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Digital contact tracing tools were developed to decrease the spread of COVID-19 by supplementing traditional manual methods. Although these tools have great potential, they were developed rather quickly resulting in tools with varying levels of success. The main issues with these tools are over privacy and who might have access to the information gathered. In general, their effectiveness varied globally, where users expressed privacy concerns associated with sharing identity, illness, and location information. This paper reviews these issues in deployments across Asia, Europe, and the United States. The goal is to begin a discussion that improves the design and development of digital technologies that not only improve the control of infectious disease spread, but also achieve an appropriate standard of privacy and security.

Objectives: We aimed to describe obstetrics and gynecology (OBGYN) trainees' anticipation of how the Dobbs v. Jackson Women's Health Organization (Dobbs) U.S. Supreme Court decision may affect their training. Methods: A REDCap survey of OBGYN residents and fellows in the United States from September 19, 2022, to December 1, 2022, queried trainees' anticipated achievement of relevant Accreditation Council for Graduate Medical Education (ACGME) training milestones, their concerns about the ability to provide care and concern about legal repercussions during training, and the importance of OBGYN competence in managing certain clinical situations for residency graduates. The primary outcome was an ACGME program trainee feeling uncertain or unable to obtain the highest level queried for a relevant ACGME milestone, including experiencing 20 abortion procedures in residency. Results: We received 469 eligible responses; the primary outcome was endorsed by 157 respondents (33.5%). After correction for confounders, significant predictors of the primary outcome were state environment (aOR = 3.94 for pending abortion restrictions; aOR = 2.71 for current abortion restrictions), trainee type (aOR = 0.21 for fellow vs. resident), and a present or past Ryan Training Program in residency (aOR = 0.55). Although the vast majority of trainees believed managing relevant clinical situations are key to OBGYN competence, 10%–30% of trainees believed they would have to stop providing the standard of care in clinical situations during training. Conclusions: This survey of OBGYN trainees indicates higher uncertainty about achieving ACGME milestones and procedural competency in clinical situations potentially affected by the Dobbs decision in states with legal restrictions on abortion. [ABSTRACT FROM AUTHOR]

Background: Rural regions of the western United States have experienced a noticeable surge in both the frequency and severity of acute wildfire events, which brings significant challenges to both public safety and environmental conservation efforts, with impacts felt globally. Identifying factors contributing to immune dysfunction, including endocrinological phenotypes, is essential to understanding how hormones may influence toxicological susceptibility. Methods: This exploratory study utilized male and female C57BL/6 mice as in vivo models to investigate distinct responses to acute woodsmoke (WS) exposure with a focus on sex-based differences. In a second set of investigations, two groups were established within the female mouse cohort. In one group, mice experienced ovariectomy (OVX) to simulate an ovarian hormone-deficient state similar to surgical menopause, while the other group received Sham surgery as controls, to investigate the mechanistic role of ovarian hormone presence in driving immune dysregulation following acute WS exposure. Each experimental cohort followed a consecutive 2-day protocol with daily 4-h exposure intervals under two conditions: control HEPA-filtered air (FA) and acute WS to simulate an acute wildfire episode. Results: Metals analysis of WS particulate matter (PM) revealed significantly increased levels of 63Cu, 182W, 208Pb, and 238U, compared to filtered air (FA) controls, providing insights into the specific metal components most impacted by the changing dynamics of wildfire occurrences in the region. Male and female mice exhibited diverse patterns in lung mRNA cytokine expression following WS exposure, with males showing downregulation and females displaying upregulation, notably for IL-1β, TNF-α, CXCL-1, CCL-5, TGF-β, and IL-6. After acute WS exposure, there were notable differences in the responses of macrophages, neutrophils, and bronchoalveolar lavage (BAL) cytokines IL-10, IL-6, IL-1β, and TNF-α. Significant diverse alterations were observed in BAL cytokines, specifically IL-1β, IL-10, IL-6, and TNF-α, as well as in the populations of immune cells, such as macrophages and polymorphonuclear leukocytes, in both Sham and OVX mice, following acute WS exposure. These findings elucidated the profound influence of hormonal changes on inflammatory outcomes, delineating substantial sex-related differences in immune activation and revealing altered immune responses in OVX mice due to ovarian hormone deficiency. In addition, the flow cytometry analysis highlighted the complex interaction between OVX surgery, acute WS exposure, and their collective impact on immune cell populations within the hematopoietic bone marrow niche. Conclusions: In summary, both male and female mice, alongside females subjected to OVX and those who had sham surgery, exhibit significant variations in the expression of proinflammatory cytokines, chemokines, lung mRNA gene expression, and related functional networks linked to signaling pathways. These differences potentially act as mediators of sex-specific and hormonal influences in the systemic inflammatory response to acute WS exposure during a wildfire event. Understanding the regulatory roles of genes expressed differentially under environmental stressors holds considerable implications, aiding in identifying sex-specific therapeutic targets for addressing acute lung inflammation and injury. [ABSTRACT FROM AUTHOR]

This interdisciplinary cross-cultural research project surveyed teachers in elementary schools in five countries: South Africa, Australia, Jamaica, England, and the United States. This study attempted to define and identify best practices used in teaching children considered to be "at-risk" in these five countries: Three research questions guided this study 1). How do classroom teachers define children "at-risk" in their culture and country? 2). How do classroom teachers identify children "at-risk" in their classrooms? 3). What educational strategies do teachers implement to make learning meaningful for children "at-risk" for academic failure in their classrooms. An extensive cross-cultural literature review was conducted by the research team and a summary of the most frequently cited best practices for teaching children considered to be "at-risk" from the five countries was presented. In addition, detailed responses by classroom teacher study participants that addressed the three key research questions were also included.

Background: Residence in rural areas is often a barrier to health care access. To date, differences in access to kidney transplantation among children who reside in rural and micropolitan areas of the US have not been explored. Methods: A retrospective cohort study of children < 18 years who developed kidney failure between 2000 and 2019 according to the United States Renal Data System (USRDS). We examined the association between rurality of patient residence and time to living and/or deceased donor kidney transplantation (primary outcomes) and waitlist registration (secondary outcome) using Fine–Gray models. Results: We included 18,530 children, of whom 14,175 (76.5%) received a kidney transplant (39.8% from a living and 60.2% from a deceased donor). Residence in micropolitan (subhazard ratio (SHR) 1.16; 95% CI 1.06–1.27) and rural (SHR 1.18; 95% CI 1.06–1.3) areas was associated with better access to living donor transplantation compared with residence in metropolitan areas. There was no statistically significant association between residence in micropolitan (SHR, 0.95; 95%CI 0.88–1.03) and rural (SHR, 0.94; 95%CI 0.86–1.03) areas compared with metropolitan areas in the access of children to deceased donor transplantation. There was also no difference in the time to waitlist registration comparing micropolitan (SHR 1.04; 95%CI 0.98–1.10) and rural (SHR 1.05; 95% CI 0.98–1.13) versus metropolitan areas. Conclusions: In children with kidney failure, residence in rural and micropolitan areas was associated with better access to living donor transplantation and similar access to deceased donor transplantation compared with residence in metropolitan areas. [ABSTRACT FROM AUTHOR]

Transgender individuals face stigma, discrimination, and other barriers impacting their ability to engage in physical activity (PA). We aim to review current literature on PA among transgender individuals. A systemic literature search of research studies from 2010–2023 was conducted. Studies must have reported a measure of PA and gender, be original research, and focus on transgender participants' PA. Rates of PA for transgender individuals were lower compared to cisgender or sexual minority individuals. Transgender women were less likely to engage in PA than other groups. Qualitative results suggest transgender oppression, stigma, discrimination, body image, unwelcoming environments (gyms, locker rooms, swimming pools), and the dichotomous structure of sport contribute to lower rates of PA among transgendered individuals. Disparities in PA for transgender individuals exist. Policy, environment, and system changes are needed to reduce transgender stigma in sport and PA settings. Current legislation is being developed and implemented in the United States regarding the place of transgender individuals in sport and PA. These results should inform public discourse on the topic. [ABSTRACT FROM AUTHOR]

Myriad cross-sector initiatives seek to remake capitalism into a more just, sustainable, and inclusive system. But how do these distributed efforts--which often vary in strength--interact? To answer this question, we attend to the interaction between weak and strong governance reforms. Drawing on longstanding research on organizational values and the sociology of law, we theorize how the enactment of weak and broad sustainability legislation is likely to increase pressure on values-driven businesses to pursue both values authentication and material authentication by way of strong third-party certification. We test our conceptual model by examining the effects of the frequently criticized benefit corporation legislation passed in 36 U.S. jurisdictions on the related B Corporation certification. We find that new certifications and recertifications both increase in jurisdictions with such legislation and these effects are amplified or attenuated depending on corporate sustainability norms in the region. Taken together, our findings contribute to the intensifying societal conversation regarding the prospects for remaking capitalism, illustrating how even weak legislation can contribute to systems change not only by encouraging incremental sustainability reforms within a field but also by triggering an authentication imperative that mobilizes values-driven businesses to pursue rigorous certifications. [ABSTRACT FROM AUTHOR]

The article explores developments in the cannabis industry in the U.S., including federal regulations, tribal policies, state laws and their effect on the industry. Topics include the legalization of cannabis for medical purposes in 39 states in the U.S. including District of Columbia, the reason for the absence of legal interstate commerce for cannabis and the court ruling related to Maine Medical Marijuana Act in Northeast Patients Group v. United Cannabis Patients & Caregivers of Maine.

Purpose: Adolescent and young adult cancer survivors (AYAs) experience early-onset chronic conditions and disrupted psychosocial development. We report prevalence of disruptions in care delivery and social support during the early wave of the pandemic in a national sample of AYAs in the United States. Materials and Methods: We used data from the population-based National Health Interview Survey (NHIS; July–December 2020), which allows for nationally representative estimates, and included questions related to COVID-19. We identified 61 AYAs diagnosed with cancer between ages 15 and 39 years and not currently receiving cancer treatment and 244 age- and sex-matched controls. We compared the proportion of AYAs and controls reporting delayed care due to the pandemic, not getting needed care due to the pandemic, and changes in social and emotional support. Results: AYAs were predominantly non-Hispanic White (61.3%) and female (58.8%), with a median age at diagnosis of 28 years (interquartile range [IQR] 21–31 years). Fewer AYAs were employed (52.1% vs. 71.5%), and more lived in poverty (32.0% vs. 12.4%) and felt depressed daily (9.9% vs. 3.0%, all p < 0.05). The proportion of AYAs reporting delayed care (39.8% vs. 15.3%) and not getting needed care (31.7% vs. 10.4%) due to the pandemic was more than double that of controls (both p < 0.01). One in five AYAs experienced less social and emotional support compared to the prior year, although not significantly different from controls (21.6% vs. 12.4%, p = 0.10). Conclusions: The pandemic disrupted AYAs' care and exacerbated their psychosocial challenges. Providers and health systems should prioritize reconnecting AYAs to affordable and comprehensive care. [ABSTRACT FROM AUTHOR]

The American public often wonders what goes on in the White House and how domestic and foreign policy are made. Designed for use by the research and teaching communities, whitehousetapes.org provides teachers and students the opportunity to learn more about how American presidents have made decisions and exercised leadership during pivotal moments in United States history. The website offers free access to presidential recordings covering myriad topics that range from the significant--World War II, the Cold War, the Space Race, the War on Poverty, the Civil Rights Movement, the Cuban Missile Crisis--to the mundane--President Lyndon B. Johnson ordering some custom-made pants. All presidential recordings, declassified and released by the respective presidential libraries, are available on the website. This article highlights the resources available on this site for teaching about a topic that continues to be both controversial and extremely relevant to the current political debate: the Vietnam War. Strategies for classroom use are presented. (Contains 2 figures and 4 notes.)

A growing number of adolescents in the United States identify as transgender and gender nonbinary, and many will seek medical management of menstruation. In this evidence-based review, we recommend a model of gender-affirming care grounded in the tenants of reproductive justice, emphasizing patient autonomy and the development of holistic management plans centered around the patient's unique goals for affirming their gender identity. We then review strategies for achieving menstruation suppression for transgender and gender nonbinary adolescents, including dosing considerations, menstruation, ovulation, contraceptive effects, and metabolic considerations specific to the adolescent population. [ABSTRACT FROM AUTHOR]

Youth citizenship and injustices within civic education throughout the United States of America are timely topics during a time when there is a heightened interest in globalisation and Global Citizenship. Throughout the history of the U.S., there have been various paradigm shifts and campaigns anchored to the ideal of creating informed and active citizens who would be loyal to the republic. While the collective interest has not waivered, the methods of reaching the pinnacle of united states for the people, by the people, have been broad and varied. Youth activists, experts, and politicians have attempted to alter civics measures through a combination of academic, grassroots, and legal systems changes on local and federal levels. Thus far, results have been multifarious, and it is clear that unity among these groups of catalysts is necessary to alter the foundation and face of civics learning and youth citizenship throughout the United States K-12 public education system. [ABSTRACT FROM AUTHOR]

Objective: Inclusion of minority women in gynecologic research is vital for preventing health care inequities and disparities. This research was conducted to determine how frequently race and ethnicity data were reported in oral presentations at the Society for Gynecologic Surgeons (SGS)'s annual meeting. Materials and Methods: The abstracts and articles associated with SGS oral presentations between 2016 and 2020 were reviewed. Data regarding the numbers of subjects and reported races and ethnicities were extracted from each study. The proportion of studies that reported data about race and ethnicity was calculated. The racial and ethnic distributions of subjects within the studies that reported race and ethnicity were compared to distributions in the U.S. census data. Results: The inclusion criteria were met by 72/92 available abstracts and 28/37 available, articles. Data were reported on participants' race in 10/72 (13.9%) abstracts and 21/28 (75.0%) articles. Ethnicity was reported in 3/72 (4.2%) abstracts and 14/28 (50.0 %) articles. In the abstracts and articles that did report on race, races other than White were underrepresented, compared to the U.S. population. Conclusions: Most research abstracts at SGS annual meetings did not include race or ethnicity data. SGS articles were more likely to report these data but did not represent the the U.S. population diversity accurately. (J GYNECOL SURG 38:241) [ABSTRACT FROM AUTHOR]

Schizophrenia is a debilitating psychiatric disorder, leading to both physical and social morbidity. Worldwide 1% of the population is struggling with the disease, with 100,000 new cases annually only in the United States. Despite its importance, the goal of finding effective treatments for schizophrenia remains a challenging task, and previous work conducted expensive large-scale phenotypic screens. This work investigates the benefits of Machine Learning for graphs to optimize drug phenotypic screens and predict compounds that mitigate abnormal brain reduction induced by excessive glial phagocytic activity in schizophrenia subjects. Given a compound and its concentration as input, we propose a method that predicts a score associated with three possible compound effects, i.e., reduce, increase, or not influence phagocytosis. We leverage a high-throughput screening to prove experimentally that our method achieves good generalization capabilities. The screening involves 2218 compounds at five different concentrations. Then, we analyze the usability of our approach in a practical setting, i.e., prioritizing the selection of compounds in the SWEETLEAD library. We provide a list of 64 compounds from the library that have the most potential clinical utility for glial phagocytosis mitigation. Lastly, we propose a novel approach to computationally validate their utility as possible therapies for schizophrenia. Author summary: Phagocytosis is a fundamental biological process to protect biological organisms from exogenous infectious particles as well as to preserve equilibrium and efficiency of the host by removing its unwanted cells. A dysregulation of the phagocytic activity can lead to severe consequences for the host. In this study, we focus on a recent theory that relates an excessive phagocytic activity in brain cells, and a consequent abnormal reduction in brain volume, to the development of schizophrenia. Our working hypothesis is that pharmaceutical compounds that can reduce excessive of phagocytic activity might prove effective as a schizophrenia treatment. Rather than attempting to develop ex-novo such a chemical compound, we rely on a more cost-effective and efficient approach that seeks candidate therapies in a set of approved chemical compounds. To achieve this, we train a machine learning model capable of predicting, with good accuracy, the ability of a molecular compound to increase or decrease phagocytosis in the target brain cells. Our approach leverages learning models capable of directly processing the molecular graph of the compound, leading to the identification of 64 candidate drugs of potential clinical utility. [ABSTRACT FROM AUTHOR]

Recent reform documents in postsecondary science, technology, engineering, and mathematics (STEM) fields recommend the use of evidence-based instructional practices (EBIPs) in the classroom. National surveys in the United States suggest a continued reliance on instructorcentered practices that have little evidentiary support for long-term impacts on student learning. This study utilized a cross-sectional survey research design to explore the awareness and use of EBIPs by STEM instructors at two large universities (n = 104) in the southeastern United States. Participants' perceived individual and situational barriers impaired their use of EBIPs. We also examined how these barriers may be related to faculty use of these instructional practices. Results indicate high awareness of many EBIPs but with little subsequent classroom use. Results also suggest that STEM faculty's gender and pedagogical beliefs may mediate what they perceive as significant barriers to EBIP implementation. [ABSTRACT FROM AUTHOR]

Background: Objectives were to describe barriers to pediatric cancer symptom management care pathway implementation and the impact of the COVID-19 pandemic on clinical research evaluating their implementation.Methods: We included 25 pediatric oncology hospitals in the United States that supported a grant submission to perform a cluster randomized trial in which the intervention encompassed care pathways for symptom management. A survey was distributed to site principal investigators prior to randomization to measure contextual elements related to care pathway implementation. Questions included the inner setting measures of the Consolidated Framework for Implementation Research (CFIR), study-specific potential barriers and the impact of the COVID-19 pandemic on clinical research. The Wilcoxon rank sum test was used to compare characteristics of institutions that agreed that their department supported the implementation of symptom management care pathways vs. institutions that did not agree.Results: Of the 25 sites, one withdrew because of resource constraints and one did not respond, leaving 23 institutions. Among the seven CFIR constructs, the least supported was implementation climate; 57% agreed there was support, 39% agreed there was recognition and 39% agreed there was prioritization for symptom management care pathway implementation at their institution. Most common barriers were lack of person-time to create care pathways and champion their use (35%), lack of interest from physicians (30%) and lack of information technology resources (26%). Most sites reported no negative impact of the COVID-19 pandemic across research activities. Sites with fewer pediatric cancer patients were more likely to agree that staff are supported to implement symptom management care pathways (P = 0.003).Conclusions: The most commonly reported barriers to implementation were lack of support, recognition and prioritization. The COVID-19 pandemic may not be a major barrier to clinical research activities in pediatric oncology. [ABSTRACT FROM AUTHOR]

We aimed to describe coronavirus disease 2019 (COVID-19) deaths among first responders early in the COVID-19 pandemic. We used media reports to gather timely information about COVID-19–related deaths among first responders during March 30–April 30, 2020, and evaluated the sensitivity of media scanning compared with traditional surveillance. We abstracted information about demographic characteristics, occupation, underlying conditions, and exposure source. Twelve of 19 US public health jurisdictions with data on reported deaths provided verification, and 7 jurisdictions reported whether additional deaths had occurred; we calculated the sensitivity of media scanning among these 7 jurisdictions. We identified 97 COVID-19–related first-responder deaths during the study period through media and jurisdiction reports. Participating jurisdictions reported 5 deaths not reported by the media. Sixty-six decedents worked in law enforcement, and 31 decedents worked in fire/emergency medical services. Media reports rarely noted underlying conditions. The media scan sensitivity was 88% (95% CI, 73%-96%) in the subset of 7 jurisdictions. Media reports demonstrated high sensitivity in documenting COVID-19–related deaths among first responders; however, information on risk factors was scarce. Routine collection of data on industry and occupation could improve understanding of COVID-19 morbidity and mortality among all workers. [ABSTRACT FROM AUTHOR]

Objectives: In this paper we report the evaluation of a proprietary recall system for promoting compliance with recommended follow-up in high-risk patients. Methods: We conducted a retrospective chart review for patients of an active private colon and rectal surgery practice having colonoscopy in 2006. Patients selected were <80 years of age and assessed to be high-risk by findings at exam or personal/family history of colorectal neoplasm with a recommendation for follow-up surveillance colonoscopy ranging from months to 5 years. Up to 6 months from recommendation was considered to be within compliance. Results: A total of 795 patients met the inclusion criteria, with average age of 63.2 years, 422 (53.1%) being men. Compliance with surveillance colonoscopy recommendations was 62.5%. The recall system impacted patient behavior with compliant patients being sent a median of one letter (average, 1.5) and late or no follow-up patients being sent a median of 4 letters (average, 3.9). Conclusions: Multiple contacts with patients are required to improve compliance with surveillance. Our findings support at least 4 to 5 efforts to remind patients of the importance to schedule a colonoscopy is necessary to optimize compliance. [ABSTRACT FROM AUTHOR]

Background: Little is known about factors associated with recovery of kidney function-and return to dialysis independence-or temporal trends in recovery after starting outpatient dialysis in the United States. Understanding the characteristics of individuals who may have the potential to recover kidney function may promote better recognition of such events. The goal of this study was to determine factors associated with recovery of kidney function in children compared with adults starting dialysis in the US.Methods and Findings: We determined factors associated with recovery of kidney function-defined as survival and discontinuation of dialysis for ≥90-day period-in children versus adults who started maintenance dialysis between 1996 and 2015 according to the United States Renal Data System (USRDS) followed through 2016 in a retrospective cohort study. We also examined temporal trends in recovery rates over the last 2 decades in this cohort. Among 1,968,253 individuals included for study, the mean age was 62.6 ± 15.8 years, and 44% were female. Overall, 4% of adults (83,302/1,953,881) and 4% of children (547/14,372) starting dialysis in the outpatient setting recovered kidney function within 1 year. Among those who recovered, the median time to recovery was 73 days (interquartile range [IQR] 43-131) in adults and 100 days (IQR 56-189) in children. Accounting for the competing risk of death, children were less likely to recover kidney function compared with adults (sub-hazard ratio [sub-HR] 0.81; 95% CI 0.74-0.89, p-value <0.001; point estimates <1 indicating increased risk for a negative outcome). Non-Hispanic black (NHB) adults were less likely to recover compared with non-Hispanic white (NHW) adults, but these racial differences were not observed in children. Of note, a steady increase in the incidence of recovery of kidney function was noted initially in adults and children between 1996 and 2010, but this trend declined thereafter. The diagnoses associated with the highest recovery rates of recovery were acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) in both adults and children, where 25%-40% of patients recovered kidney function depending on the calendar year of dialysis initiation. Limitations to our study include the potential for residual confounding to be present given the observational nature of our data.Conclusions: In this study, we observed that discontinuation of outpatient dialysis due to recovery occurred in 4% of patients with end-stage kidney disease (ESKD) and was more common among those with ATN or AIN as the cause of their kidney disease. While recovery rates rose initially, they declined starting in 2010. Additional studies are needed to understand how to best recognize and promote recovery in patients whose potential to discontinue dialysis is high in the outpatient setting. [ABSTRACT FROM AUTHOR]

Objective: To determine whether high school start time is associated with headache frequency in adolescents with migraine. Background: Adolescence is marked by a physiologic delayed circadian phase, characterized by later bedtimes and wake times. The American Academy of Pediatrics (AAP) recommends that high schools start no earlier than 8:30 a.m., but most high schools in the United States start earlier. The study hypothesis was that adolescents with migraine whose high schools start at 8:30 a.m. or later (late group) would have lower headache frequency than those whose schools start earlier than 8:30 a.m. (early group). Methods: This was a cross‐sectional Internet survey study of US high schoolers with migraine recruited online through social media. Comparisons were made between the late group and the early group. The primary outcome measure was self‐reported headache days/month. Results: In total, 1012 respondents constituted the analytic set: n = 503 in the late group versus n = 509 in the early group. Mean (SD) self‐reported headache days/month was 4.8 (4.6) versus 7.7 (6.1) in the late and early groups, respectively (p < 0.001); mean difference −2.9 (95% CI −2.2 to −3.6). Mean (SD) self‐reported hours of sleep on a school night was 7.9 (0.9) versus 6.9 (1.3), p < 0.001. Adjusting for total hours of sleep, sex, taking a migraine preventive, days of acute medication use, hours of homework, grade level, and missing breakfast, mean (SD) self‐reported headache days/month remained lower in the late group than in the early group: 5.8 (95% CI 5.3–6.2) versus 7.1 (95% CI 6.7–7.4), (p < 0.001); mean difference −1.3 (95% CI −1.9 to −0.7). Conclusion: Adolescents with migraine who attend high schools that follow AAP recommendations for start times have lower self‐reported headache frequency than those whose high schools start before 8:30 a.m. If prospective studies confirm this finding, shifting to a later high school start time may be an effective strategy for migraine prevention in adolescents. [ABSTRACT FROM AUTHOR]

Importance: Intravenous alteplase is an effective treatment for acute ischemic stroke and is significantly underutilized. It is known that stroke centers with accreditation are more likely to provide intravenous alteplase treatment, and therefore, policies that increase the number of certified stroke centers and the number of acute ischemic stroke patients routed to these centers may be beneficial. Objective: To determine whether increasing access to primary stroke centers (regionalization) led to an increase in intravenous alteplase use in acute ischemic stroke patients. Design: An observational, longitudinal study to examine treatment trends with log-link binomial regression modeling to compare pre-post policy implementation changes in the proportions of patients treated with intravenous alteplase in two counties. Setting: Two urban counties, Santa Clara and San Mateo, in the western region of US that regionalized acute stroke care between 2005 and 2010. Participants: Patients with primary or secondary diagnosis of stroke were identified from the statewide patient discharge database by International Classification of Diseases (ICD-9) codes. We linked ambulance and hospital data to create complete patient care records. Main outcomes and measures: Stroke treatment, defined as a documented primary procedure code for intravenous alteplase administration (ICD-9: 99.10). Results: In Santa Clara County, intravenous alteplase was administered to 35 patients (1.7%) in the pre-regionalization period and 240 patients (2.1%) in the post-regionalization period. In San Mateo County, intravenous alteplase was administered to 29 patients (1.3%) in the pre-policy period and 135 patients (3.2%) in the post-policy period. After regionalization of stroke care, intravenous alteplase increased two-fold in San Mateo County [adjusted RR 2.20, p = 0.003, 95% CI (1.31, 3.69)] but did not show any statistically significant change in Santa Clara County [adjusted RR 1.10, p = 0.55, 95% CI (0.80, 1.51)]. In the post-regionalization phase, when compared with Santa Clara County, we found that San Mateo County had greater change in paramedic stroke detection, higher number of transports to primary stroke centers and more frequent use of intravenous alteplase at stroke centers. Conclusions: Our findings suggest that greater post-regionalization improvements in San Mateo County contributed to significantly better county-level thrombolysis use than Santa Clara County. [ABSTRACT FROM AUTHOR]

Context : Medicaid expansion has costs and benefits for states. The net impact on a state's budget is a central concern for policy makers debating implementing this provision of the Affordable Care Act. How large is the state-level fiscal impact of expanding Medicaid, and how should it be estimated? Methods: We use Michigan as a case study for evaluating the state-level fiscal impact of Medicaid expansion, with particular attention to the importance of macroeconomic feedback effects relative to the more straightforward fiscal effects typically estimated by state budget agencies. We combine projections from the state of Michigan's House Fiscal Agency with estimates from a proprietary macroeconomic model to project the state fiscal impact of Michigan's Medicaid expansion through 2021. Findings: We find that Medicaid expansion in Michigan yields clear fiscal benefits for the state, in the form of savings on other non-Medicaid health programs and increases in revenue from provider taxes and broad-based sales and income taxes through at least 2021. These benefits exceed the state's costs in every year. Conclusions: While these results are specific to Michigan's budget and economy, our methods could in principle be applied in any state where policy makers seek rigorous evidence on the fiscal impact of Medicaid expansion. [ABSTRACT FROM AUTHOR]

Describes the Delaware Indian experience in Kansas. Representation of the Cheyenne Dog soldier pictograph; Implication of Indian presence in Kansas for socialization; Existence of demographic pressures in Kansas.

In the past decade, multiple mumps outbreaks have occurred in the United States, primarily in close-contact, high-density settings such as colleges, with a high attack rate among young adults, many of whom had the recommended 2 doses of mumps-measlesrubella (MMR) vaccine. Waning humoral immunity and the circulation of divergent wild-type mumps strains have been proposed as contributing factors to mumps resurgence. Blood samples from 71 healthy 18- to 23-year-old college students living in a nonoutbreak area were assayed for antibodies and memory B cells (MBCs) to mumps, measles, and rubella. Seroprevalence rates of mumps, measles, and rubella determined by IgG enzyme-linked immunosorbent assay (ELISA) were 93, 93, and 100%, respectively. The index standard ratio indicated that the concentration of IgG was significantly lower for mumps than rubella. High IgG avidity to mumps Enders strain was detected in sera of 59/71 participants who had sufficient IgG levels. The frequency of circulating mumpsspecific MBCs was 5 to 10 times lower than measles and rubella, and 10% of the participants had no detectable MBCs to mumps. Geometric mean neutralizing antibody titers (GMTs) by plaque reduction neutralization to the predominant circulating wild-type mumps strain (genotype G) were 6-fold lower than the GMTs against the Jeryl Lynn vaccine strain (genotype A). The majority of the participants (80%) received their second MMR vaccine =10 years prior to study participation. Additional efforts are needed to fully characterize B and T cell immune responses to mumps vaccine and to develop strategies to improve the quality and durability of vaccine-induced immunity. [ABSTRACT FROM AUTHOR]

Conversational agents (CAs) are an integral component of many personal and business interactions. Many recent advancements in CA technology have attempted to make these interactions more natural and human-like. However, it is currently unclear how human-like traits in a CA impact the way users respond to questions from the CA. In some applications where CAs may be used, detecting deception is important. Design elements that make CA interactions more human-like may induce undesired strategic behaviors from human deceivers to mask their deception. To better understand this interaction, this research investigates the effect of conversational skill—that is, the ability of the CA to mimic human conversation—from CAs on behavioral indicators of deception. Our results show that cues of deception vary depending on CA conversational skill, and that increased conversational skill leads to users engaging in strategic behaviors that are detrimental to deception detection. This finding suggests that for applications in which it is desirable to detect when individuals are lying, the pursuit of more human-like interactions may be counter-productive. • People type differently when conversing with conversational agents that have more human-like conversational skill. • People show strategic behavior to conceal their deception when conversing with a more human-like conversational agent. • Conversational agents that indicate understanding affect behavior more than agents that merely have variety in responses. [ABSTRACT FROM AUTHOR]

Background: Infant colic, or excessive crying in an otherwise healthy infant, is common, although the cause(s) are not known. This study aimed to determine whether parental migraine is associated with infant colic. Methods: This was a cross‐sectional online survey study of biological parents of 4‐8 week olds in the United States during February and March 2017 and October 2017‐April 2018. Parents self‐reported information about their and their infant's health using validated instruments wherever possible. Parents were recruited using social media advertisements and completed the survey online. Migraine was identified with a validated screener using modified International Classification of Headache Disorders 3rd edition criteria. Parental depression and anxiety were screened with the Patient Health Questionnaire‐2 (PHQ‐2) and Generalized Anxiety Disorder Scale‐2 (GAD‐2). Parental seasonal allergies and asthma were assessed by self‐report. Infant colic was determined based on parental response to the question, "Has your baby cried for at least 3 hours on at least 3 days in the last week?" Results: A total of 1,715 surveys were completed over 2 recruitment periods; 1,419 formed the analysis set. Eight hundred twenty‐seven were completed by biological mothers and 592 by biological fathers. Mean (SD) maternal age: 28.9 (5.1) years; 33.5% had migraine/probable migraine. Maternal migraine was associated with increased odds of infant colic: OR 1.7 (1.3‐2.4). Among mothers with migraine, headache frequency ≥15 days/month was associated with higher risk of infant colic (OR 2.5 (1.2‐5.3)); and anxiety was borderline associated (OR 1.7 (1.0‐2.9)). Mean (SD) paternal age was 31.6 (4.5) years; 20.8% had migraine/probable migraine. Paternal migraine was not associated with infant colic: OR 1.0 (0.7‐1.5). Fathers with depression (OR 2.4 (1.4‐4.3)) or anxiety (OR 1.7 (1.1‐2.7)) were more likely to have a baby with colic but having a girl infant was protective: (OR 0.7 (0.5‐0.97)). Conclusions: Mothers with migraine are more likely to have a baby with colic, while fathers with migraine are not. Further research is needed to determine the mechanisms underlying these findings. In the meantime, clinicians may wish to counsel parents with a maternal history of migraine about the increased possibility of having a colicky infant and provide resources and education about infant crying. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether later high school start time is associated with lower migraine frequency in high school students with migraine. Background: Adequate sleep is thought to be important in managing adolescent migraine. The American Academy of Sleep Medicine recommends teenagers sleep ≥8 hours/night. Adolescents have a physiologically delayed sleep phase, going to bed, and waking later than children and adults. The American Academy of Pediatrics (AAP) accordingly recommends high schools start no earlier than 8:30 AM. Methods: Cross‐sectional observational study of U.S. high schoolers with migraine. Participants were recruited nationally using social media. Respondents attending high schools starting at 8:30 AM or later were compared to those attending earlier start time schools. The primary outcome was headache days/month. Results: Two hundred and fifty‐six subjects constituted the analysis set: 115 later group vs 141 earlier group. Age and sex did not differ. Mean (SD) self‐reported headache days/month were 7 (5) vs 8 (7), respectively, (P = .985); mean difference (95% CI for the difference) was −0.8 (−2.3‐0.7) days. Median (IQR) self‐reported total hours of sleep/school night were: 5.6 (5.0‐6.6) vs 5.6 (4.5‐6.4), P = .058. Students attending later start time schools woke later (median [IQR] 6:38 AM [55 minutes] vs 6:09 AM [59 minutes], P < .0001) and left home later (median [IQR] 7:28 AM [28 minutes] vs 7:02 AM [60 minutes], P < .0001). Average commute time was also longer: 41 (21) minutes vs 28 (16), P < .0001. The vast majority in both groups reported missing breakfast at least once/week: 103/114 (90.4%) vs 128/141 (90.8%), P = .907. Hours of sleep did not correlate with headache days per month. Conclusion: High school start time does not have a large effect on headache frequency in high schoolers with migraine. Given the high variance in headache days/month observed in this study, a larger study would be needed to determine whether there might still be a small effect of starting high school at/after 8:30 AM. More research is needed to establish evidence‐based recommendations about lifestyle factors in adolescent migraine management. [ABSTRACT FROM AUTHOR]

BACKGROUND: Guidelines recommend avoidance of several psychoactive medications such as hypnotics in older adults due to their adverse effects. Older patients on hemodialysis may be particularly vulnerable to complications related to use of these agents, but only limited data are available about the risks in this population. OBJECTIVES: To evaluate the association between the use of psychoactive medications and time to first emergency department visit or hospitalization for altered mental status, fall, and fracture among older patients receiving hemodialysis. DESIGN: Observational cohort study. SETTING: National registry of patients receiving hemodialysis (US Renal Data System). PARTICIPANTS: A total of 60 007 adults 65 years or older receiving hemodialysis with Medicare Part D coverage in 2011. MEASUREMENTS: The predictors were use of sedative‐hypnotics and anticholinergic antidepressants (modeled as separate time‐varying exposures). The outcomes were time to first emergency department visit or hospitalization for altered mental status, fall, and fracture (modeled separately). RESULTS: Overall, 17% and 6% used sedative‐hypnotics and anticholinergic antidepressants, respectively, in 2011. In multivariable‐adjusted Cox regression, anticholinergic antidepressant use was associated with a 25%, 27%, and 39% higher hazard of altered mental status, fall, and fracture, respectively, compared with no use. Use of sedative‐hypnotics was not associated with adverse outcomes. CONCLUSION: Anticholinergic antidepressants were associated with adverse outcomes in older hemodialysis patients, and alternative treatments should be considered. Sedative‐hypnotics were not associated with the risks evaluated in this study, but further investigation of the harms of this class of agents is warranted before their recommendation as a treatment option for insomnia in this population. J Am Geriatr Soc 67:449–454, 2019. See related Editorial by Rasheeda Hall in this issue. [ABSTRACT FROM AUTHOR]

Summary: Background: There is no cure or firm clinical recommendations for the treatment of vitiligo. One of the main issues is the heterogeneity of outcome measures used in randomized controlled trials for vitiligo. Objectives: To define successful repigmentation from the patients' point of view and to propose how and when repigmentation should be evaluated in clinical trials in vitiligo. Methods: We conducted three workshops with patients with vitiligo and their parents or caregivers. Workshop 1 was held at World Vitiligo Day (Detroit, MI), workshop 2 at the University of Texas Southwestern Medical Center and workshop 3 at the Vitiligo and Pigmentation Institute of Southern California, University of California. Results: Seventy‐three participants were recruited. Consensus on the following questions was achieved unanimously: (i) the definition of 'successful repigmentation' was 80–100% of repigmentation of a target lesion and (ii) both an objective and a subjective scale to measure repigmentation should be used. Conclusions: This was the largest patients' outcomes workshop. We followed the guidance from the CSG‐COUSIN and the Vitiligo Global Issues Consensus Group. Our recommendations to use percentage of repigmentation quartiles (0–25%, 26–50%, 51–79%, 80–100%) and the Vitiligo Noticeability Scale are based on the best available current evidence. A limitation of the research is that the workshops were conducted only in the U.S.A., due to pre‐existing organisational support and the availability of funding. What's already known about this topic? There are no firm clinical recommendations for the treatment of vitiligo.One of the main issues is the heterogeneity of outcome measures used in randomized controlled trials for vitiligo. What does this study add? Based on international consensus and the best available evidence, repigmentation should be assessed by measuring the percentage of repigmentation in quartiles (0–25%, 26–50%, 51–79%, 80–100%).The cosmetic acceptability of results should also be assessed, for example using the Vitiligo Noticeability Scale. Respond to this article Linked Comment:Wolkerstorfer. Br J Dermatol 2019; 180:454–455. Plain language summary available online [ABSTRACT FROM AUTHOR]

Natural gas production in the United States has increased rapidly over the past decade, along with concerns about methane (CH4) fugitive emissions and its climate impacts. Quantification of CH4 emissions from oil and natural gas (O&NG) operations is important for establishing scientifically sound policies for mitigating greenhouse gases. We use the aircraft mass balance approach for three flight experiments in August and September 2015 to estimate CH4 emissions from O&NG operations over the southwestern Marcellus Shale. We estimate a mean CH4 emission rate as 21.2 kg/s with 28% coming from O&NG operations. The mean CH4 emission rate from O&NG operations was estimated to be 1.1% of total NG production. The individual best‐estimate emission rates from the three flight experiments ranged from 0.78 to 1.5%, with overall limits of 0% and 3.5%. These emission rates are at the low end of other top‐down studies, but consistent with the few observational studies in the Marcellus Shale region as well as the U.S. Environmental Protection Agency CH4 inventory. A substantial source of CH4 (~70% of observed CH4 emissions) was found to contain little ethane, possibly due to coalbed CH4 emitted either directly from coal mines or from wells drilled through coalbed layers in O&NG operations. Recent regulations requiring capture of gas from the completion‐venting step of hydraulic fracturing appear to have reduced the atmospheric release of CH4. Our study suggests that for a 20‐year time scale, energy derived from the combustion of natural gas extracted from this region likely exerts a net climate benefit compared to coal. Plain Language Summary: In this study methane (CH4) emission rates were estimated for the southwest Marcellus Shale based on airborne observations. A mean emission rate of ~21 kg CH4/s was observed from a 4,200‐km2 study area. A significant portion (~70%) of the emitted CH4 was found to originate likely from coalbeds. Our mean estimated emission rate of 1.1% of total natural gas production indicates a climate benefit of natural gas combustion compared to coal, but the full range includes values above the 2.4% break‐even point for the CH4 global warming potential over a 20‐year time horizon. Key Points: A CH4 emission rate of ~21 kg/s from a 4200 km2 area of the southwestern Marcellus in 2015 with the bulk of the CH4 coming from coalbedsWe estimate a mean CH4 emission rate of 1.1% of total natural gas production with a lower limit of 0% and an upper limit of 3.5%The mean emission rate indicates a climate impact of CH4 combustion below that of coal, but the full range includes values above this point [ABSTRACT FROM AUTHOR]

Food insecurity in US affects African Americans, Hispanic, and American Indians disproportionately compared to Caucasians. Ethnicity/race may influence the strategies parents use to reduce the effects of food insecurity. The purpose of this review is to compare coping strategies for food insecurity used by parents of different ethnicities/race as reported in published literature. A systematic search on PubMed and Embase yielded 983 studies, of which 13 studies met inclusion criteria and were reviewed. All groups used public and private assistance, social networks, nutrition related, and financial-related strategies. The limited evidence suggests that there are differences in how parents of different ethnicities/race apply these coping strategies. Current evidence is insufficient to confidently determine the extent of these differences. This review is a starting point for exploration of cultural differences in how parents of various ethnicities/race cope with food insecurity and identifies specific areas for further research. [ABSTRACT FROM AUTHOR]

With pharmaceutical companies shrinking their research departments and exiting out of efforts related to unprofitable diseases, society has become increasingly dependent on academic institutions to perform drug discovery and early-stage translational research. Academic drug discovery and translational research programs assist in shepherding promising therapeutic opportunities through the so-called valley of death in the hope that a successful new drug will result in saved lives, improved health, economic growth, and financial return. We have interviewed directors of 16 such academic programs in the United States and found that these programs and the projects therein face numerous challenges in reaching the clinic, including limited funding, lack of know-how, and lack of a regional drug development ecosystem. If these issues can be addressed through novel industry partnerships, the revision of government policies, and expanded programs in translational education, more effective new therapies are more likely to reach patients in need. [ABSTRACT FROM AUTHOR]

The article describes the weather conditions in U.S. during the month of May 2018. Topics discussed include occurrence of warmth and erratic rainfall, prevalence of wet weather in middle and southern Atlantic States and transition from winter to summer climate. Topics including the occurrence of severe thunderstorms during May 1-3, 2018, precipitation during May 12, 2018 and details on the Alberto storm are discussed.

The article focuses on weather conditions in the U.S. from March to April 2018. Topics include a late season barrageof storms nearly quadrupled the average water content of the Sierra Nevada, California and Nevada snowpack between mid-February 2018 and the end of March 2018, and wild weather moved around as storms continued to batter various parts of the country and heavy showers and locally severe thunderstorms struck parts of the Southeast.

This study investigated relationships between cross-cultural competence, social support, and international students' psychological adjustment. Participants included 94 international students studying in the United States. The researchers conducted a series of standard multiple regression analysis to predict autonomy and environmental mastery as measured by the Ryff Scales of Psychological Well-Being (Ryff & Keyes, 1995). They found significant positive relationships between autonomy and cross-cultural competence as measured by the Intercultural Competence Scale (ICCS; Fantini & Tirmizi, 2006), and environmental mastery and social support as measured by the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, & Farely, 1988). A significant negative relationship was also found between length of residency in the host country, autonomy, and environmental mastery. [ABSTRACT FROM AUTHOR]

The article describes weather conditions in the U.S. in July 2017. During the month, a lack of rainfall was observed in much of the upper Midwest and from the Pacific Coast to the northern Plains, which contributed to a rash of wildfires in California and the Northwest and stress on crops in the country's breadbasket. Parts of the southeastern Plains experienced early-July downpours. Record flooding occurred in southeastern Wisconsin and northeastern Illinois during the first half of the month.

Current antitrust orthodoxy focuses on short-term price/output factors. This increasingly criticized model does not adequately protect competition in industries in which individuals and small firms thrive. Small entrepreneurs may be efficient for a variety of reasons, including the incentives that flow from owner operation, the personal relationships that lead to superior service, or the strong creative component of the business. Despite advantages in efficiencies and superior willingness to innovate, small providers have been forced out of the market by intended or unintended effects of antitrust enforcement decisions and regulatory initiatives. This Article explores the concept of entrepreneurial choice and its application to small entrepreneurs. Recognizing the metric of entrepreneurial choice, along with consumer choice, is critical to protecting competition and restoring antitrust relevancy. To address these issues, the Article examines shortcomings in enforcement and regulatory policies in three critical industries--agriculture, healthcare, and communications and entertainment--and compares these industries to the wine and beer industries, where creative small entrepreneurs have a revitalized presence. This Article concludes by offering an approach for protecting efficient and in-demand small entrepreneurs while enhancing life choices for consumer and seller alike. In industries in which small entrepreneurs are efficient, this formula includes enhanced merger control, more vigorous antitrust enforcement to maintain open distribution, and greater tolerance for small seller collective actions needed to offset monopsony power. [ABSTRACT FROM AUTHOR]

Management of symptoms following traumatic brain injury (TBI) can be complex and remains a high priority for Department of Defense (DoD) and Department of Veteran Affairs (VA). Concurrently, awareness of TBI in the public has increased. VA convened a State of the Art (SOTA) Conference to identify priorities for future research and promote best practices for TBI care. Scientific evidence of effective management of symptoms following TBI is expanding, and this evidence has been synthesized into Clinical Practice Guidelines (CPGs) and Clinical Practice Recommendations (CPRs). Knowledge gaps still exist and research efforts to address these gaps should include leveraging large administrative data sets and existing registries to determine effective treatments, investigate compliance of existing clinical care with CPGs and study limitations to determine modifiable vs. non-modifiable core tenants of the evidence-based treatments. [ABSTRACT FROM PUBLISHER]

Since the racially segregated space of the United States operates as a habitat of white supremacy, the vice of white supremacy pervades the church's corporate body and thereby permeates all of its practices, including those of baptism and the Eucharist. Rather than turning to the church's sacraments as an antidote to the vices of a presumed external culture, this paper chronicles the way in which these very practices have been corrupted by it. The church cannot reform itself from within. In order to enable these sacraments to build the body of Christ, the church must work to dismantle regnant patterns of white supremacist racial segregation in the world. [ABSTRACT FROM PUBLISHER]

The article profiles the life and career of former Idaho attorney and U.S. Securities and Exchange Commission (SEC) Chairman Hamer H. "Judge" Budge, and it mentions the author's experiences during a legal clerkship at the SEC during the twentieth century. Ex-University of Idaho College of Law Dean George Bell is addressed, along with information about Budge's 10 years as a member of the U.S. Congress, his political skills, and his service in the U.S. Navy during World War II.

Background: Homeless and unstably housed women living in an urban setting are at risk for sexually transmitted diseases, yet the seroprevalence and correlates of herpes simplex virus type 2 (HSV-2) specific to impoverished women are poorly understood. Materials and Methods: Between April and October 2010, we conducted a cross-sectional analysis of sociodemographic, structural, and behavioral factors associated with prevalent HSV-2 infection (recent and historical infections) within a community-recruited cohort of homeless and unstably housed women. Logistic regression modeling was used to identify independent sociobehavioral correlates of HSV-2 infection. Results: Among 213 women (114 HIV positive and 99 HIV negative), the median age was 49, 48% were African American, and 63% had completed high school. HSV-2 seroprevalence was 88%, and only 17% of infected women were aware of their infection. In adjusted analysis, odds of HSV-2 infection were significantly higher for those reporting at-risk drinking (adjusted odds ratio [AOR] = 7.04; 95% confidence interval [CI] = 1.59, 67.91), heterosexual orientation (AOR = 4.56; 95% CI = 1.81, 11.69), and for those who were HIV positive (AOR = 3.64; 95% CI = 1.43, 10.30). Odds of HSV-2 infection decreased as current income increased (AOR for each $500 monthly increase = 0.90; 95% CI = 0.78, 0.997). Conclusions: There is an extremely high seroprevalence of HSV-2 infection among homeless and unstably housed women, and most are unaware of their HSV-2 status. Screening all unstably housed women for HSV-2 infection, with additional counseling for sexual risk and alcohol use, may lead to the identification of more infections and be a first step in reducing additional disease transmission. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explain urban wage differentials with a special focus on educational levels. The authors explore whether the share of people with a bachelor’s degree or higher in the community matters to the wages of those within specific educational cohorts, accounting for cost of living, human capital externalities, consumer externalities, policy factors, and local labor market conditions. Using data for all U.S. Metropolitan Statistical Areas between 2005 and 2012, the authors find that the presence of more highly educated people will result in a higher median wage in the community overall, as do many studies, but that this factor does not significantly increase the wage for any individual education cohort. These results are hidden if we only look at the entire workforce in the aggregate. [ABSTRACT FROM AUTHOR]

Background: Illicit drug use is common and known to cause and exacerbate a wide spectrum of kidney disease, often leading to end-stage renal disease (ESRD), but little is known about its prevalence or associated mortality among incident hemodialysis patients.Methods: This study is a retrospective cohort analysis using data obtained from the United States Renal Data System. We assembled a cohort of 511,821 incident hemodialysis patients age 20 years and older who initiated hemodialysis between January 1, 2006 and December 31, 2010. Illicit drug dependence was defined by comorbidity on the ESRD Medical Evidence Report (Form CMS-2728). We performed survival analysis to examine the association of drug dependence with overall mortality and mortality due to diagnoses that can be associated with intravenous drug use (drug-sensitive diagnoses) in the first year after initiating hemodialysis.Results: Drug dependence was recorded for 1.5 % (n = 7,461). Drug dependence was independently associated with a 1.3-fold and 2.5-fold higher hazard of overall mortality and mortality due to a potentially drug-sensitive diagnosis [adjusted hazard ratio (AHR) 1.34 (1.27-1.41) and 2.54 (2.05-3.14), p < 0.001, respectively]. This association varied significantly by age (pinteraction < 0.001), with a 9-fold higher hazard of mortality due to a potentially drug-sensitive diagnosis among the youngest patients with drug dependence [AHR 9.21 (5.15-16.44), p < 0.001].Conclusion: Illicit drug dependence is a burden within the ESRD program and is strongly associated with premature mortality, particularly among younger patients. Targeted intervention is needed to help reduce this burden. [ABSTRACT FROM AUTHOR]