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Objectives: We investigated coronavirus disease 2019 (COVID-19) opinions, experiences, and willingness to accept COVID-19 vaccination during pregnancy at two prenatal clinics in early 2021 and early 2022. Materials and Methods: Paper questionnaires were distributed to pregnant women at prenatal care facilities in Virginia and Florida between January and April 2021 and January and April 2022. Questions regarding acceptance and opinions of the influenza vaccine served as a baseline to assess COVID-19 vaccine opinions. Associations between demographic parameters and vaccine opinions and acceptance were examined using Chi-square. A COVID-19 concern score was constructed by principal component analysis with differences between groups assessed by analysis of variance (ANOVA) and analysis of covariance (ANCOVA). Results: Many participants (40.6%) reported that the COVID pandemic had affected their pregnancy. Main themes were problems with social networks, increased stress/anxiety, and being more cautious. In 2021, 19.5% reported they would accept a COVID-19 vaccination during their pregnancy, which increased to 45.8% in 2022. Vaccine hesitancy did not vary by race or between sites, but educational attainment was significant (p < 0.001). Women with a higher concern score were more likely to report they would accept a COVID-19 vaccine. Women who would accept COVID vaccination had a positive opinion regarding the influenza vaccine. Main themes for refusing COVID-19 vaccination were concerns about side effects, lack of research/data, and mistrust of vaccines. Conclusions: The proportion of women willing to accept COVID-19 vaccination increased but remained below 50%. Willingness to accept vaccination during pregnancy was associated with higher education, higher concern about COVID-19, and a positive opinion of the influenza vaccine. [ABSTRACT FROM AUTHOR]

The housing unit method of population estimation is often characterized as being imprecise and having an upward bias. In an earlier paper we argued that the method itself cannot be properly characterized by a particular level of precision or direction of bias. Only specific techniques of applying the method can have such characteristics. In that paper we presented several new techniques for estimating the number of households and average number of persons per household (PPH). However, the testing of these new techniques was limited by the lack of census results against which the estimates could be compared. Complete census data on population, households, and PPH are now available and can be used to test alternate estimation techniques. In this paper we replicate the tests reported in our earlier paper using 1980 census data for Florida's 67 counties. These tests provide further evidence that the new techniques produce more precise, less biased estimates than previously used techniques. [ABSTRACT FROM AUTHOR]

Marronage was an extreme form of anti-slavery resistance in the Americas, however, we should not isolate Maroons from others fighting to maintain autonomy in the colonial Americas. This paper undertakes a comparative analysis of three Florida sites – Bulow Plantation, an urban plantation in St. Augustine, and the Maroon settlement of Pilaklikaha – through the dual frameworks of resistance and ethnogenesis, with the purpose of placing Maroons within a regional context. Ultimately, the archaeological materials examined highlight the common experiences shared by Maroons and their enslaved peers, and emphasize the significant role played by opportunity in shaping African diasporic cultural transformations in the nineteenth century. [ABSTRACT FROM AUTHOR]

Depression is recognized as a significant public health issue in the United States. The National Survey on Drug Use and Health reports that 21.0 million adults aged 18 or older had major depressive disorder in 2020, including 14.8 million experiencing a major depressive episode with severe impairment. The aim is to predict the positivity of Patient Health Questionnaire-2 (PHQ-2) outcomes among patients in primary care settings by analyzing a range of variables, including socioeconomic status, demographic characteristics, and health behaviors, thereby identifying those at increased risk for depression. Employing a machine learning approach, the study utilizes retrospective data from electronic health records across 15 primary care clinics in South Florida to explore the relationship between social determinants of health (SDoH), including area of deprivation index (ADI) and PHQ-2 positivity. The study encompasses 15 primary care clinics located in South Florida, where a diverse patient population receives care. Analysis included 94,572 patient visits; 74,636 records were included in the study. If a zip+4 was not available or an ADI score did not exist, the visit was not included in the final analysis. Screening involved the PHQ-2, assessing depressed mood and anhedonia, with a cutoff >2 indicating positive screening. ADI was used to assess SDoH by matching patients' residential postal codes to ADI national percentiles. Demographics, sexual history, tobacco use, caffeine intake, and community involvement were also evaluated in the study. Over 40 machine learning algorithms were explored for their accuracy in predicting PHQ-2 outcomes, using software tools including Scikit-learn and stats models in Python. Variables were normalized, scored, and then subjected to predictive regression models, with Random Forest showing outstanding performance. Feature engineering and correlation analysis identified ADI, age, education, visit type, coffee intake, and marital status as significant predictors of PHQ-2 positivity. The area under the curve and model accuracies varied across clinics, with specific clinics showing higher predictive accuracy and others (p >.05). The study concludes that the ADI, as a proxy for SDoH, alongside other individual factors, can predict PHQ-2 positivity. Health organizations can use this information to anticipate health needs and resource allocation. [ABSTRACT FROM AUTHOR]

How do organizations that explicitly state the intention to be “positive impact companies” differ from traditional entrepreneurial companies? How does the quality of relationships in those companies affect the ability to deliver positive impact? This study explores the conditions under which business leaders turn their organizations toward generating prosperity for all stakeholders, achieving positive societal outcomes, improving human wellbeing, and delivering great business results. Seven case study companies are examined based on interviews with three executives from each firm, including the CEO. All seven companies are privately owned small/medium sized businesses from a cross section of industries and diverse geographic bases, ranging from Michigan to the Pacific Northwest, to Singapore, Egypt, and Florida. Four of the companies are considered “positive impact companies” (PICs) based on their organizational affiliations, while the other three are considered traditional entrepreneurial companies (TECs). The overall findings suggest that the core of positive impact leadership resides in a shift in the mindset of leaders toward one of connectedness and purpose, and that these factors influence the quality of relationships in organizations in a positive way whether the company is considered a PIC or a TEC. The results also suggest a close relationship between several core indicators of a fundamental shift in understanding about the role of business in society: shared values of human wellbeing, a common shared vision, an emphasis on collaboration and caring in organizations, and a long-term perspective toward the creation of shared economic prosperity. [ABSTRACT FROM AUTHOR]

Social support is widely seen as an integral component for coping with the stresses of everyday life. While there are various sources and types of support potentially available to young people, it is perhaps less obvious the extent to which young people differentially experience these sources and types. Anecdotal evidence suggests that context, culture and other factors unique to local life shape the many dimensions of social support for youth. In this paper, we seek to examine this research need in more detail by focusing on a broad range of factors shaping youth social support and youth well-being. Drawing on mixed methods research, we examine social support evidence for adolescents in Florida, USA, and Offaly, Ireland. Through this research, we investigate how the connection between social support and well-being bears out in these two different socio-cultural contexts; second, we seek to understand whether types and sources of social support differ among youth in both countries; and what relationship exists between well-being and types and sources of support. Comparing similar measures of social support across two distinct societal contexts allows us to determine similarities and differences, while also providing suggestions for application that can shape future programmes and policy. [ABSTRACT FROM AUTHOR]

The operational forecast demands and constraints of the National Hurricane Center require that a storm surge model in research mode be tested against a benchmark model such as Sea, Lake, and Overland Surges from Hurricanes (SLOSH) for accuracy, computation time, and numerical stability before the model is used for operational forecasts. Additionally, the simulated results must be in a geographic information system format to facilitate the usage of computed storm surge for various applications. This paper presents results from a demonstration project to explore the pathway for the transition of the Coastal and Estuarine Storm Tide (CEST) model to an operational forecast model by testing CEST over SLOSH basins in Florida. The performance and stability of CEST were examined by conducting simulations for Hurricane Andrew (1992) and more than 100 000 synthetic hurricanes for nine SLOSH basins covering the Florida coast and Lake Okeechobee. The results show that CEST produces peak surge heights similar to those from SLOSH. Additionally, CEST has proven to be numerically stable against all synthetic hurricanes and the computation time of CEST is comparable to that of SLOSH. Therefore, CEST has the potential to be used for operational forecasts of storm surge. The potential of producing more detailed real-time surge inundation forecasts was also investigated through the simulations of Andrew's surge on various grids with different cell sizes. The results indicate that CEST can produce 48-h forecasts using a single processor in about 40 min over a grid generated by reducing the cell edge size of the SLOSH grid by 4 times. [ABSTRACT FROM AUTHOR]

The important goals of Magnet® hospitals are to create supportive professional nursing care environments. A recently published paper found little difference in work environments between Magnet and non-Magnet hospitals. The aim of this study was to determine whether work environments, staffing, and nurse outcomes differ between Magnet and non-Magnet hospitals. A secondary analysis of data from a 4-state survey of 26,276 nurses in 567 acute care hospitals to evaluate differences in work environments and nurse outcomes in Magnet and non- Magnet hospitals was conducted. Magnet hospitals had significantly better work environments (t = -5.29, P < .001) and more highly educated nurses (t = -2.27, P < .001). Magnet hospital nurses were 18% less likely to be dissatisfied with their job (P <.05) and 13% less likely to report high burnout (P < .05). Magnet hospitals have significantly better work environments than non-Magnet hospitals. The better work environments of Magnet hospitals are associated with lower levels of nurse job dissatisfaction and burnout. [ABSTRACT FROM AUTHOR]

The housing unit method of population estimation is often characterized as being imprecise and having an upward bias. We believe that the method itself cannot properly be characterized by a particular level of precision or direction of bias. Only specific techniques of applying the method can have such characteristics. In this paper we discuss several new techniques we have developed for estimating households and the average number of persons per household. Estimates produced by these techniques are compared to estimates produced by several other techniques. Special census results from Florida provide preliminary evidence that the new techniques produce more precise, less biased estimates than the other techniques. [ABSTRACT FROM AUTHOR]

Previous studies have found Latinx cultural values to be positively associated with healthy behaviors. This study aims to examine socioeconomic and cultural correlates of alcohol use among Latinx adult men living in Miami-Dade County, Florida. The study sample included 122 Latinx adult men (mean age = 44, SD = 10), predominantly of South and Central American origin. Data was collected using REDCap. Interviews included the Timeline Follow-Back scale for alcohol use. Results indicate that Caribbean participants were significantly less likely to report drinking in the past 90 days (aOR = 0.08, p = 0.042) compared to their Venezuelan counterparts. Higher machismo scores were associated with low drinking frequency (aRR = 0.67, p = 0.043), while no significant associations were found between machismo and other drinking outcomes. Drinking quantity and frequency are significantly associated with higher income and authorized immigration status in the US among Latinx men in South Florida. Higher machismo scores were associated with low drinking frequency. [ABSTRACT FROM AUTHOR]

Aims: Chronic Toxoplasma gondii infection is not thought to affect pregnancy or birth outcomes, but there are few prospective studies. The study aims were T. gondii immunoglobulin G measurement and relationship of chronic T. gondii infection with gestational age at birth and adverse pregnancy outcomes in 690 Hispanic women in Tampa, Florida. Methods: Hispanic women, born either in the United States or in Latin America or the Caribbean had a venous blood sample drawn to measure T. gondii IgG and T. gondii serotype at the first prenatal visit, along with collection of demographic and health‐related measures. Seropositive and seronegative women were followed throughout their pregnancy. Gestational age, infant weights, and adverse pregnancy outcomes (miscarriages, preterm births) were compared in the two groups. Results: There were 740 women of self‐reported Hispanic ethnicity screened and enrolled in Tampa, Florida, with 690 having birth data extracted from the electronic health record (538 T. gondii negative and 152 T. gondii seropositive). T. gondii seropositivity was 22.4% and the majority (83%) had high avidity titers, indicating chronic infection. Compared to T. gondii seronegative Hispanic women, seroseropositive women had more smaller for gestational age infants and higher prevalences of miscarriages and preterm birth. Conclusion: This is one of the largest longitudinal cohort studies of women with chronic T. gondii infection followed through pregnancy. There was a higher percentages of adverse pregnancy outcomes in this group compared to T. gondii seronegative controls. The mechanism for this is unknown and warrants reexamination of the dogma that chronic T. gondii infection in pregnant women has no significant clinical consequences. [ABSTRACT FROM AUTHOR]

Background: Methicillin-resistant Staphylococcus aureus (MRSA) nasal screen identifies the presence of MRSA nasal colonization, which can be used as a valuable antimicrobial stewardship tool to de-escalate empiric vancomycin therapy in patients with pneumonia. Current practices at a Florida hospital include using respiratory culture and MRSA nasal screening results to assist in treating MRSA pneumonia infections. This study aimed to evaluate the total duration of vancomycin therapy in patients with suspected MRSA respiratory tract infections. Methods: This was a single-center, retrospective chart review conducted at a tertiary medical center. Adult patients were assigned to either the respiratory culture-directed group or the MRSA nasal screening-directed group. The primary outcome was the duration of vancomycin therapy, in hours, in patients who were started on vancomycin for suspected pneumonia. Secondary outcomes included new onset acute kidney injury, length of stay, 30-day in-hospital mortality, number of vancomycin levels obtained, cost-avoidance analysis, and duration of mupirocin therapy before MRSA nasal screening. Results: Thirty-four patients were evaluated in the culture-directed group and 56 in the MRSA nasal screen-directed group (N = 90). The MRSA nasal screen-directed cohort had a statistically significant reduction in the duration of vancomycin therapy compared to the culture-directed group (24 vs. 94 hours; p < .00001). Discussion: The empiric vancomycin therapy duration was significantly lower in the MRSA nasal screen cohort compared to the respiratory culture cohort. Hospitals could have a beneficial, cost-saving impact by utilizing MRSA nasal screening for patients with a lower respiratory tract infection. [ABSTRACT FROM AUTHOR]

Aims: In recent years, studies have indicated that consumers of alcohol mixed with energy drink (AmED) are more likely to drink heavily and experience more negative consequences than consumers who avoid these beverages. Although researchers have identified a number of plausible hypotheses that explain how alcohol-energy drink co-ingestion could cause greater alcohol consumption, there has been no postulation about reverse causal relations. This paper identifies several plausible hypotheses for the observed associations between AmED consumption and greater alcohol consumption, and provides initial evidence for one such hypothesis suggesting that heavy drinking may be a determinant of AmED use.Method: Data collected from 511bar patrons were used to examine the plausibility of one of the proposed hypotheses, i.e., AmED is an artifact of heavy drinking. Associations between the consumption of an assortment of alcoholic beverage types and total alcohol consumption were examined at the event-level, to assess whether AmED is uniquely related with greater alcohol consumption.Results: Increased alcohol consumption was associated with greater odds of consuming most alcoholic beverage types; this association was not unique to AmED.Conclusions: Results support the overlooked hypothesis that AmED use is an artifact of heavy drinking. Thus, AmED consumption may be a consequence or marker of heavier drinking. Much of the existing research on alcoholic beverage types is limited in its ability to implicate any specific type of drink, including AmED, as a cause of increased alcohol consumption and related harm. More rigorous study designs are needed to examine causal relationships. [ABSTRACT FROM AUTHOR]

Introduction: Technology has transformed our lifestyles in dramatic and significant ways, including new and less expensive options for recruiting study participants. This study examines cost and participant differences between two recruitment sources, Craigslist (CL), and print newspapers (PNs). This paper also reviewed and compared studies involving clinical trials published since 2010 that recruited participants using CL alone or in combination with other methods.Method: Secondary data analyses from a parent study involving a randomized controlled trial of a mail-based intervention to promote self-change with problem drinkers.Results: Significant differences were found between CL and PN participants on most demographic and pretreatment drinking variables. While all participants had AUDIT scores suggestive of an alcohol problem and reported drinking at high-risk levels, CL participants had less severe drinking problem histories, were considerably younger, and had a higher socioeconomic status than PN participants. The total advertising costs for the 65 CL ads ($275) were significantly less than the 69 PN ads ($33, 311). The recruiting cost per eligible participant was vastly less expensive using CL ($1.46) compared to print newspaper ads ($116.88).Conclusions: Using CL is a viable recruitment method for soliciting participants, particularly those that are younger, for alcohol intervention studies. It is also less expensive than newspaper ads. When CL participants were recruited, they reported being slightly more confident to change their drinking than PN participants. Limitations of using CL are discussed, including that some initial ad responders gave inconsistent answers to similar questions and a few tried to enter the study more than once. [ABSTRACT FROM AUTHOR]

Abstract: In this paper, the preliminary breakdown (PB) pulse train preceding the negative first return stroke (RS) is recorded using a broad band antenna system. These analyses were carried out in Johor Bahru, Malaysia and Florida, United States. This is a novel initiative at examining and identifying the characteristics of the PB pulse trains in the negative cloud-to-ground flashes observed in Malaysia. The arithmetic mean of the total pulse train duration is 12.3ms and the weighted arithmetic mean of the pulse durations and interpulse intervals are 11μs and 152μs, respectively. The arithmetic mean ratio between the maximum peak amplitude of the PB pulse and the peak RS electric field was 27.8%, and the corresponding value in Florida was 29.4%. The arithmetic mean of the time duration between the most active part of the pulse train, and the RS was 57.6ms in Malaysia and 22ms in Florida. A qualitative comparison of our results with those obtained earlier in Sri Lanka, Sweden and Finland supports the hypothesis that the PBP/RS ratio is higher in the northern regions compared to the tropical regions. [Copyright &y& Elsevier]

Abstract: A diverse array of spatial optimization models dealing with protection, service, coverage, equity, and risk can potentially aid with the effective placement of critical assets. Protection of assets can be enhanced using the p-dispersion model, which locates facilities to maximize the minimum distance between any two. Dispersion, however, is rarely the only objective for a system of facilities, and the p-dispersion model is known to be difficult to solve. Therefore, this paper analyzes the trade-offs and computational times of four multi-objective models that combine the p-dispersion model with other facility location objectives relevant to siting critical assets, such as the p-median, max-cover, p-center, and p-maxian models. The multi-objective models are tested on a case study of Orlando, Florida. The dispersion/center model produced the most gradual trade-off curve, while the dispersion/maxian trade-off curve had the most pronounced “elbow.” The center and median multi-objective models were far more computationally demanding than the models using max cover and p-maxian. These findings may inform decision-makers and researchers in deciding what type of multi-objective models to use for planning dispersed networks of critical assets. [Copyright &y& Elsevier]

Abstract: This paper discusses the results of high frequency earthing impedance measurements made on the earthing systems installed at Camp Blanding, Florida. Much of the initial information used to confirm the results obtained from high frequency earthing impedance testers is based on comparison of measured data from specifically designed earthing systems with simulations of the expected response of the grounding system. More recently, testing using devices injecting a surge current into a grounding system was compared with earthing impedance testers measuring selected frequencies of up to 1MHz. It was found that these devices yielded similar results. The impedance measurements at Camp Blanding were compared with currents measured during triggered lightning testing conducted in 2004 and 2005. Even though the dry porous sand at the site made the measurements difficult and the earthing impedance measurements were made four years and longer after system installation and current measurements, correlation was also found between the measured impedance and the measured current distribution. [Copyright &y& Elsevier]

This study describes predictors of secondary traumatic stress and burnout in a national sample of helping professionals, with a specific focus on the unique responses of child welfare (CW) workers. Specific worker and exposure characteristics are examined as possible predictors of these forms of occupational distress in a sample of 669 professionals from across the country who responded to mailed (e-mail and post) invitations to participate in an online survey. Email and home mailing addresses were secured from licensure boards and professional membership organizations in six states from across the country that had high rates of child related deaths in 2009. Respondents completed the Professional Quality of Life IV (Stamm, 2005) to ascertain compassion fatigue (CF) and burnout symptoms. Being male, young, Hispanic, holding rural residence, and endorsing a lack of religious participation were significant predictors of secondary traumatic stress. Similarly, being male and young predicted high burnout rates, while actively participating in religious services predicted lower burnout. CW worker job status as a professional was significantly more likely to predict CF and burnout compared to all other types of behavioral healthcare professionals. Based on the findings from this study, this paper proposes strategies for enhancing self-care for CW workers, and describes the essential elements of a trauma-informed CW agency that addresses secondary traumatic stress and burnout. [ABSTRACT FROM AUTHOR]

Summary: This paper presents the development of expert system related models using the concepts of Geno-Kalman Filtering (GKF) and fuzzy logic to predict the concentration of total suspended solids (TSS) with the input of wind speed at the locations of Cat Point and Dry Bar in Apalachicola Bay, USA. The TSS and wind speed data recorded from June 1, 2005 to July 30, 2005 are used for the present modeling study. Data set is divided into two parts for the model development. The June data are selected for calibration and the July data are for model verification. The predicted TSS concentrations from the Geno-Kalman Filtering and fuzzy logic models are compared with those from a hydrodynamic model and measured data reported in . The statistical values in terms of the mean squared error (MSE), the coefficient of efficiency (CE) and the chi-square (χ 2) parameter between the observed data and predicted results for the evaluation of each model’s performance are presented. It is noted that both the hydrodynamic and Geno-Kalman Filtering models are capable of predicting TSS concentration with the trend of dynamic variation. Although the fuzzy logic and the Geno-Kalman Filtering models outperform the hydrodynamic model, the Geno-Kalman Filtering model is found to be able to produce the most accurate results at the studied locations. The fuzzy logic model tends to under-predict the TSS concentrations. [ABSTRACT FROM AUTHOR]

Abstract: During landfall of Hurricane Ivan on the Florida ’panhandle’ in 2004, pressure time-history data were recorded on multiple pressure sensors installed on the roofs of six single-family homes. An analysis approach was developed to determine the peak negative, mean, peak positive, and standard deviation of pressure coefficients for these datasets. This paper presents a comparison of the full scale pressure coefficients from one of these homes, which experienced sustained hurricane force winds, with the results of wind tunnel experiments on a 1:50 scale model of that home. It was determined that the wind tunnel and full-scale mean and rms pressure coefficients matched very closely at almost every monitored location on the roof, while the peak negative pressure coefficients in the wind tunnel study generally underestimated the full-scale values, consistent with observations from previous full-scale/wind tunnel comparative studies. Field-measured hurricane wind loads may prove useful for evaluating existing wind load provisions. However, recommendations in that regard are premature without the analyses of multiple homes in multiple storms, performed by more than one wind tunnel facility. Future work will focus on building such a joint study. [Copyright &y& Elsevier]

Introduction: Wor kplace incivility and bullying ar e concer ning issues in healthcar e with detrimental consequences for healthcare workers (HCW) and healthcare organizations. Organizational leaders' recognition of incivility/bullying within healthcare organizations, and their sources, is imperative to prevent and/or address issues by creating "zero tolerance" work environments. The purpose of this cross-sectional, descriptive study was to explore HCWs' experiences with incivility and bullying at a South Florida community hospital. Methods: A convenience sample of HCWs at a South Florida community hospital were recruited to voluntarily complete the Nursing Incivility Scale. Results: A sample of 325 HCWs responded to the survey. The results showed general incivility as the highest source across all HCWs, with certified nursing assistants having the highest level of incivility across all sources (general, nurse, supervisor, physician, and patients). Correlative analysis showed statistically significant relationships between a) several sources of incivility (general, supervisor, physician, and patient; r = .250 to .390) for those reporting past experiences with incivility/bullying, and b) healthcare role and physician incivility (r = -.224). Independent t tests and one-way ANOVA showed statistically significant differences. Of note, compared to other HCW roles, registered nurses reported physicians as their highest source of incivility. Discussion: Workplace incivility/bullying is a serious issue in healthcare across all disciplines and roles, requiring healthcare organization leaders' awareness and subsequent interventions to prevent and address its occurrence. The results of this study provide necessary insight for hospital organization leaders as they endeavor to create and nurture "zero tolerance" work environments. [ABSTRACT FROM AUTHOR]

We investigate the association between nativity status (U.S.- vs foreignborn) and viral suppression among women of color (WOC) with HIV (HIV +) and whether this association was modified by education and housing. Methods: Data were from 549 HIV + WOC, who participated in the Health Resources and Services Administration-funded WOC Initiative 2009–2013. We used generalized estimating equation models to quantify the association between the respondents' nativity status and viral suppression. Results: After adjusting for covariates, foreign-born WOC were 2.2 times (95% confidence interval: 1.25, 3.85) more likely to achieve viral suppression than U.S.-born WOC. This association was not modified by education or housing status. Conclusions: Despite facing barriers to care, foreign-born WOC were more likely to achieve viral suppression than U.S.-born WOC. Programs aiming to end the HIV epidemic and reduce HIV disparities in the U.S. should consider these findings as they provide a more nuanced understanding of HIV + WOC. [ABSTRACT FROM AUTHOR]

Aim: Opioid misuse is a severe threat to justice-involved children and adolescents. Identifying risk factors and sex differences is critical to design accurate risk assessments and person-centered interventions. Stress theory and research posit that abuse may be linked to opioid misuse, and the consequences may be harsher for females. The study tests the hypothesis that physical and sexual abuse will individually and cumulatively increase the risk for opioid misuse, and females will have a higher risk than males. Methods: A statewide sample of 79,960 justice-involved children in Florida were examined. Opioid misuse, illicit and non-medical use, was measured by urine analysis or self-disclosure within the past-30 days. Bivariate and multivariate logistic regression analyses were employed. Marginal effects were estimated to investigate the interaction between abuse and sex. Results: Over 2000 youth met the criteria for opioid misuse. One-third of female opioid users experienced both physical and sexual abuse. Compared to those with no history of physical or sexual abuse, those who were physically abused had 43% higher odds of opioid misuse, those who were sexually abuse had 78% higher odds, and those who experienced both had twice as high odds of opioid misuse. The individual and combined effects of these abuse types were higher for females. For example, female youth who were sexually abused had 2.7-times higher odds of opioid misuse than males who were sexually abused. Conclusion: Intervention efforts can be improved by integrating physical and sexual abuse into risk assessments and tailoring assessments by sex. [ABSTRACT FROM AUTHOR]

Objective: Disparities in type 1 diabetes related to use of technologies like continuous glucose monitors (CGMs) and utilization of diabetes care are pronounced based on socioeconomic status (SES), race, and ethnicity. However, systematic reports of perspectives from patients in vulnerable communities regarding barriers are limited.Research Design and Methods: To better understand barriers, focus groups were conducted in Florida and California with adults ≥18 years old with type 1 diabetes with selection criteria including hospitalization for diabetic ketoacidosis, HbA1c >9%, and/or receiving care at a Federally Qualified Health Center. Sixteen focus groups were conducted in English or Spanish with 86 adults (mean age 42 ± 16.2 years). Transcript themes and pre-focus group demographic survey data were analyzed. In order of frequency, barriers to diabetes technology and endocrinology care included 1) provider level (negative provider encounters), 2) system level (financial coverage), and 3) individual level (preferences).Results: Over 50% of participants had not seen an endocrinologist in the past year or were only seen once including during hospital visits. In Florida, there was less technology use overall (38% used CGMs in FL and 63% in CA; 43% used pumps in FL and 69% in CA) and significant differences in pump use by SES (P = 0.02 in FL; P = 0.08 in CA) and race/ethnicity (P = 0.01 in FL; P = 0.80 in CA). In California, there were significant differences in CGM use by race/ethnicity (P = 0.05 in CA; P = 0.56 in FL) and education level (P = 0.02 in CA; P = 0.90 in FL).Conclusions: These findings provide novel insights into the experiences of vulnerable communities and demonstrate the need for multilevel interventions aimed at offsetting disparities in diabetes. [ABSTRACT FROM AUTHOR]

Purpose: Patients are frequently asked to share their personal health information. The objective of this study was to compare the effects on patient experiences of 3 electronic consent (e-consent) versions asking patients to share their health records for research.Methods: A multi-arm randomized controlled trial was conducted from November 2017 through November 2018. Adult patients (n = 734) were recruited from 4 family medicine clinics in Florida. Using a tablet computer, participants were randomized to (1) a standard e-consent (standard), (2) an e-consent containing standard information plus hyperlinks to additional interactive details (interactive), or (3) an e-consent containing standard information, interactive hyperlinks, and factual messages about data protections and researcher training (trust-enhanced). Satisfaction (1 to 5), subjective understanding (0 to 100), and other outcomes were measured immediately, at 1 week, and at 6 months.Results: A majority of participants (94%) consented to future uses of their health record information for research. No differences in study outcomes between versions were observed at immediate or 1-week follow-up. At 6-month follow-up, compared with the standard e-consent, participants who used the interactive e-consent reported greater satisfaction (B = 0.43; SE = 0.09; P <.001) and subjective understanding (B = 18.04; SE = 2.58; P <.001). At 6-month follow-up, compared with the interactive e-consent, participants who used the trust-enhanced e-consent reported greater satisfaction (B = 0.9; SE = 1.0; P <.001) and subjective understanding (B = 32.2; SE = 2.6, P <.001).Conclusions: Patients who used e-consents with interactive research details and trust-enhancing messages reported higher satisfaction and understanding at 6-month follow-up. Research institutions should consider developing and further validating e-consents that interactively deliver information beyond that required by federal regulations, including facts that may enhance patient trust in research. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to describe emergency commitment of residents from nursing homes and to discuss relevant policy issues. Design and Methods: This study used statewide, archival emergency commitment data from July 2000 through June 2008. These data are created by entering data from paper emergency commitment initiation forms of law enforcement, mental health professionals, and judges submitted by facilities as required by Florida law. Results: During the 1 year from July 2007 through June 2008 there were 898 residents of Florida nursing homes with a total of 1032 emergency commitments. Some individuals had more than one emergency commitment from a nursing home during the year, with 9% having between two and five emergency commitments. One-third of the emergency commitments were for residents younger than 65. Some of these individuals also had substantial numbers of emergency commitments in the 7 years from July 2000 through June 2007. Implications: There are facility, client, and regulatory factors that can be addressed to reduce the inappropriate usage of emergency commitments in nursing homes. [Copyright &y& Elsevier]

Background: Hepatitis B (HBV), the leading cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects minorities in the USA. Undiagnosed HBV precludes HCC screening and contributes to late-stage cancer presentation and decreased survival. Barriers to HBV and HCC screening include lack of insurance and limited diffusion of guidelines. We aimed to assess knowledge about HBV and HCC screening indications and explore barriers to screening.Methods: We surveyed trainees from the University of Miami/Jackson Memorial Hospitals, Palmetto General Hospital, and Mount Sinai Medical Center. We assessed knowledge using clinical vignettes. We performed bivariate and Chi-squared analyses.Results: There were 183 respondents; median age was 31 and 52% were male. The sample was 35% Hispanic, 29% White, 18% Asian, and 9% Black. Training department was Internal Medicine, 71%; Family Medicine, 11%; Infectious Diseases, 6%; or Gastroenterology, 7%. Only 59% correctly estimated national HBV prevalence; 25% correctly estimated global prevalence. In vignettes with behavioral risk factors, trainees correctly advised screening, 63-96%. However, when the risk factor was the birthplace, correct responses ranged from 33 to 53%. Overall, 45% chose an incorrect combination of HBV screening tests. Perceived barriers to screening included limited expertise in screening of immigrants and limited patient education. Respondents were more likely to recommend HCC screening in cirrhotic patients versus non-cirrhotic HBV patients. Key barriers to HCC screening included uncertainty about HCC guidelines and patient financial barriers.Conclusions: Knowledge of HBV and HCC screening recommendations is suboptimal among trainees. Efforts to broadly disseminate HBV and HCC guidelines through targeted educational interventions are needed. [ABSTRACT FROM AUTHOR]

Purpose: In designing a Project ECHO™ type 1 diabetes (T1D) program in Florida and California, the Neighborhood Deprivation Index (NDI) was used in conjunction with geocoding of primary care providers (PCPs) and endocrinologists in each state to concurrently identify areas with low endocrinology provider density and high health risk/poverty areas. The NDI measures many aspects of poverty proven to be critical indicators of health outcomes.Methods: The data from the 2013-2017 American Community Survey (ACS) 5-year estimates were used to create NDI maps for California and Florida. In addition, geocoding and 30-minute drive-time buffers were performed using publicly available provider directories for PCPs and endocrinologists in both states by Google Geocoding API and the TravelTime Search Application Programming Interface (API).Results: Based on these findings, we defined high-need catchment areas as areas with (1) more than a 30-minute drive to the nearest endocrinologist but within a 30-minute drive to the nearest PCP; (2) an NDI in the highest quartile; and (3) a population above the median (5199 for census tracts, and 1394 for census block groups). Out of the 12 181 census tracts and 34 490 census block groups in California and Florida, we identified 57 tracts and 215 block groups meeting these criteria as high-need catchment areas.Conclusion: Geospatial analysis provides an important initial methodologic step to effectively focus outreach efforts in diabetes program development. The integration of the NDI with geocoded provider directories enables more cost-effective and targeted interventions to reach the most vulnerable populations living with T1D. [ABSTRACT FROM AUTHOR]

Introduction and Aims: People with opioid use disorder are prevalent in criminal problem-solving courts and dependency courts, which have rehabilitative aims. Medication for opioid use disorder (MOUD) is the standard of care. Court staff set treatment policies for court clients. They may receive training from MOUD manufacturers, but no studies have examined court staff receipt of such training.Design and Methods: To examine receipt of training from MOUD manufacturers, we designed a cross-sectional survey for court staff. We distributed it online to all Florida court staff in criminal problem-solving or dependency courts (n = 585). Outcome variables were receipt of training from one or more MOUD manufacturers and training source. Covariates included dichotomous measures of court type, staff role, gender and rurality. Logistic regression models estimated the relationship between receipt of training and covariates.Results: Twenty-one percent of Florida criminal problem-solving and dependency court staff completed the survey. The most common receipt of training was from the manufacturer of extended-release naltrexone (36%), followed by buprenorphine (24%) and methadone (11%). Fifty-seven percent of those who received training received it from more than one MOUD manufacturer. Criminal problem-solving court staff were more likely than dependency court staff to receive training from MOUD manufacturers. Court program co-ordinators were more likely than other staff roles to receive training from MOUD manufacturers.Discussion and Conclusions: A large minority of respondents received training from a MOUD manufacturer, primarily from extended-release naltrexone's manufacturer, raising concerns regarding information accuracy and conflicts of interest. Court staff should seek MOUD training from academic institutions and non-profit organisations instead. [ABSTRACT FROM AUTHOR]

BACKGROUND: Transgender adolescents are at increased risk for negative sexual health outcomes compared to their cisgender peers. METHODS: Using data from 10,231 students from 7 high schools in a large, urban school district, our analysis compared sexual behaviors, referral to sexual health services by school staff, and use of sexual health services between transgender and cisgender students. We used propensity score matching to create a comparable sample of transgender and cisgender students and logistic regression models to examine how gender identity was associated with aforementioned outcomes. RESULTS: Transgender students were more likely to have ever had sex, less likely to have used a condom at last sex, and more likely to have been referred for human immunodeficiency virus (HIV) testing, sexually transmitted disease (STD) testing, and other sexual health services than cisgender students. Transgender students were no more likely than cisgender students to have tested for HIV or STDs. CONCLUSIONS: These findings underscore the need for understanding the risk perceptions held by transgender students and for prevention efforts that are inclusive for all gender identities. Research is needed to understand if school‐based sexual health interventions such as staff referrals for sexual health services are effective for transgender students. [ABSTRACT FROM AUTHOR]

Objective: The purpose was to compare nurse education, patient‐to‐nurse staffing, nursing skill mix, and nurse work environments across hospitals depending on extent of rurality. Design: Cross‐sectional, comparative, and descriptive. Sample: The final sample included 566 urban, 49 large, 18 small, and 9 isolated hospitals from California, Florida, and Pennsylvania. Measurement: Data collected from large random samples from the 2005–2008 Multi‐State Nursing Care and Patient Safety Study funded by the National Institute of Nursing Research and National Institutes of Health were linked to 2005–2006 American Hospital Association data. Rural–Urban Commuting Area codes developed by the University of Washington and the United States Department of Agriculture Economic Research Service were used to determine the extent of hospital rurality across the sample. Results: Hospital percentages of baccalaureate prepared nurses differed significantly among urban (38%), large (28%), small (31%), and isolated rural hospitals (21%). Patient‐to‐registered nurse ratios in urban (4.8), large (5.6), small (5.6), and isolated rural hospitals (7.3) differed. Rural hospital nursing skill mix differed, and was lowest in isolated rural hospitals (65%). Nursing foundations for quality care were poorer in large, small, and isolated rural hospitals. Conclusion: Results support bolstering rural nursing resources in more remote locations, potentially through rural health policies. [ABSTRACT FROM AUTHOR]

This study examined the association between generalized anxiety disorder (GAD) symptoms and healthcare utilization (HCU) among 801 people living with HIV (PLWH). Participants recruited from community health centers in Florida completed questionnaires assessing demographics, substance use, symptoms of GAD and depression, and HCU. Adjusted binary and multinomial logistic regressions assessed the association between moderate-severe GAD symptoms and past 6-month missed HIV-care appointments, overnight hospitalization, and emergency department (ED)/urgent care visits. Participants reporting moderate-severe GAD symptoms had a greater odds of missing an HIV-care appointment (AOR 2.03, 95% CI 1.28–3.24, p = 0.003), spending 2 (AOR 4.35, 95% CI 2.18–8.69, p < 0.001) or 3+ (AOR 2.79, 95% CI 1.20–6.45, p = 0.016) nights in the hospital, and visiting an ED/urgent care facility 2 (AOR 2.63, 95% CI 1.39–4.96, p = 0.003) or 3+ (AOR 2.59, 95% CI 1.27–5.26 p = 0.008) times compared to participants reporting none-mild anxiety. Depression was associated with fewer ED/urgent care visits and overnight hospitalizations, while no association was found with missed primary care appointments. The role of anxiety in illness management remains understudied among PLWH. Anxiety identification and the development of interventions for anxiety among PLWH may have important consequences for healthcare cost saving, patient retention in care, and HIV-disease management. [ABSTRACT FROM AUTHOR]

Objective To estimate the effect of a patient-centered medical home (PCMH) intervention on asthma-related emergency room (ER) visits of pediatric patients. Methods Patients receiving care at pediatric primary care practices participating in the Florida Pediatric Medical Home Demonstration Project as well as pediatric patients treated at non-participating clinics were identified from 4 years of claims and enrollment data. We estimate several fixed effects logistic regression models using one pre-treatment year and three post-treatment years to investigate whether asthma-related ER visits decreased because of the PCMH intervention. Results The estimation suggests that the intervention did have a negative effect on asthma-related ER visits in the earlier part of the intervention (OR 0.34; 95% CI 0.16-0.73). However, this effect was not detected in the later years. Because fixed effects models require repeated observations on the same individual, we believe our estimations of the PCMH model's impact is more accurate than previous studies. Conclusion for Practice Reducing asthma ER visits is a task that might be immediately actionable for PCMH practices, or those undergoing transformation. Our results adds to the others suggesting positive impacts of the PCMH. [ABSTRACT FROM AUTHOR]

Mobile Integrated Healthcare (MIH) is a patient-centered, innovative delivery model offering on-demand, needs-based care and preventive services, delivered in the patient's home or mobile environment. An interprofessional MIH clinical team delivered a care coordination program for a Medicare Advantage Preferred Provider Organization that was risk assigned prior to intervention to target the highest risk members. Using claims and eligibility data, 6 months of pre-program experience and 6 months of program-influenced experience from the intervention cohort was compared to a propensity score–matched comparison cohort to measure impact. The intervention led to a reduction in inpatient and emergency department utilization, resulting in net savings amount totals of $2.4 million over the 6 months of the program. After accounting for the costs of implementing the program, the intervention produced a return on investment of 2.97. Additionally, high patient activation and experience lend strength to this MIH intervention as a promising model to reduce utilization and costs while keeping patient satisfaction high. [ABSTRACT FROM AUTHOR]

Background: Surgical education relies heavily upon simulation. Assessment tools include robotic simulator assessments and Global Evaluative Assessment of Robotic Skills (GEARS) metrics, which have been validated. Training programs use GEARS for proficiency testing; however, it requires a trained human evaluator. Due to limited time, learners are reliant on surgical simulator feedback to improve their skills. GEARS and simulator scores have been shown to be correlated but in what capacity is unknown. Our goal is to develop a model for predicting GEARS score using simulator metrics.Methods: Linear and multivariate logistic regressions were used on previously reported data by this group. Subjects performed simple (Ring and Rail 1) and complex (Suture Sponge 1) tasks on simulators, the dV-Trainer (dVT) and the da Vinci Skills Simulator (dVSS). They were scored via simulator metrics and GEARS.Results: A linear model for each simulator and exercise showed a positive linear correlation. Equations were developed for predicting GEARS Total Score from simulator Overall Score. Next, the effects of each individual simulator metric on the GEARS Total Score for each simulator and exercise were examined. On the dVSS, Excessive Instrument Force was significant for Ring and Rail 1 and Instrument Collision was significant for Suture Sponge 1. On the dVT, Time to Complete was significant for both exercises. Once the significant variables were identified, multivariate models were generated. Comparing the predicted GEARS Total Score from the linear model (using only simulator Overall Score) to that using the multivariate model (using the significant variables for each simulator and exercise), the results were similar.Conclusions: Our results suggest that trainees can use simulator Overall Score to predict GEARS Total Score using our linear regression equations. This can improve the training process for those preparing for high-stakes assessments. [ABSTRACT FROM AUTHOR]

Objective: To evaluate relationships between hair cortisol levels and perceived stress in mothers who deliver preterm and term. We hypothesized that the rate of change in cortisol levels would be greater in the preterm delivery group. Methods: This preliminary study compared hair cortisol levels and Perceived Stress Scale (PSS) scores in predominately Caucasian mothers who delivered preterm (n = 22) and term (n = 30). We collected PSS and hair samples of ≥10 cm in length from mothers after delivery. Hair was segmented into three sections, and cortisol was measured using enzyme-linked immunosorbent assay. Results: The mean gestational age was 31.45 (SD = 4.2) weeks for preterm deliveries and 39.45 (SD = 1.1) for term. Cortisol differed significantly in the third trimester between mothers delivering term and preterm (t = 2.16, df = 48, p = .04) and trended toward significance in the second trimester (t = 1.88, df = 48, p = .06). PSS differed significantly between the two groups (t = −2.96, df = 50, p = .05). Our data did not provide support for our hypothesis. Conclusion: There appeared to be a blunted, flattened pattern of change in cortisol levels across gestation in the women who delivered preterm, suggesting diminished hypothalamic–pituitary–adrenal axis responsiveness in mechanisms that promote preterm labor. Future studies are needed to further evaluate best strategies for measuring the mechanisms of allostatic load during pregnancy along with the psychoneuroendocrine and immune triggers and placental responses that lead to premature birth. [ABSTRACT FROM AUTHOR]

Objectives: To determine how frequently patients revisit the emergency department after an initial encounter, and to describe revisit capture rates for the same hospital, health system, and geographic region.Data Sources/study Setting: Florida state data from January 1, 2010, to June 30, 2011, from the Healthcare Cost and Utilization Project.Study Design: This is a retrospective cohort study of emergency department return visits among Florida adults over an 18-month period. We evaluated pairs of index and 30-day return emergency department visits and compared capture rates for hospital, health system, and geographic units.Data Collection/extraction Methods: Data were obtained from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project and the American Hospital Association Annual Survey Database.Principal Findings: Among 9,416,212 emergency department visits, 22.6 percent (2,124,441) were associated with a 30-day return. Seventy percent (1,477,772) of 30-day returns occurred to the same hospital. The 30-day return capture rates were highest within the same geographic area: county-level capture at 92 percent (IQR=86-96 percent) versus health system capture at 75 percent (IQR = 68-81 percent).Conclusions: Acute care utilization patterns are often independent of health system boundaries. Current population-based health care models that attribute patients to a single provider or health system may be strengthened by considering geographic patterns of acute care utilization. [ABSTRACT FROM AUTHOR]

Background: Obesity is common among individuals with COPD and associated with increased COPD morbidities. However, little is known about the impact of weight reduction on COPD-related outcomes in patients who are obese.Methods: Using the population-based ED and inpatient sample in three US states (California, Florida, and Nebraska), we performed a self-controlled case series study of 481 adults who were obese (40-65 years of age) with COPD who underwent bariatric surgery. The primary outcome was an ED visit or hospitalization for acute exacerbation of COPD (AECOPD) from 2005 through 2011. We compared each patient's risk of the outcome during sequential 12-month periods using presurgery months 13 through 24 as the reference period.Results: During the 13 to 24 months before bariatric surgery (ie, reference period), 28% (95% CI, 24%-32%) of patients had an ED visit or hospitalization for AECOPD. In the subsequent 12-month presurgery period, the risk did not change materially (31%; 95% CI, 27%-35%), with an adjusted OR (aOR) of 1.16 (95% CI, 0.88-1.53; P = .29). By contrast, during the first 12 months after bariatric surgery, the risk declined significantly (12%; 95% CI, 9%-15%; aOR, 0.35; 95% CI, 0.25-0.49; P < .001). Likewise, in the subsequent period of 13 to 24 months after bariatric surgery, the risk remained significantly low (13%; 95% CI, 11%-17%; aOR, 0.39; 95% CI, 0.28-0.55; P < .001).Conclusions: The risk of an ED visit or hospitalization for AECOPD substantially decreased after bariatric surgery in patients who are obese. This observation suggests the effectiveness of substantial weight reduction on COPD morbidity. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of implementation of the Statewide Medicaid Managed Care (SMMC) program in Florida on access to and quality of primary care for Medicaid enrollees, measured by hospitalizations for ambulatory care sensitive conditions (ACSCs).Data Sources: We examine inpatient data obtained from the Agency for Health Care Administration for 285 hospitals in Florida from January 2010 to June 2015. The analysis includes 3,645,515 discharges for Florida residents between the ages 18 and 64 with a primary payer of Medicaid or private insurance.Study Design: We use a difference-in-differences approach, comparing the change in the incidence of ACSC-related inpatient visits among Medicaid patients before and after the implementation of SMMC, relative to the change among the privately insured.Principal Findings: After implementation of SMMC, Medicaid patients experienced a 0.35 percentage point slower growth in overall ACSC-related inpatient visits, and a 0.21 percentage point slower growth in chronic ACSC-related inpatient visits. The effects were significant in counties with above median Medicaid managed care penetration rates.Conclusions: Implementing mandatory managed care in Medicaid in Florida leads to slower growth in inpatient visits for conditions that can potentially be prevented with improved access to outpatient care. [ABSTRACT FROM AUTHOR]

Mission statements are key elements of how an organization communicates its purpose and priorities to its community. This study considers how mission statements from Ohio, Florida, and Texas hospitals approach key concepts in healthcare - access, cost, and quality. It also considers the concept of community benefit, given its recent prevalence in policy changes. The analysis found quality represented within hospital mission statements at a rate of 65%, compared to 21% for access, 21% for cost, and 24% for community benefit. Investor-owned hospitals emphasize quality and cost at significantly higher rates while not-for-profit hospitals emphasize access and community benefit at significantly higher rates than other organization types. [ABSTRACT FROM AUTHOR]

Although the effects of parenting styles have received much consideration in the research literature, less attention has been given to outcomes in emerging adults. Also, regional differences among areas of the United States may influence parents to use varying degrees of parenting practices such as affection and discipline. The current study investigated the differences in parenting in two geographically close yet distinct regions of the United States and the associated psychological outcomes in emerging adults. The sample was derived from two datasets: one consisting of participants predominantly from Southern states and one predominantly from Florida. The participants reported on maternal and paternal perceived parenting styles and discipline tactics as well as their own internalizing problems. Most notably, authoritative style of both parents shared a direct relationship with authoritarian style in the Southern sample, whereas this was an inverse relationship in the Florida sample. Maternal authoritarian parenting shared a negative relationship with internalizing symptoms in the Mississippi sample, whereas this relationship was positive in the Florida sample. Additionally, paternal permissive parenting shared a negative relationship with internalizing symptoms in the Florida sample, whereas no relationship was found in the Mississippi sample. For both samples, paternal, not maternal, corporal punishment and maternal, not paternal, psychological aggression were related positively to emerging adult internalizing problems. Overall, it was found that both parenting characteristics as well as associated outcomes differed by region, suggesting the need for increased awareness and sensitivity to these differences. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine individual and neighborhood determinants of late HIV diagnosis by gender and birthplace among Latinos. Florida HIV surveillance data for 2007-2011 were merged with American Community Survey data to estimate the odds of late HIV diagnosis (AIDS within 3 months of HIV diagnosis). Of 5522 HIV-positive Latinos, 26.5 % were diagnosed late. The odds ratio (OR) for late diagnosis was 1.39 times higher for males than females [95 % confidence interval (CI) 1.14-1.69]. Neighborhood-level factors associated with late diagnosis included residing in the 3 highest quartiles of neighborhood unemployment for males. The OR was 1.22 times higher for foreign- than US-born Latinos (95 % CI 1.07-1.40). Among foreign-born, residing in areas in the 2nd and 3rd quartiles of unemployment, in rural areas, and areas with <25 % Hispanic/Latino population were associated with late diagnosis. Population-based HIV testing campaigns may require tailoring to ensure that they effectively reach male Latinos in areas with high unemployment and foreign-born Latinos in rural and predominantly non-Latino areas. [ABSTRACT FROM AUTHOR]

Background: It is unknown if completing educational modules on understanding, reviewing, and synthesizing research literature is associated with higher value of, attitudes toward, and implementation of evidence-based practices. Method: Nurses completed valid, reliable questionnaires on the value of, attitudes toward, and implementation of evidence-based practice 6 months after four educational modules were introduced. Multivariable modeling was used to learn associations of education modules and evidence-based practice themes. Results: Of 1,033 participants, 54% completed at least one education module; 22% completed all modules. Value and attitude about evidence-based practice were moderately high, but implementation was low (mean =15.15 6 15.72; range = 0 to 72). After controlling for nurse characteristics and experiences associated with evidence-based practice value, attitudes, and implementation scores, education modules completion was associated with the implementation of evidence-based practice (p = .001), but not with value or attitude of evidencebased practices scores. Conclusion: Education on reviewing and synthesizing literature strengthened implementation of evidencebased practices. [ABSTRACT FROM AUTHOR]

Background: Underserved ethnic minority women experience significant disparities in cervical cancer incidence and mortality, mainly due to lack of cervical cancer screening. Barriers to Pap smear screening include lack of knowledge, lack of health insurance and access, and cultural beliefs regarding disease prevention. In our previous SUCCESS trial, we demonstrated that HPV self-sampling delivered by a community health worker (CHW) is efficacious in circumventing these barriers. This approach increased screening uptake relative to navigation to Pap smear screening. SUCCESS trial participants, as well as our community partners, provided feedback that women may prefer the HPV self-sampler to be delivered through the mail, such that they would not need to schedule an appointment with the CHW. Thus, our current trial aims to elucidate the efficacy of the HPV self-sampling method when delivered via mail.Design: We are conducting a randomized controlled trial among 600 Haitian, Hispanic, and African-American women from the South Florida communities of Little Haiti, Hialeah, and South Dade. Women between the ages of 30 and 65 years who have not had a Pap smear within the past 3 years are eligible for the study. Women are recruited by CHWs and complete a structured interview to assess multilevel determinants of cervical cancer risk. Women are then randomized to receive HPV self-sampling delivered by either the CHW (group 1) or via mail (group 2). The primary outcome is completion of HPV self-sampling within 6 months post enrollment.Discussion: Our trial is among the first to examine the efficacy of the mailed HPV self-sampling approach. If found to be efficacious, this approach may represent a cost-effective strategy for cervical cancer screening within underserved and underscreened minority groups.Trial Registration: ClinicalTrials.gov, NCT02202109 . Registered on 9 July 2014. [ABSTRACT FROM AUTHOR]

Objective: Taking a socioecological perspective, this study assessed the relationship of intrapersonal, interpersonal, and organizational factors to positive aspects of caregiving (PAC) for 642 dementia caregivers by racial/ethnic group from the baseline data of the multisite Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) intervention. Methods: Nine intrapersonal indicators, 4 interpersonal indicators, and 12 organizational indicators were used. Blocked-multiple regression analyses by three racial/ethnic groups were computed to examine significant factors related to PAC among caregivers after controlling for memory and behavioral problems. Results: Data showed a significant difference in PAC and significantly different indicators of PAC by racial/ethnic group. Hispanic caregivers reported the highest level of PAC while White participants showed the lowest scores on the measure of PAC. Education, marital status, and using formal transportation services were significant predictors for PAC among Hispanic caregivers; age, education, caregiving duration, and received social support were significant for PAC among African American caregivers; and sex, education, being a spousal caregiver, satisfaction with social support, using help from homemaker and visiting nurse services, and participating in support groups were significant among White caregivers. Conclusion: Findings indicate that PAC varies significantly across the three studied racial/ethnic groups of family caregivers and that intrapersonal, interpersonal, and organizational factors relate uniquely to PAC. Additional investigations of PAC could serve an important role in the development of family caregiving supports and services. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the quality/comprehensiveness of nursing documentation of pressure ulcers and to investigate the relationship between the nursing documentation and the incidence of pressure ulcers in four intensive care units. Background Pressure ulcer prevention requires consistent assessments and documentation to decrease pressure ulcer incidence. Currently, most research is focused on devices to prevent pressure ulcers. Studies have rarely considered the relationship among pressure ulcer risk factors, incidence and nursing documentation. Thus, a study to investigate this relationship is needed to fill this information gap. Design A retrospective, comparative, descriptive, correlational study. Method A convenience sample of 196 intensive care units patients at the selected medical centre comprised the study sample. All medical records of patients admitted to intensive care units between the time periods of September 1, 2011 through September 30, 2012 were audited. Data used in the analysis included 98 pressure ulcer patients and 98 non-pressure ulcer patients. The quality and comprehensiveness of pressure ulcer documentation were measured by the modified European Pressure Ulcer Advisory Panel Pressure Ulcers Assessment Instrument and the Comprehensiveness in Nursing Documentation instrument. Result The correlations between quality/comprehensiveness of pressure ulcer documentation and incidence of pressure ulcers were not statistically significant. Patients with pressure ulcers had longer length of stay than patients without pressure ulcers stay. There were no statistically significant differences in quality/comprehensiveness scores of pressure ulcer documentation between dayshift and nightshift. Conclusion This study revealed a lack of quality/comprehensiveness in nursing documentation of pressure ulcers. This study demonstrates that staff nurses often perform poorly on documenting pressure ulcer appearance, staging and treatment. Moreover, nursing documentation of pressure ulcers does not provide a complete picture of patients' care needs that require nursing interventions. Relevance to clinical practice The implication of this study involves pressure ulcer prevention and litigable risk of nursing documentation. [ABSTRACT FROM AUTHOR]

Objective: This article aims to evaluate the safety performance of cable median barriers on freeways in Florida.Method: The safety performance evaluation was based on the percentages of barrier and median crossovers by vehicle type, crash severity, and cable median barrier type (Trinity Cable Safety System [CASS] and Gibraltar system). Twenty-three locations with cable median barriers totaling about 101 miles were identified. Police reports of 6,524 crashes from years 2005-2010 at these locations were reviewed to verify and obtain detailed crash information. A total of 549 crashes were determined to be barrier related (i.e., crashes involving vehicles hitting the cable median barrier) and were reviewed in further detail to identify crossover crashes and the manner in which the vehicles crossed the barriers; that is, by either overriding, underriding, or penetrating the barriers.Results: Overall, 2.6% of vehicles that hit the cable median barrier crossed the median and traversed into the opposite travel lane. Overall, 98.1% of cars and 95.5% of light trucks that hit the barrier were prevented from crossing the median. In other words, 1.9% of cars and 4.5% of light trucks that hit the barrier had crossed the median and encroached on the opposite travel lanes. There is no significant difference in the performance of cable median barrier for cars versus light trucks in terms of crossover crashes. In terms of severity, overrides were more severe compared to underrides and penetrations. The statistics showed that the CASS and Gibraltar systems performed similarly in terms of crossover crashes. However, the Gibraltar system experienced a higher proportion of penetrations compared to the CASS system. The CASS system resulted in a slightly higher percentage of moderate and minor injury crashes compared to the Gibraltar system.Conclusions: Cable median barriers are successful in preventing median crossover crashes; 97.4% of the cable median barrier crashes were prevented from crossing over the median. Of all of the vehicles that hit the barrier, 83.6% were either redirected or contained by the cable barrier system. Barrier crossover crashes were found to be more severe compared to barrier noncrossover crashes. In addition, overrides were found to be more severe compared to underrides and penetrations. [ABSTRACT FROM AUTHOR]

Familias Unidas is a family-focused preventive intervention that has been found to reduce drug use and sexual risk behaviors among Hispanic adolescents. In some trials, Familias Unidas has also been found to be efficacious in reducing adolescent internalizing symptoms (i.e., depressive and anxiety symptoms), even though the intervention did not specifically target internalizing symptoms. This study examines potential mediators or mechanisms by which Familias Unidas influences internalizing symptoms, specifically the role of intervention-targeted improvements in parent-adolescent communication and reductions in youth externalizing behaviors. A total of 213 Hispanic eighth grade students with a history of externalizing behavior problems and their primary caregivers were recruited from the public school system. Participants, with a mean age of 13.8 years, were randomized into the Familias Unidas intervention or community practice control condition and assessed at baseline, 6, 18, and 30 months post-baseline. A cascading mediation model was tested in which the Familias Unidas intervention was hypothesized to decrease adolescent internalizing symptoms through two mediators: improvements in parent-adolescent communication leading to decreases in externalizing behaviors. Findings show that the intervention had significant direct effects on youth internalizing symptoms at 30 months post-baseline. In addition, the cascading mediation model was supported in which the Familias Unidas intervention predicted significant improvements in parent-adolescent communication at 6 months, subsequently decreasing externalizing behaviors at 18 months, and ultimately reducing youth internalizing symptoms at 30 months post-baseline. Implications for prevention interventions are discussed. [ABSTRACT FROM AUTHOR]

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