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Background: Palliative care integration into cardiology is growing, allowing primary cardiology care teams increasing opportunities to utilize palliative care to support processes such as advance care planning (ACP). Objective: The aim of the study is to understand perspectives of cardiac care team members about the involvement and impact of palliative care on ACP in heart failure. Design: A qualitative study using a semistructured interview guide was performed. Settings/Subjects: Interviews were conducted with cardiac care team members, including cardiologists, cardiac surgeons, and nurse practitioners, at a large academic medical center in the United States with an integrated cardiac palliative care team. Measurements: Deductive and inductive thematic analysis of interview transcripts enabled characterization of themes around the role of palliative care in ACP. Results: Two themes were identified with regard to providers' perspectives about ACP: (1) different levels of comfort with initiating and conducting ACP conversations and (2) different opinions about the desired role of palliative care in the ACP process. In exploring these themes, we characterized four distinct approaches to ACP with palliative care as a novel framework for planning consultation. Conclusions: The different approaches to ACP and the implications for how cardiac providers interact with the palliative care team present an important opportunity to guide ACP consultation in practice. Adoption of this framework may help cardiac providers enhance the process of care delivery and ACP in important ways that improve care for their patients. [ABSTRACT FROM AUTHOR]

Background: Characteristics of patients undergoing outpatient evaluation for advanced cardiac therapies are largely unknown. Objective: To describe demographics, baseline quality of life, and frailty of patients undergoing evaluation for advanced therapies at the time of presentation for evaluation in an outpatient cardiac palliative care clinic and examine key quality of life differences across patients. Design: Retrospective chart review to report baseline demographics and quality of life. Settings/Subjects: Patients at a large academic medical center in the United States referred for advanced cardiac therapies in 2021. Measurements: Depression and anxiety were measured using the Hospital Anxiety and Depression Scale; quality of life was measured using the Functional Assessment of Chronic Illness Therapy–Palliative care (FACIT-Pal) tool; and frailty was measured using the Fried Frailty Phenotype. Differences in quality of life by disease etiology, demographic characteristics, and frailty were assessed. Results: Fifty-four patients were seen in the outpatient cardiac palliative care clinic for advanced therapy evaluation. Most were Caucasian (80%) and male (74%). Patients traveled an average of 61 minutes to the clinic. All but five lived in a rural, medically underserved, or health professional shortage area. Forty percent scored abnormal or borderline abnormal for anxiety; 22% scored abnormal or borderline abnormal for depression. The FACIT-Pal mean score was 129 (standard deviation 23), with emotional and functional well-being domains contributing most to poor quality of life. Seventy-one percent were frail. Patients with a nonischemic etiology had a 3.32 times higher rate of anxiety than nonischemic patients (95% confidence interval = 1.05–10.54, p = 0.041). Conclusion: As patients undergoing transplant evaluation have high levels of depression, anxiety, and frailty, interdisciplinary care teams will be needed to properly manage the needs of this complex population. These results can inform efforts to integrate palliative care into advanced cardiac therapy and improve patients' experiences. [ABSTRACT FROM AUTHOR]

Background: There are many ways that palliative care can support patients with heart failure, but the role of palliative care in supporting patients who are considering or are already using advanced cardiac therapies is less clear. Objective: To understand referring providers' perspectives about the role of palliative care in the treatment of patients with heart failure considering or using advanced cardiac therapies. Design: Qualitative study using a semistructured interview guide. Setting/Subjects: This study was conducted at an academic medical center in the United States with an integrated cardiac palliative care program. Interviews were conducted with cardiology providers, including cardiologists, cardiac surgeons, and nurse practitioners who care for patients with heart failure and who are considering or receiving advanced cardiac therapies. Measurements: Interview transcripts were analyzed deductively and inductively to reveal themes in providers' perspectives. Results: Five themes were identified about the role of palliative care when advanced therapies were considered or being used: (1) educating patients; (2) supporting goal-concordant care; (3) managing symptoms; (4) addressing psychosocial needs; and (5) managing end-of-life care. Providers suggested palliative care could be a facilitator of advanced therapies, rather than merely something to add to end-of-life care. Conclusions: Cardiology providers recognize the value of integrating palliative care across the heart failure disease trajectory to provide therapy options, support decision-making processes, and provide goal-concordant care for patients considering or receiving advanced therapies. Increasing awareness of opportunities to integrate palliative care throughout the treatment of these patients may help cardiology providers better coordinate with palliative care specialists to improve patient care. [ABSTRACT FROM AUTHOR]

The climate change crisis poses a central threat to public health. The health outcomes of this crisis are well known, but lesser known to medical professionals is the role that healthcare delivery plays in worsening this crisis. The United States healthcare system is responsible for producing 10% of the total greenhouse gases. The adverse health outcomes caused by the overall healthcare system emissions in the United States is estimated to be 470,000 disability-adjusted life years lost, which is commensurate with the 44,000 to 98,000 people who die in hospitals each year in the United States as a consequence of preventable medical errors. Factors that contribute to healthcare greenhouse gas emissions include emissions from our facilities and from the purchase, transport, and use of supplies and waste. In the purview of obstetrics and gynecology, providers should minimize their use of disposable supplies, replace single-use specula with stainless steel specula, and educate themselves and operating room staff about best waste disposal practices. In addition, they can use their individual and collective voice to advocate for sustainable energy and supply practices. A transformation in the way we supply and power our hospitals is needed, and providers should be early adopters of this transformational change. Physician buy-in is essential to decrease the carbon footprint of our care. This narrative is a call to action for obstetricians and gynecologists to reduce our carbon footprint as a public health measure to uphold the quality of care we provide to women. [ABSTRACT FROM AUTHOR]

These findings indicate an anonymous self-screening instrument for mental health and stress concerns among employees is a potential valuable resource. Study participant responders were stressed, experiencing burnout, and 26-37% screened positive for depression and/or anxiety. Fifty-eight percent of the variance in depression scores was explained by a depression model. Objective: This study aimed to examine relationships among worked hours, stress, sleep hours, burnout, posttraumatic stress disorder (PTSD), anxiety, and depression reported by academic medical center employees. Methods: Employees completed an anonymous electronic mental health survey with automated feedback that included self-help and professional local resources. Data were analyzed using structural equation modeling. Results: Eighty percent of participants reported (n = 693) medium/high stress, 58% reported burnout, 37%/26% screened positive for anxiety/depression, and 14% reported PTSD. Structural equation modeling attained highly significant coefficients (P < 0.05) and excellent goodness of fit, with strong stress and PTSD positive direct associations with anxiety, burnout, and depression. The model explained 58% of variation in depression scores. A clinician only model demonstrated stronger PTSD effects, but no work hours effects. Conclusion: Workplace self-screening tools can guide employee mental health self-assessment, self-help programs, and professional resources, while also informing targets for employer programs. [ABSTRACT FROM AUTHOR]

Background: National Comprehensive Cancer Network (NCCN) guidelines recommend biomarker testing as the first step in the management of patients with advanced non‐small cell lung cancer (aNSCLC). We assessed anaplastic lymphoma kinase (ALK) testing rates and factors related to underuse in community medical systems between 2012 and 2019 to understand guideline adoption. Methods: A retrospective observational study using a nationwide electronic health record (EHR)‐derived deidentified database was conducted. Patients with aNSCLC diagnosed in community medical centers from January 2012 to May 2019 were included to describe the ALK testing trend. This cohort was further restricted to patients diagnosed after 2015 to understand factors associated with testing underuse using mixed‐effects multivariable logistic regression models. Results: Trends for increased ALK testing rates by year were observed in both NCCN guideline‐eligible patients (59.5% in 2012 to 84.1% in 2019) and ‐ineligible patients (15.6% to 50.8%) in a cohort of 41,728 patients. Histology type and smoking status had the greatest impact on test use. Compared with patients with nonsquamous histology and no smoking history, patients with squamous histology and no smoking history (adjusted odds ratio [aOR], 7.6; 95% confidence interval [CI], 5.6–10.4), NSCLC histology not otherwise specified (NOS) with smoking history (aOR, 3.4; 95% CI, 2.8–4.2); NSCLC NOS/nonsmoker (aOR, 1.8; 95% CI, 1.1–3.2), and nonsquamous/smoker (aOR, 1.5; 95% CI, 1.3–1.7) were less likely to be tested. Factors related to underuse also included Eastern Cooperative Oncology Group performance status, stage at initial diagnosis, and demographics. Conclusion: This analysis of real‐world data shows increasing test use by year; however, one fifth of patients eligible for ALK testing still remain untested and potentially missing therapeutic options. Implications for Practice: Advancement in treatment of lung cancer is accompanied by an increasing number of tests that should be run to determine potential therapy options for each patient. This study assessed adoption of testing recommendations for anaplastic lymphoma kinase rearrangements in a national database. Although test use increased over the time period studied (2012–2019), there is still room for improvement. Efforts are needed to increase test use in undertested groups, thus enabling eligible patients to benefit from novel lung cancer therapies. This article provides insights on the use of ALK testing recommendations for lung cancer, using a real‐world database and focusing on the adoption of current guideline recommendations at the community practice level. [ABSTRACT FROM AUTHOR]

We focused our attention on the causes of the current trade war between the United States and China. The article analyzes the influence of electoral processes in the USA on the choice between free trade and protectionism. The relationship between China’s accession to the WTO, mutually beneficial cooperation with the United States, and trends in the trade balance between major trading partners have been determined. The article illustrates the main mutual claims between the United States and China, which led to the outbreak of «the largest trade war in economic history». We determined the main stages of the conduct of «military operations» and characterized the directions of the conflict escalation. The attention is focused on the losses in the trade war; the main beneficiaries from the «trade disagreements» were identified. We proposed an alternative opinion on the real consequences of the trade war for the warring parties. The article studies the impact of trade wars on world GDP and the national economies of the largest countries of the world. Attention is focused on the existence of «phantom trade» for finding the way out of sanctions and tariffs. The role of Ukrainian business in trade wars is examined in detail. We analyzed the main trade wars Ukrainian enterprises are involved in and possible results for the business. The article gives the author’s vision of the impact of the trade war on the trade balance between Ukraine and the key participants in the trade war: the United States and China. We concluded which branches of the Ukrainian industry are in priority for developing trade relations with China. The article highlights the main barriers to the development of trade with the United States and the reasons for the decline in the export of Ukrainian goods. We predicted how the improvement in relations between the United States and China will affect the role of Ukrainian business in the context of world trade wars. [ABSTRACT FROM AUTHOR]

Approximately 20% of children and adolescents in the United States are affected by mental, emotional, and behavioral (MEB) disorders. Child flourishment and family resilience contribute to healthy family development, including the promotion of child MEB wellbeing. Identifying factors that promote child flourishment and family resilience are critical. This study aimed to determine the prevalence and parenting factors associated with family resilience and child flourishment among children aged 6–17 years with MEB disorders. This was a secondary analysis of the 2016–2017 National Survey of Children's Health. The sample consisted of parents and their children (n = 1,900, weighted n = 5,375,670). Data were weighted to be representative of the US population and analyzed using descriptive statistics and linear regression. We found that only 6.3% of children aged 6–17 with an MEB were optimally flourishing. Parental aggravation was negatively associated with child flourishment, and parental coping was positively associated with child flourishment. In total, 66.5% of families with children exhibited resilience. Parental coping and availability of parental emotional support were positively associated with family resilience. Potential interventions that leverage study findings include parent training to increase parental emotional regulation (e.g., increase frustration tolerance, coping skills) and family navigation services to increase parental support (e.g., emotional support, coping skills) through the child's treatment trajectory. Overall, this study provides evidence of a disparity in flourishment in America's youth with MEB disorders, and despite this adversity, families are resilient. [ABSTRACT FROM AUTHOR]

In the last 10 years, there has been an increased interest in improved environmental management. The interest has been made more noteworthy since it is global in nature. Given the global interest in improved environmental management, it is still important to understand how specific business organizations are influenced by the local environment in which they are located. This study examines how US plants have reacted to various programmes and initiatives encountered in the USA. These initiatives, which include Responsible Care® 33/50 and ISO 14001 certification, can be viewed as embodying alternative foci (outcome versus process) and procedures (self-assessment versus external assessment). The study assesses the relative effectiveness of four voluntary environmental programmes using data generated from a large-scale mail survey. The results indicate that while all four environmental programmes generate a positive impact on the various dimensions of corporate performance, one (ISO 14001 certification), tends to have a greater relative impact on several dimensions of corporate performance. [ABSTRACT FROM AUTHOR]

Since its introduction in 1987, the Malcolm Baldrige National Quality Award (MBNQA) has come to have a major influence in the assessment of quality efforts and systems. Many public and private institutions, for example, use the measures derived from this award programme to carry out self-assessments. Many programmes at the local, state and international levels are based on the MBNQA. Implicit in this evidence is the assumption that the MBNQA adequately captures the major dimensions of Total Quality Management. This study empirically assesses this assumption. Specifically, it assesses the extent of fit between the factors of the MBNQA and their measures. It also evaluates the extent to which these factors really do capture this important higher-level construct known as TQM. The results reported in this study are based on a field survey consisting of responses gathered from 526 plant managers within the US automotive industry. The assessment is carried out using confirmatory factory analysis and structural equation models. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) is becoming a major etiological risk factor for hepatocellular carcinoma (HCC) in the United States and other Western countries. In this study, we investigated the role of gene-specific promoter cytosine DNA methylation and gene expression alterations in the development of NAFLD-associated HCC in mice using (1) a diet-induced animal model of NAFLD, (2) a Stelic Animal Model of nonalcoholic steatohepatitis-derived HCC, and (3) a choline- and folate-deficient (CFD) diet (CFD model). We found that the development of NAFLD and its progression to HCC was characterized by down-regulation of glycine N-methyltransferase (Gnmt) and this was mediated by progressive Gnmt promoter cytosine DNA hypermethylation. Using a panel of genetically diverse inbred mice, we observed that Gnmt down-regulation was an early event in the pathogenesis of NAFLD and correlated with the extent of the NAFLD-like liver injury. Reduced GNMT expression was also found in human HCC tissue and liver cancer cell lines. In in vitro experiments, we demonstrated that one of the consequences of GNMT inhibition was an increase in genome methylation facilitated by an elevated level of S-adenosyl-L-methionine. Overall, our findings suggest that reduced Gnmt expression caused by promoter hypermethylation is one of the key molecular events in the development of NAFLD-derived HCC and that assessing Gnmt methylation level may be useful for disease stratification. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the feasibility, fidelity and preliminary efficacy of Camp NERF to prevent unhealthy weight gain and promote healthy behaviours in children during the summer.Design: Camp NERF was an 8-week, multicomponent, theory-based programme coupled with the US Department of Agriculture's Summer Food Service Program. Twelve eligible elementary-school sites were randomized to one of three treatment groups: (i) Active Control (non-nutrition, -physical activity (PA), -mental health); (ii) Standard Care (nutrition and PA); or (iii) Enhanced Care (nutrition and PA, plus cognitive behavioural techniques) programming. Efficacy was determined by assessing mean change by group in child outcomes using hierarchical linear regression models.Setting: Low-income, urban neighbourhoods in Columbus, OH, USA.ParticipantsEconomically disadvantaged, racial minority children of elementary school age (kindergarten-5th grade).Results: Eighty-seven child-caregiver dyads consented; eighty-one completed pre- and post-intervention assessments resulting in a 93·10 % retention rate. Delivery of the intended lesson occurred 79-90 % of the time. Of the children, 56·98 % (n 49) were female; 89·53 % (n 77) were Black. Overall mean change in BMI Z-score from baseline to post-intervention was -0·03 (se 0·05); change in BMI Z-score did not differ significantly between treatment group. Change in nutrition, PA, mental health or psychosocial outcomes did not differ between groups.Conclusions: Results from the current study demonstrate feasibility and fidelity, yet no intervention effect of Camp NERF. Instead, findings suggest that participation in structured programming of any type (health behaviour-related or not) may prevent unhealthy summer weight gain. Additional studies are needed to confirm findings. Results have implications for child nutrition policy addressing the issue of summer health. [ABSTRACT FROM AUTHOR]

Purpose: To present nationally representative data on the prevalence of "social" smoking and its relationship to cardiovascular health.Design: A population-based, cross-sectional survey on cardiovascular health and its risk factors across the United States.Setting: Million Hearts® cardiovascular screenings that took place in community settings.Participants: De-identified data were collected on a convenient sample of 39, 555 participants.Measures: Reported smoking status, blood pressure, and total cholesterol.Analysis: The prevalence of current smoking, social smoking, and non-smoking were cross-tabulated and stratified by sample characteristics. The adjusted estimates were derived from multiple logistic regression models, adjusting for demographics and other biometric measures.Results: Ten percent identified as social smokers. Social smokers were more likely to be aged between 21 and 40, male, and Hispanic. Social smokers had significantly higher risks of having hypertension (odds ratio [OR]: 2.08, 95% confidence interval [CI]: 1.80-2.41) and elevated cholesterol (OR: 1.53, 95% CI: 1.33-1.75) than non-smokers. There was no significant difference between social smokers and current smokers (OR = 0.94, 95% CI = 0.80-1.14 for hypertension and OR = 0.95, 95% CI = 0.81-1.11 for elevated cholesterol).Conclusion: This is the first population health study to compare the blood pressure and cholesterol levels of people who self-identify as current verses social smokers. Although previous smoking behavior was not controlled for in the analysis, this study demonstrates there is no significant difference in the prevalence of elevated blood pressure or cholesterol among the 2 smoking groups. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe (1) nurses' physical and mental health; (2) the relationship between health and medical errors; and (3) the association between nurses' perceptions of wellness support and their health. Methods: A cross-sectional descriptive survey was conducted with 1790 nurses across the U.S. Results: Over half of the nurses reported suboptimal physical and mental health. Approximately half of the nurses reported having medical errors in the past 5 years. Compared with nurses with better health, those with worse health were associated with 26% to 71% higher likelihood of having medical errors. There also was a significant relationship between greater perceived worksite wellness and better health. Conclusion: Wellness must be a high priority for health care systems to optimize health in clinicians to enhance high-quality care and decrease the odds of costly preventable medical errors [ABSTRACT FROM AUTHOR]

The growth of both commercial and recreational boating has posed significant environmental challenges to waterways. As an effort by the U.S. government and other public service organizations to prevent and mitigate the environmental impact, Clean Marina Programs (CMP) have been developed to encourage marina owners and operators to meet environmental standards and become better stewards of the environment. This study examines the impact of geospatial proximity on the adoption timing and diffusion of a CMP in marinas, a special form of a maritime transportation hub. Drawing upon case study methodology and literature on geography and organizational clusters, we find that the adoption timing of an environmental standard varies with the density of the market within which it is promoted. These results lend support to the notion that firms in close proximity can accelerate standard adoption, hastening information flow about environmental standards through local labor pools, customer interactions, and resources. [ABSTRACT FROM AUTHOR]

During recent months, there has been growing international public concern about the Zika virus. As scientific understanding of the Zika virus unfolds, there are still many unanswered questions. Public health officials, clinicians, and consumers alike have questions about the Zika virus and the Zika virus disease. There is a need to know where to turn for the most up-to-date and reliable online information sources. Although aspects of Zika virus disease and associated medical conditions can be frightening, information seekers may find reassurance in the following online sources to guide their understanding of risk, prevention, transmission, affected geographical areas, symptoms, and disease management. [ABSTRACT FROM PUBLISHER]

Background Cardiovascular disease (CVD) is the leading cause of mortality for U.S. women. Racial minorities are a particularly vulnerable population. The increasing female veteran population has an higher prevalence of certain cardiovascular risk factors compared with non-veteran women; however, little is known about gender and racial differences in cardiovascular risk factor control among veterans. Methods We used analysis of variance, adjusting for age, to compare gender and racial differences in three risk factors that predispose to CVD (diabetes, hypertension, and hyperlipidemia) in a cohort of high-risk veterans eligible for enrollment in a clinical trial, including 23,955 men and 1,010 women. Findings Low-density lipoprotein (LDL) values were higher in women veterans than men with age-adjusted estimated mean values of 111.7 versus 97.6 mg/dL ( p < .01). Blood pressures (BPs) were higher among African-American than White female veterans with age-adjusted estimated mean systolic BPs of 136.3 versus 133.5 mmHg, respectively ( p < .01), and diastolic BPs of 82.4 versus 78.9 mmHg ( p < .01). African-American veterans with diabetes had worse BP, LDL values, and hemoglobin A1c levels, although the differences were only significant among men. Conclusions Female veterans have higher LDL cholesterol levels than male veterans and African-American veterans have higher BP, LDL cholesterol, and A1c levels than Whites after adjusting for age. Further examination of CVD gender and racial disparities in this population may help to develop targeted treatments and strategies applicable to the general population. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) is a major health problem and a leading cause of chronic liver disease in the United States and developed countries. In humans, genetic factors greatly influence individual susceptibility to NAFLD. The goals of this study were to compare the magnitude of interindividual differences in the severity of liver injury induced by methyl-donor deficiency among individual inbred strains of mice and to investigate .the underlying mechanisms associated with the variability. Feeding mice a choline- and folate-deficient diet for 12 wk caused liver injury similar to NAFLD. The magnitude of liver injury varied among the strains, with the order of sensitivity being A/J ≈ C57BL/6J ≈ C3H/HeJ < 129S1/SvImJ ≈ CAST/EiJ < PWK/PhJ < WSB/EiJ. The interstrain variability in severity of NAFLD liver damage was associated With dysregulation of genes involved in lipid metabolism, primarily with a down-regulation of the peroxisome proliferator receptor ot (PPARα)-regulated lipid catabolic pathway genes. Markers of oxidative stress and oxidative stress-induced DNA damage were also elevated in the livers but were not correlated with severity of liver damage. These findings suggest that the PPARα-regulated metabolism network is one of the key mechanisms determining interstrain susceptibility and severity of NAFLD in mice. [ABSTRACT FROM AUTHOR]

The article states that as per a survey conducted with a random sample of 1015 registered nurses enrolled with American Nurses Association, the number of years in clinical practice negatively correlated with the importance of and interest in EBP and levels of education positively correlated with being clear and confident about EBP. Magnet hospitals were found to engage into organizational culture for EBP. It implies incorporation of evidence-based care processes across disciplines and continuum, sustenance of EBP through mentors, teaching how to use research to promote an evidence-based approach to care and working effectively with health professionals who resist implementation of EBP as means to achieve the Institute of Medicine's 2020 goal that 90 percent of decisions be evidence-based.

Children's unstructured eating habits and activities may lead to excess dietary exposures not traditionally measured by the US Environmental Protection Agency. Influence of these activities on transfer of pesticides from treated Formica to foods was studied. The objective was to perform simulation experiments using four foods (bread, apple slices, bologna, and sugar cookies) exposed to treated Formica after varied time intervals between surface contamination and contact (1, 6, and 24 h) and frequency of contact with and without recontamination. Pesticides investigated included permethrin, bifenthrin, cyfluthrin, cypermethrin, and deltamethrin. Data will be used as input parameters for transfer efficiencies (TEs) within the Children's Dietary Intake Model (CDIM), which predicts total dietary exposure of a child. Pesticide transfer from surfaces to bologna and apples was more efficient than to bread and cookies. For the bread and cookies, all pyrethroids had a TE that ranged from below detectible levels to ≤4%. A combined average of 32-64% and 19-43% was transferred to bologna and apples, respectively, for the three contact times for all pyrethroids. The TEs of the varied time intervals indicated that increased time between contamination and contact showed little difference for bologna, bread, and cookies, but a significant difference for apples. As long as pesticide levels are measureable on surfaces in children's eating environment, it can be concluded that transfer of pesticides to foods will take place. Foods' characteristics had an important function in the transfer of pesticides when multiple contacts occurred. Regardless of recontamination, pesticides were efficiently transferred from the treated surface to bologna. The bologna did not reach a saturation point during the contacts. Pesticides were also efficiently transferred to apples, but reached a maximum TE during the second contact. The distribution of activity factors within CDIM needs to reflect the differences in the characteristics of the foods. [ABSTRACT FROM AUTHOR]

When a child is diagnosed with a chronic, life-threatening illness, there is a significant impact on the healthy siblings. Few studies have addressed the adaptation of well siblings in diagnoses other than cancer. The purpose of this descriptive correlational study was to examine the relationships between the risk and protective factors that affect the psychological adaptation of healthy siblings of a child with cystic fibrosis. Findings from this study suggest family environment, especially parental stress and perceived social support, may affect the adaptation of the well sibling. Adolescent well siblings were more at risk for environmental influences than their younger counterparts. [ABSTRACT FROM AUTHOR]

In the United States, the prevalence of childhood overweight and obesity has reached epidemic levels, with U.S. Hispanic children, a sub-group mainly composed of children of Mexican decent, disproportionately affected. Prior research has suggested that Mexican parents may view overweight in early childhood as desirable; however, it is unclear if this is still the case. Therefore, this qualitative study explored the beliefs of 11 Mexican parents of preschoolers regarding weight and health. Following coding and clustering of themes from the transcribed audio-recorded meetings, six patterns were identified: (a) meanings and relationships about excess weight in childhood and child health, (b) causes of overweight and obesity, (c) uncertainty about knowing and not knowing, (d) from Mexico to America: enticements of a new land and time as a commodity, (e) the effects of society on personal and parental goals: the work of parenting in the United States, and (f) identified needs and action strategies. In summary, parents involved in this group discussion readily associated overweight/obesity with poor mental and physical health; however, they were uncertain how they would "know" if their children were overweight. [ABSTRACT FROM AUTHOR]

The decision for hospice care in the United States is a sudden realization that life is coming to an end, which often brings heightened anxiety and depression for family caregivers. The need to involve and educate family caregivers of dying loved ones has become a common underlying theme in current literature. The purpose of this article was to provide a comprehensive literature review and critical appraisal of intervention studies with family caregivers of loved ones on hospice to provide recommendations for future research and clinical practice. A systematic search was performed in multiple databases using the MeSH terms of family caregiver, hospice care, terminal care, and palliative care, and the key word intervention. Five intervention studies were found. Sample sizes, interventions, and outcome measures varied widely, and most of the studies lacked a theoretical framework. Although these interventions provided a needed focus on family caregivers of hospice patients, the methodological flaws make it difficult to draw conclusions about the efficacy of the interventions. Therefore, theory-based and methodologically rigorous interventional research is needed to develop and test interventions that assist family caregivers of hospice patients in coping and caring for dying patients. [ABSTRACT FROM AUTHOR]

More than 500,000 premature infants are born in the United States every year. Preterm birth results in a multitude of negative adverse outcomes for children, including extended stays in the neonatal intensive care unit (NICU), developmental delays, physical and mental health/behavioral problems, increased medical utilization, and poor academic performance. In addition, parents of preterms experience a higher incidence of depression and anxiety disorders along with altered parent-infant interactions and overprotective parenting, which negatively impact their children. The costs associated with preterm birth are exorbitant. In 2005, it is estimated that preterm birth cost the United States $26.2 billion. The purpose of this study was to perform a cost analysis of the Creating Opportunities for Parent Empowerment (COPE) program for parents of premature infants, a manualized educational-behavioral intervention program comprising audiotaped information and an activity workbook that is administered to parents in 4 phases, the first phase commencing 2 to 4 days after admission to the NICU. Findings indicated that the COPE program resulted in cost savings of at least $4864 per infant. In addition to improving parent and child outcomes, routine implementation of COPE in NICUs across the United States could save the healthcare system more than $2 billion per year. [ABSTRACT FROM AUTHOR]

Although evidence-based practice (EBP) integrates the best evidence from well-designed studies with a clinician's expertise and patient preferences and values, most of what is emphasized in books and reports on EBP is the 5-step EBP process. However, the consideration of patient values and preferences in making clinical decisions is essential to deliver the highest quality of care. This article briefly reviews the status of EBP in the United States, described the ARCC mentorship model, and highlights how to engage consumers in the EBP process. [ABSTRACT FROM AUTHOR]

Background: The paradigm shift to evidence-based nursing practice in the United States has been slow. Although multiple barriers to evidence-based practice (EBP) have been identified through prior studies, there is a gap in the literature specifically identifying key variables (e.g., belief that EBP produces quality outcomes) that are correlated with the extent to which nurses engage in EBP. Aim: The primary aims of this study were to (1) describe nurses' knowledge, beliefs, skills, and needs regarding EBP; (2) determine whether relationships exist among these variables; and (3) describe major barriers and facilitators to EBP. Methods: A descriptive survey was conducted with a convenience sample of 160 nurses who were attending EBP conferences or workshops in four states located within the Eastern Region of the United States. Results: Although participant beliefs about the benefit of EBP were high, knowledge of EBP was relatively low. Significant relationships were found between the extent to which the nurses' practice is evidence-based and (1) nurses' knowledge of EBP, (2) nurses' beliefs about the benefits of EBP, (3) having an EBP mentor, and (4) using the Cochrane Database of Systematic Reviews and the National Guideline Clearinghouse. Conclusion and Implications: Health care systems need to implement interventions that not only increase nurses' EBP knowledge and skills, but also strengthen their beliefs about the benefit of evidence-based care. EBP mentors may be key in accelerating a more rapid shift toward evidence-based nursing practice. Theoretically driven randomized controlled trials are urgently needed to test the effectiveness of interventions on advancing evidence-based care. [ABSTRACT FROM AUTHOR]

Effective public communication about terrorism is essential to promoting resilience and helping people stay healthy during very stressful experiences. Since September 11, 2001, most communication with the public has failed. Raising the alert level to Code Orange may be useful for security personnel, but it creates confusion and heightens anxiety for the public. The Department of Homeland Security and other agencies charged with homeland security forget to address the psychology of terrorism. This must change. As federal and state governments improve public communications, they must understand the critical role of the nation's health care system, especially primary care. Primary care providers are first-responders and are trusted by the public. Opportunities to support agendas for both preparedness and response occur naturally in primary care environments. [ABSTRACT FROM AUTHOR]

ISO 14001 constitutes a major dilemma for many American firms. This new standard holds the promise of waste reduction and better process management, but the benefits and costs are very difficult to predict. This study attempts to identify and explain antecedents impacting the decision to pursue certification for some of the first plants certified in the United States. Using data from a large survey of U.S. managers and a Logit analysis, we find the factors influencing management decisions to actively pursue ISO 14001 certification to be distinctly different from those factors influencing management's decision not to pursue certification. For the latter, the decision is economically based; for the former, it is driven by other, more qualitative considerations. [ABSTRACT FROM AUTHOR]

In 1998, a city in Indiana reported 4-fold increase in the number of cases of tuberculosis (TB). An investigation to assess the increase in cases and to identify possible epidemiologic links among persons with TB identified 41 cases of active TB. Epidemiologic links and/or matching DNA fingerprints were identified for 31 patients (76%). The majority of these patients were members of a single social network within the community. Links for most of these patients were identified after multiple interviews with patients and their contacts. TB control activities in the county were limited prior to the identification of the outbreak. At least 24 cases may have been preventable. This outbreak may have been prevented with prompt case identification and effective contact tracing and screening during the years before the outbreak. The use of social networks should be considered in the investigation of outbreaks that involve difficult-to-reach populations. TB control measures should be maintained in areas with historically low TB incidence. [ABSTRACT FROM AUTHOR]

Correlates cerebral oximetry measurement with carotid artery stump pressures during carotid endarterectomy (CEA) in patients in Minneapolis, Minnesota. Assessment of the mean internal carotid artery stump pressure; Use of Spearman's correlation coefficient in the study; Implications of using CEA as an alternative for stump pressure measurements.

The purpose of this study was to provide 1 year follow-up data to a previous paper that compared single-session (SS) treatment to treatment-as-needed (TAN) outcomes for mild traumatic brain injury (MTBI) survivors at 3 months post-injury. Participants were 105 adults with MTBI who were recruited from consecutive admissions to two hospital emergency wards, and randomly assigned to either the SS or TAN modality. No group differences in outcome were evident at 12 months postinjury. As well, improvements seen in the groups after 3 months were maintained at 12 months. As improvements between 3 and 12 months were negligible, self-reported improvement after a treated MTBI typically occurred within the first 3 months. Brief educational intervention given soon after MTBI appears to be as helpful as more intensive treatment for most MTBI survivors for at least 12 months post-injury. [ABSTRACT FROM AUTHOR]

Reviews the evolution and the state of evidence-based practice (EBP) in the United States. Factors to be considered in practicing evidence-based nursing; Recommendations for implementing and advancing EBP; Strategies for implementing EBP; Conclusion.

Hertz Rent-A-Car operates a substantial fleet of vehicles in more than 100 rental cities in the U.S. and Canada. Most of the important field operations are organized on a pool basis. In a pool, a group of cities, each run by its own management, shares a fleet of cars. The Pool Control System (PCS), a timeshare based model-oriented system, helps answer these questions for each city for the next few days: How many cars will be needed? How many cars will be available or can be moved in from other pool cities? How many reservations can be accepted? How will the actions taken for any city on any day affect future days and other cities? The fluctuations in demand, the disparities in customer characteristics from city to city and day to day, and the interdependencies that exist between cities ere accounted for by the PCS model which provides a detailed picture of the pool for the coming week. Assumptions can be easily modified to yield different pictures so that alternative strategies can be fully evaluated. PCS is run daily by local management in the major pools representing some 50 cities and over 60% of Hertz' domestic car rental fleet. It has been used most successfully in handling the Super Bowl, the Florida winter season, the Montreal Olympics, the West Coast summer peak and major conventions. Dramatic improvement in fleet utilization and control, as well as customer satisfaction, have all been attributed to the system. In a more general way, the basic concepts underlying PCS have impacted management's approach to decision making at all levels. [ABSTRACT FROM AUTHOR]

The article focuses on the problem of long cycles in residential construction. According to the author, cycles are understood to be alternations of expansions and contractions. Ideally the duration of either one should not be less than one and one-half business cycles. Lord swings are generally periods of acceleration and retardation in growth. They would become cycles only after the elimination of secure trend. The causes of prolonged periods of expansion are now not difficult to find. They cannot be attributed to short-term factors alone because they were much too strong and decisively dominated more than one business cycle. The fundamental cause was the accumulated demand strongly reinforced by international and internal immigration. The statistical evidence of a study does not suggest the existence of building cycles in total residential construction. this construction activity can be most appropriately described by such terms as breaks in the series, vigorous expansions following the breaks, and changes of pace or at most changes in short trends.

Background Genital ulcers (GUs) remain a common reason that both men and women seek treatment at US sexual health clinics. Presumptive diagnosis based solely on the macroscopic lesion characteristics is insensitive for differentiating between the common etiologies of GUs, which include HSV1/2, VZV, and syphilis. Given the ongoing and rapidly-expanding Syphilis epidemic, more accurate and timely identification of GU etiology would facilitate accurate therapeutic decision making, promote antibiotic stewardship, and have positive impacts on public health. The current study describes diagnostic workflows that allow for sequential/reflex or parallel GU testing, relying on a combination of IVD and published NAAT-based solutions, performed on the cobas® 4800 and/or cobas® 6800 Systems, to detect HSV1/2, VZV, and T. pallidum from a single specimen. Methods Commercially available control material for HSV1, HSV2, VZV, and T. pallidum were spiked into MSwab™ and cobasâ PCR medium at varying concentrations. The spiked medium was either aliquoted directly to cobas® PCR Media Secondary Tubes (for testing on the cobasâ 6800 System) or MSwabs were dipped directly into the spiked specimen vials and transferred to their respective collection tubes (cobasâ 4800 System). GU testing on the cobas® 4800 System was sequential: performing the cobas® HSV1 and 2 Test first, followed by VZV and T. pallidum detection using residual DNA eluates and the User Defined Workflow (UDF) software. Testing on the cobas® 6800 System allowed for parallel processing and simultaneous detection of the 4 targets utilizing the cobas omni Utility Channel, which supports a complete, automated Lab Developed Test workflow. Results Qualitative detection of HSV1, HSV2, VZV and T. pallidum was demonstrated on both systems. Conclusion Novel solutions that aim to reduce empiric therapy, or shorten the interval to treatment success, are critical for both diagnostic and antibiotic stewardship. Through parallel or sequential testing algorithms, panel testing schematics on either the cobas® 4800 and 6800 Systems allow for more accurate discrimination between GU etiologies that may help address the re-emergence of Syphilis in the USA. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

The article stresses the need for nurse leaders in the U.S. to create a culture in which evidence-based practice (EBP) is intrinsic. Topics discussed include the healthcare crisis being experienced by the U.S., the perception of the U.S. healthcare sector as time consuming, and a study which showed that view of nurses on EBP.

Background: The number of obese children in the US remains high, which is problematic due to the mental, physical, and academic effects of obesity on child health. Data indicate that school-age children, particularly underserved children, experience unhealthy gains in BMI at a rate nearly twice as fast during the summer months. Few efforts have been directed at implementing evidence-based programming to prevent excess weight gain during the summer recess.Methods: Camp NERF is an 8-week, multi-component (nutrition, physical activity, and mental health), theory-based program for underserved school-age children in grades Kindergarten - 5th coupled with the USDA Summer Food Service Program. Twelve eligible elementary school sites will be randomized to one of the three programming groups: 1) Active Control (non-nutrition, physical activity, or mental health); 2) Standard Care (nutrition and physical activity); or 3) Enhanced Care (nutrition, physical activity, and mental health) programming. Anthropometric, behavioral, and psychosocial data will be collected from child-caregiver dyads pre- and post-intervention. Site-specific characteristics and process evaluation measures will also be collected.Discussion: This is the first, evidence-based intervention to address the issue of weight gain during the summer months among underserved, school-aged children. Results from this study will provide researchers, practitioners, and public health professionals with insight on evidence-based programming to aid in childhood obesity prevention during this particular window of risk.Trial Registration: NCT02908230/09-19-2016. [ABSTRACT FROM AUTHOR]

The 2007 Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards and Guidelines for the Professional Program in Pharmacy delineate new expectations for experiential education within curricula and include guidance on the development and conduct of Pharmacy Practice Experiences. The American College of Clinical Pharmacy (ACCP) Educational Affairs Subcommittee C developed a position statement to further delineate the views of ACCP on factors necessary to meet contemporary standards for doctoral education in pharmacy and to provide guidance to our membership on how to implement the new standards. This White Paper provides explanation and supporting documentation for positions on quantitative and qualitative aspects of experiential education, as well as requirements for practice sites, preceptor roles, qualification, credentialing, and development and assessment of student performance. [ABSTRACT FROM AUTHOR]

Context.--With multiple therapeutic options available for patients with advanced non--small cell lung cancer, the timely ordering and return of results to determine therapy are of critical importance. Objective.--To assess factors impacting anaplastic lymphoma kinase (ALK) test ordering and time to result delivery. Design.--A retrospective study using a de-identified electronic health record database was performed. Postdiagnosis ALK tests (n ¼ 14 657) were analyzed from 14 197 patients with advanced non--small cell lung cancer diagnosed between January 2015 and May 2019. Time from non--small cell lung cancer diagnosis to ALK sample receipt in the laboratory was a surrogate for test order time. Test ordering was considered delayed if order time was more than 20 days. Turnaround time from sample received to test result was calculated and considered delayed if more than 10 days. Multivariable logistic regression was used to assess factors associated with order time and turnaround time delays. Results.--Median ALK test order time was 15 days, and 36.4% (5342) of all 14 657 orders were delayed. Factors associated with delays were non-fluorescence in situ hybridization testing, send-out laboratories, testing prior to 2018, nonadenocarcinoma histology, and smoking history. Median turnaround time was 9 days, and 40.3% (5906) of all 14 657 test results were delayed. Non-fluorescence in situ hybridization testing, tissue sample, and orders combining ALK with other biomarkers were associated with delayed ALK result reporting. Conclusions.--This study provides a snapshot of realworld ALK test ordering and reporting time in US community practices. Multiple factors impacted both test ordering time and return of results, revealing opportunities for improvement. It is imperative that patients eligible for targeted therapy be identified in a timely fashion. [ABSTRACT FROM AUTHOR]

Purpose Elevated low-density lipoprotein cholesterol (LDL-C) is a major modifiable risk factor for cardiovascular disease (CVD), a leading cause of death in the United States. Despite clinical practice guidelines aimed at facilitating LDL-C control, many Veterans do not achieve guideline-recommended LDL-C levels. Methods We describe a study focused on VA healthcare system users at risk for CVD (i.e., LDL-C level > 130 mg/dl and/or < 80% cholesterol pill refill adherence in the last 12 months). We are conducting a two and a half year randomized controlled trial (i.e., intervention administered over 12 months) among Veterans with uncontrolled cholesterol receiving care at select VA-affiliated primary care clinics in North Carolina. We anticipate enrolling 250 diverse patients (10% women; 40% African American). Patients are randomized to an educational control group or intervention group. Intervention group participants' medication is provided in special blister packaging labeled for daily use that includes reminders; MeadWestvaco Corporation's pre-filled DosePak® contains standard doses of statins in accordance with the existing prescriptions. Conclusions Pre-filled blister packaging may provide an inexpensive solution to improve medication adherence. Our study enrolls a diverse sample and provides information about whether an adherence packaging intervention can: 1) improve medication adherence; 2) improve patients' LDL-C levels; 3) be well received by patients and providers; and 4) provide a cost effective solution to improve medication adherence. [ABSTRACT FROM AUTHOR]

The availability of millions of SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) sequences in public databases such as GISAID (Global Initiative on Sharing All Influenza Data) and EMBL-EBI (European Molecular Biology Laboratory-European Bioinformatics Institute) (the United Kingdom) allows a detailed study of the evolution, genomic diversity, and dynamics of a virus such as never before. Here, we identify novel variants and subtypes of SARS-CoV-2 by clustering sequences in adapting methods originally designed for haplotyping intrahost viral populations. We asses our results using clustering entropy-the first time it has been used in this context. Our clustering approach reaches lower entropies compared with other methods, and we are able to boost this even further through gap filling and Monte Carlo-based entropy minimization. Moreover, our method clearly identifies the well-known Alpha variant in the U.K. and GISAID data sets, and is also able to detect the much less represented (<1% of the sequences) Beta (South Africa), Epsilon (California), and Gamma and Zeta (Brazil) variants in the GISAID data set. Finally, we show that each variant identified has high selective fitness, based on the growth rate of its cluster over time. This demonstrates that our clustering approach is a viable alternative for detecting even rare subtypes in very large data sets.