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Cow's milk protein allergy (CMPA) affects 2% to 3% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding health care providers' (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices. This study utilized US HCPs' de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages. A total of 104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1's safety and effectiveness. Findings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care. [ABSTRACT FROM AUTHOR]

Debate continues to feature prominently in many countries on such notions as skills, skill shortages and employability. Clearly such notions remain significant internationally in the rhetoric of both economic reform and training policy and practice. However, the problem remains of differing perceptions. The purpose of this comparative study was to examine the expectations of small and medium-sized enterprises (SMEs) when they recruit young people. Focusing on Germany, Australia and the United States, interviews were held with 30 managers in two diverse job roles--hospitality front-desk staff and automotive technicians. In addition to differences in the range of desired skills between the job roles in these countries, difficulties in recruiting young people were highlighted by the study. Generational differences and academization were perceived as having effects on the hiring of young workers. Various problems with each country's general education system were also emphasized, as managers perceived many young people being inadequately prepared for work. The study also demonstrates the influence of the skill formation system of the countries is less relevant in comparison to the sector in which the SMEs are active.

Background: Marijuana is a widely used substance in the United States (US) and worldwide. We explored trends in self-reported marijuana use among US adolescents overall as well as by gender, race/ethnicity, and school grade. Methods: Biennial data from the Youth Risk Behavior Survey from 2011 to 2021 included 88,183 adolescents in grades 9th through 12th. We used percentage change as a measure of effect and the chi-square test for significance. All analyses were conducted at the national level. Results: The percentage of adolescents who reported current marijuana use dropped significantly from 23.1% in 2011 to 15.8% in 2021 (p < 0.05). The self-report of trying marijuana for the first time before age 13 also decreased significantly from 8.1% in 2011 to 4.9% in 2021 (p < 0.05). For current use, there were similar significant decreases by race/ethnicity, with Asian, Hispanic, and White adolescents experiencing the steepest declines. In 2021, the percentage of Black adolescents self-reporting marijuana use was significantly higher (20.5%) compared to White (14.8%), Hispanic (16.7%), and Asian (5.1%) adolescents. Although current marijuana use declined significantly for both girls and boys over time, in 2021 girls were more likely (17.8%) to currently use marijuana than boys (13.6%). In 2011, the opposite was true, with boys (25.9%) being more likely to use marijuana than girls (20.1%). Conclusions: In US adolescents in 2021, there were decreases in self-reports of marijuana use compared to 2011. Behavioral interventions within school and family environments may be critical in mitigating the risk of marijuana use. [ABSTRACT FROM AUTHOR]

Purpose: The Speech Accessibility Project (SAP) intends to facilitate research and development in automatic speech recognition (ASR) and other machine learning tasks for people with speech disabilities. The purpose of this article is to introduce this project as a resource for researchers, including baseline analysis of the first released data package. Method: The project aims to facilitate ASR research by collecting, curating, and distributing transcribed U.S. English speech from people with speech and/or language disabilities. Participants record speech from their place of residence by connecting their personal computer, cell phone, and assistive devices, if needed, to the SAP web portal. All samples are manually transcribed, and 30 per participant are annotated using differential diagnostic pattern dimensions. For purposes of ASR experiments, the participants have been randomly assigned to a training set, a development set for controlled testing of a trained ASR, and a test set to evaluate ASR error rate. Results: The SAP 2023-10-05 Data Package contains the speech of 211 people with dysarthria as a correlate of Parkinson's disease, and the associated test set contains 42 additional speakers. A baseline ASR, with a word error rate of 3.4% for typical speakers, transcribes test speech with a word error rate of 36.3%. Fine-tuning reduces the word error rate to 23.7%. Conclusions: Preliminary findings suggest that a large corpus of dysarthric and dysphonic speech has the potential to significantly improve speech technology for people with disabilities. By providing these data to researchers, the SAP intends to significantly accelerate research into accessible speech technology. [ABSTRACT FROM AUTHOR]

Background: Depressive moods and behaviors are developmentally normative, yet potentially impairing, in preschool‐aged children. In addition to frequency, duration of behavior is an important parameter to consider when characterizing risk for worsening mood dysregulation. The goal of this study was to identify the duration and severity of depressive moods and behaviors and associations with impairment in a large community sample of preschool‐aged children using an online parent‐report daily diary. Methods: Primary caregivers (N = 900) of 3–5‐year‐old children reported the daily duration of each instance of seven depressive moods and behaviors for 14 days. We used item response theory analyses to examine duration item characteristics. Results: Moods and behaviors occurred at specific durations to be considered psychometrically severe/rare; for example, instances of sadness had to last an average total of 32 min per day or more, irritability at least 38 min, tantrums at least 30 min, and tearfulness/sensitivity at least 35 min. Longer durations of mood and behavior were associated with daily impairment, as well as older child age and less parental education. Conclusions: To our knowledge, this is the first study to delineate specific duration ranges for depressive moods and behaviors in preschool‐aged children. These data, coupled with information about the frequency of mood‐related behaviors, can assist child practitioners in differentiating normative patterns from less normative mood problems to evaluate which children may be at risk. Future work should identify the duration of depressive moods and behaviors in early childhood that predict clinically significant psychopathology over time. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has forced changes in the delivery of medical education. We aimed to explore these changes and determine whether they will impact the future of medical education in any way. We invited leaders in medical education from all accessible US-based medical schools to participate in an online individual semi-structured interview. Representatives of 16 medical schools participated. They commented on the adequacy of online education for knowledge transfer, and the logistical advantages it offered, but decried its negative influence on social learning, interpersonal relationships and professional development of students, and its ineffectiveness for clinical education. Most participants indicated that they would maintain online learning for didactic purposes in the context of flipped classrooms but that a return to in-person education was essential for most other educational goals. Novel content will be introduced, especially in telemedicine and social medicine, and the students' roles and responsibilities in patient care and in curricular development may evolve in the future. This study is the first to document the practical steps that will be adopted by US medical schools in delivering medical education, which were prompted and reinforced by their experience during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The preschool facility is a critical element of an effective preschool program. The recent economic downturn in the United States makes it difficult for states and individual school districts to consider developing new preschool programs or enhancing current programs or facilities. Yet many Americans still agree that public investment in preschool education is important to the nation's economic well-being. Given the importance of preschool education and the physical environment that is necessary for its successful implementation, the authors reviewed all 50 states' department of education Websites for documents related to facility planning or construction. An analysis of that work indicates that decision makers should be familiar not only with the state facility planning or construction document(s) but also, in many cases, with state early childhood learning standards documents. Thirty-one states had documents specifically related to school facility planning or construction. Only North Carolina has a document exclusively focused on early childhood facilities. Some documents make no mention of early childhood environments, whereas others, such as Ohio's, address specific topics, such as program activities, spatial relationships, environmental considerations, finishes, features, and loose furnishings. The Ohio document also includes a sample classroom layout diagram. The majority of the state facility documents merely mention preschool in reference to some specific standard (e.g., square footage). The most often addressed topics are classroom square footage minimums; playground space requirements; and restroom, window, and exit requirements. When it comes to facility planning, the golden rule is "Form Follows Function." Simply put, the facility design must reflect the instructional approach that has been selected by the community. In planning an early childhood facility, one must be familiar not only with the "facility" standards or guidelines of the state, but also any "curricular" standards or guidelines, as they will affect the facility planning process. Many states offer some form of guidance related to preschool facilities. However, those states provide research-based guidance specifically related to preschool learning environments. Preschools, for the most part, need only meet minimum local or state standards that are generally items related to health and life safety and minimum square footage requirements for indoor and outdoor areas. The development and enhancement of preschool facilities and programs state by state may be the most important educational change for the future success of the nation and its children.

Black men are disproportionately affected by firearm assaults in the United States, and these disparities are rooted in structural and social inequities. The objective of this scoping review of research was to identify risk and protective factors for firearm assault injuries among Black men at all levels of the social-ecological framework. The search was conducted in 2021. The initial search generated 1,122 articles. Studies were eligible if they (a) included an analysis of modifiable risk or protective factors for firearm assaults among Black men; (b) reported an estimate of correlation, association, or effect between risk or protective factors and firearm assault injuries, firearm violence, and/or firearm homicides; and (c) were published peer-reviewed articles. In all, 19 articles were identified for review. Risk factors identified at each ecological level include the following: (1) Individual: firearm possession/weapon use and criminal legal system interaction; (2) Relationships: gang membership and exposure to other people who have experienced a firearm assault; (3) Community: indicators for socioeconomic status and racial residential segregation; and (4) Societal: historical racist policy. Individual-level substance use had mixed results. Few (26%) studies examined protective factors at any ecological level, but community-level factors like neighborhood tree cover were identified. Future research needs to examine risk and protective factors at the societal level and multiple ecological levels simultaneously leading to more effective multi-level interventions that will guide policy formation. A greater diversity of study designs, research methods, and theoretical frameworks is needed to better understand factors associated with firearm assault among Black men. [ABSTRACT FROM AUTHOR]

We explored temporal trends in drug-related infant deaths in the United States (U.S.) from 2018 to 2022. We used data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER). A total of 295 drug-involved infant deaths were identified from 2018 to 2022 (provisional mortality data for year 2022) based on the underlying cause of death. In the U.S. from 2018 to 2022, there was a significant 2.2-fold increase in drug-involved infant mortality. The observed increases were higher in non-Hispanic White and Black infants. The findings show that drug-involved infant deaths were more likely to occur in the postneonatal period, defined as ages 28–364 days (81.4 %) compared to the neonatal period. The most prevalent underlying causes of death included assault (homicide) by drugs, medicaments and biological substances (35.6 %) followed by poisoning due to exposure to narcotics and psychodysleptics (hallucinogens) (15.6 %). The most common multiple causes of drug-involved infant deaths were psychostimulants with abuse potential of synthetic narcotics. Drug-related infant mortality has increased significantly from 2018 to 2022. These increases are particularly evident among White and Black infants and occurred predominantly in the postneonatal period. These findings require more research but also indicate the need to address drug-involved infant deaths as preventable clinical and public health issues. Effective strategies to reduce drug-involved infant deaths will require preventing and treating maternal substance use disorders, enhancing prenatal care access, and addressing broader social and behavioral risk factors among vulnerable maternal and infant populations. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective analysis of a national database. Objectives: COVID-19 resulted in the widespread shifting of hospital resources to handle surging COVID-19 cases resulting in the postponement of surgeries, including numerous spine procedures. This study aimed to quantify the impact that COVID-19 had on the number of treated spinal conditions and diagnoses during the pandemic. Methods: Using CPT and ICD-10 codes, TriNetX, a national database, was utilized to quantify spine procedures and diagnoses in patients >18 years of age. The period of March 2020-May 2021 was compared to a reference pre-pandemic period of March 2018-May 2019. Each time period was then stratified into four seasons of the year, and the mean average number of procedures per healthcare organization was compared. Results: In total, 524,394 patient encounters from 53 healthcare organizations were included in the analysis. There were significant decreases in spine procedures and diagnoses during March-May 2020 compared to pre-pandemic levels. Measurable differences were noted for spine procedures during the winter of 2020-2021, including a decrease in lumbar laminectomy and anterior cervical arthrodesis. Comparing the pandemic period to the pre-pandemic period showed significant reductions in most spine procedures and treated diagnoses; however, there was an increase in open repair of thoracic fractures during this period. Conclusions: COVID-19 resulted in a widespread decrease in spinal diagnosis and treated conditions. An inverse relationship was observed between new COVID-19 cases and spine procedural volume. Recent increases in procedural volume from pre-pandemic levels are promising signs that the spine surgery community has narrowed the gap in unmet care produced by the pandemic. [ABSTRACT FROM AUTHOR]

Internalizing symptoms associated with anxiety and depression have been correlated with harmful alcohol use among Latino/as, but little attention has been paid to assessing the association between perceived discrimination and harmful alcohol use. The present study was designed to investigate the association between perceived discrimination, internalizing symptoms associated with anxiety and depression, and harmful alcohol use among Latino/a immigrants living in the United States (US). Our sample included 426 Latino/a immigrants. Their mean age was 40.05 years (SD = 6.50), 65.50% were women, 80.00% had a partner, 54.20% lived on less than $2,000 a month, and 41.50% reported having attained a college degree. Perceived discrimination was assessed using the Perceived Discrimination Scale, anxious symptoms were assessed using the GAD-7, depressive symptoms were assessed using the CES-D short form, and harmful alcohol use was assessed using AUDIT. We estimated a linear regression model using cross-sectional, self-reported data. The model was statistically significant, R² = 0.38, F (8, 425) = 32.09, p < 0.01. Discrimination was significantly associated with AUDIT scores, (b = 0.21, p < 0.01) after accounting for covariates and for symptoms of anxiety and depression. Our results indicate that experiences of discrimination in the US are associated with increased harmful alcohol use even after controlling for other variables. These findings may be useful in designing coping interventions specifically for Latino/a immigrants to reduce the risk of alcohol use disorder. This study also has political and public health implications for acknowledging the detrimental health consequences of experiencing discrimination, providing support to the position that reducing racism and discrimination represent important public health priorities. [ABSTRACT FROM AUTHOR]

Introduction: Pit viper envenomation may cause coagulopathy. The coagulopathy has been treated with crotalidae polyvalent immune fragment antigen-binding (Fab) ovine antivenom for the last few decades in the United States and usually corrects the acute coagulopathy within hours. Days after receiving Fab, coagulopathy may recur in approximately half of the patients. Another divalent antivenom, crotalidae immune F(ab’)2 (equine)–F(ab’)2–was approved by the US Food and Drug Administration for the treatment of pit viper envenomation. F(ab’)2 is composed of two linked antigen-binding fragments of immunoglobulin G. Several studies have demonstrated that F(ab’)2 is less likely to be associated with recurrence. There is no reported case of F(ab’)2-associated late coagulopathy in very young patients. We report the first case of recurrence associated with F(ab’)2 use in a preschool-age child. Case Report: A preschool-age male developed leg swelling and hypofibrinogenemia after rattlesnake envenomation. F(ab’)2 was administered to stabilize the leg edema and to correct the hypofibrinogenemia. The patient improved clinically and was discharged on hospital day five. Seven days after the rattlesnake envenomation, he returned to the emergency department as instructed. Laboratory data revealed recurrent hypofibrinogenemia. Conclusion: There are two antivenoms available in the US to treat crotalid envenomation, Fab and F(ab’)2. F(ab’)2 is less likely to be associated with recurrent coagulopathy in comparison to Fab. We report the first case of recurrence associated with F(ab’)2 in a preschool-age child. It is important that the emergency physician be aware of potential F(ab’)2-associated recurrent coagulopathy. Adult and pediatric patients may need to follow up to be evaluated for hypofibrinogenemia and/or thrombocytopenia after receiving F(ab’)2. [ABSTRACT FROM AUTHOR]

Background Patients with inflammatory bowel disease (IBD) are at increased risk of anxiety and mood disorders. This study examines the temporal trends and clinical impact of anxiety and mood disorder diagnoses in hospitalized IBD patients in the United States during a 10-year period. Methods Using the National Inpatient Sample from 2009-2018, all IBD-related discharges in adults were analyzed. Primary outcomes were the prevalence and temporal trends of mood disorder and anxiety diagnoses for IBD-related admissions. The impact of the psychiatric comorbidities on clinical outcomes was also evaluated. Results A total of 1,718,736 IBD-related discharged were identified. A diagnosis of anxiety or a mood disorder was found to have a prevalence of 16.44% and 18.97%, respectively, amongst IBDrelated admissions. The prevalence of anxiety disorders amongst hospitalized IBD patients increased significantly (from 12.13% to 20.26%), whereas the prevalence of mood disorders did not (17.46% and 18.9%). IBD admissions with psychiatric comorbidities had lower rates of IBD-related complications or mortality during hospitalization compared to IBD admissions without comorbid psychiatric diagnoses. This population, however, was more likely to experience certain comorbidities such as Clostridioides difficile, pneumonia, and venous thromboembolism, as well as a longer hospitalization. Conclusions The prevalence of comorbid anxiety among hospitalized IBD patients in the United States matches or exceeds the prevalence of anxiety in the general hospitalized population. Given its association with more in-hospital complications and a longer hospital stay, it is important to further understand how psychological screening and mental health services can improve the management of hospitalized IBD patients. [ABSTRACT FROM AUTHOR]

Gun violence is a serious problem in the United States and elsewhere and more so among men than women. We conducted an experiment to examine if men whose masculinity was threatened are more attracted to guns than non-threatened men, presumably to compensate for the threat. After completing a gender knowledge test, men (N = 168) randomly received either false masculinity threatening (experimental condition) or masculinity affirming (control condition) feedback. Subsequently, we measured men's attitudes toward guns and their choice of a gun-range voucher. Men whose masculinity was threatened (vs. affirmed) showed more positive attitudes toward guns and were more likely to choose the voucher. Both effects were statistically significant when the whole sample was analyzed and when very strict exclusion criteria were applied. However, when data exclusions were based on a suspicion check, effects were statistically significant only when a covariate was included (i.e., social dominance orientation, patriotism, or experience with guns). We discuss reasons for this mixed evidence, including the possibility that suspicion regarding the masculinity feedback could itself be a compensatory reaction to threat. [ABSTRACT FROM AUTHOR]

The role of pre-vocational education in general compulsory education has become increasingly relevant over recent years, with the international debate focussing particularly on its importance in school-to-work transitions. This study considers curriculum design and the implementation of pre-vocational education in four countries with radically different cultures: India, China, Germany and the USA. Using a theoretically framed concept of relevance to inform curriculum analysis, it compares the widely divergent content of curricula. In addition to this, interviews with teachers in all four countries flesh out how the curriculum is implemented in practice. The study, which is based on the "prescribed curriculum" and "enacted curriculum" approach, demonstrates that a range of factors means implementation varies widely from country to country but that teachers in all four countries focus in pre-vocational education on equipping students with life-skills.

In the United States (US), salt marshes are especially vulnerable to the effects of projected sea level rise, increased storm frequency, and climatic changes. Sentinel-2 data offer the opportunity to observe the land surface at high spatial resolutions (10 m). The Sentinel-2 data, encompassing Cumberland Island National Seashore, Fort Pulaski National Monument, and Canaveral National Seashore, were analyzed to identify temporal changes in salt marsh presence from 2016 to 2020. ENVI-derived unsupervised and supervised classification algorithms were applied to determine the most appropriate procedure to measure distant areas of salt marsh increases and decreases. The Normalized Difference Vegetation Index (NDVI) was applied to describe the varied vegetation biomass spatially. The results from this approach indicate that the ENVI-derived maximum likelihood classification provides a statistical distribution and calculation of the probability (>90%) that the given pixels represented both water and salt marsh environments. The salt marshes captured by the maximum likelihood classification indicated an overall decrease in salt marsh area presence. The NDVI results displayed how the varied vegetation biomass was analogous to the occurrence of salt marsh changes. Areas representing the lowest NDVI values (−0.1 to 0.1) corresponded to bare soil areas where a salt marsh decrease was detected. [ABSTRACT FROM AUTHOR]

Background: This study examined the conflicts between different generations working in US emergency departments (ED). We sought to record generational differences involving communication preferences, perceived areas of conflict, work motivations, and attitudes regarding work-life balance. Methods: We developed a survey to assess the physician perspective on generational conflict in the ED. The survey was distributed to members of the American College of Emergency Physicians, a professional organization comprising emergency medicine physicians in the USA. Results: We received 696 completed responses. Men represented 60% of respondents and the largest proportion of respondents were emergency physicians working in community settings (53%); 11% were residents. Generation representation was smallest for Traditionalist (2%) and largest for Gen X (43%). Seventy percent reported observing conflict due to generational communication with the largest frequency being once a week (26%). In the associated open-ended questions, 247 (33%) provided 316 anecdotal descriptions of observed conflict. Responses clustered into seven themes (ordered by frequency): Work Ethic, Treatment Approach, Technology Application, Entitlement, Professionalism, Work Life/Balance, and Communication Style. Comparing Work Ethic responses, 52–70-year-olds reported that younger providers are less interested in "accomplishing anything" while 26–34-year-olds resented that attitude. Respondents completing the open-ended questions regarding preventing and responding to conflict provided some insight into helpful strategies including actions supportive of clear communication and standardized policies and expectations. Only 5% of respondents reported that they had discussed generational communication in department meetings with the odds of a woman reporting conflict being less than males (p =.01). Conclusion: Conflicts in the ED in the USA can be attributed to how an individual views the values of someone from another generation. Understanding the frequency and areas of generational conflict in the ED can help medical leaders find strategies to mitigate negative workplace interactions. [ABSTRACT FROM AUTHOR]

Preliminary efficacy data are reported for a research-based reading intervention designed for struggling readers in high school. PHAST PACES teaches (a) word identification strategies, (b) knowledge of text structures, and (c) reading comprehension strategies. In a quasi-experimental design, 268 intervention and 83 waiting list control students meeting criteria for reading disability were assessed before and after their semester. After 60 to 70 hours of PHAST PACES instruction, struggling readers demonstrated significant gains on standardized tests of word attack, word reading, and passage comprehension and on experimental measures of letter-sound knowledge and multisyllabic word identification relative to control students. An average effect size of 0.68 was revealed across these outcome measures. One year follow-up data on 197 PHAST PACES students revealed an average trend to decelerated growth after the intervention, except for passage comprehension outcomes that demonstrated continued growth over follow-up. (Contains 5 tables, 3 figures, and 1 note.)

Psychotherapy is a service-delivery that is provided for both general and special education students. This manuscript examines a conceptual framework for determining when to employ psychotherapy within the school-based setting. Decisions are informed by the relationship between problem behavior, therapeutic techniques, short-term outcomes, and overall child development. Both the individual needs of students and the cumulative body of evidence regarding treatment effectiveness are required for intervention selection. The school psychologists' unique training in psychology and education affords the opportunity to effectively use psychotherapy to enhance the academic and social development of children.

This study examined the prediction of different forms of adult aggression in 2 countries from child and adolescent aggression. It was based on 2 longitudinal projects: the Jyvaskyla Longitudinal Study of Personality and Social Development (JYLS; N = 196 boys and 173 girls) conducted in Finland and the Columbia County Longitudinal Study (CCLS; N = 436 boys and 420 girls) conducted in the United States. The same peer-nominated items for aggression were used in both studies at age 8; comparable measures of aggression were also available in adolescence (age 14 in the JYLS/19 in the CCLS) and adulthood (ages 36/30 and 42/48). Results showed that in both countries and in both genders, aggression in school age was linked significantly to physical aggression and lack of self-control of anger in adulthood but not to verbal aggression. This differential predictability of aggression over 40 years suggests that individual differences in physical aggression are more determined by lasting individual differences (including emotional reactivity) than are individual differences in verbal aggression.

Background: Research on the impacts of exposure to workplace harassment (WH) is largely cross-sectional, and existing prospective studies generally are between two and five years of follow-up, with the longest US study being 10 years. However, the effects of exposure to WH may persist longer, particularly if exposure has been chronic. This study fills this gap by examining effects of prior exposure to chronic sexual and generalized WH on psychological distress and alcohol misuse over an approximately 25 year study period. Methods: Individuals originally recruited from a university-employed sample in the United States were surveyed at 8 time points from 1996–2007 and again in 2020–2021. A series of hybrid path analyses were tested on a sample of 2352 individuals, regressing recent outcomes on latent classes of harassment derived from earlier survey waves, controlling baseline outcomes and demographics. Model fit was assessed using a variety of fit statistics, and standardized regression coefficients were used to assess significance of individual pathways. Results: Prior exposure to chronic sexual harassment had significant direct associations with psychological distress, alcohol misuse, and recent stressors at follow-up. Prior exposure to chronic generalized harassment had significant direct associations with lower income and alcohol misuse. Both forms of WH were significantly indirectly associated with psychological distress through recent stressors at follow-up. Conclusions: Exposure to chronic WH is associated with long-term effects on psychological distress and alcohol misuse in a sample representing a wide variety of job types and racial/ethnic identities. Enforcement of anti-sexual harassment law and policies and enactment of policies and laws to prevent generalized harassment/workplace bullying are imperative for the protection of worker health. [ABSTRACT FROM AUTHOR]

Scholarship shows that Black immigrants to the United States resist assimilation to reduce exposure to racial discrimination faced by U.S.-born African Americans. But, not all Black immigrants are equally likely to be (mis)perceived as African American. We argue that immigrants who are likely to be misidentified as African American have incentives to reify ethnic boundaries as a form of protection against racial discrimination. We develop this argument from interviews and focus groups with African immigrants. We then use a lab experiment to measure rates of miscategorization and identify its correlates among African immigrants. Finally, we test our argument with a novel survey of Somalis, an immigrant population with two ethnic subgroups who differ in their likelihood of being miscategorized as African Americans. We show that this difference shapes the degree of resistance to assimilation. These findings improve our understanding of the relationship between racial discrimination and incentives for Black immigrants to resist assimilation. [ABSTRACT FROM AUTHOR]

Introduction: The Brazilian population in the United States (U.S.), a Latinx subgroup, is rapidly growing and aging but remains underrepresented in U.S. health research. In addition to group‐specific genetic and environmental risks, Brazilian immigrants and their offspring in the U.S. likely have cumulative risks for health inequities. It is estimated that 71% of Brazilian immigrants in the U.S. are undocumented, which may limit healthcare access/utilization. Furthermore, mental health is reported as a health priority by Brazilian immigrants in the U.S., and there is a lack of research on Alzheimer's disease and related dementia (AD/ADRD) in this population. Methods: We reviewed the scientific literature using traditional (e.g., PubMed) sources and databases generated by U.S. and Brazilian governments, as well as international organizations, and press articles. Results: This perspective review lists recommendations for researchers, health providers, and policymakers to promote greater inclusion of U.S. Brazilian populations in health research and care. The review identifies research areas in need of attention to address health inequities and promote mental/brain health in Brazilian immigrants and their offspring living in the U.S. These research areas are: 1) epidemiological studies to map the prevalence and incidence of mental/brain health conditions; 2) research on aging and AD/ADRD risk factors among Brazilian populations in the U.S.; and 3) the need for greater representation of U.S‐residing Brazilian population in other relevant research areas involving genetics, neuropathology, and clinical trials. Conclusions: The recommendation and research efforts proposed should help to pave the way for the development of community‐engagement research and to promote mental/brain health education, improvement of mental/brain health and AD/ADRD services, and the development of culturally‐informed intervention to the U.S.‐residing Brazilian communities. HIGHLIGHTS: The Brazilian population in the United States is growing but is underrepresented in U.S. health research.Approximately 71% of Brazilian immigrants in the United States are undocumented, with an increased risk for health inequities.Mental health is reported as a central health priority by Brazilian immigrants in the United States.There is a lack of research on Alzheimer's disease and other dementias (ADRD) in Brazilian immigrants in the United States.Epidemiological research is needed to map the prevalence/incidence of mental health conditions and ADRD risk factors among Brazilian immigrants in the United States. [ABSTRACT FROM AUTHOR]

Background People with human immunodeficiency virus (HIV) (PWH) may be at increased risk for severe coronavirus disease 2019 (COVID-19) outcomes. We examined HIV status and COVID-19 severity, and whether tenofovir, used by PWH for HIV treatment and people without HIV (PWoH) for HIV prevention, was associated with protection. Methods Within 6 cohorts of PWH and PWoH in the United States, we compared the 90-day risk of any hospitalization, COVID-19 hospitalization, and mechanical ventilation or death by HIV status and by prior exposure to tenofovir, among those with severe acute respiratory syndrome coronavirus 2 infection between 1 March and 30 November 2020. Adjusted risk ratios (aRRs) were estimated by targeted maximum likelihood estimation, with adjustment for demographics, cohort, smoking, body mass index, Charlson comorbidity index, calendar period of first infection, and CD4 cell counts and HIV RNA levels (in PWH only). Results Among PWH (n = 1785), 15% were hospitalized for COVID-19 and 5% received mechanical ventilation or died, compared with 6% and 2%, respectively, for PWoH (n = 189 351). Outcome prevalence was lower for PWH and PWoH with prior tenofovir use. In adjusted analyses, PWH were at increased risk compared with PWoH for any hospitalization (aRR, 1.31 [95% confidence interval, 1.20–1.44]), COVID-19 hospitalizations (1.29 [1.15–1.45]), and mechanical ventilation or death (1.51 [1.19–1.92]). Prior tenofovir use was associated with reduced hospitalizations among PWH (aRR, 0.85 [95% confidence interval,.73–.99]) and PWoH (0.71 [.62–.81]). Conclusions Before COVID-19 vaccine availability, PWH were at greater risk for severe outcomes than PWoH. Tenofovir was associated with a significant reduction in clinical events for both PWH and PWoH. [ABSTRACT FROM AUTHOR]

Despite the availability of health resources such as immunizations on campus, HPV vaccination rates in college students remain low with existing gender disparities in HPV vaccine uptake. The purpose of this systematic review was to identify common limitations to HPV vaccination interventions among college students, utilized health promotion theories that have been reported to improve HPV vaccination rates among the population of interest, and lessons learned from intervention outcomes. The review team consisted of a group of researchers with medical and/or public health backgrounds who are experts in the assessment, development, implementation, and evaluation of HPV vaccination interventions for US college students. The Arksey and O'Malley framework methodology guided the review. Out of the 21 included studies, only 16 utilized health promotion theories and/or models to disseminate and implement the research intervention, with the most common theory being the Health Belief Model (HBM) (n = 7). A total of 50 limitations were identified from 19 studies and classified accordingly. Results may contribute to a broader understanding of major limitations to consider when designing HPV vaccination initiatives in college settings. Different NCHEC areas were applied in the design and administration of this study. [ABSTRACT FROM AUTHOR]

This study examined the attitudes toward physical activity and exercise of university students enrolled in Personal Wellness classes. 1,625 undergraduate students completed the Attitudes Toward Exercise and Physical Activity (ATEPA) inventory on the first and last day of the class. Paired-samples t test results comparing the mean pretest ATEPA score to the mean posttest score revealed a significant improvement, ([bar.t](1624) = 2.91, [bar.p] is less than .01). A repeated measures multivariate analysis of variance (MANOVA) also revealed significant between-subjects effects for gender, [bar.F](1, 1579) = 30.23, [bar.p] is less than .01, and exercise history, [bar.F](2, 1579) = 35.16, [bar.p] is less than .01. Results suggest that students showed a significant improvement in attitude toward physical activity and exercise following completion of the university-required personal wellness course. Both exercise history and gender appeared to have influenced these effects.

Pregnant people living in rural areas are at an increased risk of experiencing poor perinatal outcomes due, in part, to the need to travel long distances to see a perinatal care provider. Telehealth care has been used successfully to increase access to perinatal care but requires patients to have access to broadband Internet access and devices capable of establishing secure connections so they can participate in their care. This places an additional burden on unstably housed pregnant persons who may not have access to the required technology. The Midwifery Integrated Home Visitation Program was developed to bridge this digital divide by bringing perinatal care services to the unstably housed at their desired location of care. The included case studies outline how telehealth and portable technology were used to address the medical and nonmedical needs of unstably housed pregnant people. They also outline how bridging the digital divide by combining in-person perinatal care with mobile technology, portable technology, and telehealth care has the potential to decrease unnecessary emergency department care and ambulance use while facilitating the receipt of appropriate care and thus potentially preventing poor perinatal outcomes. [ABSTRACT FROM AUTHOR]

Research–practice partnerships play an important role in critically examining racial disparities in schools, as well as supporting the immediate adoption of practice improvement. This article outlines the results of a multisite case study with students, teachers, and administrators across two racially and ethnically diverse middle schools in the Pacific Northwest. Using a multisite case study approach (N  =   2), authors explored practice challenges and successes in four phases of the research–practice partnership: (1) building the partnership, (2) designing the study, (3) data analysis, and (4) translating the data into action for racial justice. Data sources include field notes, observations, teacher and administrator interviews, and student focus groups. A cross-case synthesis analytical approach was used. Linking these perspectives offers an ecological approach to identifying, understanding, and interrupting racism in schools. Article concludes by discussing the importance of research–practice partnerships for racial justice in schools and the powerful role that student and teacher voices can play in the process. [ABSTRACT FROM AUTHOR]

The authors comment on women in pharmacy leadership. Topics discussed include percentage of women that make up all entry-level healthcare employees, according to a 2019 Women in the Workplace report, impact of the Covid-19 pandemic on women, and recommendations focused on Black, Indigenous, and Persons of Color (BIPOC) women in pharmacy.

Since the first publication of the American College of Obstetricians and Gynecologists committee opinion in 2012, and following the update in 2017, multiple institutions in the United States (US) adopted the practice of delayed cord clamping (DCC) and/or umbilical cord milking (UCM) in preterm and term infants. However, there have been variations reported in practices with regard to method of placental transfusion, timing of cord clamping and gestational age thresholds. Furthermore, the optimal cord clamping practice in situations of depressed infants needing resuscitation or in higher-risk delivery situations, such as placental abruption, intrauterine growth restriction, multiple gestation, chorioamnionitis, maternal human immunodeficiency virus syndrome/hepatitis or maternal general anesthesia is often debated. An evaluation of these variations and exploration of associated factors was needed to optimally target opportunities for improvement and streamline research activities. The objective of this survey, specifically aimed at neonatologists working in the US was to identify and describe current cord clamping practices and evaluate factors associated with variations. The survey was distributed electronically to the US neonatologists in August 2019 with a reminder email sent in October 2019. Clinicians were primarily identified from Perinatal Section of AAP, with reminders also sent through various organizations including California Association of Neonatologists, Pediatrix and Envision national groups. Descriptive variables of interest included years of experience practicing neonatology, affiliation with a teaching institution, level of the neonatal intensive care unit (NICU) and practicing region of the US. Questions on variations in cord management practices included information about center specific guideline/protocol, cord clamping practices, gestational age threshold of placental transfusion, performance of UCM and practice in higher-risk delivery situations. The response rate was 14.8%. Among 517 neonatologists whom responded, majority (85.5%) of the practices had a guideline and performed (81.7%) DCC in all gestational ages. The cord clamping practice was predominantly DCC and it was categorized as reporting clamping times <60 s in 46.6% and ≥60 s in 48.7% of responses. A significant association was detected between time of delay in cord clamping and region of practice. The Northeast region was more likely to clamp the cord in <60 s than other regions in the US. More than half of the providers responded not performing any UCM (57.3%) in their practice. Significant associations were detected between performance of UCM and all queried demographic variables independently. Clinicians with >20 years of experience were more likely from institutions performing UCM compared to the providers with fewer years of experience. However, teaching hospitals were less likely to perform UCM compared to non-teaching hospitals. Similarly, practices with level IV NICUs were less likely to perform UCM compared to practices with level III units. Hospitals in the Midwest region of US were less likely to perform UCM compared to hospitals in the Western region. Significant variations were also noticed for not providing placental transfusion in higher-risk deliveries. Demographic and professional factors were noted to be associated with these differences. Although the majority of practices have a guideline/protocol and are performing DCC in all gestational ages, there are variations noted with regard to timing, method, and performance in higher-risk deliveries. Demographic and professional factors play an important role in these variations. Future research needs to focus on the modifiable factors to optimize the procedure and impact of DCC. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic presents a continued public health challenge. Veterinary diagnostic laboratories in the United States use RT-rtPCR for animal testing, and many laboratories are certified for testing human samples; hence, ensuring that laboratories have sensitive and specific SARS-CoV2 testing methods is a critical component of the pandemic response. In 2020, the FDA Veterinary Laboratory Investigation and Response Network (Vet-LIRN) led an interlaboratory comparison (ILC1) to help laboratories evaluate their existing RT-rtPCR methods for detecting SARS-CoV2. All participating laboratories were able to detect the viral RNA spiked in buffer and PrimeStore molecular transport medium (MTM). With ILC2, Vet-LIRN extended ILC1 by evaluating analytical sensitivity and specificity of the methods used by participating laboratories to detect 3 SARS-CoV2 variants (B.1; B.1.1.7 [Alpha]; B.1.351 [Beta]) at various copy levels. We analyzed 57 sets of results from 45 laboratories qualitatively and quantitatively according to the principles of ISO 16140-2:2016. More than 95% of analysts detected the SARS-CoV2 RNA in MTM at ≥500 copies for all 3 variants. In addition, for nucleocapsid markers N1 and N2, 81% and 92% of the analysts detected ≤20 copies in the assays, respectively. The analytical specificity of the evaluated methods was >99%. Participating laboratories were able to assess their current method performance, identify possible limitations, and recognize method strengths as part of a continuous learning environment to support the critical need for the reliable diagnosis of COVID-19 in potentially infected animals and humans. [ABSTRACT FROM AUTHOR]

Healthy individuals in the United States identified as having Black race have lower neutrophil counts, on average, than individuals identified as having White race, which could result in more negative diagnostic evaluations for neutropenia. To test this hypothesis, the proportion of evaluations where the final diagnosis was clinically insignificant neutropenia for Black and White individuals who underwent an evaluation by a haematologist that included a bone marrow (BM) biopsy to investigate neutropenia was assessed. 172 individuals without prior haematological diagnoses who underwent a haematological evaluation to investigate neutropenia. Individuals diagnosed with clinically insignificant neutropenia between Black and White individuals were compared using a propensity‐score‐adjusted logistic regression. Of 172 individuals, 42 (24%) were classified as Black race, 86 (50%) were males, and the 79 (46%) were over 18 years old. A BM biopsy did not identify pathology in 95% (40 of 42) of Black individuals and 68% (89 of 130) of White Individuals. Black individuals (25 of 42 [60%]) received a final diagnosis of clinically insignificant neutropenia, compared to White individuals (12 of 130 [9%]) (adjusted odds ratio =7.9, 95% CI: 3.1 – 21.1). We conclude that black individuals were more likely to receive a diagnosis of clinically insignificant neutropenia after haematological assessment. [ABSTRACT FROM AUTHOR]

Background: Immunologic reactions are a major complication of Hansen's disease, also known as leprosy. To minimize reactions, clofazimine is added to multidrug therapy for its anti-inflammatory effect. Minocycline is an alternative antileprosy medication that has evidence to suggest it also has anti-inflammatory properties. Objective: The aim of this study was to evaluate whether there is a difference in the frequency of reactional episodes and time of onset while receiving minocycline for Hansen's disease compared with multidrug therapy. Methods: This study used an observational design comparing two independent groups. Results: No differences were found between reaction occurrence and time to onset in patients who received either alternative therapy with minocycline or standard multidrug therapy treatment with clofazimine. Logistic regression indicated a significant association between borderline tuberculoid and reactions (χ2[1] = 3.898, p =.048). Patients with borderline tuberculoid were 68% less likely to develop reactions (Type 1 or 2) than other types of Hansen's disease while accounting for treatment, age, and race (OR = 0.320, 95% CI [0.103, 0.992]). Conclusion: Although there was no significant difference in reaction rate between treatment groups, these findings indicate the clinical form borderline tuberculoid is a significant negative predictor for reactions. However, sample size limited the ability to determine significance based on reaction type. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric patients are an important population in every community, and providing patient‐centered care to this population relies on fundamental knowledge of pediatric care. Objectives: To describe the availability of pediatric electives and depth of pediatric topics taught throughout the curricula offered at Doctor of Pharmacy (Pharm.D.) programs in the United States. Methods: This was a quantitative/qualitative survey study assessment. A 21‐question survey was created, reviewed, and pilot‐tested prior to full distribution. The electronic survey was administered and distributed via email to relevant faculty at 145 identified Pharm.D. programs. Results: The survey achieved a 65% response rate with 69.2% of responding programs reported offering at least one pediatric elective. Pharmacy schools that responded represented all areas of the United States. The majority, 57.5% (n = 54), of responding programs employed at least one full‐time pediatric faculty member, and 14.9% (n = 2) had two pediatric faculty members. The most common topics taught in pharmacy curricula without a pediatric elective (>80%) were cystic fibrosis, asthma, attention‐deficit/hyperactivity disorder, immunizations, otitis media, and calculations. Pediatric topics that were not offered anywhere in these curriculum (>40%) were cardiology, congenital heart disease, hypersensitivity reactions, child abuse, neonatal intensive care, and health disparities in children. However, topics that were most commonly covered within a pediatric elective (>50%) consisted of cardiology, congenital heart disease, cystic fibrosis, growth and development, neonatal intensive care unit foundations, medication errors/safety, and calculations. The most common type of assessments utilized in the pediatric electives were exams or quizzes (n = 53). Case‐based learning was the most common teaching method. Conclusion: This study demonstrates a growth in pediatric education, the extent of pediatric topics taught throughout curricula, and an increase in pediatric faculty members in pharmacy programs. There remains a need for all programs to teach pediatric patient‐centered care and for more pediatric pharmacists leading this education in pharmacy curricula. [ABSTRACT FROM AUTHOR]

Few investigations have comprehensively described methods for assessing and monitoring suicidal ideation in pragmatic clinical trials of mental health services interventions. This investigation's goal was to assess a collaborative care intervention's effectiveness in reducing suicidal ideation and describe suicide monitoring implementation in a nationwide protocol. The investigation was a secondary analysis of a stepped wedge cluster randomized trial at 25-Level I trauma centers. Injury survivors (N = 635) were randomized to control (n = 370) and intervention (n = 265) conditions and assessed at baseline hospitalization and follow-up at 3-, 6- and 12-months post-injury. The Patient Health Questionnaire (PHQ-9) item-9 was used to evaluate patients for suicidal ideation. Mixed model regression was used to assess intervention versus control group changes in PHQ-9 item-9 scores over time and associations between baseline characteristics and development of suicidal ideation longitudinally. As part of the study implementation process assessment, suicide outreach call logs were also reviewed. Over 50% of patients endorsed suicidal ideation at ≥1 assessment. Intervention patients relative to control patients demonstrated reductions in endorsements of suicidal ideation that did not achieve statistical significance (F[3,1461] = 0.74, P =.53). The study team completed outreach phone calls, texts or voice messages to 268 patients with PHQ-9 item-9 scores ≥1 (n = 161 control, n = 107 intervention). Suicide assessment and monitoring can be feasibly implemented in large-scale pragmatic clinical trials. Intervention patients demonstrated less suicidal ideation over time; however, these comparisons did not achieve statistical significance. Intensive pragmatic trial monitoring may mask treatment effects by providing control patients a supportive intervention. ClinicalTrials.gov NCT02655354 [ABSTRACT FROM AUTHOR]

Background: Population aging will lead to a dramatic increase in dementia prevalence, which will disproportionally affect racial minorities. The presence of racial differences in dementia prevalence has been widely reported in United States, but there are no relevant studies on this topic in low- and middle-income countries.Methods: In a cross-sectional survey, 2944 older Cubans were recruited at a community-based level aimed to identify the effects of self-identified race and genetic admixture on cognitive performance. Dementia diagnosis was established using 10/66 Dementia and DSM-IV criteria. APOE-ε4 genotype was determined in 2511 (85%) and genetic admixture was completed for all dementia cases and in a randomly selected sample of cognitive healthy participants (218 dementia cases and 367 participants without dementia).Results: The overall prevalence of dementia was 8.7%, without large or statistically significant differences on dementia prevalence (p = .12) by self-identified race. Mean cognitive scores were similar across racial groups (p = .46). After controlling for age, sex, and education, greater proportion of African ancestry was not associated with cognitive performance (p = .17).Conclusions: We found no evidence of an independent effect of self-identified race and/or population ancestry on dementia prevalence or cognitive performance. This suggests that observed differences in dementia prevalence among diverse populations may be driven primarily by social determinants of health. [ABSTRACT FROM AUTHOR]

One of the most commonly searched topics on the internet in the United States is cancer. Our study aims to provide a general overview of the predictors of trust for two health information sources, doctors and the internet, when seeking cancer-related information. The data were obtained from the 2018 HINTS 5 Cycle 2 survey, which was administered from January through May to a total of 3,504 respondents. We carried out next a series of ordinal logistic regression models to identify predictors of high trust in doctors and the internet separately for cancer-seeking information. Demographic predictor variables varied as predictors of high trust for cancer knowledge across both sources. Respondents who reported less confidence in their ability to seek cancer information had significantly higher odds of high trust in both doctors (OR = 8.43, CI: 5.58–12.73) and the internet (OR = 2.93, CI: 1.97–4.35) as compared to those who reported being "completely confident" in their ability to obtain cancer information. Understanding the key predictors of trust in doctors and the internet is crucial to the enhancement of health. The role of confidence as a predictor of trust in seeking cancer information has been shown to consistently influence the levels of trust attributed to each topic. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess parents' firearm storage behaviors during the COVID-19 pandemic and characterize reasons why some parents made their firearms more accessible during this time. In June-July 2020, the study team conducted the FACTS National Survey—a cross-sectional, web-based, survey of 2,924 parents and their teens (ages14–18) regarding firearm-related practices. We weighted descriptive analyses to be nationally representative of parents of teens in the United States. We utilized qualitative thematic analysis to identify parents' reasons for making firearms more accessible. Five percent of firearm-owning parents of teens reported making their firearms more accessible during the beginning of the COVID-19 pandemic. Reasons why parents increased the ease of firearm access included: (1) Increased civil unrest and riots; (2) Threat of home invasion and/or crime victimization; (3) Fear of panic and the unknown; and (4) Easier access and greater protection, threat unspecified. Some parents—largely motivated by fear—chose to store firearms in a more accessible manner during the beginning of the COVID-19 pandemic to protect their family against possible external threats. Understanding the fear that motivates parents' decisions regarding storage practices might aid interventions focused on harm reduction and safer storage. [ABSTRACT FROM AUTHOR]

In the 1870s, microscopy societies began to proliferate in the United States. Most of these societies attracted microscopists from surrounding cities, but the American Postal Microscopical Club, modelled on the British Postal Microscopical Society, used the postal system to connect microscopists scattered across the country. Club members exchanged microscope slides and notes following a chain-letter system. The main objective of the club was to teach its members how to make permanent slides. Preparation and mounting methods required technical skill, which was, as even club members had to admit, difficult to learn without personal instruction. Yet members developed ways to share craft knowledge through the post. Drawing on the private notes of a member and published reports on the slides circulated, this paper challenges the widespread assumption that the generation of craft knowledge depended on the co-location of artisans. It argues that microscopists' knowledge of preparation methods was intertwined with their skill in building and navigating information infrastructures, and that by tracing these infrastructures we gain a better understanding of how craft knowledge travelled in the late nineteenth century. [ABSTRACT FROM AUTHOR]

This study examines the role of heavy commenters on social media. We propose typologies of heavy commenters on Facebook pages of six news organizations in two systems that historically embraced different discourse cultures—the United States and Germany. We find that discourse cultures are impacted by news outlet and country: the US discourse is more participatory in terms of comment frequency, but further characterized by a strong non-discursive culture compared to a participatory liberal discourse culture in Germany. Frequency of commenting as normative ideal of social media sites (e.g. web traffic) does not lead to higher amounts of deliberation. On the contrary, it may contribute to what we conceptualize as the non-discursive model. As an expression of this, heavy commenters in the United States more often perform hate watching that manifests in hostile commenting on stories that are incongruent with their political ideologies. Implications for the democratic function of media organizations on social media are discussed. [ABSTRACT FROM AUTHOR]

Objective: This study provides information on food insecurity and child malnutrition in a technologically advanced nation.Design: Population-based study using multistage probability cluster sampling design to collect survey data. Multivariable regression models were used to determine associations between food security status and various malnutrition indices.Setting: We used a national sample from the US National Health and Nutrition Examination Survey 2011-2014.Participants: The anthropometric and demographic data sets of 4121 children <7 years old were analysed for this study.Results: Food-insecure infants younger than 6 months had shorter upper arm length (-0·4 cm, P = 0·012) and smaller mid-upper arm circumference (-0·5 cm, P = 0·004); likewise those aged 6 months-1 year had shorter upper arm length (-0·4 cm, P = 0·008), body length (-1·7 cm, P = 0·007) and lower body weight (-0·5 kg, P = 0·008). Food-insecure children younger than 2 years were more likely to be underweight (OR: 4·34; 95 % CI 1·99, 9·46) compared with their food-secure counterparts. Contrariwise, food-insecure children older than 5 years were more likely to be obese (OR: 3·12; 95 % CI 1·23, 7·96).Conclusions: Food insecurity associates with child growth deficits in the USA. Food-insecure infants and young children are generally smaller and shorter, whereas older children are heavier than their food-secure counterparts, implying a double burden of undernutrition-overnutrition associated with child food insecurity. Child food and nutrition programmes to improve food insecurity should focus on infants and children in the transition ages. [ABSTRACT FROM AUTHOR]

• About 4.8% of US adults report pain in the temporomandibular joint (TMJ) • Vibroacoustic therapy (VAT) is noninvasive, safe, and uses low-frequency vibrations. • VAT has mechanisms of benefit but limited clinical studies to support the hypothesis. • Randomized trials are needed to adequately test the hypothesis that VAT reduces TMJ pain. • VAT may be a breakthrough or "another beautiful hypothesis slain by ugly facts". Pain in the temporomandibular joint (TMJ) affects about 4.8 % of the United States population. Pain is the most common symptom of TMJ and the chief reason patients seek care. Conventional treatments range from non-invasive therapies including physical therapy, dental guards and occlusal splints to interventions such as corticosteroid injections and surgery. At present, the most common challenge to healthcare providers in patients presenting with TMJ is the reduction of pain. Vibroacoustic therapy (VAT) is noninvasive and safe as a potential treatment for TMJ pain. VAT involves low-frequency vibrations from 30 to 120 + Hertz. Biological mechanisms to explain a beneficial effect include enhanced blood circulation, decreased swelling, and promotion of muscle relaxation. VAT also appears to have beneficial effects on skin and bone conduction as well as stimulates relaxation responses and the release of nitric oxide. Clinical studies of VAT to reduce TMJ pain are promising but limited in design and sample sizes. The most reliable design strategy to detect the most plausible small to moderate benefit of VAT on TMJ pain is a randomized trial. This trial should be of sufficient size, dose, and duration. If VAT has a favorable benefit-to-risk ratio, then it would represent a safe, noninvasive, feasible and cost-effective means to treat TMJ. [ABSTRACT FROM AUTHOR]

Translanguaging through story documents the progression of an emerging bilingual preschooler who draws on his full linguistic repertoire to story his experiences with others. Over the course of the school year, Diego progresses in his ability to tell a complete story in both English and Spanish. Repeated engagement in storytelling provides the support needed for Diego to continue and extend ideas in his stories and in his drawing and play. The case shows how opening the space for children to use their full language repertoire enables a child to reciprocally develop named languages like English and Spanish as he improves at academic tasks like telling stories. [ABSTRACT FROM AUTHOR]

Zika virus diagnostic testing and laboratory research increased considerably when Zika virus began spreading through the Americas in 2015, increasing the risk for potential Zika virus exposure of laboratory workers and biomedical researchers. We report 4 cases of laboratory-associated Zika virus disease in the United States during 2016-2019. Of these, 2 were associated with needlestick injuries; for the other 2 cases, the route of transmission was undetermined. In laboratories in which work with Zika virus is performed, good laboratory biosafety practices must be implemented and practiced to reduce the risk for infection among laboratory personnel. [ABSTRACT FROM AUTHOR]