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Giant cell arteritis (GCA) is a large vessel vasculitis whereby up to half of all patients show ocular involvement, highlighting the importance of treating GCA before it leads to irreversible blindness. Most of the research published for GCA and associated adverse ocular events are based on majority Caucasian populations establishing the current belief that Hispanics have a much lower incident of GCA. We sought to investigate the incidence of GCA in Hispanics and characterize associated ocular events, stroke rates, and comorbid diseases. We conducted a retrospective cohort study of GCA-coded medical records in self-identified Hispanics assessed at the University Medical Center Hospital in El Paso, Texas. From 2000 to 2019, there were 68 new cases of GCA in the Hispanics which represents an average incidence of 0.062% with a 95% confidence interval of [0.05, 0.09] of Hispanics over the age of 50 admitted to University Medical Center hospital. Of the subjects diagnosed with GCA, the majority had ocular involvement such as blurry vision (47.06%), ocular pain (26.47%), and blindness (14.71%). We did not observe a history of stroke had a statistically significant difference associated with GCA with ophthalmic disease compared to GCA without ophthalmic disease. Polymyalgia rheumatica (PMR) was identified in only 2.94% of the Hispanic subjects with GCA. Major conclusions in our study advocate Hispanics with GCA are prevalent and unique in its associations with other comorbid diseases. Unlike non-Hispanic White populations, Hispanic subjects with GCA do not show an association with PMR nor an increased association with stroke.

Commonly used scales of psychological intimate partner violence (ψIPV) for adolescents may not include sufficient items to measure adequately different forms of ψ aggressive behaviors. They may also characterize as harmful ψ aggressive behaviors occurring in non-conflictual or joking contexts. The current study examined a new scale, the Relationship Behavior Survey (RBS), which was designed to measure three different forms of ψIPV (denigrating, controlling, and intrusive behaviors) and the appraisals of the perpetrator’s intent. Factor structure was examined, and incremental validity was tested by examining the relation of the RBS to general aggressive tendencies and physical IPV after accounting for the emotional abuse and threatening behavior subscales of the Conflict in Adolescent Dating Relationships Inventory (CADRI). Criterion validity and gender differences were also examined. Data were collected using an online survey from a national sample of 1,100 13 to 17-year-olds in the United States (51% identified as female, 80% as White) in a dating relationship. Confirmatory factor analysis supported one ψIPV construct for males and females. The RBS demonstrated incremental validity; criterion validity was supported for controlling intent for males and females and mistrust intent for females. Joking intent was the most reported intent for males and correlated unexpectedly with physical IPV. The RBS captures a larger range of ψIPV behaviors than the CADRI. The addition of intent appraisals provides important information to differentiate forms of ψIPV, particularly in relation to acts motivated by coercion and mistrust.

Background: Monitoring of vancomycin using the area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio is now preferred for serious methicillin-resistant Staphylococcus aureus infections. Vancomycin AUC/MIC monitoring is being investigated but is not yet well elucidated with other bacterial pathogens. Methods: A retrospective cross-sectional study was conducted assessing patients with streptococcal bacteremia treated with vancomycin definitive therapy. AUC was calculated using a Bayesian approach, and classification and regression tree analysis was used to identify a vancomycin AUC threshold predictive of clinical failure. Results: Eleven patients had a vancomycin AUC

To determine the frequency, characteristics, and clinical course of ophthalmic side effects associated with systemic BRAF inhibitor therapy. Medical records of patients taking BRAF inhibitors for the treatment of systemic malignances at Mayo Clinic, Rochester from 01/01/2010 to 08/30/2021, were retrospectively reviewed. Of 901 patients, 14 (1.6%) patients experienced an ophthalmic side effect. Mean age at presentation of the side effect was 60 years (median 59, range 50–80) and 11 (79%) were male. The most common side effect was uveitis in 7 (50%) patients, followed by dry eye in 4 (29%) patients, and central serous chorioretinopathy in 2 (14%) patients, with singular cases of cranial nerve VI palsy and conjunctival edema. A comparison between individual BRAF inhibitors (vemurafenib vs. dabrafenib vs. encorafenib) revealed that patients taking encorafenib had a shorter interval to any ophthalmic adverse event (mean 55.6 vs. 9.8 vs. 4.0 months, p = 0.03) and were the only patients to experience documented dry eye syndrome (DES) in this series. Outcomes were known in 13 (93%) patients, and ophthalmic adverse effects resolved or were controlled without discontinuing therapy in 10 (77%). Uveitis was successfully treated with topical corticosteroids in 4 patients, while 3 patients with refractory uveitis (2 with panuveitis and 1 with unspecified uveitis) required discontinuation of BRAF inhibitor therapy. Ophthalmic adverse events related to systemic BRAF inhibitor use are rare, with estimated frequency of 1.6%. Most events can be treated with local ophthalmic therapy. BRAF inhibitors provide life-saving therapy, and their discontinuation should be avoided.

Background: It is unknown whether traditional medical education ensures competence among fellows in the key skill of breaking bad news (BBN). While simulation-based mastery learning (SBML) has been used to train fourth-year medical students (M4s) in BBN, it is unclear if it adds similar value for fellows. Objective: We examined the effect of traditional medical training on BBN skills by comparing baseline fellow and M4 skills and confidence and assessed the impact of a BBN SBML curriculum for fellows. Methods: Fellows training in six programs at Northwestern University from November 2018 to May 2019 were eligible for inclusion. Fellows completed a BBN SBML curriculum including a pretest, individualized feedback using a previously published assessment tool, and ongoing deliberate practice until all achieved a minimum passing standard (MPS). The primary outcomes were checklist and scaled item scores on the assessment tool. Fellow performance was compared to a historical M4 cohort. Results: Twenty-eight of 38 eligible fellows completed the curriculum and were included for analysis. Fellows reported significantly more experience and confidence in BBN compared to M4s, yet their pre-training performance was significantly worse on checklist (57.1% vs 65.0%, P = .02) and scaled items; only 4% reached the MPS. After training, fellow performance significantly improved on checklist (57.1% to 92.6%, SD = 5.2%, P < .001) and scaled items; all reached the MPS. Conclusions: Despite higher confidence and BBN clinical experience, fellows performed worse than untrained M4s, confirming that experience is not a proxy for skill. Programs must develop competency-based assessments to ensure entrustment of communication skills.

Objective This study aimed to evaluate the sensitivity of a digital platform to assess attentional and executive function in systemic lupus erythematosus (SLE) patients, and to evaluate the impact of an at-home interactive digital treatment to improve cognitive dysfunction in this clinical population. Background Deficits in attention and executive function are common in patients with SLE. Despite these cognitive difficulties, there are limited brief assessment techniques and few treatment options to improve cognitive abilities in patients with SLE. Interactive digital treatment approaches (use of video game-based software) have been successful in identifying and improving cognition in other clinical populations. Methods Sixty SLE patients completed baseline neuropsychological tests (of attention, psychomotor speed, and executive function), a tablet-based digital platform (EVOTM Monitor), and biobehavioral measures. The patients were randomized into treatment SLE ( n = 30) or no contact control SLE ( n = 30) groups, and returned 4 weeks later for follow-up cognitive, EVO Monitor, and biobehavioral testing. The SLE treatment group was trained on a tablet-based digital treatment (AKL-T01) and was instructed to complete 5 sessions at least 5 days per week for 4-weeks for a total of approximately 25 min of gameplay per day. Results Systemic lupus erythematosus patients demonstrated impairment in visuomotor and processing speed, visual attention, and cognitive flexibility/sequencing skills at baseline. The video game-like treatment group (AKL-T01) had significant improvement in visuomotor speed (Trail Making A) and cognitive flexibility/sequencing (Trail Making B) compared to the control group at 4-week follow-up. The treatment group also demonstrated significant improvement in EVO Monitor multitasking at follow-up (with no change in controls). At baseline, a multitasking metric from EVO Monitor was associated with performance on tasks of cognitive flexibility (Trail Making B) and psychomotor speed (WAIS-IV Coding). Conclusions These findings provide evidence that SLE patients who participated in a 4-week interactive digital video game-like activity had significant improvement in motor speed and executive functions, and would benefit from participation in digital interventions designed to target frontoparietal networks of the brain. Preliminary findings also suggest specific metrics from EVO Monitor may also be useful to detect cognitive impairment and cognitive changes in patients with SLE.

Elder Orphans, socially/physically isolated older adults without caregiving support, are of interest in an aging population. Lack of caregivers for Elder Orphans may influence relocation to residential care facilities, including skilled nursing or assisted living facilities, compared to aging in place. Using the National Health and Aging Trends Study (NHATS), Competing Risk Survival Analyses were performed to determine if Elder Orphans or those At Risk for becoming elder orphans had increased risk for residential care relocation over nine NHATS waves (2011–2019). Elder Orphans had significantly higher risk for moving to residential care facilities in unadjusted (SHR = 1.780; p = 0.001) and adjusted (SHR = 1.571; p = 0.043) models. Those At Risk for becoming an elder orphan had significantly decreased risk for residential care residence in unadjusted (SHR = 0.517; p < 0.001) and adjusted (SHR = 0.726; p = 0.037) models. As aging in place becomes prioritized in the US healthcare system, understanding caregiving needs of older adults is vital to their health outcomes.

Background Rib fracture (RF) pain management provides analgesia while reducing opioids. We postulated: (1) Prescriber factors affect opiate duration, and (2) lidocaine infusion curtails dependency. Materials and Methods Retrospective study of RF patients undergoing multimodal analgesia at ACS-verified Level 1 Trauma Center April 2018-February 2020. Exclusions: ageResults 153 patients included – 113 (74%) stopped opiates by 30 days post-discharge (NORx30), 40 (26%) continued beyond 30 days (Rx+). No significant differences in age, gender, ISS, number of RF, bilaterality, flail chest, and discharge disposition. Significant differences included hospital LOS (7.62 NORx30 vs. 10.22 Rx+, p = .02), number of prescribers (1.73 NORx30 vs. 2.98 Rx+, p < .01), average MME/day during initial 30 days post-discharge (36.7 ± 17 NORx30 vs. 45.4 ± 30.2 Rx+, p = .03), and number of pills (49 ± 38 NORx30 vs. 120 ± 85 Rx+, p < .01). Patients who received lidocaine infusion (LIDO+) had lower MME/day prescribed (32.24 ± 19.9, p = .03), were younger (61.2 vs. 65.6, p < .01), had more RFs (7.1 vs. 6.05, p = .03), and shorter LOS (7.71 vs 10.2, p = .01). Discussion Prescriber attention to MME/day and number of pills dispensed affects opioid dependency. We recommend 35–40 MME/day with 50 pill/month limit prescribed by a single provider monitoring patient and CSMD. Early LI offers post-discharge opioid cessation advantage.

Most students with emotional and behavioral disorders (EBD) have significant reading difficulties, but educators have few in-service professional learning opportunities geared to reading instruction for these students. The Integrated Literacy Study Group was developed as an online professional development program to prepare elementary teachers to meet the literacy needs of students with or at risk of EBD. In this study, the authors use a within-subjects design to evaluate the feasibility of the 10-week digital program with 13 elementary teachers. From pretest to posttest, teachers made statistically and educationally significant gains in knowledge of evidence-based social and emotional learning and reading strategies for students with EBD, as well as significant improvements in general teacher self-efficacy, reading self-efficacy, and social and emotional self-efficacy. Pretest-to-posttest change in teacher burnout and classroom management was educationally significant, but statistically nonsignificant. Most teachers perceived the program content as relevant to their needs and those of their students.

Research on adults indicates other-oriented perfectionism (requiring perfection from others) is associated with various consequential outcomes independent of self-oriented perfectionism (requiring perfection of the self) and socially prescribed perfectionism (believing others require perfection of the self). However, historically, the most widely used and researched measure of trait perfectionism in children, the Child-Adolescent Perfectionism Scale (CAPS), has omitted other-oriented perfectionism. In the present study, we address this by reporting on the multisource development and validation of the first self-report measure of other-oriented perfectionism specifically intended for youths: the Other-Oriented Perfectionism Subscale-Junior Form (OOPjr). Children ( N = 107; Mage = 11.5, SD = 1.7) completed the OOPjr, CAPS, and measures of perfectionistic self-presentation, narcissism, social disconnection, depressive symptoms, and parental psychological control. Parents provided ratings of children’s self-oriented, socially prescribed, and other-oriented perfectionism. Psychometric analyses indicated the OOPjr is a homogenous and internally reliable scale that, when factor analyzed alongside the CAPS, displays measurement invariance across gender and replicates the three-factor solution found in adults. Furthermore, parent ratings of other-oriented perfectionism showed unique positive relationships with OOPjr scores, but not CAPS scores. Likewise, other-oriented perfectionism had independent positive relationships with narcissistic superiority and achievement-oriented parental psychological control, after controlling for self-oriented and socially prescribed perfectionism. Overall, our findings provide preliminary support for the use of the OOPjr as a measure of other-oriented perfectionism in youths.

A levels system is an intervention that uses a combination of behavioral principles, such as differential reinforcement and response cost, in order to increase appropriate behaviors and simultaneously decrease problem behaviors. Within a levels system, an individual must meet a pre-determined behavioral criterion in order to gain access to various levels of reinforcement. For example, engaging in higher rates of inappropriate behavior will result in access to highly preferred items or activities, while higher rates of inappropriate behavior will access to lesser preferred activities. Although levels systems have been applied in group settings, as well as in the individual treatment of severe problem behavior, their use has not been explored in the treatment of food refusal. The current study implemented a levels system to target increasing the variety and volume of food consumed by a 12-year-old female diagnosed with fetal alcohol spectrum disorder (FASD) effects, mild intellectual disability, and attention-deficit/hyperactivity disorder (ADHD). At the end of her admission, the participant had increased her variety consumed at an age-appropriate volume significantly, as well as the volume of food consumed.

Men comprise a small minority of the nursing workforce and there has been little increase in the numbers of men in nursing during the last three decades. This study investigated lived experiences of male nurses to understand reasons men remain a small percentage of the nursing workforce. Participants shared similar and diverse experiences. Findings included focused discussion on participants’ career motivations and strategies for success in nursing. Motivators included family influences, desire to care, and job benefits. Success strategies included assimilation, organizational involvement, and mentorship. This study highlights the need for nurses to be ambassadors for diversity and inclusivity and can be used to improve nursing recruitment efforts aimed at men.

Recent efforts have focused on developing and evaluating early intervention for toddlers with probable or emerging autism spectrum disorder. Parent-mediated approaches have gained traction, with mounting evidence of efficacy, but a research-to-practice gap exists, and community effectiveness remains to be firmly established. We report outcomes of a parent-mediated toddler intervention delivered through a research-community partnership, using a community-partnered participatory framework. Data were available for 179 of 183 toddler-parent dyads receiving Social ABCs parent coaching (mean toddler age: 25.18 months; range, 14–34 months). Of these, 89.4% completed the 12-week program and 70.6% returned for 3-month follow-up assessment. Parents attained implementation fidelity exceeding 75%, and toddlers made gains on proximal and distal measures of social communication. Parent fidelity was associated with toddlers’ responsivity at week 12, and responsivity predicted later language gains and reduced autism spectrum disorder symptoms. The roles of child, family, and system factors are discussed. Community delivery of an evidence-based parent-mediated intervention for toddlers with autism spectrum disorder is feasible and effective. Given resource efficiencies associated with parent-mediated approaches, findings bolster current efforts to promote earlier and more widespread access to intervention at the first signs of developmental concern. Lay abstract In an effort to increase access to intervention as early as possible for toddlers with autism spectrum disorder or signs thereof, many researchers have developed interventions that can be delivered by parents in their own homes. These parent-mediated approaches have gained a lot of research attention in recent years and have been found to be helpful in terms of parent and toddler learning. Several studies have used a rigorous research design (a randomized controlled trial) to show that parent-mediated intervention can work under ideal well-controlled conditions. To build on this evidence, we also need to examine whether parent-mediated interventions can be taught well through community service providers and delivered in more “real-world” conditions. This study used a research-community partnership to provide a parent-mediated intervention (called the Social ABCs) to 179 families (mean toddler age was 25 months; ranging from 14 to 34 months). Almost 90% of the families completed the 12-week program and 70% returned for a follow-up assessment 3 months later. Analyses showed that parents learned the strategies that were designed to help them support their toddlers’ development. Also, toddlers made gains in their language, communication, and social skills. Importantly, parents’ use of the strategies was related to toddlers’ skill gains, suggesting that the use of the strategies made a difference for the toddlers. Findings support the use of parent-mediated intervention in this very young age group and suggest that such intervention approaches should be made available for community delivery.

Peer reviewed: True, Funder: Sinneave Family Foundation; FundRef: https://doi.org/10.13039/100012204, Funder: alberta innovates - health solutions; FundRef: https://doi.org/10.13039/501100000145, Funder: Kids Brain Health Network; FundRef: https://doi.org/10.13039/501100015741, Funder: Government of British Columbia, Funder: Autism Speaks; FundRef: https://doi.org/10.13039/100000073, Sibling relationship quality is important for the well-being of children on the autism spectrum and their siblings. Little is known, however, about how varied behavior and abilities of children on the autism spectrum may be associated with parent perceptions of domains of sibling relationship quality. We drew data from a subsample of 119 children on the autism spectrum (ages 10-11 years), participating in an ongoing longitudinal study. We looked at how three clinical characteristics (autism symptoms, behavioral difficulties, and communication ability) related to four areas of parent-reported sibling relationship quality (warmth/closeness, conflict, relative status/power, and rivalry). We also examined whether the strength of the association between behavioral difficulties and parent-reported sibling relationship quality was influenced by communication ability. We found that more severe autism symptoms were associated with less conflict and rivalry, and higher communication ability was associated with more relative status/power. We also found that children on the autism spectrum with more behavioral difficulties and weaker communication ability had less warmth/closeness in their sibling relationships. Our findings highlight that it is important to consider autism symptoms, behavioral difficulties, and communication ability, as well as multiple domains of relationship quality, to better understand how parents view the relationships between autistic children and their siblings. Clinically, methods for improving sibling relationships may include teaching conflict resolution strategies to children on the autism spectrum with stronger communication abilities and their siblings, and fostering sibling connection for those with lower communication abilities.

Medical records were searched for dogs that had received curative intent surgery for oral malignant melanoma and ipsilateral excisional regional lymph node biopsy. Twenty-seven dogs were operated on and 25 dogs of these dogs met the inclusion criteria of signalment, post-excision margin status, presence of metastasis for each biopsied lymphocentrum, survival time post-excision, presence of recurrence or metastasis at follow-up or at death/euthanasia, location of the primary tumor, and any postoperative adjuvant treatment. These 25 dogs had complete tumor excision with tumor-free margins and 19 (76%) had postoperative adjuvant therapy. Median survival time after excision for the dogs in this study was 335.5 days. Results of this study support previous work that documents prolonged survival time following complete excision of oral malignant melanoma with tumor-free surgical margins in dogs. Additionally, 4 dogs (16%) had histologically confirmed regional lymph node metastasis at the time of definitive surgery.

Are feelings of not mattering an antecedent of depressive symptoms, a consequence, or both? Most investigations focus exclusively on feelings of not mattering as an antecedent of depressive symptoms. Our current study examines a vulnerability model, a complication model, and a reciprocal relations model according to a cross-lagged panel model (CLPM) and a random-intercept cross-lagged panel model (RI-CLPM). A sample of 197 community adults completed the General Mattering Scale (GMS), the Anti-Mattering Scale (AMS), and a depression measure at three time points (i.e., baseline, 3 weeks, and 6 weeks). GMS and AMS scores were associated robustly with depressive symptoms at each time point. Other results highlighted the need to distinguish levels of anti-mattering and mattering. CLPM analyses supported a reciprocal relations model of anti-mattering (assessed by the AMS) and depressive symptoms and a complication model linking mattering (assessed by the GMS) and depressive symptoms. The RI-CLPM analyses provided tentative support only for a complication model of anti-mattering and depressive symptoms. Our findings highlight the differences between measures of the mattering construct and the need to adopt a temporal perspective that considers key nuances and the interplay among feelings of mattering, feelings of not mattering, and depression.

Given the current unprecedented multiple pandemics of COVID-19, anti-Black and anti-Asian violence, and white supremacy, we—a group of graduate students and a faculty member who hold diverse identities across disciplines, race, gender, nationality, and additional categories—came together to focus on qualitative research as an ontological, epistemological, and axiological space toward community and culture change. Specifically, we took up scholarly personal narrative, which centers postmodernism and focuses on the reality that “we see what we believe; we observe what we narrate; we transform what we reframe.” What emerged were radical interrelated understandings of privilege, guilt, and the importance of kinship. As such, this vulnerable group reflected on graduate student experiences with multiple pandemics and how the academy may enact transformative change, reframing our own understandings of qualitative space.

Background Cannabis use is more common among nicotine users than non-users. This study characterized concurrent use of nicotine and cannabis (“co-use”) among 12,064 youth aged 16–19 years residing in Canada, the United States, and England in 2017. Methods Data were from the ITC Youth Tobacco & Vaping Survey (Wave 1). Seven modes of cannabis delivery (MOD) were characterized by country of residence and past 30-day use of combusted tobacco and electronic cigarettes. Weighted multivariable regression models were fitted to assess the correlates of co-use and each cannabis MOD. Results Seventy percent of cannabis users reported nicotine use. Co-users exhibited behavioral and demographic differences compared to exclusive users of either substance. “Smoking cannabis without tobacco” was the most popular form of use (78%). Use of nicotine-containing e-cigarettes was associated with “using an e-cigarette to vape cannabis oil/liquid” (aOR: 4.96, 95%CI: 2.23–11.06). Combustible tobacco use was associated with “smoking cannabis with tobacco in a joint/blunt” (aOR: 2.93, 95%CI: 1.89–4.56). Country-level differences were detected. Conclusions Nicotine use is substantial among cannabis users, and associations exist between modes of delivery for both drugs. Results underscore the importance of studying cannabis and nicotine use concurrently, and the need to address the use of both substances in developing interventions for youth users.

Myeloma is a rare, life-limiting blood cancer arising from plasma cells. Early diagnosis is imperative to improve clinical outcomes for patients, by both improving overall survival and reducing the morbidity associated with myeloma-related end-organ damage. This can be challenging in primary care, as myeloma can be difficult to diagnose. It may present in a number of non-specific ways that overlap with a multitude of other conditions. Tests that indicate myeloma are readily available in primary care. This article will describe the pathology of myeloma, the range and timing of diagnostic tests, guide interpretation of results, and outline the diagnostic subcategories of plasma cell disorders. Two cases looking at different aspects and complications of myeloma diagnosis are discussed with the aim of raising awareness and potential pitfalls in diagnosis. Useful resources to aid clinicians are signposted.

The opioid epidemic was declared a national public health emergency in 2017. In Georgia, standing orders for the opioid antagonist, naloxone, have been implemented to reduce mortality from opioid overdoses. Service industry workers in the Atlanta, Georgia, inner-city community of Little Five Points (L5P) have access to naloxone, potentially expanding overdose rescue efforts in the community setting. To explore the issues facing L5P, our research brings together qualitative descriptive inquiry, ethnography, community-based research, a community advisory board, and a local artist to maximize community dissemination of research findings through a graphic novel that describes encountering an opioid overdose. This format was chosen due to the ethical responsibility to disseminate in participants’ language and for its potential to empower and educate readers. This article describes the process of working on this study with the community and a local artist to create sample pages that will be tested for clarity of the message in a later phase. Working with an artist has revealed that while dissemination and implementation for collaboration begin before findings are ready, cross-collaboration with the artist requires early engagement, substantial funding, artist education in appropriate content, and member checking to establish community acceptability altering illustrations that reinforce negative stereotypes. By sharing the experiences of actions taken during an opioid overdose in L5P through a graphic novel, we can validate service industry workers’ experiences, acknowledge their efforts to contribute to harm reduction, and provide much-needed closure to those who encounter opioid overdoses in the community.

Fostering inclusive attitudes among children in host classrooms is key to integrating refugee children. A field experiment tests the prejudice reduction effects of a teacher-led activity integrating imagined intergroup contact and normative influence. To enhance the effectiveness of imagined contact, scenarios include supportive ingroup norms. In 29 classes, 545 children ( Mage = 10.88, SD = 0.96) were randomly assigned to one of five conditions: standard imagined contact, imagined contact encouraged by family, class peers, or religious ingroups, or a control. Children in all norm-framed imagined contact conditions had significantly less antirefugee bias compared with the control. The class-peer norm frame significantly reduced affective and cognitive facets of bias. The family norm frame reduced affective bias, and the religious norm frame reduced cognitive bias. Standard imagined contact did not differ from the control. Potential mediating pathways are explored. These findings illustrate the utility of incorporating norms into imagined contact interventions to reduce antirefugee bias among schoolchildren.

Purpose: We describe the development and the psychometric properties of an instrument to assess self-perceived EOL care competencies for healthcare professionals: The End-of-Life Care Questionnaire (EOL-Q). Methods: The EOL-Q consists of 28 questions assessing knowledge, attitudes and behaviors with subscale items addressing seven domains of care: decision-making, communication, continuity of care, emotional support for patients/families, symptom management, spiritual support for patients/families, and support for clinicians. The EOL-Q was used to assess competencies of 1,197 healthcare professionals from multiple work units at a large medical center. Cronbach’s alpha coefficients were calculated for the survey and subscales. A factor analysis was also conducted. Results: Internal consistency reliability was for was high for the total scale (0.93) and for the subscales addressing knowledge, behaviors, decision-making, communication, emotional support and symptom management (0.84-0.92); and moderate (>0.68) for the attitudes and continuity of care subscales. The factor analysis demonstrated robust consolidation of the communication and continuity of care subscales (eigenvalue 9.47), decision-making subscale (eigenvalue 3.38), symptom management subscale (eigenvalue 1.51), and emotional and spiritual support subscales (eigenvalue 1.13). Conclusion: Analysis of the psychometric properties of the EOL-Q care across settings supports its reliability and validity as a measure of self-perceived EOL care competencies in the domains of communication and continuity of care, decision-making, symptom management, and emotional and spiritual support. The EOL-Q displays promise as a tool for use in a variety of educational, research, and program development initiatives in EOL care.

Introduction: The purpose of this study is to examine student perceptions of accomplishment among 6 subdomains of Center for Advancement of Pharmacy Education (CAPE) Domain 3 “Approach to Practice and Care” outcomes in Advanced Pharmacy Practice Experiences (APPE) across distinct geographical regions. Methods: An 18-item electronic survey was distributed to 88 student pharmacists at a private university completing APPEs in 5 distinct regions and 2 concentrated learning experiences during their penultimate rotation. The survey assessed whether students had at least 1 opportunity to achieve Domain 3 outcomes. Students were prompted to report a percentage of perceived successful accomplishment of outcomes if they stated they had at least 1 opportunity for achievement. Results: Survey response rate was 52% (n = 46). Respondents reported a median accomplishment of at least 85% for each question. For 2 questions, respondents reported a median accomplishment of 99%. Students perceived successful accomplishment for most of the questions related to communication outcomes, while the lowest completion percentages were noted in outcomes related to patient advocacy (85%) and problem solving (88%). Student perceptions of accomplishment among the 6 subdomains were similar across regions and concentrated learning experiences. Conclusions: Students felt confident in accomplishing the outcomes associated with CAPE Domain 3. Regional assignments did not impact student perceptions of outcome accomplishment. Preceptors may play a pivotal role in providing students with opportunities to further polish their skills and increase confidence, specifically in the areas of patient advocacy and problem solving.

Unidirectional barbed suture is widely used in minimally invasive procedures as a secure alternative to traditional knot tying. In this report, a 44-year-old female with endometriosis and complex gynecological history presented to our emergency department 2 weeks after undergoing minimally invasive gynecological surgery. She had persistent, progressive signs and symptoms typical of intermittent partial small bowel obstruction. On her third admission within 7 days for this pattern, laparoscopic abdominal exploration was performed. She was noted to have small bowel obstruction secondary to ingrowth of the tail of a unidirectional barbed suture kinking the terminal ileum during this procedure. We discuss small bowel obstruction due to unidirectional barbed suture and make recommendations on how to avoid this complication.

Introduction: An 82-year-old female presented to the emergency department with presyncope and was found to be bradycardic with proptosis and ophthalmoparesis. MRI revealed an extra-axial enhancing mass compressing the medulla and bilateral enhancing retro-orbital masses. Case Description: Imaging, including nuclear medicine bone scan, PET CT, and cardiac MRI raised the suspicion for a histiocytic neoplasm. These findings, along with a fibrohistiocytic infiltrate on bone biopsy and a BRAF V600E oncogenic mutation on plasma cell-free DNA confirmed a diagnosis of Erdheim-Chester disease. Discussion: These enhancing masses invoke a broad differential, including a histiocytic or granulomatous process, fungal infection, amyloidosis, IgG4 disease, and lymphoma. Systematic laboratory, radiologic, pathology, and genetic testing yielded a diagnosis of this rare histiocytic disorder with frequent neurologic involvement.

Idiopathic, non-traumatic, radial artery aneurysms are rare in medical literature. This report presents the case of a 56-year-old man who was incidentally found to have a 1.01 cm × 1.31 cm left radial artery aneurysm during a carpal tunnel workup. The patient had no other aneurysms, nor any known predisposing diseases that could explain his condition. We proceeded with surgical intervention to prevent future complications. We describe the use of a greater saphenous vein interposition graft for the repair of an idiopathic mid-forearm radial artery aneurysm. The patient had an uncomplicated recovery course following repair.

Most humans believe in a god or gods, a belief that may promote prosociality toward coreligionists. A critical question is whether such enhanced prosociality is primarily parochial and confined to the religious ingroup or whether it extends to members of religious outgroups. To address this question, we conducted field and online experiments with Christian, Muslim, Hindu, and Jewish adults in the Middle East, Fiji, and the United States ( N = 4,753). Participants were given the opportunity to share money with anonymous strangers from different ethno-religious groups. We manipulated whether they were asked to think about their god before making their choice. Thinking about God increased giving by 11% (4.17% of the total stake), an increase that was extended equally to ingroup and outgroup members. This suggests that belief in a god or gods may facilitate intergroup cooperation, particularly in economic transactions, even in contexts with heightened intergroup tension.

Canine acanthomatous ameloblastoma (CAA) has been reported to be the most prevalent odontogenic tumor in dogs. The most common location of this tumor is the rostral mandible. Symphyseal-sparing mandibulectomy has been shown to be an effective technique to maintain mandibular continuity and promote early return to function. In this retrospective study, 35 dogs with CAA associated with a mandibular canine tooth were evaluated following a symphyseal-sparing rostral mandibulectomy. Dogs with intraoperative transection of the canine tooth root and subsequent root fragment extraction were included. The objective of this study was to evaluate outcome following excision of CAA with mid-root transection. Data retrospectively evaluated in this study included the following: narrowest tumor margin, narrowest tumor margin at the border associated with the transected canine root, tumor size, and prevalence of local recurrence. This study showed that 82.86% of CAA were completely excised with tumor-free margins (N = 29). The median narrowest overall tumor-free margin was 3.5 mm (interquartile range [IQR] 2.0-6.5 mm) and the median tumor-free margin associated with the border of the transected canine root was 5.0 mm (IQR 3.1-7.0 mm). Follow-up data was obtained in 25 cases via phone interviews with referring veterinarians and clients. No local tumor recurrence was reported in cases with incomplete tumor excision (N = 5). All dogs with follow-up data survived at least 1 year following surgery. It was concluded that segmental or rostral mandibulectomy with wide margins to include the entire mandibular canine tooth with subsequent mandibular instability may not be warranted for dogs with CAA associated with this tooth.

Veterans with mental health and substance use conditions have poor employment outcomes and would likely benefit from integrated career, mental health, and substance use related interventions. However, vocational psychology has overlooked this vulnerable population, and vocational interventions are often relegated as less important than other psychotherapeutic interventions that target substance use or symptom reduction. Drawing upon Social Cognitive Career Theory and Psychology of Working Theory, this qualitative study examined how external and internal factors influenced the vocational trajectories of eight veterans with mental health and substance use conditions. Additionally, this study examined participants’ perspective on the usefulness of improving career outcomes in supporting their lives and recoveries. Using Consensual Qualitative Research methodology, this study uncovered how personal, environmental, relational, mental health, and substance use factors impacted the vocational trajectories of veterans living with mental health and substance use conditions. Findings also highlight that veterans want fulfilling employment and more clarity in their vocational lives to support their mental well-being and prevent substance use. Implications for vocational psychology theory and integrative practice are discussed.

A routine threat to palliative care research is participants not completing studies. The purpose of this analysis was to quantify attrition rates mid-way through a palliative care study on Dignity Therapy and describe the reasons cited for attrition. Enrolled in the study were a total of 365 outpatients with cancer who were receiving outpatient specialty palliative care (mean age 66.7 ± 7.3 years, 56% female, 72% White, 22% Black, 6% other race/ethnicity). These participants completed an initial screening for cognitive status, performance status, physical distress, and spiritual distress. There were 76 eligible participants who did not complete the study (58% female, mean age 67.9 ± 7.3 years, 76% White, 17% Black, and 7% other race). Of those not completing the study, the average scores were 74.5 ± 11.7 on the Palliative Performance Scale and 28.3 ± 1.5 on the Mini-Mental Status Examination, whereas 22% had high spiritual distress scores and 45% had high physical distress scores. The most common reason for attrition was death/decline of health (47%), followed by patient withdrawal from the study (21%), and patient lost to follow-up (21%). The overall attrition rate was 24% and within the a priori projected attrition rate of 20%-30%. Considering the current historical context, this interim analysis is important because it will serve as baseline data on attrition prior to the outbreak of the COVID-19 pandemic. Future research will compare these results with attrition throughout the rest of the study, allowing analysis of the effect of the COVID-19 pandemic on the study attrition.

To examine the concordance between patients’ experience and expression of unpleasant emotions in a health care context, 21 patients presenting to a university dental clinic were observed for expressed unpleasant emotions and patients provided the intensity of their experienced unpleasant emotions. We found low convergence between experience and expression. Most of the time that patients experience unpleasant emotions they do not express them, and 80% of the time patients express unpleasant emotions they are not experiencing them at the time. Providers need to frequently check in with patients regarding their emotional experience during appointments, as it is infrequently accessible to providers.

Survivors of critical illness, including those with COVID-19, are likely to experience post-intensive care syndrome (PICS). PICS involves a constellation of physical, cognitive, and mental health problems that can occur following hospitalization in an intensive care unit (ICU). This focused review describes the impact of PICS on an individual’s function, societal participation, and family. Specific evidence-based screening tools for in-home identification of the deficits associated with PICS are recommended. Recognition of PICS through early screening by home health care providers is crucial in order to assemble the physical rehabilitation, mental health, and community resources needed to mitigate the long-term effects of COVID-19 and other critical illnesses. This review concludes with further PICS resources for community-based providers to enhance their knowledge and expertise and to prepare them for caring for COVID-19 and other critical illness survivors.

The use of extinction procedures when treating escape-maintained problem behavior can be undesirable and impractical for practitioners to use. To mitigate the risks associated with escape extinction, we explored the effectiveness of a delayed reinforcement token system without the use of extinction in school and home settings to treat escape-maintained problem behavior of students with autism spectrum disorder. In lieu of escape extinction (e.g., blocking), the researchers implemented a 30 s break contingent on problem behaviors and a token (to be exchanged at the end of the session) contingent on compliance. The results of a multiple probe design indicated substantial increases in compliance and reductions in problem behavior for all four participants. These findings suggest that extinction is not necessary to eliminate escape-maintained problem behavior in children with autism.

Child maltreatment and intimate partner abuse determinations often include judgments (e.g., severity) that go beyond whether or not the allegations are founded. Severity ratings inform multiple stakeholders (e.g., researchers, policymakers, clinicians, supervisors) and response pathways (e.g., “differential response” to child maltreatment). However, because severity guidelines typically only provide global direction for raters, these gradations are often of questionable reliability (and thus validity). Extending earlier work developing and implementing reliable and valid family maltreatment substantiation criteria (e.g., Heyman & Slep, 2006 , 2009 ), a classification system for maltreatment severity was created, refined, and field-tested with a sample of clinicians from the largest maltreatment protection agency in the United States The goal was to develop operationalized criteria delineating mild, moderate, and severe maltreatment that could be consistently applied across types of maltreatment, raters, and clinics. To facilitate proper use, a computerized clinical decision support tool for the criteria was created. First, the severity classification system was piloted and refined at four sites throughout the United States. Then, clinicians at these sites ( N = 28) and a master reviewer independently rated de-identified cases as part of the clinicians’ routine assessments. Agreement between clinicians and the master reviewer was excellent for all types of maltreatment. Implications for practical dissemination are discussed.

States are increasingly recommending that districts and schools use multi-tiered systems of support (MTSS) to improve reading outcomes for all students. States have also suggested MTSS is a viable service delivery model in response to new state legislation to screen, identify, and treat students with word-level reading disability (i.e., dyslexia). One model of MTSS that utilizes Enhanced Core Reading Instruction (ECRI MTSS), has demonstrated significant increases in students’ early acquisition of foundational reading skills (Smith et al., 2016). The purpose of this study was to conduct a conceptual replication of the Smith’s (2016) original impact study. In a cluster-randomized controlled trial, 44 schools were randomly assigned to the ECRI MTSS treatment or a business-as-usual (BAU) MTSS control condition. Across conditions, 754 students were assigned to receive Tier 2 intervention in addition to Tier 1 instruction. Impact data indicate moderate to strong effects on student decoding, word reading, and fluency skills for students in the ECRI MTSS schools. Results suggest that schools can use ECRI MTSS to improve foundational reading skills for struggling early readers, including students with or at risk for word-level reading disabilities (i.e., dyslexia).

Objectives: The Working Mind is a program designed to reduce stigmatizing attitudes toward mental illness, improve resilience, and promote mental health in the general workplace. Previous research has revealed positive program effects in a variety of workplace settings. This study advances previous work in implementing randomization and a control group to assess the intervention’s efficacy. Methods: The program was evaluated using a cluster-randomized design, with pretest, posttest, and a 3-month follow-up in 2 implementation groups across 4 sites. Results: The Working Mind program was effective at decreasing mental health stigma and increasing self-reported resilience and coping skills at the pre–post assessment in both delivery groups. The program’s effects were maintained to the time of 3-month follow-up. Qualitative data provided further evidence that participants benefited from the program. Conclusions: This study represents an advancement over past research and provides further support for efficacy of the Working Mind program. Directions for future research, including replication using rigorous methodological procedures and examination of program effects over longer follow-up intervals, are discussed.

Objectives: To examine the relationship between perceived adequacy of personal protective equipment (PPE) and workplace-based infection control procedures (ICP) and mental health symptoms among a sample of health-care workers in Canada within the context of the current COVID-19 pandemic. Methods: A convenience-based internet survey of health-care workers in Canada was facilitated through various labor organizations between April 7 and May 13, 2020. A total of 7,298 respondents started the survey, of which 5,988 reported information on the main exposures and outcomes. Anxiety symptoms were assessed using the Generalized Anxiety Disorder (GAD-2) screener, and depression symptoms using the Patient Health Questionnaire (PHQ-2) screener. We assessed the perceived need and adequacy of 8 types of PPE and 10 different ICP. Regression analyses examined the proportion of GAD-2 and PHQ-2 scores of 3 and higher across levels of PPE and ICP, adjusted for a range of demographic, occupation, workplace, and COVID-19-specific measures. Results: A total of 54.8% (95% confidence interval [CI], 53.5% to 56.1%) of the sample had GAD-2 scores of 3 and higher, and 42.3% (95% CI, 41.0% to 43.6%) of the sample had PHQ-2 scores of 3 and higher. Absolute differences of 18% (95% CI, 12% to 23%) and 17% (95% CI, 12% to 22%) were observed in the prevalence of GAD-2 scores of 3 and higher between workers whose perceived PPE needs and ICP needs were met compared to those who needs were not met. Differences of between 11% (95% CI, 6% to 17%) and 19% (95% CI, 14% to 24%) were observed in PHQ-2 scores of 3 and higher across these same PPE and ICP categories. Conclusions: Our results suggest strengthening employer-based infection control strategies likely has important implications for the mental health symptoms among health-care workers in Canada.

This article applies to sport the question: to what extent is God involved in the outcomes of worldly affairs? It examines Lincoln Harvey’s assertion that sport is one unique area of creation in which God has left the outcomes entirely up to us, as a ‘liturgical celebration of our contingency’. Not entirely satisfied with this answer, I take up concepts from Kathryn Tanner’s work to try to arrive at a solution wherein God’s providential care over all worldly affairs is maintained but with sufficient care so as not to imagine God choosing one team over another during every sporting event.

This study examines the construct validity of the First-Year Inventory 2.0 with respect to other established instruments in a sample of high-risk infant siblings of children with Autism Spectrum Disorder. The First-Year Inventory 2.0 is a parent-report screening instrument designed to identify 12-month-old infants at risk for an eventual diagnosis of Autism Spectrum Disorder and consists of two domains: Social-Communication and Sensory-Regulatory. Although the First-Year Inventory 2.0’s screening psychometrics have been examined, its construct validity has not been investigated. In a sample of 112 high-risk 12-month-olds, we examined the First-Year Inventory 2.0’s associations with the Autism Observation Scale for Infants, an observer-based Autism Spectrum Disorder screener, and with other developmental instruments measuring similar areas in social communication and regulatory functioning in young children. Findings generally supported the First-Year Inventory 2.0 associations with other instruments in expected ways. The First-Year Inventory 2.0 Social-Communication domain was notably associated with the Autism Observation Scale for Infant’s total score and with language and communication domains of the Vineland and the Mullen. The Sensory-Regulatory domain showed minimal associations with other instruments that only had a few sensory items. Considering different objectives and strengths of assessments, researchers and clinicians are encouraged to utilize a variety of instruments in a comprehensive evaluation of a child. Lay abstract The First-Year Inventory 2.0 is a parent-report screening instrument designed to identify 12-month-old infants at risk for an eventual diagnosis of Autism Spectrum Disorder. This instrument focuses on Social-Communication and Sensory-Regulatory areas of infant behavior. Although the First-Year Inventory 2.0 screening performance has been previously studied, its validity has not been examined. Establishing validity of an instrument is important because it supports the effectiveness and the reliability of the instrument. In this study, we examined relationship between the First-Year Inventory 2.0 (Social-Communication and Sensory-Regulatory areas) and other instruments that measure similar areas of infant behavior in a sample of high-risk infant siblings of children with Autism Spectrum Disorder. These other instruments share some common aims and theoretical areas with the First-Year Inventory 2.0: the Autism Observation Scale for Infants, the Mullen Scales of Early Learning, the Vineland Adaptive Behavior Scales-II, and the Infant Behavior Questionnaire. Findings generally supported the validity of the First-Year Inventory 2.0 with other instruments. In particular, the Social-Communication area of the First-Year Inventory 2.0 showed greater commonality with other instruments than in the Sensory-Regulatory area. The Sensory-Regulatory area seemed to be a unique feature of the First-Year Inventory 2.0 instrument. Considering different aims and strengths of assessments, researchers and clinicians are encouraged to utilize a variety of instruments in a comprehensive evaluation of a child.

Criminal organizations, like legitimate organizations, adapt to shifts in markets, competition, regulations, and enforcement. Exogenous shocks can be consequential moments of power consolidation, resource hoarding, and inequality amplification in legitimate organizations, but especially in criminal organizations. This research examines how the exogenous shock of the U.S. prohibition of the production, transportation, and sale of alcohol in 1920 restructured power and inequality in Chicago organized crime. I analyze a unique relational database on organized crime from the early 1900s via a criminal network that tripled in size and centralized during Prohibition. Before Prohibition, Chicago organized crime was small, decentralized, and somewhat inclusive of women at the margins. However, during Prohibition, the organized crime network grew, consolidated the organizational elites, and left out the most vulnerable participants from the most profitable opportunities. This historical case illuminates how profits and organizational restructuring outside of (or in response to) regulatory environments can displace people at the margins.

Background: Students contribute to health care through clinical interventions made during rotations. Previous studies assessed student interventions through cost savings instead of student progression throughout the year. Objective: The purpose of this project is to assess clinical interventions made by student pharmacists completing internal medicine and critical care rotations during their Advanced Pharmacy Practice Experiences (APPE) year to determine whether there is a difference in the number and type of interventions between three 3-block rotations, rotation type, and participation in a concentrated learning experience. Methods: Student clinical interventions from 2013 to 2018 were collected. Interventions were organized into categories and subcategories. The primary end point was the difference in the number of interventions between rotation blocks 1 to 3, 4 to 6, and 7 to 9. Secondary objectives compared interventions based on rotation type and participation in a concentrated learning experience. Descriptive statistics and Fisher’s exact tests were conducted. Results: A total of 848 interventions were analyzed. Average student interventions were 39 in blocks 1 to 3, 18 in blocks 4 to 6, and 62 in blocks 7 to 9. Interventions were significantly above the median for students in blocks 1 to 3 and blocks 7 to 9 compared to blocks 4 to 6 ( P = .048 and P = .036), respectively. Interventions were significantly above the median for students completing critical care rotations ( P = .03). No significant difference was noted in the number of interventions above the median based on participation in a concentrated learning experience ( P = .34). Conclusions: Although a difference exists in the number of interventions made during 3 semesters, more research is needed to assess the relationship of rotation block, student program, and rotation type to intervention number.

African American and Hispanic students receive more punitive school discipline than White students even when students of color commit similar infractions as Whites. Similarly, students with a disability status are more likely to experience harsher discipline in schools compared to their counterparts without a disability label. This study examines whether these discrepancies are a result of a difference in the number of infractions students of different racial/ethnic groups and disability categories commit. Using secondary educational data from a state educational agency in the United States, we demonstrate that African American and Hispanic students and students with an emotional behavioral disorder status receive more severe sanctions than White students and students without a disability label at their first discipline encounter. This racial disparity in discipline severity continues through six sanctions and is eliminated at the 13th sanction. The disability disparity in discipline severity dissipates after 10 sanctions for students with emotional behavioral disorder and intellectual disability. Implications for school personnel and future directions are discussed.

Throughout history and across countries, women appear more likely than men to enter politics on the heels of a close family relative or spouse. To explain this dynastic bias in women’s representation, we introduce a theory that integrates political selection decisions with informational inequalities across social groups. Candidates with dynastic ties benefit from the established reputations of their predecessors, but these signals of quality are more important to political newcomers such as women. Legislator-level data from twelve democracies and candidate-level data from Ireland and Sweden support the idea that dynastic ties are differentially more helpful to women, and that the quality of predecessors may be more relevant for the entry and evaluation of female successors than their male counterparts. The role of informational inequalities is also reflected in the declining dynastic bias over time (as more women enter politics), and in the differential effect of a gender quota across Swedish municipalities.

Temperament is a construct that is relatively stable over time but varies between individuals. Research suggests that children with autism spectrum disorder have a ‘reactive’ temperament profile when compared to peers with or without disabilities. However, our understanding of how temperament varies within children with autism and how it relates to child symptoms and outcomes is limited. This study aimed to (a) explore the variation of individual temperament traits within a sample of school-aged children with autism to determine whether subgroups of children with similar trait profiles emerge and (b) examine whether temperament influences the relationship between autism symptoms and adaptive functioning outcomes. Results revealed that children with autism can be classified empirically into two distinct profiles – ‘Even’ and ‘Reactive’ temperaments. Correlational and hierarchical regression analyses indicated that both temperament profiles and baseline symptom severity predicted adaptive functioning outcomes 1 year later. There was a significant interaction between temperament and symptom severity, suggesting temperament can influence the impact of increasing symptom severity on adaptive functioning skills in children with autism. Study findings highlight the importance of considering temperament in understanding the individual differences that influence the development of daily functioning and developmental outcomes in children with autism. Lay Abstract Temperament is often thought of as behavioural traits that are relatively stable over time but can vary between individuals. Children diagnosed with autism spectrum disorder are often characterized as having ‘reactive’ and ‘negative’ temperaments when compared to same-aged peers with or without disabilities, which can negatively impact the development of adaptive functioning skills but little is known about variations of temperament between individual children diagnosed with autism spectrum disorder. This study aimed to (a) explore the variation of individual temperament traits within a sample of school-aged children with autism spectrum disorder to determine whether subgroups with similar trait profiles emerge and (b) examine whether temperament influences the relationship between autism symptoms and adaptive functioning outcomes. Results from our dataset suggest that children diagnosed with autism spectrum disorder fit under two profiles: ‘even’ and ‘reactive’. Furthermore, our analysis shows that temperament can influence the impact of increasing symptom severity on adaptive functioning skills in children with autism spectrum disorder. Study findings highlight the importance of considering temperament when trying to understand the individual differences that influence the development of functioning and developmental outcomes in children with autism spectrum disorder.

Objectives: By 2050, individuals aged 65 years and older will comprise over 20% of the American population. A portion is at risk for becoming elder orphans: older adults living in the community who lack caregivers or surrogates. Methods: Using the first wave of the National Health and Aging Trends Survey, we estimated the prevalence of older adults who reside in the community, who are socially or physically isolated, and who lack caregivers. Individuals who are “at risk” meet all of these criteria, with the exception that they live with and receive caregiving from their spouse. Results: We estimated the elder orphan prevalence for this population to be 2.62% (2.24–3.00), with an additional 21.29% determined to be at risk. Discussion: As the population of the United States ages, an understanding of the prevalence and demographics of elder orphans will be useful to guide policies and services to assist this population.

Objective(s): To describe a single institution’s experience with the use of steroid-eluting stents after endoscopic transnasal repair of choanal atresia. Methods: A case series with review of children who underwent choanal atresia repair at a tertiary children’s hospital from June 2017 to January 2018 was performed. Those who had a mometasone drug-eluting stent (Propel® Mini, Intersect ENT Inc., Palo Alto, CA) placed after primary or secondary choanal atresia repair at our institution were included. The primary outcome measure was need for revision surgery due to stenosis. Postoperative regimens, duration of stenting, and need for return to the operating room (OR) were also assessed. Results: Five patients with a median age of 22 months at the time of repair met inclusion criteria. Two (40%) had bilateral atresia and 3 (60%) had confirmed CHARGE syndrome. A total of 6 mometasone drug-eluting stents were used in the 5 cases. Three patients were reassessed at least once in the OR; however, the majority (57.1%) of postoperative evaluations were able to be performed in the office or bedside setting. The first and last evaluations occurred a mean of 14 and 124 days after surgery, respectively. There were no instances of restenosis, repeat surgical interventions, or stent-related complications noted. Conclusion: Placement of a mometasone drug-eluting stent is a promising method to improve postoperative results and management of choanal atresia repair by limiting the need for repeat anesthetics and OR procedures, as well as the complications of traditional stents.

Girls are increasingly becoming involved with the juvenile justice system; however, what brings girls to engage in delinquency or what obstacles these girls face later in life resulting from adolescent criminal behavior is understudied. In the present study, we used latent class analysis to identify subtypes of risks among adolescent girls ( N = 1,174) who have engaged in delinquent behaviors and mixture modeling to determine what distal psychological, social, educational, and economic outcomes in young adulthood are associated with each subtype. Four adolescent subtypes were identified, which were distinguished primarily based on the severity of their self-reported victimization experiences and mental health concerns. Classes with higher levels of victimization experiences tended to report more engagement with delinquent behavior in adolescence and had a larger proportion of Black and Hispanic girls than lower-victimization classes. Identified classes differed from each other on distal (i.e., young adulthood) measures of economic instability, educational attainment, drug use, depression, and adult arrests. Generally, latent classes which were characterized by higher rates of victimization and mental health concerns and lower educational performance in adolescence fared worse in young adulthood. Implications for those who care for girls who engage in delinquency, including suggestions for using trauma and culture informed screening, prevention, and intervention services, and directions for future research are discussed. Additional online materials for this article are available on PWQ’s website at http://journals.sagepub.com/doi/suppl/0361684320918243 .

Stay-at-home dads (SAHDs) have become more prevalent in today’s society. Despite these changes, there remains a paucity of research on the mental health needs of SAHDs. This qualitative study examined SAHDs’ social experiences and mental health needs. The research identified three themes: (1) becoming a SAHD, (2) being a SAHD at home, and (3) being a SAHD in society. Implications for mental health counseling practices and future areas of research are discussed.