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Intercultural Perspectives on Information Literacy and Metaliteracy (IPILM) is a discourseoriented learning environment that engages students from diverse cultural backgrounds to participate in collaborative knowledge construction. The objective is to evolve a thematic approach to course design that includes elements of open pedagogy, information literacy, and metaliteracy. IPILM invites participation from educators and learners from around the world and has witnessed an increase in participating countries. This paper describes the concept of IPILM and demonstrates the implementation of this approach in practice. The initiative was well received by students and is both feasible and sustainable as an intercultural learning endeavor. IPILM is an ongoing project and a work in progress that is an adaptable model which may be transferred to disparate fields of teaching and learning or adopted by international communities of instructors.

A comprehensive graduate teaching assistant (GTA) training program in mathematical sciences designed at one institution is being adapted and replicated at two peer institutions. Using a case study approach, this paper outlines the development of the program components, which include a first-year teaching seminar, peer mentoring and support from a peer TA Coach, a Critical Issues in STEM Education seminar, and K-12 outreach to inform understanding of the pipeline. Additionally, adaptations due to institutional context and the impact of the COVID-19 pandemic are described. Implications for components of the comprehensive program, based on GTA-provided feedback, are discussed.

Purpose: In this paper, the authors recap the history and evolution of ISSPP research in the USA with research teams that grew from one location in 2002 to seven teams at present. The authors also examine the unique context of public education in America by describing its governance, key policies and funding as well as increasing student diversity due to changing internal student demographics and global population migrations. In particular, the authors describe how decentralization in American public education that has led to long-standing systemic inequities in school resource allocations and subsequently to marked gaps in performance outcomes for children from poor communities, especially for those of color. These existing inequities were the reason the USA research team was the only national ISSPP team from the original network of eight countries that choose to study exclusively leadership in challenging, high needs schools that performed beyond expectations. Design/methodology/approach: The authors describe the common multi-case case study methodology (Merriam, 1988) and interview protocols employed in order to gather multiple perspectives on school success in high-needs communities and the principal's contribution to that success. Leithwood and Riehl's (2005) framework of core leadership practices for successful school leadership was used to analyze our data across all cases. Findings: The authors present key findings from cases across the USA and synthesize common trends across these findings. Research limitations/implications: The authors conclude the paper with a discussion of their overarching impressions from almost two decades of study, the importance of national and local context in examining school leadership and, lastly, suggestions for future research. Originality/value: This article contributes to findings from the longest and largest international network on successful leadership.

In 2023, the US Centers for Disease Control and Prevention recommended universal screening for hepatitis B virus (HBV); however, the proportion of US adults screened before implementing this recommendation is unknown. We analysed nationally representative data from the National Health Interview Survey (2013–2017) on self‐reported HBV testing among noninstitutionalized US adults ≥18 years. We employed Poisson logistic regression to identify factors associated with self‐reported testing, using a conceptual framework that included four overarching factors: sociodemographic characteristics, healthcare access, health‐seeking behaviours and experiences, and access to internet‐based health information. Among 149,628 survey respondents, the self‐reported HBV testing rate was 27.2% (95% CI 26.2–28.7) and increased by 1.7% from 2013 to 2017 (p =.006). In adjusted analysis, health‐seeking behaviours and experiences had the strongest associations of self‐reported testing including a history of hepatitis (AOR 2.68, 95% CI 1.92–3.73), receipt of hepatitis B vaccination (AOR 5.11, 95% CI 4.61–5.68) and prior testing for hepatitis C (AOR 9.14, 95% CI 7.97–10.48) and HIV (AOR 2.69, 95% CI 2.44–2.97). Other factors associated with testing included being male (AOR 1.14, 95% CI 1.03–1.26), ages 30–44 years (AOR 1.37, 95% CI 1.17–1.61), 45–60 years (AOR 1.55, 95% CI 1.30–1.80) and ≥60 years (AOR 1.53, 95% CI 1.28–1.84), residence in the Western US region (AOR 1.23, 95% CI 1.06–1.43), and access to internet‐based health information (AOR 1.32, 95% CI 1.18–1.47). Being Hispanic was associated with lower odds of testing (AOR 0.80, 95% CI 0.66–0.97). These findings may help guide optimal HBV screening in the universal testing era. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer is becoming more common in low- and middle-income countries (LMICs). The challenges faced by communities in LMICs, settings with few resources available, can be compared to rural America, where resources are also limited. Common barriers to taking care of colorectal cancer patients in these communities are variation in individual provider behavior, social determinants of health such as poverty, how healthcare systems are set up, and the number of specialty doctors practicing in these communities. This review also highlights how LMICs and rural American communities have addressed these problems, through projects such as training new specialty doctors, collaborating with larger hospitals, and technological innovation. Finally, as an example, we highlight a new colorectal surgery fellowship program that addresses the barriers to providing colorectal cancer care in a low-resource setting at both the individual patient and provider level, all the way to the systems level. Background/Objectives: Colorectal cancer remains a significant global health challenge, particularly in resource-limited settings where patient-centered outcomes following surgery are often suboptimal. Although more prevalent in low- and middle-income countries (LMICs), segments of the United States have similarly limited healthcare resources, resulting in stark inequities even within close geographic proximity. Methods: This review compares and contrasts colorectal cancer outcomes in LMICs with those in resource-constrained communities in rural America, utilizing an established implementation science framework to identify key determinants of practice for delivering high-quality colorectal cancer care. Results: Barriers and innovative, community-based strategies aimed at improving patient-centered outcomes for colorectal cancer patients in low resource settings are identified. We explore innovative approaches and community-based strategies aimed at improving patient-centered outcomes, highlighting the newly developed colorectal surgery fellowship in Sub-Saharan Africa as a model of innovation in this field. Conclusions: By exploring these diverse contexts, this paper proposes actionable solutions and strategies to enhance surgical care of colorectal cancer and patient outcomes, ultimately aiming to inform global health practices, inspire collaboration between LMIC and rural communities, and improve care delivery across various resource settings. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Most studies of the effects of prenatal alcohol exposure (PAE) on cognitive function have assumed that the dose-response curve is linear. However, data from a few animal and human studies suggest that there may be an inflection point in the dose-response curve above which PAE effects are markedly stronger and that there may be differences associated with pattern of exposure, assessed in terms of alcohol dose per drinking occasion and drinking frequency. Methods: We performed second-order confirmatory factor analysis on data obtained at school age, adolescence, and early adulthood from 2227 participants in six US longitudinal cohorts to derive a composite measure of cognitive function. Regression models were constructed to examine effects of PAE on cognitive function, adjusted for propensity scores. Analyses based on a single predictor (absolute alcohol (AA)/day) were compared with analyses based on two predictors (dose/occasion and drinking frequency), using (1) linear models and (2) nonparametric general additive models (GAM) that allow for both linear and nonlinear effects. Results: The single-predictor GAM model showed virtually no nonlinearity in the effect of AA/day on cognitive function. However, the two-predictor GAM model revealed differential effects of maternal drinking pattern. Among offspring of infrequent drinkers, PAE effects on cognitive function were markedly stronger in those whose mothers drank more than ~3 drinks/occasion, and the effect of dose/occasion was strongest among the very frequent drinkers. Frequency of drinking did not appear to alter the PAE effect on cognitive function among participants born to mothers who limited their drinking to ~1 drink/occasion or less. Conclusions: These findings suggest that linear models based on total AA/day are appropriate for assessing whether PAE affects a given cognitive outcome. However, examination of alcohol dose/occasion and drinking frequency is needed to fully characterize the impact of different levels of alcohol intake on cognitive impairment. [ABSTRACT FROM AUTHOR]

Two experiments investigated the extent to which the concreteness of titles affects metacognitive text expectations, study motivation, and comprehension test performance. Sixty-three American and 61 German students were presented with three titles (either concrete or abstract), based upon which the students estimated their expected ease-of-comprehension, and the expected interestingness, of three expository texts. Students also reported how motivated they were to study the texts. The students then studied the texts and completed comprehension tests. The results revealed that students expected texts with concrete (as opposed to abstract) titles to be easier to comprehend and more interesting, and were more motivated to study those texts. Structural Equation Modelling revealed that the effects of titles on reported study motivation were mediated by expected interestingness. In addition to that, expected interestingness and reported study motivation were partially mediated by expected ease-of-comprehension. Comprehension test performance was not affected. The results provide robust evidence for positive motivational effects of concrete titles. More specifically, the results indicate that concrete titles--which are specific and easy to imagine--promote students' motivation to study expository texts by encouraging the students to expect that they will find the texts interesting, and that they will be able to understand the texts.

The causes that individuals attribute to reading outcomes shape future behaviors, including engagement or persistence with learning tasks. Although previous reading motivation research has examined differences between typical and struggling readers, there may be unique dynamics related to varying levels of reading and attention skills. Using latent profile analysis, we found 4 groups informed by internal attributions to ability and effort. Reading skills, inattention, and hyperactivity/impulsivity were investigated as functional correlates of attribution profiles. Participants were 1,312 youth (8-15 years of age) of predominantly African American and Hispanic racial/ethnic heritage. More adaptive attribution profiles had greater reading performance and lower inattention. The reverse was found for the least adaptive profile with associations to greater reading and attention difficulties. Distinct attribution profiles also existed across similar-achieving groups. Understanding reading-related attributions may inform instructional efforts in reading. Promoting adaptive attributions may foster engagement with texts despite learning difficulties and, in turn, support reading achievement.

Objective: The objective was to measure specialty provider networks in Medicare Advantage (MA) and examine associations with market factors. Data Sources and Study Setting: We relied on traditional Medicare (TM) and MA prescription drug event data from 2011 to 2017 for all Medicare beneficiaries in the United States as well as data from the Area Health Resources File. Study Design: Relying on a recently developed and validated prediction model, we calculated the provider network restrictiveness of MA contracts for nine high‐prescribing specialties. We characterized network restrictiveness through an observed‐to‐expected ratio, calculated as the number of unique providers seen by MA beneficiaries divided by the number expected based on the prediction model. We assessed the relationship between network restrictiveness and market factors across specialties with multivariable linear regression. Data Collection/Extraction Methods: Prescription drug event data for a 20% random sample of beneficiaries enrolled in prescription drug coverage from 2011 to 2017. Principal Findings: Provider networks in MA varied in restrictiveness. OB‐Gynecology was the most restrictive with enrollees seeing 34.5% (95% CI: 34.3%–34.7%) as many providers as they would absent network restrictions; cardiology was the least restrictive with enrollees seeing 58.6% (95% CI: 58.4%–58.8%) as many providers as they otherwise would. Factors associated with less restrictive networks included the county‐level TM average hierarchical condition category score (0.06; 95% CI: 0.04–0.07), the county‐level number of doctors per 1000 population (0.04; 95% CI: 0.02–0.05), the natural log of local median household income (0.03; 95% CI: 0.007–0.05), and the parent company's market share in the county (0.16; 95% CI: 0.13–0.18). Rurality was a major predictor of more restrictive networks (−0.28; 95% CI: −0.32 to −0.24). Conclusions: Our findings suggest that rural beneficiaries may face disproportionately reduced access in these networks and that efforts to improve access should vary by specialty. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Due to the exclusion of pregnant and lactating people from most clinical trials, there is an incomplete understanding of the risks and benefits of medication use in these populations and therapeutic decision-making is often conducted without adequate evidence. To change this paradigm, it is imperative to understand the perspectives of pregnant and lactating individuals concerning their participation in clinical trials. Objectives: To describe attitudes, perceptions, barriers, and preferences of pregnant and postpartum people in the United States (US) regarding participation in clinical trials and to identify factors influencing participation. Methods: In November 2022, individuals aged ≥ 18 residing in the US who self-identified as pregnant or pregnant within the last 12 months were invited to complete an online survey about their perspectives regarding clinical trial participation. The survey included questions about demographic characteristics, health history, behaviors, and willingness to participate in clinical trials while pregnant and/or lactating. Multivariable logistic regression models were fit to identify predictors of clinical trial participation. Results: Among the 654 respondents, 34.8% and 40.9% reported being likely or extremely likely to participate in a clinical trial for a new medication while pregnant or lactating, respectively; and 24.5% and 41.7% for a new vaccine while pregnant or lactating, respectively. Higher educational attainment (≥ Bachelor's degree) was associated with greater likelihood of clinical trial participation in pregnancy (odds ratio (OR) = 1.50, 95% Confidence Interval (CI): 1.01, 2.25 for medications; OR = 2.00, 95% CI: 1.28, 3.12 for vaccines). Chronic medical conditions were associated with a greater likelihood of participation in clinical trials for vaccines during lactation (OR = 1.59, 95% CI: 1.07, 2.36). The most cited motivator for participation in a clinical trial while pregnant or lactating was anticipated personal medical benefit (85.8% and 75.6%, respectively), while the primary deterrent was possible risk to the fetus or baby (97.9% and 97.2%, respectively). Conclusions: Willingness of a US sample to participate in clinical trials while pregnant or lactating varied by demographics and health status, with safety to the fetus being a nearly universal concern. These findings have implications for enhancing inclusion of pregnant and lactating people in clinical research and developing effective and equitable recruitment strategies. [ABSTRACT FROM AUTHOR]

Introduction: Increased risks fromglobal climate change and sun-blocking global catastrophic risks (such as a nuclear winter), warrant the reevaluation of our food systems and their resilience to these climatic changes. Increasing native agrobiodiversity is a simple way of increasing food system resilience, and despite the vast amount of native genetic resources available in North America, the United States has shown little systematic effort to improve its agrobiodiversity. Methods: We use a systematic literature review of staple Native American food plants (NAFPs) to determine the current state of research interest among themand suggest species of interest for domestication. The nutrient profiles and nutrient adequacy scores for the most researched staple NAFPs were also collected and calculated. Results: A total of 174 Staple NAFPs were evaluated through systematic review, resulting in a total of 5302 peer-reviewed articles searched. Our findings show that most NAFPs are understudied and are more commonly seen by the agricultural community as weeds. However, there are a few that have current scientific interest in their value as a potential crop. Discussion: We discuss the 24 most researched NAFPs and their nutritional content. We also discuss potential actions, protocols, and ethical issues regarding future steps in using NAFPs to increase agrobiodiversity and food resilience in the United States through more resilient agroforestry systems. [ABSTRACT FROM AUTHOR]

Methionine is an essential amino acid critical for cell growth and survival. Preclinical evidence suggests a methionine restricted diet (MRD) sensitizes cancer to radiation therapy (RT), without significant adverse effects. However, this has never been evaluated in humans. The purpose of this pilot study was to evaluate the safety and feasibility of concurrent MRD with standard-of-care definitive RT in adults with any non-skin cancer malignancy. The MRD extended from 2 wk before RT initiation, through 2 wk beyond RT completion. The primary endpoint of safety was assessed as rate of grade 3 or higher acute and late toxicities. Feasibility was assessed with quantitative plasma amino acid panel every 2 wk during the MRD (target plasma methionine 13 μM). Nine patients were accrued over a two-year period, with five able to complete the treatment course. The trial was closed due to slow accrual and subjects' difficulty maintaining the diet. No grade 3 or higher adverse events were observed. Subjects' average methionine level was 18.8 μM during treatment, with average nadir 16.8 μM. These findings suggest the safety of concurrent MRD with RT, with toxicities comparable to those expected with RT alone. However, the diet was challenging, and unacceptable to most patients. [ABSTRACT FROM AUTHOR]

The article analyzes demographic reporting and representation of participants in completed Alzheimer's disease (AD) clinical trials between 2000 and 2019. Topics covered include the racial diversity of trial participants, the need for a range of strategies to increase diverse participants, and the inflexible participation of socioeconomically disadvantaged adults. Also noted is the urgent need to determine the most effective strategy to increase clinical trial diversity.

Background: Identifying modifiable risk factors of autism spectrum disorders (ASDs) may inform interventions to reduce financial burden. The infant/toddler gut microbiome is one such feature that has been associated with social behaviors, but results vary between cohorts. We aimed to identify consistent overall and sex-specific associations between the early-life gut microbiome and autism-related behaviors. Methods: Utilizing the Environmental influences on Children Health Outcomes (ECHO) consortium of United States (U.S.) pediatric cohorts, we gathered data on 304 participants with fecal metagenomic sequencing between 6-weeks to 2-years postpartum (481 samples). ASD-related social development was assessed with the Social Responsiveness Scale (SRS-2). Linear regression, PERMANOVA, and Microbiome Multivariable Association with Linear Models (MaAsLin2) were adjusted for sociodemographic factors. Stratified models estimated sex-specific effects. Results: Genes encoding pathways for synthesis of short-chain fatty acids were associated with higher SRS-2 scores, indicative of ASDs. Fecal concentrations of butyrate were also positively associated with ASD-related SRS-2 scores, some of which may be explained by formula use. Limitations: The distribution of age at outcome assessment differed in the cohorts included, potentially limiting comparability between cohorts. Stool sample collection methods also differed between cohorts. Our study population reflects the general U.S. population, and thus includes few participants who met the criteria for being at high risk of developing ASD. Conclusions: Our study is among the first multicenter studies in the U.S. to describe prospective microbiome development from infancy in relation to neurodevelopment associated with ASDs. Our work contributes to clarifying which microbial features associate with subsequent diagnosis of neuropsychiatric outcomes. This will allow for future interventional research targeting the microbiome to change neurodevelopmental trajectories. [ABSTRACT FROM AUTHOR]

Alcohol use was associated with elevated COVID-19 risk in the general population. People with HIV (PWH) have high prevalences of alcohol use. To evaluate the effect of alcohol use on COVID-19 risks among PWH, we estimated the risk of COVID-19 diagnosis and COVID-19-related hospitalization among PWH in routine care at 8 HIV primary care centers that contributed data to the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort according to their alcohol use just prior to the COVID-19 pandemic. The CNICS data repository includes demographic characteristics, clinical diagnoses, and laboratory test results from electronic medical records and other sources. Alcohol use, substance use, and mental health symptoms were self-reported on tablet-based standardized surveys. Alcohol use was categorized according to standard, sex-specific Alcohol Use Disorder Identification Test-Consumption instrument cut-offs. We followed 5,496 PWH (79% male, 48% Black race, median age = 53 years) from March 1, 2020 to December 31, 2020. Relative to PWH with no baseline alcohol use, the adjusted hazard ratio (aHR) of COVID-19 diagnosis was 1.09 (95% confidence interval [CI]: 0.78, 1.51) for lower-risk drinking and 1.19 (95%CI: 0.81, 1.73) for unhealthy drinking. The aHR of COVID-19-related hospitalization was 0.82 (95%CI: 0.33, 1.99) for lower-risk drinking and 1.25 (95%CI: 0.50, 3.09) for unhealthy drinking. Results were not modified by recent cocaine or non-prescribed opioid use, depressive symptoms, or diagnoses of alcohol use disorder. The study suggested a slightly increased, but not statistically significant risk of COVID-19 diagnosis and hospitalization associated with unhealthy alcohol use. [ABSTRACT FROM AUTHOR]

We examined changes in the proportion of people with human immunodeficiency virus (PWH) with virologic suppression (VS) in a multisite US cohort before and since the coronavirus disease 2019 (COVID-19) pandemic. Overall, prior gains in VS slowed during COVID-19, with disproportionate impacts on Black PWH and PWH who inject drugs. [ABSTRACT FROM AUTHOR]

On seasonal time scales, vapor pressure deficit (VPD) is a known predictor of burned area in the southwestern United States ("the Southwest"). VPD increases with atmospheric warming due to the exponential relationship between temperature and saturation vapor pressure. Another control on VPD is specific humidity, such that increases in specific humidity can counteract temperature-driven increases in VPD. Unexpectedly, despite the increased capacity of a warmer atmosphere to hold water vapor, near-surface specific humidity decreased from 1970 to 2019 in much of the Southwest, particularly in spring, summer, and fall. Here, we identify declining near-surface humidity from 1970 to 2019 in the southwestern United States with both reanalysis and in situ station data. Focusing on the interior Southwest in the months preceding the summer forest fire season, we explain the decline in terms of changes in atmospheric circulation and moisture fluxes between the surface and the atmosphere. We find that an early spring decline in precipitation in the interior region induced a decline in soil moisture and evapotranspiration, drying the lower troposphere in summer. This prior season precipitation decline is in turn related to a trend toward a Northern Hemisphere stationary wave pattern. Finally, using fixed humidity scenarios and the observed exponential relationship between VPD and burned forest area, we estimate that with no increase in temperature at all, the humidity decline alone would still lead to nearly one-quarter of the observed VPD-induced increase in burned area over 1984–2019. Significance Statement: Burned forest area has increased significantly in the southwestern United States in recent decades, driven in part by an increase in atmospheric aridity [vapor pressure deficit (VPD)]. Increases in VPD can be caused by a combination of increasing temperature and decreasing specific humidity. As the atmosphere warms with climate change, its capacity to hold moisture increases. Despite this, there is a decrease in near-surface air humidity in the interior southwestern United States over 1970–2019, which during the summer is likely caused by a decline in early spring precipitation leading to limited soil moisture and evaporation in spring and summer. We estimate that this declining humidity alone, without an increase in temperature, would cause about one-quarter of the VPD-induced increase in burned forest area in this region over 1984–2019. [ABSTRACT FROM AUTHOR]

Introduction: Tenofovir‐based oral pre‐exposure prophylaxis is currently approved for HIV prevention; however, adherence in women has been low. A vaginal gel containing tenofovir (TFV) demonstrated partial protection to HIV but protection was not confirmed in additional studies. Vaginal rings offer user‐controlled long‐acting HIV prevention that could overcome adherence and protection challenges. TFV may also help prevent herpes simplex virus type 2 acquisition when delivered intravaginally. We evaluated the pharmacokinetics, safety, adherence and acceptability of a 90‐day TFV ring. Methods: Between January and June 2019, Microbicide Trials Network (MTN)‐038 enrolled 49 HIV‐negative participants into a phase 1, randomized (2:1) trial comparing a 90‐day ring containing 1.4 grams (g) TFV to a placebo ring. TFV concentrations were quantified in plasma, cervicovaginal fluid (CVF), rectal fluid and cervical tissue, and TFV‐diphosphate (TFV‐DP) in cervical tissue. Used rings were analysed for residual TFV. Safety was assessed by adverse events (AEs); acceptability and adherence by self‐report. Results: Mean age was 29.5; 46 identified as cisgender‐female and three gender non‐conforming. There were no differences in the proportion of participants with grade ≥2 genitourinary AEs in the TFV versus placebo arms (p = 0.41); no grade ≥3 AEs were reported. Geometric mean TFV concentrations increased through day 34 in CVF/rectal fluid and day 59 in plasma, but declined across compartments by day 91. Geometric mean TFV‐DP tissue concentrations exceeded the 1000 fmol/mg target through day 56, but fell to 456 fmol/mg at day 91. Among 32 rings returned at the end of the study, 13 had no or low (<0.1 g) residual TFV. Residual TFV did not differ by socio‐demographics, sexual activity, Nugent Score or vaginal microbiota. Most participants reported being fully adherent to ring use: 85% and 81% in the TFV and placebo arms, respectively (p = 1.00). A majority of participants reported liking the ring (median 8 on a 10‐point Likert scale) and reported a high likelihood of using the ring in the future, if effective (median 9). Conclusions: The 90‐day TFV ring was well‐tolerated, acceptable and exceeded target cervical tissue concentrations through day 56, but declined thereafter. Additional studies are needed to characterize the higher release from TFV rings in some participants and the optimal duration of use. [ABSTRACT FROM AUTHOR]

Discussion on the advantages of integrating health literacy into adult education has primarily been theoretical and conceptual. There is a need for studies that assess the impact of adult education on health literacy. This study implemented a quasi-experimental design to explore whether basic adult instruction may constitute a venue for improving health literacy among Spanish-speaking immigrants. Participants included adults in a High School Equivalency program in a US-Mexico border community who received either a standard GED curriculum or a GED curriculum enhanced with health literacy content. The Short Spanish TOFHLA was used to measure health literacy. While S-TOFHLA scores and health literacy levels improved in all participants, no statistically significant differences were observed across groups. Results are consistent with recommendations supporting adult education as a strategy for improving health literacy.

Background: The role of body fat on metabolic complications remains poorly understood in young people living with perinatally acquired HIV (YPHIV). Objective: Our objective was to assess the association of changes in adiposity over 2 years with metabolic outcomes in YPHIV. Methods: The PHACS Adolescent Master Protocol (AMP) study enrolled YPHIV from 2007 to 2009 across 15 US sites, including Puerto Rico. We included YPHIV aged 7–19 years with body composition data assessed by whole‐body dual‐energy X‐ray absorptiometry (DXA) at baseline and 2 years later. Metabolic outcomes included homeostatic model assessment of insulin resistance (HOMA‐IR) and non‐high‐density lipoprotein cholesterol (non‐HDL‐C). We fitted linear regression models to assess the association of increase in body fat over 2 years with metabolic outcomes at years 2 and 3. Results: In all, 232 participants had a second DXA and either HOMA‐IR or non‐HDL‐C measured at year 2. Participant characteristics at the first DXA were: age 12 years (9–14) [median (Q1–Q3)], 69% Black, and median CD4 count 714 cells/μL; 70% with HIV RNA <400 copies/mL. In adjusted analyses for every 1% increase in body fat from baseline to year 2, HOMA‐IR was higher by 1.03‐fold at year 3 (95% CI: 1.00, 1.05). We observed that for every 1% increase in body fat from baseline to year 2, non‐HDL‐C was 0.72 mg/dL higher at year 2 (95% CI: −0.04–1.49) and 0.81 mg/dL higher at year 3 (95% CI: −0.05–1.66). Conclusions: Increases in adiposity over time may lead to downstream decreased insulin sensitivity and dyslipidaemia in YPHIV. [ABSTRACT FROM AUTHOR]

This study examined whether avoidant coping behaviours and acculturative stress functioned as mechanisms linking perceived discrimination to internalising mental health symptoms among African immigrants living in the United States. We used cross‐sectional data collected between December 2019 and January 2020 from US‐based first and second‐generation African immigrants (N = 599, 50% first‐generation, 82% Black, 71% female, mean age = 30). Path modelling was performed to examine the mediating role of avoidant coping and acculturative stress on the relationship between perceived discrimination and internalising symptoms. Results showed that perceived discrimination was related to internalising symptoms via avoidant coping and acculturative stress (specifically social and environmental stress). These results provide support that coping strategies and acculturative stress are likely important micro‐level mechanisms by which the discrimination‐mental health association persists. Implications and recommendations for prevention and intervention to reduce negative impacts of perceived discrimination on immigrant mental health are discussed. [ABSTRACT FROM AUTHOR]

Objective We aimed to measure provider perspectives on the acceptability, appropriateness, and feasibility of teleneonatology in neonatal intensive care units (NICUs) and community hospitals. Study Design Providers from five academic tertiary NICUs and 27 community hospitals were surveyed using validated implementation measures to assess the acceptability, appropriateness, and feasibility of teleneonatology. For each of the 12 statements, scale values ranged from 1 to 5 (1 = strongly disagree; 5 = strongly agree), with higher scores indicating greater positive perceptions. Survey results were summarized, and differences across respondents assessed using generalized linear models. Results The survey response rate was 56% (203/365). Respondents found teleneonatology to be acceptable, appropriate, and feasible. The percent of respondents who agreed with each of the twelve statements ranged from 88.6 to 99.0%, with mean scores of 4.4 to 4.7 and median scores of 4.0 to 5.0. There was no difference in the acceptability, appropriateness, and feasibility of teleneonatology when analyzed by professional role, years of experience in neonatal care, or years of teleneonatology experience. Respondents from Level I well newborn nurseries had greater positive perceptions of teleneonatology than those from Level II special care nurseries. Conclusion Providers in tertiary NICUs and community hospitals perceive teleneonatology to be highly acceptable, appropriate, and feasible for their practices. The wide acceptance by providers of all roles and levels of experience likely demonstrates a broad receptiveness to telemedicine as a tool to deliver neonatal care, particularly in rural communities where specialists are unavailable. Key Points Neonatal care providers perceive teleneonatology to be highly acceptable, appropriate, and feasible. Perceptions of teleneonatology do not differ based on professional role or years of experience. Perceptions of teleneonatology are especially high in smaller hospitals with well newborn nurseries. [ABSTRACT FROM AUTHOR]

Background: The prevalence of substance use in people with HIV (PWH) in the United States is higher than in the general population and is an important driver of HIV-related outcomes. We sought to assess if previously identified genetic associations that contribute to substance use are also observed in a population of PWH. Methods: We performed genome-wide association studies (GWAS) of alcohol, smoking, and cannabis use phenotypes in a multi-ancestry population of 7,542 PWH from the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). We conducted multi-ancestry GWAS for individuals of African (n = 3,748), Admixed American (n = 1,334), and European (n = 2,460) ancestry. Phenotype data were self-reported and collected using patient reported outcomes (PROs) and three questions from AUDIT-C, an alcohol screening tool. We analyzed nine phenotypes: 1) frequency of alcohol consumption, 2) typical number of drinks on a day when drinking alcohol, 3) frequency of five or more alcoholic drinks in a 30-day period, 4) smoking initiation, 5) smoking cessation, 6) cigarettes per day, 7) cannabis use initiation, 8) cannabis use cessation, 9) frequency of cannabis use during the previous 30 days. For each phenotype we considered a) variants previously identified as associated with a substance use trait and b) novel associations. Results: We observed evidence for effects of previously reported single nucleotide polymorphisms (SNPs) related to alcohol (rs1229984, p = 0.001), tobacco (rs11783093, p = 2.22E-4), and cannabis use (rs2875907, p = 0.005). We also report two novel loci (19p13.2, p = 1.3E-8; and 20p11.21, p = 2.1E-8) associated with cannabis use cessation. Conclusions: Our analyses contribute to understanding the genetic bases of substance use in a population with relatively higher rates of use compared to the general population. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to examine how code status orders for patients hospitalized with COVID-19 changed over time as the pandemic progressed and outcomes improved. Methods: This retrospective cohort study was performed at a single academic center in the United States. Adults admitted between March 1, 2020, and December 31, 2021, who tested positive for COVID-19, were included. The study period included four institutional hospitalization surges. Demographic and outcome data were collected and code status orders during admission were trended. Data were analyzed with multivariable analysis to identify predictors of code status. Results: A total of 3615 patients were included with full code (62.7%) being the most common final code status order followed by do-not-attempt-resuscitation (DNAR) (18.1%). Time of admission (per every six months) was an independent predictor of final full compared to DNAR/partial code status (p = 0.04). Limited resuscitation preference (DNAR or partial) decreased from over 20% in the first two surges to 10.8% and 15.6% of patients in the last two surges. Other independent predictors of final code status included body mass index (p < 0.05), Black versus White race (0.64, p = 0.01), time spent in the intensive care unit (4.28, p = <0.001), age (2.11, p = <0.001), and Charlson comorbidity index (1.05, p = <0.001). Conclusions: Over time, adults admitted to the hospital with COVID-19 were less likely to have a DNAR or partial code status order with persistent decrease occurring after March 2021. A trend toward decreased code status documentation as the pandemic progressed was observed. [ABSTRACT FROM AUTHOR]

This article extends the analysis of how presidents influence popular beliefs and feelings about their parties to include Donald Trump's full term and the first 2 years of Joe Biden's presidency. The results from examination of hundreds of surveys confirm that both presidents, like their predecessors, have strongly influenced evaluations of their parties generally and of their congressional wings specifically. They have also had a powerful impact on assessments of their party's competence in dealing with the COVID‐19 pandemic and on voters' preferences in their midterm election. For the most part, Trump's impact has been notably greater than Biden's, whose influence generally matches that of earlier presidents. Trump also stands out as having a larger and more consistent impact on opinions of the opposition, and he is exceptional in continuing to influence his party's reputation and standing after leaving office. [ABSTRACT FROM AUTHOR]

Engaging in exercise and appropriate nutritional intake improves mental health by reducing anxiety, depression, and sleep disturbances. However, few researchers have examined energy availability (EA), mental health, and sleep patterns in athletic trainers (ATs). To examine ATs' EA, mental health risk (ie, depression, anxiety), and sleep disturbances by sex (male, female), job status (part time [PT AT], full time [FT AT]), and occupational setting (college or university, high school, or nontraditional). Cross-sectional study. Free living in occupational settings. A total of 47 ATs (male PT ATs = 12, male FT ATs = 12; female PT ATs = 11, female FT ATs = 12) in the southeastern United States. Anthropometric measurements consisted of age, height, weight, and body composition. Energy availability was measured through energy intake and exercise energy expenditure. We used surveys to assess the depression risk, anxiety (state or trait) risk, and sleep quality. Thirty-nine ATs engaged in exercise, and 8 did not exercise. Overall, 61.5% (n = 24/39) reported low EA (LEA); 14.9% (n = 7/47) displayed a risk for depression; 25.5% (n = 12/47) indicated a high risk for state anxiety; 25.5% (n = 12/47) were at high risk for trait anxiety, and 89.4% (n = 42/47) described sleep disturbances. No differences were found by sex and job status for LEA, depression risk, state or trait anxiety, or sleep disturbances. Those ATs not engaged in exercise had a greater risk for depression (risk ratio [RR] = 1.950), state anxiety (RR = 2.438), trait anxiety (RR = 1.625), and sleep disturbances (RR = 1.147), whereas ATs with LEA had an RR of 0.156 for depression, 0.375 for state anxiety, 0.500 for trait anxiety, and 1.146 for sleep disturbances. Although most ATs engaged in exercise, their dietary intake was inadequate, they were at increased risk for depression and anxiety, and they experienced sleep disturbances. Those who did not exercise were at an increased risk for depression and anxiety. Energy availability, mental health, and sleep affect overall quality of life and can affect ATs' ability to provide optimal health care. [ABSTRACT FROM AUTHOR]

PURPOSE Cancer care-related greenhouse gas (GHG) emissions harm human health. Many cancer drugs are administered at greater-than-necessary doses, frequencies, and durations. Alternative dosing strategies may enable reductions in cancer care GHG emissions without compromising patient outcomes. MATERIALS AND METHODS We used streamlined life-cycle analysis in a case-control simulation to estimate the relative reductions in GHG emissions that would be expected to result from using each of three alternative dosing strategies of trastuzumab (6-month adjuvant treatment duration, once every 4-week dosing, and both) in human epidermal growth factor receptor 2 (HER2)1 breast cancer. Using primary data and conversion factors from the environmental science literature, we estimated per-patient relative reduction in GHG emissions and, using SEER data, health impacts (in terms of disability-adjusted life-years [DALYs] and excess mortality per kg CO2) on bystanders for each alternative dosing strategy. RESULTS Compared with the trastuzumab dosing strategy commonly used at baseline (12-month duration of adjuvant therapy and once every 3-week dosing in all settings), adoption of both 6-month adjuvant trastuzumab and once every 4-week trastuzumab dosing would reduce GHG emissions by 4.5%, 18.7%, and 14.6% in the neoadjuvant, adjuvant, and metastatic settings, respectively. We estimate that US-based adoption of alternative trastuzumab dosing would reduce annual DALYs and excess lives lost due to environmental impact of US-based trastuzumab therapy for HER21 breast cancer by 1.5 and 0.9, respectively. CONCLUSION Alternative dosing strategies may materially reduce the population health impacts of cancer care by reducing environmental impact. Regulatory decision making and health technology assessments should consider a treatment's environmental and population health impacts. Clinical trials of alternative dosing strategies are justified on the basis of environmental and population health impacts. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA), sedentary behavior, and sleep are interconnected, promoting optimal health. Few studies have examined these factors holistically. Therefore, the purpose of this study was to capture the 24-hour activity cycles of the US population by examining PA, sedentary behavior, and sleep based on the presence of a child within the home, as well as gender and weight. Methods: Cross-sectional health-related variables from the National Health and Nutrition Examination Survey were used for analysis. The primary variables were the total and type of PA (recreation, work, and active transportation), sedentary behavior, and sleep. Chi-square and regression models were applied to compare the outcomes across participants' characteristics. Results: The adults with children within the home reported less recreational PA, more work activity, less sedentary activity, and less sleep, but no differences in total PA. The females with children in the home not only had the lowest levels of recreational activity and sleep, but also the lowest levels of sedentary behavior. The obese individuals with children in the home had less sedentary time than the adults without children in the home, regardless of weight status. Conclusions: Unhealthy sleep and PA behaviors are prevalent in adults with children living at home, and women are particularly impacted. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this paper is to utilize successful leadership practices drawn from seven nations to improve leadership preparation. Design/methodology/approach: This study used a case study approach to gain a contextualized understanding of successful leadership across seven nations. Data sources primarily featured interviews with principals, teachers, staff members, parents, and students. Cases were analyzed within and then across nations with regards to organizational learning (OL), instructional leadership (IL), and culturally responsive practices (CRP). Findings: The cross-national analysis of successful leaders indicated emerging policy trends, demographic changes, similarities and differences among leaders, and recommendations for leadership preparation. Originality/value: This paper draws from successful practices in OL, IL and CRP in seven nations to make recommendations for improving leadership preparation. (Contains 1 table, 1 figure and 1 note.)

Introduction: Despite a recent global decrease in suicide rates, death by suicide has increased in the United States. It is therefore imperative to identify the risk factors associated with suicide attempts to combat this growing epidemic. In this study, we aim to identify potential risk factors of suicide attempt using geospatial features in an Artificial intelligence framework. Methods: We use iterative Random Forest, an explainable artificial intelligence method, to predict suicide attempts using data from the Million Veteran Program. This cohort incorporated 405,540 patients with 391,409 controls and 14,131 attempts. Our predictive model incorporates multiple climatic features at ZIPcode-level geospatial resolution. We additionally consider demographic features from the American Community Survey as well as the number of firearms and alcohol vendors per 10,000 people to assess the contributions of proximal environment, access to means, and restraint decrease to suicide attempts. In total 1,784 features were included in the predictive model. Results: Our results show that geographic areas with higher concentrations of married males living with spouses are predictive of lower rates of suicide attempts, whereas geographic areas where males are more likely to live alone and to rent housing are predictive of higher rates of suicide attempts. We also identified climatic features that were associated with suicide attempt risk by age group. Additionally, we observed that firearms and alcohol vendors were associated with increased risk for suicide attempts irrespective of the age group examined, but that their effects were small in comparison to the top features. Discussion: Taken together, our findings highlight the importance of social determinants and environmental factors in understanding suicide risk among veterans. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents and young adults with cancer have lower college attendance and graduation rates than their peers, but the reasons for this and extent to which cancer impacts college is unknown. This study explores post-high school experiences of young adults with cancer, detailing impacts of diagnosis and treatment on higher education attainment. Materials and Methods: A convergent mixed-methods design disseminated nationally obtained data regarding post-high school transition experiences in adults diagnosed with cancer before age 25. Results: Participants (n = 47) indicated struggles with employment and education; 81% attended some college, but 44% have not completed their degree, citing logistic challenges and lasting effects of therapy as major barriers. Nearly 20% of participants reported that cancer made higher education too difficult, so they did not attend, and most of these individuals (66.6%) are unemployed. Qualitative findings detail that accessing appropriate accommodations was made difficult by a lack of understanding from college faculty and staff. Conclusion: For many, cancer presents a barrier to higher education attainment; changing course of studies, repeating classes, and switching majors may impact degree completion. A minority of students with cancer access educational supports or get assistance obtaining these resources from their medical or high school team. Changes to clinical practice to ensure supports for young adults transitioning from high school have the potential to create improved pathways to higher education success. Additionally, supporting college faculty and staff understanding of cancer and its late effects may be a low-cost, high-impact way to improve adolescent/young adult college success. [ABSTRACT FROM AUTHOR]

We used an agent-based simulation model (Progression and Transmission of HIV) to follow for 20 years a cohort of persons in the United States infected with HIV in 2015. We assessed the benefits of reducing the delay between HIV infection and diagnosis and increasing adherence to HIV care and treatment on the percent of persons surviving 20 years after infection, average annual HIV transmission rates, and time spent virally suppressed. We examined average diagnosis delays of 1.0–7.0 years, monthly care drop-out rates of 5% to 0.1%, and combinations of these strategies. The percent of the cohort surviving the first 20 years of infection varied from 70.8% to 77.5%, and the annual transmission risk, from 1.5 to 5.2 HIV transmissions per 100 person-years. Thus, individuals can enhance their survival and reduce their risk of transmission to partners by frequent testing for HIV and adhering to care and treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Cotton leafroll dwarf virus (CLRDV) is capable of causing yield loss in cotton. Eight species of aphids have been reported to feed on cotton, but Aphis gossypii is the only known CLRDV vector in the United States (U.S.). Little is known about their distribution, abundance, and seasonal dynamics in the southern U.S. The epidemiological value of understanding this prompted a two-year study to monitor the populations of aphids that infest cotton fields throughout the southern U.S., where CLRDV has been reported. Aphis gossypii and Protaphis middletonii were the most abundant aphid species collected. Aphis craccivora, Macrosiphum euphorbiae, Myzus persicae, Rhopalosiphum rufiabdominale, and Smynthurodes betae were also detected in this study; however, their populations remained consistently low throughout the collection period. Results from this study presented novel information regarding the seasonal variation of the species and populations of aphids associated with cotton in the region. Cotton leafroll dwarf virus (CLRDV) is an emerging aphid-borne pathogen infecting cotton, Gossypium hirsutum L., in the southern United States (U.S.). The cotton aphid, Aphis gossypii Glover, infests cotton annually and is the only known vector to transmit CLRDV to cotton. Seven other species have been reported to feed on, but not often infest, cotton: Protaphis middletonii Thomas, Aphis craccivora Koch, Aphis fabae Scopoli, Macrosiphum euphorbiae Thomas, Myzus persicae Sulzer, Rhopalosiphum rufiabdominale Sasaki, and Smynthurodes betae Westwood. These seven have not been studied in cotton, but due to their potential epidemiological importance, an understanding of the intra- and inter-annual variations of these species is needed. In 2020 and 2021, aphids were monitored from North Carolina to Texas using pan traps around cotton fields. All of the species known to infest cotton, excluding A. fabae, were detected in this study. Protaphis middletonii and A. gossypii were the most abundant species identified. The five other species of aphids captured were consistently low throughout the study and, with the exception of R. rufiabdominale, were not detected at all locations. The abundance, distribution, and seasonal dynamics of cotton-infesting aphids across the southern U.S. are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Psychosocial impacts of cancer are well-recognized for pediatric patients but few studies examine challenges specific to schooling after diagnosis and caregiver-related factors that may influence coping. This study describes caregiver experiences of school-related psychosocial functioning and how caregiver preparedness and understanding of these challenges influence coping. Methods: Caregivers of 175 childhood cancer survivors completed a nationally disseminated survey related to caregiver preparedness, clinician-provided education, and school-related experiences. Caregiver-reported preparedness and understanding were evaluated as predictors of psychosocial coping; factor analysis was performed to identify compound scales of preparedness and understanding. Results: Caregivers reported that the cancer treatment experience resulted in their children being more stressed and anxious about returning to school (60.2% and 70.2%, respectively) and more sensitive to peers (73.4%). It also made it harder for them to socialize and fit in with peers (58.2% and 49.7%, respectively). Caregiver preparedness and understanding predicted improved psychosocial coping with regard to child stress regarding socialization, fitting in, and anxiety but not sensitivity to peers. Teacher supportiveness and caregiver perception of clinician understanding also correlated with function. Discussion: Findings highlight the importance of caregiver education and preparedness as these reliably predict child psychosocial function and coping as they return to school after a cancer diagnosis and that all children are at risk for psychosocial challenges following a cancer diagnosis. Opportunities exist for clinicians to provide more education and anticipatory guidance to families as a potential means to reduce poor coping when a child returns to school following cancer. [ABSTRACT FROM AUTHOR]

Almost half of the Latino immigrants working in the United States are women. However, studies concerning the work experiences of Latinas are almost absent in the literature. This article reports the findings from a qualitative study using eight focus groups (n = 53) of Latina immigrant workers. The focus group transcripts were analyzed using the grounded theory approach in which themes emerge from iterative readings of the transcripts by a group of investigators. This study identified themes related to excessive workload, familiar work/unfamiliar hazards, cultural tensions, lack of health care, pregnancy, sexual harassment, and family obligations/expectations. The responses of the Latina workers in this study clearly indicated that they live within a complex web of stressors, both as workers and as women. The increased economic opportunities that come with immigration to the United States are accompanied by many opportunities for exploitation, especially if they are undocumented. It is hoped that the findings of this study will raise awareness regarding these issues and spur further work in this area. (Contains 1 table.)

This article presents a review of seven national governments' online collections of adult literacy-related research. This study explored the type of learning associated with official web spaces by asking the following research questions: (1) What kind of research do these governments present on their websites? (2) How is the presentation organized? (3) What opportunities for learning do these spaces provide? Clear differences emerged in the type of research presented and in how it was organized. Sites varied in the way they presented opportunities to learn, which was suggestive of underlying differences in how the research base was being conceptualized.

This article provides a cross-national perspective on successful school principalship in three countries derived from an analysis of case studies in the International Successful School Principalship Project (ISSPP). The ISSPP aims to investigate the characteristics, processes and effects of successful school leadership across eight countries (i.e. Australia, Canada, England, the United States, China, Denmark, Sweden and Norway). Examples from the USA, Norway and China (Shanghai) were selected to illustrate cross-national differences related to the societal purposes of education, the structure and funding of different national educational systems and the influence of particular governmental educational policies (i.e. accountability-oriented policies) on the leadership practices of individual school principals. Variations in selection criteria and research procedures were also noted. Recommendations for further research using a cultural framework include analysing multiethnic schools to identify culturally specific leadership practices as well as developing further ISSPP case studies in non-Western contexts. (Contains 1 note.)

This article draws on findings from a larger international study and the literature to examine successful principals of challenging high-poverty schools in the USA, England, and Australia. Specifically, this article reports case-study findings for 13 challenging schools, 4 each in the USA and Australia and 5 in England. Findings from this study indicate that successful principals used similar leadership practices and traits to make a difference and improve student performance in very challenging schools. These findings extend previous research conducted in single-nation contexts. The presentation of findings also considers differences in the role of the principal, the school context, and larger national policies. The article concludes with implications for leadership training and future research. (Contains 3 tables.)

This article explores how recent federal legislation has increased the extent to which US children's citizenship is dependent upon their parents' citizenship, by contrasting children who are adopted internationally by US citizens and second-generation US children. Two interconnected phenomena are examined: (1) the broader material and theoretical relationships between children's membership in families and the state; and (2) the social, political and economic inequalities that exist between these two groups of child citizens. The article also discusses some practical and theoretical implications of these analyses, regarding the dependence of child citizenship and the multidimensionality of citizenship. (Contains 2 notes.)

Purpose: This study aims to examine seven challenging schools in the US and the practices their principals employed in leading these schools to a measure of success in terms of student performance. Design/methodology/approach: Uses a case study methodology, a two-stage framework is used to analyze the data. First, uses Leithwood and Riehl's three core leadership practices to determine whether these leaders were demonstrating the necessary practices for success, then develops and describes three principles that enabled these leaders to translate their core practices into school success: accountability, caring and learning. Findings: The principals formed a diverse group, varying in gender, race, experience and education. But they shared some common characteristics, most notably, all seven demonstrated facility with the core leadership practices of direction setting, developing people and redesigning the organization. They were leaders who managed to set and maintain a sense of purpose and direction for their schools and generally exerted a positive influence on people's willingness to follow their lead, even in the face of challenging conditions. Originality/value: Provides recommendations for the preparation and practice of school leaders. (Contains 1 table and 5 notes.)

Background: Polypharmacy, using five or more medications, may increase the risk of nonadherence to prescribed treatment. We aimed to identify the interrelationship between trajectories of adherence to antiretroviral therapy (ART) and polypharmacy. Methods: We included women with HIV (aged ≥ 18) enrolled in the Women's Interagency HIV Study in the United States from 2014 to 2019. We used group-based trajectory modeling (GBTM) to identify trajectories of adherence to ART and polypharmacy and the dual GBTM to identify the interrelationship between adherence and polypharmacy. Results: Overall, 1,538 were eligible (median age of 49 years). GBTM analysis revealed five latent trajectories of adherence with 42% of women grouped in the consistently moderate trajectory. GBTM identified four polypharmacy trajectories with 45% categorized in the consistently low group. Conclusions: The joint model did not reveal any interrelationship between ART adherence and polypharmacy trajectories. Future research should consider examining the interrelationship between both variables using objective measures of adherence. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this study were to assess the incidence of vitamin D deficiency in orthopaedic trauma patients, evaluate the safety and efficacy of a vitamin D supplementation protocol, and investigate the utility of vitamin D supplementation in reducing nonunions. Methods: Three hundred seventy patients with operative tibia and/or fibula fractures were retrospectively reviewed. Both overall and matched cohorts were analysed. Results: Ninety-eight per cent (n = 210) were found to have vitamin D insufficiency (serum 25(OH)D level < 30 ng/ml). There were no cases of vitamin D toxicity following vitamin D replacement. Median follow-up vitamin D level was 22.7 ng/mL. No statistical difference between union rates was found between either the two consecutive cohorts or matched cohorts. Conclusion: This vitamin D replacement protocol was a safe treatment for hypovitaminosis D, but post hoc analysis shows there would need to be over 1200 matched patients to achieve adequate power. [ABSTRACT FROM AUTHOR]

The 2022 midterm elections tested both American democracy's resilience and the referendum theory of midterm elections. Democracy met the test better than the theory. For several reasons, Democrats lost far fewer House seats than referendum models predicted given Biden's low approval ratings, inflation, and an unhappy electorate. Trump's meddling in nomination politics on behalf of his big lie and the Court's Dobbs decision put democracy and abortion on the agenda, mobilizing Democrats and redefining what was at stake in the election. The referendum was also blunted by hardened political attitudes that minimized partisan defections and by independents who voted for Democrats despite negative opinions of Biden. Overall voting patterns showed record levels of continuity and cohesion in 2022, reiterating the stark political divisions that have emerged over the past decade. [ABSTRACT FROM AUTHOR]

Background Little is known about inflammation/immune activation during pregnancy in people with HIV (PWH) and growth in their children who are HIV-exposed and uninfected (CHEU). Methods Using data from the Pediatric HIV/AIDS Cohort Study and an HIV-seronegative comparison group, we assessed associations of (1) HIV status, mode of HIV acquisition (perinatally vs nonperinatally acquired), and type of antiretroviral therapy (ART) with inflammation/immune activation in pregnancy; and (2) inflammation/immune activation in pregnancy with growth of CHEU at 12 months. Interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), soluble(s) TNF-α receptor 1 and 2 (sTNFR1, sTNFR2), sCD14, and sCD163 were measured between 13 and 27 weeks' gestation. Linear regression models were fit to estimate differences between groups for each log-transformed biomarker, adjusted for confounders. Results Pregnant PWH (188 total, 39 perinatally acquired, 149 nonperinatally acquired) and 76 HIV-seronegative persons were included. PWH had higher IL-6, sTNFR1, sCD14, and sCD163 and lower sTNFR2 compared to HIV-seronegative persons in adjusted models. Among PWH, sCD163 was higher in those with perinatally versus nonperinatally acquired HIV and on PI-based versus INSTI-based ART. Higher maternal concentrations of IL-6, sTNFR2, and hs-CRP were associated with poorer growth at 12 months. Conclusions Maternal HIV status is associated with a distinct profile of inflammation/immune activation during pregnancy, which may influence child growth. [ABSTRACT FROM AUTHOR]

• National metrics do not include LDL-C measurement as a necessary performance metric. • This clinical perspective reviews history of LDL-C as a quality/performance metric. • Lipid monitoring is essential for assessing lipid-lowering pharmacotherapy. • Evidence favors LDL-C measurement to improve population-wide lipid control. Despite the established role of low-density lipoprotein cholesterol (LDL-C) as a major risk factor for cardiovascular disease (CVD), and the persistence of CVD as the leading cause of morbidity and mortality in the United States, national quality assurance metrics no longer include LDL-C measurement as a required performance metric. This clinical perspective reviews the history of LDL-C as a quality and performance metric and the events that led to its replacement. It also presents patient, healthcare provider, and health system rationales for re-establishing LDL-C measurement as a performance measure to improve cholesterol control in high-risk groups and to stem the rising tide of CVD morbidity and mortality, cardiovascular care disparities, and related healthcare costs. [ABSTRACT FROM AUTHOR]

Non-timber forest products (NTFPs) are derived from natural populations of plants or fungi, or farmed in forests. Harvesters and producers often benefit from NTFPs by selling them to generate income. This article explores research on the producers, production, marketing, and sales of NTFPs in the United States, including the continuum of production from wild-harvesting to forest farming of NTFPs, and their costs and benefits. Specific examples are presented, but the concepts and generalizations are broadly applicable to many NTFPs throughout the U.S. and other parts of the world. Integrating NTFPs into forest management can enhance economic opportunities but also will increase complexity, and will entail balancing multiple and potentially conflicting objectives among a diverse community of stakeholders. We identify information gaps including the need for inventories and yield models of NTFPs, understanding the effect of silvicultural activities on NTFP survival and yield, time series and trends in collection of NTFPs by U.S. households, identification of vulnerable and marginalized communities associated with NTFP harvest, and harvesters' motivations and drivers. [ABSTRACT FROM AUTHOR]