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Assessment is a central feature of teaching and learning. It is both complex and challenging in ordinary times, and these aspects are magnified in an online learning environment. Given its central role, it is crucial that its design and purpose is rigorous and robust. This paper presents justification for using interactive oral assessment as an online, innovative, authentic assessment approach that prepares students for professional life, combats plagiarism and promotes academic integrity. It shares findings through four brief case study examples of using interactive oral assessments in computing, education, French literature, and aviation. This study also demonstrates the value of a Community of Practice in developing expertise, confidence, and resources to support the effective application of interactive oral assessment.

Objectives: To describe nursing home (NH) characteristics associated with antipsychotic use and test whether associations changed after implementation of the National Partnership to Improve Dementia Care's antipsychotic reduction initiative (ARI). Methods: Longitudinal quasi-experimental design using data from multiple sources and piecewise linear mixed models were used for statistical analyses. Results: There was a significant decrease in monthly antipsychotic use across the study period (pre-ARI b = −0.0003, p <.001; post-ARI b = −0.0012, p <.001), which held after adjusting for NH characteristics. Registered nurse hours (b = −0.0026, p <.001), licensed practical nurse hours (b = −0.0019, p <.001), facility chain membership (b = −0.0013, p <.01), and health inspection ratings (b = −0.0003, p >.01) were associated with decreased antipsychotic use. Post-ARI changes in associations between NH characteristics and antipsychotic use were small and not statistically significant. Conclusions: Decreases in antipsychotic use were associated with most NH characteristics, and associations persisted post-ARI. Further research is warranted to examine the interactions between ARI policy and NH characteristics on antipsychotic prescribing, as well as other NH factors, such as facility prescribing cultures and clinical specialty of staff. Clinical Implications: Decreases in monthly antipsychotic use were observed following the ARI. The decreases in monthly antipsychotic use were associated with most NH characteristics, and these associations persisted during the post-ARI period. [ABSTRACT FROM AUTHOR]

Across the globe, students with disabilities have been increasing in prevalence in higher education settings. In the twenty-first century the struggle to include individuals with disabilities into nursing schools and workplaces continues in different parts of the world. Historically, entry criteria in nursing schools have been based on essential functions, which were primarily designed to be used in the workforce, rather than technical standards for education. In other health professions, such as medicine, this is not necessarily the case. For example, the American Association of Medical Colleges has worked over the past two decades to develop appreciation among medical schools for the need to admit and accommodate students with disabilities. We argue that nursing has not followed suit. This paper presents an integrative literature review, consisting of material from the United States, Ireland, United Kingdom, and Australia, investigating compelling stories, legal mandates, websites, and extant literature looking at essential functions or technical standards as entry criteria for nursing schools. The results show that, when essential functions for employment are used in nursing education, they may be a barrier to entry into that program. The paper concludes with recommendations for well-defined technical standards for nursing schools to be used primarily as entry criteria.

The article argues that health equity requires working toward antiracist local public health departments (LHD). It explains the role of LHDs in antiracist capacity building to earn public trust where there is race discrimination in the health infrastructure. It proposes the disruption of structural racism and racial health inequities by engaging LHDs in advocacy efforts, cross-sector collaborations and community-based partnerships, and providing services in racially marginalized communities.

Background: Posttraumatic osteoarthritis (PTOA) arises secondarily to joint trauma and is driven by catabolic inflammatory pathways. Alpha-2-macroglobulin (α2M) is a naturally occurring proteinase inhibitor found in human serum and synovial fluid that binds proteases as well as proinflammatory cytokines involved in the pathogenesis of PTOA. Purpose: (1) To investigate the therapeutic potential of intra-articular α2M injections during the acute stages of PTOA by inhibiting inflammatory pathways driven by the cytokines expressed by the synovium in a large preclinical Yucatan minipig model and (2) to determine if 3 intra-articular α2M injections have greater chondroprotective effects compared with 1 intra-articular injection. Study Design: Controlled laboratory study. Methods: A total of 48 Yucatan minipigs were randomized into 4 groups (n = 12 each): (1) modified intra-articular drilling (mIAD) and saline (mIAD + saline), (2) mIAD and 1 intra-articular α2M injection (mIAD +α2M-1), (3) mIAD and 3 α2M injections (mIAD +α2M-3), and (4) sham control. Surgical hindlimbs were harvested at 15 weeks after surgery. Cartilage degeneration, synovial changes, inflammatory gene expression, and matrix metalloproteinase levels were evaluated. Gait asymmetry was measured before and after surgery using a pressure-sensing walkway system. Results: Macroscopic lesion areas and microscopic cartilage degeneration scores were lower in the mIAD +α2M-1 and mIAD +α2M-3 groups compared with the mIAD + saline group (P <.05) and similar to those in the sham group (P >.05). Synovial membrane scores of the mIAD +α2M-1 and mIAD +α2M-3 groups were lower than that of the mIAD + saline group (P <.05) and higher than that of the sham group (P <.05). Interleukin-1 beta, nuclear factor kappa B, and tumor necrosis factor alpha mRNA expression in the synovium and matrix metalloproteinase-1 levels in synovial fluid were significantly lower in the mIAD +α2M-1 and mIAD +α2M-3 groups compared with the mIAD + saline group (P <.05). No significant differences were observed between the mIAD +α2M-1 and mIAD +α2M-3 groups for all measured outcomes. There were early changes in gait (P <.05) between preoperative and postoperative time points for the mIAD + saline, mIAD +α2M-1, and mIAD +α2M-3 groups that normalized by 15 weeks. Conclusion: Animals receiving early α2M treatment exhibited less cartilage damage, milder synovitis, and lower inflammation compared with animals with no α2M treatment. These results exemplify the early anti-inflammatory effects of α2M and provide evidence that intra-articular α2M injections may slow the progression of PTOA. Clinical Relevance: In patients presenting with an acute joint injury, an early intervention with α2M may have the potential to reduce cartilage degeneration from catabolic pathways and delay the development of PTOA. [ABSTRACT FROM AUTHOR]

Subjective well-being influences mental and physical health. Fortunately, interventions exist to improve people's subjective well-being. Emotion regulation and self-compassion are two transdiagnostic factors that impact mental health and have been separately shown to be associated with subjective well-being. However, their combined relationship with subjective well-being has not yet been examined. To address this gap, the current novel study aimed to determine if there is a combined relationship between self-compassion, emotion regulation, and dimensions of subjective well-being cross-sectionally in adults living in the United States. Participants (n = 559; 50% female; M age = 57.70 years) completed an online survey via Prime Panels from CloudResearch, capturing their responses on the interested constructs. Analyses showed that emotion regulation significantly mediated the relationships between self-compassion and various subjective well-being dimensions, specifically, positive affect (d = 0.32), negative affect (d = 1.17), and eudemonic well-being (d = 0.79). Our findings have both clinical and research implications. [ABSTRACT FROM AUTHOR]

Foundation models are transforming artificial intelligence (AI) in healthcare by providing modular components adaptable for various downstream tasks, making AI development more scalable and cost-effective. Foundation models for structured electronic health records (EHR), trained on coded medical records from millions of patients, demonstrated benefits including increased performance with fewer training labels, and improved robustness to distribution shifts. However, questions remain on the feasibility of sharing these models across hospitals and their performance in local tasks. This multi-center study examined the adaptability of a publicly accessible structured EHR foundation model (FMSM), trained on 2.57 M patient records from Stanford Medicine. Experiments used EHR data from The Hospital for Sick Children (SickKids) and Medical Information Mart for Intensive Care (MIMIC-IV). We assessed both adaptability via continued pretraining on local data, and task adaptability compared to baselines of locally training models from scratch, including a local foundation model. Evaluations on 8 clinical prediction tasks showed that adapting the off-the-shelf FMSM matched the performance of gradient boosting machines (GBM) locally trained on all data while providing a 13% improvement in settings with few task-specific training labels. Continued pretraining on local data showed FMSM required fewer than 1% of training examples to match the fully trained GBM's performance, and was 60 to 90% more sample-efficient than training local foundation models from scratch. Our findings demonstrate that adapting EHR foundation models across hospitals provides improved prediction performance at less cost, underscoring the utility of base foundation models as modular components to streamline the development of healthcare AI. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, nurses have faced innumerable challenges, which have contributed to staggering increases in burnout rates. In the health care arena, burnout has been associated with the onset or exacerbation of physical illness, neglect of self-care, fatigue, decreased patient satisfaction, higher medication error rates, lack of nurse engagement, and increased nurse turnover. Purpose: This cross-sectional study sought to determine whether a correlation exists between self-reported physical activity and nurses' perception of burnout in a sample of hospital RNs. The secondary aim was to determine whether a correlation exists between the level of perceived burnout and the number of medication errors or near misses. Methods: Participants were asked to provide demographic information, complete the Copenhagen Burnout Inventory (CBI) and the Godin Leisure-Time Exercise Questionnaire (GLTEQ), and self-report the number of medication errors or near misses they were involved in during the previous 12 months. Data were analyzed using Stata version 17 software. Results: A total of 216 participants returned usable surveys. Regarding the relationship between burnout and physical activity levels, data analysis was performed for the 210 participants who completed both the CBI and the GLTEQ. Compared with the least physically active nurses, the most active nurses had significantly lower CBI scores, with 68.5% of those reporting low or no burnout also scoring 24 or more on the GLTEQ. The least physically active nurses had significantly higher CBI scores, with 47.6% of those reporting high burnout also scoring 13 or less on the GLTEQ. Moreover, 90% of the nurses with high burnout levels had directly cared for COVID-19 patients at some point between 2020 and 2022. Medical–surgical nurses experienced significantly higher levels of burnout compared with nurses working in other service areas. No significant relationship was found between the number of medication errors or near misses and burnout levels. Conclusions: This study found that the most physically active nurses reported lower levels of burnout, while the highest levels of burnout were found in the least active nurses. Although COVID-19 infection rates have eased, many nurses, particularly those who have cared for COVID-19 patients and those who work in medical–surgical environments, continue to experience burnout. Targeted programs to reduce work-related burnout, as well as organizational sponsorship of and unit-level support for such programs, are urgently needed. This study's findings suggest that promotion of physical activity may be an essential component to alleviating burnout. This cross-sectional study sought to determine whether a correlation exists between self-reported physical activity levels and nurses' perception of burnout in a sample of hospital RNs. [ABSTRACT FROM AUTHOR]

This article is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee and provides educators recommendations for optimizing inclusive education for our students with disabilities. Medical educators are increasingly encountering students with disabilities and have the responsibility of ensuring requirements are met. Medical education committee members from the US and Canada reviewed the literature on disabilities in medical student education to identify best practices and key discussion points. An iterative review process was used to determine the contents of an informative paper. Medical schools are required to develop technical standards for admission, retention, and graduation of their students to practice medicine safely and effectively with reasonable accommodation. A review of the literature and obstetrics and gynecology expert opinion formed a practical list of accommodation strategies and administrative steps to assist educators and students. Medical schools must support the inclusion of students with disabilities. We recommend a collaborative approach to the interactive process of determining reasonable and effective accommodations that includes the students, a disability resource professional and faculty as needed. Recruiting and supporting medical students with a disability strengthens the diversity commitment and creates a more inclusive workforce. Medical School Education Medical schools have the responsibility to train a diverse physician workforce including those with disabilities. The integration of students with disabilities is important and should be done in a structured and timely manner that maximizes the individual's abilities and incorporates reasonable accommodations in the clinical learning environment. Though the definition of disability traverses a wide variety of diagnoses, this review highlights sensory and physical disabilities and the various accommodations to facilitate access and successful completion of required objectives. [ABSTRACT FROM AUTHOR]

Background: In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States. Methods: A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis. Conclusions: These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.) [ABSTRACT FROM AUTHOR]

BACKGROUND: The Rehabilitation Act, as amended in the Workforce Innovation and Opportunity Act of 2014 (WIOA), highlights the need to improve outcomes for transition-age students and youth with disabilities. The amendments require state vocational rehabilitation agencies to allocate 15% of their federal funding to provide pre-employment transition services (Pre-ETS) to an expanded population of transition-age students and youth with disabilities. Rapid implementation of this mandate required state vocational rehabilitation agencies to begin offering the five required Pre-ETS before mechanisms for monitoring and improvement could be created and field-tested. Nearly a decade since the passage of WIOA, many states are still without practical mechanisms for evaluating Pre-ETS despite increasing emphasis on using evidence-based practices in public programs. OBJECTIVE: The objective of this article is to present insights from the systematic implementation of The Transition Readiness Toolkit (TRT) within a state vocational rehabilitation agency. METHODS: We detail the creation of the TRT, our approach for implementing it across multiple states, and how it supports data-driven decision making for Pre-ETS providers and agencies. RESULTS: Initial results of implementation are promising. State VR agencies and Pre-ETS providers are using the data to increase accountability and understand the impact of their services. CONCLUSION: We present reflections on use of the TRT in a state agency and implications from an evidenced-based policy framework. [ABSTRACT FROM AUTHOR]

Introduction: Migraines are the leading cause of disability in the United States, and the use of non-pharmaceutical treatments like osteopathic manipulative treatment (OMT) has shown promise. Despite its potential, the lack of mechanistic understanding has hindered widespread adoption. This study aims to investigate the efficacy of OMT in treating acute migraines and unravel its underlying mechanisms of action. Methods: Female rats were subjected to a "two-hit" approach to induce migrainelike pain. This involved bilateral injections of Complete Freund's Adjuvant (CFA) into the trapezius muscle (1st hit) followed by exposure to Umbellulone, a human migraine trigger, on Day 6 post-CFA (2nd hit). Soft tissue and articulatory techniques were applied to the cervical region for acute abortive or repeated prophylactic treatment. Cutaneous allodynia and trigeminal system activation were assessed through behavioral tests and immunohistochemical staining. Results: Following Umbellulone inhalation, CFA-primed rats exhibited periorbital and hind paw allodynia. Immediate application of OMT after Umbellulone inhalation as an abortive treatment partially alleviated cutaneous allodynia. With OMT applied thrice as a prophylactic measure, complete suppression of tactile hypersensitivity was observed. Prophylactic OMT also prevented the increase of c-fos signals in the trigeminal nucleus caudalis and the elevation of calcitonin gene-related peptide expression in trigeminal ganglia induced by CFA and Umbellulone exposure at 2 h post-inhalation. Discussion: These findings providemechanistic insights intoOMT'smigraine-relief potential and underscore its viability as a non-pharmacological avenue for managing migraines. [ABSTRACT FROM AUTHOR]

On September 12, 2023, CDC's Advisory Committee on Immunization Practices recommended updated 2023-2024 (updated) COVID-19 vaccination with a monovalent XBB.1.5-derived vaccine for all persons aged ≥6 months to prevent COVID-19, including severe disease. During fall 2023, XBB lineages co-circulated with JN.1, an Omicron BA.2.86 lineage that emerged in September 2023. These variants have amino acid substitutions that might increase escape from neutralizing antibodies. XBB lineages predominated through December 2023, when JN.1 became predominant in the United States. Reduction or failure of spike gene (S-gene) amplification (i.e., S-gene target failure [SGTF]) in real-time reverse transcription-polymerase chain reaction testing is a time-dependent, proxy indicator of JN.1 infection. Data from the Increasing Community Access to Testing SARS-CoV-2 pharmacy testing program were analyzed to estimate updated COVID-19 vaccine effectiveness (VE) (i.e., receipt versus no receipt of updated vaccination) against symptomatic SARS-CoV-2 infection, including by SGTF result. Among 9,222 total eligible tests, overall VE among adults aged ≥18 years was 54% (95% CI = 46%-60%) at a median of 52 days after vaccination. Among 2,199 tests performed at a laboratory with SGTF testing, VE 60-119 days after vaccination was 49% (95% CI = 19%-68%) among tests exhibiting SGTF and 60% (95% CI = 35%-75%) among tests without SGTF. Updated COVID-19 vaccines provide protection against symptomatic infection, including against currently circulating lineages. CDC will continue monitoring VE, including for expected waning and against severe disease. All persons aged ≥6 months should receive an updated COVID-19 vaccine dose. [ABSTRACT FROM AUTHOR]

Objectives: To assess the gender composition of upper-level specialty-specific editor positions among United States (U.S.) medical society-affiliated journals and to evaluate the equitable inclusion of women and women physicians. Materials and Methods: The gender composition of upper-level (e.g., editor-in-chief, deputy) specialty-specific editor positions among 39 U.S. medical society-affiliated journals as of January 5, 2023, was analyzed. Editor positions below the level of associate editor were excluded. Parity (50:50 representation) and equity (compared with the proportion of practicing physicians in each medical specialty) benchmarks were utilized to determine if women are underrepresented in editor positions. Results: A total of 862 editor positions among 39 journals were assessed. Women held 32.9% (284/862) of positions (95% confidence interval [CI]: 29.9%–36.2%), significantly less than expected based on the U.S. population (p < 0.001). Physicians comprised 90.8% (783/862) of positions, of whom 30.4% (238/783) were women physicians (95% CI: 27.3%–33.7%), significantly less than expected (p < 0.001). Thirty-three (84.6%, 95% CI: 70.3%–92.8%) journals were below parity for women overall, whereas 34 (87.2%, 95% CI: 73.3%–94.4%) were below parity for women physicians. Fourteen (35.9%, 95% CI: 22.7%–51.6%) journals were below equity for women physicians. Notably, 13 (33.3%, 95% CI: 20.6%–49.0%) journals were below both parity and equity for women overall and women physicians. Conclusions: This study reveals mixed results in the equitable inclusion of women in editor positions of journals affiliated with U.S. medical societies. Despite the equitable inclusion of women in editorial roles being a remediable issue, approximately one third of journals affiliated with major U.S. medical societies remain inequitable. [ABSTRACT FROM AUTHOR]

Burn injuries affect more than 500,000 people per year in the United States but no previous studies have looked at the impact on the healthcare system. Several prior studies have shown decreased unplanned healthcare utilization after acute care discharge and increased healthcare costs for patients who have undergone burn injury grafting. This study describes postacute care hospitalization healthcare use in burn patients. A retrospective commercial claims database review was performed utilizing Truven MarketScan (MS) database. In a 10-year MS sample, 23,262 patients with burn injuries were identified and matched to a control population in a 1:1 ratio based on age, sex, and total time in the MS database. Pre- and postburn utilization of therapy, emergency department, nutritional support, psychiatry/psychology, home health, skilled nursing facility, inpatient, and outpatient visits were recorded. For controls, pre- and postburn periods were defined using the burn event date of the matched case adjusted by the pair's relative difference in enrollment into the MS database. A series of negative binomial regressions were completed to evaluate the data. For every outcome, except skilled nursing facility, healthcare utilization was greater in the preinjury burn group relative to controls. Healthcare utilization for the burn cohort postinjury was greater for every outcome compared to controls and remained higher for at least 25-month postinjury and did not return to preinjury levels during this time frame. Relatively higher healthcare utilization prior to injury in burn patients may indicate an important difference in baseline health, and an opportunity for injury prevention. [ABSTRACT FROM AUTHOR]

Background: Through the Children's Food and Beverage Advertising Initiative (CFBAI), U.S. food companies pledge to only advertise healthier products in children's television (TV) programming, but previous research shows that highly advertised products do not qualify as nutritious according to independent nutrition criteria. In 2020, the CFBAI implemented stricter nutrition criteria for products that may be advertised to children, but the potential impact of these changes has not been assessed. This observational study evaluates (1) improvements in energy and individual nutrient composition of products that companies indicated may be advertised to children (i.e., CFBAI-listed products) in 2020 versus 2017, (2) amount of advertising on children's TV for CFBAI-listed versus other products in 2021, and 3) the nutrition quality of advertised versus non-advertised CFBAI-listed products. Methods: Data include energy, saturated fat, sodium, and sugar content and overall nutrition quality (Nutrition Profile Index [NPI] scores) of CFBAI-listed products in 2017 (n = 308) and 2020 (n = 245). Nielsen data provided total ad spending and children's exposure to ads on children's TV channels for all foods and beverages in 2021. Results: From 2017 to 2021, energy, saturated fat and sugar declined for CFBAI-listed products in three of six food categories (yogurt, sweet and salty snacks). Although CFBAI-listed products accounted for 79% of food ads viewed by children on children's TV channels, just 50% of CFBAI-listed food and 36% of drink brands were advertised on children's TV. Moreover, advertised products were significantly less nutritious than non-advertised CFBAI-listed products. Conclusion: Despite revised nutrition standards and improvements in nutrient content of some product categories, participating companies continued to primarily advertise nutritionally poor food and beverages on children's TV. CFBAI companies have not delivered on their promises to advertise healthier products to children. [ABSTRACT FROM AUTHOR]

Divisive social rhetoric and prevalent racism make the need for infusing social justice throughout counselor education even more urgent than the decades-long calls for it. There is a dearth of empirical inquiry into the ways social justice concepts are enacted across rehabilitation counseling curricula. The current study used an exploratory survey to collect information about the techniques used by U.S. rehabilitation counselor educators (N = 71) to infuse social justice across all of their courses, including their pedagogical choices, rates of frequency for updating coursework, and professional development choices. Findings reveal that educators have favorable attitudes about social justice, are more likely to use academic journals and related disciplines in course development, and are more likely to use self-reflection and intuition-based opportunities for social justice professional development. Implications of the findings also include relevancy for supervisors and practitioners, who have the responsibility to and lead social justice education once trainees have entered the field as professionals. [ABSTRACT FROM AUTHOR]

We applied a structural intersectionality approach to cross-sectionally examine the relationships between macro-level systems of oppression, their intersections, and access to oral care in the United States. Whether and the extent to which the provision of government-funded dental services attenuates the emerging patterns of associations was also assessed in the study. To accomplish these objectives, individual-level information from over 300,000 respondents of the 2010 US Behavioral Risk Factor Surveillance System was linked with state-level data for 2000 and 2010 on structural racism, structural sexism, and income inequality, as provided by Homan et al. Using multilevel models, we investigated the relationships between systems of oppression and restricted access to oral health services among respondents at the intersections of race, gender, and poverty. The degree to which extended provision of government-funded dental services weakens the observed associations was determined in models stratified by state-level coverage of oral care. Our analyses bring to the fore intersectional groups (e.g., non-Hispanic Black women and men below the poverty line) with the highest odds of not seeing a dentist in the previous year. We also show that residing in states where high levels of structural sexism and income inequality intersect was associated with 1.3 greater odds (95% confidence interval, 1.1–1.5) of not accessing dental services in the 12 mo preceding the survey. Stratified analyses demonstrated that a more extensive provision of government-funded dental services attenuates associations between structural oppressions and restricted access to oral health care. On the basis of these and other findings, we urge researchers and health care planners to increase access to dental services in more effective and inclusive ways. Most important, we show that counteracting structural drivers of inequities in dental services access entails providing dental care for all. [ABSTRACT FROM AUTHOR]

Existing research suggests that victimization risk is higher among urban residents. Violence against women is a notable exception in this trend. While the literature does indicate that rural women are at equal risk for violent victimization, it does not differentiate between types of non-urban spaces (exurbs, suburbs, small towns, dispersed rural). We use a five-category measure of rural-urban location articulated land use to disentangle victim–offender relationship distribution using a female victim sample from the 1996–2005 United States National Crime Victimization Survey (NCVS). In the most rural areas (dispersed rural locations), women are most likely to be victimized by friends or acquaintances. The proportion of women victimized by strangers in dispersed rural locations is very low. As urbanicity increases, so does the proportion of women victimized by strangers. The findings indicate that victim–offender relationships may be dictated by proximity. In dispersed rural locations, there are comparatively fewer people unknown to the victim than in central city locations. Consequently, proximity dictates that offenders in dispersed rural locations are unlikely to be strangers. The articulated land use measure ensures that the differences between types of rural and suburban locations are identified. Future research should consider the impact of proximity on rural victimization and increased specificity in rural measurements. [ABSTRACT FROM AUTHOR]

Given the disproportionately higher rates of stalking among sexual minority individuals, the present study aimed to explore factors that influence these victims' help-seeking behaviors. Employing data from the United States' 2019 National Crime Victimization Survey (NCVS) Supplemental Victimization Survey (SVS), this study explores various demographic and psychological factors impacting help-seeking among sexual minority and heterosexual victims. Results indicate that sexual minority individuals are significantly more likely to seek help than heterosexual victims of stalking. Further exploration through logistic regression, limited to the sexual minority group, shows significant associations between help-seeking and age, sex, and emotional distress from stalking, but not race. Indicating that younger respondents, female respondents, and those experiencing an emotional impact are more likely to seek help for stalking victimization among sexual minority victims. These findings emphasize the importance of sexual orientation in understanding help-seeking behaviors among stalking victims, suggesting a need for more tailored support services for the sexual minority community. [ABSTRACT FROM AUTHOR]

While the oral health status of the United States (U.S.) population has improved over the years, racial/ethnic inequities are pervasive with Black Americans carrying a greater burden of oral diseases in most measured outcomes. Access to dental care is a major structural and societal determinant of oral health inequities rooted in structural racism. From post‐Civil War‐era to present day, this essay presents a series of examples of racist policies that have shaped access to dental insurance for Black Americans both directly and indirectly. Additionally, this essay explains the unique challenges of Medicare and Medicaid highlighting the specific disparities that these public insurance programs face, and proposes policy recommendations aimed to reduce racial/ethnic inequities in dental coverage and access to advance the nation's oral health with comprehensive dental benefits in public insurance programs. [ABSTRACT FROM AUTHOR]

An important element of precision medicine is the ability to identify, for a specific therapy, those patients for whom benefits of that therapy meaningfully exceed the risks. To achieve this goal, treatment effect usually is examined across subgroups defined by a variety of factors, including demographic, clinical, or pathologic characteristics or by molecular attributes of patients or their disease. Frequently such subgroups are defined by the measurement of biomarkers. Even though such examination is necessary when pursuing this goal, the evaluation of treatment effect across a variety of subgroups is statistically fraught due to both the danger of inflated false-positive error rate from multiple testing and the inherent insensitivity to how treatment effects differ across subgroups. Pre-specification of subgroup analyses with appropriate control of false-positive (i.e. type I) error is recommended when possible. However, when subgroups are specified by biomarkers, which could be measured by different assays and might lack established interpretation criteria, such as cut-offs, it might not be possible to fully specify those subgroups at the time a new therapy is ready for definitive evaluation in a Phase 3 trial. In these situations, further refinement and evaluation of treatment effect in biomarker-defined subgroups might have to take place within the trial. A common scenario is that evidence suggests that treatment effect is a monotone function of a biomarker value, but optimal cut-offs for therapy decisions are not known. In this setting, hierarchical testing strategies are widely used, where testing is first conducted in a particular biomarker-positive subgroup and then is conducted in the expanded pool of biomarker-positive and biomarker-negative patients, with control for multiple testing. A serious limitation of this approach is the logical inconsistency of excluding the biomarker-negatives when evaluating effects in the biomarker-positives, yet allowing the biomarker-positives to drive the assessment of whether a conclusion of benefit could be extrapolated to the biomarker-negative subgroup. Examples from oncology and cardiology are described to illustrate the challenges and pitfalls. Recommendations are provided for statistically valid and logically consistent subgroup testing in these scenarios as alternatives to reliance on hierarchical testing alone, and approaches for exploratory assessment of continuous biomarkers as treatment effect modifiers are discussed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this research note was to examine the sample repre- sentation, feasibility and completion, and data quality when using an unmoder- ated remote study (i.e., conducted without direct contact with a researcher) for a listening comprehension task with 4- to 11-year-old children. Method: Thirty-five participants met inclusionary criteria for this study. Sample rep- resentation was examined descriptively. Feasibility and completion (i.e., submission of parent questionnaires and more than 50% of task with no missing data) were examined descriptively and compared with differences of proportions tests. Data quality (i.e., missing data for items with interference or not codable) was examined descriptively with multilevel logistic regression models, as well as one-sample pro- portions tests by listening comprehension task and participant characteristics. Results: Our sample skewed toward predominantly White and toward families with highly educated parents. Overall, most participants completed the task and had quality data (i.e., audibly clear responses that could be coded, few missing responses, and task completion) in this unmoderated format. There were not any statistically significant effects across participant characteristics in terms of rates of completion. Data quality only significantly differed by response type with mouse selection having the least amount of missing data followed by prompted audio-recorded questions and then open-ended audio-recorded questions. Conclusions: The unmoderated remote study approach seems feasible for a listening comprehension task for most children ages 4–11 years old. Future work is needed to determine if these results apply to samples with broader rep- resentation. Overall, we found good data quality despite the less controlled environment in remote studies. [ABSTRACT FROM AUTHOR]

Objective: Transition from school to early adulthood incurs many changes and may be associated with deterioration in general health in youth with autism. We aimed to investigate this. Method: The National Longitudinal Transitions Study-2 is a USA nationally representative sample of youth receiving special education services, aged 13–17 at wave 1, followed-up over 10 years in five data collection waves. We conducted random-effects ordered logistic regressions to determine the odds ratios (OR) with 95% confidence intervals of wave, age, sex, ethnicity/race, additional intellectual disabilities, parental/guardian relationship status, and household income being associated with general health status in youth with autism. Results: Across waves, only between 74.3%–69.6% had excellent/very good health (71.7%–58.8% in those with co-occurring intellectual disabilities), but wave was not associated with health status. Associations were with age OR = 1.18 (1.04, 1.33), co-occurring intellectual disabilities OR = 1.56 (1.00, 2.44), and household income OR = 0.61 (0.40, 0.94) at $30,001–$50,000, OR = 0.44 (0.27, 0.72) at $50,001–$70,000, and OR = 0.34 (0.20, 0.56) at $70,001+. Sex, ethnicity/race, and parental/guardian relationship status were not associated with health status. Conclusion: There was little change in general health status longitudinally across the transitional period, but the proportion with excellent/very good health was low at each wave. Transitional planning should consider co-occurring intellectual disabilities, and the wider socioeconomic context in which children/youth with autism are raised. Lack of other longitudinal studies indicates a need for replication. [ABSTRACT FROM AUTHOR]

Purpose: This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders. Method: We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine. Results: The NASEM’s three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes. Conclusion: Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates. [ABSTRACT FROM AUTHOR]

Information about the undergraduate psychology courses preferred by graduate programs is useful for a number of purposes, including (a) advising psychology majors who are interested in graduate school, (b) undergraduate curriculum planning, and (c) examining whether graduate programs' preferences reflect national guidelines for the undergraduate psychology curriculum. The authors examined the undergraduate course preferences of U.S. psychology graduate programs (N = 548). Among Clinical/Counseling (C/C) programs, PsyD programs' course preferences were more likely than those of master's and PhD programs to reflect national undergraduate curriculum guidelines. Differences also emerged among various types of training (e.g., C/C vs. Educational/School), and these are important for advisors and students to understand. (Contains 2 tables and 2 notes.)

Objective: The authors examined whether alcohol use decreased condom use. Participants: The subjects were heavy-drinking students on 5 different college campuses. Methods: A face-to-face interview, administered between November of 2004 and February of 2007, gathered information about condom use, alcohol use, and other behaviors. Multivariate logistic regression was used to assess predictors of condom use. Results: Of the 1715 participants, 64% reported that they did not always use condoms. Male students who drank heavily were less likely to always use condoms (adjusted odds ratio [AOR] 0.61). Participants with more sexual partners used condoms less when drinking (AOR 1.93 for men, 1.45 for women). Conclusions: Many students do not use condoms consistently, especially those who drink heavily or have multiple sexual partners. Clinicians at student health need to encourage all students to use condoms every time they have intercourse. (Contains 4 tables.)

As contact between cultures continues to increase, the impact that this has on cultural identity and belonging is unclear. Cross-cultural or bicultural identification remains a relatively unexplored phenomenon. Is it possible, natural or potentially good to have an identity rooted in more than one culture? If so, how is cross-cultural identity negotiated? Semi-structured interviews were undertaken with nine women who have lived as immigrants in the UK or the USA for at least 20 years. The focus was on the experience of cross-cultural identification, including its benefits and drawbacks. The variety of experience does not permit generalisation at this stage, but the main characteristics of being bicultural in their experience include heightened self-awareness and understanding of difference, and a potential for critical, objective perspective on their environment. It is argued that emphasising the benefits of bicultural identity can be an important step toward improving cross-cultural interaction. (Contains 1 table.)

Toward the end of the of the twentieth century, the idea that young people are social actors gained increasing predominance. Since then, there has been a growing recognition of young people's ability to understand and contribute to forming their environments. In this article, the authors discuss the state of youth participation in the United Kingdom and United States and then describe two projects--one in each country--that represent efforts to stimulate young people's initiative in working for community change. The principles of social action, as developed by the Centre for Social Action, informed both of these projects. The projects demonstrate how social action practice can be a valuable framework for youth engagement. It emphasizes youth voice, participatory practice, and community building. Older youth consistently point to these components as necessary and desirable features of youth organizations and projects. Project examples help educators to understand the challenges and tasks of using the social action framework to inspire youth leadership and healthy development. (Contains 9 notes.)

In this paper, we seek to understand feminization of the dentist workforce moving beyond previous research that has looked at gender in isolation. We contend that little consideration has been given to how gender interacts with other important social identities such as race/ethnicity to influence the opportunities and barriers that female dentists encounter during their dental career. We argue that the scholarly debate about the feminization of the dentistry has not acknowledged the intersectionality of women's lives. Intersectionality describes how multiple social identities (such as race/ethnicity, gender, and class) overlap and interact to inform outcomes, creating disadvantages and/or privileges. Our thesis is that the increasing feminization of the dentist workforce is complicated and paradoxical, creating both opportunities for women and gender imbalances and blockages within the profession. To support our thesis, we critically reviewed the literature on feminization and analysed UK and US workforce data. While the female dentist workforce in both the UK and the US has increased significantly over the past decade, the growth in the number of female dentists was not equal across all racial/ethnic groups. The largest increase in the number of female dentists was among White and Asian women. Viewing the feminization of the dentist workforce through an intersectionality lens exposes the multiple and complex experiences of women, as well as the power dynamics in dentistry. Feminization in dentistry demonstrates the importance of presence, privilege, and power. Based on our assessment of the dentist workforce, dentistry may be less inclusive, despite being perceived as more diverse. Further research should explore how power and privilege may operate in dentistry. Dentistry should embrace intersectionality to provide an inclusive evaluation of equity in the workforce. [ABSTRACT FROM AUTHOR]

Background: In July 2012, the Centers for Medicare & Medicaid services launched an antipsychotic reduction initiative (ARI) to improve care for nursing facility residents with Alzheimer's disease and related dementias (ADRD). We examined the impact of this policy on antipsychotic and psychotropic medication (PM) utilization and diagnosis patterns in long‐stay nursing facility residents with ADRD and other conditions in which antipsychotics are indicated. Methods: Using an 80% sample of fee‐for‐service Medicare beneficiaries with Part D, we conducted a retrospective cohort study of nursing facility residents with ADRD, bipolar disorder, psychosis, Parkinson's disease, and residents exempt from the policy due to diagnoses of schizophrenia, Tourette syndrome, and/or Huntington's disease. We used interrupted time‐series analyses to compare changes in diagnoses, antipsychotic use, and PM utilization before (January 1, 2011–June 30, 2012) and after (July 1, 2012–September 30, 2015) ARI implementation. Results: We identified 874,487 long‐stay nursing facility residents with a diagnosis of ADRD (n = 358,518), exempt (n = 92,859), bipolar (n = 128,298), psychosis (n = 93,402), and Parkinson's disease (n = 80,211). In all cohorts, antipsychotic use declined prior to the ARI; upon policy implementation, antipsychotic use reductions were sustained throughout the study period, including statistically significant ARI‐associated accelerated declines in all cohorts. PM changes varied by cohort, with ARI‐associated increases in non‐benzodiazepine sedatives and/or muscle relaxants noted in ADRD, psychosis, and Parkinson's cohorts. Although anticonvulsant use increased throughout the study period in all groups, with the exception of the bipolar cohort, these increases were not associated with ARI implementation. Findings are minimally explained by increased post‐ARI membership in the psychosis and Parkinson's cohorts. Conclusions: Our study documents antipsychotic use significantly declined in non‐ADRD clinical and exempt cohorts, where such reductions may not be clinically warranted. Furthermore, ARI‐associated compensatory increases in PMs do not offset these reductions. Changes in PM utilization and diagnostic make‐up of residents using PMs require further investigation to assess the potential for adverse clinical and economic outcomes. See related commentary by Reppas‐Rindlisbacher et al. in this issue. [ABSTRACT FROM AUTHOR]

Health care systems throughout the United States are developing programmes to address patients' 'social determinants of health' – such as housing, food, income and transportation. I investigate the concepts, technologies and infrastructures through which health care systems are turning towards 'the social' as an object of clinical knowledge and intervention. Proponents of this movement suggest that developing the clinical capacity to prescribe social resources promises to improve the 'value' of care, defined as the amount of health achieved per dollar spent. I argue that initiatives to improve value through social intervention are reconstituting broader arrangements of welfare provisioning. [ABSTRACT FROM AUTHOR]

This article offers Ancestral Computing for Sustainability (ACS) to dismantle the logics of settler colonialism that affect accessibility, identities, and epistemologies of computer science education (CSE). ACS centers Indigenous epistemologies in researching CSE across four public universities in the United States. This paper describes Ancestral Computing for Sustainability and explores reflections of two students engaging as researchers in ACS inquiry. Drawing on Indigenous methodologies and Participatory Action Research, they share their reflections as co-researchers in ACS through storywork. These critical reflections include their relationship to computing, observations of the interdependent work within ACS, ethics and sustainability, and their experiences within the focus groups. The article ends with recommendations for furthering ACS as a decolonial approach that centers Indigenous epistemologies in CSE. Recommendations for CSE education include Ancestral Knowledge Systems and adding sustainability as a topic within computing education pathways and building student-faculty relationships based on trust is recommended to foster students' academic and personal growth within CSE education and research. [ABSTRACT FROM AUTHOR]

Appropriately designed sport contexts have the potential to offer participants a range of positive developmental outcomes across domains. However, excessive pressure from parents and an emphasis on achievement outcomes may lead young athletes to develop maladaptive personality characteristics such as perfectionism, which may undermine the positive outcomes from participating in sport. While parenting styles have been broadly explored in relation to the development of perfectionism, individual parenting behaviours have not been examined as unique predictors. The present study was designed to test the potential mediating role of perceived parental warmth on the association of perceived parent pressure and athletes' perfectionism in the context of competitive club soccer. Data were drawn from a sample of 149 adolescents in the United States who were participating in competitive club soccer. Results demonstrated an acceptable model fit with paternal pressure positively predicting both perfectionistic concerns and strivings, and perceived paternal warmth mediating the relationship between paternal pressure and perfectionistic strivings (β = -.18, p <.05) and concerns (β = -.19, p <.05). Perceived maternal pressure had no relationship with athlete perfectionistic strivings (β = -.03, p =.38) or concerns (β = -.02, p =.46). These findings extend knowledge of the pressure-perfectionism association while also accounting for the mediating effect of perceived parental warmth. The present study highlights the relationship between perceived paternal pressure and warmth in relation to perfectionism in competitive club soccer. Findings have the potential to inform future research examining parenting styles in the context of adolescent sport. [ABSTRACT FROM AUTHOR]

Aim: The National Accreditation Program for Rectal Cancer (NAPRC) was developed to improve rectal cancer patient outcomes in the United States. The NAPRC consists of a set of process and outcome measures that hospitals must meet in order to be accredited. We aimed to assess the potential of the NAPRC by determining whether achievement of the process measures correlates with improved survival. Methods: The National Cancer Database was used to identify patients undergoing curative proctectomy for non‐metastatic rectal cancer from 2010 to 2014. NAPRC process measures identified in the National Cancer Database included clinical staging completion, treatment starting <60 days from diagnosis, carcinoembryonic antigen level measured prior to treatment, tumour regression grading and margin assessment. Results: There were 48 669 patients identified with a mean age of 62 ± 12.9 years and 61.3% of patients were men. The process measure completed most often was assessment of proximal and distal margins (98.4%) and the measure completed least often was the serum carcinoembryonic antigen level prior to treatment (63.8%). All six process measures were completed in 23.6% of patients. After controlling for age, gender, comorbidities, annual facility resection volume, race and pathological stage, completion of all process measures was associated with a statistically significant mortality decrease (Cox hazard ratio 0.88, 95% CI 0.81–0.94, P < 0.001). Conclusion: Participating institutions provided complete datasets for all six process measures in less than a quarter of patients. Compliance with all process measures was associated with a significant mortality reduction. Improved adoption of NAPRC process measures could therefore result in improved survival rates for rectal cancer in the United States. [ABSTRACT FROM AUTHOR]

Summary: Background: Child health experts raise numerous concerns about the negative effects of children's exposure to unhealthy digital food marketing, including advertising and branded product placements on child‐oriented videos. Objectives: YouTube banned food advertising on "made‐for‐kids" channels in 2020, but research is needed to assess food‐related appearances on increasingly popular child‐influencer videos. Methods: Content analysis examined a sample of videos (n = 400) uploaded in 2019–2020 by popular child‐influencers on YouTube "made‐for‐kids" channels. We identified and coded all branded and non‐branded food‐related appearances (i.e., food, beverages, restaurants), ads, promotions, and sponsorship disclosures, and compared 2019 to 2020. Results: Two‐thirds of videos (n = 260) had at least one food‐related appearance, including branded product appearances (n = 153), other brand appearances (n = 60), and non‐branded food‐related appearances (n = 203). Branded products appeared 592 times (M = 3.9/video), including candy brands (42% of appearances) and sweet/salty snacks, sugary drinks, and ice cream (32% combined). Total food‐related appearances did not change (2019–2020), but candy brand appearances increased significantly. Videos with non‐branded healthy food category appearances also increased, but 70% also showed unhealthy branded and/or unbranded foods. Just one video disclosed a food‐brand sponsorship. Conclusions: Additional policies are needed to protect young children from potential exposure to unhealthy branded foods on popular YouTube child‐influencer channels. [ABSTRACT FROM AUTHOR]

Surveyed business curriculum internationalization at U.S. colleges and universities. Found most curricula have substantially increased international exposure during the 1990s. Diverse methods of internationalization remain; joint programs, student and faculty exchanges, and foreign language requirements are increasingly present. Elective specialized international courses are the dominant method of curriculum internationalization, but many schools add international content to existing non-international courses. (EV)

The increasing number and high prices of orphan drugs have triggered concern among patients, payers, and policymakers about the affordability of new drugs approved using the incentives set by the Orphan Drug Act (ODA) of 1983. This study evaluated the factors associated to the differences in the treatment cost of new orphan and non-orphan drugs approved by the FDA from 2017 to 2021. A generalized linear model (GLM) with the Gamma log-link analysis was used to ascertain the association of drug characteristics with the treatment costs of orphan and non-orphan drugs. The results of the study showed that the median and interquartile range (IQR) drug cost was USD 218,872 (IQR = USD 23,105) for orphan drugs and USD 12,798 (IQR = USD 57,940) for non-orphan drugs (p < 0.001). Higher market entry prices were associated with biologics (108%; p < 0.001), orphan status (177%; p < 0.001), US sponsor companies (48%; p = 0.035), chronic use (1083%; p < 0.001), treatment intent (163%; p = 0.004), and indications for oncology (624%; p < 0.001) or genetic disorders (624%; p < 0.001). Higher market entry treatment cost for newly approved drugs were associated with biologics, orphan status, US sponsor companies, chronic use, therapeutic intent, and indications for oncology or genetic disorders. [ABSTRACT FROM AUTHOR]

We analyzed 9630 invasive GAS surveillance isolates in the USA. From 2015–2017 to 2018–2019, significant increases in erythromycin-nonsusceptibility (18% vs 25%) and clindamycin-nonsusceptibility (17% vs 24%) occurred, driven by rapid expansions of genomic subclones. Prevention and control of clustered infections appear key to containing antimicrobial resistance. [ABSTRACT FROM AUTHOR]

92 Background: To address identified gaps in knowledge and confidence of US-based healthcare professionals (HCPs) when using cyclin-dependent kinase 4/6 inhibitors (CDK 4/6i) to treat metastatic breast cancer (mBC), an adaptive learning program (ALP) was deployed to review guideline recommendations and evidence from randomized clinical trials (RCTs) and real-world data (RWD). Methods: The ALP consisted of reading materials (guideline excerpts, RCTs, RWD, cases) with a virtual tutor that taught. The ALP continued to review necessary content until responders were both correct and confident (conscious competence). Impact on learning was interpreted as greater for learning objectives with the lowest accuracy score (% of correct responses) and higher distance to 100% conscious competency at baseline. Immediately post-ALP, satisfaction, perceived impact on knowledge, confidence and intent to change practice were assessed quantitatively and qualitatively. ANOVA compared continuous measures by profession. Results: Participants (n=261) were physicians (MD, 17%), advanced practice practitioners (APP, 20%), registered nurses (RN, 49%), pharmacists (11%), and other (3%). Mean completion time was 44 minutes and learners' proficiency shifted +64% towards conscious competency. The learning objectives most impacted by the education are shown (Table). Learners most satisfied with the ALP (47% with 9-10 on a 10-point satisfaction scale) appreciated the challenge and reported positive impact on their knowledge and confidence, resulting in intent to change their patient-communication, clinical decisions and interprofessional collaboration when using CDK4/6i. Conclusions: This ALP initiative addressed the educational gaps of US HCPs regarding CDK4/6i in HR+/HER2- mBC by challenging participants to re-consider their knowledge and confidence until conscious competency was demonstrated. Engaged learners found the activity impactful and reported intent to change practice. Future studies should seek to address attrition challenges and assess long term impacts of such programs. Top five learning objectives with lowest-ranking accuracy, by profession. Learning Objectives (LOs) Most Impacted Initial Scores by Profession Final Score ALL MD APP RN PharmD Other Identify appropriate CDK4/6i treatment options for a premenopausal woman with newly diagnosed HR+/HER2- mBC 54 57 53 53 62 52 100 Match RWD sources with their characteristics 56 55 60 55 61 41 100 Interpret results from the landmark CDK4/6i RCTs 58 62 61 53 64 56 100 Interpret RWE related to the use of CDK4/6i in patients who are underrepresented in RCTs* 62 62 63 58 74 65 100 Identify the latest updates from CDK4/6i RCTs 62 60 63 61 62 82 100 Average accuracy score for all 24 LOs 71 72 73 69 74 64 100 *Significantly different between professions (p<0.05; one-way ANOVA). [ABSTRACT FROM AUTHOR]

On September 1, 2022, bivalent COVID-19 mRNA vaccines, composed of components from the SARS-CoV-2 ancestral and Omicron BA.4/BA.5 strains, were recommended by the Advisory Committee on Immunization Practices (ACIP) to address reduced effectiveness of COVID-19 monovalent vaccines during SARS-CoV-2 Omicron variant predominance (1). Initial recommendations included persons aged ≥12 years (Pfizer-BioNTech) and ≥18 years (Moderna) who had completed at least a primary series of any Food and Drug Administration-authorized or -approved monovalent vaccine ≥2 months earlier (1). On October 12, 2022, the recommendation was expanded to include children aged 5-11 years. At the time of recommendation, immunogenicity data were available from clinical trials of bivalent vaccines composed of ancestral and Omicron BA.1 strains; however, no clinical efficacy data were available. In this study, effectiveness of the bivalent (Omicron BA.4/BA.5-containing) booster formulation against symptomatic SARS-CoV-2 infection was examined using data from the Increasing Community Access to Testing (ICATT) national SARS-CoV-2 testing program.* During September 14-November 11, 2022, a total of 360,626 nucleic acid amplification tests (NAATs) performed at 9,995 retail pharmacies for adults aged ≥18 years, who reported symptoms consistent with COVID-19 at the time of testing and no immunocompromising conditions, were included in the analysis. Relative vaccine effectiveness (rVE) of a bivalent booster dose compared with that of ≥2 monovalent vaccine doses among persons for whom 2-3 months and ≥8 months had elapsed since last monovalent dose was 30% and 56% among persons aged 18-49 years, 31% and 48% among persons aged 50-64 years, and 28% and 43% among persons aged ≥65 years, respectively. Bivalent mRNA booster doses provide additional protection against symptomatic SARS-CoV-2 in immunocompetent persons who previously received monovalent vaccine only, with relative benefits increasing with time since receipt of the most recent monovalent vaccine dose. Staying up to date with COVID-19 vaccination, including getting a bivalent booster dose when eligible, is critical to maximizing protection against COVID-19 (1). [ABSTRACT FROM AUTHOR]