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Background: It is increasingly important for faculty to teach deliberately and provide timely, detailed, and formative feedback on surgical trainee performance. We initiated a multicenter study to improve resident evaluative processes and enhance teaching and learning behaviors while engaging residents in their education.Study Design: Faculty from 7 US postgraduate training programs rated resident operative performances using the perioperative briefing, intraoperative teaching, debriefing model, and rated patient visits/academic performances using the entrustable professional activities model via a web-based platform. Data were centrally analyzed and iterative changes made based on participant feedback, individual preferences, and database refinements, with trends addressed using the Plan, Do, Check, Act improvement methodology.Results: Participants (92 surgeons, 150 residents) submitted 3,880 assessments during July 2014 through September 2017. Evidence of preoperative briefings improved from 33.9% ± 2.5% to 95.5% ± 1.5% between April and September 2014 compared with April and September 2017 (p < 0.001). Postoperative debriefings improved from 10.6% ± 2.7% to 90.2% ± 2.5% (p < 0.001) for the same period. Meaningful self-reflection by residents improved from 28.6% to 67.4% (p < 0.001). The number of assessments received per resident during a 6-month period increased from 6.4 ± 6.2 to 13.4 ± 10.1 (p < 0.003). Surgeon-entered assessments increased from 364 initially to 685 in the final period, and the number of resident assessments increased from 308 to 445. We showed a 4-fold increase in resident observed activities being rated.Conclusions: By adopting recognized educational models with repeated Plan, Do, Check, Act cycles, we increased the quality of preoperative learning objectives, showed more frequent, detailed, and timely assessments of resident performance, and demonstrated more effective self-reflection by residents. We monitored trends, identified opportunities for improvement and successfully sustained those improvements over time, applying a team-based approach. [ABSTRACT FROM AUTHOR]

Objective: To prospectively assess the effect of endometriosis and uterine fibroids on the long term risk of premature mortality (younger than 70 years)., Design: Prospective cohort study SETTING: The Nurses' Health Study II, United States (1989-2019)., Participants: 110 091 women aged 25-42 years in 1989 without a history of hysterectomy before endometriosis or fibroids diagnosis, cardiovascular diseases, or cancer., Main Outcome Measures: Hazard ratios (estimated by Cox proportional hazards models) for total and cause specific premature mortality according to laparoscopically confirmed endometriosis or ultrasound or hysterectomy confirmed uterine fibroids reported in biennial questionnaires., Results: 4356 premature deaths were recorded during 2 994 354 person years of follow-up (27.2 years per person), including 1459 from cancer, 304 from cardiovascular diseases, and 90 from respiratory diseases. The crude incidence of all cause premature mortality for women with and without laparoscopically confirmed endometriosis was 2.01 and 1.40 per 1000 person years, respectively. In age adjusted models, laparoscopically confirmed endometriosis was associated with a hazard ratio of 1.19 (95% confidence interval 1.09 to 1.30) for premature death; these models were strengthened after also adjusting for potential confounders including behavioral factors (1.31, 1.20 to 1.44). Cause specific mortality analyses showed that the association was largely driven by mortality from senility and ill-defined diseases (1.80, 1.19 to 2.73), non-malignant respiratory diseases (1.95, 1.11 to 3.41), diseases of the nervous system and sense organs (2.50, 1.40 to 4.44), and malignant neoplasm of gynecological organs (2.76, 1.79 to 4.26). Ultrasound or hysterectomy confirmed uterine fibroids were not associated with all cause premature mortality (1.03, 0.95 to 1.11), but were associated with a greater risk of mortality from malignant neoplasm of gynecological organs (2.32, 1.59 to 3.40) in cause specific mortality analyses. The risk of mortality caused by cardiovascular and respiratory diseases varied according to joint categories of endometriosis and uterine fibroids, with an increased risk of all cause premature mortality among women reporting both endometriosis and uterine fibroids., Conclusion: Women with a history of endometriosis and uterine fibroids might have an increased long term risk of premature mortality extending beyond their reproductive lifespan. These conditions were also associated with an increased risk of death due to gynecological cancers. Endometriosis was associated with a greater risk of non-cancer mortality. These findings highlight the importance for primary care providers to consider these gynecological disorders in their assessment of women's health., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and have declared: support from National Natural Science Foundation of China and the National Institutes of Health for the submitted work. No financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: Physician-industry relationships can be useful for driving innovation and technologic progress, though little is known about the scale or impact of industry involvement in neuroradiology. The purpose of this study was to assess the trends and distributions of industry payments to neuroradiologists., Materials and Methods: Neuroradiologists were identified using a previously-validated method based on Work Relative Value Units and Neiman Imaging Types of Service classification. Data on payments from industry were obtained from the Open Payments database from the Centers for Medicare & Medicaid Services, from 2016 to 2021. Payments were grouped into 7 categories, including consulting fees, education, gifts, medical supplies, research, royalties/ownership, and speaker fees. Descriptive statistics were calculated., Results: A total of 3019 neuroradiologists were identified in this study. Between 2016 and 2021, 48% (1440/3019) received at least 1 payment from industry, amounting to a total number of 21,967 payments. Each year, among those receiving payments from industry, each unique neuroradiologist received between a mean of 5.49-7.42 payments and a median of 2 payments, indicating a strong rightward skew to the distribution of payments. Gifts were the most frequent payment type made (60%, 13,285/21,967) but accounted for only 4.1% ($689,859/$17,010,546) of payment value. The greatest aggregate payment value came from speaker fees, which made up 36% ($6,127,484/$17,010,546) of the total payment value. The top 5% highest paid neuroradiologists received 42% (9133/21,967) of payments, which accounted for 84% ($14,284,120/$17,010,546) of the total dollar value. Since the start of the coronavirus 2019 (COVID-19) pandemic, the number of neuroradiologists receiving industry payments decreased from a mean of 671 neuroradiologists per year prepandemic (2016-2019) to 411 in the postpandemic (2020-2021) era ( P = .030). The total number of payments to neuroradiologists decreased from 4177 per year prepandemic versus 2631 per year postpandemic ( P = .011)., Conclusions: Industry payments to neuroradiologists are highly concentrated among top earners, particularly among the top 5% of payment recipients. The number of payments decreased during the COVID-19 pandemic, though the dollar value of payments was offset by coincidental increases in royalty payments. Further investigation is needed in subsequent years to determine if the postpandemic changes in industry payment trends continue., (© 2024 by American Journal of Neuroradiology.)

Stress fractures, including both fatigue and insufficiency types, are frequently encountered in clinical practice as a source of pain in a variety of patients (athletes, older patients, and patients with predisposing conditions). Radiography is the imaging modality of choice for baseline diagnosis. MRI has greatly improved our ability to diagnose radiographically occult stress fractures. Nuclear medicine scintigraphy and CT may also be useful as diagnostic tools. Although fatigue and insufficiency fractures can be self-limited and go on to healing even without diagnosis, there is usually value in initiating prompt therapeutic measures as incomplete stress fractures have the potential to progress to completion, necessitating surgery. This is particularly important in the setting of stress fractures of the femoral neck. Accuracy in the identification of these injuries is also relevant because the differential diagnosis includes entities that would otherwise be treated differently (ie, metastatic disease). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Background: The Get With The Guidelines-Stroke program is a quality improvement initiative designed to enhance adherence to evidence-based stroke care. Since its inception in 2003, over 2800 hospitals in the United States have participated in the program., Methods: We examined patient characteristics, adherence to performance measures, and in-hospital outcomes in patients hospitalized for acute ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and transient ischemic attack in The Get With The Guidelines-Stroke hospitals from 2003 through 2022. We quantified temporal changes in performance measure adherence and clinical outcomes over time. Performance measure denominators consisted of patients who were eligible, excluding those with contraindications., Results: Over the 20 years of the program, a total of 7837 849 stroke cases (median age 71 years, 51.0% female; 69.2% ischemic strokes, 3.9% SAHs, 11.5% ICHs, and 15.3% TIAs) were entered into the registry. Except for antithrombotics at discharge, in which the baseline performance was >92%, there was sustained improvement in all performance metrics regardless of type of cerebrovascular event ( P <0.01 for all). In patients with acute ischemic stroke, large improvements were observed for anticoagulation for atrial fibrillation (55.7% in 2003 to 97.2% in 2022), smoking cessation counseling (44.7%-97.8%), dysphagia screening (53.8%-83.5%), thrombolytic treatment for patients arriving by 3.5 hours, treat by 4.5 hours (15.2%-92.9%), door-to-needle time within 60 minutes (19.0%-75.3%), and endovascular door-to-puncture time within 90 minutes (54.7%-62.8%). Similar improvements were also observed for measures relevant to patients with subarachnoid hemorrhage, intracerebral hemorrhage, and transient ischemic attack. Multivariable analysis showed that there was a sustained increase in odds of receiving each performance measure over time, independent of patient and hospital characteristics for each type of cerebrovascular event. After risk adjustment, there were temporal trends that patients were less likely to be discharged to a skilled nursing facility, and, for ischemic stroke only, more likely to be discharged directly home., Conclusions: During the first 20 years, Get With The Guidelines-Stroke participation was associated with sustained improvement in evidence-based care and outcomes for patients with stroke and transient ischemic attack in the United States., Competing Interests: Dr Xian reports research funding from the American Heart Association and the National Institute on Aging (R01AG062770 and R01AG066672);grants from Daiichi Sankyo Company; grants from Genentech; travel support from Boehringer Ingelheim; and grants from Janssen Pharmaceuticals Inc. Dr Smith reports service as an editor for the Stroke journal. Dr Saver reports consulting fees for advising on rigorous and safe clinical trial design and conduct from Abbott, Acticor, Aeromics, Amgen, Argenica, Astrocyte, Bayer, Biogen, Boehringer Ingelheim, BrainsGate, BrainQ, CSL Behring, Filterlex, Genentech, Johnson&Johnson, MindRhythm, Medtronic, NeuroMerit, Neuronics, Novo Nordisk, Occlutech, Phenox, Phillips, QuantalX, Rapid Medical, Roche, and Stream Biomedical; compensation from MIVI Neuroscience for data and safety monitoring services; and stock options in Rapid Medical, Neuronics Medical, and MindRhythm. Dr Sheth reports grant support from National Institutes of Health, American Heart Association, and Hyperfine; consulting from Astrocyte, Rhaeos, Cerevasc, Bexorg, Sense and Philips Data and Safety Monitoring Board; and patent with Alva; and compensation from Certus for consultant services; stock options in BrainQ. Dr Messé reports personal compensation from Novo Nordisk for work on the Clinical Event Committee for ONWARDS and Zeus Trials; Terumo for work on the Subject Selection Committee for the RelayBranch Trial; WL Gore for work on the Data Safety Monitoring Committee for the GORE CARDIOFORM Septal Occluder Post Marketing Trial; and Conformal Medical for work on the Clinical Event Committee for work on the Conformal left atrial appendage closure trial. He also reports equity in Neuralert Technologies. Dr Schwamm reports consulting for Genentech (member of TIMELESS steering committee NCT03785678), LifeImage, Penumbra (DSMB MIND NCT03342664), Medtronic (co-PI Stroke AF NCT02700945, advise on stroke prevention), grant funding from NINDS (PI, U24NS107243; Co-I, R01NS111952) and PCORI (R-1609-35995), and serves as member board of directors for the American Heart Association. Dr Fonarow reports consulting for Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Eli Lilly, Johnson & Johnson, Medtronic, Merck, Novartis, and Pfizer. The other authors report no conflicts.

Background: Young Arab American women are at risk for cardiovascular disease, but there is limited data on their physical activity (PA) engagement., Objectives: The aim of this study was to examine the relationship between PA and its correlates in young Arab American women. The objectives of this study were to: (1) describe self-reported lifestyle PA behaviors of young Arab American women and (2) examine the relationship between their self-reported lifestyle PA, device-measured lifestyle PA (combined moderate / vigorous and steps), and potentially associated factors (demographics, physical measures, individual factors, and behavior cognition factors)., Methods: This cross-sectional study was conducted with women 18 to 35 years of age and Arab American (n = 50) in the Midwest Region of the United States. Participants wore ActiGraph GT3X-BT monitors for 7 days; self-report measures included the International Physical Activity Questionnaire, demographics, acculturation, discrimination, religiosity, self-efficacy, and social support., Results: The mean age of participants was 25.5 years ( SD : 5.5; range: 18-35). Per ActiGraph, the average daily steps were 5946 ( SD : 2783); only 24% met the moderate-intensity PA guidelines. Self-efficacy was significantly associated with increased moderate-to-vigorous PA ( B  = 0.37; P  = .012)., Conclusion: The average daily steps for the young Arab American women in this study were of low active classification. More than 75% of the women failed to meet the recommended weekly moderate / vigorous PA guidelines. Our study supports the importance of targeting and tailoring PA interventions on young Arab American women who have low self-efficacy for overcoming barriers to lifestyle PA., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The median cost of anti-seizure medications (ASM) in the United States (U.S.) nearly doubled per person between 2006 and 2021. This increase, combined with shifts in ASM usage and the impact of the COVID-19 pandemic on drug supply chains amid rising inflation, underscored the urgent need to scrutinize ASM pricing dynamics. This study aimed to analyze the complex dynamics of ASM pricing in the U.S. over the past decade (2013-2023); this included how the entry of generic ASMs influenced the pricing of brand-name counterparts and what impacted price variations across different ASM formulations (e.g., significant inflation, the COVID-19 pandemic)., Methods: This study utilized National Average Drug Acquisition Cost (NADAC) data from November 2013 to July 2023. We adjusted ASM prices for inflation using the Consumer Price Index for Medicinal Drugs - Seasonally Adjusted (CPI-MDS). Statistical analyses included fixed effects regressions and multivariable regression analysis to evaluate the impact of inflation, the number of medication labelers, and the COVID-19 pandemic on ASM prices., Results: Our study analyzed 23 ASMs approved by the U.S. Food and Drug Administration (FDA), which encompassed 223 oral formulations:112 brand-name and 111 generics. From 2013-2016 to 2020-2023, accounting for standard deviations (SD), the average price of brand-name ASMs increased from $8.71 (SD 5.9) to $15.43 (SD 10.7), while generic ASMs saw a slight decrease from $1.39 (SD 1.8) to $1.26 (SD 1.6). Consequently, the price gap between brand-name and generic ASMs surged from 1452.39 % to 3399.26 %. The proportion of matched brand-name and generic ASMs with a price difference of 1000 %-9999 % increased from 32.88 % (2013-2016) to 41.43 % (2020-2023), while those exceeding 10,000 % rose from 16.44 % to 20 % in the same period. Generic immediate-release (IR) formulations were significantly less expensive than extended-release (ER) or delayed-release (DR) counterparts, with cost differences reaching up to 7751.20 %. The number of medication labelers was inversely related to generic ASM prices, which decreased by 5.45 % (p = 0.001) with each additional generic labeler, while brand-name ASM prices increased by 2.46 % (p < 0.001) with each additional generic labeler. The COVID-19 pandemic led to a 24.4 % increase in brand-name ASM prices and a 23.1 % decrease in generic ASM prices., Conclusions: The findings reveal an expanding price disparity between brand-name and generic oral ASMs. An inverse relationship was observed between the number of medication labelers and generic ASM prices, with additional labelers driving down generic prices. However, introducing more generic labelers led to a significant increase in brand-name ASM prices. Furthermore, following patent expirations, brand-name ASM prices rose-a trend explained by the "generics paradox," where, contrary to expectations, brand prices do not decrease and may even increase when generics enter the market. These findings underscore the need for targeted interventions in drug pricing policies to manage the rising costs associated with epilepsy treatment. To ensure equitable access to ASMs, stakeholders must understand and address the factors driving these pricing dynamics., Competing Interests: Declaration of competing interest The authors report no disclosures., (Copyright © 2024 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Background: Chronic hepatitis C virus (HCV) infection is associated with early onset of chronic diseases and increased risk of chronic disorders. Chronic viral infections have been linked to accelerated biological aging based on epigenetic clocks. In this study, we aimed to investigate the association between HCV infection and clinical measures of biological aging among 8 306 adults participating in the 2015-2018 waves of the National Health and Nutrition Examination Survey (NHANES)., Methods: NHANES 2015-2018 participants aged 20 years and older who had complete data on clinical blood markers and HCV-related tests were included in the current study. We estimated biological age using 2 approaches including phenotypic age (PhenoAge) and allostatic load (AL) score based on 9 clinical biomarkers., Results: After adjusting for demographic and other confounding factors, HCV antibody-positivity was associated with advanced PhenoAge (β = 2.43, 95% confidence interval: 1.51-3.35), compared with HCV antibody-negativity. Additionally, both active HCV infection (HCV RNA (+)) and resolved infection were associated with greater PhenoAge acceleration. The positive association with the AL score was not statistically significant. We did not observe any significant interactions of potential effect modifiers, including smoking and use of drug/needle injection, with HCV infection on measures of biological aging., Conclusions: Our findings suggest that HCV infection is independently associated with biological aging measured by phenotypic age in the U.S. general population. Further studies are warranted to confirm the findings., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Importance: Limited access to healthy foods, resulting from residence in neighborhoods with low food access, is a public health concern. The contribution of this exposure in early life to child obesity remains uncertain., Objective: To examine associations of neighborhood food access during pregnancy or early childhood with child body mass index (BMI) and obesity risk., Design, Setting, and Participants: Data from cohorts participating in the US nationwide Environmental Influences on Child Health Outcomes consortium between January 1, 1994, and March 31, 2023, were used. Participant inclusion required a geocoded residential address in pregnancy (mean 32.4 gestational weeks) or early childhood (mean 4.3 years) and information on child BMI., Exposures: Residence in low-income, low-food access neighborhoods, defined as low-income neighborhoods where the nearest supermarket is more than 0.5 miles for urban areas or more than 10 miles for rural areas., Main Outcomes and Measures: BMI z score, obesity (age- and sex-specific BMI ≥95th percentile), and severe obesity (age- and sex-specific BMI ≥120% of the 95th percentile) from age 0 to 15 years., Results: Of 28 359 children (55 cohorts; 14 657 [51.7%] male and 13 702 [48.3%] female; 590 [2.2%] American Indian, Alaska Native, Native Hawaiian, or Other Pacific Islander; 1430 [5.4%] Asian; 4034 [15.3%] Black; 17 730 [67.2%] White; and 2592 [9.8%] other [unspecified] or more than 1 race; 5754 [20.9%] Hispanic and 21 838 [79.1%] non-Hispanic) with neighborhood food access data, 23.2% resided in low-income, low-food access neighborhoods in pregnancy and 24.4% in early childhood. After adjusting for individual sociodemographic characteristics, residence in low-income, low-food access (vs non-low-income, low-food access) neighborhoods in pregnancy was associated with higher BMI z scores at ages 5 years (β, 0.07; 95% CI, 0.03-0.11), 10 years (β, 0.11; 95% CI, 0.06-0.17), and 15 years (β, 0.16; 95% CI, 0.07-0.24); higher obesity risk at 5 years (risk ratio [RR], 1.37; 95% CI, 1.21-1.55), 10 years (RR, 1.71; 95% CI, 1.37-2.12), and 15 years (RR, 2.08; 95% CI, 1.53-2.83); and higher severe obesity risk at 5 years (RR, 1.21; 95% CI, 0.95-1.53), 10 years (RR, 1.54; 95% CI, 1.20-1.99), and 15 years (RR, 1.92; 95% CI, 1.32-2.80). Findings were similar for residence in low-income, low-food access neighborhoods in early childhood. These associations were robust to alternative definitions of low income and low food access and additional adjustment for prenatal characteristics associated with child obesity., Conclusions: Residence in low-income, low-food access neighborhoods in early life was associated with higher subsequent child BMI and higher risk of obesity and severe obesity. We encourage future studies to examine whether investments in neighborhood resources to improve food access in early life would prevent child obesity.

Introduction: Opioid overdose deaths in the U.S. have risen dramatically in the past decade, largely due to the surge in illicitly manufactured fentanyl. Injection drug use is a known risk factor for HIV, further complicating the long-term consequences of opioid use. The baseline prevalence of HIV among adults in the US is 0.46 %. The primary purpose of this study was to determine the prevalence and risk factors of HIV among patients presenting to the emergency departments (ED) with an acute opioid overdose., Methods: This study is a prospective observational cohort study from the ToxIC Fentalog Study group. Patients age 18 years of age or older are included if they present to one of 10 participating U.S. hospitals in 9 states between September 2020 and May 2023 with a suspected opioid overdose and had waste serum available after routine laboratory testing. Clinical data is collected from the medical record and patient serum is sent for comprehensive toxicologic analysis via liquid chromatography quadrupole time-of-flight mass spectroscopy to detect the presence of over 1200 substances including illicit opioids, novel synthetic opioids, medications, and adulterants. Logistic multivariable regression was performed to examine the association between demographic, behavioral, and serum toxicology data with risk factors and HIV status., Results: Among the total cohort (n=1690), 1062 cases had known HIV status (62.8 % of total sample). Among patients with a known HIV status, 60 (5.6 % [95 % CI: 4.2 %, 7.0 %]) were HIV positive. Patients with HIV reported stimulant use more frequently (13.3 %) than those without HIV (6.8 %; p=0.003). After controlling for confounding, bipolar psychiatric history was a significant independent predictor of HIV positivity (aOR: 1.08; 95 % CI: 1.02, 1.13) in this population., Conclusions: In this large multicenter cohort, the prevalence of HIV for ED patients with illicit opioid overdose was 9 times higher than that expected by the general population. Bipolar disorder appears to be a novel risk factor for HIV positivity in this patient population., Competing Interests: Declaration of Competing Interest There are no financial, litigational, or other conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier B.V.)

Objective: Youth athletes are beginning to specialize in a single sport more often. Previous studies in sports medicine and orthopedics have shown an association between intensity of sport specialization and incidence of injuries. This study is the first of its kind to explore the effects of early sport specialization on injury risk through a multicenter framework with a concentration on NCAA athletics., Design: Retrospective cohort study., Setting: SAFE Consortium., Participants: A total of 211 collegiate athletes from the NCAA's 3 levels of competition: Division I, II, and III. Data were collected by the SAFE investigators., Intervention: N/A., Main Outcome Measures: Participants completed a questionnaire about their demographics, sport participation, specialization status, physical injuries, recovery period, and treatment method. Specialization status was calculated with a previously published 3-point scale: low, moderate, and high. Injuries were categorized as upper extremity injuries (UEIs) and lower extremity injuries (LEIs)., Results: Highly specialized athletes were more likely to report UEIs and LEIs than low specialized athletes ( P < 0.0001). Moderate specialization, in contrast to low specialization, was associated with a higher likelihood of LEIs ( P = 0.03) but not UEIs ( P = 0.052). Highly specialized athletes were more likely to report an injury of any kind., Conclusions: The SAFE investigators found high specialization was associated with a history of UEIs and LEIs. Return to play was longer for highly specialized athletes versus low specialized athletes (112 days and 85 days, respectively). Highly specialized athletes were more likely to be from Division I and to require surgery., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Black Americans in the US not only suffered from disproportionately high hospitalization and death rates throughout the pandemic but also from the consequences of low COVID-19 vaccination rates. This pattern of disparity is linked to distrust of public health systems that originates from a history of medical atrocities committed against Black people. For that reason, mitigation of race-based inequity in COVID-19 impacts might find more success in grassroots information contagion than official public health campaigns. While Black Twitter is well-positioned as a conduit for such information contagion, little is known about message characteristics that would afford it. Here, we tested the impact of four different message frames (personalization, interactive, fear appeal, neutral) on the social contagion potential of bi-modal social media messages promoting COVID-19 vaccinations and finding personalized messages to be the most shareable. Wary of recommending personalization as the blueprint for setting a social contagion health campaign in motion, we probed further to understand the influence of individual-level variables on the communicability of personalized messages. Subsequently, regression models and focus group data were consulted, revealing that thinking styles, vaccine confidence levels, and attitudes toward social media were significant factors of influence on the contagion potential of personalized messages. We discussed the implications of these results for health campaigns.

Background: Despite widespread acceptance of the importance of diversity in leadership, systemic challenges in leadership attainment in orthopaedic surgery still exist for several groups. We hypothesize that women, underrepresented in medicine groups, and Asians have decreased odds of achieving program director and chairperson positions compared with peers., Methods: Demographic data were collected from the Association of American Medical Colleges for faculty, program directors, and chairpersons in orthopaedic surgery. Odds ratios were calculated treating race, ethnicity, or sex as the predictor variables and attainment of a leadership position as the outcome, comparing the composition of program directors in 2020 and chairpersons in 2019 with faculty in 2019., Results: Significantly decreased odds were found for women at 0.37 (0.264 to 0.51 [ P < 0.0001]) and the Other category at 0.16 (0.065 to 0.3864 [ P = 0.0001]) while significantly increased odds were found for White and Black/African American faculty at 1.32 (1.02 to 1.71 [ P = 0.0314]) and 1.95 (1.17 to 3.26 [ P = 0.011]), respectively, in holding program director positions. Significantly decreased odds of attaining chairpersonship were found for women at 0.17 (0.07 to 0.41 [ P = 0.0075]) and Asian faculty at 0.33 (0.14 to 0.75 [ P = 0.0062]) while White faculty demonstrated significantly increased odds at 2.43 (1.41 to 4.19 [ P = 0.0013])., Conclusions: Women showed markedly decreased odds of leadership attainment while Black/African American faculty had increased likelihood of becoming program directors but were not markedly more likely to become chairs. Asian faculty were less likely to become program directors and markedly less likely to become chairs. While decreased odds for women were expected based on current literature, decreased odds of Asians becoming chairs and an increased likelihood of Black/African American orthopaedic surgeons becoming program directors but not attaining the role of chairs at the same rate were novel findings, revealing concerning trends for these groups., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Federal, state, tribal, or local entities in the United States issue fish consumption advisories (FCAs) as guidance for safer consumption of locally caught fish containing contaminants. Fish consumption advisories have been developed for commonly detected compounds such as mercury and polychlorinated biphenyls. The existing national guidance does not specifically address the unique challenges associated with bioaccumulation and consumption risk related to per- and polyfluoroalkyl substances (PFAS). As a result, several states have derived their own PFAS-related consumption guidelines, many of which focus on one frequently detected PFAS, known as perfluorooctane sulfonic acid (PFOS). However, there can be significant variation between tissue concentrations or trigger concentrations (TCs) of PFOS that support the individual state-issued FCAs. This variation in TCs can create challenges for risk assessors and risk communicators in their efforts to protect public health. The objective of this article is to review existing challenges, knowledge gaps, and needs related to issuing PFAS-related FCAs and to provide key considerations for the development of protective fish consumption guidance. The current state of the science and variability in FCA derivation, considerations for sampling and analytical methodologies, risk management, risk communication, and policy challenges are discussed. How to best address PFAS mixtures in the development of FCAs, in risk assessment, and establishment of effect thresholds remains a major challenge, as well as a source of uncertainty and scrutiny. This includes developments better elucidating toxicity factors, exposures to PFAS mixtures, community fish consumption behaviors, and evolving technology and analytical instrumentation, methods, and the associated detection limits. Given the evolving science and public interests informing PFAS-related FCAs, continued review and revision of FCA approaches and best practices are vital. Nonetheless, consistent, widely applicable, PFAS-specific approaches informing methods, critical concentration thresholds, and priority compounds may assist practitioners in PFAS-related FCA development and possibly reduce variability between states and jurisdictions. Integr Environ Assess Manag 2024;20:1839-1858. © 2024 The Author(s). Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC)., (© 2024 The Author(s). Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).)

Background: Injury characteristics of high school track and field throwing athletes in the United States are not well studied. Understanding epidemiology of injuries is important to identify treatment and prevention strategies., Objective: To describe injury rates and patterns in U.S. high school track and field throwing events from a longitudinal national sports injury surveillance system., Design: Descriptive epidemiology study., Setting: Data were provided by the National High School Sports Related Injury Surveillance System, High School RIO (Reporting Information Online)., Methods: Athletic trainers reported injury and exposure data through the High School RIO website on a weekly basis. An athlete exposure (AE) was defined as one athlete participating in one school-sanctioned practice or competition. Throwing events of discus, shot put, and javelin were analyzed in this study., Main Outcome Measures: Injury rate, rate ratios (RR), injury proportion ratios (IPR)., Participants: U.S. high school athletes., Results: A total of 267 track and field throwing injuries occurred during 5,486,279 AEs. Overall, the rate of injuries in competition was higher than in practice (RR 1.35, 95% confidence interval [CI] 1.01-1.80). In practice, the rate of injuries was higher for girls than boys (RR 1.53, 95% CI 1.12-2.08). The most frequently injured body part was the shoulder (21.7%), followed by the ankle (16.5%) and knee (12.0%). The most common types of injury were muscle strains (26.14%) and ligament sprains (25%). Recurrent injuries accounted for a higher proportion of chronic injuries compared to new injuries (IPR 1.85, 95% CI 1.16-2.97)., Conclusion: This study described injury characteristics of high school track and field throwing athletes from 2008 to 2019. Based on our results, injury prevention may be particularly important for female throwers with prior injury., (© 2024 American Academy of Physical Medicine and Rehabilitation.)

To reduce the impact of communicable diseases like COVID-19, collective action is required and likely to be susceptible to normative influence as well as whether people are more or less collectively oriented. We extend the theory of normative social behavior (TNSB) to account for group orientation and predict the relationships between social norms and physical distancing behaviors. Using a rolling cross-sectional design during 17 weeks of the pandemic, a national sample of US residents from 20 states ( N  = 8,778) participated in the study. The findings show that perceived descriptive norms, injunctive norms, and group orientation are significantly associated with physical distancing. The descriptive norm-behavior relationship and injunctive norm-behavior relationship are moderated by group orientation and the other predicted moderators in the TNSB. The findings extend the TNSB and highlight the need to understand social norms and group orientation in formative research for health communication campaigns designed to promote prevention behaviors.

Background: Transfemoral (TF) access is the preferred approach for transcatheter aortic valve replacement (TAVR). Limited data exist regarding the outcomes of intravascular lithotripsy (IVL)-assisted TF TAVR in patients with peripheral artery disease., Objectives: This study sought to examine contemporary characteristics, trends, and outcomes of IVL TAVR in the United States., Methods: The Vizient Clinical Database was queried for patients who underwent percutaneous TAVR between October 1, 2020, and November 30, 2023. Outcomes with IVL TAVR vs non-IVL TAVR were examined after propensity score matching. The primary outcome was a composite of in-hospital death, stroke, vascular complications, surgical vascular intervention, and major bleeding., Results: Over the study period, 129,655 patients (mean age of 78.4 years, 42.2% women, 87.1% White) underwent percutaneous TAVR at 361 hospitals, 1,242 (0.96%) of whom underwent IVL TAVR. There was an uptrend in IVL TAVR, but the frequency remained low. IVL TAVR patients had a higher median Elixhauser comorbidity score (5 [Q1-Q3: 4-7] vs 4 [Q1-Q3: 3-6]) compared to non-IVL TAVR. TAVR was completed via the TF approach in 1,238 (99.7%) IVL TAVR patients. In a 3:1 propensity score matching analysis, IVL TAVR was associated with a higher rate of the primary composite outcome (21.9% vs 13.7%; P < 0.001) driven by higher rates of vascular complications, surgical vascular intervention, and major bleeding. In-hospital death and stroke were similar in both groups., Conclusions: In the United States, IVL is increasingly adopted to facilitate TF TAVR. IVL TAVR patients exhibited a higher burden of comorbidities and experienced more complications compared to non-IVL TAVR patients. Further studies are needed to identify appropriate anatomical and clinical use criteria for IVL TAVR and to compare its outcomes vs alternative non-TF TAVR., Competing Interests: Funding Support and Author Disclosures Dr Soukas has received institutional research grants from Shockwave Medical. Dr Abbott has received personal fees for consulting from Abbott, Medtronic, and Penumbra Inc; and has received institutional research grants from Boston Scientific, Recor Medical, Med Alliance, and Shockwave Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Depression and anxiety are significant health burdens that greatly impact the quality of life of refugees and migrants. In this study, we have translated and culturally adapted the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Screener (GAD-7) into Kinyarwanda and performed a validation study in a United States (US) primary care setting., Methods: A committee of seven experts including psychiatric and family medicine providers, health researchers, and trained medical interpreters translated and culturally adapted the PHQ-9 and GAD-7, and incorporated feedback from cognitive interviews with bilingual participants. The translated instruments were then tested in a cross-sectional validation study. Analyses include internal consistency, discriminant validity, principal component analyses, and confirmatory factor analyses., Results: Analyses of 119 responses indicated overall good internal consistency with Cronbach's α of 0.85 (PHQ-9) and 0.92 (GAD-7). Both scales showed acceptable factor loadings between 0.44 and 0.90 in the principal component analyses and showed strong correlations with health-related quality of life and depression/anxiety symptoms measured with visual analog scales. Significantly higher scores for PHQ-9 and GAD-7 were shown among participants with known psychiatric conditions., Discussion: PHQ-9 and GAD-7 demonstrated commendable applicability for Kinyarwanda-speaking patients in primary healthcare settings in the US. Our instruments can already be used in primary care settings and thus help to mitigate health disparities. Future research should further validate our tool against gold-standard diagnostics in larger, geographically diverse samples., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Müller et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In the Spring of 2020, the United States of America (USA) deployed COVID-19 convalescent plasma (CCP) to treat hospitalized patients. Over 500,000 patients were treated with CCP during the first year of the pandemic. In this study, we estimated the number of actual inpatient lives saved by CCP treatment in the United States of America based on CCP weekly use, weekly national mortality data, and CCP mortality reduction data from meta-analyses of randomized controlled trials and real-world data. We also estimate the potential number of lives saved if CCP had been deployed for 100% of hospitalized patients or used in 15 to 75% of outpatients. Depending on the assumptions modeled in stratified analyses, we estimated that CCP saved between 16,476 and 66,296 lives. The CCP ideal use might have saved as many as 234,869 lives and prevented 1,136,133 hospitalizations. CCP deployment was a successful strategy for ameliorating the impact of the COVID-19 pandemic in the USA. This experience has important implications for convalescent plasma use in future infectious disease emergencies., Competing Interests: Competing interests statement:Klassen S.A., Senefeld J.W., Johnson P.W., Carter R.E., Wiggins C.C., Shoham S., Henderson J.P., Pirofski L.A., Wright R.S., Paneth N.S., Casadevall A., and Joyner M.J. and reviewers Musser J. and Hartmann W.R. were co-authors in a review/position paper dealing with the use of CCP published in 2021.

In the United States, Black men who have sex with men (BMSM) represent the most vulnerable population for HIV infection. A potential vaccine could ultimately be the most effective HIV prevention strategy. Understanding the factors that may adversely affect HIV vaccine acceptance among BMSM is critical. We conducted two online surveys with BMSM; one recruited 432 respondents, and another recruited 204. Respondents completed a demographic assessment and questions derived from health behavior change theories and the relevant empirical literature. The two surveys yielded similar results. The findings indicate that vaccine uptake self-efficacy, perceived likelihood of important others receiving the vaccine, and susceptibility to HIV were related to intentions to receive a future HIV vaccine. Other potentially important variables include perceived HIV stigma, response efficacy, how much one conceals one's sexual orientation, and perceived HIV discrimination. Future research and health communication campaigns should consider these factors in potential HIV vaccine programs.

Importance: An improved understanding of autism spectrum disorder (ASD) prevalence over time and across the lifespan can inform health care service delivery for the growing population of autistic children and adults., Objective: To describe trends in the prevalence of ASD diagnoses using electronic records data from a large network of health systems in the US., Design, Setting, and Participants: This cross-sectional study examined annual diagnosis rates in health records of patients in US health systems from January 1, 2011, to December 31, 2022. Eligible individuals were included in the study sample for a given calendar year if they were enrolled in a participating health system for at least 10 months out of the year. Data were extracted from 12 sites participating in the Mental Health Research Network, a consortium of research centers embedded within large, diverse health care systems., Main Outcome and Measures: Diagnoses of ASD were ascertained using International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) revision codes. Annual diagnosis rates were calculated as the number of unique members diagnosed, divided by the total members enrolled., Results: A total of 12 264 003 members were enrolled in 2022 (2 359 359 children aged 0 to 17 years [19.2%]; 6 400 222 female [52.2%]; 93 002 American Indian or Alaska Native [0.8%], 1 711 950 Asian [14.0%], 952 287 Black or African American [7.8%], 2 971 355 Hispanic [24.2%], 166 144 Native Hawaiian or Pacific Islander [1.4%], and 6 462 298 White [52.7%]). The ASD diagnosis rate was greatest among 5-to-8-year-olds throughout the study period and increased by 175% among the full sample, from 2.3 per 1000 in 2011 to 6.3 per 1000 in 2022. The greatest relative increase in diagnosis rate from 2011 to 2022 occurred among 26-to-34-year-olds (450%) and increases were greater for female vs male individuals among children (305% [estimated annual percentage change (EAPC), 13.62 percentage points; 95% CI, 12.49-14.75 percentage points] vs 185% [EAPC, 9.63 percentage points; 95% CI, 8.54-10.72 percentage points], respectively) and adults (315% [EAPC, 13.73 percentage points; 95% CI, 12.61-14.86 percentage points] vs 215% [EAPC, 10.33 percentage points; 95% CI, 9.24-11.43 percentage points]). Relative increases were greater in racial and ethnic minority groups compared with White individuals among children, but not adults., Conclusions and Relevance: In this cross-sectional study of children and adults in the US, ASD diagnosis rates increased substantially between 2011 and 2022, particularly among young adults, female children and adults, and children from some racial or ethnic minority groups. Diagnosis prevalence trends generated using health system data can inform the allocation of resources to meet the service needs of this growing, medically complex population.

Despite decades of research documenting the consequences of naturalized and invasive plant species on ecosystem functions, our understanding of the functional underpinnings of these changes remains rudimentary. This is partially due to ineffective scaling of trait differences between native and naturalized species to whole plant communities. Working with data from over 75,000 plots and over 5,500 species from across the United States, we show that changes in the functional composition of communities associated with increasing abundance of naturalized species mirror the differences in traits between native and naturalized plants. We find that communities with greater abundance of naturalized species are more resource acquisitive aboveground and belowground, shorter, more shallowly rooted, and increasingly aligned with an independent strategy for belowground resource acquisition via thin fine roots with high specific root length. We observe shifts toward herbaceous-dominated communities but shifts within both woody and herbaceous functional groups follow community-level patterns for most traits. Patterns are remarkably similar across desert, grassland, and forest ecosystems. Our results demonstrate that the establishment and spread of naturalized species, likely in combination with underlying environmental shifts, leads to predictable and consistent changes in community-level traits that can alter ecosystem functions., Competing Interests: Competing interests statement:The authors declare no competing interest.

Historically, low-moisture foods were considered to have minimal microbial risks. However, they have been linked to many high-profile multistate outbreaks and recalls in recent years, drawing research and extension attention to low-moisture food safety. Limited studies have assessed the food safety research and extension needs for the low-moisture food industry. The objectives of this needs assessment were to explore the food safety culture and education needs, identify the food safety challenges and data gaps, and understand the barriers to adopting food-safety-enhancing technologies in the U.S. low-moisture food industry. This needs assessment was composed of two studies. In Study 1, food safety experts from the low-moisture food industry upper management participated in online interviews and a debriefing discussion session. In Study 2, an online anonymous survey was disseminated to a different group of experts with experience in the low-moisture food industry. The qualitative data were analyzed using deductive and inductive coding approaches, while the quantitative data were analyzed via descriptive analysis. Twenty-five experts participated in the studies (Study 1: n = 12; Study 2: n = 13). Common commodities that participants had worked with included nuts and seeds, spices, flour, and dried fruits and vegetables. A food safety culture conceptual framework was adapted, which included three main components: infrastructure conditions (foundation), individual's food safety knowledge, attitudes, and risk perceptions; and organizational conditions (supporting pillars). Major barriers to establishing a positive food safety culture were identified to be limited resources, difficulties in risk communication, and difficulties in behavioral change. For continual improvement in food safety performance, two major themes of food safety challenges and data gaps were identified: cleaning, sanitation, and hygienic design; and pathogen reduction. Participants perceived the main barriers discouraging the low-moisture food industry from adopting food-safety-enhancing technologies were: (1) budgetary priorities, (2) operation constraints, (3) technology validation, (4) consumer acceptance, and (5) maintaining desired product characteristics such as quality and sensory functionality. The findings of this needs assessment provide guidance for the food industry, academia, and government agencies about the direction of future research and the development of targeted extension programs that might help improve food safety in the low-moisture food industry., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflict of Interest All authors declare no conflicts of interest related to the matter of this statement.

This study analyzes the effect of avian influenza outbreaks on retail price premiums in the US poultry market. We estimate hedonic price models for eggs, chickens, and turkeys, controlling for quality characteristics, unobserved time, and regional factors. To measure the impact of avian influenza outbreaks we use 2 proxies. The first proxy is a measure of the number of new bird infections at the production level. The second proxy measures online search queries related to the outbreak. The results show that, on average, prices increase across product categories, that is, egg, broiler, and turkey markets, during avian influenza outbreaks. Furthermore, we observe price convergence and reduced dispersion within product categories, which is consistent with the economic theory of asymmetric substitutability between conventional and premium products. Our analysis finds that the HPAI outbreak caused a reduction of the price gap between conventional and premium products., Competing Interests: DISCLOSURES The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: For patients who seek to camouflage cancer-related hair loss, cranial prostheses such as wigs and hair pieces exist. We sought to determine the availability of yaki-textured, type IV curls, and afro wigs at boutiques in Comprehensive Cancer Centers (CCCs)., Methods: The 56 CCCs in the United States were surveyed to see whether they had an affiliated wig boutique for patients experiencing hair loss. Boutique workers were then asked a series of seven questions regarding cranial prostheses options for patients seeking yaki-textured, type IV curls, and afro wigs. The availability of wigs was compared with US Census data on population size and density of Black residents., Results: Of the 56 CCCs, 27 (46%) institutions had active affiliated hair boutiques. We were able to reach 19 (70%) of the 27 boutiques, of which 53% (n = 10) offered yaki-textured wigs, 37% (n = 7) offered type IV curls or afro wigs, and 47% (n = 9) offered neither. Two additional boutiques offered in-store catalogs for Black patients who were interested in naturally appearing wigs. Although two institutions offered a wig bank that was free to all patients, neither had yaki-textured or afro wigs in stock. There was no significant relationship between population size or density of Black residents and availability of these wigs., Conclusion: Many Black patients undergoing cancer treatment interested in cranial prosthesis do not have consistent access to wigs with textures comparable with type IV hair at CCCs. With increased inventory of racially inclusive wigs, partnerships with third-party vendors, and support for the previous authorization process, we can better support Black patients experiencing cancer-related hair loss.

Background: Transvenous lead removal (TLR) is associated with increased mortality and morbidity. This study sought to evaluate the impact of TLR on in-hospital mortality and outcomes in patients with and without CIED infection., Methods: From January 1, 2017, to December 31, 2020, we utilized the nationally representative, all-payer, Nationwide Readmissions Database to assess patients who underwent TLR. We categorized TLR as indicated for infection, if the patient had a diagnosis of bacteremia, sepsis, or endocarditis during the initial admission. Conversely, if none of these conditions were present, TLR was considered sterile. The impact of infective vs sterile indications of TLR on mortality and major adverse events was studied., Results: Out of the total 25,144 patients who underwent TLR, 14,030 (55.8%) received TLR based on sterile indications, while 11,114 (44.2%) received TLR due to device infection, with 40.5% having systemic infection and 59.5% having isolated pocket infection. TLR due to infective indications was associated with a significant in-hospital mortality (5.59% vs 1.13%; OR = 5.16; 95% CI 4.33-6.16; p < 0.001). Moreover, when compared with sterile indications, TLR performed due to device infection was associated with a considerable risk of thromboembolic events including pulmonary embolism and stroke (OR = 3.80; 95% CI 3.23-4.47, p < 0.001). However, there was no significant difference in the conversion to open heart surgery (1.72% vs. 1.47%, p < 0.111), and infection was not an independent predictor of cardiac (OR = 1.12; 95% CI 0.97-1.29) or vascular complications (OR = 1.12; 95% CI 0.73-1.72) between the two groups., Conclusion: Higher in-hospital mortality and rates of thromboembolic events associated with TLR resulting from infective indications may warrant further pursuing this diagnosis in patients., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

ObjectivesThis study examined the magnitude, changes, and racial/ethnic disparities in the economic costs of the 16-year preclinical phase of dementia-a period of cognitive decline without significant impact on daily activities. Methods: The study utilized two dementia algorithms to classify individuals with incident dementia in the Health and Retirement Study. These cases were compared to matched controls in terms of poverty status, labor force participation, and unsecured debts. Results: Older adults classified with dementia were more likely to drop out of the labor force and become poor than similar older adults without dementia. Racial/ethnic disparities in poverty persisted during the preclinical period, with non-Hispanic Black older adults more likely to leave the labor force and Hispanic older adults more likely to have unsecured debt. Discussion: Findings highlight the economic costs during prodromal phase of dementia, emphasizing need for early interventions to reduce financial strain across diverse older adults., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Telemedicine has emerged as a vital healthcare delivery model, especially pronounced during the COVID-19 pandemic. Our study uniquely focuses on an institutional lens, examining US hospitals to offer targeted policy implications., Objective: To investigate the trend in telemedicine adoption across US hospitals from 2017 to 2022 and analyze the institutional challenges they encounter, particularly in the realm of electronic health information exchange., Design: Cross-sectional study leveraging data from the American Hospital Association's (AHA) annual surveys for the years 2017 to 2021 and the 2022 AHA IT Supplement Survey., Setting: The study includes a national sample of US hospitals, covering a diverse range of hospital types including large, nonprofit, teaching, and system-affiliated institutions., Participants: US hospitals form the study's participants, with a substantial response rate to the surveys., Main Measures: Key metrics include the number of telemedicine patient encounters, percentage of hospitals offering telemedicine services, and institutional challenges to electronic health information exchange., Key Results: Telemedicine encounters saw a 75% increase, growing from approximately 111.4 million in 2020 to nearly 194.4 million in 2021. The percentage of hospitals offering at least one form of telemedicine service went from 46% in 2017 to 72% in 2021. Larger, nonprofit, and teaching hospitals were more prone to telehealth adoption, without notable urban-rural disparities. While over 90% of hospitals allow patients to view and download medical records, only 41% permit online data submission. Importantly, 25% of hospitals identified Certified Health IT Developers such as EHR vendor as frequent culprits in information blocking, with cost being the primary obstacle., Conclusions: The findings underscore the rapid yet uneven adoption of telemedicine services in U.S. hospitals. The results point to the need for comprehensive policy interventions to address the challenges identified and realize telemedicine's full potential in healthcare delivery and resilience., (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Objective: To explore differences in depressive symptoms for older adults (Black, Latinx, and White) by cognitive status during the 2020 COVID-19 pandemic. Methods: Data from the Health and Retirement Study identified older adults as cognitively normal, cognitively impaired without dementia (CIND), and persons living with dementia (PLWD). Multiple linear regression analyses examined associations between cognitive status and depressive symptoms among these racialized groups. Results: Compared to the cognitively normal older adults racialized as Black, those with CIND reported higher depressive symptoms during the pandemic (overall and somatic) and PLWD had higher somatic symptoms ( p < .01). Older adults racialized as White with CIND reported higher somatic ( p < .01) symptoms compared to cognitively normal older adults racialized as White. Discussion: The COVID-19 pandemic was a challenging event among older adults racialized as Black with CIND and PLWD. Future studies should examine if these depressive symptoms persist over time., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Real-time clinical care, policy, and research decisions need real-time evidence synthesis. However, as we found during the COVID-19 pandemic, it is challenging to rapidly address key clinical and policy questions through rigorous, relevant, and usable evidence. Our objective is to present three exemplar cases of rapid evidence synthesis products from the Veterans Healthcare Administration Evidence Synthesis Program (ESP) and, in the context of these examples, outline ESP products, challenges, and lessons learned. We faced challenges in (1) balancing scientific rigor with the speed in which evidence synthesis was needed, (2) sorting through rapidly evolving large bodies of evidence, and (3) assessing the impact of evidence synthesis products on clinical care, policy, and research. We found solutions in (1) engaging stakeholders early, (2) utilizing artificial intelligence capabilities, (3) building infrastructure to establish living reviews, and (4) planning for dissemination to maximize impact., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

The public acceptance of evolution remains a contentious issue in the United States. Numerous investigations have used national cross-sectional studies to examine the factors associated with the acceptance or rejection of evolution. This analysis uses a 33-year longitudinal study that followed the same 5000 public-school students from grade 7 through midlife (ages 45-48) and is the first to do so in regard to evolution. A set of structural equation models demonstrate the complexity and changing nature of influences over these three decades. Parents and local influences are strong during the high school years. The combination of post-secondary education and occupational and family choices demonstrate that the 15 years after high school are the switchyards of life.

Background: Although endometriosis is a common condition-affecting ∼10% of premenopausal individuals-its etiology is unknown. Diet receives a lot of attention from patients, but studies of the role of diet are limited. Examining dietary patterns is essential to provide new insight., Objective: We sought to determine whether dietary patterns are associated with laparoscopically-confirmed endometriosis diagnosis., Study Design: We conducted a prospective cohort study among 81,997 premenopausal participants of the Nurses' Health Study II, who were followed from 1991-2015. Diet was assessed with validated food frequency questionnaires every 4 years. We examined 6 dietary patterns: Western, Prudent, Alternative Healthy Eating Index, Dietary Approaches to Stop Hypertension, an estrogen-associated pattern, and a proinflammatory pattern. Cox proportional hazard ratios and 95% confidence intervals were used to quantify the association between each of these patterns and laparoscopically-confirmed endometriosis diagnosis., Results: Three thousand eight hundred ten incident cases of endometriosis were diagnosed during 24 years of follow-up. Adherence to the Alternative Healthy Eating Index, reflecting a healthier dietary pattern, was associated with a 13% lower risk of endometriosis diagnosis (fifth vs first quintile 95% confidence interval, 0.78-0.96; P trend =.02). Participants in the highest quintile of the Western dietary pattern, characterized by high intake of red meat, processed meat, refined grains, and desserts, had a 27% higher risk of endometriosis diagnosis than those in the lowest quintile (95% confidence interval, 1.09-1.47; P trend =.004). The Prudent, Dietary Approaches to Stop Hypertension, and estrogen-associated dietary patterns did not demonstrate clear associations with endometriosis risk, and there was the suggestion of a higher risk of endometriosis diagnosis among those with a higher proinflammatory diet score (hazard ratio for fifth vs first quintile, 1.10 [95% confidence interval, 0.99-1.23]; P trend =.01)., Conclusion: Our results suggest that consuming a dietary pattern that adheres to the Alternative Healthy Eating Index-2010 recommendations lowers the risk of endometriosis diagnosis, potentially through a beneficial impact on pelvic pain. In addition, consuming a less healthy diet high in red/processed meats and refined grains may have a detrimental impact on endometriosis symptoms., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Opioid use disorder (OUD) is a growing public health crisis, with opioids involved in an overwhelming majority of drug overdose deaths in the United States in recent years. While medications for opioid use disorder (MOUD) effectively reduce overdose mortality, only a minority of patients are able to access MOUD; additionally, those with unstable housing receive MOUD at even lower rates., Objective: Because MOUD access is a multifactorial issue, we leverage machine learning techniques to assess and rank the variables most important in predicting whether any individual receives MOUD. We also seek to explain why persons experiencing homelessness have lower MOUD access and identify potential targets for action., Methods: We utilize a gradient boosted decision tree algorithm (specifically, XGBoost) to train our model on SAMHSA's Treatment Episode Data Set-Admissions, using anonymized demographic and clinical information for over half a million opioid admissions to treatment facilities across the United States. We use Shapley values to quantify and interpret the predictive power and influencing direction of individual features (i.e., variables)., Results: Our model is effective in predicting access to MOUD with an accuracy of 85.97% and area under the ROC curve of 0.9411. Notably, roughly half of the model's predictive power emerges from facility type (23.34%) and geographic location (18.71%); other influential factors include referral source (6.74%), history of prior treatment (4.41%), and frequency of opioid use (3.44%). We also find that unhoused patients go to facilities that overall have lower MOUD treatment rates; furthermore, relative to housed (i.e., independent living) patients at these facilities, unhoused patients receive MOUD at even lower rates. However, we hypothesize that if unhoused patients instead went to the facilities that housed patients enter at an equal percent (but still received MOUD at the lower unhoused rates), 89.50% of the disparity in MOUD access would be eliminated., Conclusion: This study demonstrates the utility of a model that predicts MOUD access and both ranks the influencing variables and compares their individual positive or negative contribution to access. Furthermore, we examine the lack of MOUD treatment among persons with unstable housing and consider approaches for improving access., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Esguerra, Weinandy. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Air pollution is a known risk factor for cardiovascular diseases, including stroke. This study examines the impact of county-level air pollution on ischemic and hemorrhagic stroke mortality among U.S. individuals aged 65 and older, emphasizing racial and socioeconomic disparities., Methods: Using data from the Center for Disease Control (CDC) Interactive Atlas of Heart Disease and Stroke, we analyzed county-level ischemic stroke mortality rates for older residents between 2016 and 2020. The data on air pollution at the county level, specifically particulate matter (PM2.5) levels, were obtained from the CDC. We applied multivariable linear and logistic regression models to examine the association between PM2.5 levels and stroke mortality, as well as the probability of meeting the Environmental Protection Agency (EPA) air quality standards., Results: County-level analysis revealed a significant correlation (R = 0.68, R 2 = 0.48, p < 0.001) between PM2.5 levels and overall stroke mortality. For every 1 μg/m 3 increase in PM2.5, there was an increase of 1.89 ischemic stroke deaths per 100,000 residents. Racial and socioeconomic disparities were evident. Counties with predominantly Black populations exhibited a stark disparity, with each 1 μg/m 3 increase in PM2.5 correlating with a significant rise in mortality, amounting to 5.81 additional deaths per 100,000 residents. Persistently poor counties displayed vulnerability, experiencing a 4.05 increase in ischemic stroke deaths per 100,000 residents for every 1 μg/m 3 increase in PM2.5 levels. Conversely, in counties with a White majority and counties without a persistent state of poverty, the associated increases in stroke mortality per 100,000 residents for every 1 μg/m 3 rise in county-level PM2.5 were 1.85 and 1.60, respectively. Counties with a majority of Black residents were over twice as likely to be non-compliant with EPA air quality standards compared to predominantly White counties (aOR 2.36 95% CI: 1.27-4.38, p = 0.006)., Conclusion: This study underscores the significant impact of county-level air pollution, particularly PM2.5, on ischemic stroke mortality among older U.S. residents. Our findings indicate that counties with predominantly Black populations and those experiencing persistent poverty not only suffer from higher mortality rates but also are more likely to be non-compliant with EPA air quality standards. Targeted interventions and policies are urgently needed to reduce air pollution in these vulnerable communities and promote equitable public health outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kabangu, Fowler, Hernandez, Newsome-Cuby, Joseph, Dugan, Fry, Bah and Eden.)

This article explores the legal status of nonhuman animals used in biomedical research. While acknowledging that, presently, nonhuman animals in research settings hold no personal legal rights, this article explores what a legal person is and proposes that it is possible for nonhuman animals to become legal persons and receive better protections under the federal Animal Welfare Act., (Copyright 2024 American Medical Association. All Rights Reserved.)

Background Recent advancements, including image processing capabilities, present new potential applications of large language models such as ChatGPT (OpenAI), a generative pretrained transformer, in radiology. However, baseline performance of ChatGPT in radiology-related tasks is understudied. Purpose To evaluate the performance of GPT-4 with vision (GPT-4V) on radiology in-training examination questions, including those with images, to gauge the model's baseline knowledge in radiology. Materials and Methods In this prospective study, conducted between September 2023 and March 2024, the September 2023 release of GPT-4V was assessed using 386 retired questions (189 image-based and 197 text-only questions) from the American College of Radiology Diagnostic Radiology In-Training Examinations. Nine question pairs were identified as duplicates; only the first instance of each duplicate was considered in ChatGPT's assessment. A subanalysis assessed the impact of different zero-shot prompts on performance. Statistical analysis included χ 2 tests of independence to ascertain whether the performance of GPT-4V varied between question types or subspecialty. The McNemar test was used to evaluate performance differences between the prompts, with Benjamin-Hochberg adjustment of the P values conducted to control the false discovery rate (FDR). A P value threshold of less than.05 denoted statistical significance. Results GPT-4V correctly answered 246 (65.3%) of the 377 unique questions, with significantly higher accuracy on text-only questions (81.5%, 159 of 195) than on image-based questions (47.8%, 87 of 182) (χ 2 test, P < .001). Subanalysis revealed differences between prompts on text-based questions, where chain-of-thought prompting outperformed long instruction by 6.1% (McNemar, P = .02; FDR = 0.063), basic prompting by 6.8% ( P = .009, FDR = 0.044), and the original prompting style by 8.9% ( P = .001, FDR = 0.014). No differences were observed between prompts on image-based questions with P values of .27 to >.99. Conclusion While GPT-4V demonstrated a level of competence in text-based questions, it showed deficits interpreting radiologic images. © RSNA, 2024 See also the editorial by Deng in this issue.

Objective/background: Migraine is underdiagnosed. On average, medical students have approximately 3 h of exposure to headache education throughout medical school training. Moreover, some medical students have racially-based biases in pain. There is a paucity of underrepresented in medicine (UIM) headache practitioners. UIM practitioners are more likely to practice in underserved communities and provider-patient ethnic concordance may help eliminate healthcare disparities. The Student National Medical Association (SNMA) is an organization committed to supporting current and future UIM medical students and addressing the needs of underserved communities. The goal of this project was to develop and deliver a brief Migraine Diagnosis and Disparities Undergraduate Medical Education Program (MD 2 UMEP) to increase awareness of migraine diagnosis and disparities in UIM medical students in the SNMA., Methods: For connecting/relationship-building with SNMA, the SNMA Region V website was reviewed. Calls were made to Wayne State University School of Medicine (WSUSOM) Office of Diversity, Equity, and Inclusion (ODEI) explaining the educational initiative with subsequent emails to the Director of WSUSOM's ODEI followed by a video-conference meeting (VCM). VCMs were conducted with two SNMA member leaders from WSUSOM. A local and regional presentation/delivery of the MD 2 UMEP was planned. Communication was maintained electronically. For development/delivery of the MD 2 UMEP, headache literature was reviewed for key concepts underpinning migraine diagnosis and migraine disparities with a focus on African Americans. Slides with talking points were developed with references. Pre- and posttest questions were drafted and made accessible via a QR code. The MD 2 UMEP was presented and students completed the questionnaires. Descriptive statistics were used to quantify responses., Results: The MD 2 UMEP work began July 31, 2021, with program delivered in final form on October 1, 2022. A professional relationship was established with SNMA leadership. A MD 2 UMEP was developed then administered at the 2022 SNMA Region V Medical Education Conference. Headache medicine was introduced to UIM SNMA medical students. Anonymously, nine individuals responded to the MD 2 UMEP pretest questions. Eight individuals answered the posttest questions. At the program's conclusion, UIM student performance improved on seven of 10 test questions on migraine diagnosis and disparities and remained at 100% on one of 10 test questions. On two of the questions, the number correct remained the same (although percentage overall increased due to the smaller denominator). There was a higher proportion of correct responses on the posttest., Conclusions: There is great need for migraine diagnosis and disparities education among medical students. A new migraine diagnosis and disparities program was developed for medical students. SNMA members were receptive to the MD 2 UMEP and it strengthened their knowledge of migraine diagnosis and disparities. This program exposed UIM medical students to headache medicine., (© 2024 The Author(s). Headache: The Journal of Head and Face Pain published by Wiley Periodicals LLC on behalf of American Headache Society.)

Care provider communication with Black birthing families is impactful. This cross-sectional study asked 216 Black fathers to recall treatment by birthing care providers and tested variables contributing to birth satisfaction and fathering identity salience. Most fathers reported that care providers were respectful resulting in a positive birthing experience; however, 15% reported negative experiences with care providers. Perceived social support was shown to be a mediator between disrespect, mistreatment, inclusive communication, trust, and positive emotion with birth satisfaction and fathering identity salience. Care provider disrespect served as a "spoiler" of the birthing experience and subsequently diminished positive fathering identity salience. Analysis of open-ended comments showed that contrary to stereotypes about absent, disengaged Black fathers, fathers in this study were caring toward their newborns, present for them, and engaged in fathering. More work needs to be done with care provider communication to make every birth a positive and inclusive experience for Black fathers and their partners.

Body dissatisfaction is a key factor contributing to the development of disordered eating, and body dissatisfaction is often influenced by media, peer, and parental pressures during adolescence. Little research has explored ways in which parents can help their children manage pressures from social media and their peers. The present study used the MyVoice National Poll of Youth, a large text-message cohort of young people (14-24 years old) in the United States, to collect and examine qualitative data about their experiences with parental weight-related communication and how they think parents can best support their children regarding messages they see/hear surrounding weight, body shape and size by their peers and media sources. 801 participants responsed to at least one question. Results from the present study suggest that young people want their parents to model healthy relationships with food and their body, teach body neutrality/acceptance, and normalize all body types. Findings suggest that there are many proactive, practical approaches parents can adopt to help support their children and offset weight-related pressures from other sources., Competing Interests: Declaration of Competing Interest The authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Adverse childhood experiences (ACEs) and social determinants of health (SDoH) are associated with increased incidence of pediatric obesity. Recent literature highlights an imperative need to assess ACEs and SDoH among youth and families with obesity to identify those individuals requiring targeted interventions. The primary objective of the present study was to examine the frequency, methodology, and barriers in evaluation of ACEs and SDoH within pediatric weight management programs (PWMPs). Methods: Invitations were e-mailed to a comprehensive directory of 92 PWMPs in the United States with a link to complete an electronic survey. Results: Forty-one PWMPs from 26 states completed the survey. Assessment of one or more ACEs and SDoH was common and typically took place during the initial patient visit by the psychologist or medical practitioner through unstructured conversations. Reported barriers to assessment included lack of time to assess and to follow-up, lack of clinic protocols, and inadequate referral resources. Programs offering bariatric surgery and those with embedded mental health clinicians reported fewer barriers to ACEs/SDoH referral resources, while family-based and healthy lifestyle-focused programs perceived more barriers related to insufficient support staff and time to follow-up with families. Conclusions: Most PWMPs assess a subset of ACEs and SDoH; however, approaches to assessment vary, are often unstructured, and several barriers remain to optimizing assessment and follow-up. Future research should evaluate standardized ACEs/SDoH assessment protocols, ideal workflow, and their impact on obesity treatment and related health outcomes.

A previous study has found a negative correlation between meeting one's romantic partner in online dating (vs. offline) and marriage quality through a quota sample of the U.S. population. This current study replicates and extends this previous study by analyzing another sample of the U.S. population from the Pew Research Center ( N = 2,787). Largely consistent with the previous finding, we found that meeting one's partner in online dating (vs. offline) was marginally related to experiencing less relationship success among people in a marital relationship. However, the difference was not observed among people in a nonmarital romantic relationship. In addition, sharing or discussing one's relationship or dating life (i.e., relationship talks) on social media (RToSM) conditioned the link between meeting venue and relationship success. That is, for marital relationships, meeting in online dating was only linked to less relationship success among people with no RToSM but not among those who had RToSM; for nonmarital relationships, there was a positive link between meeting in online dating and relationship success among those who had RToSM, but this positive link was not observed among those who had no RToSM. We further discuss the implications of our findings on the long-term impact of online dating in marital and nonmarital romantic relationships.

Objective: To identify and disseminate research priorities for the headache field that should be areas of research focus during the next 10 years., Background: Establishing research priorities helps focus and synergize the work of headache investigators, allowing them to reach the most important research goals more efficiently and completely., Methods: The Headache Research Priorities organizing and executive committees and working group chairs led a multistakeholder and international group of experts to develop headache research priorities. The research priorities were developed and reviewed by clinicians, scientists, people with headache, representatives from headache organizations, health-care industry representatives, and the public. Priorities were revised and finalized after receiving feedback from members of the research priorities working groups and after a public comment period., Results: Twenty-five research priorities across eight categories were identified: human models, animal models, pathophysiology, diagnosis and management, treatment, inequities and disparities, research workforce development, and quality of life. The priorities address research models and methods, development and optimization of outcome measures and endpoints, pain and non-pain symptoms of primary and secondary headaches, investigations into mechanisms underlying headache attacks and chronification of headache disorders, treatment optimization, research workforce recruitment, development, expansion, and support, and inequities and disparities in the headache field. The priorities are focused enough that they help to guide headache research and broad enough that they are widely applicable to multiple headache types and various research methods., Conclusions: These research priorities serve as guidance for headache investigators when planning their research studies and as benchmarks by which the headache field can measure its progress over time. These priorities will need updating as research goals are met and new priorities arise., (© 2024 American Headache Society.)

Importance: Approximately 31 000 cases of human papillomavirus (HPV)-associated cancers are diagnosed annually in the US. The HPV vaccine can prevent more than 90% of these cancers, yet national uptake remains lower than the Healthy People 2030 target of 80% completion. To devise targeted interventions to increase the uptake of HPV vaccines, it is crucial to understand the vaccination rates across various health care settings., Objective: To examine the association between health care facility type and adolescent HPV vaccine uptake and clinician recommendation for the vaccine in the US., Design, Setting, and Participants: This cross-sectional study uses a complex sampling design of data from the 2020 National Immunization Survey-Teen. The study included adolescents aged 13 to 17 years. The data analysis was completed between March 1 and May 31, 2022., Exposure: Health care facility type classified as public, hospital-based, private, mixed (more than 1 type), and other facilities (eg, military health care facility; Women, Infants, and Children clinic; school-based health center; pharmacy)., Main Outcomes and Measures: Initiation of HPV vaccination was defined as the receipt of at least 1 dose of the HPV vaccine and completion as receipt of at least 2 or 3 doses, depending on age of initiation. Parent or guardian self-reported clinician recommendation was categorized as yes or no. Weighted, multivariable logistic regression models were used to estimate the odds of initiating and completing the HPV vaccine series and receiving clinician recommendation by health care facility type adjusted for adolescent and maternal characteristics., Results: A total of 20 162 adolescents (mean [SD] age, 14.9 [1.4] years; 51.0% male) were included. Clinician recommendation for the HPV vaccine was received by 81.4% of adolescents, and 75.1% initiated and 58.6% completed the HPV vaccine series. In the adjusted analyses, adolescents who received recommended vaccinations at public facilities had lower odds of initiating (adjusted odds ratio [AOR], 0.71; 95% CI, 0.58-0.88) and completing (AOR, 0.62; 95% CI, 0.51-0.76) HPV vaccination compared with those who received recommended vaccinations at private facilities. Similarly, adolescents who received recommended vaccinations at public facilities (AOR, 0.62; 95% CI, 0.51-0.77) had lower odds of receiving a clinician recommendation for the HPV vaccine compared with those who received recommended vaccinations at private facilities., Conclusions and Relevance: These findings reveal health disparities in HPV vaccination among adolescent populations served by public health care facilities, suggesting that a greater focus is needed on vaccine recommendations and uptake in public facilities.