceptive use: allowed children to stay on a parent's health insurance until age 26, required insurers to impose no co-payment for contraceptives beginning in 2012, and increased funding for family planning services. The authors examined data from the National Survey of Family Growth for 3 time periods: 2006–2010 (pre ACA), 2011–2013, and 2013–2015 (post ACA). In the earlier data set, 50% of female respondents ages 20 to 25 were using a prescribed form of birth control; by 2011–2013, the percentage using prescribed birth control rose to 89% (CI 95%: 0.83 – 0.92). However, by 2013–2015, the percentage of women using prescribed birth control had decreased to 55%, a nonsignificant change from 2006–2010. The percentage of respondents ages 20 to 25 reporting health insurance coverage for 6 months or more grew slightly, from 77% in 2006–2010 to 80% in 2013–2015. The ACA encouraged significantly more young adult women to increase their use of prescribed (or otherwise covered by health insurance) birth control methods over non-prescribed methods during 2011–2013; however, use returned to nearly pre-ACA levels by 2015. In a nationally representative sample, the percentage of young women insured increased only slightly after the ACA took effect. [ABSTRACT FROM AUTHOR]

Aims and Objective: The aim of this study was to evaluate and compare the effect of chlorhexidine (CHX) chip and turmeric chip as a local drug delivery (LDD) agent in the treatment of patients with chronic periodontitis. Materials and Methods: A total of 120 sites with pocket depths 5-8 mm were chosen as a split mouth design at 3 sites in the same patient. Selected sites were randomly divided into three groups to receive CHX chip in addition to scaling and root planing (SRP) in group A, turmeric chip in addition to SRP in group B, and SRP only in group C. Clinical parameters, that is, plaque index (PI), gingival index (GI), probing pocket depth (PPD), and relative attachment level (RAL) were recorded at baseline, 1 month, and 3 months interval. Result: On applying statistical analysis, results revealed that there was a significant reduction in all the clinical parameters, that is, PI, GI, PPD, and gain in RAL from baseline to 1 month and 3 months in all the three groups. These results were found to be significantly high in the CHX group and turmeric group than in the SRP group. Also, the results in both the test groups were maintained till the end of the study periods, but SRP group showed a significant deterioration after 1 month as was seen by increase in PPD and decrease in RAL scores after 3 months in the SRP group. Conclusion: Both the treatment modalities with the application of LDD as an adjunct to SRP proved to be equally beneficial in the treatment of chronic periodontitis. [ABSTRACT FROM AUTHOR]

Over the past decade, reimbursement in the US health care system has undergone rapid transformation. The Affordable Care Act and the Medicare Access and CHIP Reauthorization Act are some of the many changes challenging traditional modes of practice and raising concerns about practitioners' ability to adapt. Recently, physician satisfaction was proposed as an addition to the Triple Aim in acknowledgment of how the physician's attitude can affect outcomes. To understand how physicians perceive alternative payment models (APMs) and how those perceptions may vary by their organizational role, non-leader physicians ( N = 31), physician leaders ( N = 67), and health system leaders ( N = 49) were surveyed using a mixed-methods approach. Respondents to the electronic survey, who were identified from a Jefferson College of Population Health program participant database, rated their organizations' responses to APMs and provided commentary. Analysis of the Likert scale quantitative data indicates a significant difference in ratings between the 3 groups, particularly between health system leaders and non-leader physicians. The aggregated Attitudes Toward APMs Scale indicates that health system leaders were statistically significantly more likely to rate themselves and their organizations as better prepared for APMs compared to non-leader physicians and physician leaders. Qualitative analysis of comments indicates that non-leader physicians are more negative of APMs, often expressing frustration at added administrative burdens, barriers to implementation, and inconsistent or unclear measurement requirements. These findings indicate that the negative feelings non-leader physicians and physician leaders, in particular, expressed could contribute to physician burnout and decreased professional satisfaction, and impede the effective implementation of APMs. [ABSTRACT FROM AUTHOR]

Objective: Describe the establishment of the palliative care quality network (PCQN) with guidance on how teams can develop similar collaborations. Background: In the current healthcare environment, palliative care (PC) teams must be able to demonstrate value and provide efficient care while supporting the clinicians who provide that care. Description: The PCQN is a national quality improvement (QI) collaborative comprised of specialty PC teams from a diverse range of hospitals across the United States Results: PCQN members identified five core activities to support PC teams. 1) Collection of standardized data: 23 core items and 22 optional data elements document patient demographics, consultation characteristics, processes of care, and clinical outcomes. 2) Data analyses with benchmarking including reports generated in real time providing summary, trend, member comparison, and cross-tab analyses. 3) QI collaborative; QI initiatives have addressed pain management, surrogate decision-making, spiritual screening, and anxiety assessment. 4) Education and personal development provided through monthly conference calls, a listserv, PCQN website, and twice-yearly conferences. 5) Financial analysis; a software program enables PC teams to calculate the financial impact of the care provided. Conclusions: The central tenet of the PCQN is to improve quality of care for patients with serious illness and their families, increase the efficient use of healthcare resources, and support growth and sustainability of PC programs. Building and tending to this community takes time to ensure engagement of all members and remain responsive to evolving needs of patients, families, PC teams, and stakeholders. [ABSTRACT FROM AUTHOR]

In 2003, the Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), a nonprofit organization, began administering antiretroviral therapy (ART) to its patients. This practice transformed HIV from a fatal disease to a more manageable chronic condition. However, relatively few studies focus on the experiences of survivors. This study provided a unique opportunity to interview patients who survived at least 10 years after being treated with ART at GHESKIO. The goal of the study was to elicit from patients their perspectives on what enabled them to survive with AIDS. Grounded Theory, a qualitative research method was used to guide data collection, coding, and analysis. Individual interviews were conducted, audio-taped, transcribed and analyzed in Creole, and translated into English. Data saturation was reached at 25 participants. Of which, 64% were women, the mean age was 49, range of 43-55 years, 24% were married, 44% had not completed elementary school, and 72% had no income, the remaining participants had incomes ranging from $1000 to $5000 annually. Qualitative analysis resulted in 681 codes, which were grouped into six categories: being spiritually grounded, having supportive interactions with providers, caring for children, setting personal goals, persevering and living life as usual, and maintaining strict medication adherence practices. The overarching theory was that having a reason to live despite one's circumstances and living life as usual enabled one to survive. Having a strong spiritual foundation coupled with supportive family and providers motivated participants to live and adhere to their ART. As the number of patients who are living longer with HIV in Haiti increases, results from this study will be important in helping tailor interventions that enhance their overall quality of life. [ABSTRACT FROM AUTHOR]

Background: Grounding health claims in an evidence base is essential for determining safety and effectiveness. However, it is not appropriate to evaluate all healthcare claims with the same methods. 'Gold standard' randomized controlled trials may skip over important qualitative and observational data about use, benefits, side effects, and preferences, issues especially salient in research on complementary and integrative health (CIH) practices. This gap has prompted a move toward studying treatments in their naturalistic settings. In the 1990s, a program initiated under the National Institutes of Health was designed to provide an outreach to CIH practices for assessing the feasibility of conducting retrospective or prospective evaluations. The Claim Assessment Profile further develops this approach, within the framework of Samueli Institute's Scientific Evaluation and Review of Claims in Health Care (SEaRCH) method. Methods/Design: The goals of a Claim Assessment Profile are to clarify the elements that constitute a practice, define key outcomes, and create an explanatory model of these impacts. The main objective is to determine readiness and capacity of a practice to engage in evaluation of effectiveness. This approach is informed by a variety of rapid assessment and stakeholder-driven methods. Site visits, structured qualitative interviews, surveys, and observational data on implementation provide descriptive data about the practice. Logic modeling defines inputs, processes, and outcome variables; Path modeling defines an analytic map to explore. Discussion: The Claim Assessment Profile is a rapid assessment of the evaluability of a healthcare practice. The method was developed for use on CIH practices but has also been applied in resilience research and may be applied beyond the healthcare sector. Findings are meant to provide sufficient data to improve decision-making for stakeholders. This method provides an important first step for moving existing promising yet untested practices into comprehensive evaluation. [ABSTRACT FROM AUTHOR]