Search

BACKGROUND: Continued substance use is common during opioid use disorder (OUD) treatment. There are still inconsistencies in how continued substance use and concurrent patterns of substance use among patients with OUD varies by gender. There is still more to learn regarding how factors associated with continued and concurrent use might differ for men and women in methadone maintenance treatment (MMT). METHODS: This cross-sectional study examined predictors of concurrent substance use subgroups among patients receiving MMT. The sample included 341 (n = 161 women) MMT patients aged 18 and older from opioid treatment programs in Southern New England and the Pacific Northwest. Patients completed a survey assessing sociodemographic and clinical characteristics including past-month substance use. Latent class analyses were conducted by gender to identify groups based on substance use and determine predictors of those classes. RESULTS: Three-class solutions were the optimal fit for both men and women. For both genders, the first subgroup was characterized as Unlikely Users (59.8% women, 52.8% men). Classes 2 and 3 among women were Cannabis/Opioid Users (23.7%) and Stimulant/Opioid Users (13.0%). Among men, Classes 2 and 3 consisted of Alcohol/Cannabis Users (21.9%) and Cannabis/Stimulant/Opioid Users (25.3%). Ever using Suboxone (buprenorphine/naloxone) and depression/anxiety symptoms were significantly linked to substance use group among women, whereas homelessness and employment status were significantly associated with substance use group among men. CONCLUSIONS: This study furthers understanding of gender differences in factors associated with continued substance use and distinctive patterns of concurrent substance use that may guide tailored treatments among patients MMT.

Background Nine oral disease-modifying therapies (DMTs) have been approved for the treatment of multiple sclerosis (MS) in the United States. Few studies have examined self-reported quality of life (QoL) and functional status outcomes among patients who switch to oral medications from injectable MS therapies. This study compares self-reported QoL and disability status between participants switching from injectable to oral DMTs, to those who stay on injectable DMTs continuously for the same time period. Methods Longitudinal data were assessed from relapsing MS participants in the Pacific Northwest MS Registry completing a minimum of two surveys between 2012 and 2018 with a maximum of 36 months between surveys. Stayers were defined as those who remained on injectable DMTs continuously from Time 1 to Time 2; switchers were those who switched from injectable to either fingolimod, teriflunomide or dimethyl fumarate during the same time interval. Outcomes of interest were physical and psychological QoL, measured by the Multiple Sclerosis Impact Scale (MSIS-29), and disability, measured by the Patient Determined Disease Steps (PDDS). To analyze the effect of switching to oral DMT on outcomes at Time 2, a one-to-two propensity score matching (PSM) was used to match switchers to stayers. Outcomes at Time 2 were analyzed using paired t-test for QoL scores, and Stuart Maxwell test for PDDS as a categorical variable. Results Among 2385 participants who returned consecutive yearly surveys, 413 met the inclusion criteria for stayers and 66 for switchers. After one-to-two PSM, 124 stayers were matched to 62 switchers. Paired t-test showed no differences between switchers and stayers for physical (mean difference: − 0.41; [95% confidence interval CI: − 3.3-2.4]; p = 0.78) or psychological (mean difference: − 0.23; [95% CI, − 1.6- 1.1]; p = 0.74) QoL. Additionally, no differences were seen between switchers and stayers in self-reported disability status. Conclusions MS registry participants who switched to an oral DMT from injectable showed no significant differences in QoL or self-reported disability status compared to those remaining on injectable DMT continuously in the same time period.

This paper describes a multi-phase effort to develop a web-based training for adults serving as mentors in school-based programs for youth with a parent in the military. In Phase 1, we conducted focus groups with military parents to: gauge their receptivity to this type of supportive intervention, identify program features that would make the option of mentoring for their children more or less appealing, and identify specific training needs for adult volunteers preparing for the role of mentor to youth in this population. In Phase 2, we used an iterative process to develop the training protocol, including cycling through multiple drafts, creating a web-based platform, reviewing and incorporating feedback from various stakeholders, and then pilot testing the training with two groups of mentor volunteers as part of a school-based mentoring program for military-connected students. We report on what we learned from the military parent focus groups, including parent skepticism about the need for such a program, concerns about potential stigma, and the need for mentors to have some understanding of military culture. We describe how we used that information to develop a practical and accessible training module for volunteer mentors, especially those without a military background, who could be matched with military-connected youth.

Aims This study considered urban-rural differences in maternal-infant interactions (sensitivity/responsiveness and synchrony/reciprocity), infant temperament, and parenting stress, for samples similar in socioeconomic and racial composition. Higher sensitivity/responsiveness and synchrony/reciprocity were hypothesized for urban dyads, with more challenging temperament profiles predicted for rural infants. Rural mothers were expected to report more parenting-role stress. Methods Urban (n = 68; San Francisco Bay) and rural (n = 120; inland Pacific Northwest) mothers of infants provided ratings of temperament and parenting stress. Parental sensitivity/responsiveness and synchrony/reciprocity were coded from mother-infant play observations. Groups were compared via analyses of covariance. Results Urban mothers demonstrated significantly more sensitivity/responsiveness and synchrony/reciprocity compared to their rural counterparts. Rural mothers rated their infants significantly higher in negative affectivity and distress in response to limitations. Conclusion Although socioeconomic status is traditionally implicated in rural and urban population differences, our results suggest other factors (e.g., isolation, access to resources) warrant further exploration. Rural ecology appears to present risk that should be examined more closely in maternal-infant interactions and child social-emotional development. The variability of risk within urban and rural classifications (e.g., suburban, inner-city) also requires consideration.

Although there has been increasing attention on a dyadic perspective of illness, contemporary dyadic research methods are still rarely utilized in cardiovascular disease. The focus of this paper is to describe the advantages of two types of multilevel dyadic models (the matched pairs model and the lesser known incongruence model). Data exemplars in a sample of heart failure family dyads are used to illustrate the distinct advantages of these two related multilevel dyadic models with particular emphasis on alignment with research questions. The more commonly known matched pairs model examines separate outcomes for each member of the dyad, controlling for the interdependent nature of the data. By re-parameterizing this model into a univariate dyadic outcomes model, researchers can address distinct, and sometimes more appropriate, research questions (e.g. incongruent appraisals of the illness experience). This paper promotes greater application of these methods in cardiovascular research to further understanding of the dyadic experience and more appropriately target interventions.

Purpose: The present study aims to contribute to current knowledge about nurses’ perceived importance of lighting in patient rooms and to compare these perceptions across different ages, work shifts, (day and night), and environments of care (traditional and contemporary). Background: Creating an environment of care in patient rooms that successfully balances energy efficiency concerns with the holistic needs of patients, families, and caregivers poses a major challenge for future lighting systems. This study adds to a growing evidence base on the effects of lighting on nurses’ job performance, job satisfaction, and overall perceptions of the environment. Method: Survey responses from 138 participants working in medical–surgical units in four hospitals were analyzed using a mixed-methods approach, with three of the hospitals having lighting systems characterized as providing a traditional environment of care (TEC) and the other hospital having lighting systems characterized as providing a contemporary environment of care (CEC). Results: No significant differences were found based on age or work shift, but several significant differences were found between participants working in the hospital with a CEC and those working in hospitals with a TEC. Participants from the hospital with a CEC lighting system consistently reported higher lighting quality, fewer patient complaints, and less need for supplemental lighting than the participants from the three hospitals with TEC lighting systems. Conclusion: The results of this study provide evidence that innovative lighting approaches and technologies are worth considering as an investment by hospital administrators looking to improve perceptions of the patient room environment.

Objectives To understand breast cancer survivors' and providers' attitudes and beliefs regarding exercise counseling and structured exercise programs within cancer care. Sample & setting 61 female breast cancer survivors and 11 breast cancer providers from a university cancer center in the Pacific Northwest. Methods & variables Survivors completed anonymous self-report surveys, and providers participated in semistructured interviews. Survey data were analyzed using descriptive statistics, and interview transcripts were analyzed using qualitative content analysis. Results Breast cancer survivors and providers believed that including exercise counseling within cancer care was important. More than half of the survivors reported that they would attend structured exercise classes; a majority of providers thought cancer centers should offer exercise programs. Implications for nursing Nurses could facilitate exercise counseling within cancer care and advocate for clinic-based exercise programs.

To explore the mental health needs of parents of infants in a neonatal intensive care unit (NICU), as well as barriers and solutions to meeting these needs.Qualitative interviews conducted with parents and staff (n = 15) from a level IV NICU in the Northwestern United States. Thematic analysis completed using an inductive approach, at a semantic level.(1) Information and mental health needs change over time, (2) Staff-parent relationships buffer trauma and distress, (3) Lack of continuity of care impacts response to mental health concerns, (4) NICU has a critical role in addressing parental mental health.Mental health support should be embedded and tailored to the NICU trajectory, with special attention to the discharge transition, parents living in rural areas, and non-English-speaking parents. Research should address structural factors that may impact mental health such as integration of wholistic services, language barriers, and staff capacity.

BackgroundSecondary contact between closely related lineages can result in a variety of outcomes, including hybridization, depending upon the strength of reproductive barriers. By examining the extent to which different parts of the genome introgress, it is possible to infer the strength of selection and gain insight into the evolutionary trajectory of lineages. Following secondary contact approximately 8000 years ago in the Pacific Northwest, mule deer (Odocoileus hemionus hemionus) and black-tailed deer (O. h. columbianus) formed a hybrid swarm along the Cascade mountain range despite substantial differences in body size (up to two times) and habitat preference. In this study, we examined genetic population structure, extent of introgression, and selection pressures in freely interbreeding populations of mule deer and black-tailed deer using mitochondrial DNA sequences, 9 microsatellite loci, and 95 SNPs from protein-coding genes.ResultsWe observed bi-directional hybridization and classified approximately one third of the 172 individuals as hybrids, almost all of which were beyond the F1 generation. High genetic differentiation between black-tailed deer and mule deer at protein-coding genes suggests that there is positive divergent selection, though selection on these loci is relatively weak. Contrary to predictions, there was not greater selection on protein-coding genes thought to be associated with immune function and mate choice. Geographic cline analyses were consistent across genetic markers, suggesting long-term stability (over hundreds of generations), and indicated that the center of the hybrid swarm is 20-30 km to the east of the Cascades ridgeline, where there is a steep ecological transition from wet, forested habitat to dry, scrub habitat.ConclusionsOur data are consistent with a genetic boundary between mule deer and black-tailed deer that is porous but maintained by many loci under weak selection having a substantial cumulative effect. The absence of clear reproductive barriers and the consistent centering of geographic clines at a sharp ecotone suggests that ecology is a driver of hybrid swarm dynamics. Adaptive introgression in this study (and others) promotes gene flow and provides valuable insight into selection strength on specific genes and the evolutionary trajectory of hybridizing taxa.

Here we report Illumina-based whole genome sequencing of three rockfish species of Sebastes in northwest Pacific. The whole genomic DNA was used to prepare 350-bp pair-end libraries and the high-throughput sequencing yielded 128.5, 137.5, and 124.8 million mapped reads corresponding to 38.54, 41.26, and 37.43 Gb sequence data for S. schlegelii, S. koreanus, and S. nudus, respectively. The k-mer analyses revealed genome sizes were 846.4, 832.5, and 813.1 Mb and the sequencing coverages were 45×, 49×, and 46× for three rockfish, respectively. Comparative genomic analyses identified 46,624 genome-wide single nucleotide polymorphisms (SNPs). Phylogenetic analysis revealed closer relationships of the three species, compared to other six rockfish species. Demographic analysis identified contrasting changes between S. schlegelii and other two species, suggesting drastically different response to climate changes. The reported genome data in this study are valuable for further studies on comparative genomics and evolutionary biology of rockfish species., Design Type(s)species comparison design • sequence analysis objectiveMeasurement Type(s)whole genome sequencing assayTechnology Type(s)DNA sequencingFactor Type(s)Sample Characteristic(s)Sebastes schlegelii • Sebastes koreanus • Sebastes nudus Machine-accessible metadata file describing the reported data (ISA-Tab format)

Objective To determine whether the use of child-centered nutrition phrases (CCNP) with repeated exposure (RE) improved willingness to try, liking, and consumption of healthful foods compared with RE alone. Design The researchers used a 2 × 2 × 4 fractionated within-subjects experimental design in the study: phrase condition (RE vs CCNP + RE) by time of measurement (preintervention, postintervention, and 1-month follow-up), by type of food (tomatoes, bell peppers, lentils, and quinoa). Setting Children were recruited from 2 early education centers; 89% participated. Participants Children aged 3–6 years old (n = 87) who were predominantly white (67%) and from middle-income homes and had parents with some higher education. Intervention Adult delivery of CCNP + RE weekly for 6 weeks. Main Outcome Measure(s) Willingness to try, change in liking, and change in consumption. Analysis Two-level random-effects models were used to account for repeated measurements of willingness to try, liking, and consumption nested within participants. Results Children exhibited greater consumption of CCNP foods at follow-up assessment compared with RE foods (b = –16.28, SE = 5.41, t(528) = 3.01; P = .003). Conclusions and Implications Use of CCNP combined with RE may encourage healthy eating, especially for novel foods that children may typically refuse.

This study examined the impact of a school-based indicated prevention program on depression and anxiety symptoms for youth during the transition from middle to high school. The High School Transition Program (HSTP) was designed to build social and academic problem-solving skills and engagement during this period of particular vulnerability for adolescents. Students (N = 2664) at six middle schools in the Pacific Northwest completed a universal emotional health screening during the second half of the 8th grade year, and those with elevated depression scores and low conduct problem scores were invited to participate in the trial. Eligible students (N = 497) were randomized to either the HSTP (N = 241) or control (N = 256) conditions. Depression and anxiety symptoms were measured at five time points over an 18-month period using validated self-report measures. Hierarchical linear modeling was used to assess prevention effects and moderators such as baseline symptoms, race, and sex. Results suggested that students randomized to the HSTP group had accelerated rate of reduction in depressive symptoms over time (d = .23) relative to the control group. Students randomized to the HSTP group also had significantly faster rates of change of anxiety scores (d = 0.25). Baseline anxiety severity, race, and sex did not differentially impact the trajectories of symptom outcomes between conditions. Implications for prevention efforts during this normative but stressful period of transition for youth are discussed. ClinicalTrials.gov registration number is NCT00071513.

To quantify vitamin D status among pregnant women in the Pacific Northwest (Portland, OR, and Seattle, WA) and examine pregnancy and newborn outcomes in relationship to maternal serum blood samples obtained during pregnancy.A retrospective cohort design.Data from 2009 to 2013 were abstracted from the health records of two out-of-hospital midwifery practices in the Pacific Northwest.Women with recorded serum blood samples for vitamin D during pregnancy were included. We reviewed health records of 663 women, and 357 met criteria.We extracted demographic, biometric, and pregnancy outcome data from participants' records and analyzed them using regression models.Mean serum 25-hydroxy vitamin D (25[OH]D) was 29.96 ± 10.9 ng/ml; 45.5% of participants were sufficient (≥30 ng/ml), and 55.5% were insufficient or deficient (29 ng/ml). Lower vitamin D levels were predicted by Seattle location, greater prepregnancy body mass index, and blood samples drawn during the winter. Vitamin D status was not a predictor of spontaneous abortion, glucose tolerance test result, cesarean birth, infant birth weight, or any other outcome investigated.Although there is a high prevalence of vitamin D insufficiency and deficiency in pregnant women in the Pacific Northwest, adverse health effects were not observed. This may be attributable to the overall healthy profile of the women in our sample. Further research on maternal vitamin D status should focus on identification of optimal vitamin D levels in pregnancy and long-term outcomes among offspring of women who are vitamin D deficient, particularly those from high-risk, vulnerable populations.

Background Delayed hemolytic transfusion reactions (DHTRs) are reported to be rare occurrences but may be more frequently observed in the trauma setting where patients are heavily transfused, followed over long inpatient admissions, and have frequent subsequent blood counts as they undergo multiple surgical interventions. Study design and methods We examined the rates of DHTRs on a per transfusion and per patient basis in an academic county hospital with a level 1 trauma center serving a four-state region and over a 3-year period. DHTRs were entered sequentially into a registry as they were observed, and a retrospective review of all new alloantibodies detected was performed to identify any additional DHTRs. The number of units of red blood cells (RBCs), the number of unique patients, types of alloantibodies, and number of transfusions were extracted from blood bank records. Results Twenty-nine DHTRs were observed from January 1, 2017, through December 31, 2019, from newly observed alloantibodies after a median of 12 red blood cells (RBCs) transfusions per patient. These reactions occurred in response to 24,633 unique transfusions in 6905 unique patients, so the observed rates were about 1:849 RBC transfusions and 1:238 transfused patients. Evidence of delayed hemolysis was seen in five additional patients who were transfused during emergency resuscitation and later found to have had known RBC antibodies. Discussion We report a higher rate of DHTRs than previously described to demonstrate that DHTRs are not rare in trauma centers.

The observed variability in susceptibility to SARS-CoV-2 and severity of the ensuing COVID-19 have raised intense interest in their environmental and genetic risk factors. An early report from China1 suggested that blood group A was associated with increased susceptibility and blood group O was associated with reduced susceptibility to SARS-CoV-2 infection. These reports motivated widespread interest in examining ABO blood groups as potential COVID-19 risk factors. Subsequent studies from Italy and Spain2 reported that blood group A was associated with an increased risk of severe COVID-19 and blood group O was associated with a reduced risk. In contrast, a large Danish study3 implicated disease susceptibility but not severity. However, observations from Boston, Massachussets,4 and New York, New York,5 did not confirm any specific associations between ABO blood group and disease. The controversy raised by these contrasting reports led to this case-control study.

Key Points Question What hospital characteristics are associated with overuse of health care services in the US? Findings In this cross-sectional study of 1 325 256 services performed at 3351 hospitals, we found that hospitals in the South, for-profit hospitals, and nonteaching hospitals were associated with the highest rates of overuse. Meaning Variation within specific hospital types and regions may uncover opportunities for targeted interventions to address overuse., This cross-sectional study uses Medicare fee-for-service claims data to assess overuse of medical tests and treatments in US hospitals., Importance Overuse of health care services exposes patients to unnecessary risk of harm and costs. Distinguishing patterns of overuse among hospitals requires hospital-level measures across multiple services. Objective To describe characteristics of hospitals associated with overuse of health care services in the US. Design, Setting, and Participants This retrospective cross-sectional analysis used Medicare fee-for-service claims data for beneficiaries older than 65 years from January 1, 2015, to December 31, 2017, with a lookback of 1 year. Inpatient and outpatient services were included, and services offered at specialty and federal hospitals were excluded. Patients were from hospitals with the capacity (based on a claims filter developed for this study) to perform at least 7 of 12 investigated services. Statistical analyses were performed from July 1, 2020, to December 20, 2020. Main Outcomes and Measures Outcomes of interest were a composite overuse score ranging from 0 (no overuse of services) to 1 (relatively high overuse of services) and characteristics of hospitals clustered by overuse rates. Twelve published low-value service algorithms were applied to the data to find overuse rates for each hospital, normalized and aggregated to a composite score and then compared across 6 hospital characteristics using multivariable regression. A k-means cluster analysis was used on normalized overuse rates to identify hospital clusters. Results The primary analysis was performed on 2415 cohort A hospitals (ie, hospitals with capacity for 7 or more services), which included 1 263 592 patients (mean [SD] age, 72.4 [14] years; 678 549 women [53.7%]; 101 017 191 White patients [80.5%]). Head imaging for syncope was the highest-volume low-value service (377 745 patients [29.9%]), followed by coronary artery stenting for stable coronary disease (199 579 [15.8%]). The mean (SD) composite overuse score was 0.40 (0.10) points. Southern hospitals had a higher mean score than midwestern (difference in means: 0.06 [95% CI, 0.05-0.07] points; P

BACKGROUND The literature on community-engaged research provides important principles to guide research partnerships, but concrete descriptions of the complexities involved in developing, navigating, and maintaining such partnerships are lacking. OBJECTIVES To describe and assess a longstanding, complex research partnership between Indigenous and academic pharmacogenetic research partners, with attention to co-learning and capacity building lessons learned. METHODS Descriptive thematic analysis of 11 semistructured interviews with interdisciplinary research partners situated at Indigenous and academic settings. RESULTS Lessons learned included the need for explicit negotiation around mentoring expectations, and discussion on advisory and staff roles. Partners need to be aware not only of the structures, policies, and hierarchies within each partner institution, but also the tacit value commitments and understandings entailed in their different missions. CONCLUSIONS This study highlights that the concept of "bidirectional" learning as it is usually presented in the literature fails to capture the complexity of how partnerships work.

Objective To assess whether frequency of marijuana and alcohol use are cross-sectionally associated with indicators of social and emotional well-being including loneliness, psychological distress, and flourishing across important life domains among young adults. Method The study sample included 562 participants ages 22–29 who were originally recruited from an urban Pacific Northwest region in the US as part of a longitudinal study of social role transitions and alcohol use. At one assessment, participants completed an online survey that included a 3-item measure of loneliness, a 4-item measure of depression and anxiety symptoms, and a 12-item measure of flourishing as well as measures of marijuana and alcohol use frequency. Linear and generalized linear models were used to estimate associations of marijuana and alcohol use frequency with indicators of well-being. Results Greater frequency of marijuana use was associated with higher levels of loneliness, higher levels of psychological distress, and lower levels of flourishing, with the greatest difference observed for daily marijuana users compared to non-users. However, these indicators of well-being did not significantly differ by levels of alcohol use frequency. Conclusion Study findings suggest that frequent users of marijuana, but not alcohol, may experience more loneliness, more psychological distress, and less flourishing. Intervention approaches for frequent marijuana users may be warranted to reduce impacts of loneliness and psychological distress and improve overall well-being.

This study investigated the frequency of false positive dermatophyte cultures, dermatophyte prevalence, and dermatophytosis risk factors in an animal sheltering system in British Columbia. Records for 80 471 incoming shelter animals over 3.5 years were accessed retrospectively. For 831 high-risk animals cultured, the false positive rate was 28% [N = 229; 95% confidence interval (CI): 25% to 31%]. Microsporum canis was diagnosed in 201 cases (0.25%, 95% CI: 0.22% to 0.29%) and Trichophyton was diagnosed in 43 cases (0.055%, 95% CI: 0.040% to 0.072%). Microsporum canis cases occurred only in cats and rabbits, but not in dogs. Cats were twice as likely to be diagnosed with Trichophyton as dogs. Puppies and kittens (versus adults) and animals from cruelty investigations (versus other sources) were significantly more likely to be diagnosed with dermatophytosis. Animals seized from 4 cruelty cases with enzootic dermatophytosis did not follow overall prevalence or population risk patterns. Understanding patient and population risk factors can help expedite diagnosis, treatment, and recovery, and reduce contagious risk to humans and animals.

Strong school engagement is crucial for school success among adolescents and particularly important for reducing recidivism. Yet, little is known about school engagement among youth serving probation while attending community schools. This study tested the multivariate associations between risk and promotive factors with three components of school engagement (behavioral, cognitive, and emotional). The study’s sample was derived from 5,378 intake assessments (23.6% female) of youth entering juvenile probation in a Pacific Northwest county who were assessed as either moderate or high risk for recidivism. The racial composition of the sample was predominantly White or European American (56.0%) and Black or African American (24.2%) and ranged in age from 10 to 19 years old (M = 15.5, SD = 1.46). The results suggest that dimensions of school engagement can be strengthened by increased relational and skill-building supports throughout youth’s social ecologies. The promotive factors of prosocial attitudes and prosocial community connections were significantly associated with increased school engagement. The implications of these findings are discussed regarding opportunities and strategies that promote school engagement for youth on probation.

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is marked by a wide range and severity of symptoms. Most patients have mild to moderate symptoms, whereas 10%–15% require hospitalization. Mortality is higher with cardiovascular disorders, diabetes, and older age.1

The genus Neorickettsia includes obligate, intracellular bacteria responsible for diseases including Potomac horse fever caused by Neorickettsia risticii and salmon poisoning disease (SPD) caused by Neorickettsia helminthoeca. The Stellanchasmus falcatus (SF) agent is a member of this genus previously associated only with mild clinical signs in dogs. Between 2013 and 2016, 3 dogs in Washington State (USA) presented with disease suggestive of SPD, but N. helminthoeca was not detected by molecular techniques. Clinical signs included depression, anorexia, and diarrhea. Cytologic examination of aspirates supported a diagnosis of granulomatous lymphadenitis with organisms suggestive of Neorickettsia. Dogs either died or were humanely euthanized due to poor response to therapy. Necropsy findings included lymphadenomegaly and hepatomegaly. Histopathology identified granulomatous and lymphoplasmacytic splenitis, lymphadenitis, enteritis, and hepatitis with extensive necrosis. Neorickettsia DNA was detected using genus-specific primers and direct sequencing showed 100% sequence identity to the SF agent in all 3 dogs. This is the first clinicopathologic description of severe disease in dogs attributed to the SF agent. These findings may suggest the emergence of a novel neorickettsial disease in the Pacific Northwest.

American Indian youth substance use is a major public health concern. To date, there has been limited evaluation of American Indian youth substance use prevention programs. Evaluation of prevention programs is necessary to understand the aspects of programming that are effective or not effective. This mixed-methods evaluation focuses on select outcomes of a 3-year culturally-based prevention program located in six American Indian communities in the Rocky Mountain Region. The goals of the prevention program are to reduce binge drinking by 30% and increase community readiness by 1-point over a 5- year period. In the first year of the program, community members worked with program staff to develop an evaluation plan that would measure the following outcomes: lowering substance use, increasing community readiness, and increasing the reach of prevention messaging through culturally based prevention. The primary research questions this outcome evaluation sought to answer were as follows: 1) Are there differences in American Indian youth who participate in culturally-based prevention activities compared with American Indian youth who do not participate in these activities? 2) Was the prevention program effective in increasing community readiness over a 3-year period? 3) Did community involvement in prevention activities increase overtime? Results from this evaluation indicate that substance use was similar among intervention (n = 200) and non-intervention youth (n = 369). This was somewhat surprising because Intervention youth reported higher levels of social support and community connections than non-intervention group youth. Community readiness decreased -.81 point from 2015 to 2017. The reach of prevention activities increased 365% from 2015 to 2017. We provide lessons learned that may help other communities as they document outcomes related to prevention efforts. Substance use is a multi-faceted problem facing our communities, families, schools, and nation. Innovative, effective, culturally-based prevention programs like the one highlighted in this paper underscore the need for primary prevention strategies.

Background This study evaluates the Northwestern Medicine Group Transitional Care clinic (NMG-TC), which transitions patients from an urban hospital to primary care at partner community clinics. We evaluate change over the 55 month study period in emergency department, observation or inpatient use within 90 days of an initial NMG-TC visit. Methods Electronic health records were used to determine patient demographic, insurance and clinical characteristics, including inflation-adjusted total hospital charges in the 90 days prior and the 90 days after an initial NMG-TC visit. Multiple logistic regression was used to estimate the likelihood of any 90-day post-NMG-TC visit hospital use, controlled for the simultaneous effects of patient characteristics and pre-visit hospital use level. Results There were 3318 patients with 90-day follow-up of whom 28.5% had 90 day post-visit hospital encounters. Patients with cancer, infectious disease or pain diagnoses at the time of a NMG-TC visit had the highest 90-day post-visit hospital use. The level of pre-NMG-TC visit hospital charges, the number of NMG-TC visit diagnostic categories and the number of NMG-TC visits all showed a sharply graded effect on subsequent hospital use. Patients with a first NMG-TC visit in the last nine months of the study (2015–2016) had a 38% lower likelihood of any 90-day hospital use (OR = 0.62, 95% CI = 0.45–0.84) as compared to patients seen in 2011–2012. Conclusion and implications Reduced post-visit hospital use is likely related to increased clinic resources, Affordable Care Act insurance expansions, and improved clinical and community social service expertise. Level of evidence Cohort study, Level 2

Background Threatening and assaultive behaviors against healthcare workers are a growing national concern.1,2,3 Objective To assess the incidence and impact of aggression against healthcare workers, a safety and quality improvement project was initiated in an academic, tertiary care, urban hospital. Methods Through the Northwestern Academy of Quality and Safety Initiatives program, an invitation to complete an online survey was sent to healthcare workers. The survey inquired about prevalence, location, and type of experience of physical or verbal abuse by patients or families. Other goals were: 1) worker knowledge and use of reporting systems, 2) effect on healthcare worker engagement, and 3) report of posttraumatic symptoms. Results 34.4% of healthcare workers reported any incident of verbal or physical violence in the preceeding 12 months, with 13.5% reporting physical assault. Of those with any incident of physical or verbal violence, 60.2% endorsed at least one posttraumatic symptom, 9.4% missed work, and 30.1% had thoughts about leaving their job or career. The reported impact was the same for physical or verbal incidents. Discussion Physical and verbal abuse of healthcare workers is prevalent and has a significant impact on employee engagement and posttraumatic spectrum symptoms. These results are based on a cross-sectional survey at one institution and may have a significant selection and response bias. Conclusion Assessment of both verbal and physical aggression against healthcare workers should be standard. Front-line consulting psychiatrists and psychiatric programs for employee wellness could assess and manage this impact.

Admixture resulting from natural dispersal processes can potentially generate novel phenotypic variation that may facilitate persistence in changing environments or result in the loss of population-specific adaptations. Yet, under the US Endangered Species Act, policy is limited for management of individuals whose ancestry includes a protected taxon; therefore, they are generally not protected under the Act. This issue is exemplified by the recently re-established grey wolves of the Pacific Northwest states of Washington and Oregon, USA. This population was likely founded by two phenotypically and genetically distinct wolf ecotypes: Northern Rocky Mountain (NRM) forest and coastal rainforest. The latter is considered potentially threatened in southeast Alaska and thus the source of migrants may affect plans for their protection. To assess the genetic source of the re-established population, we sequenced a ~ 300 bp portion of the mitochondrial control region and ~ 5 Mbp of the nuclear genome. Genetic analysis revealed that the Washington wolves share ancestry with both wolf ecotypes, whereas the Oregon population shares ancestry with NRM forest wolves only. Using ecological niche modelling, we found that the Pacific Northwest states contain environments suitable for each ecotype, with wolf packs established in both environmental types. Continued migration from coastal rainforest and NRM forest source populations may increase the genetic diversity of the Pacific Northwest population. However, this admixed population challenges traditional management regimes given that admixture occurs between an adaptively distinct ecotype and a more abundant reintroduced interior form. Our results emphasize the need for a more precise US policy to address the general problem of admixture in the management of endangered species, subspecies, and distinct population segments.

Multiple sclerosis (MS) is associated with high total health care cost, the majority of which is attributable to medications. Patients with MS are less likely to experience relapses, emergency department (ED) visits, and hospitalizations when they are adherent to disease-modifying treatments. Disease management programs are hypothesized to improve medication adherence thereby improving clinical and economic outcomes.To evaluate the clinical and economic effects of a specialty pharmacy and chronic disease management program for patients with MS from a health plan perspective.This study was a retrospective analysis using prescription drug claims, medical claims, and electronic medical record information (2013-2015) 1 year before and after enrollment in the disease management program for members with 24 months of continuous health plan coverage. Medication adherence was calculated using proportion of days covered (PDC). Relapse rate was defined as an MS outpatient visit associated with a corticosteroid dispense within 7 days of the visit or an MS hospitalization. Disease progression was assessed using the Modified Expanded Disability Status Scale (mEDSS). Resource use included outpatient visits, ED visits, and hospitalizations. Cost information was collected as health plan-paid amount and was reported in 2013 U.S. dollars.The analysis included 377 patients (mean age 55 years, 76.4% female). After enrollment in the program, 78.7% of the study group had a PDC of ≥ 0.80 compared with 70.0% before enrollment (P0.001). There was no difference in MS relapse rate (0.25 after vs. 0.45 before, P = 0.11) or mEDSS score (3.77 after vs. 3.76 before, P = 0.19). Health care resource utilization was minimal and did not change significantly throughout the study period: mean outpatient visits (13.09 after vs. 13.78 before, P = 0.69); mean ED visits (0.18 after vs. 0.16 before, P = 0.60); and mean hospitalizations (0.12 after vs. 0.12 before, P = 1.00). This nonsignificant finding remained when the analysis was limited to MS-related visits only. Average annual health plan spend per patient on MS medications significantly increased ($55,835 after vs. $40,883 before, P0.001).Specialty pharmacy and chronic disease management for patients with MS can increase the proportion of patients adherent to medication. The increase in health plan spend on MS medications is not offset by savings in health care resource utilization.This study was funded by Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington Pharmacy Administration. The authors have no disclosures to report.

The quality of parent-child relationships likely influences many decisions and behaviors made by early adolescents, including their alcohol and marijuana use. We examined how parent-youth relationship quality, parental monitoring, and parent substance use were associated with initiation of alcohol use, binge drinking, and marijuana use by 400 adolescents by the spring of 8th grade (ages 13-14), and changes in initiation through 9th grade (assessed 3 times; fall, winter, and spring). We measured both parent and adolescent report of parent-youth relationship quality and parental monitoring, expecting that both perspectives would uniquely contribute. Discrete Time Survival models showed that youth report of both a poorer parent-youth relationship and lower parental monitoring were associated with alcohol use, binge drinking, and marijuana use onset. Parent binge drinking also predicted youth alcohol onset and parent report of poor quality relationship predicted marijuana onset. Youth report of a poor relationship with parents was a stronger predictor for girls than boys on their alcohol use onset, and youth report of parental monitoring was more protective for girls than boys for both alcohol and marijuana use onset. Implications for preventing use of these substances during early and mid-adolescence are discussed. (PsycINFO Database Record

This study explored factors related to substance misuse and recovery among Native mothers in a Pacific Northwest tribe, focusing on motherhood as a motivating factor in seeking treatment and sustaining recovery.Using a community-based participatory research approach, we conducted a thematic analysis of 20 in-depth interviews and one focus group (N = 12) with Native women 18 years and older living on or near the reservation.Qualitative findings highlighted challenges, motivations and strategies for seeking treatment and recovery in four major themes: (a) the close relationship between interpersonal violence and substance misuse; (b) traditional healing in recovery; (c) community-specific challenges to recovery; and (d) the motivating role of motherhood in seeking treatment and successful recovery.A central finding of this work is that pregnancy and motherhood may be underexplored factors in Native women's substance use. Results support previous work suggesting that Native women are at high risk of interpersonal trauma and that trauma contributes to substance misuse. Findings offer several rich implications for treatment and recovery among Native mothers in tribal communities including the necessity of trauma-informed treatment, community and culturally-based interventions, more integration of treatment services with Child Protective Services, and drawing on motherhood as a motivation for seeking and succeeding in recovery.

Spotted wing drosophila, Drosophila suzukii (Matsumura) (Diptera: Drosophilidae), was monitored from 2010 to 2014 in 314-828 sites located in interior fruit-growing regions of OR and WA, United States, and BC, Canada, using traps baited with apple cider vinegar or sugar-water-yeast. Seasonal population dynamics and sex ratios were summarized for berry, cherry, stone fruit, grape, non-crop host plants, non-host sites, and for conventional IPM, certified organic, backyard, and feral sites, by region and year. Overwintering was detected in all regions and years, despite winter temperatures below -17°C. A spatial analysis was conducted using a Geographic Information System (GIS), daily weather data, geomorphometric measures of terrain, distance to water, and other variables, at each site. Overwintering success at a site, measured as Julian week of first capture of D. suzukii, was significantly related (R2 = 0.49) in cherry habitats to year, agronomic treatment, and number of winter days with temperatures >-5°C. In berry, cherry, stone fruit and grape habitats, 2011-2014, it was significantly related (R2 = 0.42) to year, agronomic treatment, the logarithm of peak population of D. suzukii in the prior autumn, latitude, elevation, and topographic wetness index. The results show that D. suzukii has adapted to exploit a succession of irrigated crops and feral habitats in mixed landscapes of a semi-arid region with cold winters and hot dry summers, and are shaping strategies for pest management and for biological control.

Background Exercise‐induced pulmonary hemorrhage (EIPH) refers to bleeding from the lungs in association with strenuous exercise. It has been documented in race horses but little information exists on EIPH in barrel racing horses. Hypothesis/Objectives Our goals were to evaluate the presence of EIPH in barrel racing horses and estimate its prevalence in the Pacific Northwest. Animals 149 barrel racing horses enrolled at events in WA (11), ID (3), and MT (33). Methods Observational cross‐sectional study. Data collected included signalment, history of illness, respiratory disease, race division, and pre‐race medications. Endoscopy was performed and tracheobronchoscopic (TBE) EIPH score was assigned based on quantity of blood in the trachea (0 = no blood to 4 = abundance of blood within the trachea). After TBE, bronchoalveolar lavage (BAL) was performed. Erythrocyte (red blood cell, RBC) counts were obtained from bronchoalveolar lavage fluid (BALF). Statistical analysis included linear and logistic regression, Fisher's exact t test, and calculation of correlation coefficient. Significance was set at P 1,000 cells, EIPH prevalence was 66%. Race time did not significantly affect the presence of EIPH. A significant (P

Record high temperatures are occurring more frequently in the United States, and climate change is causing heat waves to become more intense (1), directly impacting human health, including heat-related illnesses and deaths. On average, approximately 700 heat-related deaths occur in the United States each year (2). In the northwestern United States, increasing temperatures are projected to cause significant adverse health effects in the coming years (3). During June 25-30, 2021, most of Oregon and Washington were under a National Weather Service excessive heat warning.* Hot conditions persisted in parts of Oregon, Washington, or Idaho through at least July 14, 2021. The record-breaking heat had the largest impact in Oregon and Washington, especially the Portland metropolitan area, with temperatures reaching 116°F (46.7°C), which is 42°F (5.6°C) hotter than the average daily maximum June temperature.

Traditional 0-to-10 pain assessment may be inadequate during labor. The Coping Assessment for Laboring Moms (CALM) scale was developed to focus on facial, behavioral, psychosocial, vocalization, and verbal expressions to aid holistic nursing support during childbirth. Using a comparative design, the 0-to-10 pain and CALM scales were evaluated to determine differences in women's perceptions of nursing presence using the Positive Presence Index during labor at a community hospital in the Pacific Northwest. Positive Presence Index scores for knowing what would work best for me, comforting touch, taking care of everything so I could concentrate, and understanding what I was saying were significantly higher among women when nurses used the CALM tool to guide labor support. The CALM scale needs further testing with a larger, more diverse population.

e18175 Background: There is limited available information on the patterns of utilization and efficacy of alternative medicine (AM) for patients with cancer. The primary objective was to compare survival between patients with cancer receiving AM and conventional cancer treatment. The secondary objective was to determine cancer patient characteristics associated with selection of AM. Methods: Patients diagnosed with non-metastatic breast, prostate, lung, or colorectal cancer were identified between 2004-2013 using the National Cancer Database (NCDB). Alternative medicine use was defined as ‘Other-Unproven: Cancer treatments administered by nonmedical personnel’ administered as sole anti-cancer treatment among patients who did not receive chemotherapy, radiotherapy, surgery, and/or hormone therapy. Treatment selection was evaluated by the chi-square test, t-test, and logistic regression. Patients were 2:1 matched on age, clinical group stage, Charlson-Deyo comorbidity score, insurance type, race, year of diagnosis, and cancer type. Overall survival was analyzed using the Kaplan-Meier method, log-rank test, and Cox proportional hazards regression. Results: We identified 281 patients who chose AM in lieu of conventional cancer treatment. Approximately 44% of these patients had breast cancer, followed by prostate (25.5%), lung (18.4%) and colorectal cancer (12.1% of patients). Independent covariates associated with increased likelihood of AM use included breast or lung primary site (vs. prostate), higher socioeconomic status, Intermountain West or Pacific location (vs. Northeast), stages II or III (vs. I) and Charlson-Deyo comorbidity score of 0 (vs. 1). Alternative medicine was independently associated with greater risk of death compared to conventional cancer treatment overall (HR: 2.50, 95% confidence interval 1.88-3.27) and in subgroups of patients with breast, lung, and colorectal cancer. Conclusions: Alternative medicine utilization in patients with cancer is rare and varied by geographic, socioeconomic, and disease-related factors. Patients who chose alternative medicine for primary treatment of their curable cancer had greater risk of death compared to those who chose conventional cancer treatment.

Pain is a nursing sensitive indicator and yet pain is often not well managed in both hospital and ambulatory settings. Improving nurse knowledge and attitudes about pain may translate to improved patient outcomes. The objective of this study was to investigate knowledge and attitudes about pain (KAP) in nurses who work in diverse settings, professional and personal characteristics that predict KAP, and whether KAP correlated with patient satisfaction according to Hospital Consumer Assessment of Healthcare Providers (HCAHPS). Descriptive, cross-sectional, correlational study. A large integrated health care facility in the northwest. A total of 217 registered nurses working in acute, ambulatory, and long-term care. A Pain Knowledge and Attitudes Survey was administered to registered nurses in diverse settings. Scores were examined for personal and professional predictors of KAP and correlated with HCAHPS patient satisfaction surveys. Nurses scored an average of 72%; nurses in long-term care scored the highest. Having more than 5 years of nursing experience, being a certified nurse, and receiving pain education in the last year were predictive of a higher score on the KAP survey, which explained only 9.8% of the variance. Unit mean KAP scores were highly correlated with unit-based HCAHPS scores (r = 0.917, p = .01). Certified nurses scored higher on the KAP survey, consistent with other studies. This study suggests that having more knowledge and better attitudes about pain may improve patient satisfaction of pain. Further studies are needed that link knowledge and attitudes about pain to patient outcomes.

The purpose of the present paper was to examine the extent to which college students underestimate the quantity of alcohol they will consume during Spring Break (SB), and whether individual, interpersonal, and contextual factors may be related to underestimation of SB drinking and drinking consequences. College students participated in web-based surveys prior to and after SB (N = 603; 57% women). Overall, results indicated that individual factors (being male, being a member of a fraternity or sorority, previously experiencing more alcohol-related consequences, and intending to drink less during SB), interpersonal factors (reporting friends encourage getting drunk), and contextual factors (going on a SB trip with friends and receiving drinks from others) predicted underestimating peak drinks consumed during SB. Underestimating the peak number of drinks to be consumed on SB was associated with experiencing a greater number of alcohol-related consequences. Targeted interventions designed specifically to focus on underestimation of college student drinking and the impact of SB contextual and interpersonal factors may be an important area of study to reduce negative consequences of alcohol use during SB.

Minority and majority elementary school students from a Native American reservation (N = 188; K-fifth grade; 5- to 10-year-olds) completed tests of academic self-concepts and self-esteem. School grades, attendance, and classroom behavior were collected. Both minority and majority students exhibited positive self-esteem. Minority students demonstrated lower academic self-concepts and lower achievement than majority students. Two age-related patterns emerged. First, minority students had lower academic achievement than majority students, and this effect was stronger in older (Grades 3-5) than in younger (Grades K-2) students. Second, children's actual achievement was related to their academic self-concepts for older students but more strongly linked to self-esteem in younger students. The authors offer a developmental account connecting students' developing self-representations to their school achievement.

Background The American Academy of Dermatology recommends dermatologists understand the costs of dermatologic care. Objective This study sought to measure dermatology providers' understanding of the cost of dermatologic care and how those costs are communicated to patients. We also aimed to understand the perspectives of patients and dermatological trainees on how cost information enters into the care they receive or provide. Methods Surveys were systematically developed and distributed to 3 study populations: dermatology providers, residents, and patients. Results Response rates were over 95% in all 3 populations. Dermatology providers and residents consistently underestimated the costs of commonly recommended dermatologic medications but accurately predicted the cost of common dermatologic procedures. Dermatology patients preferred to know the cost of procedures and medications, even when covered by insurance. In this population, the costs of dermatologic medications frequently interfered with patients' ability to properly adhere to prescribed regimens. Limitations The surveyed population was limited to the northwestern United States and findings may not be generalizable. Cost estimations were based on average reimbursement rates, which vary by insurer. Conclusion Improving dermatology providers' awareness and communication of the costs of dermatologic care might enhance medical decision-making, improve adherence and outcomes, and potentially reduce overall health care expenditures.

Introduction Hearing loss and tinnitus are common in most populations, although few data have addressed hearing-related health among tribal members and the need for public health interventions. Methods This cross-sectional study examined prevalence and risk factors for hearing loss and tinnitus among 217 adults in a Pacific Northwest tribe. Frequency measures were conducted for difficulty hearing certain sounds and hearing aid use. In 2006, risk factors were examined for two outcomes—hearing loss and tinnitus—with analysis conducted in the same year. Results Although self-reported hearing loss was more common in men (24%) than women (13%), a larger percentage of women compared with men reported difficulty hearing certain sounds. Only 8% of study participants reported hearing aid use. After age adjustment, significant noise exposure was associated with hearing loss (OR=8.30, 95% CI=1.84, 37.52). The overall prevalence of tinnitus was 33% (similar in men and women). After adjusting for age, the odds of tinnitus in individuals with more than four ear infections was 4.77 (95% CI=1.89, 12.02) times the odds in those who never had an ear infection. Tinnitus was also associated with significant noise exposure (OR=2.24, 95% CI=1.28, 6.73) even after age adjustment. Conclusions Increasing age and significant noise exposure were associated with hearing loss in this tribe. Tinnitus was associated with significant noise exposure and history of otitis media, even after age adjustment. Public health efforts are needed to improve hearing-related health in this tribe through messages about noise exposure and use of hearing protection.

Item does not contain fulltext Background: There is limited empirical integration between peer clustering theory and the Gateway framework. The goal of the present study was to test the hypothesis that friendship associations partly predict gateway escalations in the use of drugs from adolescence to adulthood. Method: This longitudinal study analyzed 3 waves of data from a community sample of 711 male and female participants without a history of illicit drug use reporting drug use at age 17, 22, and 27. Substance use assessments including tobacco, alcohol, cannabis, onset and abuse/dependence tendency of illicit drugs other than cannabis (i.e., cocaine, methamphetamine, and opiates), and friends' reported use of illicit drugs. Structural equation modeling was used to test the hypothesized model. Results: Participants' cannabis use level at age 17 was positively associated with perceived friends' drug use at age 22, which in turn predicted participants' onset of illicit drug use between ages 22 and 27. Moreover, progression of tobacco use throughout age 17 to 22 was associated with an increased onset of illicit drug use between ages 22 and 27. Apart for an effect of cannabis use at age 22 on abuse and dependence tendency to various drugs at age 28, results were similar. Conclusions: During this period of development, the availability and selection of drug-using friends contributes to the progression to potentially more rewarding and damaging illicit drugs. These findings suggest the need to attend to the peer ecology in prevention and support the common practice of using abstaining peers in treatment for drug dependence. 7 p.

BACKGROUND Studies in countries with high human papillomavirus (HPV) vaccination coverage have demonstrated marked reductions in anogenital wart (AGW) incidence. Our goal was to assess the impact of HPV vaccination in a population with suboptimal coverage by comparing AGW incidence trends in the years before and after vaccine introduction. METHODS We conducted a retrospective analysis of AGW incidence trends using an ecologic study design among 11- through 39-year-olds enrolled at Kaiser Permanente Northwest. We defined incidence as the proportion of persons who had a new AGW diagnosis for each calendar year in the prevaccine periods (2000 through 2006 for female individuals, 2000 through 2010 for male individuals) and the postvaccine periods (2007 through 2016 for female individuals, 2011 through 2016 for male individuals). We also described cumulative HPV vaccination coverage. RESULTS The average annual AGW incidence rates in the prevaccine periods were 27.8 per 10,000 in female individuals and 26.9 per 10,000 in male individuals. In the postvaccine periods, AGW incidence rates decreased by 31% (P < 0.001) in female individuals and 10% (P = 0.006) in male individuals; the largest reductions were observed in 15- to 19-year-old female individuals (67%, P < 0.001) and male individuals (45%, P < 0.001). Three dose HPV coverage rates were less than 50% in all age groups and both sexes. CONCLUSIONS In a population of young adults with moderate HPV vaccination coverage, we observed declines in AGW incidence among both female and male year after the introduction of HPV vaccination. The largest incidence reductions were observed in 15- to 19-year-olds who were most likely to have been vaccinated.

Spouses perceiving that they have shared power in marriage has been linked to higher marital quality and attachment security. Existing research, however, is limited in assessing how these perceptions influence both spouses and whether these influences endure over time. To address these limitations, we analyzed the longitudinal relationship reports from 319 couples from the Flourishing Families Project (FFP) to estimate biyearly (Waves 1, 3, and 5) and yearly (Waves 3-5) longitudinal actor-partner interdependence models. Reporting shared power in marriage was linked to the actors' higher marital quality and lower attachment insecurity over time (although less consistently for attachment insecurity). Longitudinal partner effects and indirect effects were also found from reports of shared marital power on both marital quality and attachment insecurity over time. The combined evidence suggests that power dynamics in a marriage are an important predictor of changes in couples' overall relational well-being. Accordingly, marriages appear to benefit from husbands and wives mutually seeking to help each other feel empowered in a relationship as equal and full partners. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Multiple strategies to cure HIV infection are under investigation, including cell and gene therapy (C&GT) approaches. Research, and ultimately treatment, with these novel strategies will require patients' willingness to participate. To elicit the perspectives of people living with HIV specific to these novel approaches, we conducted 4 focus group discussions with a diverse group of 19 English-speaking men and women living with HIV in care at a large academic HIV clinic in the northwestern United States. Thematic analysis indicated participants expressed initial fear about C&GT research. They articulated specific concerns about risks, including analytical treatment interruptions, and thought only a person in desperate straits would participate. They voiced significant mistrust of research in general and believed there was already a cure from HIV that was being withheld from the poor. Overall, they were satisfied with their health and quality of life on antiretroviral therapy. These findings suggest the importance of community engagement and educational efforts about C&GT for HIV cure to ensure optimal collaborative partnerships.

BACKGROUND: Loneliness has been linked to greater substance use, especially among women. Yet little is known about how loneliness is associated with treatment outcomes for patients with opioid use disorder (OUD). OBJECTIVES: We evaluated how patient reports of using illicit opioids (i.e., heroin or non-prescription pain medications) are linked to perceptions of loneliness in a sample of adults receiving methadone maintenance treatment (MMT), and whether this link varies by gender. METHODS: Participants for this cross-sectional observational study included 371 MMT patients aged 18 and older drawn from four opioid treatment programs in Southern New England and the Pacific Northwest. Patients completed a self-administered survey assessing sociodemographic and health information, loneliness, illicit opioid use, and MMT characteristics. Logistic regressions were estimated to examine the link between patient odds of illicit opioid use in the past month and perceived loneliness. RESULTS: Patient gender moderated the association between illicit opioid use and loneliness such that severe loneliness was associated with higher odds of using illicit opioids among women (OR = 3.00, 95% CI [1.19, 7.57], p = .020) but lower odds of using illicit opioids among men (OR = 0.35, 95% CI [0.14, 0.87], p = .024), accounting for age, marital status, work status, depressive symptoms, and MMT characteristics (treatment episode, treatment duration, and methadone dose). CONCLUSIONS/IMPORTANCE: This study underscores the importance of considering loneliness in the management of OUD. Routine clinical care and treatment may benefit from strategies to build and sustain social connections that support long-term recovery among MMT patients.

Introduction Unmet social and economic needs are associated with poor health outcomes, but little is known about how these needs are predictive of future healthcare utilization. This study examined the association of social and economic needs identified during medical visits with future hospitalizations and emergency department visits. Methods Individuals with electronic health record–coded social and economic needs during a primary care, emergency department, or urgent care visit at Kaiser Permanente Northwest from October 1, 2016 to November 31, 2017 (case patients) were identified, as well as individuals who had visits during that time period but had no electronic health record–coded needs (control patients). The 2 groups were compared on sociodemographic characteristics, comorbidities, and healthcare utilization in the prior year. Finally, logistic regression assessed the relationship between documented needs and hospitalizations and emergency department visits in the 12 months following the index visit, controlling for sociodemographic characteristics, comorbidities, and prior healthcare utilization. Statistical analysis was completed in April 2019. Results Case patients differed significantly from control patients on sociodemographic characteristics and had higher rates of comorbidities and prior healthcare utilization. Social and economic needs documented during the index visit were associated with significantly higher rates of hospitalization and emergency department visits in the 12 months following the visit, controlling for sociodemographic characteristics, comorbidities, and prior utilization. Conclusions These results demonstrate that documented social and economic needs are a powerful predictor of future hospitalization and emergency department use and suggest the need for research into whether interventions to address these needs can influence healthcare utilization.

Introduction Couched in Positive Youth Development (PYD) theory and relevant empirical work, this study investigated bidirectional associations between intentional self-regulation and prosocial behavior toward strangers from age 12 to age 18. Method Participants included 500 adolescents (52% female, 77% European American; age Time 1 = 12 years, Time 2 = 14 years, Time 3 = 16 years, Time 4 = 18 years) from the Northwestern United States. Adolescents self-reported on their intentional self-regulation and prosocial behavior toward strangers across four time points. A random-intercept cross-lagged panel model (RICLPM) was estimated in order to assess bidirectionality while avoiding conflating intra- and inter-individual variability. Results Results revealed intentional self-regulation and prosocial behavior toward strangers were bidirectionally related during early adolescence (i.e., from age 12 to 14). During mid-to-late adolescence (i.e. age 14 to 18), prosocial behavior toward strangers facilitated intentional selfregulation, whereas intentional self-regulation did not drive the development of prosocial behavior toward strangers. Conclusions Findings indicate that early adolescence may be a particularly plastic developmental period in terms of PYD. Findings also suggest that investigations of relations between adolescents' personal assets and contribution factors merit further scholarly attention. Several directions for future research are presented.

The objective is to document changes in the etiologic spectrum of hypertension in premature infants. We reviewed all cases of systemic hypertension (HTN) in premature infants at two centers over 8 years. Infants were sorted into categorical groups as described in 2012 by Flynn. Analyses included frequency of diagnosis, timecourse of HTN, and diagnostics. Phthalate exposure via intravenous fluid and respiratory equipment was compared among groups and centers. One hundred and twenty-nine infants having 130 episodes of HTN met the inclusion criteria. Sixty-five percent of cases were classified as pulmonary and 16% as miscellaneous. Plasma renin activity (PRA) was undetectable or

There has been limited prospective investigation of correlates of persistent (repeated within and across relationships) physical intimate partner violence (IPV) victimization compared to episodic (not repeated within or across relationships) IPV in young adulthood. The primary aim of the current study was to examine prior victimization, posttraumatic stress disorder (PTSD) symptoms, psychological IPV (emotional abuse and threats), and remaining with the same partner, as unique correlates of persistent physical IPV during a 6-month period. Female undergraduates who completed baseline and follow-up assessments (n = 254) were classified into victimization groups according to their self-report of physical IPV: no physical IPV (65.0%), persistent IPV (at baseline and follow-up [11.0%]), and episodic IPV (at follow-up [9.8%] or baseline only [14.2%]). Multinomial logistic regression analyses showed that the number of prior victimizations, PTSD hyperarousal symptoms, psychological IPV at baseline, and remaining with the same partner at follow-up significantly discriminated the IPV groups. The likelihood of membership in the persistent physical IPV group was associated with all variables. Episodic physical IPV at baseline only was associated with fewer childhood victimizations and being in a new relationship at follow-up. Results highlight assessment and intervention approaches that may assist females experiencing both persistent and episodic physical IPV.