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Whereas advocates point to benefits of employing people with disabilities for organizations, employers’ concern over negative customer reactions is still a barrier to the employment of people with ...

Objective: : To develop an international Core Outcome Set (COS), a minimal collection of outcomes that should be measured and reported in all future clinical trials evaluating treatments of acute simple appendicitis in children.Summary Background Data: A previous systematic review identified 115 outcomes in 60 trials and systematic reviews evaluating treatments for children with appendicitis, suggesting the need for a COS.Methods: The development process consisted of four phases: (1) an updated systematic review identifying all previously reported outcomes, (2) a two-stage international Delphi study in which parents with their children and surgeons rated these outcomes for inclusion in the COS, (3) focus groups with young people to identify missing outcomes, and (4) international expert meetings to ratify the final COS.Results: The systematic review identified 129 outcomes which were mapped to 43 unique outcome terms for the Delphi survey. The first-round included 137 parents (eight countries) and 245 surgeons (10 countries), the second-round response rates were 61% and 85% respectively, with ten outcomes emerging with consensus. After two young peoples’ focus groups, two additional outcomes were added to the final COS (12): mortality, bowel obstruction, intra-abdominal abscess, recurrent appendicitis, complicated appendicitis, return to baseline health, readmission, reoperation, unplanned appendectomy, adverse events related to treatment, major and minor complications.Conclusion: An evidence-informed COS based on international consensus, including patients and parents has been developed. This COS is recommended for all future studies evaluating treatment of simple appendicitis in children, to reduce heterogeneity between studies and facilitate data synthesis and evidence-based decision-making.

OBJECTIVE To assess the prevalence of household food insecurity (HFI) and Supplemental Nutrition Assistance Program (SNAP) participation among youth and young adults (YYA) with diabetes overall and by type, and sociodemographic characteristics. RESEARCH DESIGN AND METHODS The study included participants with youth-onset type 1 diabetes and type 2 diabetes from the SEARCH for Diabetes in Youth study. HFI was assessed using the 18-item U.S. Household Food Security Survey Module (HFSSM) administered from 2016 to 2019; three or more affirmations on the HFSSM were considered indicative of HFI. Participants were asked about SNAP participation. We used χ2 tests to assess whether the prevalence of HFI and SNAP participation differed by diabetes type. Multivariable logistic regression models were used to examine differences in HFI by participant characteristics. RESULTS Of 2,561 respondents (age range, 10–35 years; 79.6% ≤25 years), 2,177 had type 1 diabetes (mean age, 21.0 years; 71.8% non-Hispanic White, 11.8% non-Hispanic Black, 13.3% Hispanic, and 3.1% other) and 384 had type 2 diabetes (mean age, 24.7 years; 18.8% non-Hispanic White, 45.8% non-Hispanic Black, 23.7% Hispanic, and 18.7% other). The overall prevalence of HFI was 19.7% (95% CI 18.1, 21.2). HFI was more prevalent in type 2 diabetes than type 1 diabetes (30.7% vs. 17.7%; P < 0.01). In multivariable regression models, YYA receiving Medicaid or Medicare or without insurance, whose parents had lower levels of education, and with lower household income had greater odds of experiencing HFI. SNAP participation was 14.1% (95% CI 12.7, 15.5), with greater participation among those with type 2 diabetes compared with those with type 1 diabetes (34.8% vs. 10.7%; P < 0.001). CONCLUSIONS Almost one in three YYA with type 2 diabetes and more than one in six with type 1 diabetes reported HFI in the past year—a significantly higher prevalence than in the general U.S. population.

Background Malnutrition is a factor associated with mortality, particularly for older residents in long-term care facilities. Aim This study aimed to evaluate the Minimum Data Set-based Screening for Nutritional Problem (MDS-SNP) and Mini Nutritional Assessment (MNA) in screening malnutrition among institutionalised older adults in Taiwan. Methods A cross-sectional research design was employed and data from 131 residents were collected in northern Taiwan. Demographic and clinical variables such as cognitive function, activities of daily living, depression status, MDS-SNP, MNA, and dietary habits were obtained from residents’ profiles. Findings The prevalence of malnutrition and risk of malnutrition defined by MNA were 32.8% (n = 43) and 30.5% (n = 40), respectively and 59.5% (n = 78) was at risk of malnutrition according to MDS-SNP. Multivariate logistic regression disclosed that some of the MDS-SNP items such as BMI and complaints of hunger, were significantly associated with MNA-defined risk and malnutrition but none of these were considered as trigger items in MDS-SNP. Discussion Our study suggested that the MDS-SNP may be considered as an appropriate malnutrition screening tool. Screening nutritional status of older people is important because of its significant association with chronic conditions and function as well as quality of life. Conclusion A modified MDS-based malnutrition screening tool in long-term care settings which considered BMI, complaints of hunger and nutritional approaches to deliver food as predictors is warranted.

The lack of mutual communication and collaboration between academic research and management practice, and the limited implementation of the research findings in strategic and tactical decision-making in practice settings, known as the science-practice ‘gap’, remains an essential issue in management research. We challenge the primary focus on academics for the possibilities of bridging the gap by arguing that the picture remains incomplete without a closer look at the positions, perceptions, and attitudes of practicing managers toward the joint production of relevant management knowledge. Based on the inductive, grounded theory approach, we conducted a qualitative study of 47 practicing managers with different organizational and functional responsibilities across various industry sectors. Although practitioners perceived practice-engaged research design and execution, relevant management research, and benefits from complementary knowledge as enablers of fruitful science-practice collaboration, our emerging findings revealed limited trust, limited cognition, coping strategies, and heuristic information processing to be important barriers for practitioners that hamper the collaboration process. Relying on the cognitive and information processing framework and theory of the conservation of resources, we aimed to explain the antecedent of (un)successful collaboration on the practitioners' side, thus extending our understanding of the scholarship of integration.

OBJECTIVE The Affordable Care Act mandates that primary preventive services have no out-of-pocket costs but does not exempt secondary prevention from out-of-pocket costs. Most commercially insured patients with diabetes have high-deductible health plans (HDHPs) that subject key microvascular disease–related services to high out-of-pocket costs. Brief treatment delays can significantly worsen microvascular disease outcomes. RESEARCH DESIGN AND METHODS This cohort study used a large national commercial (and Medicare Advantage) health insurance claims data set to examine matched groups before and after an insurance design change. The study group included 50,790 patients with diabetes who were continuously enrolled in low-deductible (≤$500) health plans during a baseline year, followed by up to 4 years in high-deductible (≥$1,000) plans after an employer-mandated switch. HDHPs had low out-of-pocket costs for nephropathy screening but not retinopathy screening. A matched control group included 335,178 patients with diabetes who were contemporaneously enrolled in low-deductible plans. Measures included time to first detected microvascular disease screening, severe microvascular disease diagnosis, vision loss diagnosis/treatment, and renal function loss diagnosis/treatment. RESULTS HDHP enrollment was associated with relative delays in retinopathy screening (0.7 months [95% CI 0.4, 1.0]), severe retinopathy diagnosis (2.9 months [0.5, 5.3]), and vision loss diagnosis/treatment (3.8 months [1.2, 6.3]). Nephropathy-associated measures did not change to a statistically significant degree among HDHP members relative to control subjects at follow-up. CONCLUSIONS People with diabetes in HDHPs experienced delayed retinopathy diagnosis and vision loss diagnosis/treatment of up to 3.8 months compared with low-deductible plan enrollees. Findings raise concerns about visual health among HDHP members and call attention to discrepancies in Affordable Care Act cost sharing exemptions.

Background A combination of yoga practices has been documented to reduce stress and stress-induced cortisol levels. The objective of the current study is to examine the effects of six months of a single pranayama practice (Bhramari [Bhr. P]) on reducing salivary cortisol response to the cold pressor test (CPT) among adolescents. Methods Twenty-six healthy adolescents between the ages of 11 and 19 were randomly assigned to either yoga group (n-13) or control group (n-13). Yoga group participants were trained to do Bhr. P for 45 min, thrice a week for six months. All participants underwent CPT at baseline and at end of six months. Saliva samples were collected at baseline (t0), at 20 min (t1), 40 min (t2), and 60 min after the CPT (t3). Results Contradictory to our hypothesis, participants in the yoga group exhibited a higher salivary cortisol response to the CPT at t1 (p = 0.04) when compared to the control group. However, the t3 salivary cortisol levels showed a statistically significant reduction (p = 0.03) in yoga group when compared to the control group. A significant interaction with time (F (1, 88) = 316.5, p = .001, ηp2:0.91) and between the group × time (F (3, 88) = 2.83, p = 0.04, ηp2:0.8) was found after the intervention. Conclusions An increase in the cortisol responsiveness observed in the study is an indication of the adaptive capability achieved through regular yoga training, evidenced by an initial rise in cortisol followed by a rapid fall below baseline after 60 min. Further research is required to conclusively determine the changes in cortisol levels over time in response to stress in long-term yoga practitioners.

The concept of ‘one size fits all’ - one treatment for patients with a particular disease, seems to be outdated. The advent of precision medicine has prompted profound changes in clinical research and it allows researchers to predict more accurately, the prevention and treatment strategies for a specific disease population. Novel study designs are, therefore, essential to establish safe and effective personalized medicine. Basket, umbrella and platform trial designs (collectively referred to as master protocols) are biomarker enrichment designs that allow for testing more than one hypotheses within a protocol, thus accelerating drug development. These trial designs tailor intervention strategies based on patient’s risk factor(s) that can help predict whether they will respond to a specific treatment. Basket trials evaluate therapy for various diseases that share a common molecular alteration, while umbrella trials evaluate multiple targeted therapies for a single disease that is stratified into subgroups based on different molecular alterations/ risk factors. These designs are complex and their major limitations stem from the fact that it would be inappropriate to completely replace histological typing with molecular profiling alone. However, in the upcoming decades, these trial designs are likely to gain popularity and improve the efficiency of clinical research. This article briefly overviews the characteristics of master protocol designs with examples of completed and ongoing clinical trials utilizing these study designs.

Background: The use of levetiracetam (LEV) has been increasing given its favorable pharmacokinetic profile. Numerous population pharmacokinetic studies for LEV have been conducted. However, there are some discrepancies regarding factors affecting its pharmacokinetic variability. Therefore, this systematic review aimed to summarize significant predictors for LEV pharmacokinetics as well as the need for dosage adjustments. Methods: We performed a systematic search for population pharmacokinetic studies of LEV conducted using a nonlinear-mixed effect approach from PubMed, Scopus, CINAHL Complete, and Science Direct databases from their inception to March 2020. Information on study design, model methodologies, significant covariate-parameter relationships, and model evaluation was extracted. The quality of the reported studies was also assessed. Results: A total of 16 studies were included in this review. Only two studies were conducted with a two-compartment model, while the rest were performed with a one-compartment structure. Bodyweight and creatinine clearance were the two most frequently identified covariates on LEV clearance (CLLEV). Additionally, postmenstrual age (PMA) or postnatal age (PNA) were significant predictors for CLLEV in neonates. Only three studies externally validated the models. Two studies conducted pharmacodynamic models for LEV with relatively small sample size. Conclusion: Significant predictors for LEV pharmacokinetics are highlighted in this review. For future research, a population pharmacokinetic-pharmacodynamic model using a larger sample size should be conducted. From a clinical perspective, the published models should be externally evaluated before clinical implementation.

Hospital Occupational Health and Safety (K3RS) are all activities to ensure and protect the safety and health of hospital human resources, patients, patient companions, visitors, and the hospital environment through efforts to prevent work accidents and occupational diseases in hospitals. This study aims to determine the factors related to compliance with the use of personal protective equipment (PPE) for nurses during the COVID-19 pandemic in the ER RSUD dr. Zubir Mahmud 2021. The research design used was a quantitative design with a cross sectional approach. The population is all nurses who work in the ER dr. Zubir Mahmud as many as 29 and the sample in this study as many as 29 respondents. Collecting data using a questionnaire. Data analysis using Chi-Squre and looking at Fisher's Exact Test. The results of research on the bivariate test show that there is a significant influence on the independent variables, namely the knowledge factor (p-value = 0.008), attitude (p-value = 0.006), availability (p-value =0.000) and supervision (p-value =0.001). and there was no significant effect, namely the education factor (p-value = 0.622) and years of service (p-value = 0.139) with the dependent variable being the compliance with the use of personal protective equipment (PPE) by nurses during the Covid-19 pandemic.Suggestions in this study are hospitals must make clear SOPs about the use of PPE and increase vigilance during the pandemic.

Malnutrition is a health disorder due to a lack or imbalance of nutrients needed for growth, thinking activities and all things related to life. One of the efforts made to help meet the nutritional needs of malnourished children under five is the Recovery Supplementary Feeding (PMT) program. The purpose of this study was to analyze whether the effect of supplementary feeding with local ingredients on changes in body weight of undernourished children under five. The type of research used is pre-experimental research design with one group pre and post-test design. This research was conducted in the working area of the Nanga Public Health Center. The population in this study were all underweight children under five in the working area of the Nanga Health Center as many as 30 people, the sampling technique in this study was total sampling. Data processing is done by editing, coding, entry, tabulating and cleaning. Data analysis in this study was bivariate with Paired Test. The results showed that there was an effect of providing local-based supplementary food to changes in body weight of undernourished children under five as indicated by a p value of 0.000 < 0.05, with a pre-test Mean value (9.744) < Post-test Mean (10.022). and the value of t-count (7.409) > t-table (2005). Based on these results, it can be concluded that the provision of local-based supplementary food is effective in increasing the weight of undernourished children under five.

Central obesity is influenced by many factors such as changes in age, gender, economic status, life habits including lack of physical activity, low fiber consumption, consumption of simple carbohydrates, consumption of fatty foods, and smoking behavior. Smoking behavior is thought to be a significant factor in forming central obesity in adult males. The purpose of this study was to determine the relationship between smoking behavior and central obesity in healthy adults. This study used an analytic observational design with a cross-sectional research design. The research was conducted in Suradadi Village, Suradadi District, Tegal Regency. Sampling was carried out by stratified sampling in November 2020 – January 2021. The sample size was 90 men aged 25-60 years. Data were collected by measuring the waist circumference of the respondents and recording other personal data such as age, occupation, and smoking status. Data processing is done descriptively and cross-tabulation. Testing the relationship between smoking behavior and obesity was carried out using the chi-square statistical test with the help of the SPSS version 22 application. The majority of respondents in this study had a smoking status of 68.9% and did not have central obesity 64.4%. The results of the test of the relationship between smoking status and central obesity got a p-value of 0.813. There is no significant relationship between smoking status and central obesity.

Children under the age of five or under five are a group that is prone to nutrition, because they are prone to malnutrition due to lack of food needed. Malnutrition in children will cause decreased immunity, which means that the ability to defend themselves against bacterial infection decreases. Children who have less nutritional status have the potential to suffer from pyoderma. Lack of the amount of food consumed both in quality and quantity can reduce the nutritional status of children. The purpose of this study was to determine the relationship between nutritional status and the incidence of pyoderma in toddlers (1-5 years) in Kuok Village, the working area of Puskesmas Kuok in 2020. This study used an analytical research design with a case control design. The sample in this study were 62 children (1-5 years). 31 samples for the case group and 31 samples for the control group. data collection through questionnaires. Data processing used univariate and bivariate analysis with the Chi-Square test. The results showed that there was a significant relationship between nutritional status and the incidence of pyoderma in toddlers (1-5 years) with p value = 0.001. By holding this research, the researchers expected parents of toddlers to pay more attention to the nutritional status of their children in order to avoid infectious diseases such as pyoderma.

The development of high-quality research is desired in all healthcare fields. Experimental and nonexperimental designs are used to investigate the effect or association of an intervention and clinical or surrogate outcome. The aims of these methods are to improve knowledge and to develop new strategies to manage a disease or condition. Randomized clinical trials are considered one of the standard methods to test the efficacy of a new drug or intervention; however, they are costly, have reduced generalizability, and cannot be feasible in all scenarios. Well-designed observational studies can provide valuable information regarding exposure factor and the event under investigation. In physical and rehabilitation medicine, where complex procedures and multiple risk factors can be involved in the same disease, the use of observational study must be planned in detail and a priori to avoid overestimations. In this article, we will give an overview of the methods used for observational design studies in physical and rehabilitation medicine using clinical examples to illustrate each method. We will describe when it is appropriate and how to use the observational studies in different scenarios explaining how to deal with potential bias and confounders using the adequate design and statistical plan for the situation.

OBJECTIVE Prior trauma history is a reliable and robust risk predictor for PTSD development. Obtaining an accurate measurement of prior trauma history is critical in research of trauma-related outcomes. The Life Events Checklist (LEC) is a widely used self-report measure of trauma history that categorizes events by the proximity to trauma exposure; however, the field has published multiple scoring methods when assessing the LEC. Herein, we propose a novel scoring procedure in which total scores from the LEC are weighted according to the proximity of trauma exposure with "experienced" events weighted most and "learned about" events weighted least. METHOD The utility of this weighted score was assessed in two traumatically-injured civilian samples and compared against previously published scoring methods, including a nonweighted score including all events experienced, witnessed, and learned about, as well as a score consisting of only experienced events. RESULTS Results indicated the standard total score was most reliable, followed by the weighted score. The experienced events score was least reliable, but the best predictor of future PTSD symptoms. CONCLUSIONS One method to balance the predictive strength of experienced events and the excellent reliability of a total LEC score, is to adopt the newly proposed weighted score. Future use of this weighted scoring method can provide a comprehensive estimate of lifetime trauma exposure while still emphasizing the direct proximity of experienced events compared with other degrees of exposure. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Feature selection is one of the most frequent tasks in data mining applications. Its ability to remove useless and redundant features improves the classification performance and gains knowledge about a given problem makes feature selection a common first step in data mining. In many feature selection applications, we need to combine the results of different feature selection processes. The two most common scenarios are the ensembles of feature selectors and the scaling up of feature selection methods using a data division approach. The standard procedure is to store the number of times every feature has been selected as a vote for the feature and then evaluate different selection thresholds with a certain criterion to obtain the final subset of selected features. However, this method is suboptimal as the relationships of the features are not considered in the voting process. Two redundant features may be selected a similar number of times due to the different sets of instances used each time. Thus, a voting scheme would tend to select both of them. In this article, we present a new approach: instead of using only the number of times a feature has been selected, the approach considers how many times the features have been selected together by a feature selection algorithm. The proposal is based on constructing an undirected graph where the vertices are the features, and the edges count the number of times every pair of instances has been selected together. This graph is used to select the best subset of features, avoiding the redundancy introduced by the voting scheme. The proposal improves the results of the standard voting scheme in both ensembles of feature selectors and data division methods for scaling up feature selection.

Bayesian inference requires the specification of prior distributions that quantify the pre-data uncertainty about parameter values. One way to specify prior distributions is through prior elicitation, an interview method guiding field experts through the process of expressing their knowledge in the form of a probability distribution. However, prior distributions elicited from experts can be subject to idiosyncrasies of experts and elicitation procedures, raising the spectre of subjectivity and prejudice. Here, we investigate the effect of interpersonal variation in elicited prior distributions on the Bayes factor hypothesis test. We elicited prior distributions from six academic experts with a background in different fields of psychology and applied the elicited prior distributions as well as commonly used default priors in a re-analysis of 1710 studies in psychology. The degree to which the Bayes factors vary as a function of the different prior distributions is quantified by three measures of concordance of evidence: We assess whether the prior distributions change the Bayes factor direction, whether they cause a switch in the category of evidence strength, and how much influence they have on the value of the Bayes factor. Our results show that although the Bayes factor is sensitive to changes in the prior distribution, these changes do not necessarily affect the qualitative conclusions of a hypothesis test. We hope that these results help researchers gauge the influence of interpersonal variation in elicited prior distributions in future psychological studies. Additionally, our sensitivity analyses can be used as a template for Bayesian robustness analyses that involve prior elicitation from multiple experts.

Emotion dysregulation frequently co-occurs with chronic pain, which in turn leads to heightened emotional and physical suffering. This cycle of association has prompted a recommendation for psychological treatment of chronic pain to target mechanisms for emotion regulation. The current trial addressed this need by investigating a new internet-delivered treatment incorporating emotional skills training from dialectical behavioural therapy (DBT). Using a single-case experimental design that is suited to heterogeneous populations and can demonstrate efficacy with a small sample, three participants with chronic pain were recruited. Participants received four weeks of online DBT skills training (iDBT-Pain intervention) which incorporated one-on-one sessions over Zoom and a web app. Results revealed compelling evidence for the intervention on the primary outcome of emotion dysregulation and were promising for the secondary outcome of pain intensity. Improvement was also identified on pre-and post-measures of depression, coping behaviours, sleep problems, wellbeing, and harm avoidance, indicating that the intervention may positively influence other factors related to chronic pain. Overall, the trial provides preliminary efficacy for the intervention to improve chronic pain. However, we recommend further investigation of the iDBT-Pain intervention, either in single case trials, which when conducted with scientific rigour may be aggregated to derive nomothetic conclusions, or in a group-comparison trial to compare with usual modes of treatment. Perspective: This trial advances understanding of emotion-focused treatment for chronic pain and provides evidence for a viable new technological treatment. Importantly, as an internet-delivered approach, the iDBT-Pain intervention is accessible to those with restricted mobility and remote communities where there are often limited psychological services for people with chronic pain. Trial registration: The trial was registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12620000604909)

Summary Researchers and practitioners are faced with an exponential increase in the number of systematic reviews (SRs) (with or without meta-analysis), a so-called `secondary' research method that synthesizes data from primary research. This growing number, sometimes with discordant results on the same subject or with non-conclusions, has led to the introduction of the concept of reviews to synthesize SR in order to combine scientific knowledge useful to practitioners. These so-called ``umbrella reviews'' (UR) constitute a new tertiary research tool. Surgical research is no exception to this development but umbrella surgical reviews remain relatively rare. Any UR must be transparent and meet rigorous methodological criteria. The UR could thus provide answers to practical questions in the field of surgery, but only on condition that the bias of the included SRs is limited. Let us not forget that the base requirement of clinical surgical research remains the good methodological quality of clinical studies (primary research). Only thus can SRs or URs (secondary or tertiary research) be more useful and decisive.

Characterized by small, highly heterogeneous patient populations, rare disease trials magnify the challenges often encountered in traditional clinical trials. In recent years, there have been increased efforts by stakeholders to improve drug development in rare diseases through novel approaches to clinical trial designs and statistical analyses. We highlight and discuss some of the current and emerging approaches aimed at overcoming challenges in rare disease clinical trials, with a focus on the ultimate stakeholder, the patient.

Objectives Clinical artificial intelligence (AI) is a novel technology, and few economic evaluations have focused on it to date. Before its wider implementation, it is important to highlight the aspects of AI that challenge traditional health technology assessment methods. Methods We used an existing broad value framework to assess potential ways AI can provide good value for money. We also developed a rubric of how economic evaluations of AI should vary depending on the case of its use. Results We found that the measurement of core elements of value—health outcomes and cost—are complicated by AI because its generalizability across different populations is often unclear and because its use may necessitate reconfigured clinical processes. Clinicians’ productivity may improve when AI is used. If poorly implemented though, AI may also cause clinicians’ workload to increase. Some AI has been found to exacerbate health disparities. Nevertheless, AI may promote equity by expanding access to medical care and, when properly trained, providing unbiased diagnoses and prognoses. The approach to assessment of AI should vary based on its use case: AI that creates new clinical possibilities can improve outcomes, but regulation and evidence collection may be difficult; AI that extends clinical expertise can reduce disparities and lower costs but may result in overuse; and AI that automates clinicians’ work can improve productivity but may reduce skills. Conclusions The potential uses of clinical AI create challenges for health technology assessment methods originally developed for pharmaceuticals and medical devices. Health economists should be prepared to examine data collection and methods used to train AI, as these may impact its future value.

Objective To demonstrate the clinical value of OneTouch (OT) Verio Flex glucose meter used in combination with a Spanish-language version of the OT Reveal mobile application (app) to support diabetes care and improve glycemic control in an underserved Hispanic population with type 2 diabetes. Research Design and Methods Test subjects (n = 81) used the meter and app for 12 weeks, while a randomized control group (n = 39) used their own glucose meters without connection to an app. Thereafter, test subjects continued the same regimen for an additional 12 weeks to determine the durability of effect, and control subjects crossed over to use the new meter and app. Results Test subjects experienced a mean reduction in A1C of 1.0% after 12 weeks (P Conclusion Use of the OT meter and a Spanish-language version of its diabetes management app in an underserved population helped participants achieve a sustained improvement in glycemic control. The tools were well received by the subjects and may have important utility in other low-numeracy, low-literacy populations.

Given the persistence of racial health disparities, scholars have called for investigations into structural origins of health inequity and deeper engagement with theory. We systematically assessed uses of theory-including theory-informed conceptualizations of race and ethnicity, social structure, and racial hierarchy-in epidemiology and other quantitative population health literature on racial health disparities. We conducted a scoping review of systematically identified original research articles (n=650) that sought to explain racial health disparities; articles were published in 17 high-impact epidemiology, public health, and social science journals. Trained coders abstracted data from each article. We applied Public Health Critical Race Praxis and an iterative data-charting method to identify key themes. Only 63 (9.7%) of 650 racial health disparities articles explicitly used theory. Among studies that engaged theory, one third (n=21/63) clearly conceptualized race and/or ethnicity, and a minority theorized social structure (n=19/63; 30%) and/or racial hierarchy as a structural relation (n=4/63; 6%). There is a pressing need for racial health disparities researchers to unambiguously use theory to conceptualize race and ethnicity in social and historical contexts and explain relational aspects of racial hierarchy. These approaches can better elucidate and inform action on structural determinants of both racial inequity and racial health inequity.

The significant growth of luxury products and services and their marketing in the last three decades has fueled substantial research interest among scholars and practitioners investigating the various aspects of luxury. However, the existing literature lacks a comprehensive review that includes all possible aspects of luxury. This paper responds to this gap by systematically reviewing the studies on this subject to provide a macro picture to identify the existing state of research, potential synergies, differences, and direction for future research. This review includes articles from 34 journals, covering 125 articles in total. The paper finds that the research on luxury revolves around four major themes: branding, consumption drivers, counterfeits, and marketing strategy. The paper then integrates various studies into these themes, enabling it to provide key insights for each domain, while examining their research design permits the analysis of the industry, geography, and methodological approaches. The paper finds that there are multiple theoretical paradoxes in the existing literature. Luxury research requires theoretical integration, should use real-world data to generate insights, and pay attention towards managerially relevant problems. The paper synthesizes implications across studies, identifies overlap and replication, understands disagreements and issues, and outlines potential research areas.

The study was aimed at exploring the clinical value of a 14-zone lung ultrasound scoring (LUS) method in treating neonatal respiratory distress syndrome (NRDS) with pulmonary surfactant (PS) and determining the timing of mechanical ventilation (MV). In this study, 88 neonates with NRDS who received PS replacement therapy were selected. We applied a new 14-zone LUS method before and 12, 24, 48 and 72 h after PS treatment to explore the clinical value of assessing PS replacement therapy efficacy in NRDS. Additionally, 67 patients with NRDS under MV received LUS during extubation. The receiver operating characteristic curve was used to analyze the diagnostic efficacy of LUS in the timing of extubation. LUS score was inversely associated with PS treatment. At 12 h after PS, only the 14-zone LUS method was significantly different (t = 4.08, p0.05) as compared with before PS, which was consistent with the change on chest x-ray (CXR); the other LUS methods did not differ (p0.05). The 14-zone LUS method exhibited better diagnostic performance for withdrawal time. A score of 41.0 points was used as the diagnostic threshold to predict the risk of withdrawal failure, with an area under the curve of 0.955, sensitivity of 92.4% and specificity of 93.8%. The new 14-zone LUS method improved scoring in the early efficacy of PS and had good diagnostic efficiency for timing the removal of MV in NRDS.

Background Perceived comfort levels of older people living in long-term care facilities (LTCFs) influence their health and wellbeing. Aim This study aimed to investigate the comfort levels and factors that contributed to comfort among older people living in LTCFs. Methods A cross-sectional research design was used. Sociodemographic profile, physical function, pain, depressive symptom, social support, and comfort levels were collected. Stepwise multiple regression was utilised to identify the factors of residents’ comfort level in the LTCFs. Findings A total of 114 residents were recruited in the study. Depressive symptom (β = -0.630, p Discussion Comfort, as perceived by older people living in LTCFs, is influenced by a combination of physiological and psychological factors. For older people to live comfortably in LTCFs, clinicians need to consider early detection of potential mental health issues such as depression, enhance the social support networks within and external to LTCFs and effectively manage pain. Conclusion The findings inform gerontological nurses in assessing comfort levels of the residents and in implementing interventions to increase the comfort levels of older people living in long term care facilities.

Medical instrument segmentation in 3D ultrasound is essential for image-guided intervention. However, to train a successful deep neural network for instrument segmentation, a large number of labeled images are required, which is expensive and time-consuming to obtain. In this article, we propose a semi-supervised learning (SSL) framework for instrument segmentation in 3D US, which requires much less annotation effort than the existing methods. To achieve the SSL learning, a Dual-UNet is proposed to segment the instrument. The Dual-UNet leverages unlabeled data using a novel hybrid loss function, consisting of uncertainty and contextual constraints. Specifically, the uncertainty constraints leverage the uncertainty estimation of the predictions of the UNet, and therefore improve the unlabeled information for SSL training. In addition, contextual constraints exploit the contextual information of the training images, which are used as the complementary information for voxel-wise uncertainty estimation. Extensive experiments on multiple ex-vivo and in-vivo datasets show that our proposed method achieves Dice score of about 68.6%-69.1% and the inference time of about 1 sec. per volume. These results are better than the state-of-the-art SSL methods and the inference time is comparable to the supervised approaches., Comment: Accepted by IEEE JBHI

Implementation science is the study of processes that promote reliable uptake of evidence-based practices into clinical care. The integration of implementation science and health disparities research approaches has been proposed as a method to reduce health inequity through detection, understanding, and implementation of health equity-focused interventions. In this review, we provide an argument for the study of implementation science in pediatric rheumatology in light of previously observed health disparities, present a framework for the study of health equity and implementation science in pediatric rheumatology, and propose next steps to accelerate action.

Background Reporting complications and/or adverse events after spinal surgical procedures enables the estimation of their prevalence and of their impact on patient outcomes. However, the documentation of complications is relatively infrequent and highly heterogeneous. The purpose of this study was to evaluate the quality of complication and adverse event reporting in spinal surgery literature. Methods A systematic review of the literature from 5 international, peer-reviewed, indexed spinal journals was performed. Included studies were published between January and December 2020 and reported the surgical results of spinal procedures. Data on the level of evidence and study design were collected and analyzed as well as whether the studies were single-center or multicenter studies. The quality of complication reports was evaluated through a 5-item checklist, with 5 questions divided into 3 parts: definition, evaluation, and report. Results Complications associated with spinal surgical procedures were reported in 292 studies. According to the level of evidence, significantly higher reporting quality was seen in level I and II studies compared with level III and IV studies (P = 0.003). Regarding the 5-item checklist, 49% (143/292) of studies fulfilled the definition section, 16.4% (48/292) fulfilled the evaluation section, and 92% (270/292) fulfilled the report section. Conclusions Overall quality assessment when reporting complications in surgical spinal studies showed that only 13% (38/292) of publications that reported complications as part of the outcomes exhibited all items of the 5-item checklist. Additionally, significantly better reports were observed in level I studies compared with level II–IV studies.

The Covid-19 pandemic situation has affected community activities, work, income which decreased, psychological disorders such as stress, and limited accessibility to dental practice service, which is now for emergency cases only. This condition can affect oral health in the community. This study aimed to assess the oral health condition in the community during the Covid-19 pandemic. This study was implementing a cross-sectional research design. Data were obtained from online questionnaires with the respondent's consent. The sample selection with inclusion criteria comprised 1960 years old who lived in Bandung West Java. The self-report questionnaire for oral health assessment was followed, the previous research, by Levin et al.,2013. It has been trans-adapted to Bahasa Indonesia and validated. Respondents of the study were 380 participants. Poor oral hygiene maintenance was the wrong frequency of brushing teeth (12.1%), only visiting the dentist when having a toothache (72.9%), and smoking (7.9%). Oral health problems include gingival bleeding on brushing (15.3%), tooth mobility (13.2%), tooth cavities (62.9%), toothache (27.1%), and bad breath (22.6%). Most of the oral health problems were tooth cavities followed by toothache. The contributing factors include poor oral hygiene maintenance, improper brushing, smoking habits, and infrequent dental care. Furthermore, the accessibility and availability of services in dental practice in the pandemic situation are limited. Therefore, it is reasonable to say that oral self-examination probably could minimize the distancingrelated problem in this Covid-19 pandemic situation and be helpful in the early detection of oral health problems. KEYWORDS: assessment, Covid-19 pandemic, oral health

Approximately 37% or 9 million Indonesian children under five suffer from stunting.Although the prevalence of stunting under five tended to decline in 2013-2018 from 37.2% to 30.8%,stunting remains a top priority in the problem of improving Indonesia's nutrition for 2018-2024. Theresearch objective was to describe the family's knowledge of fish consumption in preventing stunting inMeuraxa District, Banda Aceh City. The descriptive exploratory nature of this type of research is evident.The research design was cross-sectional, with frequency distribution data being analyzed. Thepopulation for this study was made up of families with children ranging in age from one to five years.With 101 respondents, the sampling technique used was nonprobability sampling with a purposivesampling method. The data collection technique was carried out using a questionnaire, with guidedinterviews conducted via telephone. The results showed that as many as 51 (50.50%) respondents werecategorized as having good knowledge, 35 (36.65%) respondents were categorized as having sufficientknowledge. As many as 15 (14.85%) were classified as having less knowledge. It is recommended thathealth workers conduct and provide education about the importance of eating fish to prevent stuntingfor increased knowledge and application in the family. KEYWORDS: Fish consumption, Family knowledge, Stunting

Background Functional neurological disorder is defined by symptoms not explained by the current model of disease and its pathophysiology. It is found in 8.4% of patients presenting as acute stroke. Treatment is difficult and recurrence rates are high. We introduced hypnotherapy as a therapeutic option in addition to standard stroke unit care. Methods This is an observational study of successive patients with functional neurological disorder presenting as acute stroke treated with hypnotherapy between 1 April 2014 and 1 February 2018. The diagnosis of functional neurological disorder was confirmed by clinical examination and computed tomography/magnetic resonance imaging. Hypnosis was delivered by a hypnotherapy trained stroke physician using imagery for induction. A positive response was defined as a National Institutes of Health Stroke score reduction to 0 or by ≥4 points posthypnotherapy. Costs were calculated as therapist time and benefits as reduction in disability/bed days. Results Sixty-eight patients (mean age 36.4 years, 52 (76%) females, mean baseline National Institutes of Health Stroke 5.0 (range 1–9)) were included. Two patients (3%) could not be hypnotized. Fifty-eight 58 (85%) responded, 47 (81%) required one treatment session, while 19% needed up to three sessions for symptomatic improvement. No adverse events were observed. Disability (modified Rankin Scale) reduced from a mean of 2.3 to 0.5 resulting in an average cost saving of £1,658 per patient. Most (n = 50, 86%) remained well without recurrence at six-month follow-up. Conclusions In this case series, hypnotherapy was associated with rapid and sustained recovery of symptoms. A prospective randomized controlled study is required to confirm the findings and establish generalizability of the results.

Elderly people are the most vulnerable group for high morbidity and mortality from Covid-19 and need high effort to meet their health needs. As nurses are at the front of fighting this pandemic in all geriatric settings, they have faced stress and fear of corona which can affect the provided elderly care. Therefore, this study aimed to explore nurses' fear of Covid-19 and stress, and their relations to health care behaviors towards elderly people. Research design: A cross-sectional research design was conducted on 185 nurses from ten governorates of Egypt, who completed an online questionnaire distributed through Google forms from September 2020 to February 2021. Tools: Demographic characteristics, added to, three research instruments were used: (1) The Expanded Nursing Stress Scale (ENSS), (2) The Fear of COVID-19 Scale (FCV-19S), and (3) The Caring Behaviors Inventory (CBI). Results indicated that 41.0 % of the studied nurses had a mild level of fear of COVID-19. Besides, there was a significantly positive association between nurses' Fear of COVID-19 and stress (r=.77, p

Since the outbreak of COVID-19 in Wuhan, China in December 2019, it has spread quickly and become a global pandemic. While the epidemic has been contained well in China due to unprecedented public health interventions, it is still raging or not yet been restrained in some neighboring countries. Chinese government adopted a strict policy of immigration diversion in major entry ports, and it makes Suifenhe port in Heilongjiang Province undertook more importing population. It is essential to understand how imported cases and other key factors of screening affect the epidemic rebound and its mitigation in Heilongjiang Province. Thus we proposed a time switching dynamical system to explore and mimic the disease transmission in three time stages considering importation and control. Cross validation of parameter estimations was carried out to improve the credibility of estimations by fitting the model with eight time series of cumulative numbers simultaneous. Simulation of the dynamics shows that illegal imported cases and imperfect protection in hospitals are the main reasons for the second epidemic wave, the actual border control intensities in the province are relatively effective in early stage. However, a long-term border closure may cause a paradox phenomenon such that it is much harder to restrain the epidemic. Hence it is essential to design an effective border reopening strategy for long-term border control by balancing the limited resources on hotel rooms for quarantine and hospital beds. Our results can be helpful for public health to design border control strategies to suppress COVID-19 transmission.

BACKGROUND Critically ill patients who are mechanically ventilated are at a high risk for malnutrition, which is associated with poor clinical outcomes. AIM The aim of this study was to determine whether the modified version of Nutrition Risk in the Critically Ill (mNUTRIC) score predicts patients' clinical and functional outcomes in intensive care units (ICUs) in Jordan. METHODS A prospective, observational, quantitative research design was used. A convenience sample of 129 mechanically ventilated patients was recruited from ICUs in 7 hospitals across the different Jordanian health care sectors. Each patient was assessed and scored by the mNUTRIC tool. RESULTS Of the total 129 mechanically ventilated patients, the mean (SD) age of critically ill participants was 66.38 (17.46) years, 69.8% of the participants were male (n = 90), and 30.2% were female (n = 39). Approximately 88.4% of mechanical ventilator patients were at a high risk of malnutrition at the time of ICU admission. Overall, high mNUTRIC score (≥5) was significantly associated with MV duration (P = .004), ICU length of stay (P = .002), mortality (odds ratio, 5.43; P = .005), and functional outcomes (odds ratio, 0.184; P = .009). RELEVANCE TO CLINICAL PRACTICE Using nutrition risk screening tools such as the mNUTRIC score will add great benefits to nursing practice through identifying patients who are at a high risk of malnutrition within the first 48 hours of their admission in the ICU.

The opioid abuse epidemic represents a major public health threat to global populations. The role social media may play in facilitating illicit drug trade is largely unknown due to limited research. However, it is known that social media use among adults in the US is widespread, there is vast capability for online promotion of illegal drugs with delayed or limited deterrence of such messaging, and further, general commercial sale applications provide safeguards for transactions; however, they do not discriminate between legal and illegal sale transactions. These characteristics of the social media environment present challenges to surveillance which is needed for advancing knowledge of online drug markets and the role they play in the drug abuse and overdose deaths. In this paper, we present a computational framework developed to automatically detect illicit drug ads and communities of vendors. The SVM- and CNN- based methods for detecting illicit drug ads, and a matrix factorization based method for discovering overlapping communities have been extensively validated on the large dataset collected from Google+, Flickr and Tumblr. Pilot test results demonstrate that our computational methods can effectively identify illicit drug ads and detect vendor-community with accuracy. These methods hold promise to advance scientific knowledge surrounding the role social media may play in perpetuating the drug abuse epidemic.

Introduction : Understanding how incentives and their timing influence study enrollment rates is important to efficient study design and increasing the generalizability of findings. This 2-arm, parallel randomized trial evaluated how conditional versus unconditional mailed incentives of a $20 gift card affected study enrollment in a sample of participants screened for lung cancer screening. Methods : Eligible participants included Black and White adults who underwent lung cancer screening with low-dose CT and had negative screening results at two North Carolina imaging facilities in 2018. We used a stratified randomization scheme, by sex and race, to assign incentive type (conditional vs. unconditional). We used the Tailored Design Method with six points of mailed contact to engage participants. We compared study enrollment rates using chi-square tests and logistic regression analyses. Results : After adjusting for sex, race, age, smoking status, participant residence, and screening site, participants who received unconditional incentives were 74% more likely to enroll than those who received conditional incentives (adjusted OR= 1.74 (95% CI: 1.01, 3.00). Conclusions : Type of incentive can play a role in increasing study enrollment, especially mailed surveys that target individuals who currently or previously smoked. Unconditional incentives may be worth the initial cost to engage study participants.

In the United States, nutrition-related morbidities are rising steadily at rates corresponding to increasing overweight and obesity in the population. Such morbidities take huge tolls on personal health and impose high costs on health care systems. In 2019, the Academy of Nutrition and Dietetics (Academy) and the Academy of Nutrition and Dietetics Foundation (Academy Foundation) embarked on a new project titled "The State of Food and Nutrition Series" to demonstrate the value of nutrition interventions led by registered dietitian nutritionists for individuals with the following 3 high-priority non-communicable diseases that affect many in the United States and globally: type 2 diabetes mellitus, chronic kidney disease, and hypertension. Poor nutritional status contributes to disease onset and progression in these non-communicable diseases, and appropriate medical nutrition therapy can prevent or delay worsening and ameliorate poor health outcomes. However, many people who have these conditions do not have access to an registered dietitian nutritionist, and consequently do not receive the nutrition care they need. On February 19-20, 2020 in Arlington, VA, as the first stage in The State of Food and Nutrition Series, the Academy and the Academy Foundation gathered health care policymakers, clinicians, and researchers from across the country for the State of Food and Nutrition Series Forum, where Academy leaders sought input to build a comprehensive research strategy that will quantify the impact of patient access to registered dietitian nutritionist-led nutrition interventions for type 2 diabetes mellitus, chronic kidney disease, and hypertension. This article summarizes the findings of that forum.

Summary Despite several recent meta-analyses on the topic, the comparative risk of hepatocellular carcinoma in patients with chronic hepatitis B (CHB) receiving entecavir (ETV) or tenofovir disoproxil fumarate (TDF) remains controversial. The controversy partly results from the arbitrary nature of significance levels leading to contradictory conclusions from very similar datasets. However, the use of observational data, which is prone to both within- and between-study heterogeneity of patient characteristics, also lends additional uncertainty. The asynchronous introduction of ETV and TDF in East Asia, where the majority of these studies have been conducted, further complicates analyses, as does the ensuing difference in follow-up time between ETV and TDF cohorts. Researchers conducting meta-analyses in this area must make many methodological decisions to mitigate bias but are ultimately limited to the methodologies of the included studies. It is therefore important for researchers, as well as the audience of published meta-analyses, to be aware of the quality of observational studies and meta-analyses in terms of patient characteristics, study design and statistical methodologies. In this review, we aim to help clinicians navigate the published meta-analyses on this topic and to provide researchers with recommendations for future work.

Contains fulltext : 237219.pdf (Publisher’s version ) (Open Access) Objective: To describe characteristics of randomised controlled trials (RCTs) conducted using electronic health records (EHRs), including completeness and transparency of reporting assessed against the 2021 CONSORT Extension for RCTs Conducted Using Cohorts and Routinely Collected Data (CONSORT-ROUTINE) criteria. Study design: MEDLINE and Cochrane Methodology Register were searched for a sample of RCTs published from 2011–2018. Completeness of reporting was assessed in a random sample using a pre-defined coding form. Results 183 RCT publications were identified; 122 (67%) used EHRs to identify eligible participants, 139 (76%) used the EHR as part of the intervention and 137 (75%) to ascertain outcomes. When 60 publications were evaluated against the CONSORT 2010 item and the corresponding extension for the 8 modified items, four items were 'adequately reported' for the majority of trials. Five new reporting items were identified for the CONSORT-ROUTINE extension; when evaluated, one was 'adequately reported', three were reported 'inadequately or not at all', the other 'partially'. There were, however, some encouraging signs with adequate and partial reporting of many important items, including descriptions of trial design, the consent process, outcome ascertainment and interpretation. Conclusion: Aspects of RCTs using EHRs are sub-optimally reported. Uptake of the CONSORT-ROUTINE Extension may improve reporting. 12 p.

Background Local outbreak control plans (LOCPs) are statutory documents produced by local authorities (LAs) across England. LOCPs outline LAs’ response to Coronavirus Disease 19 (COVID19) outbreaks and the coordination of local resources, data and communication to support outbreak response. LOCPs are therefore crucial in the nation’s response to COVID-19. However, there has been no previous systematic assessment of these documents. We performed this study to systematically assess the quality of LOCPs and to offer recommendations of good practice. Methods All published LOCPs were assessed for basic characteristics. A framework based on Department of Health and Social Care guidelines was used to assess a random sample of LOCPs. Qualitative analysis was undertaken for LOCPs with highest completeness. Results Hundred and thirty-seven of 150 LAs publicly published a full LOCP; 9 were drafts. Statistical analysis demonstrated the significant difference between reporting of mainstream schools, care homes and the homeless population and other educational settings, high-risk settings and other vulnerable groups. LOCPs varied in approach when structuring outbreak response information and focused on different areas of outbreak management. Conclusions The majority of LAs are publicly accessible. There is significant variation between the reporting of high-risk settings and groups. Suggested recommendations may help to improve future LOCP updates.

Chronic obstructive pulmonary disease (COPD) is the end result of a series of dynamic and cumulative gene–environment interactions over a lifetime. The evolving understanding of COPD biology provides novel opportunities for prevention, early diagnosis, and intervention. To advance these concepts, we propose therapeutic trials in two major groups of subjects: “young” individuals with COPD and those with pre-COPD. Given that lungs grow to about 20 years of age and begin to age at approximately 50 years, we consider “young” patients with COPD those patients in the age range of 20–50 years. Pre-COPD relates to individuals of any age who have respiratory symptoms with or without structural and/or functional abnormalities, in the absence of airflow limitation, and who may develop persistent airflow limitation over time. We exclude from the current discussion infants and adolescents because of their unique physiological context and COPD in older adults given their representation in prior randomized controlled trials (RCTs). We highlight the need of RCTs focused on COPD in young patients or pre-COPD to reduce disease progression, providing innovative approaches to identifying and engaging potential study subjects. We detail approaches to RCT design, including potential outcomes such as lung function, patient-reported outcomes, exacerbations, lung imaging, mortality, and composite endpoints. We critically review study design components such as statistical powering and analysis, duration of study treatment, and formats to trial structure, including platform, basket, and umbrella trials. We provide a call to action for treatment RCTs in 1) young adults with COPD and 2) those with pre-COPD at any age.

Context Urine color (Uc) is used to asses urine concentration when laboratory techniques are not feasible. Objective To compare the accuracy of Uc scoring using 4 light conditions and 2 scoring techniques with a 7-color Uc chart. Additionally, to assess the results' generalizability, a subsample was compared with scores obtained from fresh samples. Design Descriptive laboratory study. Samples A total of 178 previously frozen urine samples were scored, and 78 samples were compared with their own fresh outcomes. Main Outcome Measure(s) Urine color and accuracy for classifying urine samples were calculated using receiver operating characteristics analysis, allowing us to compare the diagnostic capacity against a 1.020 urine specific gravity cutoff and defining optimal Uc cutoff value. Results Urine color was different among light conditions (P < .01), with the highest accuracy (80.3%) of correct classifications of low or high urine concentrations occurring at the brightest light condition. Lower light intensity scored 1.5 to 2 shades darker on the 7-color Uc scale than bright conditions (P < .001), but no further practical differences in accuracy occurred between scoring techniques. Frozen was 0.5 to 1 shade darker than freshly measured Uc (P < .004), but the values were moderately correlated (r = 0.64). A Bland-Altman plot showed that reporting bias mainly affected darker Uc without affecting the diagnostic ability of the method. Conclusions Urine color scoring, accuracy, and Uc cutoff values were affected by lighting condition but not by scoring technique, with greater accuracy and a 1-shade-lower Uc cutoff value at the brightest light (ie, light-emitting diode flashlight).

Background Physical inactivity is highly prevalent after stroke, increasing the risk of poor health outcomes including recurrent stroke. Tailoring of exercise programs to individual preferences can improve adherence, but no tools exist for this purpose in stroke. Methods We identified potential questionnaire items for establishing exercise preferences via: (i) our preliminary Exercise Preference Questionnaire in stroke, (ii) similar tools used in other conditions, and (iii) expert panel consultations. The resulting 35-item questionnaire (SEPI-35) was administered to stroke survivors, along with measures of disability, depression, anxiety, fatigue and self-reported physical activity. Exploratory factor analysis was used to identify a factor structure in exercise preferences, providing a framework for item reduction. Associations between exercise preferences and personal characteristics were analysed using multivariable regression. Results A group of 134 community-dwelling stroke survivors (mean age 64.0, SD 13.3) participated. Analysis of the SEPI-35 identified 7 exercise preference factors (Supervision-support, Confidence-challenge, Health-wellbeing, Exercise context, Home-alone, Similar others, Music-TV). Item reduction processes yielded a 13-item version (SEPI-13); in analysis of this version, the original factor structure was maintained. Lower scores on Confidence-challenge were significantly associated with disability (p = 0.002), depression (p = 0.001) and fatigue (p = 0.001). Self-reported barriers to exercise were particularly prevalent in those experiencing fatigue and anxiety. Conclusions The SEPI-13 is a brief instrument that allows assessment of exercise preferences and barriers in the stroke population. This new tool can be employed by health professionals to inform the development of individually tailored exercise interventions.

Background Young people account for more than a quarter of new HIV infections in the US, with the majority of cases among young men who have sex with men; young transgender women are also vulnerable to infection. Substance use, particularly alcohol misuse, is a driver of sexual transmission and a potential barrier to engagement in the HIV prevention and care continuum, however vulnerable youth are difficult to reach for substance use services due, in part, to complex social and structural factors and limited access to health care. The Community Prevention Services Task Force recommends electronic screening and brief intervention as an evidence-based intervention for the prevention of excessive alcohol consumption; however, no prior studies have extended this model to community-based populations of youth that are susceptible to HIV infection. This paper describes the study protocol for an electronic screening and brief intervention to reduce alcohol misuse among adolescents and young adults vulnerable to HIV infection in community-based settings. Methods This study, Step Up, Test Up, is a randomized controlled trial of an electronic alcohol screening and brief intervention among youth, ages 16–25, who are vulnerable to HIV infection. Individuals who present for HIV testing at one of three community-based locations are recruited for study participation. Eligibility includes those aged 16–25 years, HIV-negative or unknown HIV status, male or trans female with a history of sex with men, and English-speaking. Participants who screen at moderate to high risk for alcohol misuse on the Alcohol Use Disorders Identification Test (AUDIT) are randomized (1:1) to either an electronic brief intervention to reduce alcohol misuse or a time-and attention-matched control. The primary outcome is change in the frequency/quantity of recent alcohol use at 1, 3, 6 and 12-month follow-up. Discussion Testing of evidence-based interventions to reduce alcohol misuse among youth vulnerable to HIV infection are needed. This study will provide evidence to determine feasibility and efficacy of a brief electronically-delivered intervention to reduce alcohol misuse for this population. Trial registration ClinicalTrials.gov number, NCT02703116, registered March 9, 2016.

BackgroundApproaches are needed to better delineate the continuum of opioid misuse that occurs in hospitalized patients. A prognostic enrichment strategy with latent class analysis (LCA) may facilitate treatment strategies in subtypes of opioid misuse. We aim to identify subtypes of patients with opioid misuse and examine the distinctions between the subtypes by examining patient characteristics, topic models from clinical notes, and clinical outcomes.MethodsThis was an observational study of inpatient hospitalizations at a tertiary care center between 2007 and 2017. Patients with opioid misuse were identified using an operational definition applied to all inpatient encounters. LCA with eight class-defining variables from the electronic health record (EHR) was applied to identify subtypes in the cohort of patients with opioid misuse. Comparisons between subtypes were made using the following approaches: (1) descriptive statistics on patient characteristics and healthcare utilization using EHR data and census-level data; (2) topic models with natural language processing (NLP) from clinical notes; (3) association with hospital outcomes.FindingsThe analysis cohort was 6,224 (2.7% of all hospitalizations) patient encounters with opioid misuse with a data corpus of 422,147 clinical notes. LCA identified four subtypes with differing patient characteristics, topics from the clinical notes, and hospital outcomes. Class 1 was categorized by high hospital utilization with known opioid-related conditions (36.5%); Class 2 included patients with illicit use, low socioeconomic status, and psychoses (12.8%); Class 3 contained patients with alcohol use disorders with complications (39.2%); and class 4 consisted of those with low hospital utilization and incidental opioid misuse (11.5%). The following hospital outcomes were the highest for each subtype when compared against the other subtypes: readmission for class 1 (13.9% vs. 10.5%, pConclusionsA 4-class latent model was the most parsimonious model that defined clinically interpretable and relevant subtypes for opioid misuse. Distinct subtypes were delineated after examining multiple domains of EHR data and applying methods in artificial intelligence. The approach with LCA and readily available class-defining substance use variables from the EHR may be applied as a prognostic enrichment strategy for targeted interventions.

This study investigated the reliability of measurements of ankle dorsiflexion obtained using the Lidcombe Template, an instrument that allows the magnitude and direction of force applied to dorsiflex the foot to be measured and standardised. Ten unimpaired physiotherapy students and 21 subjects who had suffered stroke were tested twice. Twenty minutes separated tests. Measurements of passive dorsiflexion range were highly reliable for both groups (r > 0.92) when the mean of three measurements was used. Significantly more variability occurred in measurements of impaired subjects than unimpaired subjects. For the subjects tested, for 95 per cent confidence that real differences exist between measurements taken 20 minutes apart, 7 degrees and 3 degrees must be allowed around measurements of impaired and unimpaired subjects respectively. These small error margins confer confidence in the potential utility of this instrument for measuring ankle dorsiflexion.