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Alcohol misuse among young adults remains a primary public health concern given the wide range of short- and long-term physical, social, and societal consequences of the behavior. On-premise drinking establishments, which allow alcohol consumption on site (i.e., bars), are frequent locations for young adult alcohol use. Risks for alcohol misuse within the bar setting are key factors to identify for prevention. Notably, alcohol price and promotions are associated with alcohol consumption among young adults. This study sought to develop and pilot test an observational protocol to assess the alcohol environment at on-premise drinking establishments. Following qualitative exploration of salient risk factors in these settings through focus groups with young adults, an observational tool was adapted and tested in a feasibility study. The refined tool was then pilot tested with two independent data collectors conducting natural observation at 13 establishments in the downtown nightlife district of a small, southeastern city. High interrater reliability was noted. Descriptive summary statistics of bar characteristics demonstrate low alcohol prices with variability across types of alcohol (e.g., beer, wine, and liquor), greater numbers of alcohol promotions inside rather than outside the building, and higher rates of manual versus electronic age verification procedures. Observational assessment of alcohol price and marketing at on-premise drinking establishments as described in this study is needed to inform prevention policy and programs to reduce harms associated with young adult alcohol misuse.

OBJECTIVE To examine the proposition that identical summary statistics (mean and/or SD) in different randomized controlled trials (RCT) or clinical cohorts can be explained by common or homogeneous source populations. STUDY DESIGN We estimated the probability of identical summary data in studies with high proportions of identical summary statistics, in simulations, and in control datasets. RESULTS The probability of both an identical mean and an identical SD for a variable in separate RCT is low (

Study ObjectivesTo evaluate the level of shared genetic components between attention-deficit/hyperactivity disorder (ADHD) and sleep phenotype, common pathways between them and a possible causal relationship between traits.MethodsWe used summary statistics of the largest genome-wide association studies available for ADHD and sleep-related phenotypes including insomnia, napping, daytime dozing, snoring, ease getting up, daytime sleepiness, sleep duration and chronotype. We estimated the genomic correlation between ADHD and sleep-related traits using cross-trait LD-score regression and investigated potential common mechanisms using gene-based cross-trait metanalyses and functional enrichment analyses. The causal effect between the sleep related traits and ADHD was estimated with two sample Mendelian randomization (TSMR), using the Inverse Variance Weighted method as the main estimator.ResultsPositive genomic correlation between insomnia, daytime napping, daytime dozing, snoring, daytime sleepiness, short and long sleep duration, and ADHD were observed. Insomnia, sleep duration, daytime sleepiness, and snoring shared genes with ADHD, which were involved in neurobiological functions and regulatory signaling pathways. The TSMR approach supported a causal effect of insomnia, daytime napping, and short sleep duration on ADHD, and of ADHD on long sleep duration and chronotype.ConclusionOur findings suggest that the comorbidity between sleep phenotypes and ADHD may be mediated by common genetic factors with an important role on neuronal signaling pathways. In addition, it may also exist a causal effect of sleep disturbances and short sleep duration on ADHD, reinforcing the role of these sleep phenotypes as predictors or early markers of ADHD.Statement of SignificanceOur findings suggest that the comorbidity between sleep phenotypes and ADHD may be linked to common genetic factors with an important role on neuronal signaling pathways. They also show that a causal effect of sleep disturbances and short sleep duration on ADHD may exist, reinforcing the role of these sleep phenotypes as ADHD early markers, being able to predict the disorder. This study adds important information about the relationship between sleep, circadian rhythm, and ADHD since it raises new questions about the complexity of the phenomenon involving them and may also provide new treatment insights in this research field.

BACKGROUND: Transgender and gender-diverse individuals are particularly vulnerable to healthcare discrimination and related health sequelae. OBJECTIVE: To demonstrate diversity in demographics and explore variance in needs at the time of intake among patients seeking care at a large, urban gender health program. DESIGN: We present summary statistics of patient demographics, medical histories, and gender-affirming care needs stratified by gender identity and sexual orientation. PARTICIPANTS: We reviewed all intake interviews with individuals seeking care in our gender health program from 2017 to 2020. MAIN MEASURES: Clients reported all the types of care in which they were interested at the time of intake as their “reason for call” (i.e., establish primary care, hormone management, surgical services, fertility services, behavioral health, or other health concerns). KEY RESULTS: Of 836 patients analyzed, 350 identified as trans women, 263 as trans men, and 223 as non-binary. The most prevalent sexual identity was straight among trans women (34%) and trans men (38%), whereas most (69%) non-binary individuals identified as pansexual or queer; only 3% of non-binary individuals identified as straight. Over half of patients reported primary care, hormone management, or surgical services as the primary reason for contacting our program. Straight, transgender women were more likely to report surgical services as their primary reason for contacting our program, whereas gay transgender men were more likely to report primary care as their reason. CONCLUSIONS: Individuals contacting our gender health program to establish care were diverse in sexual orientation and gender-affirming care needs. Care needs varied with both gender identity and sexual orientation, but primary care, hormone management, and surgical services were high priorities across groups. Providers of gender-affirming care should inquire about sexual orientation and detailed treatment priorities, as trans and gender-diverse populations are not uniform in their treatment needs or goals. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-021-06791-9.

Background: Much of Sub-Saharan Africa meets the rising rates of musculoskeletal injury with traditional bone setting, especially given limitations in access to allopathic orthopaedic care. Concern for the safety of bone setter practices as well as recognition of their advantages have spurred research to understand the impact of these healers on public health. Objectives: Our study investigates the role of bone setting in Tanzania through patient utilization and perspectives. Methods: We surveyed 212 patients at the outpatient orthopaedic clinic at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Surveys were either self-administered or physician-administered. Summary statistics were calculated using XLSTAT. Open responses were analyzed using a deductive framework method. Results: Of all surveys, 6.3% (n=13) reported utilizing traditional bone setting for their injury prior to presenting to KCMC. Of the self-administered surveys, 13.6% (n=6) reported utilizing bone setting compared to 4.3% (n=7) of the physician-ad- ministered surveys (p=0.050). Negative perceptions of bone setting were more common than positive perceptions and the main reason patients did not utilize bone setting was concern for competency (35.8%, n=67). Conclusion: Our study found lower bone setting utilization than expected considering the reliance of Tanzanians on tradi- tional care reported in the literature. This suggests patients utilizing traditional care for musculoskeletal injury are not seeking allopathic care; therefore, collaboration with bone setters could expand allopathic access to these patients. Patients were less likely to report bone setter utilization to a physician revealing the stigma of seeking traditional care, which may present an obstacle for collaboration. Keywords: Bone setting; traditional medicine; traditional practitioners; orthopaedics; trauma.

Objective Describe the early impact of the COVID-19 pandemic on general surgery residency training nationwide. Design A 31-question electronic survey was distributed to general surgery program directors. Qualitative data underwent iterative coding analysis. Quantitative data were evaluated with summary statistics and bivariate analyses. Participants Eighty-four residency programs (33.6% response rate) with representation across US geographic regions, program affiliations, and sizes. Results Widespread changes were observed in the surgical training environment. One hundred percent of programs reduced the number of residents on rounds and 95.2% reduced the size of their in-hospital resident workforce; on average, daytime staffing decreased by nearly half. With telehealth clinics (90.5%) and remote inpatient consults (26.2%), both clinical care and resident didactics (86.9%) were increasingly virtual, with similar impact across all program demographics. Conversely, availability of some wellness initiatives was significantly higher among university programs than independent programs, including childcare (51.2% vs 6.7%), housing (41.9% vs 13.3%), and virtual mental health services (83.7% vs 53.3%). Conclusions Changes in clinical care delivery dramatically reduced in face-to-face learning opportunities for surgical trainees during the COVID-19 pandemic. While this effect had equal impact across all program types, sizes, and geographies, the same cannot be said for wellness initiatives. Though all programs initiated some strategies to protect resident health, the disparity between university programs and independent programs may be cause for action.

BackgroundCancer atlases often provide estimates of cancer incidence, mortality or survival across small areas of a region or country. A recent example of a cancer atlas is the Australian cancer atlas (ACA), that provides interactive maps to visualise spatially smoothed estimates of cancer incidence and survival for 20 different cancer types over 2148 small areas across Australia.MethodsThe present study proposes a multivariate Bayesian meta-analysis model, which can model multiple cancers jointly using summary measures without requiring access to the unit record data. This new approach is illustrated by modelling the publicly available spatially smoothed standardised incidence ratios for multiple cancers in the ACA divided into three groups: common, rare/less common and smoking-related. The multivariate Bayesian meta-analysis models are fitted to each group in order to explore any possible association between the cancers in three remoteness regions: major cities, regional and remote areas across Australia. The correlation between the pairs of cancers included in each multivariate model for a group was examined by computing the posterior correlation matrix for each cancer group in each region. The posterior correlation matrices in different remoteness regions were compared using Jennrich’s test of equality of correlation matrices (Jennrich in J Am Stat Assoc. 1970;65(330):904–12.10.1080/01621459.1970.10481133).ResultsSubstantive correlation was observed among some cancer types. There was evidence that the magnitude of this correlation varied according to remoteness of a region. For example, there has been significant negative correlation between prostate and lung cancer in major cities, but zero correlation found in regional and remote areas for the same pair of cancer types. High risk areas for specific combinations of cancer types were identified and visualised from the proposed model.ConclusionsPublicly available spatially smoothed disease estimates can be used to explore additional research questions by modelling multiple cancer types jointly. These proposed multivariate meta-analysis models could be useful when unit record data are unavailable because of privacy and confidentiality requirements.

Purpose: Because financial conflicts of interest (FCOIs) may potentially influence patient care, hospital drug formularies, and treatment guidelines, it is important that these are disclosed. The purpose of this observational study was to quantify the changes in FCOI among U.S.-based academic authors in industry-sponsored oncology trials after a high-impact publication. Methods: A list of all U.S.-based academic authors (authors) of industry-sponsored solid tumor clinical trials published between August 1, 2014, and December 31, 2015, in 6 high-impact journals (New England Journal of Medicine, Nature, Science, Lancet Oncology, Journal of Clinical Oncology, and Cancer Discovery) was assembled. Studies were limited to solid tumor oncology trials. After all authors were identified, direct and research funding was tabulated from CMS Open Payments for the year prior (Ypre) and the first 3 years following publication (Y1, Y2, Y3) in the high-impact journal. Summary statistics were tabulated and repeated-measures linear mixed-effects regression models were fit to examine changes after publication. Results: A total of 102 publications with a total of 620 authors were identified. No FCOI was declared by 11, 12, 21, and 24 authors in Ypre, Y1, Y2, and Y3, respectively. In Ypre, Y1, Y2, and Y3: median FCOI for direct payments was $16,702 (range: $0–$3,180,356), $20,830 (range: $0–$3,180,356), $22,031 (range: $0–$920,746), and $21,356 (range: $0–$920,707), respectively; while median research funding was $559,202 (range: $0–$19,973,818), $505,031 (range $0–$19,920,452), $502,726 (range: $0–$15,729,776), and $497,342 (range: $0–$43,036,716), respectively. There were nonsignificant increases in total direct payments and total direct payments received from the sponsor (P > 0.0125 for both) and statistically significant decreases in total associated research funding and total research funding from the research sponsor in Y1, Y2, and Y3 as compared to Ypre (P < 0.0001 for both). Conclusions: After publication of an industry-sponsored solid tumor clinical trial in a high-impact journal, authors had statistically significant decreases in research funding FCOI in the first 3 years postpublication compared to the year prior.

Summary Repurposing of existing antiviral drugs, immunological modulators, and supportive therapies represents a promising path toward rapidly developing new control strategies to mitigate the devastating public health consequences of the COVID‐19 pandemic. A comprehensive text‐mining and manual curation approach was used to comb and summarize the most pertinent information from existing clinical trials and previous efforts to develop therapies against related betacoronaviruses, particularly SARS and MERS. In contrast to drugs in current trials, which have been derived overwhelmingly from studies on taxonomically unrelated RNA viruses, a number of untested small molecule antivirals had previously demonstrated remarkable in vitro specificity for SARS‐CoV or MERS‐CoV, with high selectivity indices, EC50, and/or IC50. Due to the rapid containment of the prior epidemics, however, these were generally not followed up with in vivo animal studies or clinical investigations, and thus largely overlooked as treatment prospects in the current COVID‐19 trials. This brief review summarizes and tabulates core information on recent or ongoing drug repurposing‐focused clinical trials, while detailing the most promising untested candidates with prior documented success against the etiologic agents of SARS and/or MERS.

Background The Oregon Occupational Public Health Program (OOPHP) monitors occupational health indicators (OHIs) to inform occupational safety and health (OSH) surveillance. In 2018, OOPHP evaluated the performance of the OSH surveillance system and identified areas for future improvement. Methods Following the Centers for Disease Control and Prevention (CDC) updated guidelines for evaluating public health surveillance systems, the OOPHP evaluation team engaged internal and external stakeholders using a mixed‐methods approach. Operational measures for ten surveillance attributes were developed. Multiple data collection methods resulted in credible evidence for evaluation conclusions. Analyses included summary statistics and qualitative analysis of interviews, a focus group, and online surveys. Results Twenty stakeholders took part in this evaluation, with an average participation rate of 55%. Results showed the Oregon OSH surveillance system was simple, flexible, and highly accepted by its stakeholders. Funding security presents challenges for stability. A lack of timeliness of OHIs, low relevance of OHIs to local OSH issues, and the system's ineffectual data dissemination all limit the usefulness of the OSH surveillance system. A review of key data sources for the system showed good data quality and predictive value positive, but relatively poor sensitivity and representativeness. Conclusions The evaluation team successfully adapted attributes and examples in the CDC guidelines to this Oregon OSH surveillance evaluation. The evaluation findings have informed the development of recommendations for improvements to OOPHP's OSH surveillance. Future research is needed to develop guidance specific to OSH surveillance evaluation.

Objective The Royal College of Physicians and Surgeons of Canada is implementing a competency-by-design (CBD) curriculum for residency training across Canada. Although praise and criticism have been published regarding competency-based residency training, little has been published from the resident perspective. The University of Calgary obstetrics and gynaecology residents were surveyed to gather information on their viewpoints and allow their expectations and concerns to be incorporated into the design and implementation process for the curriculum. Methods An anonymous survey was administered to residents from the University of Calgary obstetrics and gynaecology program. The survey contained a mixture of Likert-scale responses, multiple-choice questions, and free-text response questions. Summary statistics were used to analyze the Likert-scale and multiple-choice responses, and thematic analysis was performed on free-text responses (Canadian Task Force Classification Level III). Results The survey respondents identified several anticipated benefits and challenges regarding the CBD curriculum. Overall, resident respondents seemed optimistic about the curriculum redesign; however, many residents identified concerns, including potential impacts on work relationships, challenges with operating room and call scheduling given the less rigid structure of CBD, and the amount of time and effort that evaluation will require. Conclusion Residents offer a valuable perspective on CBD curriculum redesign and implementation. Gathering their input and including it in the curriculum redesign and implementation process will only strengthen the new curriculum and resident buy-in.

Aim The study aimed to assess the self-rated knowledge, attitude toward, and practice (KAP) of evidence-based medicine (EBM) among resident doctors in Nigeria. Methods This was a cross-sectional web-based survey among 238 resident doctors in four selected teaching hospitals in southern Nigeria. Survey questionnaire contained items assessing the KAP of EBM, familiarity with and understanding of key EBM terms, the use of EBM in decision making, barriers militating against EBM and ways to improve EBM adoption. Proportions and summary statistics were reported for the distribution of survey items. Results Mean number of years in clinical practice was 9.3 ± 4.5 years. Respondents were uniformly distributed in major clinical specialties. The majority (70.5%) were senior registrars. Respondents' understanding of EBM components included; current best clinical evidence (98.3%), clinical expertise (65.5%), and patients' choices (36.6%). Self-rated familiarity with EBM terms was high while perceived understanding of the terms was lower. The least understood concept was heterogeneity (20.6%). The attitude toward EBM was generally positive. Only about half (53.6%) had used medical bibliographic databases within the last 6 months prior to the survey. Barriers against EBM included lack of time (47.1%) and lack of requisite skills (32.4%). Suggestions to improve EBM adoption included training (58.1%), provision of free Wi-Fi, and free access to bibliographic databases (25.2%) and increased political will (23.1%). Conclusion A further understanding of the EBM concept, provision of enabling infrastructure, regular clinical audit and advocacy to hospital management and clinical consultants, may improve the level of adoption of EBM.

Objective This study aimed to explore the attitudes of obstetrics and gynaecology residents in Canada towards interventions that influence caesarean section rates. The study looked at residents’ attitudes towards four guidelines that support vaginal and assisted delivery (vaginal birth after caesarean section, induction of labour, operative vaginal birth, and fetal health surveillance in labour) and towards Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines in general. The study also sought to investigate whether these attitudes vary by residency training location. Methods An online survey of obstetrics and gynaecology residents across Canada was conducted. Residents responded to statements derived from guidelines using a five-point attitudinal scale and to an optional long-answer question about how residency has prepared them to make decisions around interventions. Descriptive summary statistics are used to present the findings (Canadian Task Force Classification III). Results A total of 27% of residents completed the survey. The majority demonstrated attitudes congruent with guidelines and favourable towards SOGC guidelines in general. Residents attitudes were least favourable towards electronic fetal monitoring, with 67.4% of responses congruent with the guideline. Attitudes were most aligned with the operative vaginal birth guideline, with 87.9% of responses congruent with the guideline. This sample was underpowered to detect statistically significant differences among residency programs, although there was some variation in attitudes across programs, with the most congruent scoring program at 81.8% congruent responses and the lowest at 66.7%. Conclusion Obstetrics and gynaecology residents in Canada have favourable attitudes towards interventions that support vaginal and assisted delivery. There was variability in observed attitudes across programs, although this was not statistically significant.

Non-compliance with respiratory protection programs among firefighters may put them at increased risk of injury and illness from occupational exposures during fire extinguishing activities. This research aims to characterize respiratory protection practices among Florida firefighters. This information will allow better understanding of factors that are associated with non-compliance with respiratory protection guidelines. A survey questionnaire was used to characterize Florida fire departments in this cross-sectional study. Four hundred and seventy-seven surveys were administered to Florida firefighters both in person and electronically to collect information regarding firefighter knowledge and participation in their respective respiratory protection programs during the past twelve months. Survey questions were developed from the model set by the National Fire Protection Association (NFPA) which provides standards and regulations regarding firefighter protections. Summary statistics regarding firefighter department size, coverage area, and firefighter employment type were produced. Multinomial logistic regression analysis was performed to evaluate factors that impact respiratory protection programs. The 477 respondents were 91% male with a mean age of 39 years old (range 21 - 65 years). The majority of respondents, 76%, were non-smokers, 21% former smokers, and 3% current smokers. In regard to ethnicity, respondents were 77% Caucasian, 13% Hispanic, 3% African American, and 4% other. Most respondents were career firefighters, 97%, with less than ten years of experience, 44%, working in a fire department with at least 21 firefighters, 98%. Most respondents, 80%, had a written respiratory program in place. The most cited reason for not having implemented a written respiratory protection program was lack of knowledge related to the program. Multinomial logistic regression analysis of departments with response areas of at least 250,000 square miles produced a statistically significant 0.444 (0.219 - 0.901 CI) odds ratio for having a written respiratory program as compared to those with a less than 10,000 square miles response area. Additional resources need to be given to Florida fire departments to ensure that all firefighters receive adequate respiratory protection in accordance with NFPA guidelines. There is an association between fire departments with large response areas and non-compliance with respiratory protection guidelines in regard to: having a written respiratory program, the frequency of respiratory fit testing, and the frequency of medical fitness testing. This suggests that rural fire departments need additional resources to ensure firefighters are adequately protected. Additional research should focus on why these differences exist in the rural fire departments. Respondents stating a lack of knowledge or no requirement for a written respiratory program suggest that future efforts should focus on respiratory protection education and training.

Increasing amounts of genetic data have led to the development of polygenic risk scores (PRSs) for a variety of diseases. These scores, built from the summary statistics of genome-wide association studies (GWASs), are able to stratify individuals based on their genetic risk of developing various common diseases and could potentially be used to optimize the use of screening and preventative treatments and improve personalized care for patients. Many challenges are yet to be overcome, including PRS validation, healthcare professional and patient education, and healthcare systems integration. Ethical challenges are also present in how this information is used and the current lack of diverse populations with PRSs available. In this review, we discuss the topics above and cover the nature of PRSs, visualization schemes, and how PRSs can be improved. With these tools on the horizon for multiple diseases, scientists, clinicians, health systems, regulatory bodies, and the public should discuss the uses, benefits, and potential risks of PRSs.

Background Approximately 116.4 million adults in the USA have hypertension, and the rates of uncontrolled hypertension remain higher among racial and ethnic minorities. There is a need for effective interventions that promote healthy behaviors and long-term behavioral change in the management of hypertension. The primary objective of this study was to determine the feasibility of developing a lifestyle intervention that would assess hypertension management and the use of technology among Blacks and Latinx with hypertension. The secondary objective is to explore perceptions of community-based resources for hypertension and preferences for a lifestyle intervention for hypertension among Blacks and Latinx with hypertension. Methods In this explanatory mixed-methods study, quantitative data were collected using surveys, participants reported their use of technology and adherence to antihypertensive medication. Participants were Black and Latinx adults with hypertension living in Central Pennsylvania, USA. Qualitative data were obtained from semi-structured interviews and focus groups, and participants were asked about managing hypertension, local resources, and preferences for a behavioral intervention. Data were examined using summary statistics for quantitative data and thematic analysis for qualitative data. Results Black and Latinx participants (n=30) completed surveys for the quantitative study. The majority (75%) of participants self-reported being confident in managing their medication without help and remembering to take their medication as prescribed. Fewer participants (54.2%) reported using technology to help manage medication. There were 12 participants in the qualitative phase of the study. The qualitative findings indicated that participants felt confident in their ability to manage hypertension and were interested in participating in a lifestyle intervention or program based online. Some participants reported a lack of resources in their community, while others highlighted local and national resources that were helpful in managing high blood pressure. Conclusion This study provides important insights on barriers and facilitators for managing hypertension, current use of technology and interest in using technology to manage hypertension, and preferences for future lifestyle interventions among racial and ethnic minorities. This study also provides insights to the health needs and resources available in this community and how future behavioral interventions could be tailored to meet the needs of this community. The findings of this study will be used to inform the tailoring of future lifestyle interventions; specifically, we will include text messaging reminders for medication and to disseminate educational materials related to hypertension and provide resources to connect study participants with local and national resources.

Background: We aimed at investigating causal associations between matrix metalloproteinases (MMPs) and bone mineral density (BMD) by the Mendelian randomization (MR) analysis.Methods: From genome-wide association studies of European ancestry, we selected instrumental variables for MMP-1, MMP-3, MMP-7, MMP-8, MMP-10, and MMP-12. Accordingly, we retrieved summary statistics of three site-specific BMD, namely, forearm, femoral neck, and lumbar spine. We conducted an inverse variance weighted MR as the primary method to compute overall effects from multiple instruments, while additional MR approaches and sensitivity analyses were implemented. Bonferroni-adjusted significance threshold was set at p < 0.05/18 = 0.003.Results: Totally, there was no evidence for causal effects of genetically-predicted levels of MMPs on BMD measurement at three common sites. MR results indicated that there were no causal associations of circulating MMPs with forearm BMD (all p ≥ 0.023) by the inverse variance weighted method. Similarly, there were no causal effects of MMPs on femoral neck BMD (all p ≥ 0.120) and MR results did not support causal relationships between MMPs and lumbar spine BMD (all p ≥ 0.017). Multiple sensitivity analyses suggested the robustness of MR results, which were less likely to be biased by unbalanced pleiotropy or evident heterogeneity.Conclusion: We found no evidence for the causal relationship between MMPs and BMD in the European population.

Background Women’s health (WH) includes a broad array of concerns and challenges that affect health across the lifespan. Considerable research shows that women continue to experience disparities in access to and quality of care. Apart from surveys of medical trainees and faculty, little research and none in Canada examined medical curriculum for WH. This study assessed how Canadian medical schools integrate WH in their curriculum. Methods We used deductive and summative content analysis to describe instances and the nature of WH topics in program and course descriptions that were publicly-available on web sites of Canadian medical schools. We reported results using summary statistics and text examples. We employed a framework, tested in our prior research, that included mention of women’s health principles and practices relevant to any health concern or condition including factors (e.g. sex, gender, social determinants) that influence health, and access to or quality of care. Results We retrieved 1459 documents from 16 medical schools (median 49.5, range 16 to 301). Few mentioned WH (125, 8.6 %), and the quantity of mentions varied by school (range 0.0–37.5 %). Pre-clerkship course documents more frequently mentioned WH (61/374, 17.3 %, chi square 43.2, p p Conclusions Based on program and course descriptions, WH may not be well-integrated at Canadian medical schools, and future physicians may not be consistently exposed to the full breadth of WH. This reveals opportunities for enhancing WH in the medical curriculum. Future research is needed to engage stakeholders including women in developing, implementing and evaluating competencies and corresponding curriculum that reflect the full range of WH concepts and practices.

In the original publication, the summary statistics for child BMI in Tables 2 and 8 were incorrect. The correct version of tables (with updated summary statistics) are provided in this correction.

Meta-analysis has become an integral part of evidence-based decision-making processes and is being increasingly used in medical and non-medical disciplines. Aggregate data or summary statistics continue to be the mainstay of meta-analysis and are used by many professional societies to support clinical practice guidelines. Meta-analyses synthesize the summary statistics from independent trials by pooling them to estimate the underlying common effect size. The results represent the highest level of evidence but only if the chosen studies are of high quality and the selection criteria are fully satisfied. It is important to address the issues of defining an explicit and relevant question, exhaustively searching for the totality of evidence, meticulous and unbiased data transfer or extraction, assessment of between study heterogeneity and the use of appropriate statistical methods for estimating summary effect measures. This article reviews the methodology, benefits and drawbacks of performing a meta-analysis.

Objective: Continuous outcome measures are essential in rehabilitation research. Incomplete reporting of their mean and standard deviation, required for meta-analysis, potentially introduces bias and imprecision if it prevents studies being included. We aimed to determine how often systematic reviewers encounter missing mean or standard deviation values and to recommend practical statistical solutions. Design: 1. Cross-sectional survey of systematic review authors. 2. Reanalysis of Cochrane review data to evaluate how accurately statistical methods for recovering missing mean or standard deviation values estimate the true meta-analysis treatment effect. Setting: Rehabilitation intervention systematic reviews. Participants: Cochrane stroke rehabilitation review authors; stroke patients. Interventions: Reanalysis of a Cochrane review of early supported discharge services. Main measures: Hospital length of stay. Results: Survey responses covered 53 of 70 Cochrane reviews. Almost all studied continuous outcome measures, 68% encountering missing summary statistics. Various solutions were attempted but 76% of meta-analyses omitted at least one study due to missing information. In the review reanalysis ( N = 1055), a method based on the minimum and maximum performed best in recovering missing standard deviations; a method based on the median, lower and upper quartiles successfully estimated a missing mean. Conclusion: Practical statistical methods help reduce risk of bias, maximise the evidence included in rehabilitation meta-analyses and offer a clear hierarchy of solutions to handling unreported mean and standard deviation values.

Background and Objectives: The optimal length of residency training in family medicine is under debate. This study compared applicant type, number of applicants, match positions filled, matched applicant type, and ranks to fill between 3-year (3YR) and 4-year (4YR) residencies. Methods: The Length of Training Pilot (LOTP) is a case-control study comparing 3YR (seven residencies) and 4YR (six residencies) training models. We collected applicant and match data from LOTP programs from 2012 to 2018 and compared data between 3YR and 4YR programs. National data provided descriptive comparisons. An annual resident survey captured resident perspectives on training program selection. Summary statistics and corresponding t-tests and χ2 tests of independence were performed to assess differences between groups. We used a linear mixed model to account for repeated measures over time within programs. Results: There were no differences in the mean number of US MD, US DO, and international medical graduate applicants between 3YR and 4YR programs. Both the 3YR and 4YR programs had a substantially higher number of US MD and DO applicants compared to national averages. The percentages of positions filled in the match and positions filled by US MDs, DOs and IMGs were not different between groups. The percentage of residents in 4YR programs who think training in family medicine requires a fourth year varied significantly during the study period, from 35% to 25% (P

BACKGROUND/OBJECTIVES Improving quality performance in home health is an increasingly high priority. The objective of this study was to examine trends in industry performance over time using three quality measures: a composite quality metric (Q index), an infection prevention measure (vaccination verification), and an outcome measure (hospital avoidance). DESIGN/SETTING/PARTICIPANTS/MEASURES We linked Home Health Compare and Provider of Services data from 2012 to 2016, which included 39 211 observations during the 5-year study period and 7670 agencies in 2016. The Q index was developed to allow comparability over time, equally weighting the contributions of each element. After examining summary statistics, we developed three regression models stratified by ownership (for-profit/nonprofit agency) and included two constructs of nurse staffing, in addition to controlling for known confounders. RESULTS Most agencies (80.4%) were for-profit agencies. The Q index and vaccination verification improved substantially over time, but there was no change in hospital avoidance. Ownership status was associated with all three measures (P

As countries transition toward malaria elimination, malaria programs rely on surveillance–response systems, which are often supported by web- and mobile phone–based reporting tools. Such surveillance–response systems are interventions for elimination, making it important to determine if they are operating optimally. A metric to measure this by is timeliness. This study used a mixed-methods approach to investigate the response time of Zanzibar’s malaria elimination surveillance–response system, Malaria Case Notification (MCN). MCN conducts both passive and reactive case detection, supported by a mobile phone–based reporting tool called Coconut Surveillance. Using data obtained from RTI International and the Zanzibar Malaria Elimination Program (ZAMEP), analysis of summary statistics was conducted to investigate the association of response time with geography, and time series techniques were used to investigate trends in response time and its association with the number of reported cases. Results indicated that response time varied by the district in Zanzibar (0.6–6.05 days) and that it was not associated with calendar time or the number of reported cases. Survey responses and focus groups with a cadre of health workers, district malaria surveillance officers, shed light on operational challenges faced during case investigation, such as incomplete health records and transportation issues, which stem from deficiencies in aspects of ZAMEP’s program management. These findings illustrate that timely response for malaria elimination depends on effective program management, despite the automation of web-based or mobile phone–based tools. For surveillance–response systems to work optimally, malaria programs should ensure that optimal management practices are in place.

Purpose: The COVID-19 pandemic modified the Residency Match process for fourth-year medical students. In-person away rotations were discouraged, interviews were virtual, and traditional factors used to rank programs were absent. Here, we compare survey results administered to both the 2020 and 2021 Match applicants to assess the influence of the pandemic on the radiation oncology (RO) Match process. Methods: An institutional review board–approved prospective cross-sectional study was conducted. The 2020 and 2021 RO Match applicants at a large RO program were invited to participate. Descriptive summary statistics were assessed. Results: The 2020 and 2021 Matches each had 76 applicants complete the survey with response rates of 54% and 57%, respectively. The 2 groups were predominantly white, cisgender male, single, and without children. Whereas 11% of 2020 applicants did not complete away rotations, 45% of 2021 applicants did not. For 2021 Match applicants, 65% of away rotations were performed virtually, whereas 51% were not for medical school credit. Of the applicants, 84% were satisfied with virtual interviews and 72% felt cost savings were worth not having in-person interviews. Whereas 49% of Match 2020 applicants spent >$5000 in interview costs, 0% of the Match 2021 applicants did so, with 45% spending

INTRODUCTION Individuals who are incarcerated in the United States often struggle to access family planning care because of the common practice of jails not providing contraceptives on site. However, less is known about the contraceptive needs and preferences, including the desirability of intrauterine devices and implants, among those who are incarcerated. METHODS Cross-sectional, in-person surveys were administered to 148 reproductive-age women (aged 18-48) incarcerated at an urban jail in Utah to identify women's contraceptive needs and preferences while incarcerated. We used summary statistics and logistic regression to investigate relationships between demographic characteristics, the desire to access contraceptive services while incarcerated, and interest in specific contraceptive methods. RESULTS Surveys indicate a high interest in accessing contraceptives while in jail (73%). Participants who were more likely to prefer access to contraceptive services in jail were also more likely to be interested in the injectable (odds ratio [OR], 4.75; 95% CI, 1.03-21.94), the implant (OR, 8.44; 95% CI, 1.70-41.99), and intrauterine devices (OR, 10.04; 95% CI, 3.46-29.20) than participants indicating no desire to access contraceptive services while in jail. DISCUSSION Jails could be an access point for contraceptive methods requiring health care provider intervention in the state of Utah. However, care must be taken due to broader historical legacies of reproductive coercion in carceral settings.

Background Since the Global Burden of Disease study (GBD) has become more comprehensive, data for hundreds of causes of disease burden, measured using Disability Adjusted Life Years (DALYs), have become increasingly available for almost every part of the world. However, undergoing any systematic comparative analysis of the trends can be challenging given the quantity of data that must be presented. Methods We use the GBD data to describe trends in cause-specific DALY rates for eight regions. We quantify the extent to which the importance of ‘major’ DALY causes changes relative to ‘minor’ DALY causes over time by decomposing changes in the Gini coefficient into ‘proportionality’ and ‘reranking’ indices. Results The fall in regional DALY rates since 1990 has been accompanied by generally positive proportionality indices and reranking indices of negligible magnitude. However, the rate at which DALY rates have been falling has slowed and, at the same time, proportionality indices have tended towards zero. These findings are clearest where the focus is exclusively upon non-communicable diseases. Notably, large and positive proportionality indices are recorded for sub-Saharan Africa over the last decade. Conclusion The positive proportionality indices show that disease burden has become less concentrated around the leading causes over time, and this trend has become less prominent as the DALY rate decline has slowed. The recent decline in disease burden in sub-Saharan Africa is disproportionally driven by improvements in DALY rates for HIV/AIDS, as well as for malaria, diarrheal diseases, and lower respiratory infections.

The Sustainable Development Goals include a target on eliminating child marriage, a human rights abuse. Yet, the indicator used in the SDG framework is a summary statistic and does not provide a full picture of the incidence of marriage at different ages. This paper aims to address this limitation by providing an alternative method of measuring child marriage. The paper reviews recent data on nuptiality and captures evidence of changes in the proportion married and in the age at marriage, in 98 low- and middle-income countries (LMICs). Using data collected from nationally representative Demographic and Health Surveys and Multiple Indicator Cluster Surveys, survival analysis is applied to estimate (a) age-specific marriage hazard rates among girls before age 18; and (b) the number of girls that were married before age 18 in 2020. Results show that the vast majority of girls remain unmarried until age 10. Child marriage rates increase gradually until age 14 and accelerate significantly thereafter at ages 15–17. By accounting for both single-year-age-specific child marriage hazard rates and the age structure of the population with a survival analysis approach, lower estimates in countries with a rapid decrease in child marriage and higher estimates in countries with constant or slightly rising child marriage rates relative to the direct approach are obtained.

Background Female sex workers are extremely vulnerable and highly susceptible to being infected with human immunodeficiency virus. As a result, community-based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. We conducted a systematic review to (1) assess the effect of FSW-targeted community interventions on the improvement of HIV services access along the treatment cascade and (2) describe community-based interventions that positively affect continuation in HIV care across the HIV treatment cascade for FSWs in sub-Saharan Africa. Methods We defined the 5 steps that make up the HIV care cascade and categorized them as outcomes, namely, HIV testing and diagnosis, linkage to care, receipt of ART, and achievement of viral suppression. We conducted a systematic search of randomized controlled trials, cohort, and cross-sectional studies done in sub-Saharan African countries and published from 2004 to 2020. The period was selected based on the time span within which ART was scaled up through widespread roll-out of comprehensive HIV programs in sub-Saharan Africa. We reviewed studies with data on the implementation of community interventions for any of the HIV care cascade stage. The data were analyzed using random effects meta-analysis where possible, and for the rest of the studies, data were synthesized using summary statistics. Results The significant impact of the community interventions was observed on HIV testing, HIV diagnosis, and ART use. However, for HIV testing and ART use, the improvement was not sustained for the entire period of implementation. There were minimal interventions that had impact on HIV diagnosis, with only one community service delivery model showing significance. Generally, the interventions that had reasonable impact are those that implemented targeted and comprehensive package of HIV services provided at one location, and with unique strategies specific to each cascade stage. Conclusions The evidence brought forward from this review shows that the effect of community-based interventions varies across the different stages of HIV care cascade. A broad package of interventions including a combination of behavioral, biomedical, and structural, designed with specific strategies, unique to each cascade stage appears to be more effective, although information on long-term treatment outcomes and the extent to which FSWs remain engaged in care is sparse. There is need to conduct a further research to deepen the assessment of the effectiveness of community-based interventions on HIV care cascade for FSWs. This will enhance identification of evidence-based optimal interventions that will guide effective allocation of scarce resources for strategies that would have a significant impact on HIV service delivery. Systematic review registration PROSPERO CRD42020157623

Background In oncology, Whole Genome Sequencing (WGS) is not yet widely implemented due to uncertainties such as the required infrastructure and expertise, costs and reimbursements, and unknown pan-cancer clinical utility. Therefore, this study aimed to investigate possible future developments facilitating or impeding the use of WGS as a molecular diagnostic in oncology through scenario drafting. Methods A four-step process was adopted for scenario drafting. First, the literature was searched for barriers and facilitators related to the implementation of WGS. Second, they were prioritized by international experts, and third, combined into coherent scenarios. Fourth, the scenarios were implemented in an online survey and their likelihood of taking place within 5 years was elicited from another group of experts. Based on the minimum, maximum, and most likely (mode) parameters, individual Program Evaluation and Review Technique (PERT) probability density functions were determined. Subsequently, individual opinions were aggregated by performing unweighted linear pooling, from which summary statistics were extracted and reported. Results Sixty-two unique barriers and facilitators were extracted from 70 articles. Price, clinical utility, and turnaround time of WGS were ranked as the most important aspects. Nine scenarios were developed and scored on likelihood by 18 experts. The scenario about introducing WGS as a clinical diagnostic with a lower price, shorter turnaround time, and improved degree of actionability, scored the highest likelihood (median: 68.3%). Scenarios with low likelihoods and strong consensus were about better treatment responses to more actionable targets (26.1%), and the effect of centralizing WGS (24.1%). Conclusions Based on current expert opinions, the implementation of WGS as a clinical diagnostic in oncology is heavily dependent on the price, clinical utility (both in terms of identifying actionable targets as in adding sufficient value in subsequent treatment), and turnaround time. These aspects and the optimal way of service provision are the main drivers for the implementation of WGS and should be focused on in further research. More knowledge regarding these factors is needed to inform strategic decision making regarding the implementation of WGS, which warrants support from all relevant stakeholders.

Introduction: Transitions of care between acute hospital and community settings are points of vulnerability for people with geriatric syndrome. Routinely including informal caregivers into the transition processes may mitigate risk. Guidance for operational aspects of caregiver inclusion is currently lacking in healthcare policy and fails to address the barriers faced by caregivers and healthcare professionals. Methods: A questionnaire and a semi-structured interview were piloted with acute care physiotherapists who facilitate patient discharge into community settings. The questionnaire was analysed using summary statistics and interviews were thematically analysed by researchers, using NVivo 12 software. Results: Questionnaire responses indicated mixed satisfaction with current caregiver integration by the multidisciplinary team. Four themes were shaped in the interviews: inconsistent caregiver engagement, individuals working in a system, an outdated model of care, and invisible care gaps. Discussion: Feedback loops constructed from participant questionnaires and interview responses informed the identification of barriers and solutions. These are system wide and address automated integration, cultural shift, reimbursement models, and flexible structures to enhance informal caregiver participation. Future research is urgently required to translate, implement, and evaluate enhanced caregiver integration to ensure sustainable, person-centred healthcare delivery.

Background Patients with kidney disease are referred late to tertiary institutions with increased morbidity and mortality. The accurate diagnoses and management of kidney disease by primary healthcare staff is dependent on the requisite knowledge and availability of adequate laboratory services. We set out to describe the practice pattern of districts Hospitals. Methods We conducted a situational cross-sectional descriptive survey of district hospitals within the Ashanti region of Ghana. A structured questionnaire was designed via google survey and the links sent to medical superintendents and/or administrators for completion. Data was exported onto an Excel sheet and analyzed with Stata 13. Summary statistics with means ± standard deviation and medians with interquartile range were used where appropriate. Percentages and proportions were used for categorical data. Results We surveyed 26 hospitals in the Ashanti region of Ghana. This included 23(88.5%) public facilities. Most 25(96.2%) of hospitals had a dedicated diabetes mellitus clinic and 24(92.3%) had dedicated hypertension clinic. Only 5(19.2%) hospitals routinely requested urinalysis for patients with diabetes and hypertension during visits. Almost all 25(96.2%) hospitals could carry out routine urine analysis in their laboratory but only 16 (61.5%) of the hospitals could run serum urea and creatinine test. Most 25(96.2%) of respondents suggested that the training of health staff for the early diagnosis and management of kidney disease as key to improve care. Conclusion Primary healthcare staff in district hospitals do not routinely screen high risk patients for kidney disease and call for training to manage patients with kidney disease appropriately.

Bayesian predictive coding theories of autism spectrum disorder propose that impaired acquisition or a broader shape of prior probability distributions lies at the core of the condition. However, we still know very little about how probability distributions are learned and encoded by children, let alone children with autism. Here, we take advantage of a recently developed distribution learning paradigm to characterize how children with and without autism acquire information about probability distributions. Twenty-four autistic and 25-matched neurotypical children searched for an odd-one-out target among a set of distractor lines with orientations sampled from a Gaussian distribution repeated across multiple trials to allow for learning of the parameters (mean and variance) of the distribution. We could measure the width (variance) of the participant's encoded distribution by introducing a target-distractor role-reversal while varying the similarity between target and previous distractor mean. Both groups performed similarly on the visual search task and learned the distractor distribution to a similar extent. However, the variance learned was much broader than the one presented, consistent with less informative priors in children irrespective of autism diagnosis. These findings have important implications for Bayesian accounts of perception throughout development, and Bayesian accounts of autism specifically. LAY SUMMARY: Recent theories about the underlying cognitive mechanisms of autism propose that the way autistic individuals estimate variability or uncertainty in their perceptual environment may differ from how typical individuals do so. Children had to search an oddly tilted line in a set of lines pointing in different directions, and based on their response times we examined how they learned about the variability in a set of objects. We found that autistic children learn variability as well as typical children, but both groups learn with less precision than typical adults do on the same task. ispartof: AUTISM RESEARCH vol:14 issue:7 pages:1484-1495 ispartof: location:United States status: published

Severe or major trauma is a pandemic and one of the leading causes of death and disability; It is distributed unequally worldwide with most of these deaths occurring in LMICs. The WHO estimates that in 2030 there will be 1.485.365 in the African region. Mozambique has no prehospital care system nor trauma centers despite having a high incidence of injuries. The few critical patients that arrive in the ER rely on self-arranged transport to reach emergency care and have a low chance of survival because of few resources and lack of training of the staff. Basic trauma resuscitation techniques are unknown to most hospital personnel in LMICs. The aim of this study is to evaluate the attitude and knowledge of the management of trauma care among clinical staff of three quaternary level Hospitals of Mozambique. It will be conducted a prospective cross-sectional study between April and May 2020, in Maputo, Beira and Nampula Central Hospitals. The participants will include the medical doctors and technicians (general practitioners, general surgeons, orthopedic surgeons and anesthetists) that work on an ER. Data will be collected using a three-part questionnaire including: demographic information, trauma knowledge questionnaire and trauma attitude questionnaire. All the data will be analysed using SPSS version 22.0. Standard descriptive and summary statistics will be generated for the demographic part of the survey. Independent t-test and one-way ANOVA will be used to compare the level of knowledge and attitude with each other and with the demographic variables.

Background Civil strife has long been recognized as a significant barrier in the fight against vaccine preventable diseases in several parts of the world. However, little is known about the impact of the ongoing civil strife on the immunisation system in the Northwest (NW) and Southwest (SW) regions of Cameroon, which erupted in late 2016. In this paper, we assessed the effect of the conflict on key immunisation outcomes in the North West and South West regions of Cameroon. Methods Data were obtained from the standard EPI data reporting tool, the District Vaccine and Data Management Tool (DVDMT), from all the districts in the two regions. Completed forms were then reviewed for accuracy prior to data entry at central level. Summary statistics were used to estimate the variables of interest for each region for the years 2016 (pre-conflict) and 2019 (during conflict). Results In the two regions, the security situation has deteriorated in almost all districts, which in turn has disrupted basic healthcare delivery in those areas. A total of 26 facilities were destroyed and 11 healthcare workers killed in both regions. Reported immunisation coverage rates for key antigens including, BCG, DPT-3 and MR, witnessed a dramatic decline between 2016 and 2019, ranging from 22% points decline for BCG in the NW and to 42% points decline for DPT-3 in the SW. Similarly, the proportion of districts with DPT-3 coverage of at least 80% dropped from 75% in 2016 to 11% in 2019 in the NW. In the SW this proportion dropped from 16% in 2016 to 0 % in 2019. Conclusion Our data demonstrates the marked negative impact of the ongoing civil strife on key immunisation outcomes in the two regions and the country at large. This decline could amplify the risk of vaccine preventable diseases vaccine preventable diseases outbreaks in the two regions. Besides the ongoing actions to contain the crises, effective strategies for reaching children in the conflict zones as well as the internally displaced population are needed. There is also the need to rebuild destroyed facilities as well as to protect health facilities and staff from targeted violence.

BackgroundIn two-sample Mendelian randomization (MR) studies, sex instrumental heterogeneity is an important problem needed to address carefully, which however is often overlooked and may lead to misleading causal inference.MethodsWe first employed cross-trait linkage disequilibrium score regression (LDSC), Pearson’s correlation analysis, and the Cochran’s Q test to examine sex genetic similarity and heterogeneity in instrumental variables (IVs) of exposures. Simulation was further performed to explore the influence of sex instrumental heterogeneity on causal effect estimation in sex-specific two-sample MR analyses. Furthermore, we chose breast/prostate cancer as outcome and four anthropometric traits as exposures as an illustrative example to illustrate the importance of taking sex heterogeneity of instruments into account in MR studies.ResultsThe simulation definitively demonstrated that sex-combined IVs can lead to biased causal effect estimates in sex-specific two-sample MR studies. In our real applications, both LDSC and Pearson’s correlation analyses showed high genetic correlation between sex-combined and sex-specific IVs of the four anthropometric traits, while nearly all the correlation coefficients were larger than zero but less than one. The Cochran’s Q test also displayed sex heterogeneity for some instruments. When applying sex-specific instruments, significant discrepancies in the magnitude of estimated causal effects were detected for body mass index (BMI) on breast cancer (P = 1.63E-6), for hip circumference (HIP) on breast cancer (P = 1.25E-20), and for waist circumference (WC) on prostate cancer (P = 0.007) compared with those generated with sex-combined instruments.ConclusionOur study reveals that the sex instrumental heterogeneity has non-ignorable impact on sex-specific two-sample MR studies and the causal effects of anthropometric traits on breast/prostate cancer would be biased if sex-combined IVs are incorrectly employed.

Genotype imputation across populations of mixed ancestry is critical for optimal discovery in large‐scale genome‐wide association studies (GWAS). Methods for direct imputation of GWAS summary‐statistics were previously shown to be practically as accurate as summary statistics produced after raw genotype imputation, while incurring orders of magnitude lower computational burden. Given that direct imputation needs a precise estimation of linkage‐disequilibrium (LD) and that most of the methods using a small reference panel for example, ~2,500‐subject coming from the 1000 Genome‐Project, there is a great need for much larger and more diverse reference panels. To accurately estimate the LD needed for an exhaustive analysis of any cosmopolitan cohort, we developed DISTMIX2. DISTMIX2: (a) uses a much larger and more diverse reference panel compared to traditional reference panels, and (b) can estimate weights of ethnic‐mixture based solely on Z‐scores, when allele frequencies are not available. We applied DISTMIX2 to GWAS summary‐statistics from the psychiatric genetic consortium (PGC). DISTMIX2 uncovered signals in numerous new regions, with most of these findings coming from the rarer variants. Rarer variants provide much sharper location for the signals compared with common variants, as the LD for rare variants extends over a lower distance than for common ones. For example, while the original PGC post‐traumatic stress disorder GWAS found only 3 marginal signals for common variants, we now uncover a very strong signal for a rare variant in PKN2, a gene associated with neuronal and hippocampal development. Thus, DISTMIX2 provides a robust and fast (re)imputation approach for most psychiatric GWAS‐studies.

Summary The auditory system relies on local and global representations to discriminate sounds. This study investigated whether vision influences the development and functioning of these fundamental sound computations. We employed a computational approach to control statistical properties embedded in sounds and tested samples of sighted controls (SC) and congenitally (CB) and late-onset (LB) blind individuals in two experiments. In experiment 1, performance relied on local features analysis; in experiment 2, performance benefited from computing global representations. In both experiments, SC and CB performance remarkably overlapped. Conversely, LB performed systematically worse than the other groups when relying on local features, with no alterations on global representations. Results suggest that auditory computations tested here develop independently from vision. The efficiency of local auditory processing can be hampered in case sight becomes unavailable later in life, supporting the existence of an audiovisual interplay for the processing of auditory details, which emerges only in late development., Graphical abstract, Highlights • Computational and deprivation models can be combined to assess sensory plasticity • Basic auditory computations develop independently from early visual input • Late-onset sight loss can hamper the efficiency of local auditory processing, Biological sciences; Neuroscience; Sensory neuroscience

Background There are unique challenges to parenting in residency and there is limited data to guide policy regarding lactation facilities and support for female physicians-in-training. We aimed to assess issues surrounding breast-feeding during graduate medical training for current residents or recent graduates from United States (US) residency programs. Methods A national cross-sectional survey was sent to current and recently graduated (2017 and later) female residents in June 2020. This questionnaire was administered using the Qualtrics Survey tool and was open to each participating woman’s organization for 4 weeks. Summary statistics were used to describe characteristics of all respondents and free-text responses were reviewed to identify common themes regarding avenues for improvement. Results Three hundred twelve women responded to the survey, representing a 15.6% response rate. The median duration of providing breastmilk was 9 months (IQR 6–12). 21% of residents reported access to usable lactation rooms within their training hospital, in which 12% reported a computer was present. 60% of lactating residents reported not having a place to store breast milk. 73% reported residency limited their ability to lactate, and 37% stopped prior to their desired goal. 40% reported their faculty and/or co-residents made them feel guilty for their decision to breastfeed, and 56% reported their difficulties with breastfeeding during residency impacted their mental health. Conclusion Residents who become mothers during training face significant obstacles to meeting their breastfeeding/pumping needs and goals. With these barriers defined, informed policy change can be instituted to improve the lactation experience for physicians-in-training.

Objectives To provide accessible, uniform, comprehensive, and balanced information to families deciding whether to initiate long-term ventilation (LTV) for their child, we sought to develop and validate a novel informational resource. Methods The Ottawa Decision Support Framework was followed. Previous interviews with 44 lay and 15 professional stakeholders and published literature provided content for a booklet. Iterative versions were cognitive tested with six parents facing decisions and five pediatric intensivists. Ten parents facing decisions evaluated the booklet using the Preparation for Decision Making Scale and reported their decisional conflict, which was juxtaposed to the conflict of 21 parents who did not read it, using the Decisional Conflict Scale. Twelve home ventilation program directors evaluated the booklet's clinical sensibility and sensitivity, using a self-designed six-item questionnaire. Data presented using summary statistics. Results The illustrated booklet (6th-grade reading level) has nine topical sections on chronic respiratory failure and invasive and noninvasive LTV, including the option to forgo LTV. Ten parents who read the booklet rated it as helping "Quite a bit" or more on all items of the Preparation for Decision Making Scale and had seemingly less decisional conflict than 21 parents who did not. Twelve directors rated it highly for clinical sensibility and sensitivity. Conclusions The LTV booklet was rigorously developed and favorably evaluated. It offers a resource to improve patient/family knowledge, supplement shared decision-making, and reduce decisional conflict around LTV decisions. Future studies should validate it in other settings and further study its effectiveness.

Background Inflammatory bowel disease poses substantial challenges to travel. We aimed to investigate inflammatory bowel diseases (IBD)-associated challenges to travel, information-seeking behaviour and associated factors. Methods We collected data on patients’ demographics, disease characteristics, travel barriers, information-seeking behaviour and travel outcomes in UK, Australia, New Zealand and Israel (2016–2018). Summary statistics were used to describe the sample, whereas multivariate binary and nominal logistic regression were used to model the outcome variables. Results Almost 75.4% (1878/2491) participants’ data were analysed with 71.14%, 15.4%, 11.2% and 2.1% from UK, Australia, NZ and Israel, respectively (76.3% females, 48.2% 30–49 years old 58.8% Crohn’s disease). About 7.7% of study participants sought medical advice/were hospitalised while overseas. About 43.8% cancelled/changed their plans due to IBD. The most common barriers were worry about toilet facilities (76.3%), cleanliness/sanitation (50.9%) and availability of medical care (41.1%). Only 60.5% sought travel advice; the most popular information source was IBD doctor/nurse (32.6%). Almost 32.6% of study participants did not get travel insurance that covered their IBD. Those who did not receive advice or found obtaining travel insurance difficult, were less likely to obtain travel insurance (P Conclusions We report a detailed investigation on the IBD-associated barriers while travelling abroad, common information-seeking behaviours and factors associated with worse outcomes. Importantly, patients from all the surveyed countries provided similar travel barrier and preparation habits, highlighting the consistent nature of the challenge.