Search

Being visually impaired or legally blind (having vision that is uncorrectable or cannot be corrected to a legally acceptable level) is inherently uncertain. Although uncertainty can result in positive, negative, or neutral consequences, little is known about how uncertainty is experienced and negotiated in this understudied population. Thus, through in-depth, semi-structured interviews of 24 individuals with a visual impairment, we apply uncertainty management theory (UMT) to examine the communication strategies visually impaired individuals used to manage the personal, vision-related, and social uncertainty they experienced. Many participants appraised the uncertainty negatively and consequently aimed to reduce it by seeking social support and information, using instrumental strategies, and proactively disclosing their visual impairment. Interviewees who preferred to remain uncertain maintained it by avoiding thinking about their visual impairment or worsening vision and/or by concealing their low vision and passing as sighted. Last, some participants, particularly those who were born with low vision or had been visually impaired longer, learned to adapt to the uncertainty through reframing and accepting, self-care, and by turning to God. The study also uncovered that some participants' uncertainty management was limited by ableist constraints, such as inadequate support systems, systemic barriers, and stigma. The study also underscores the universal and fluid nature of uncertainty and uncovers tangible ways individuals with visual impairment can navigate uncertainty within a pervasive cultural biomedical model of disability. [ABSTRACT FROM AUTHOR]

Context.--: Autopsies performed on COVID-19 patients have provided critical information about SARS-CoV-2's tropism, mechanisms of tissue injury, and spectrum of disease. Objective.--: To provide an updated database of postmortem disease in COVID-19 patients, assess relationships among clinical and pathologic variables, evaluate the accuracy of death certification, and correlate disease variables to causes of death. Design.--: The 272 postmortem examinations reported in this paper were submitted by 14 pathologists from 9 medical or forensic institutions across the United States. The study spans the eras of the 3 principal COVID-19 strains and incorporates surveyed demographic, clinical, and postmortem data from decedents infected with SARS-CoV-2, including primary and contributing causes of death. It is the largest database of its kind to date. Results.--: Demographics of the decedents reported here correspond well to national statistics. Primary causes of death as determined by autopsy and official death certificates were significantly correlated. When specifically cited disease conditions found at autopsy were correlated with COVID-19 versus non-COVID-19 deaths, only lung findings characteristic of SARS-CoV-2 infection or the absence of lung findings were significantly associated. Conclusions.--: Changes in hospitalization and disease likely stem from longer lifespans after COVID-19 diagnosis and alteration in treatment approaches. Although Omicron variants preferentially replicate in the upper airways, autopsied patients who died of COVID-19 in that time period showed the same lung damage as earlier decedents. Most importantly, findings suggest that there are still unelucidated risk factors for death from COVID-19 including possibly genetic susceptibility. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiology of hamstring tears in National Collegiate Athletic Association (NCAA) sports. Design: Descriptive epidemiology study. Athletic trainers from NCAA schools reported injuries to the NCAA Injury Surveillance Program. Setting: A convenience sample of NCAA hamstring tear injuries during the 2014/2015 through 2018/2019 academic years. Patients (or Participants): NCAA student-athletes. Independent Variables: Sport, sex, event type, season segment, injury history, and activity at the time of injury. Main Outcome Measures: Injury counts, rates, and proportions were used. Results: Two thousand ninety-six hamstring tears from 8 474 400 athlete-exposures (AEs) were reported (2.47 per 10 000 AEs). Rates were highest in Men's Soccer (5.97 per 10 000 AEs) and Women's Soccer (3.13 per 10 000 AEs), among all Men's and Women's sports, respectively. Competition-related rates in Men's and Women's sports were highest in 2015 to 2016 then followed a decreasing pattern across the remainder of the study period. Among sex-comparable sports, rates were higher in men's (compared with women's) Baseball/Softball, Soccer, and Track and Field. The prevalence of recurrent injuries was comparable among men's (14.8%) and women's (11.5%) sports. Time loss hamstring tears were more prevalent in Men's sports than Women's sports [injury proportion ratio 5 1.33; 95% confidence interval, (1.21, 1.47)]. Conclusions: Overall, hamstring tear rates were higher across all Men's sports compared with Women's sports. Rates across event type were comparable in several sports; and so, adjustments to practice are needed considering that practice environments are more modifiable than competitions. Indeed, improving hamstring tear prevention programs to reduce the burden of this injury in NCAA athletes remains critical. [ABSTRACT FROM AUTHOR]

Simple Summary: The mainstay of treatment for non-muscle invasive bladder cancer is transurethral resection of the tumor followed by intravesical treatment for intermediate- or high-risk disease. Duration and type of intravesical treatment depend on specific characteristics of the tumor and the patient's disease course. Patients with non-muscle invasive bladder cancer are closely monitored with frequent surveillance cystoscopies following treatment. This type of cancer has a low progression rate; however, it has a high rate of recurrence with the current recommended treatments. Therefore, patients often find themselves having to undergo multiple resections and rounds of intravesical treatment throughout their lifetime. This is not only burdensome for patients but also costly for the healthcare system. Given the high recurrence with the standard treatment options, it is important to continue investigating novel therapies. The goal of this review article is to outline the most recent therapies available or in clinical trials for the treatment of non-muscle invasive bladder cancer. The landscape of treatment for non-muscle invasive bladder cancer is rapidly changing. A complete and careful transurethral resection is the mainstay of initial treatment and is followed by intravesical therapy in intermediate or high-risk cases. The standard of care is intravesical BCG. Many alternative or additive approaches to this are being explored. We divided this review into three relevant spaces to consider these novel treatment approaches: (1) low-risk disease, for which intravesical therapy is not usually considered, (2) BCG-naïve disease (i.e., considering alternatives to the standard therapy), and (3) BCG-unresponsive disease. We performed a review of published literature and summarized ongoing trials in the United States. Novel approaches that we explored include surgical techniques for resection, alterations in dwell time for intravesical therapy, delivery method and schedule of intravesical therapies, new intravesical therapy agents, and systemic therapies (especially immunotherapy). These are thoroughly outlined throughout this review article, and the numerous modalities being studied demonstrate significant promise for the future treatment of the expanding space of NMIBC. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding provides many short- and long-term health benefits for mothers and their infants and is a particularly relevant strategy for women who experience Gestational Diabetes Mellitus (GDM) during pregnancy. However, breastfeeding rates are generally lower amongst this group of women than the general population. This review's objective is to identify the factors that influence breastfeeding by exploring the experiences and outcomes of women in in high-income health care contexts when there is a history of GDM in the corresponding pregnancy. Methods: A comprehensive search strategy explored the electronic databases Medline, CINAHL, Web of Science and Scopus for primary studies exploring breastfeeding practices for papers published between January 2011 and June 2023. All papers were screened independently by two researchers with included papers assessed using the Crowe Critical Appraisal tool. Findings were analysed using a narrative synthesis framework. Results: From an initial search result of 1037 papers, 16 papers representing five high-income nations were included in this review for analysis – the United States of America (n = 10), Australia (n = 3), Finland (n = 1), Norway (n = 1), and Israel (n = 1). Fifteen papers used a quantitative design, and one used a qualitative design. The total number of participants represented in the papers is 963,718 of which 812,052 had GDM and 151,666 did not. Women with an immediate history of GDM were as likely to initiate breastfeeding as those without it. However, they were more likely to have the first feed delayed, be offered supplementation, experience delayed lactogenesis II and or a perception of low supply. Women were less likely to exclusively breastfeed and more likely to completely wean earlier than the general population. Maternity care practices, maternal factors, family influences, and determinants of health were contextual and acted as either a facilitator or barrier for this group. Conclusion: Breastfeeding education and support need to be tailored to recognise the individual needs and challenges of women with a history of GDM. Interventions, including the introduction of commercial milk formula (CMF) may have an even greater impact and needs to be very carefully considered. Supportive strategies should encompass the immediate and extended family who are major sources of influence. [ABSTRACT FROM AUTHOR]

Since the 1800s, there have been live load surveys and analyses carried out, particularly of area-dependent loads in office buildings. While some occupancies have received careful examination, there has been no systematic review and consideration of reliability-based scenarios for office gathering space live loads. The results of the research reported here indicates (supports) a more consistent, reliable, and economic design load for office gathering spaces in buildings. These results provide the theoretical and practical basis for design live loads for gathering spaces within offices, a step toward possible enactment in the current standard, and subsequently by adoption into the International Building Code and materials standards. Following a review of historical load surveys and theoretical models, the paper presents models and observations of crowding, serving as a basis for a different approach for such areas, including a Delphi among leading design firms in the United States. The paper concludes with recommendations for a new live load use category for gathering spaces for offices. Modern office usage often contains work spaces for meeting, gathering, and collaboration. The current standard for minimum design loads and associated criteria for buildings and other structures does not directly address this situation. Interpretation has led to conflicting requirements for the design loads of such spaces, including the possibility of assigning them as assembly areas. This can lead to overdesign and uneconomical structures. This research reviews historical office surveys with an emphasis on assembly spaces, presents the results of a Delphi of design firms throughout the United States, and contains a stochastic maximum load analysis. These various assessments lead to a consistent evaluation of plausible loads for such spaces, and a recommendation for a new subcategory in the standard live load table. The study recommends treating these spaces similar to general offices, with a basic live load of 2.39 kN/m2 (50 psf), and permissible live load reduction as is currently in the standard for offices. Exception is made for such work spaces that are directly accessible from outside and intended for use by the general public. [ABSTRACT FROM AUTHOR]

This study examined differences in mental health in older adult women before versus during the COVID-19 pandemic. Participants who were community dwelling (N = 227) included n = 67 women aged 60–94 in the pre-pandemic group and n = 160 women aged 60–85 in the peri-pandemic group who completed self-report measures assessing mental health and quality of life (QOL). We compared mental health and QOL indices across the pre- and peri-pandemic groups. Results indicated that the peri-pandemic group reported higher anxiety (F = 4.94, p =.027) than the pre-pandemic group. No other significant differences emerged. Given the differential effects in this pandemic across SES, we conducted exploratory analyses investigating differences by income group. Controlling for education and race, within the pre-pandemic group, women with lower income reported worse physical function compared to the mid- and high-income groups. Within the peri-pandemic group, women with lower income reported worse anxiety, poorer sleep, and poorer QOL (physical function, role limitations due to physical problems, vitality, and pain) than high-income individuals. Overall, women who reported lower income reported worse mental health and QOL than those with high-income, especially during the pandemic. This indicates that income might act as a buffer for older women against negative psychological outcomes of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

There are only a few instruments that assess for parentification in adults and even fewer that examine current levels of parentification among adolescents. The original Parentification Inventory (PI; Hooper, 2009) was developed to assess for parentification—a family caregiving process abdicated by adults to children—among adults in the United States. The current study evaluated the psychometric properties of an adapted version of the PI scores for its use in Polish-speaking adolescents (N = 272). The results of the confirmatory factor analysis showed that the current PI holds its original three-factor structure among the current sample and thus supports its use in Polish adolescents. [ABSTRACT FROM AUTHOR]

Objectives. There are rising concerns about the health of classroom teachers in the USA, including stress, hypertension and frequent urinary tract infections. Teacher working conditions are likely a contributor to their health concerns. Many teachers report that they cannot easily take a restroom break at work, and therefore they consume minimal water or other fluids. This study investigated the relationship between restroom access and fluid consumption and the prevalence of renal and cardiovascular health complications in classroom teachers. Methods. The responses of 844 teachers (92% women, 8% men; 65.1% between age 26 and 45 years) to an online survey about restroom accessibility, fluid consumption and health were analyzed using descriptive statistics, χ2 analyses and logistic regression. Results. Fifty-nine percent of teachers could not easily take a restroom break, and 54.7% consumed fewer than 2 cups of water per workday. Furthermore, 44.8% reported being pre-hypertensive and 4.9% reported being hypertensive. Teachers with insufficient restroom access were significantly more likely to report frequent urinary tract infections. Conclusions. This study demonstrates a relationship between restroom access, fluid consumption and renal/cardiovascular health in classroom teachers. Future research should directly investigate how teacher work environment impacts renal and cardiovascular health. [ABSTRACT FROM AUTHOR]

Background: In May 2022, the first case of monkeypox virus (MPXV) infection in the United States in the current global outbreak was identified. As part of the public health and health care facility response, a contact tracing and exposure investigation was done.Objective: To describe the contact tracing, exposure identification, risk stratification, administration of postexposure prophylaxis (PEP), and exposure period monitoring for contacts of the index patient, including evaluation of persons who developed symptoms possibly consistent with MPXV infection.Design: Contact tracing and exposure investigation.Setting: Multiple health care facilities and community settings in Massachusetts.Participants: Persons identified as contacts of the index patient.Intervention: Contact notification, risk stratification, and symptom monitoring; PEP administration in a subset of contacts.Measurements: Epidemiologic and clinical data collected through standard surveillance procedures at each facility and then aggregated and analyzed.Results: There were 37 community and 129 health care contacts identified, with 4 at high risk, 49 at intermediate risk, and 113 at low or uncertain risk. Fifteen health care contacts developed symptoms during the monitoring period. Three met criteria for MPXV testing, with negative results. Two community contacts developed symptoms. Neither met criteria for MPXV testing, and neither showed disease progression consistent with monkeypox. Among 4 persons with high-risk exposures offered PEP, 3 elected to receive PEP. Among 10 HCP with intermediate-risk exposures for which PEP was offered as part of informed clinical decision making, 2 elected to receive PEP. No transmissions were identified at the conclusion of the 21-day monitoring period, despite the delay in recognition of monkeypox in the index patient.Limitation: Descriptions of exposures are subject to recall bias, which affects risk stratification.Conclusion: In a contact tracing investigation involving 166 community and health care contacts of a patient with monkeypox, no secondary cases were identified.Primary Funding Source: None. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents with mild to moderate chronic kidney disease (CKD) are at high risk for mild but persistent impairment in executive functions, which have been associated with low health‐related quality of life (HRQOL) among children and adolescents with chronic health conditions. However, no similar link has been established among children and adolescents with mild to moderate CKD. Given the essential role executive functions play in the development of adequate cognitive, emotional and social skills, it is essential to gain a clearer understating of the magnitude and attributes of executive functions and its link to HRQOL in order to inform appropriate medical and educational interventions for this patient population. Objective: The aim of this study is to examine the relationship between executive functions, socio‐emotional functioning and HRQOL in children and adolescents with mild to moderate CKD. Methods: A cross‐sectional design was used for this secondary data analysis of 199 children and adolescents (ages 6–17) with mild to moderate CKD from the United States and Canada who receive care at hospitals associated with the Chronic Kidney Disease in Children Study (CKiD). Results: The presence of impairment in executive functions and socio‐emotional functioning (internalizing problems) significantly predicted lower HRQOL after controlling for key covariates (i.e., maternal education, anaemia and hypertension). Further, internalizing problems partially mediated the relationship between executive functions and HRQOL such that impairment in executive functions predicted lower HRQOL directly and indirectly by contributing to higher internalizing problems, which further contributed to low HRQOL. Conclusion: This study underscores the importance of executive functions and socio‐emotional functioning in the manifestation of HRQOL. Given that HRQOL is potentially compromised for many children and adolescents with mild to moderate CKD, it will be important for both clinicians and researchers to examine a range of factors, including executive functions and socio‐emotional functioning, in order to optimize HRQOL. [ABSTRACT FROM AUTHOR]

Aims In the UK, adolescents under the minimum legal purchasing age (<18 years) are aware of a variety of alcohol marketing activities. It is therefore important to examine how such marketing appeals and how it might shape consumption. This study assessed the relationships between positive reactions to alcohol adverts and susceptibility to drink among never drinkers and higher-risk drinking among current drinkers. Methods Online cross-sectional survey of 11–17 year olds (n  = 2582) in the UK. Adolescents were shown three video alcohol adverts (Fosters Radler/Haig Club Clubman/Smirnoff). Reactions to each were measured by eight scale-items (e.g. 1 = makes [Brand] seem unappealing to 5 = makes [Brand] seem appealing), which were combined into a composite score (coded: positive versus other). Logistic regressions assessed associations between overall positive advert reactions and drinking behaviours. Results Half of adolescents had overall positive reactions to the Smirnoff (52%) and Fosters (53%) adverts, and a third (34%) had a positive reaction to the Haig Club advert. Across all three adverts, positive reactions were associated with ~1.5 times increased odds of being susceptible to drink among never drinkers. Among current drinkers, positive reactions to the Foster's Radler and Haig Club adverts were associated with around 1.4 times increased odds of being a higher-risk drinker. Conclusions These alcohol advertisements commonly appealed to underage adolescents, and these reactions were associated with susceptibility among never drinkers and higher-risk consumption among current drinkers. Regulatory consideration should be given to what messages are permitted in alcohol advertising, including international alternatives (e.g. only factual information). [ABSTRACT FROM AUTHOR]

Introduction: NexQuest Natural Frequency Technology® (NFT®), intended to enhance biological function using naturally occurring frequencies, may be a nonpharmacological intervention to improve stress and health. The study purpose was to determine the effectiveness of NFT® for improving stress, sleep quality, mood, and cognition in adults. Methods: Using a double‐blind placebo‐controlled crossover design, participants with high perceived stress (N = 42, M age = 43.8) were assessed at baseline (BL) and assigned to either the Placebo Watch (PW) or Wellness Watch (WW) condition for 2 weeks, and then 2 weeks in the alternate condition. Participants completed the following self‐report surveys of Perceived Stress Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Food Craving Questionnaire, and Profile of Mood States, as well as the CNS Vital Signs neurocognitive test at BL and following each condition. Results: The WW condition had significant improvements in sleep duration and Complex Attention compared to the PW group. Compared to BL, both conditions had significant improvements for perceived stress, food cravings, mood, sleep quality, and several cognitive tests, p's <.05. Conclusion: Despite the placebo effect, NFT® may be a natural alterative for improving stress and health. Research is needed examining the efficacy of NFT® in a variety of populations and environments. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated a) racial/ethnic differences in past-year discrimination experiences and b) associations between discrimination and smoking abstinence.Design: Prospective, longitudinal analysis of smoking status. Perceived past-year discrimination was assessed at baseline. ANCOVAs and intent-to-treat hierarchical logistic regressions were conducted.Setting: Dual-site (Tampa, FL and Miami, FL) randomized controlled trial testing the effects of a group cessation intervention plus pharmacotherapy.Participants: Treatment-seeking adult smokers (N=347; non-Hispanic White, non-Hispanic African American/Black, or Hispanic).Main Outcome Measures: Biochemically verified 7-day point prevalence abstinence (7-day ppa) was assessed immediately post-intervention and at 6-month follow-up.Results: After controlling for covariates, African Americans/Blacks reported greater perceived discrimination compared with non-Hispanic Whites (P=.02), and Hispanics (P=.06). Non-Hispanic Whites and Hispanics did not differ in perceived racial/ethnic discrimination experiences over the past year. Irrespective of race/ethnicity, past-year perceived discrimination was inversely associated with 7-day ppa, both post-intervention (AOR=.97, CI: .95-.99) and at 6-months (AOR=.98, CI: .96-.99). Among African Americans/Blacks, past-year perceived discrimination was inversely associated with 7-day ppa, both post-intervention (AOR=.95, CI: .92-.97) and at 6-months (AOR=.97, CI: .94-.99). Perceived discrimination was unrelated to 7-day ppa among Hispanics. Among non-Hispanic Whites, past-year perceived discrimination was inversely associated with post-intervention 7-day ppa (AOR=.95, CI: .91-.99), but not 6-months.Conclusions: Perceived racial/ethnic discrimination was greater among African American/Black smokers compared with non-Hispanic Whites. Perceived discrimination was negatively associated with tobacco cessation in the full sample, and for African Americans at 6-months post-intervention. These data have implications for intervention delivery and health disparities. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is associated with increased risk of poor health outcomes from respiratory infections, including COVID-19 illness. We used US death data to investigate changes in SCD-related mortality before and during the COVID-19 pandemic. We estimated annual age- and quarter-adjusted SCD-related mortality rates for 2014-2020. We estimated the number of excess deaths in 2020 compared with 2019 using the standardized mortality ratio (SMR). We found 1023 SCD-related deaths reported in the United States during 2020, of which 86 (8.4%) were associated with COVID-19. SCD-related deaths, both associated and not associated with COVID-19, occurred most frequently among adults aged 25-59 years. The SCD-related mortality rate changed <5% year to year from 2014 to 2019 but increased 12% in 2020; the sharpest increase was among adults aged ≥60 years. The SMR comparing 2020 with 2019 was 1.12 (95% CI, 1.06-1.19). Overall, 113 (95% CI, 54-166) excess SCD-related deaths occurred in 2020. [ABSTRACT FROM AUTHOR]

Research Findings: This study provides a framework for categorizing one subset of the large and heterogeneous group of home-based child care providers, unlisted paid providers. We analyzed data on unlisted paid home-based child care providers (n = 448) from the 2012 National Survey of Early Care and Education conducted in the United States. We used latent profile analysis to explore how providers align into profiles based on key characteristics related to their caregiving beliefs, self-reported instructional practices, professional engagement, and family supportive practices. Findings reveal that unlisted paid home-based providers align into three profiles: Low Instruction, Low Professional Development (51.3%, n = 230); Higher Instruction (35.2%, n = 158); and Engaged with Outside Systems (13.4%, n = 60). Results suggest that there is variation in providers' instructional practices, family supports, and professional engagement activities among profiles. Additionally, provider age, enrollment characteristics, and neighborhood urban density predicted profile membership. Practice or Policy: Results provide insight into the design and implementation of quality improvement supports for this subset of home-based child care providers. Using this typology can help match unlisted paid home-based providers with supports that align with their beliefs and practices. It also adds to the limited research base about this subset of providers that can be used to guide practices and policies related to home-based child care. [ABSTRACT FROM AUTHOR]

Sexual harassment (SH) and sexual assault (SA) continue to be a focus of prevention efforts in the U.S. military because of the prevalence and potential to affect the health and readiness of service members. Limited research exists on the association of SH and SA with coping behaviors, such as physical activity, within the military. Data including self-reported SA, SH, and physical activity were obtained from the Millennium Cohort Study, a longitudinal cohort study designed to examine the impact of military service on the health and well-being of service members. A hierarchical regression approach was applied to examine the association between SH or SA and subsequent physical activity levels. Hierarchical regression showed that, among those self-reporting recent SA, the odds of medium-high (300-449 min/week) and high physical activity levels (≥450 min/week) were significantly increased. Although the magnitude of these associations was attenuated with an increasing amount of adjustment, the odds of high physical activity levels remained statistically significant in the fully adjusted model (medium-high: odds ratio [OR] = 1.72, 95% confidence interval [CI] = [1.08, 2.73]; high: OR = 1.58, 95% CI = [1.02, 2.44]). We observed statistically significant negative associations between recent SH and medium-high physical activity levels in adjusted models (OR = 0.70, 95% CI = [0.54, 0.91]). The current results demonstrate that SA is generally associated with increased levels of physical activity among military service members. Analyzing the relationship between sexual trauma and physical activity is valuable because of the high prevalence of SH and SA in the military, long-term health implications including physical and emotional well-being, and potential impact on military readiness. [ABSTRACT FROM AUTHOR]

Background Tremendous progress towards elimination of trachoma as a public health problem has been made. However, there are areas where the clinical indicator of disease, trachomatous inflammation—follicular (TF), remains prevalent. We quantify the progress that has been made, and forecast how TF prevalence will evolve with current interventions. We also determine the probability that a district is a transmission-hotspot based on its TF prevalence (ie, reproduction number greater than one). Methods Data on trachoma prevalence come from the GET2020 global repository organized by the World Health Organization and the International Trachoma Initiative. Forecasts of TF prevalence and the percent of districts with local control is achieved by regressing the coefficients of a fitted exponential distribution for the year-by-year distribution of TF prevalence. The probability of a district being a transmission-hotspot is extrapolated from the residuals of the regression. Results Forecasts suggest that with current interventions, 96.5% of surveyed districts will have TF prevalence among children aged 1–9 years <5% by 2030 (95% CI: 86.6%–100.0%). Districts with TF prevalence < 20% appear unlikely to be transmission-hotspots. However, a district having TF prevalence of over 28% in 2016–2019 corresponds to at least 50% probability of being a transmission-hotspot. Conclusions Sustainable control of trachoma appears achievable. However there are transmission-hotspots that are not responding to annual mass drug administration of azithromycin and require enhanced treatment in order to reach local control. [ABSTRACT FROM AUTHOR]

* Context.--This study represents the largest compilation to date of clinical and postmortem data from decedents with coronavirus disease 2019 (COVID-19). It will augment previously published small series of autopsy case reports, refine clinicopathologic considerations, and improve the accuracy of future vital statistical reporting. Objective.--To accurately reflect the preexisting diseases and pathologic conditions of decedents with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection through autopsy. Design.--Comprehensive data from 135 autopsy evaluations of COVID-19--positive decedents is presented, including histologic assessment. Postmortem examinations were performed by 36 pathologists at 19 medical centers or forensic institutions in the United States and Brazil. Data from each autopsy were collected through the online submission of multiple-choice and open-ended survey responses. Results.--Patients dying of or with COVID-19 had an average of 8.89 pathologic conditions documented at autopsy, spanning a combination of prior chronic disease and acute conditions acquired during hospitalization. Virtually all decedents were cited as having more than 1 preexisting condition, encompassing an average of 2.88 such diseases each. Clinical conditions during terminal hospitalization were cited 395 times for the 135 autopsied decedents and predominantly encompassed acute failure of multiple organ systems and/or impaired coagulation. Myocarditis was rarely cited. Conclusions.--Cause-of-death statements in both autopsy reports and death certificates may not encompass the severity or spectrum of comorbid conditions in those dying of or with COVID-19. If supported by additional research, this finding may have implications for public health decisions and reporting moving forward through the pandemic. [ABSTRACT FROM AUTHOR]

Importance: Occupational therapy students must master knowledge of occupation, yet how educators assess such knowledge has not been explored. In this study, we elucidate robust assessment practices that can help students master knowledge of occupation. Objective: To examine practices that educators use to assess knowledge of occupation. Design: Basic qualitative research. Using inductive and constant comparative methods, we coded 25 interviews and 82 educational artifacts for assessment practices, categorized practices as direct or indirect, and analyzed their alignments with features of robust assessments. Setting: Twenty-five randomly selected occupational therapy and occupational therapy assistant academic programs in the United States, stratified by geographic region and institution type. Participants: Twenty-nine educators who represented selected programs. Results: We found occupation at instruction and program levels primarily in relation to practice using indirect more than direct practices. Assignments were often highly creative and experiential, yet varied in their alignments with established criteria of robust assessments. Conclusions and Relevance: Knowledge of occupation was often intertwined with practice-oriented learning experiences and skills; hence, it was not assessed as a distinctly indispensable learning outcome. Educators can build on current practices to design robust assessments that require students to demonstrate knowledge of occupation in practice contexts and everyday life. What This Article Adds: In this study, we elucidate a continuum of prevalent educational practices used to assess knowledge of occupation; we also review best practices for robust assessments of such knowledge not only related to practice but also as a dynamic instrument of individual and societal well-being more broadly. [ABSTRACT FROM AUTHOR]

Background: Childhood vaccines prevent more than 10 million illnesses and 33,000 deaths in the United States each year. Noncompliance rates for children 2 and under are higher in underserved and resource poor communities. Objective: The aim of this project was to develop and implement a five-step, direct-call reminder system to increase vaccination rates among children ages 2 and under presenting to a federally qualified health center (FQHC). Methods: This project examined whether direct phone contact with parents can increase office visits to discuss vaccine status over a 6-week period following implementation of a five-step, direct-call reminder system. Results: 47 parents/guardians were contacted from a list of 455 patients. Thirty-six percent of parents contacted scheduled and kept appointments. Conclusions: This study found that the vaccines rates of a FQHC practice initiative are directly affected by methods of contact and knowledge of the vaccine schedule. Reaching out and discussing vaccine schedules with parents can increase vaccination rates. Yet, many of them have limited methods of contact. Implications for Nursing: A five-step, direct-call reminder system has a positive impact on vaccination compliance. Vaccination compliance is complicated, and approaches should be multifaceted. [ABSTRACT FROM AUTHOR]

Introduction: Despite the strong relationship between marijuana and tobacco use, especially among African American individuals and males, very few studies have examined the association between marijuana and menthol cigarette use. This study was designed to identify the prevalence of past month, past year and lifetime marijuana use and marijuana dependence among menthol and non-menthol cigarette smokers, as well as the association between marijuana and menthol cigarette use among African American female and male cigarette smokers. Methods: Data were drawn from 1,173 African American adult cigarette smokers in the 2017 National Survey on Drug Use and Health. Results: Overall, 8.8%, 13.9% and 44.7% of African American menthol and non-menthol cigarette smokers reported past month, past year and lifetime marijuana use, respectively. Weighted multivariable logistic regression models revealed a significant interaction between gender and past month marijuana use on menthol cigarette use (AOR = 1.49, 95% CI: 1.21-2.42, p <.05). Past month marijuana use was associated with an increased odds of past month menthol cigarette use (relative to non-menthol cigarette use) among females, but a decreased odds of past of past month menthol cigarette use among males. Conclusions: When stratified by gender, marijuana use is differentially related to menthol cigarette use among African American adults. Given the prevalence of menthol cigarette use among this population, it is important to examine factors such as marijuana use that could be targeted in prevention and treatment interventions for African Americans, especially females, who are at risk for smoking or are currently smoking menthol cigarettes. Implications: This study found that marijuana use was associated with an increased odds of menthol cigarette use among African American females, while marijuana use was associated with a decreased odds of menthol cigarette use among their male counterparts. The impact of marijuana use on menthol cigarette smoking differs among females and males, highlighting the need for gender-tailored interventions that target marijuana use among African American individuals, especially females, who are at risk for smoking or are currently smoking menthol cigarettes. [ABSTRACT FROM AUTHOR]

Introduction: There are many options available to patients who are placed on constant positive airway pressure (CPAP) for obstructive sleep apnea. Despite the success of CPAP in correcting apnea, a significant number of patients have difficulty with the therapy. A large number of those patients who have difficulty stop therapy and are often labeled as "CPAP Failure". Non-sleep specialists may view CPAP therapy as a singular course of treatment, but there are many ways CPAP may be ordered for a patient. Each patient experiences a unique set of options that constitute a unique order set. Methods: In order to demonstrate the magnitude of the possible options, estimates of the number of unique order sets were calculated. The author chose individual order options and the number of selections possible within each option. The calculated sets included a "Generous, Limited and Minimal" number of selections for each option. Calculations were done separately for standard CPAP and for auto-adjusting CPAP. Additional calculations were performed using the number of commercially available masks in the United States. Results: The maximum number of unique order sets was seen using a standard CPAP combined with commercially available masks: 49,152 unique order sets. The fewest number of unique order sets were seen with the auto-adjusting CPAP and the "Minimal" selections: 288 unique order sets. Discussion: There are a large number of unique CPAP orders that a patient may experience. CPAP treatment is not a singular or simple therapy. When evaluating obstructive sleep apnea patients with histories of CPAP failure or prior difficulty with CPAP, paying close attention to the patient's treatment experiences may help explain a significant number of those patients' CPAP therapy problems. [ABSTRACT FROM AUTHOR]

Importance: Artifacts convey essential skills, tools, and concepts to students. Studies of artifacts can therefore illumine priorities for learning. Objective: To describe the skills, tools, and concepts that assignment artifacts required students to learn, especially in relation to occupation. Design: Educators submitted 243 artifacts that illustrated how their programs addressed occupation. Artifacts included syllabi, lectures, assignments, rubrics, study guides, texts, and learning objectives. A sociocultural research paradigm informed a secondary analysis of all assignment artifacts. Assignments were coded for the skills, tools, and underlying concepts students were to use, particularly related to occupation. Setting: U.S. occupational therapist and occupational therapy assistant academic programs. Participants: Twenty-five U.S academic programs selected through stratified random sampling that targeted representation by geographic region and the Carnegie Classification of Institutions of Higher Education. Fifteen occupational therapy and 10 occupational therapy assistant programs consented. Results: Assignment artifacts required students to interview, observe, analyze, and teach (skills); artifacts emphasized learning the Occupational Therapy Practice Framework: Domain and Process (tool). Few artifacts required students to relate skills and tools to broader concepts, including occupation. Those that did used prompts that were ancillary to the assignment. Grading rubrics seldom measured students' ability to connect skills and tools to occupation. Conclusions and Relevance: By emphasizing skills and tools detached from the concepts supporting their relevance to occupation, the artifacts reflected black box learning. Creating artifacts that reflect glass box learning can improve education. In glass box learning, artifacts are transparent and clearly delineate the skills, tools, and conceptual understandings to be gained. What This Study Adds: For researchers, the study highlights the importance of including artifacts in studies of occupational therapy education. For educators, the study gives guidance for creating assignments that clearly delineate skills, tools, and concepts. [ABSTRACT FROM AUTHOR]

Background: In 2014, passive immunization by transfusion of Ebola convalescent plasma (ECP) was considered for treating patients with acute Ebola virus disease (EVD). Early Ebola virus (EBOV) seroconversion confers a survival advantage in natural infection, hence transfusion of ECP plasma with high levels of neutralizing EBOV antibodies is a potential passive immune therapy. Techniques to reduce the risk of other transfusion-transmitted infections (TTIs) are warranted as recent ECP survivors are ineligible as routine blood donors. As part of an ongoing clinical trial to evaluate the safety and effectiveness of ECP, the impact of amotosalen/UVA pathogen reduction technology (PRT) on EBOV antibody characteristics was examined.Study Design and Methods: Serum and plasma samples were collected from EVD-recovered subjects at multiple timepoints and evaluated by ELISA for antibodies to recombinant EBOV glycoprotein (GP) and irradiated whole EBOV antigen, as well as for EBOV microneutralization, classic plaque reduction neutralization test (PRNT) and EBOV pseudovirion neutralization assay (PsVNA) activity.Results: Six subjects donated 40 individual ECP units. Substantial antibody titers and neutralizing activity results were demonstrated but were generally lower for the ACD plasma samples compared to the serum samples. Anti-EBOV titers by all assays remained essentially unchanged after PRT.Conclusion: Treatment of ECP with PRT to reduce the risk of TTI did not significantly reduce EBOV IgG antibody titers or neutralizing activity. Although ECP was used in the treatment of repatriated patients, no PRT units from this study were transfused to EVD patients. This inventory of PRT-treated ECP is currently available for future clinical evaluation. [ABSTRACT FROM AUTHOR]

The resegregation of public schools in the United States continues to place African American students at an academic disadvantage with—oftentimes—limited educational resources and fewer qualified teachers. Providing African American students with skills and strategies to succeed has never been more urgent. Metacognition, often defined simply as "thinking about thinking," is a construct and process that may explain how students can improve and control their thinking and learning. Given the educational inequality African American students often face, providing strategies—with which they have control—may help empower students to better navigate and make the best of their daily academic experiences and environment composed of limited physical and human resources. Toward this end, recent research on metacognition looks promising and may be one viable option to enhance academic achievement among students. In this article, we consider three related areas that inform African American youth educational experiences: (a) the history of the educational context which African American youth have long faced, (b) the laws that have historically and currently buttress and inform the educational landscape for African American youth, and (c) one potential solution (i.e., metacognitive knowledge, skills, and awareness) to reduce or ameliorate some of the problems outlined in the history and laws that have been implicated in the low levels of academic achievement among some African American youth. Following the review of these related literature bases, we offer recommendations on how the extant literature bases may inform directions for future research that is focused on metacognition and that is ethically and culturally responsive. [ABSTRACT FROM AUTHOR]

Research indicates that executive functioning may predict health behavior. This systematic review provides an overview of the relationship between domains of executive functioning and health behaviors associated with the leading causes of death in the United States. A total of 114 articles met the inclusion criteria (adult sample, published in English between 1990 and November 2016) and were reviewed and synthesized. Results indicated that although many studies had mixed findings, at least one executive function component was associated with every health behavior. Based on these results, health professionals should consider the role of executive functions in behavior change interventions. [ABSTRACT FROM AUTHOR]

The arrival of spotted wing Drosophila, Drosophila suzukii (Matsumura), to the United States has caused many berry and cherry growers to replace IPM programs with calendar-based broad-spectrum insecticide programs. Alternative management tactics are urgently needed to mitigate the current dependency on chemical control. Postharvest burial is a cultural crop sanitation strategy that has the potential to reduce D. suzukii reproductive habitat and eliminate infested fruit wastes. This study revealed that D. suzukii rarely pupate on the soil's surface or below 1 cm, but are capable of unburying themselves from depths up to 48 cm. Although zero emergence was not obtained in the field, adult emergence decreased exponentially with deeper burial depths. A burial depth of 24 cm reduced D. suzukii emergence by 97%, although soil texture may influence this optimal burial depth. Soils that had a higher concentration of sand had a negative impact on D. suzukii survival at shallower burial depths. The mechanism behind the reduction in adult emergence from differing burial depths remains unclear as the lipid concentration between emerging D. suzukii was the same regardless of burial depth. [ABSTRACT FROM AUTHOR]

Americans first saw motion pictures on a screen in 1896 but had begun to tire of cinema's stale offerings by the end of 1897, and American filmmakers were considering abandoning the unprofitable medium. Then the USS Maine exploded in Havana Harbor (15 February 1898), and a small band of entrepreneurs rushed to capitalize on the disaster. Seizing upon the Spanish-American War's inherent drama, they created films with narrative power, which brought audiences back to theaters and enabled the pioneers to survive the embryonic American film industry's near financial collapse. They soon led the motion picture industry west and helped to make Hollywood the cinematic capital of the world. [ABSTRACT FROM AUTHOR]

Background: Focal segmental glomerulosclerosis (FSGS) in pediatric patients is typically difficult to treat and will progress to end-stage renal disease (ESRD) in about 10% of cases. Following kidney transplantation, FSGS can recur in up to 56% of renal allografts—with a near 100% recurrence in subsequent transplants. Methods: Four different pediatric centers across the USA and the UK employed a protocol using LDL-apheresis (LDL-A) and pulse solumedrol to treat recurrent FSGS after transplantation in seven patients. All the patients included in this series demonstrated immediate, or early, recurrence of FSGS, which clinically presented as nephrotic-range proteinuria within hours to days after implantation of the kidney. Results: All patients experienced reductions in urinary protein to creatinine ratios resulting in partial or complete remission. All patients demonstrated improvements in their estimated GFRs at their most recent follow-up since LDL-A discontinuation. Conclusions: This case series describes the successful treatment, across four different pediatric centers, of seven pediatric patients with recurrent post-transplant FSGS using the Liposorber® LA-15 in combination with pulse solumedrol. [ABSTRACT FROM AUTHOR]

Background: While the keeping of pets has been shown to protect against childhood allergic disease and obesity, less is known regarding potential associations of prenatal pet keeping and attention deficit hyperactivity disorder (ADHD). We sought to examine the associations between prenatal dog or cat keeping with caregiver-reported ADHD in preadolescents in the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study (WHEALS) birth cohort (N = 1258).Methods: At an interview with the caregiver at child age 10-12 years, caregivers reported if the WHEALS child had ever been diagnosed with ADHD. Similarly, during an interview with the mother prenatally, pet keeping (defined as dog or cat kept inside ≥1 h/day) was ascertained. Logistic regression models were fit to examine the association of prenatal pet keeping (dog keeping and cat keeping, separately) with ADHD.Results: A subset of 627 children were included in the analyses: 93 who had ADHD and 534 with neurotypical development. After accounting for confounders and loss to follow-up, maternal prenatal dog exposure was associated with 2.23 times (95% CI: 1.15, 4.31; p = 0.017) greater odds of ADHD among boys. Prenatal dog keeping was not statistically significantly associated with ADHD in girls (odds ratio = 0.27, 95% CI: 0.06, 1.12; p = 0.070). Prenatal cat keeping was not associated with ADHD.Conclusions: In boys, but not girls, maternal prenatal dog keeping was positively associated with ADHD. Further study to confirm these findings and to identify potential mechanisms of this association (e.g., modification of the gut microbiome, exposure to environmental toxicants or pet-related medications) is needed. [ABSTRACT FROM AUTHOR]

Importance: Occupational therapy practitioners' professional identities and distinctive contributions to health care connect essentially to their knowledge of occupation. Thus, the strategies educators use to convey occupation to students and the perspectives embedded in those strategies are critical topics for researchers. Objective: To generalize findings from a previous qualitative study of how educators in 25 U.S. occupational therapy assistant and occupational therapy programs addressed occupation to a national sample of educators. Design: As part of an exploratory sequential design, a national survey of U.S. occupational therapy and occupational therapy assistant educators explored activities and strategies used to teach occupation. Data were analyzed using descriptive statistics. Setting: An online survey about educators' practices in the academic education setting. Participants: Occupational therapy and occupational therapy assistant educators (N = 1,590) from all programs in the United States. Of these, 634 returned surveys, 315 of which were complete and included in the analysis, for an overall response rate of 19.8%. Results: Respondents identified similar learning activities and instructional strategies as those identified in the qualitative phase of the design. Most instruction was active and experiential, requiring students to integrate various skills and content areas. Definitions of occupation, as a basis for teaching, varied. Conclusions and Relevance: The combined survey and qualitative results offered initial empirical support for occupational therapy's proposed signature pedagogies and the importance of attending to the deep and implicit structures within those pedagogies. Such structures are believed to support students' formation of a professional identity and an occupational perspective. What This Article Adds: This study provides evidence for the instructional strategies that educators use to convey knowledge of occupation to students. The predominant strategies support proposed signature pedagogies in occupational therapy: relational learning, affective learning, and highly contextualized active learning. [ABSTRACT FROM AUTHOR]

Background Clinicians increasingly utilize polymyxins for treatment of serious infections caused by multidrug-resistant gram-negative bacteria. Emergence of plasmid-mediated, mobile colistin resistance genes creates potential for rapid spread of polymyxin resistance. We investigated the possible transmission of Klebsiella pneumoniae carrying mcr -1 via duodenoscope and report the first documented healthcare transmission of mcr -1–harboring bacteria in the United States. Methods A field investigation, including screening targeted high-risk groups, evaluation of the duodenoscope, and genome sequencing of isolated organisms, was conducted. The study site included a tertiary care academic health center in Boston, Massachusetts, and extended to community locations in New England. Results Two patients had highly related mcr -1–positive K. pneumoniae isolated from clinical cultures; a duodenoscope was the only identified epidemiological link. Screening tests for mcr -1 in 20 healthcare contacts and 2 household contacts were negative. Klebsiella pneumoniae and Escherichia coli were recovered from the duodenoscope; neither carried mcr -1. Evaluation of the duodenoscope identified intrusion of biomaterial under the sealed distal cap; devices were recalled to repair this defect. Conclusions We identified transmission of mcr -1 in a United States acute care hospital that likely occurred via duodenoscope despite no identifiable breaches in reprocessing or infection control practices. Duodenoscope design flaws leading to transmission of multidrug-resistant organsisms persist despite recent initiatives to improve device safety. Reliable detection of colistin resistance is currently challenging for clinical laboratories, particularly given the absence of a US Food and Drug Administration–cleared test; improved clinical laboratory capacity for colistin susceptibility testing is needed to prevent the spread of mcr -carrying bacteria in healthcare settings. [ABSTRACT FROM AUTHOR]

As the Fed begins to wrestle with how to stimulate growth in the next economic downturn in an environment of low interest rates, a number of possible changes in its policy framework are being entertained. One in particular that has gained considerable support is price-level targeting, based on the view that this approach would tend to move inflation and nominal interest rates up late in the business cycle, yielding more room for rate cuts when the downturn ensues. We outline the inherent difficulties involved in controlling the level of inflation under the current inflation-targeting regime. We then argue that requiring the Fed to meet the more stringent objective of a price-level target could introduce significantly greater volatility into output growth—potentially worsening economic downturns—than is the case under the current policy framework. We also consider a preferred course of action that adds a bit more flexibility to the current framework, at least for the near to the medium term, and how the Fed might deal with the next recession. [ABSTRACT FROM AUTHOR]

The author reflects on the disproportionate burden and health disparities in unjust social conditions of cancer or related health patients. The health disparities is referred to the adverse differences in the incidence, prevalence, mortality, survivorship, and burden of cancer among tobacco user patients in the U.S. However, it does not recognize the strong role of social injustice that distinguishes health disparities as defined by the World Health Organization (WHO).

Treatment nonadherence is a pernicious problem associated with increasing rates of chronic diseases, escalating healthcare costs, and rising mortality in some patients. Although researchers have suggested numerous factors related to treatment nonadherence, several understudied aspects warrant attention, such as primary-care settings, provider cultural competence, and patient involvement. Adding to the research base, the present pilot study examined 88 primarily Black American and White American community patients from a large university medical center in the southern part of the United States. The study explored two research questions: (a) To what extent are there associations among depressive symptoms, wellness, patient involvement, cultural competency, and treatment nonadherence in a racially diverse community patient population? And (b) to what extent do the study exploratory variables and background characteristics predict treatment nonadherence, both separately and jointly? Depressive symptoms, the patient’s perception of a provider’s cultural competence, and marital/partnered status were found to be statistically significantly associated with treatment nonadherence, but not entirely in the directions expected. [ABSTRACT FROM AUTHOR]

While previous studies have tested the mediating or moderating effects of select factors on disordered eating pathologies, no empirical studies have examined a moderated mediation model. Thus, filling a gap in the literature base, the current study examined a moderated mediation model to test the associations among disordered eating, depressive symptoms, alcohol use, and suicidality. The current study sample included 1,598 students (mean age 21.3 years; 80.9% female) across major universities in the United States. Results showed that disordered eating was significantly associated with suicidality, and the association was mediated by depressive symptoms. Further, the indirect effect of disordered eating via depressive symptoms varied in magnitude as a function of alcohol use. Findings suggest that clinical mental health counselors and other providers working with emerging adults should he vigilant in recognizing behaviors and thoughts associated with disordered eating and related signs and symptoms, including depressive symptoms and alcohol use. [ABSTRACT FROM AUTHOR]