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There can be a disconnect between the level of content covered in undergraduate coursework and the expectations of professional-level faculty of their incoming students. Some basic science faculty members may assume that students have a good knowledge base in the material and neglect to appropriately review, whilst others may spend too much class time reviewing basic material. It was hypothesised that the replacement of introductory didactic physiology lectures with interactive online modules could improve student preparedness prior to lectures. These modules would also allow faculty members to analyse incoming student abilities and save valuable face-to-face class time for alternative teaching strategies. Results indicated that the performance levels of incoming U.S. students were poor (57% average on a pre-test), and students often under-predicted their abilities (by 13% on average). Faculty expectations varied greatly between the different content areas and did not appear to correlate with the actual student performance. Three review modules were created which produced a statistically significant increase in post-test scores (46% increase, P < 0.0001, n = 114-115). The positive results of this study suggest a need to incorporate online review units in the basic science dental school courses and revise introductory material tailored to students' strengths and needs. [ABSTRACT FROM AUTHOR]

Background: There is increased prevalence of hepatocellular carcinoma (HCC) among African Americans (AA). Multicenter studies have shown advanced presentation, underutilization of treatment and decreased survival following liver transplantation (LT) among AA. However outcomes from single centers are not well reported. Objective: To determine the outcome of AA undergoing LT for HCC at Cleveland Clinic, Cleveland, Ohio, between May 2007 and December 2009. Methods: 245 consecutive patients undergoing evaluation and treatment for HCC within the mentioned time frame were studied, retrospectively. Results: 80% of patients were male, 75.5% were Caucasian, 16.7% were AA and 7.8% were other ethnic groups. Compared to other ethnicities, AA subjects with HCC were more commonly female and were more likely to have hepatitis C virus (HCV) (83% vs. 51%, p<0.001). There were higher occurrence of HCV genotype 1 among AA compared to others among patients with this information (100% vs. 65%, p<0.001). In contrast to previous reports, there was no significant difference between the groups in terms of clinical presentation or management. 27% of AA underwent liver transplantation compared to 28% of the rest (p=0.88). Of the 68 patients who had LT, 9% died with no difference in post-LT survival between the two groups. Conclusions: HCV (and genotype 1) is a significant risk factor for HCC in the AA population. LT results in similar survival compared to other ethnicities. AA patients with HCC benefit equally from LT compared to other ethnicities. [ABSTRACT FROM AUTHOR]

. Both genetic and treatment-related risk factors contribute to the development of inhibitors in haemophilia. An inhibitor surveillance system piloted at 12 US sites has the goal of assessing risk factors through prospective data collection. This report examines the relationship of genotype and race/ethnicity to history of inhibitor in a large cohort of US haemophilia patients. Mutation analysis was performed on 676 haemophilia A (HA) and 153 haemophilia B (HB) patients by sequencing, Multiplex Ligation-dependent Probe Amplification, and PCR for inversions in F8 introns 22 (inv22) and 1 (inv1). Two HB patients with deletions had history of inhibitor. In severe HA, frequency of history of inhibitor was: large deletion 57.1%, splice site 35.7%, inv22 26.8%, nonsense 24.5%, frameshift 12.9%, inv1 11.1% and missense 9.5%. In HA, 19.6% of 321 White non-Hispanics (Whites), 37.1% of 35 Black non-Hispanics (Blacks) and 46.9% of 32 Hispanics had history of inhibitor ( P = 0.0003). Mutation types and novel mutation rates were similar across ethnicities. When F8 haplotypes were constructed, Whites and Hispanics showed only H1 and H2. Within H1, history of inhibitor was 12.4% in Whites, 40.0% in Blacks ( P = 0.009) and 32.4% in Hispanics ( P = 0.002). Inhibitor frequency is confirmed to vary by mutation type and race in a large US population. White patients with history of inhibitor did not exhibit rare F8 haplotypes. F8 gene analysis did not reveal a cause for the higher inhibitor frequencies in Black and Hispanic patients. [ABSTRACT FROM AUTHOR]

The article presents a study on column averaged carbon dioxide dry air mole fraction which were obtained from spectra recorded over land by the Greenhouse gases Observing Satellite. It discusses how the study was conducted which involves several retrieval methods developed for the U.S. National Aeronautics and Space Administration's (NASA) Orbiting Carbon Observatory mission. It explores the study's findings including bias in surface pressure.

The article discusses the preparedness for radiological and nuclear disasters within the U.S. The U.S. Centers of Disease Control and Prevention (CDC) has documents to help city and state authorities, as well as authorities in the public health sector, to evaluate current response plans. According to surveys done by the Association of Public Health Laboratories and the Conference of Radiation Control Program directors, there is a need for a Laboratory Response Network in at least 10 public health laboratories for each state.

The traditional definition of sustainability calls for policies and strategies that meet society’s present needs without compromising the ability of future generations to meet their own needs. Through the 1970 National Environmental Policy Act, U.S. policy formally established the goal of creating and maintaining “conditions under which [humans] and nature can exist in productive harmony, and fulfill the social, economic and other requirements of present and future generations of Americans.” However, we have not yet succeeded in making sustainability operational. The long-standing and current debates on setting energy policy, regulating greenhouse gases, and promoting alternate fuels illustrate the complexity of making sustainability operational. Achieving operational sustainability requires three critical elements: advances in science and technology, application of effective government regulations and policies, and green business practices. Not only are these elements necessary, all three must work together across the economy. A key lesson drawn from the history of environmental regulation and especially in the climate debate is that sustainability cannot be advanced without a convergence of government and business interests even when the requisite technology is available. The biofuel system presents an immediate and tangible test case for the successful interaction of these three critical elements. The massive investments in science and technology by both government and industry to develop new feedstocks and conversion methods are showing promise. From a regulatory perspective, existing statutes and new mandates impact all parts of the biofuel supply chain—a complex system involving feedstocks, conversion technologies, transport, storage, handling, and end use. Forward-looking businesses in the biofuel sector are integrating sustainability objectives into their business strategies, such as designing feedstock conversion processes to generate biofuel coproducts that can add substantial revenue. The combination and coordination of such activities have the potential to achieve sustainable biofuel production and to demonstrate the kind of critical approaches that are essential to making sustainability operational in this and other energy sectors. [ABSTRACT FROM AUTHOR]

The fossil record indicates that the brown bear ( Ursus arctos) colonized North America from Asia over 50 000 years ago. The species historically occupied the western United States and northern Mexico but has been extirpated from over 99% of this range in the last two centuries. To evaluate colonization hypotheses, subspecific classifications, and historical patterns and levels of genetic diversity in this region, we sequenced 229 nucleotides of the mitochondrial DNA control region in 108 museum specimens. The work was set in a global context by synthesizing all previous brown bear control region sequences from around the world. In mid-latitude North America a single moderately diverse clade is observed, represented by 23 haplotypes with up to 3.5% divergence. Only eight of 23 haplotypes (35%) are observed in the extensively sampled extant populations suggesting a substantial loss of genetic variability. The restriction of all haplotypes from mid-latitude North America to a single clade suggests that this region was founded by bears with a similar maternal ancestry. However, the levels and distributions of diversity also suggest that the colonizing population was not a small founder event, and that expansion occurred long enough ago for local mutations to accrue. Our data are consistent with recent genetic evidence that brown bears were south of the ice prior to the last glacial maximum. There is no support for previous subspecies designations, although bears of the southwestern United States may have had a distinctive, but recent, pattern of ancestry. [ABSTRACT FROM AUTHOR]

The article presents a discussion of Bernard Shaw's relationship with the United States and capitalism. Shaw made antagonistic speeches involving the United States, which reflects more of Shaw's disunited self. Shaw's negative criticisms of the United States was also manifested in the film industry and in his plays.

Focuses on the concept of environmental conservation undertaken by the U.S. government agencies at federal, state and local levels to balance economic development with environmental protection. Impact o conservation on humans.

Background: The incidence of esophageal adenocarcinoma in White males has been reported to be increasing. The aims of this study were to determine: 1) the incidence trends of esophageal carcinoma in the United States with an emphasis on histologic type, sex, and ethnicity, 2) whether the reported increase in stage IV tumors can be confirmed, and 3) survival trends and factors affecting survival. Methods: Data from the SEER program of the National Cancer Institute with submission dates 1973-98 were used. Data on Hispanics were available for analysis only for the years 1992-98. Statistical analysis was performed utilizing SEER*Stat and SAS statistical software packages. Results: The incidence of adenocarcinoma in White males is still rising (7.8%/year; P < 0.0001); however, the same trend was observed for White females (6.48%/year; P < 0.0001), Hispanic males (3.91%/year; P < 0.02), and Hispanic females (9.4%/ year; P < 0.04). The incidence of squamous cell carcinoma has been steadily declining in White males and females and in Black females since 1973, with the incidence showing a dramatic and significant decline in Black males beginning in 1992 (8.53%/year; P = 0.0009). Stage 4 carcinoma is declining in incidence. Survival of patients with esophageal carcinomas has been improving. In a Cox multivariate model, independent prognostic factors in esophageal carcinoma included tumor stage, tumor type, gender, race, age at diagnosis, and year of diagnosis. Conclusions: 1) The incidence of adenocarcinoma continues to rise in White males and females, but also in Hispanics, while squamous cell carcinoma is declining; 2) the incidence of stage 4 carcinomas has been declining, and 3) survival has been steadily improving, independently of all other risk factors. [ABSTRACT FROM AUTHOR]

Evaluates the decentralized laboratory testing program (DLTP) implemented by Chicago, Ill.-based Northwestern Memorial Hospital. Purpose; History; Quality control; Practice of documentation; Personnel selection; Objectives of the training program; Trainors.

This study explored the relationship between parental satisfaction with special education IEP staffings and six variables. Together the six variables accounted for 78% of the variance in satisfaction. Simply allowing enough time for a staffing accounted for the most variance. In addition, the following three variables also had a statistically significant impact on satisfaction: (a) input from a number of people to formulate a good educational program, (b) attribution of blame to sources other than the parents, and (c) amount of parent participation. Preparing parents for what to expect, and the number of people present at a staffing had relatively minor, though statistically significant, contributions to the total explained variation in satisfaction. Strategies are discussed for improving parental satisfaction with staffings. [ABSTRACT FROM AUTHOR]

Discusses results from studies which suggest that a three-tiered approach to the evaluation of local public health performance might be feasible. Comments on a project that began in 1991 to restudy local health departments that were the subjects of an intensive case study a decade earlier. INSET: Queries constituting the revised screening survey.

Details a study in which directors of 14 public health departments were surveyed for their perceptions of the impact of 20 critical events of the 1980s on public health performance. Findings about the impact of AIDS, loss of federal grants, change in support from the state and more.

Discusses ethical and economic issues in addressing child health maintenance problems in the United States. Sources of information on the subject; Impact of fiscal cutbacks and policy changes on children's health; Effort of communities to protect prenatal services.

This study discusses the role of local health departments in delivering ambulatory care in the U.S. Utilization of public clinics and health care centers has increased over the past decade, which may have been stimulated in part by greater activity of the Early Periodic Screening, Diagnosis and Treatment programs. Services by local health departments are primarily directed toward a poverty level clientele, although the extent of some services may be provided increasingly across socioeconomic lines. Insofar as the quality of care has been studied, there is no evidence that exists to support a view that health departments operate poor programs for poor people.

A letter to the editor is presented in response to several articles including commentaries on the constant struggle of the local health departments in the U.S., on pregnancy testing that women can administer for themselves and views on the stringent controls for alcoholism, that were published in the previous issues.

The article comments on the responsibilities of local government in matters of health policy in the U.S. Concern for the responsibilities of local government in matters of health properly begins with analysis of prevailing national health policy. Health policy embraces an understanding of the way society distributes its political power and its economic resources in order to serve the health of its people.

The article presents recommendations for reforms in health care for children in the U.S. Children require a National Health Service for Mothers and Children, a program that would operated not as a token or demonstration health service. It would not depend on local organizational initiatives and it would not depend on local organizational initiatives and it would not extend appropriate health services to every child and expectant mother in the country. The program would guarantee not just payment for medical service but direct provision of services, by government agencies on behalf of all the children.

The article examines the changes in maladaptive behavior of retarded individuals referred and placed in institutional versus community settings in the U.S. The results demonstrate that no significant time trend is present for either the community and institutional groups, regardless of clients' age and level of retardation. However, placement, age, and level of retardation are related to overall prevalence of maladaptive behavior among mentally retarded people.

This article presents information on the hospital and community mortality rates among the retarded. Studies relating to community mortality rates, however, are becoming of increasing importance as the trends toward normalization and de-institutionalization accelerate. Periodic investigations are needed properly to evaluate the effect of these trends. Comparative mortality is one such measure, as it indicates whether basic procedures for maintaining life are adequate in the new forms of placement. The present study sampled mentally retarded receiving services in the southern California area of the United States.

A report is presented giving up-to-date information on State Boards of Health covering composition, functions, method of appointment, term of office, professional representation, consumer representation, recent changes, and a number of other topics. This is a useful review for all concerned with the health services. [ABSTRACT FROM AUTHOR]

The article reflects on the increasing rate of unwanted childbearing in the U.S. during the 1990s. The trend is accentuated among vulnerable populations such as teenagers, poor people, minorities, or the unmarried. The linkage between unwanted pregnancy and abuse and neglect is confirmed in a study demonstrating that a child from a family with two unplanned births is 2.8 times more likely to be abused than a child from a family with no unplanned births. Unwanted childbearing associates with indicators of poor pregnancy outcomes, including inadequate prenatal care and use of alcohol and cigarettes during pregnancy. A society which neglects and fails its children can scarcely expect parents to provide the supportive nurture that otherwise seems to be valued so lightly.

Presents a study which summarized the 1969 annual reports of tuberculin retesting for U.S. Navy and Marine Corps units assigned to the Republic of Vietnam. Method of the study; Results and discussion; Conclusion.

The article comments on the relationship between health trend data and public health policy relating to child health in the U.S. Reviews of childhood morbidity and mortality indicate that circumstances for children are improving. Homicide is the only major cause of death among young children. Universal medical care, health education, preventive and protective services and alleviation of poverty are all necessary and none alone is sufficient. It is noted that policy and data for children's health are moving in opposite directions.

The article presents an analysis of the proficiency goal for college-bound students in the U.S. There is a widely concern that American students do not have the educational foundation to attain success in introductory science courses. Several educational reforms are established concerning the accountability of schools for proficiency in mathematics and English Language Arts (ELA). In 1994, the Improving America's School Act (IASA) ordered that states should set standards by 1999 and should measure students achievement by 2000. The No Child Left Behind Act of 2001 mandated that 100% of students should be proficient in ELA and mathematics by 2014.

Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Women veterans are at elevated risk for suicide and experience a high prevalence of suicidal ideation (SI) and suicide attempt (SA) history. Knowledge regarding SI/SA correlates among women veterans who use reproductive health care services is limited, inhibiting development of evidence-based, gender-sensitive suicide prevention programming tailored to meet women veterans' needs and preferences. This study aimed to 1) describe the prevalence and characteristics of SI and SA among women veterans using Veterans Health Administration (VHA) reproductive health care services and 2) provide an initial exploration of associations between fertility-, pregnancy-, and parenting-related factors with SI and SA to guide future research., Methods: Post-9/11 women veterans (n = 352) who used VHA reproductive health care in fiscal year 2018 completed a cross-sectional survey on reproductive health, mental health, and parenting., Results: Approximately 30% and 12% experienced SI and SA(s), respectively, after military service; 10% reported past-month SI. Infertility, pregnancy loss, age at first pregnancy, and parental status were not significantly associated with SI or SA history, although notable effect sizes were observed for infertility and age at first pregnancy; further research is warranted. Among parents, parental functioning was not associated with SI/SA, but lower parental satisfaction was significantly associated with past-month SI (prevalence ratio, 3.36; 95% confidence interval, 1.19-9.46; adjusting for demographics, military characteristics, mental health symptoms)., Conclusions: Postmilitary SI and SA(s) are common among women veterans accessing VHA reproductive health care services. Those with low parental satisfaction may be at particularly high risk. Findings can guide future research and inform clinical care to facilitate suicide prevention., (Published by Elsevier Inc.)

Alfalfa growers in the Intermountain West of the United States have recently seen an increased incidence in bacterial stem blight (BSB), which can result in significant herbage yield losses from the first harvest. BSB has been attributed to Pseudomonas syringae pv . syringae and P. viridiflava ; however, little is known about the genetic diversity and pathogenicity of these bacteria or their interaction with alfalfa plants. Here, we present a comprehensive phylogenetic and phenotypic analysis of P. syringae and P. viridiflava strains causing BSB on alfalfa. A multilocus sequence analysis found that they grouped exclusively with P. syringae PG2b and P. viridiflava PG7a. Alfalfa symptoms caused by both bacterial groups were indistinguishable, although there was a large range in mean disease scores for individual strains. Overall, PG2b strains incited significantly greater disease scores than those caused by PG7a strains. Inoculated plants showed browning in the xylem and collapse of epidermal and pith parenchyma cells. Inoculation with a mixture of PG2b and PG7a strains did not result in synergistic activity. The populations of PG2b and PG7a strains were genetically diverse within their clades and did not group by location or haplotype. The PG2b strains had genes for production of the phytotoxin coronatine, which is unusual in PG2b strains. The results indicate that both pathogens are well established on alfalfa across a wide geographic range and that a recent introduction or evolution of more aggressive strains as the basis for emergence of the disease is unlikely., Competing Interests: The author(s) declare no conflict of interest.

The U.S. FDA has permanently removed the in-person prescribing requirements that previously safeguarded the use of mifepristone/misoprostol medical abortions, allowing prescribing through telemedicine or on-line ordering and distribution through the mail and pharmacies, without standard pre-abortion testing. This will increase the risk of complications due to failure to adequately determine the gestational age or rule out ectopic pregnancy by ultrasound or physical exam, failure to perform labs to document whether RhoGAM is indicated, and failure to obtain appropriate informed consent to prevent unwanted abortions, among other concerns. The FDA justified this action by referencing flawed studies with significantly undercounted complications. The details of these study deficiencies are examined in this paper., (Copyright © 2024 by the National Legal Center for the Medically Dependent and Disabled, Inc.)

Objective: The number of women graduating from United States medical schools has reached parity with that of men. However, persistent inequalities and barriers have slowed the pace toward equity in application and representation in neurosurgery residency despite initiatives to increase female representation. The objective of the present study was to assess the advancement of gender parity within neurosurgery residency programs. Additionally, the study aimed to analyze the pipeline dynamics by investigating the effects of attrition on women in neurosurgery, as well as exploring the patterns of female applications to neurosurgery residency programs versus other surgical specialties., Methods: Data on the number of active female neurosurgery residents and female applicants to neurosurgery were collected from the Accreditation Council for Graduate Medical Education Data Resource Book from 2007 to 2021 and Electronic Residency Application Service from 2014 to 2022. Linear regression analysis was used to predict the percent of active female residents based on academic year (AY). A Pearson chi-square test was used to determine the odds of a female applying to neurosurgery., Results: The percent of active female residents in neurosurgery increased from 11.0% in 2007 to 21.8% in 2021. Bivariate linear regression analysis using AY as a predictor of the percent of active females showed a statistically significant correlation. On average, the percent of active female residents increased by 0.65% per year. If trends persist, parity for females in neurosurgery will not be reached until 2069. Linear regression analysis of the overall rate of attrition in neurosurgery as a predictor of the percent of active female residents revealed that for every 1% increase in the rate of attrition, the percent of active female residents decreased by 2.91% (p = 0.001). The percent of female applicants to neurosurgery increased from 19.6% in 2014 to 29.8% in 2022 (p = 0.009), yet the odds of a female applying to neurosurgery remain low., Conclusions: Neurosurgery continues to struggle with the recruitment of female medical students even as parity has been reached for female medical school matriculants. Greater effort is needed to recruit and retain female applicants to neurosurgery, including increased transparency in match and attrition metrics.

Background: Current literature states that 6.2 million adults in the United States are living with heart failure. Studies investigating the impact of congestive heart failure (CHF) following primary total knee arthroplasty (TKA) are scarce. Hence, this research aimed to investigate whether individuals with congestive heart failure (CHF) undergoing primary total knee arthroplasty (TKA) experience: (1) longer durations of in-hospital stay; (2) increased incidences of health complications; and (3) a higher financial load., Methods: A retrospective query using the 100% Parts A and B of the Medicare claims was performed. Cohorts of interest were identified using International Classification of Disease, Ninth Revision (ICD-9) and Current Procedural Terminology. Inclusion criteria for the study group consisted of patients with CHF undergoing primary TKA, whereas patients without CHF undergoing primary TKA served as the comparison cohort., Results: The query yielded 1,101,169 patients (CHF = 183,540; case-matched = 917,629). Patients with CHF had longer in-hospital LOS (5- vs. 4-days) and a higher incidence and odds of developing 90-day medical complications (49.22% vs. 7.45%) following primary TKA. CHF patients incurred higher day of surgery and total global ninety-day episode of care costs compared to their matched counterparts., Conclusion: This study illustrated those patients with preexisting CHF undergoing a primary TKA have longer in-hospital lengths of stay and higher rates of morbidity and financial burden. With the increasing prevalence of CHF worldwide, orthopedists and other healthcare professionals can utilize the information provided in this study to educate patients and establish comprehensive treatment plans to help mitigate postoperative effects associated with CHF., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Abstract: The passage of the PACT Act of 2022 expanded the services veterans receive through the U.S. Department of Veterans Affairs (VA), ensuring they now qualify for benefits if they've been exposed to certain toxins during their military service. This significant expansion of VA benefits also highlights the need for nurses and other health providers working outside the VA system-who care for millions of veterans-to be well-informed about their patients' military experiences and any potential environmental exposures and health impacts. In this article, the author raises awareness of military environmental exposures and offers guidance about exposure-informed care., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

The suicide rate among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Veterans increased from 2001 to 2020. Identifying regions where suicide rates are elevated and increasing among AANHPI Veterans would inform targeted prevention efforts for members of this cohort. We conducted a population-based retrospective cohort study of 377,833 AANHPI Veterans to examine suicide rates and methods (2005-2019) by United States (US) region and over time (2005-2009, 2010-2014, 2015-2019), using US Veteran Eligibility Trends and Statistics and Joint DoD/VA Mortality Data Repository data. AANHPI Veterans across most regions experienced increases in suicide rates from the earliest to latest period; however, patterns differed by region. Age-adjusted suicide rates increased across all three periods among those in the Northeast and West, but increased, then declined in the Midwest and South. In 2015-2019, the age-adjusted suicide rate among AANHPI Veterans was highest in the Northeast (42.0 per 100,000) and lowest in the West (27.5). However, the highest percentages of AANHPI Veteran suicide deaths in 2005-2019 occurred in the West (39.5%) and South (34.7%), with lower percentages in the Midwest (15.0%) and Northeast (10.8%). Across regions, those ages 18-34 had the highest suicide rates. Firearms were the most frequently used suicide method across regions (44.4%-60.2%), except the Northeast (35.2%), where suffocation was more common (38.3%). Results suggest particular needs for suicide prevention efforts among AANHPI Veterans in the Northeast and to ensure that lethal means safety initiatives for AANHPI Veterans encompass both firearms and suffocation, with some variations in emphasis across regions., Competing Interests: Declaration of Competing Interest Authors were employed by the Department of Veterans Affairs (VA) during the initial analysis and writing of this manuscript. Authors have received funding from the VA Office of Mental Health and Suicide Prevention (Monteith, Schneider, Miller, Gaeddert, Holliday, Spark, Brenner, Hoffmire), VA Health Services Research and Development (Monteith, Schneider, Miller, Gaeddert, Holliday, Spark, Brenner, Hoffmire), VA Rehabilitation Research and Development (Brenner), VA Office of Rural Health (Schneider, Brenner, Spark), VA National Center on Homelessness among Veterans (Holliday, Monteith, Brenner), VA National Center for Patient Safety (Monteith, Hoffmire), VA Office of Women’s Health (Monteith), VA Office of Health Equity (Holliday, Monteith), the National Institutes of Health (Brenner, Holliday, Hoffmire), the Department of Defense (Monteith, Holliday, Brenner, Hoffmire), the American Psychological Association (Monteith), and the State of Colorado (Brenner, Hoffmire). In her current employment with Westat, Dr. Spark has also received funding from the CDC and SAMHSA. Dr. Brenner also reports editorial remuneration from Wolters Kluwer, royalties from the American Psychological Association and Oxford University Press, and consults with sports leagues via her university affiliation., (Published by Elsevier B.V.)

Sleep is a biological necessity that is a critical determinant of mental and physical well-being. Sleep may promote resilience by enhancing an individual's biological preparedness to resist, adapt and recover from a challenge or stressor. This report analyzes currently active National Institutes of Health (NIH) grants focussed on sleep and resilience, specifically examining the design of studies that explore sleep as a factor that promotes health maintenance, survivorship, or protective/preventive pathways. A search of NIH R01 and R21 research project grants that received funding in Fiscal Years (FY) 2016-2021 and focussed on sleep and resilience was conducted. A total of 16 active grants from six NIH institutes met the inclusion criteria. Most grants were funded in FY 2021 (68.8%), used the R01 mechanism (81.3%), were observational studies (75.0%), and measured resilience in the context of resisting a stressor/challenge (56.3%). Early adulthood and midlife were most commonly studied and over half of the grants focussed on underserved/underrepresented populations. NIH-funded studies focussed on sleep and resilience, or the ways in which sleep can influence an individual's ability to resist, adapt, or recover from a challenging event. This analysis highlights an important gap and the need to expand research focussed on sleep as a promotor of molecular, physiological, and psychological resilience., (Published 2023. This article is a U.S. Government work and is in the public domain in the USA. Stress and Health published by John Wiley & Sons Ltd.)

Problem/condition: During 2012-2021, the volume of international travel reached record highs and lows. This period also was marked by the emergence or large outbreaks of multiple infectious diseases (e.g., Zika virus, yellow fever, and COVID-19). Over time, the growing ease and increased frequency of travel has resulted in the unprecedented global spread of infectious diseases. Detecting infectious diseases and other diagnoses among travelers can serve as sentinel surveillance for new or emerging pathogens and provide information to improve case identification, clinical management, and public health prevention and response., Reporting Period: 2012-2021., Description of System: Established in 1995, the GeoSentinel Network (GeoSentinel), a collaboration between CDC and the International Society of Travel Medicine, is a global, clinical-care-based surveillance and research network of travel and tropical medicine sites that monitors infectious diseases and other adverse health events that affect international travelers. GeoSentinel comprises 71 sites in 29 countries where clinicians diagnose illnesses and collect demographic, clinical, and travel-related information about diseases and illnesses acquired during travel using a standardized report form. Data are collected electronically via a secure CDC database, and daily reports are generated for assistance in detecting sentinel events (i.e., unusual patterns or clusters of disease). GeoSentinel sites collaborate to report disease or population-specific findings through retrospective database analyses and the collection of supplemental data to fill specific knowledge gaps. GeoSentinel also serves as a communications network by using internal notifications, ProMed alerts, and peer-reviewed publications to alert clinicians and public health professionals about global outbreaks and events that might affect travelers. This report summarizes data from 20 U.S. GeoSentinel sites and reports on the detection of three worldwide events that demonstrate GeoSentinel's notification capability., Results: During 2012-2021, data were collected by all GeoSentinel sites on approximately 200,000 patients who had approximately 244,000 confirmed or probable travel-related diagnoses. Twenty GeoSentinel sites from the United States contributed records during the 10-year surveillance period, submitting data on 18,336 patients, of which 17,389 lived in the United States and were evaluated by a clinician at a U.S. site after travel. Of those patients, 7,530 (43.3%) were recent migrants to the United States, and 9,859 (56.7%) were returning nonmigrant travelers.Among the recent migrants to the United States, the median age was 28.5 years (range = <19 years to 93 years); 47.3% were female, and 6.0% were U.S. citizens. A majority (89.8%) were seen as outpatients, and among 4,672 migrants with information available, 4,148 (88.8%) did not receive pretravel health information. Of 13,986 diagnoses among migrants, the most frequent were vitamin D deficiency (20.2%), Blastocystis (10.9%), and latent tuberculosis (10.3%). Malaria was diagnosed in 54 (<1%) migrants. Of the 26 migrants diagnosed with malaria for whom pretravel information was known, 88.5% did not receive pretravel health information. Before November 16, 2018, patients' reasons for travel, exposure country, and exposure region were not linked to an individual diagnosis. Thus, results of these data from January 1, 2012, to November 15, 2018 (early period), and from November 16, 2018, to December 31, 2021 (later period), are reported separately. During the early and later periods, the most frequent regions of exposure were Sub-Saharan Africa (22.7% and 26.2%, respectively), the Caribbean (21.3% and 8.4%, respectively), Central America (13.4% and 27.6%, respectively), and South East Asia (13.1% and 16.9%, respectively). Migrants with diagnosed malaria were most frequently exposed in Sub-Saharan Africa (89.3% and 100%, respectively).Among nonmigrant travelers returning to the United States, the median age was 37 years (range = <19 years to 96 years); 55.7% were female, 75.3% were born in the United States, and 89.4% were U.S. citizens. A majority (90.6%) were seen as outpatients, and of 8,967 nonmigrant travelers with available information, 5,878 (65.6%) did not receive pretravel health information. Of 11,987 diagnoses, the most frequent were related to the gastrointestinal system (5,173; 43.2%). The most frequent diagnoses among nonmigrant travelers were acute diarrhea (16.9%), viral syndrome (4.9%), and irritable bowel syndrome (4.1%).Malaria was diagnosed in 421 (3.5%) nonmigrant travelers. During the early (January 1, 2012, to November 15, 2018) and later (November 16, 2018, to December 31, 2021) periods, the most frequent reasons for travel among nonmigrant travelers were tourism (44.8% and 53.6%, respectively), travelers visiting friends and relatives (VFRs) (22.0% and 21.4%, respectively), business (13.4% and 12.3%, respectively), and missionary or humanitarian aid (13.1% and 6.2%, respectively). The most frequent regions of exposure for any diagnosis among nonmigrant travelers during the early and later period were Central America (19.2% and 17.3%, respectively), Sub-Saharan Africa (17.7% and 25.5%, respectively), the Caribbean (13.0% and 10.9%, respectively), and South East Asia (10.4% and 11.2%, respectively).Nonmigrant travelers who had malaria diagnosed were most frequently exposed in Sub-Saharan Africa (88.6% and 95.9% during the early and later period, respectively) and VFRs (70.3% and 57.9%, respectively). Among VFRs with malaria, a majority did not receive pretravel health information (70.2% and 83.3%, respectively) or take malaria chemoprophylaxis (88.3% and 100%, respectively)., Interpretation: Among ill U.S. travelers evaluated at U.S. GeoSentinel sites after travel, the majority were nonmigrant travelers who most frequently received a gastrointestinal disease diagnosis, implying that persons from the United States traveling internationally might be exposed to contaminated food and water. Migrants most frequently received diagnoses of conditions such as vitamin D deficiency and latent tuberculosis, which might result from adverse circumstances before and during migration (e.g., malnutrition and food insecurity, limited access to adequate sanitation and hygiene, and crowded housing,). Malaria was diagnosed in both migrants and nonmigrant travelers, and only a limited number reported taking malaria chemoprophylaxis, which might be attributed to both barriers to acquiring pretravel health care (especially for VFRs) and lack of prevention practices (e.g., insect repellant use) during travel. The number of ill travelers evaluated by U.S. GeoSentinel sites after travel decreased in 2020 and 2021 compared with previous years because of the COVID-19 pandemic and associated travel restrictions. GeoSentinel detected limited cases of COVID-19 and did not detect any sentinel cases early in the pandemic because of the lack of global diagnostic testing capacity., Public Health Action: The findings in this report describe the scope of health-related conditions that migrants and returning nonmigrant travelers to the United States acquired, illustrating risk for acquiring illnesses during travel. In addition, certain travelers do not seek pretravel health care, even when traveling to areas in which high-risk, preventable diseases are endemic. Health care professionals can aid international travelers by providing evaluations and destination-specific advice.Health care professionals should both foster trust and enhance pretravel prevention messaging for VFRs, a group known to have a higher incidence of serious diseases after travel (e.g., malaria and enteric fever). Health care professionals should continue to advocate for medical care in underserved populations (e.g., VFRs and migrants) to prevent disease progression, reactivation, and potential spread to and within vulnerable populations. Because both travel and infectious diseases evolve, public health professionals should explore ways to enhance the detection of emerging diseases that might not be captured by current surveillance systems that are not site based., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Opioid use disorder (OUD) affects millions of people throughout the United States, yet there are only three Food and Drug Administration-approved pharmacological treatments. Though these treatments have been shown to be effective, the number of overdose deaths continues to rise. The increase of fentanyl, fentanyl analogs, and adulterants in the illicit drug supply has further complicated treatment strategies. Preclinical researchers strive to model OUD to better understand this complicated disorder, and this research is a critical enabler for the development of novel treatments. As a result, there are many different preclinical models of OUD. Often, researchers form strong opinions on what they believe to be the "best" model to mimic the human condition. Here, we argue that researchers should be supportive of multiple models to promote new perspectives and discoveries and always consider the trends in human opioid use when designing preclinical studies. We describe the benefits of contingent and noncontingent models as well as models of opioid withdrawal and how each of these can help illuminate different components of OUD.

Purpose: Rural Veterans are more likely than urban Veterans to qualify for community care (Veterans Health Administration [VHA]-paid care delivered outside of VHA) due to wait times ≥30 days and longer travel times for VHA care. For rural Veterans receiving both VHA and community care, suboptimal care coordination between VHA and community providers can result in poor follow-up and care fragmentation. We developed Telehealth-based Coordination of Non-VHA Care (TECNO Care) to address this problem., Methods: We iteratively developed and adapted TECNO Care with partners from the VHA Office of Rural Health and site-based Home Telehealth Care in the Community programs. Using templated electronic health record notes, Home Telehealth nurses contacted Veterans monthly to facilitate communication with VHA/community providers, coordinate referrals, reconcile medications, and follow up on acute episodes. We evaluated TECNO Care using a patient-level, pre-post effectiveness assessment and rapid qualitative analysis with individual interviews of Veterans and VHA collaborators. Our primary effectiveness outcome was a validated care coordination quality measure. We calculated mean change scores for each care continuity domain., Findings: Between March 2019 and October 2021, 83 Veterans received TECNO Care. Veterans were predominately White (86.4%) and male (88.6%) with mean age 71.4 years (SD 10.4). Quantitative data demonstrated improvements in perceived care coordination following TECNO Care in 7 categories. Qualitative interviews indicated that Veterans and Home Telehealth nurses perceived TECNO Care as beneficial and addressing an area of high need., Conclusions: TECNO Care appeared to improve the coordination of VHA and community care and was valued by Veterans., (Published 2023. This article is a U.S. Government work and is in the public domain in the USA.)

Background: Guillain-Barre-Syndrome (GBS), an autoimmune polyneuropathy causing acute flaccid paralysis, is a rare condition with1-2 cases per 100,000 annually (approximately 5000 cases/year) in the United States (US). There is a paucity of published data regarding patient outcomes in association with discharge destinations following inpatient-rehabilitation (IR) in this patient population, thus this study., Objectives: To analyze IR efficacy, and possible predictors of discharge to home/community in a US-national-sample of GBS patients., Methods: Retrospective-observational-cohort study of 1304 GBS patients admitted to IR comparing discharge disposition destinations (community/home, skilled-nursing-facility [SNF], or return to acute-care) by demographic (age, gender) and clinical variables (length-of-stay [LOS], case-mix-index [CMI], and Functional-Independence-Measure [FIM] score changes). Multinomial-logistic-regression and discriminant-function-analysis were performed to determine model fit in predicting discharge destination., Results: 81.8% were discharged to home/community- average LOS 19-days, total-FIM-gain 43.2; 9.8% discharged to SNFs- average LOS 27.5-days, total-FIM-gain 27.2; and 8.4% discharged to acute-care- average LOS 15.4-days and total-FIM-gain 16.5, (F = 176, p < .001). Stepwise-linear-regression for prediction of community discharge showed change in FIM-Bed/chair/wheelchair-Transfers was the most significant predictor (Wald = 42.2; p < .001), followed by CMI (Wald = 26.9; p < .001), change in FIM-walking/wheelchair (Wald = 14.9; p < .001), and age (Wald = 9.5; p < .002). Using discriminant-function-analysis to test model validity for predicting discharge disposition, FIM-change for Bed/chair/wheelchair Transfers, Walking, and Self-Care as predictors resulted in a classification rate of 78.1%, 92% of variance explained, and Eigenvalue of .53 (p < .001)., Conclusions: Total-FIM scores improved in all groups, and most patients were discharged to home/community suggesting IR efficacy. The ability to transfer bed/chair/wheelchair was the most important predictive factor associated with discharge destination., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kushner 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.)

Background: Surgery is the standard treatment for genital extramammary Paget disease (gEMPD)., Objective: To determine if gEMPD treatments and outcomes differ by sex and US region., Methods: A systematic review was performed of all English-language studies on initial gEMPD treatment in Medline via PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. At least 2 reviewers performed title and abstract review and data extraction. Surgical categories included total skinning procedures, partial skinning procedures, Mohs micrographic surgery (MMS), or unspecified surgery. Chi-squared tests of association were used for comparisons., Results: A total of 60 studies comprising 302 (79.7%) female and 77 (20.3%) male patients met criteria. Women were most often initially recommended partial skinning procedures. In all, 74 (24.5%) women and 0 men underwent a total skinning procedure. Men were more likely to be offered MMS than women (40.3% vs 1.9%, P < .0001), despite men having a significantly greater extent of disease involving the perineum and perianal skin (21.1% vs 1.7%, P < .0001). Treatment recommendations varied by US region., Limitations: Only 20 states were represented., Conclusion: Women are more frequently offered total skinning procedures for gEMPD while men are more frequently offered MMS. MMS offers less recurrence and morbidity than total skinning procedures and should be recommended equally to both female and male patients with gEMPD., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: As the opioid epidemic accelerates in the United States, numerous sociodemographic factors have been implicated its development and are, furthermore, a driving factor of the disparities in postoperative pain management. Recent studies have suggested potential associations between the influence of race and ethnicity on pain perception but also the presence of unconscious biases in the treatment of pain in minority patients., Objective: To characterize the perioperative opioid requirements across racial groups after spine surgery., Methods: A retrospective, observational study of 1944 opioid-naive adult patients undergoing a neurosurgical spine procedure, from June 2012 to December 2019, was performed at a large, quaternary care institute. Postoperative inpatient and outpatient opioid usage was measured by oral morphine equivalents, across various racial groups., Results: Case characteristics were similar between racial groups. In the postoperative period, White patients had shorter lengths of stay compared with Black and Asian patients ( P < .05). Asian patients used lower postoperative inpatient opioid doses in comparison with White patients ( P < .001). White patients were discharged with significantly higher doses of opioids compared with Black patients ( P < .01); however, they were less likely to be readmitted within 30 days of discharge ( P < .01)., Conclusion: In a large cohort of opioid-naive postoperative neurosurgical patients, this study demonstrates higher inpatient and outpatient postoperative opioid usage among White patients. Increasing physician awareness to the effect of race on inpatient and outpatient pain management would allow for a modified opioid prescribing practice that ensures limited yet effective opioid dosages void of implicit biases., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

In 2019, the first cases of SARS-CoV-2 were detected in Wuhan, China, and by early 2020 the first cases were identified in the United States. SARS-CoV-2 infections increased in the US causing many states to implement stay-at-home orders and additional safety precautions to mitigate potential outbreaks. As policies changed throughout the pandemic and restrictions lifted, there was an increase in demand for COVID-19 testing which was costly, difficult to obtain, or had long turn-around times. Some academic institutions, including Boston University (BU), created an on-campus COVID-19 screening protocol as part of a plan for the safe return of students, faculty, and staff to campus with the option for in-person classes. At BU, we put together an automated high-throughput clinical testing laboratory with the capacity to run 45,000 individual tests weekly by Fall of 2020, with a purpose-built clinical testing laboratory, a multiplexed reverse transcription PCR (RT-qPCR) test, robotic instrumentation, and trained staff. There were many challenges including supply chain issues for personal protective equipment and testing materials in addition to equipment that were in high demand. The BU Clinical Testing Laboratory (CTL) was operational at the start of Fall 2020 and performed over 1 million SARS-CoV-2 PCR tests during the 2020-2021 academic year., Competing Interests: Declaration of interests 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 © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: This is the first multisite investigation of the validity of scores from the current version of the Medical College Admission Test (MCAT) in clerkship and licensure contexts. It examined the predictive validity of MCAT scores and undergraduate grade point averages (UGPAs) for performance in preclerkship and clerkship courses and on the United States Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge examinations. It also studied students' progress in medical school., Method: Researchers examined data from 17 U.S. and Canadian MD-granting medical schools for 2016 and 2017 entrants who volunteered for the research and applied with scores from the current MCAT exam. They also examined data for all U.S. medical schools for 2016 and 2017 entrants to regular-MD programs who applied with scores from the current exam. Researchers conducted linear and logistic regression analyses to determine whether MCAT total scores added value beyond UGPAs in predicting medical students' performance and progress. Importantly, they examined the comparability of prediction by sex, race and ethnicity, and socioeconomic status., Results: Researchers reported medium to large correlations between MCAT total scores and medical student outcomes. Correlations between total UGPAs and medical student outcomes were similar but slightly lower. When MCAT scores and UGPAs were used together, they predicted student performance and progress better than either alone. Despite differences in average MCAT scores and UGPAs between students who self-identified as White or Asian and those from underrepresented racial and ethnic groups, predictive validity results were comparable. The same was true for students from different socioeconomic backgrounds, and for males and females., Conclusions: These data demonstrate that MCAT scores add value to the prediction of medical student performance and progress and that applicants from different backgrounds who enter medical school with similar ranges of MCAT scores and UGPAs perform similarly in the curriculum., (Copyright © 2022 by the Association of American Medical Colleges.)