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Rates of adolescent mood disorders and adolescent smartphone use have risen in parallel, leading some to suggest that smartphone use might have detrimental effects on adolescents' moods. Alternatively, it is possible that adolescents turn to smartphone use when experiencing negative mood. Past experimental study suggests that certain smartphone activities can reduce adolescents' negative moods or induce more positive moods, but little is known about the effects of real-world smartphone use, which can involve many different activities. A sample of N = 253 adolescents participated in an Ecological Momentary Assessment (EMA) procedure, which assessed which smartphone activities they were engaged in at random moments throughout the day. This procedure also prompted adolescents to rate their moods before and during smartphone use. Adolescents reported mood improvements during almost all smartphone activities and did not report that moods became more negative during any smartphone activity. Mood improvements were the largest when adolescents said they were listening to music, podcasts, or audiobooks. This may suggest some adolescent smartphone use is driven by a desire to alleviate negative mood. [ABSTRACT FROM AUTHOR]

Introduction: Current research estimates that over 24 million individuals experience human trafficking worldwide. There is a growing prevalence of sex trafficking in the United States. An estimated 87% of trafficked persons visit the emergency department during their captivity. Emergency departments across the United States use differing screening methods for sex trafficking. Current screening tools return a high rate of false negatives, and the appropriate use of tools or standardised lists remains unclear. Aims: To explore best practices for identifying sex trafficking among adults who visit emergency departments. We sought to answer the practice question: How does the implementation of a multifaceted screening model for sex trafficking, versus the use of a list of standardised screening questions, improve the detection of trafficked persons? Methods: We conducted an integrative review of articles published after 2016 in PubMed, CINAHL, Embase, SCOPUS, and Web of Science databases. PRISMA checklist and guidelines were used. Whittemore and Knafl's method was used to review the literature. Results: A final selection of 11 articles were reviewed and appraised using the Johns Hopkins nursing evidence‐based practice model. The synthesis of evidence yielded four themes: (1) Provider and personnel education; (2) Protocol establishment; (3) Legal consultation; and (4) Multidisciplinary teamwork. Conclusion: Through this process, we learned the importance of using multifaceted screening tools for identifying persons who are experiencing sex trafficking. In addition to using multifaceted screening tools, detection is improved when all emergency department personnel receive training on sex trafficking. There is a recognised lack of education on sex trafficking recognition nationwide. Relevance to Clinical Practice: Notably, emergency department nurses play an essential role in sex trafficking identification due to their maximised interaction with patients and the increased perception of trust that patients have with nurses. Steps include the development of an education program to improve recognition. No Patient or Public Contribution: There was no patient or public involvement in the design or drafting of this integrative review. [ABSTRACT FROM AUTHOR]

Background Antibiotic stewardship in the pretravel care of older adults is important to effectively treat infections while minimizing harm from side effects and unnecessary antibiotic use. The objective of this study was to compare the characteristics, risk behaviors, infectious diseases, and antibiotic use between older (≥60 years) and younger (18–59 years) travelers. Methods TravMil is a prospective, observational cohort of United States (US) Department of Defense beneficiaries traveling outside the continental US for ≤6.5 months. For this analysis, we included adults enrolled pretravel between January 2010 and August 2018 and excluded active duty personnel on deployment. Pre and post-travel surveys captured trip characteristics, exposures, illnesses, and antibiotic use. Results A total of 1742 travelers were analyzed: 747 (42.9%) were aged ≥60 years and 995 (57.1%) were aged 18–59 years. Older travelers were less likely to engage in high-risk dietary behaviors and experience travelers' diarrhea than younger travelers (18.2% vs 22.9%; P  < .05). Influenza-like illness (12.5%) and febrile illness (3.4%) occurred less frequently in the older cohort. Antibiotic use for self-treatment was common in both age groups (25.7% vs 26.7%) and often inappropriate, for example, for treatment of occasional loose stool or mild travelers' diarrhea (67.0% [67/100] in older adults vs 57.6% [83/144] in younger adults; P  < .05), and influenza-like illness (63.4% [64/101] vs 58.6% [68/116], respectively; P  < .05). Conclusions Older travelers were less likely to engage in high-risk behaviors and experience travelers' diarrhea, and both age groups experienced mild, self-limited infections. Inappropriate use of antibiotics was common, suggesting that antimicrobial stewardship should be emphasized at pretravel counseling with international travelers. [ABSTRACT FROM AUTHOR]

Objective: To identify subgroups of U.S. children with special health care needs (CSHCN) and characterize key outcomes.Data Source: Secondary analysis of 2009-2010 National Survey of CSHCN.Study Design: Latent class analysis grouped individuals into substantively meaningful classes empirically derived from measures of pediatric medical complexity. Outcomes were compared among latent classes with weighted logistic or negative binomial regression.Principal Findings: LCA identified four unique CSHCN subgroups: broad functional impairment (physical, cognitive, and mental health) with extensive health care (Class 1), broad functional impairment alone (Class 2), predominant physical impairment requiring family-delivered care (Class 3), and physical impairment alone (Class 4). CSHCN from Class 1 had the highest ED visit rates (IRR 3.3, p < .001) and hospitalization odds (AOR: 12.0, p < .001) and lowest odds of a medical home (AOR: 0.17, p < .001). CSHCN in Class 3, despite experiencing more shared decision making and medical home attributes, had more ED visits and missed school than CSHCN in Class 2 (p < .001); the latter, however, experienced more cost-related difficulties, care delays, and parents having to stop work (p < .001).Conclusions: Recognizing distinct impacts of cognitive and mental health impairments and health care delivery needs on CSHCN outcomes may better direct future intervention efforts. [ABSTRACT FROM AUTHOR]

Background RO4929097 is an oral inhibitor of γ -secretase that results in Notch signaling inhibition. Prior work has demonstrated that Notch signaling inhibition enhances chemotherapy sensitivity of cancer cells. This phase I study was conducted to determine maximum tolerated dose (MTD), toxicities and efficacy of RO4929097 and capecitabine in advanced solid tumors. Methods Patients with refractory solid tumors received capecitabine at a fixed dose of 1,000 mg/m twice daily with escalating doses of RO4929097 on a 21-day cycle in a 3 + 3 design. Capecitabine was administered for 14 days and the RO49029097 once daily, 3 days per week, both for a 21 day cycle. Results Thirty patients were treated on six dose levels (20 to 150 mg). The maximally tolerated dose was not reached. One dose limiting toxicity was observed at each level 3 through 6 (hypophosphatemia, fatigue, and nausea/vomiting). Three confirmed partial responses were observed: two patients with fluoropyrimide-refractory colon cancer and one patient with cervical cancer. Autoinduction of RO4929097 was demonstrated with increasing dose levels and duration. Conclusions The recommended phase 2 dose is capecitabine 1,000 mg/m orally twice daily on days 1 through 14 with RO4929097 20 mg orally once daily on days 1-3, 8-10 and 15-17 with a 21 day cycle. Clinical benefit was observed in cervical and colon cancer. Autoinduction of RO4929097 was seen both with increasing cycle number and increasing dose. Plasma concentrations of RO4929097 were above those needed for Notch inhibition. [ABSTRACT FROM AUTHOR]

Details a study which examined the prevalence of nosocomial klebsiella infections at the Veterans Administration Hospital in Denver, Colorado. Incidence of nosocomial klebsiella infections; Methodology; Information on multidrug-resistant klebsiella; Factors responsible for perpetuating the gastrointestinal reservoir of klebsiella.

Purpose: Standardized tests are one of the primary assessment tools used by speech-language pathologists (SLPs) to diagnose child language impairment. Numerous child language tests are commercially available; however, it is unknown what factors lead clinicians to select particular tests to use in clinical practice. This study investigated whether the quality of standardized tests, as measured by the test's psychometric properties, is related to how frequently the tests are used in clinical practice. Method: A total of 364 SLPs completed a survey regarding how frequently they used specific standardized tests when diagnosing suspected specific language impairment (SLI). The test manuals for 55 tests were reviewed to determine whether test characteristics, such as test reliability, validity, and accuracy, correlated with the frequency of test use. Results: The most frequently used standardized tests were omnibus measures (e.g., Clinical Evaluation of Language Fundamentals--Fourth Edition [Semel, Wiig, & Secord, 2003], Preschool Language Scale, Fourth Edition [Zimmerman, Steiner, & Pond, 2002]) and single-word vocabulary measures (e.g., Peabody Picture Vocabulary Test, Fourth Edition [Dunn & Dunn, 2007]). Publication year was the only test characteristic that correlated significantly with the frequency of test use. Conclusion: The quality of a standardized test, as measured by the test's psychometric properties, does not appear to influence how frequently a test is used. These results highlight the need for increased evidence-based practice when diagnosing children with language impairment. [ABSTRACT FROM AUTHOR]

Focuses on the 1970 International Conference on Nosocomial Infections in Atlanta, Georgia. Infancy of the hospital infection 'movement'; Minimal standards of the U.S. Joint Commission on Accreditation of Hospitals; Lack of knowledge of infection control in patient care practices; Recognition of associations of particular pathogens with particular diseases of immunologic conditions.

Editorial. Explores the efficacy of pneumococcal pneumonia vaccine in the U.S. Results of field trials; Approach in measuring vaccine efficacy; Recommendations on the use of pneumococcal vaccine.

The article discusses the results of a clinical study in the U.S. that examined the efficacy of using continuous subcutaneous insulin infusion (CSII) in meeting A1C goal in children. Several advantages of CSII over multiple daily injections are cited including increased lifestyle flexibility and decreased hypoglycemia. Among the clinical data evaluated were age, duration of diabetes and duration of CSII use.

• NVX-CoV2373 manufacturing lots are consistently immunogenic and well-tolerated. • NVX-CoV2373 can be used as a first booster dose or a later booster dose. • NVX-CoV2373 is also immunogenic against Omicron BA.1/BA.5 SARS-CoV-2 variants. To combat the SARS-CoV-2 pandemic, multiple vaccines using different manufacturing platforms have been developed, including NVX-CoV2373 (an adjuvanted recombinant protein vaccine). As SARS-CoV-2 variants have emerged, some of which evade vaccine-induced immunity, introduction of vaccine booster doses has become critical. Employing different vaccine types for primary series vaccination and boosting could expand vaccine coverage and access. This study assessed whether NVX-CoV2373 would induce robust responses when used as a booster. The 2019nCoV-307 study was a phase 3, randomized, observer-blinded trial evaluating immunogenicity and safety of NVX-CoV2373 in previously vaccinated adults aged 18–49 years in the United States (NCT05463068). Participants were randomized 1:1:1 to receive one intramuscular injection of NVX-CoV2373 from one of three different manufacturing lots. Immunogenicity was assessed by immunoglobulin G (IgG) and neutralizing antibodies (NAb). These responses were compared for the three lots, and for participants with primary series with or without a prior booster dose of the mRNA-1273, BNT162b2, Ad26.COV2.S, or NVX-CoV2373 COVID-19 vaccines. A total of 911 participants were randomized between July 11 and 13, 2022, with 905 being assessed for safety and 848 for immunogenicity. Immunogenicity of NVX-CoV2373 met prespecified equivalence criteria between lots, and the booster dose was well-tolerated. NVX-CoV2373 induced robust IgG and NAb responses when used as a first or later booster dose, regardless of primary series vaccine type. Seroconversion rates were also similar across previous vaccine types. Induced antibodies were strongly reactive, even to the immune-evasive Omicron BA.1 and BA.5 variants. NVX-CoV2373 showed consistent immunogenicity between lots, with no new safety signals identified. Use of NVX-CoV2373 as a booster dose (first or later) is supported. [ABSTRACT FROM AUTHOR]

Context: A movement exists within the Veterans Health Administration (VHA) toward incorporating complementary and alternative medicine (CAM) as an integrative complement to care for veterans. The Integrative Health and Wellness (IHW) Program is a comprehensive CAM clinic offering services such as integrative restoration (iRest) yoga nidra, individual acupuncture, group auricular acupuncture, chair yoga, qigong, and integrative health education.Objectives: The current study intended to detail the development of the CAM program, its use, and the characteristics of the program's participants.Design: Using a prospective cohort design, this pilot study tracked service use and aspects of physical and mental health for veterans enrolled in the program.Participants: During the first year, the IHW Program received 740 consults from hospital clinics; 325 veterans enrolled in the program; and 226 veterans consented to participate in the pilot study.Outcome Measures: Outcome measures included data from self-report questionnaires and electronic medical records.Results: Veterans enrolled in the program reported clinically significant depression, stress, insomnia, and pain-related interference in daily activities and deficits in health-related quality of life. Regarding use of the program services, individual acupuncture showed the greatest participation by veterans, followed by group auricular acupuncture and iRest yoga nidra. Of the 226 veterans who enrolled in the program and consented to participate in this study, 165 (73.01%) participated in >1 services in the first year of programming. Broadly speaking, enrollment in services appeared to be associated with gender and service branch but not with age or symptom severity.Conclusions: Results have assisted with a strategic planning process for the IHW Program and have implications for expansion of CAM services within the VHA. [ABSTRACT FROM AUTHOR]

With levelized electricity costs (LEC) of 10–12 USCts/kWh the well-known SEGS (Solar Electric Generating Systems) plants in California are presently the most successful solar technology for electricity generation [Price and Cable (2001) Proc. ASME Int. Solar Energy Conf. Forum 2001]. The SEGS plants apply a two-circuit system, consisting of the collector circuit and the Rankine cycle of the power block. These two-circuits are connected via a heat exchanger. In the case of the Direct Steam Generation (DSG) in the collector field [Zarza et al. (2001) Proc. Solar Forum 2001, Washington], the two-circuit system turns into a single-circuit system, where the collector field is directly coupled to the power block. This renders a lower investment and higher process temperatures resulting in a higher system efficiency. Due to the lower investment and the higher efficiency a reduction of the LEC of 10% is expected when the DSG process is combined with improved components of the solar collectors [Zarza (2002) DISS Phase II Final Report, EU Contract No. JOR3-CT98-0277]. Within the European DISS (Direct Solar Steam) project the feasibility of the direct steam generation has been proven in more than 3700 operation hours. Steam conditions of 100 bar and 400 °C have been demonstrated. This paper presents the main scientific results of the DISS project that aims at the investigation and demonstration of the DSG process in parabolic troughs under real solar conditions. [Copyright &y& Elsevier]

Introduction: Despite advances in the care of patients with cancer over the last 10 years, cancer remains the second leading cause of death in the United States. Many patients receive aggressive, in-hospital end-of-life care at high cost. There are few data on outcomes after unplanned hospitalization of patients with metastatic cancer. Methods: In 2000 and 2010, data were collected on admissions, interventions, and survival for patients admitted to an academic inpatient medical oncology service. Results: The 2000 survey included 191 admissions of 151 unique patients. The 2010 survey assessed 149 admissions of 119 patients. Lung, GI, and breast cancers were the most common cancer diagnoses. In the 2010 assessment, pain was the most common chief complaint, accounting for 28%. Although symptoms were the dominant reason for admission in 2010, procedures and imaging were common in both surveys. The median survival of patients after discharge was 4.7 months in 2000 and 3.4 months in 2010. Despite poor survival in this patient population, hospice was recommended in only 23% and 24% of patients in 2000 and 2010, respectively. Seventy percent of patients were discharged home without additional services. Conclusion: On the basis of our data, an unscheduled hospitalization for a patient with advanced cancer strongly predicts a median survival of fewer than 6 months. We believe that hospital admission represents an opportunity to commence and/or consolidate appropriate palliative care services and end-of-life care. [ABSTRACT FROM AUTHOR]

Examines the use of solar thermal power plants with direct solar steam (DISS) in parabolic trough collectors in California. Division of the collector row; Operating modes of the DISS; Advantages of the direct steam process.

Conflicting guidelines regarding universal pediatric cholesterol screening were released between 2011 and 2019, but the impact on screening rates remains understudied. The purpose of this study was to examine trends in pediatric cholesterol screening rates within a single institution in the United States and their association with release of national guidelines, local educational tools, and electronic health record (EHR) modifications. Order placement was defined as ordering a high-density lipoprotein cholesterol level in a patient aged 9-21 years with ≥1 well visit in prior 3 years. Order placement rate (OPR) was calculated per month using 3 months' moving average smoothing and analyzed based on date, patient age, and specialty of ordering clinician. Timing of educational tools, EHR modifications, and national guideline release were analyzed for changes in OPR. Prior to release of 2011 guidelines recommending universal pediatric cholesterol screening, pediatrician OPR was 35% (95% CI: 29-43%) compared to 8% (7-11%) for family physicians. For both specialties, OPR increased after 2011 guidelines, educational initiatives, and EHR changes, but decreased after 2016, with a larger decrease for family physicians (p < 0.001 for all). OPR was consistently higher for pediatricians than for family physicians during the study period, with largest OPR changes correlating with release of guidelines. The findings from the study suggest that conflicting guidelines may contribute to lower overall OPR, and to different screening rates for children cared for by pediatricians compared to family physicians. [ABSTRACT FROM AUTHOR]

Background and Aim: In the fall of 2013, the US Centers for Disease Control and Prevention (CDC) published a preliminary report on a cluster of liver disease cases that emerged in Hawaii in the summer 2013. This report claimed a temporal association as sufficient evidence that OxyELITE Pro (OEP), a dietary supplement (DS) mainly for weight loss, was the cause of this mysterious cluster. However, the presented data were inconsistent and required a thorough reanalysis., Material and Methods: To further investigate the cause(s) of this cluster, we critically evaluated redacted raw clinical data of the cluster patients, as the CDC report received tremendous publicity in local and nationwide newspapers and television. This attention put regulators and physicians from the medical center in Honolulu that reported the cluster, under enormous pressure to succeed, risking biased evaluations and hasty conclusions., Results: We noted pervasive bias in the documentation, conclusions, and public statements, also poor quality of case management. Among the cases we reviewed, many causes unrelated to any DS were evident, including decompensated liver cirrhosis, acute liver failure by acetaminophen overdose, acute cholecystitis with gallstones, resolving acute hepatitis B, acute HSV and VZV hepatitis, hepatitis E suspected after consumption of wild hog meat, and hepatotoxicity by acetaminophen or ibuprofen. Causality assessments based on the updated CIOMS scale confirmed the lack of evidence for any DS including OEP as culprit for the cluster., Conclusions: Thus, the Hawaii liver disease cluster is now best explained by various liver diseases rather than any DS, including OEP.