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Background: This state-of-the-art (SOTA) review aimed to understand the historical, current and future of rural community palliative care services (PCS) with a primary focus in rural southern Minnesota communities and the United States. Methods: This review followed the six step SOTA systematic review process described by Barry et al (2022) and examined articles from 2010–2023 regarding rural PCS. Results: Historical and current research consistently supported the benefits of PCS and reported the top facilitators as a clear definition of palliative care and PCS. The top barriers included a lack service provision, funding/resources, national policies/regulation, and shortages of trained providers in rural communities. Conclusions: Barriers to the provision of PCS have not improved based on this review in rural areas and must be addressed to reduce healthcare disparities for rural populations. [ABSTRACT FROM AUTHOR]

Background and Objectives The Individualized Positive Psychosocial Interaction (IPPI) program is an adaptable, evidence-based intervention. IPPI trains nursing home care partners to engage residents living with moderate to severe dementia in preference-based, one-to-one interactions using emotion-focused communication. We sought to understand provider-driven adaptations made to the IPPI program and whether the adaptations made were fidelity-consistent. Research Design and Methods Data were collected from n = 78 interviews with n = 23 nursing home provider champions who led a quality improvement project to implement the IPPI program with 3–5 residents per care community. Using content analysis, we report quantitative data on the adaptation characteristics according to the Framework for Reporting Adaptations and Modifications-Expanded core modules and participant quotes to illustrate adaptations. Results Champions reported 34 adaptations, with an average of 2.6 adaptations per nursing home. The majority of IPPI adaptations pertained to implementation (65%; n = 22), whereas 17% (n = 6) were content and 17% (n = 6) were context. Some adaptations were motivated by the organization (e.g. time constraints), while others were motivated by the recipient (e.g. cognitive capacity). Most adaptations made to the IPPI protocol by care partners were fidelity-consistent (92%; n = 33). Discussion and Implications Care partners' adaptations to the IPPI made the intervention more resident-centric. Future healthcare intervention providers must consider the user perspective and encourage adaptations that further tailor to the user, as long as the adaptations are fidelity-consistent. [ABSTRACT FROM AUTHOR]

Background: Rural patients with heart failure (HF) have higher mortality and hospitalization rates compared with their urban counterparts. Although research supports the inclusion of informal caregivers in daily self-care activities, data are limited regarding the problems encountered by rural patient/caregiver dyads living with HF inmanaging HF in the home and how these problems are managed. Objective: The aim of this study was to identify and describe HF self-care problems experienced by rural dyads in the home and how these problems are managed. Methods: Using a descriptive qualitative design, data were collected from rural patient/caregiver dyads living with HF via individual, semistructured, telephone interviews and analyzed using schematic content analysis. Interviews and data analysis occurred concurrently until data saturation was reached. Results: Thematic data saturation was obtained with 11 dyads. On average, patients were 65.3 (±13.9) years old, and caregivers were 62 (±12.37) years old. Four themes illustrating dyadic HF self-care problems and management strategies emerged: (1) HF self-care components, namely, maintenance, symptom monitoring, and management (diet, exercise, activities, strategies); (2) environment (rural barriers, COVID-19); (3) caregiver contributors (confidence, role); and (4) dyadic contributors (dyadic relationship). Dyads described various self-care problems, with the type of relationship and presence of mutuality influencing the problem-solving process and development of management strategies. Conclusions: The identified themes emphasize the self-care problems experienced by rural dyads living with HF and the contributions of both dyad members to effectively manage these challenges. Findings support the need for culturally sensitive, tailored interventions targeting self-care in rural dyads living with HF. [ABSTRACT FROM AUTHOR]

OBJECTIVES: For patients with asthma who remain symptomatic on a medium-dose inhaled corticosteroid/ long-acting β2 agonist, addition of a long-acting muscarinic antagonist as a supplementary controller is a recommended option. However, real-world data on the characteristics and treatment patterns of these patients are limited. This study described the demographics and clinical characteristics of new users of single- or multiple-inhaler triple therapy and treatment patterns preceding triple-therapy initiation. STUDY DESIGN: This retrospective cohort study used medical and pharmacy claims data from the IQVIA PharMetrics Plus database. METHODS: The study population comprised adults with asthma with or without chronic obstructive pulmonary disease (COPD) initiating triple therapy with single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI; 100/62.5/25 μg) or multiple-inhaler triple therapy (MITT) between September 18, 2017, and September 30, 2019. Demographics, clinical characteristics, and treatment patterns in the 12 months preceding triple-therapy initiation were described (baseline period). RESULTS: A total of 12,395 patients were included. Among FF/UMEC/VI initiators with asthma (n = 1301), the mean age was 49.0 years and 59.3% were women. During the baseline period, 81.5% of patients used controller therapy, 94.7% used rescue medications, and 42.0% reported at least 1 asthma-related exacerbation; the annual mean exacerbation rate was 0.96. Similar trends were observed among patients with asthma initiating MITT and patients with comorbid asthma-COPD initiating FF/UMEC/VI or MITT. CONCLUSION: In real-world practice, triple therapy is often utilized following other asthma controller medication use. High disease burden, as evidenced by substantial use of rescue medications and continued asthma-related exacerbations, suggests that patients may not have achieved adequate asthma control prior to triple-therapy initiation. [ABSTRACT FROM AUTHOR]

Aim: To describe the lived experiences of nurses caring for patients and families in the context of COVID‐19 in Brazil and United States. Design: A phenomenological philosophical approach following the van Manen analysis method. Methods: Participants were recruited in Brazil and the United States, including nurses working in health care settings caring for COVID‐19 patients. Recruitment used purposive and snowball sampling. Participants completed a demographic survey and semi‐structured interviews that were audio‐recorded and transcribed for analysis. A cross‐cultural examination occurred among researchers from each country. Results: The result was described (n = 35) by the themes, representing the essences of each lifeworld (relationship, time, space and body). The nurses' lived experience was one of reframing care while enduring repeated trauma of witnessing disrupted patient‐family‐nurse relationships. Themes were as follows: (a) Living a silent and lonely experience; (b) Providing connectedness for disrupted patient and family relationships; (c) Feeling the burden of the demands; (d) Being a helping connector; (e) Reshaping spaces amidst evolving interventions and policies; (f) Creating safe spaces, surrounded by turmoil, threat, and distress within an unsafe environment; (g) Reorganizing care and reframing time; (h) Reconciling losses, regrets, victories and lessons. Conclusion: The nurses' lived experience of caring for patients and families during the COVID‐19 pandemic prompted the need to respond to repeated traumas and distress posed by interrupted patient‐family and nurse‐own family relationships, vulnerable bodies, threatened space and dynamic and volatile time. Impact: Cultural nuances were discovered depending on the practice setting, political discourse and the autonomy of the nurse. Innovative models of care that create structures and processes to support nurses in caring for patients in threatening environments and the commitment to connecting family members have potential to contribute to the ongoing health of the nursing profession. [ABSTRACT FROM AUTHOR]

Background: Orthopaedic surgery is the surgical specialty with the lowest proportion of women. Conflicting evidence regarding the potential challenges of pregnancy and parenthood in orthopaedics, such as the implications of delayed childbearing, may be a barrier to recruitment and retainment of women in orthopaedic surgery. A summary of studies is needed to ensure that women who have or wish to have children during their career in orthopaedic surgery are equipped with the relevant information to make informed decisions. Questions/purposes: In this systematic review, we asked: What are the key gender-related barriers pertaining to (1) family planning, (2) pregnancy, and (3) parenthood that women in orthopaedic surgery face? Methods: Embase, MEDLINE, and PsychINFO were searched on June 7, 2021, for studies related to pregnancy or parenthood as a woman in orthopaedic surgery. Inclusion criteria were studies in the English language and studies describing the perceptions or experiences of attending surgeons, trainees, or program directors. Studies that sampled surgical populations without specific reference to orthopaedics were excluded. Quantitative and qualitative analyses were performed to identify important themes. Seventeen articles including surveys (13 studies), selective reviews (three studies), and an environmental scan (one study) met the inclusion criteria. The population sampled included 1691 attending surgeons, 864 trainees, and 391 program directors in the United States and United Kingdom. The Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices tool was used to evaluate the risk of bias in survey studies. A total of 2502 women and 560 men were sampled in 13 surveys addressing various topics related to pregnancy, parenthood, and family planning during an orthopaedic career. Three selective reviews provided information on occupational hazards in the orthopaedic work environment during pregnancy, while one environmental scan outlined the accessibility of parental leave policies at 160 residency programs. Many of the survey studies did not report formal clarity, validity, or reliability assessments, therefore increasing their risk of bias. However, our analysis of the provided instruments as well as the consistency of identified themes across multiple survey studies suggests the evidence we aggregated was sufficiently robust to answer the research questions posed in the current systematic review. Results: These data revealed that many women have witnessed or experienced discrimination related to pregnancy and parenthood, at times resulting in a decision to delay family planning. In one study, childbearing was reportedly delayed by 67% of respondents (304 of 452) because of their career choice in orthopaedics. Orthopaedic surgeons were more likely to experience pregnancy complications (range 24% to 31%) than the national mean in the United States (range 13% to 17%). Lastly, despite these challenging conditions, there was often limited support for women who had or wished to start a family during their orthopaedic surgery career. Maternity and parental leave policies varied across training institutions, and only 55% (56 of 102) of training programs in the United States offered parental leave beyond standard vacation time. Conclusion: The potential negative effects of these challenges on the orthopaedic gender gap can be mitigated by increasing the availability and accessibility of information related to family planning, parental leave, and return to clinical duties while working as a woman in orthopaedic surgery. Future research could seek to provide a more global perspective and specifically explore regional variation in the environment faced by pregnancy or parenting women in orthopaedic surgery. Level of Evidence: Level III, prognostic study. [ABSTRACT FROM AUTHOR]

Using a nationally representative sample of young adults, this study examines COVID-induced financial hardship and its association with suicide risk (N = 1,087). About 40% experienced one or more financial hardship, a third reported having suicidal ideation, and 1.57% reported suicide attempt. The association between financial hardship and suicide risk was cumulative: Those reporting four or more financial hardships were 2.61 times more likely to report suicidal ideation and 24.27 times more likely to report a suicide attempt. The finding that COVID-related financial insecurity was associated with drastically elevated suicide risks highlights the need to assess financial hardship for suicide risk. [ABSTRACT FROM AUTHOR]

Age-normed tests of listening comprehension, oral expression, reading comprehension, and written expression were administered in Grades 1 (n = 128), 3, and 5, or 3 (n = 113), 5, and 7. Confirmatory factor analyses compared 1- and 4-factor models at each grade level and supported a 4-factor model of language by ear, mouth, eye, and hand. Multiple regressions identified which of the 3 other language skills explained unique variance in each of the 4 language skill outcomes and provided additional evidence that language is not a single skill. Individuals' ipsative scores (amount that the standard score for age on each language measure deviated from individual's mean for all 4 measures) showed that 25% to 30% of individuals showed relative strengths or weaknesses ([plus or minus]1 SD) in specific language skills, but only 7% were stable across Grades 3 and 5. Findings are discussed in reference to (a) theoretical implications for idea comprehension and expression via language by ear, mouth, eye, and hand; and (b) educational applications of observed developmental and individual differences for general, special, and gifted education. (Contains 2 footnotes and 12 tables.)

The disruption of in-person delivery of a sexual health education curriculum to students in 19 urban middle schools in the Midwestern United States was one of many complications in education due the COVID-19 pandemic. Given time constraints and need for program delivery, community partners collaborated to convert the curriculum for virtual delivery. A team of school health education experts, sexual health education professionals, educational psychologists, and an E-learning professional worked together in curriculum conversion, leveraging knowledge and expertise for production of a virtual sexual health education curriculum tool for educators to use for teaching middle school students learning in a virtual format and as an aid for future in-person delivery. [ABSTRACT FROM AUTHOR]

As teen dating violence (TDV) has gained attention as a public health concern across the United States (US), many efforts to mitigate TDV appear as policies in the 50 states in the form of for programming in K-12 schools. A keyword search identified 61 state-level school-based TDV policies. We developed an abstraction form to conduct a content analysis of these policies and generated descriptive statistics and graphic summaries. Thirty of the policies were original and 31 were additions or revisions of policies enacted by 17 of the 30 states previously. Of a possible score of 63, the minimum, mean, median, and maximum scores of currently active policies were 3.0, 17.7, 18.3, and 33.8, respectively. Results revealed considerable state-to-state variation in the presence and composition of school-based TDV policies. Opportunity for improving policies was universal, even among those with most favorably scores. [ABSTRACT FROM AUTHOR]

We created a set of resources to enable research based on openly-available diffusion MRI (dMRI) data from the Healthy Brain Network (HBN) study. First, we curated the HBN dMRI data (N = 2747) into the Brain Imaging Data Structure and preprocessed it according to best-practices, including denoising and correcting for motion effects, susceptibility-related distortions, and eddy currents. Preprocessed, analysis-ready data was made openly available. Data quality plays a key role in the analysis of dMRI. To optimize QC and scale it to this large dataset, we trained a neural network through the combination of a small data subset scored by experts and a larger set scored by community scientists. The network performs QC highly concordant with that of experts on a held out set (ROC-AUC = 0.947). A further analysis of the neural network demonstrates that it relies on image features with relevance to QC. Altogether, this work both delivers resources to advance transdiagnostic research in brain connectivity and pediatric mental health, and establishes a novel paradigm for automated QC of large datasets. Measurement(s) brain white matter Technology Type(s) Diffusion Weighted Magnetic Resonance Imaging Sample Characteristic - Organism Homo sapiens Sample Characteristic - Location contiguous United States of America [ABSTRACT FROM AUTHOR]

The Atheist Identity Concealment Scale (AICS) was developed as a tool to assess the degree to which atheists conceal their atheist identity from others. Drawing on concealable stigmatized identity (CSI) theory, the aim of this study was to provide researchers with a valid means to effectively assess atheist identity concealment. Using three separate samples of more than 500 adults in the USA, exploratory and confirmatory factor analyses were conducted which ultimately resulted in a short, robust measure comprised of eight items. Additional validity evidence was provided by examining the relationship between the AICS and several previously validated tools (i.e., outness, nonreligiosity, depression, anxiety, stress, and self-esteem). [ABSTRACT FROM AUTHOR]

The needs of the Black/African American population in the United States have historically been neglected in research, including in the development of therapies and services to support people with autism. The scope of interventions to support autistic people that are designed or adapted to be culturally responsive to the Black American population is not known. The state of these interventions systematically addressing cultural factors is also underexplored. The present systematic review examined the research evidence of autism interventions either designed or adapted for Black persons in the United States. The search did not have a specific date range but identified literature starting in 1999, and the search ended in 2023. A total of eight studies were identified and reviewed: Four were interventions designed specifically for the Black autistic population, one was an adapted intervention, and three were interventions evaluated with a Black autistic sample. To evaluate these studies, we used the Cultural Adaptation Checklist and found that few autism interventions are systematically adapted for Black individuals. Autism researchers that have engaged the Black autistic population or their families have been thoughtful in ways of engaging; however, there was no universal framework that drove development or adaptation efforts of these interventions. The development of more culturally responsive autism interventions (i.e. adapted evidence-based interventions) for the Black population offers promise for more equitable autism practices.Black/African American people in the United States who have a diagnosis of autism often experience service-related disparities, including not having the same access to high-quality autism and related care (e.g. behavioral interventions), and are less likely to have sustained treatment engagement across their lifespan. While interventions to support autistic people are typically designed to be universal, there is concern that these interventions not being tailored to the Black/African American population could reduce the overall impact due to a lack of responsiveness to the needs of the Black children or families who receive the intervention. The current systematic review summarized research on interventions developed for the Black autism community, including Black children with autism and their caregivers. After a comprehensive, systematic search, eight peer-reviewed publications were identified that met the study’s inclusion criteria. The majority of the interventions were tailored to Black caregivers of children with autism. Autism researchers demonstrate different strategies for engaging Black caregivers in culturally responsive ways; however, more research into these interventions is needed in order to assess their effectiveness. In addition, there are still limited interventions adapted to be culturally responsive to Black/African American autistic people. The Cultural Adaptation Checklist framework is a novel approach with promise to become the standard for adapting interventions to meet the needs of culturally diverse groups. Cultural responsiveness is an important facet in the development of interventions that produce optimal outcomes for the range of diversity in the United States and is an important step to achieving equitable autism research practices. [ABSTRACT FROM AUTHOR]

Using a critical race theory framework and a convergent mixed-method design, this study examined the relationship between coping with stress and psychological distress among Black U.S. Americans (N = 155) during the COVID-19 pandemic in the context of race-based stressors (e.g., anti-Black racism). Path analysis revealed mixed support for hypotheses; avoidant coping was positively related to all measured facets of psychological distress, whereas socially supported coping was associated with none. Self-sufficient coping was negatively associated with only depressive symptoms. Qualitative analysis revealed four salient themes: (a) Race and the COVID-19 Pandemic, (b) Complex Pandemic Related Changes to Life, (c) Emotional Responses to the Pandemic, and (d) Coping with the COVID Pandemic. These themes suggested the pandemic disrupted participants' ability to engage in, or effectively use, typically adaptive coping strategies and distress was exacerbated by fears for the safety of other Black U.S. Americans. Implications for training, practice, research, and advocacy are discussed. [ABSTRACT FROM AUTHOR]

Background: Prognostication based on preoperative clinical factors is lacking in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). This study aims to determine the value of preoperative tumor markers as predictors of progression-free survival (PFS) and overall survival (OS) for patients with peritoneal carcinomatosis from a primary mucinous adenocarcinoma of the appendix (MACA). Methods: We queried the United States HIPEC Collaborative, a database of patients with peritoneal carcinomatosis treated with CRS/HIPEC at twelve institutions between 2000 and 2017, identifying 409 patients with MACA. Multivariate analysis was used to identify independent predictors of disease progression. Subgroup analysis was conducted to evaluate the impact of tumor grade on the predictive value of tumor markers. Results: CA19-9 [HR 2.44, CI 1.2–3.4] emerged as an independent predictor of PFS while CEA [HR 4.98, CI 1.06–23.46] was independently predictive of OS (p <0.01). Tumor differentiation was the most potent predictor of both PFS (poorly differentiated vs well, [HR 4.5 CI 2.01–9.94]) and OS ([poorly differentiated vs well-differentiated: [HR 13.5, CI 3.16–57.78]), p <0.05. Among patients with combined CA19-9 elevation and poorly differentiated histology, 86% recurred within a year of CRS/HIPEC (p < 0.01). Similarly, the coexistence of CEA elevation and unfavorable histology led to the lowest survival rate at two years [36%, p < 0.01]. CA-125 was not predictive of PFS or OS. Conclusion: Elevated preoperative CA19-9 portends worse PFS, while elevated CEA predicts worse OS after CRS/HIPEC in patients with MACA. This study provides additional evidence that CA19-9 and CEA levels should be collected during standard preoperative bloodwork, while CA-125 can likely be omitted. Tumor differentiation, when added to preoperative tumor marker levels, provides powerful prognostic information. Prospective studies are required to confirm this association. [ABSTRACT FROM AUTHOR]

Objective: The aim of this investigation was to evaluate the performance of Straumann Bone Level SLActive implants in various clinical situations in daily dental practice for up to 3 years. Method and Materials: This was a prospective, multicenter, non-interventional study in which implants were placed within approved indications in any situation deemed suitable by the treating clinician. No implant placement or loading protocol was specified, and implants were placed according to the routine treatment protocols at each participating center. Results: In this analysis, data were available from 342 implants in 233 patients in three countries (USA, Canada, and Switzerland). One or two implants were placed in the majority of patients (70.8% and 19.3%, respectively), mostly in the maxilla (71.3%); almost half (47.7%) were placed in the esthetic zone. Implant placement after 4 to > 16 weeks of healing was preferred in Switzerland (92.0%), while 42.0% of implants were placed immediately in the USA and Canada. A flapless procedure was performed in 25.2% of cases in the USA and Canada, compared to 0.5% in Switzerland. Cumulative implant survival and success rates after 3 years were 97.5% and 93.5%, respectively. Conclusion: Straumann Bone Level Implants can achieve favorable outcomes and high survival rates after 3 years in daily dental practice. The survival and success rates were comparable with those achieved in formal controlled clinical trials. [ABSTRACT FROM AUTHOR]

Drought has long been suspected as playing an important role in the abandonment of pre-Columbian Native American settlements across the midcontinental United States between 1350 and 1450 CE. However, high-resolution paleoclimatic reconstructions reflecting local effective moisture (the ratio of precipitation to evaporation) that are located in proximity to Mississippi period (1050–1450 CE) population centers are lacking. Here, we present a 1600-year-long decadally resolved oxygen isotope (δ18O) record from Horseshoe Lake (Collinsville, IL), an evaporatively influenced oxbow lake that is centrally located within the largest and mostly densely populated series of Mississippian settlements known as Greater Cahokia. A shift to higher δ18O in the Horseshoe Lake sediment record from 1200 to 1400 CE indicates that strongly evaporative conditions (i.e., low effective moisture) were persistent during the leadup to Cahokia's abandonment. These results support the hypothesis that climate, and drought specifically, strongly impacted agriculturally based pre-Columbian Native American cultures in the midcontinental US and highlights the susceptibility of this region, presently a global food production center, to hydroclimate extremes. [ABSTRACT FROM AUTHOR]

Immunizations have proven to be an important tool for public health and for reducing the impact of vaccine preventable diseases. To realize the maximum benefits of immunizations, a coordinated effort between public policy, health care providers and health systems is required to increase vaccination coverage and to ensure high-quality data are available to inform clinical and public health interventions. Immunization information systems (IIS) are confidential, population-based, computerized databases that record all immunization doses administered by participating providers to persons residing within a given geopolitical area. The key output of an IIS is high-quality data for use in targeting and monitoring immunization program activities and providing clinical decision support at the point of care. To be truly effective, IISs need to form a nationwide network and repository of immunization data. Since the early 2000s Centers for Disease Control and Prevention has made strides to help IIS move toward a nationwide network through efforts focused on improving infrastructure and functionality, such as the IIS Minimum Functional Standards, and the IIS Annual Report, a self-reported data collection of IIS progress toward achieving the functional standards. While these efforts have helped immunization programs achieve more functional standards, there is a need to shift focus from infrastructure and functionality improvements to high data quality through objective measurement of IIS performance and evaluating critical outcomes. Additionally, realizing the vision of a nationwide repository of high-quality immunization data requires tackling the many challenges that impact data quality and availability including those related to policy, data sharing, data use, aging IIS technology, sustainability, and participation in the IIS. This paper describes the current state of IIS in the United States, critical challenges impacting the quality of data in IIS, and potential components of a future IIS model to address these challenges. [ABSTRACT FROM AUTHOR]

Background: Cardiac implantable electronic devices (CIED) are sometimes required after alcohol septal ablation (ASA) for hypertrophic cardiomyopathy (HCM). The primary objectives of this study were to characterize the incidence, timing, and predictors of CIED placement after ASA for HCM. Methods: Patients were identified from the 2010–2015 Nationwide Readmissions Databases. Incidence, timing and independent predictors of CIED placement, as well as 30‐day readmission rates were examined. Results: There were 1296 patients (national estimate = 2864) with HCM who underwent ASA. CIED were implanted in 322 (25% overall; 14% permanent pacemaker, 11% implantable cardioverter defibrillator) during the index hospitalization. Of these, 21%, 23%, 21%, and 18% occurred on postprocedure day 0, 1, 2, and 3, respectively. Only 17 (1.3%) patients underwent CIED implantation between discharge and 30‐day follow up. Independent predictors of index hospitalization CIED implantation included older age, diabetes, heart failure, nonelective index hospital admission and hospitalization at a privately owned hospital. Nonelective 30‐day readmission rates among those who did and did not undergo CIED placement during their index hospitalization, were 6.8% and 7.9%, respectively (p =.53); median time to readmission was also similar between groups. Conclusions: One in four HCM patients undergoing ASA underwent CIED implantation during their index hospitalization; nearly 2/3rd during the first 48 h postprocedure. Private hospital ownership independently predicted CIED placement. More data are needed to better understand the unexpectedly high rates of CIED placement, earlier than anticipated timing of implantation and differential rates by hospital ownership. [ABSTRACT FROM AUTHOR]

The United States (U.S.) is characterized by some of the poorest sexual health outcomes in the industrialized world, as indicated by the teen and unplanned pregnancy rates, rate of sexually transmitted infections (STIs), and occurrence of sexual dysfunction. Many people seek psychotherapy for sex-related concerns, yet little is known about the specific education psychologists receive during their training regarding sex. Existing research has largely been conducted in Canada and among clinical psychologists. While studies have revealed that few applied psychology graduate programs offer training in sexuality, very little is known about the specific content areas covered by those programs who do offer this training. We surveyed faculty from 38 counseling psychology doctoral programs primarily in the U.S. Results indicated that relatively few programs offer comprehensive training in sexuality with particular areas such as sex therapy, sexual expression, and reproductive health especially unlikely to be covered. Commonly covered topics included sexual development, sexual orientation and gender identity, intimacy, sexual trauma and abuse, and intersectionality. Implications for training and future research are offered. [ABSTRACT FROM AUTHOR]

Obesity, defined as a body mass index of 30 kg/m2 or above, has increased considerably in incidence and frequency within the United States and globally. Associated comorbidities including cardiovascular disease, type 2 diabetes mellitus, metabolic syndrome, and nonalcoholic fatty liver disease have led to a focus on the mechanisms promoting the prevention and treatment of obesity. Commonly utilized in vitro models employ human or mouse preadipocyte cell lines in a 2-dimensional (2D) format. Due to the structural, biochemical, and biological limitations of these models, increased attention has been placed on "organ on a chip" technologies for a 3-dimensional (3D) culture. Herein, we describe a method employing cryopreserved primary human stromal vascular fraction (SVF) cells and a human blood product-derived biological scaffold to create a 3D adipose depot in vitro. The "fat-on-chip" 3D cultures have been validated relative to 2D cultures based on proliferation, flow cytometry, adipogenic differentiation, confocal microscopy/immunofluorescence, and functional assays (adipokine secretion, glucose uptake, and lipolysis). Thus, the in vitro culture system demonstrates the critical characteristics required for a humanized 3D white adipose tissue (WAT) model. [ABSTRACT FROM AUTHOR]

Background/aims: The impact of a scientific article in its respective field is reflected by its citation count. The purpose of this review was to conduct a citation analysis in order to identify and analyze the top 50 most cited articles published in Dental Traumatology since its inception in order to highlight the contribution of the journal to the field of Dental Traumatology.Methods: Elsevier's Scopus was used to search and analyze the 50 most frequently cited scientific papers. After the screening process, two reviewers arranged the articles in a descending order based on their citation counts. Each article was then cross-matched with Google Scholar. The articles were analyzed, and information including citation counts, citation density, publication year, authorship, contributing institutions and countries, article topic, study design, and keywords was extracted.Results: The literature search identified 2421 articles. The citation counts of the 50 selected articles varied from 117 to 580 (Scopus) and 206 to 1130 (Google Scholar). The year in which most top 50 articles were published was 2002 (n = 5). Among 105 authors, the greatest contribution was made by JO Andreasen (n = 12). Most of the articles originated from the United States (n = 12) with the greatest contributions from the University Hospital (Rigshospitalet), Copenhagen, Denmark (n = 6). Original research article was the most frequent study design (n = 34). The majority of the top 50 articles were focused on traumatic dental injuries. Among 131 unique key words, root resorption (n = 6) was the most frequently used. A non-significant correlation occurred between citation count (correlation coefficient = 0.127, P = .378), citation density (correlation coefficient = 0.654, P = 2.493), and publication age.Conclusions: This study identified the top 50 most cited articles published in this journal in the specialty of Dental Traumatology. The publication year of an article was not significantly associated with citation count nor citation density. [ABSTRACT FROM AUTHOR]

Background Dengue is a global health problem requiring an effective, safe dengue vaccine. Methods We report the results of a phase II, randomized, open-label, single-center trial in adults aged 18 to 45 years in the United States designed to explore the effects of the Chimeric Yellow Fever Derived Tetravalent Dengue Vaccine (CYD-TDV, Dengvaxia) when administered on its designated schedule (months 0, 6, and 12) or on an accelerated dosing schedule (months 0, 2, and 6) and/or given before, or concomitantly with, a vaccine against Japanese encephalitis (JE). Results Based on dengue virus serotype-specific neutralizing antibody (NAb), the accelerated dosing schedule was comparable to the 0, 6, and 12-month schedule. Giving JE vaccine concurrently with CYD-TDV did not result in an increase in overall NAb titers. Immunophenotyping of peripheral blood mononuclear cells revealed an increase in activated CD8+ T cells after CYD-TDV vaccination, a phenomenon that was greatest for the JE vaccine primed. Conclusions We conclude that an accelerated dosing schedule of CYD-TDV results in essentially equivalent dengue serotype-specific NAb titers as the currently used schedule, and there may be an early benefit in antibody titers and activated CD8+ T cells by the administration of the JE vaccine before CYD-TDV vaccination. [ABSTRACT FROM AUTHOR]

Insight into the characteristics and system experiences for youth who touch both the child welfare and juvenile justice systems has increased over the last decade. These youth are typically studied as one population and referred to as "crossover youth." While this literature contributes valuable insight into who crossover youth are, studies are virtually silent on distinguishing characteristics and experiences across different pathways leading to dual system contact. This study reviews what is currently known about dual system youth generally (i.e., youth who have contact with both the juvenile justice and child welfare systems) and introduces a framework for consistently defining dual system youth and their pathways. The utility of the framework is then explored using linked administrative data for cohorts of youth aged 10 to 18 years old with a first petition to delinquency court in three sites: Cook County, Illinois between 2010 and 2014 (N = 14,170); Cuyahoga County, Ohio between 2010 and 2014 (N = 11,441); and New York City between 2013 and 2014 (N = 1272). The findings show a high prevalence of dual system contact overall, ranging from 44.8 to 70.3%, as well as wide variation in the ways in which youth touched both systems. Specifically, non-concurrent system contact is more prevalent than concurrent system contact in all sites, and individual characteristics and system experiences vary within and across these different pathway groups. Based on study findings, implications for future research on dual system youth and for developing collaborative practices and policies across the systems are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Tubal ligation has been associated with reduced risk of epithelial ovarian cancer (EOC) in studies of primarily white women, but less is known about the association in African American (AA) women. We sought to evaluate the associations among 597 invasive ovarian cancer cases and 742 controls of AA descent recruited from the African American Cancer Epidemiology Study, a population-based case-control study in 11 geographical areas in the US.Methods: Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for potentially confounding factors.Results: An inverse association between tubal ligation and EOC was observed that was not statistically significant (OR 0.88, 95% CI 0.68-1.14). However, an inverse association with EOC risk was observed among women who had a tubal ligation at age 35 years or older (OR 0.64; 95% CI 0.41-0.98), but not among those who had a tubal ligation before age 35 (OR 0.98; 95% CI 0.74-1.29) (p for interaction = 0.08). The association also varied considerably by tumor subtype. A strong inverse association was observed for endometrioid tumors (OR 0.31, 95% CI 0.14-0.70), whereas associations with mucinous (OR 0.87, 95% CI 0.36-2.12) and serous (OR 0.94, 95% CI 0.71-1.24) tumors were weaker and not statistically significant. A statistically non-significant positive association for clear cell tumors (OR 1.84, 95% CI 0.58-5.82) was based on a low number of cases.Conclusions: Our findings show that tubal ligation may confer a reduced risk for EOC among AA women that is comparable to the associations that have been previously observed in primarily white populations. [ABSTRACT FROM AUTHOR]

Background: Urgent colectomy is a common procedure with a high mortality rate that is performed by a variety of surgeons and hospitals. We investigated patient, surgeon, and hospital characteristics that predicted mortality after urgent colectomy.Methods: The University HealthSystem Consortium was queried for adults undergoing urgent or emergent colectomy between 2009 and 2013 (n = 50,707). Hospitals were grouped into quartiles according to risk-adjusted observed-to-expected (O/E) mortality ratios and compared using the 2013 American Hospital Association Annual Survey. Multiple logistic regression was used to determine patient and provider characteristics associated with in-hospital mortality.Results: The overall mortality rate after urgent colectomy was 9 %. Mortality rates were higher for patients with extreme severity of illness (27.6 %), lowest socioeconomic status (10.6 %), weekend admissions (10.7 %), and open (10.5 %) and total (15.8 %) colectomies. Hospitals with the lowest O/E ratios were smaller and had lower volume and less teaching intensity, but there were no significant trends with regard to financial (expenses, payroll, capital expenditures per bed) or personnel characteristics (physicians, nurses, technicians per bed). On multivariate analysis, mortality was associated with patient age (10 years: OR 1.31, p < 0.01), severity of illness (extreme: OR 34.68, p < 0.01), insurance status (Medicaid: OR 1.24, p < 0.01; uninsured: OR 1.40, p < 0.01), and weekend admission (OR 1.09, p = 0.04). Surgeon volume was associated with reduced mortality (per 10 cases: OR 0.99, p < 0.01), but hospital volume was not (per case: OR 1.00, p = 0.84).Conclusions: Mortality is common after urgent colectomy and is associated with patient characteristics. Surgeon volume and practice patterns predicted differences in mortality, whereas hospital factors did not. These data suggest that policies focusing solely on hospital volume ignore other more important predictors of patient outcomes. [ABSTRACT FROM AUTHOR]

While plant community theory tends to emphasize the importance of abiotic heterogeneity along niche axes, much empirical work seeks to characterize the influence of the absolute magnitude of key abiotic variables on diversity. Both magnitude (as reflected, e.g., by a mean) and heterogeneity (variance) in abiotic conditions likely contribute to biodiversity patterns in plant communities, but given the large number of putative abiotic drivers and the fact that each may vary at different spatiotemporal scales, the challenge of linking observed biotic patterns with the underlying environment remains acute. Using monitoring data from a natural resource agency, we compared how well statistical models of the mean, heterogeneity, and both the mean and heterogeneity combined of 17 abiotic factor variables explained patterns of forb species richness in Northeast Ohio, USA. We performed our analyses at two spatial scales, repeated in spring and summer across four forest types. Although all models explained a great deal of the variance in species richness, models including both the mean and heterogeneity of different abiotic factors together outperformed models including either the mean or the heterogeneity of abiotic factors alone. Variability in forb species richness was mostly due to changes in mean calcium levels regardless of forest type. After accounting for forest type, we were able to attribute variation in forb species richness to changes in the heterogeneity of different abiotic factors as well. Our results suggest that multiple mechanisms act simultaneously according to different aspects of the abiotic environment to structure forb communities, and this underscores the importance of considering both the magnitude of and heterogeneity in multiple abiotic factors when looking for links between the abiotic environment and plant community patterns. Finally, we identify novel patterns across spatial scales, forest types, and seasons that can guide future research in this vein. OPEN RESEARCH BADGES: This article has earned an Open Data Badge for making publicly available the digitally‐shareable data necessary to reproduce the reported results. The data is available at https://doi.org/10.5061/dryad.kp3cb17. [ABSTRACT FROM AUTHOR]

Background. Retroperitoneal sarcomas (RPS) comprise approximately 15% of all soft-tissue sarcomas and frequently associated with significant morbidity and as little as 30% 5-year survival. Here, we provide a large, contemporary, and multi-institutional experience to determine which tumor, patient, and treatment characteristics are associated with long-term outcomes in RPS. Methods. 571 patients with primary RPS were identified from the United States Sarcoma Collaboration (USSC). RPS patients who underwent resection from January 2000 to April 2016 were included with patient, tumor, and treatment-specific variables investigated as independent predictors of survival. Survival analyses for disease-free and overall survival were conducted using Kaplan–Meier and Cox proportional hazards model methods. Results. The study cohort was 55% female, with a median age of 58.9 years (IQR: 48.6–70.0). The most common tumor histiotypes were liposarcoma (34%) and leiomyosarcoma (28%). Median follow-up was 30.6 months (IQR: 11.2–60.4). Median disease-free survival was 35.3 months (95% CI: 27.6–43.0), with multivariate predictors of poorer disease-free survival including higher grade tumors, nodal-positive disease, and multivisceral resection. Median overall survival was 81.6 months (95% CI: 66.3–96.8). Multivariate predictors of shorter overall survival included higher grade tumors, nodal-positive and multifocal disease, systemic chemotherapy, and grossly positive margins (R2) following resection. Conclusions. The strongest predictors of disease-free and overall survival are tumor-specific characteristics, while surgical factors are less impactful. Nonsurgical therapies are not associated with improved outcomes despite persistent interest and utilization. Complete macroscopic resection (R0/R1) remains a persistent potentially modifiable risk factor associated with improved overall survival in patients with retroperitoneal sarcomas. [ABSTRACT FROM AUTHOR]

Cahokia is the largest documented urban settlement in the pre-Columbian United States. Archaeological evidence suggests that the city, located near what is now East St. Louis, Illinois, began to rapidly expand starting around AD 1050. At its height, Cahokia extended across 1000 ha and included large plazas, timber palisade walls, and hundreds of monumental earthen mounds. Following several centuries of occupation, the city experienced a period of gradual abandonment from about AD 1200 to 1400. Here, we present geochemical data from a 1500-year-old sediment core from nearby Horseshoe Lake that records watershed impacts associated with the growth and decline of Cahokia. Sedimentary analysis shows a distinctive 24-cm-thick, gray, fine-grained layer formed between AD 1150 and 1220 and characterized by low carbonate δ13C, elevated sorbed metal concentrations, and higher organic matter δ15N. The deposition of this layer is contemporaneous with archaeological evidence of increased agricultural activity, earthen mound construction, and higher populations surrounding the lake. We hypothesize that these human impacts increased soil erosion, producing new sediment sources from deeper soil horizons, and shifted dissolved transport to the lake, producing lower carbonate δ13C values, higher concentrations of lead, copper, potassium, and aluminum, and increased δ15N, likely due to contributions of enriched nitrogen from sewage. [ABSTRACT FROM AUTHOR]

Summary Background Treatment with bone-marrow-derived mesenchymal stromal cells (MSCs) has shown benefits in preclinical models of acute respiratory distress syndrome (ARDS). Safety has not been established for administration of MSCs in critically ill patients with ARDS. We did a phase 2a trial to assess safety after administration of MSCs to patients with moderate to severe ARDS. Methods We did a prospective, double-blind, multicentre, randomised trial to assess treatment with one intravenous dose of MSCs compared with placebo. We recruited ventilated patients with moderate to severe ARDS (ratio of partial pressure of oxygen to fractional inspired oxygen <27 kPa and positive end-expiratory pressure [PEEP] ≥8 cm H 2 O) in five university medical centres in the USA. Patients were randomly assigned 2:1 to receive either 10 × 106/kg predicted bodyweight MSCs or placebo, according to a computer-generated schedule with a variable block design and stratified by site. We excluded patients younger than 18 years, those with trauma or moderate to severe liver disease, and those who had received cancer treatment in the previous 2 years. The primary endpoint was safety and all analyses were done by intention to treat. We also measured biomarkers in plasma. MSC viability was tested in a post-hoc analysis. This trial is registered with ClinicalTrials.gov , number NCT02097641. Findings From March 24, 2014, to Feb 9, 2017 we screened 1038 patients, of whom 60 were eligible for and received treatment. No patient experienced any of the predefined MSC-related haemodynamic or respiratory adverse events. One patient in the MSC group died within 24 h of MSC infusion, but death was judged to be probably unrelated. 28-day mortality did not differ between the groups (30% in the MSC group vs 15% in the placebo group, odds ratio 2·4, 95% CI 0·5–15·1). At baseline, the MSC group had numerically higher mean scores than the placebo group for Acute Physiology and Chronic Health Evaluation III (APACHE III; 104 [SD 31] vs 89 [33]), minute ventilation (11·1 [3·2] vs 9·6 [2·4] L/min), and PEEP (12·4 [3·7] vs 10·8 [2·6] cm H 2 O). After adjustment for APACHE III score, the hazard ratio for mortality at 28 days was 1·43 (95% CI 0·40–5·12, p=0·58). Viability of MSCs ranged from 36% to 85%. Interpretation One dose of intravenous MSCs was safe in patients with moderate to severe ARDS. Larger trials are needed to assess efficacy, and the viability of MSCs must be improved. Funding National Heart, Lung, and Blood Institute. [ABSTRACT FROM AUTHOR]

Abstract Multi-proxy sediment records from Castor Lake and Scanlon Lake, north-central Washington, provide a late Quaternary perspective on lake/catchment hydrologic and ecosystem responses to climate change and the Mazama volcanic ashfall event. Analyses of authigenic carbonate mineral oxygen and carbon isotope values, organic carbon and nitrogen content, and sedimentological facies were conducted on sediment from Castor Lake in order to reconstruct lake/catchment hydrologic balance, the source and abundance of organic matter, and variations in lake level. Sedimentary facies characterization was conducted on the Scanlon Lake sediment in order to provide supporting evidence for the lake-level shifts inferred from the Castor Lake data. Marked changes in Castor Lake proxy values occur from 12,860 to 11,440 calendar years before present (yr BP), suggesting lake/catchment responses to the Younger Dryas cold reversal including higher lake levels, substantial variability in productivity, and increased catchment erosion. High δ18O values at 9630 yr BP indicate that lake levels were lower than at present and that the early Holocene was dry. Sedimentological analyses and δ18O data demonstrate that subsequent to the Mazama climactic eruption (∼7600 yr BP), a transition to the lowest lake levels of the Holocene occurred over several centuries, with maximum δ18O values at 7290 (90% uncertainty range: 7020–7500) yr BP and low lake levels persisting until 6190 (5960–6410) yr BP. Lithological changes in the Scanlon Lake record support these inferences. The lowest δ18O values of the Holocene occur in sediment from ∼5000 yr BP, indicating high lake levels at this time, after which a secular trend toward higher δ18O values and lower lake levels occurred. The prolonged lowstand in the centuries following the Mazama eruption suggests that catchment hydrologic characteristics were strongly impacted by the ashfall through effects on soil water retention capacity, that similar responses may have occurred in comparable settings within the Mazama ashfall zone, and that such volcanic events have the potential confound the climate signal in lake sediment records. Were a similar event to happen in the future, catchment hydrology, stream/river discharge, and lake/catchment ecosystem dynamics could be affected for centuries. Highlights • Lake sediment records reveal late Quaternary climate change in the Pacific Northwest. • Proxy data indicate a lake/catchment environmental response to the Younger Dryas. • Volcanic ash from the Mazama eruption altered lake catchment hydrology. • The lowest lake levels of the Holocene occurred ∼300 years after the Mazama eruption. • The driest conditions of the early Holocene occurred ∼9600 years before present. [ABSTRACT FROM AUTHOR]

Two studies were conducted of students with and without persisting Specific Learning Disabilities (SLDs-WL) in Grades 4 to 9 (M = 11 years, 11 months) that supported the hypotheses that CELF 4 parent ratings for listening (language by ear), speaking (language by mouth), reading (language by eye), and writing (language by hand) were correlated with both (a) normed, standardized behavioral measures of listening, speaking, reading, and writing achievement (Study 1, 94 boys and 61 girls); and (b) fMRI connectivity or DTI white matter integrity involving brain regions for primary motor functions or motor planning and control, or motor timing in a subsample of right handers who did not wear metal (Study 2, 28 boys and 16 girls). Results of these assessment studies, which have implications for planning instruction for three SLDs-WL (dysgraphia, dyslexia, and oral and written language learning disability [OWL LD]), show that more than multisensory instruction is relevant. Language by ear, by mouth, by eye, and by hand, as well as motor planning, control, and output skills and motor timing should also be considered. Research is also reviewed that supports other processes beyond multisensory input alone that should also be considered for students with SLDs-WL. [ABSTRACT FROM AUTHOR]

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the Task Force used an iterative process and expert consensus to finalise the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport. [ABSTRACT FROM AUTHOR]

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a position statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport. [ABSTRACT FROM AUTHOR]

At a storefront museum approximately 25 miles southeast of Pittsburgh, Pennsylvania, a sign reads, "Clean Air Started Here." This is not hyperbole. At the end of October 1948, the communities of Donora and Webster in Pennsylvania were visited by a smog that changed the face of environmental protection in the United States. Conservative estimates showed that 20 individuals died, while an additional 5900--43% of the population of Donora--were affected by the smog. This event led to the first large-scale epidemiological investigation of an environmental health disaster in the United States. Questions remain about the long-term effects of the smog, because higher rates of cardiovascular disease and cancer than were expected were observed in the region in the decade following the smog. Recent work has suggested that environmental contaminants from a bygone era in Donora might have an impact even today. In addition, reports regarding air pollution have indicated that levels of pollutants similar to those estimated to have occurred in Donora are currently present in some rapidly industrializing regions of China and India. Seventy years after the smog, this event still resonates. [ABSTRACT FROM AUTHOR]

Background: The role of adjuvant therapy in patients with resected gallbladder cancer (GBC) is unclear.Methods: The American College of Surgeons National Cancer Data Base was used to identify patients with resected GBC (pathologic stage 1-3) from 1998 to 2006 (n = 6690). We compared three groups: surgery only (S, 78.6 %), surgery plus adjuvant chemotherapy (AC, 6.2 %), and surgery plus adjuvant chemotherapy and radiation therapy (ACR, 15.1 %). Univariate and Cox regression analyses were used to determine factors influencing overall survival and the use of adjuvant therapy.Results: ACR was associated with improved survival for all patients (HR 0.77, 95 % CI 0.66-0.90), especially node-positive patients (HR 0.64, 95 % CI 0.53-0.78); AC was not associated with changes in survival. Patients were less likely to have their lymph nodes examined if they had any comorbidities, lower income, or were treated at community cancer centers (all p < 0.05). Among patients with unknown lymph node status, those with T2 or T3 disease saw improved survival with ACR (T2: HR 0.79, 95 % CI 0.63-0.99; T3: HR 0.43, 95 % CI 0.30-0.62), while AC did not affect survival.Conclusion: ACR is associated with improved survival for patients with node-positive GBC, as well as those with T2 or T3 GBC with unknown lymph node status. [ABSTRACT FROM AUTHOR]

Purpose: To characterize practice patterns, including temporal trends, in fractionation schedules among patients in the United States undergoing definitive radiation therapy for early-stage glottic cancer and to compare overall survival outcomes between fractionation schedules.Methods and Materials: We queried the National Cancer Database for patients with TisN0M0, T1N0M0, or T2N0M0 squamous cell carcinoma of the glottic larynx diagnosed between 2004 and 2012 and undergoing definitive radiation therapy. Dose per fraction was calculated to define cohorts undergoing conventional fractionation (CFxn) and hypofractionation (HFxn). Logistic regression was performed to identify predictors of receiving HFxn, and Cox regression was used to determine predictors of death. One-to-one propensity score matching was then used to compare survival between fractionation schedules.Results: The study included 10,539 patients, with 6576 undergoing CFxn and 3963 undergoing HFxn. Patients with T1 disease comprised a majority of each cohort. Use of HFxn increased significantly over the period studied (P<.001), but even in the final year, nearly one-half of patients continued to receive CFxn. Receipt of HFxn was also independently associated with higher income and facility types other than community cancer programs on logistic regression. On multivariate Cox regression, HFxn was associated with improved survival (hazard ratio [HR] for death, 0.90; 95% confidence interval [CI], 0.83-0.97; P=.008), a finding redemonstrated on univariate Cox regression among a well-matched cohort after propensity score matching (HR, 0.88; 95% CI, 0.80-0.96; P=.003). Subgroup Cox multivariate analysis demonstrated a significant survival advantage with HFxn among patients with T1 disease (HR, 0.90; 95% CI, 0.81-0.99; P=.042) but a nonsignificant benefit among those with Tis (HR, 0.86; 95% CI, 0.57-1.30; P=.472) or T2 (HR, 0.88; 95% CI, 0.76-1.02; P=.099) disease.Conclusions: Use of HFxn is increasing and is associated with improved survival over CFxn. Our findings support the broadened use of HFxn for patients with early-stage glottic cancer undergoing definitive radiation therapy. [ABSTRACT FROM AUTHOR]

Background: Previous reports showed an increased early mortality after chronic dialysis initiation among the end-stage renal disease (ESRD) population. We hypothesized that ESRD patients in the Military Health System (MHS) would have greater access to pre-ESRD care and hence better survival rates during this early high-risk period.Methods: In this retrospective cohort study, using the US Renal Data System database, we identified 1,256,640 patients initiated on chronic dialysis from January 2, 2004 through December 31, 2014, from which a bootstrap sample of 3,984 non-MHS incident dialysis patients were compared with 996 MHS patients. We assessed care by a nephrologist and dietitian, erythropoietin administration, and vascular access use at dialysis initiation as well as all-cause mortality as outcome variables.Results: MHS patients were significantly more likely to have had pre-ESRD nephrology care (adjusted OR [aOR] 2.9; 95% CI 2.3-3.7) and arteriovenous fistula used at dialysis initiation (aOR 2.2; 95% CI 1.7-2.7). Crude mortality rates peaked between the 4th and the 8th week for both cohorts but were reduced among MHS patients. The baseline adjusted Cox model showed significantly lower death rates among MHS vs. non-MHS patients at 6, 9, and 12 months. This survival advantage among MHS patients was attenuated after further adjustment for pre-ESRD nephrology care and dialysis vascular access.Conclusions: MHS patients had improved survival within the first 12 months compared to the general ESRD population, which may be explained in part by differences in pre-ESRD nephrology care and vascular access types. [ABSTRACT FROM AUTHOR]

Background: Access to nephrology care prior to end-stage renal disease (ESRD) is significantly associated with lower rates of morbidity and mortality. We assessed the association of area-level and individual-level indicators of poverty and race/ethnicity on pre-ESRD care provided by nephrologists. Methods: In this retrospective cohort study using the US Renal Data System database, we identified 739 537 patients initiated on maintenance dialysis from1 January 2007 through 31 December 2012.We assessed the Medicare-Medicaid dual eligibility status as an indicator of individual-level poverty and ZIP code-level median household income (MHI) data obtained from the 2010 US census. We conducted multivariable logistic regression of pre-ESRD nephrology care as the outcome variable. Results: Among patients in the lowest area-level MHI quintile, 61.28% received pre-ESRD nephrology care versus 67.68% among those in higher quintiles (P < 0.001). Similarly, the proportions of dual-eligible and nondual-eligible patients who had pre-ESRD nephrology care were 61.49 and 69.84%, respectively (P < 0.001). Patients in the lowest area-level MHI quintile were associated with significantly lower likelihood of pre-ESRD nephrology care (adjusted odds ratio [aOR] 0.86 [95% confidence interval (CI) 0.85-0.87]) compared with those in higher quintiles. Both African American (AA) and Hispanic patients were significantly less likely to have received pre-ESRD nephrology care [aOR 0.85 (95% CI 0.84-0.86) and aOR 0.72 (95% CI 0.71-0.74), respectively]. Conclusions: Individual- and area-level measures of poverty, AA race and Hispanic ethnicity were independently associated with a lower likelihood of pre-ESRD nephrology care. Efforts to improve pre-ESRD nephrology care may require focusing on the poor and minority groups. [ABSTRACT FROM AUTHOR]

The article discusses the executive order Fair Pay and Safe Workplaces issued by the U.S. federal agencies, and a final guidance issued by the Department of Labor for its implementation by the Federal Acquisition Regulatory Council (FAR Council) and contracting agencies. Topics include certain labor law information required to be disclosed by federal contractors and subcontractors; and authority granted to contracting officers to exercise certain adverse actions based on labor law information.

Outcomes: 1. Utilizing a case-based approach, participants will self-report the concerns that lead hospice programs to ask nurses to leave the room when a patient ingests the prescribed life-ending medications 2. Utilizing the ANA Code of Ethics, participants will self-report the ethical dilemma that occurs when the nurse is required to leave the room when the patient ingests the medications Some hospices in US jurisdictions where Medical Aid in Dying (MAID) is legal have implemented policies that require nurses to "leave the room" when a patient ingests aid-in-dying medication. Two questions with ethical implications arise from these policies: (1) Is it ethically supportable for a hospice to require staff leave the room while a patient ingests aid-in-dying medication? (2) Does this requirement compromise the nurse's professional commitment to patient and family? We review the origins of this common policy, nursing codes of ethics and professional organization policy statements related to nursing commitments to patients. In the United States, physicians and nurses cannot administer aid-in-dying medication directly; the patient must self-administer. But the scope of hospice engagement and employee policies vary widely. In all ten jurisdictions with statutes permitting aid-in-dying, the statute provides that aid in dying "is not to be construed as suicide, assisted suicide, euthanasia under the law." Institutions remain concerned about the federal Assisted Suicide Funding Restriction Act (1997), legislation enacted in direct response to Oregon's first statute legalizing physician assistance in dying. The act provides that no federal funding "may be used... for the purpose of causing, or ... assisting in causing, the death of an individual... by assisted suicide." Institutional policy requiring nurses to "leave the room" while a patient ingests risks violating professional standards, reinforces stigma around MAID, potentially abandoning patients and loved ones at a critical time accessing a desired and legal death. We present a case that depicts these potential risks and conclude that such a policy is not ethically supportable. Hospice programs must be transparent about their aid-in-dying policies and procedures, including restrictions on staff participation at the time of ingestion, so that patients and families can make an informed choice of hospice providers. [ABSTRACT FROM AUTHOR]

Background: Learning to perform pelvic and breast examinations produces anxiety for many medical students. Clerkship directors have long sought strategies to help students become comfortable with the sensitive nature of these examinations. Incorporating standardized patients, simulation and gynecologic teaching associates (GTAs) are approaches gaining widespread use. However, there is a paucity of literature guiding optimal approach and timing. Our primary objective was to survey obstetrics and gynecology (Ob/Gyn) clerkship directors regarding timing and methods for teaching and assessment of pelvic and breast examination skills in United States medical school curricula, and to assess clerkship director satisfaction with current educational strategies at their institutions. Methods: Ob/Gyn clerkship directors from all 135 Liaison Committee on Medical Education accredited allopathic United States medical schools were invited to complete an anonymous 15-item web-based questionnaire. Results: The response rate was 70%. Pelvic and breast examinations are most commonly taught during the second and third years of medical school. Pelvic examinations are primarily taught during the Ob/Gyn and Family Medicine (FM) clerkships, while breast examinations are taught during the Ob/Gyn, Surgery and FM clerkships. GTAs teach pelvic and breast examinations at 72 and 65% of schools, respectively. Over 60% of schools use some type of simulation to teach examination skills. Direct observation by Ob/Gyn faculty is used to evaluate pelvic exam skills at 87% of schools and breast exam skills at 80% of schools. Only 40% of Ob/Gyn clerkship directors rated pelvic examination training as excellent, while 18% rated breast examination training as excellent. Conclusions: Pelvic and breast examinations are most commonly taught during the Ob/Gyn clerkship using GTAs, simulation trainers and clinical patients, and are assessed by direct faculty observation during the Ob/Gyn clerkship. While the majority of Ob/Gyn clerkship directors were not highly satisfied with either pelvic or breast examination training programs, they were less likely to describe their breast examination training programs as excellent as compared to pelvic examination training--overall suggesting an opportunity for improvement. The survey results will be useful in identifying future challenges in teaching such skills in a cost-effective manner. [ABSTRACT FROM AUTHOR]

Acute myeloid leukaemia is a highly malignant haematopoietic tumour that affects about 13,000 adults in the United States each year. The treatment of this disease has changed little in the past two decades, because most of the genetic events that initiate the disease remain undiscovered. Whole-genome sequencing is now possible at a reasonable cost and timeframe to use this approach for the unbiased discovery of tumour-specific somatic mutations that alter the protein-coding genes. Here we present the results obtained from sequencing a typical acute myeloid leukaemia genome, and its matched normal counterpart obtained from the same patient’s skin. We discovered ten genes with acquired mutations; two were previously described mutations that are thought to contribute to tumour progression, and eight were new mutations present in virtually all tumour cells at presentation and relapse, the function of which is not yet known. Our study establishes whole-genome sequencing as an unbiased method for discovering cancer-initiating mutations in previously unidentified genes that may respond to targeted therapies. [ABSTRACT FROM AUTHOR]