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High‐risk behaviours are sometimes encountered in Child and Adolescent inpatient mental health units and can prompt the use of coercive practices to maintain safety. Coercive practices may lead to re‐traumatisation of young people and deteriorating therapeutic relationships. Trauma‐informed practice (TIP) has successfully reduced coercive practices. While education is identified as foundational to implementation, evaluations of programmes remain minimal. The aim of this study was to explore mental health professionals' views and experiences of a trauma‐informed education programme and its likely impact on their approach to practice. Five mental health professionals agreed to participate, four contributed in a focus group and one in an individual interview. Data were analysed thematically using the Braun and Clarke Framework. Three main themes were identified. Firstly, shifting attitudes and perceptions of trauma‐informed practice. Participants believed they had developed more compassion towards clients and these attitudes were reflected in their clinical practice. Secondly, challenges associated with trauma‐informed practice educational intervention. Staffing issues and shift work made it difficult for participants to attend education sessions regularly. Participants identified barriers to practicing in a trauma‐informed manner in the current clinical environment. Finally, the need for interdisciplinary communication and support was identified. Participants saw the need for all professionals, not only nurses, to take responsibility for changing practice, and for stronger support at the organisational level. Trauma‐informed practice is crucial to recovery‐focused mental health nursing practice. These findings highlight the importance of TIP education and suggest areas for further improvement to enhance positive mental health outcomes for young people. [ABSTRACT FROM AUTHOR]

Previous research has identified the critical role of primary care for suicide prevention. Although several suicide prevention resources for primary care already exist, it is unclear how many have been created specifically for older veterans. This environmental scan sought to assemble a compendium of suicide prevention resources to be utilized in primary care. We searched four academic databases, Google Scholar, and Google to identify available suicide prevention resources. Data from 64 resources was extracted and summarized; 15 were general resources and did not meet inclusion criteria. Our scan identified 49 resources with three resources specifically developed for older veterans in primary care. Identified resources shared overlapping content, including implementing a safety plan and lethal means reduction. Although only 10 of the identified resources were exclusively primary care focused, many of the resources had content applicable to suicide prevention in primary care. Primary care providers can use this compendium of resources to strengthen suicide prevention work within their clinics including: safety planning, lethal means reduction, assessing for risk factors that place older veteran at increased risk of suicide, and mitigating risk factors through referral to programs designed to support older adult health and well-being. [ABSTRACT FROM AUTHOR]

Patient-facing websites serve as essential platforms for disseminating information, engaging with patients, and increasing access to neurosurgical resources and services. Diversity, Equity, and Inclusion are at the forefront of issues facing the field of neurosurgery, especially concerning race and gender disparities in regards to providers in the field. Data were collected in regards to the race and gender of patients and providers displayed on the neurosurgery department's patient-facing website in addition to accommodations for disabilities, decreased ability to pay, and language. Patients who were White were depicted more commonly than those of color (69% vs. 31%, P < 0.00001). White patients also were over-represented when compared with the average demographics of the communities in which the hospitals served (P = 0.03846). Neurosurgical providers who were White outnumbered those of color (70% vs. 30%, P < 0.00001). The racial depiction of providers was comparable with racial disparities currently observed in neurosurgery (P = 0.59612). Female neurosurgery providers were seen less than male providers on patient-facing websites (P < 0.00001) but were seen more commonly on patient-facing websites than the percentage of practicing neurosurgeons they currently comprise (28% vs. 8%, P < 0.00001). The results of this study suggest that patient-facing websites of neurosurgical departments are an area of improvement in regards to Diversity, Equity, and Inclusion in the field of neurosurgery. Disparities are noted in regards to the racial depiction of patients and further call to attention racial and gender disparities in the field of neurosurgery. [ABSTRACT FROM AUTHOR]

Background Customized and standard automated insulin delivery (AID) systems for use in pregnancies of women with preexisting type 1 diabetes (T1D) are being developed and tested to achieve pregnancy appropriate continuous glucose monitoring (CGM) targets. Guidance on the use of CGM for treatment decisions during pregnancy in the United States is limited. Methods Ten pregnant women with preexisting T1D participated in a trial evaluating at-home use of a pregnancy-specific AID system. Seven-point self-monitoring of blood glucose (SMBG) was compared to the closest sensor glucose (Dexcom G6 CGM) value biweekly to assess safety and reliability based on the 20%/20 mg/dL criteria. Results All participants completed the study with 7 participants satisfying the safety and reliability criteria with a mean absolute relative difference of 10.3%. Three participants did not fulfill the criteria, mainly because the frequency of SMBG did not meet the requirements. Conclusion Dexcom G6 CGM is safe and accurate in the real-world setting for use in pregnant women with preexisting T1D with reduced SMBG testing as part of a pregnancy-specific AID system. [ABSTRACT FROM AUTHOR]

Studies of stream macroinvertebrates traditionally use sampling methods that target benthic habitats. These methods could underestimate biodiversity if important assemblage components exist outside of the benthic zone. To test the efficacy of different sampling methods, we collected paired reach‐wide benthic and edge samples from up to 10 study reaches in nine basins spanning an aridity gradient across the United States. Edge sampling targeted riparian‐adjacent microhabitats not typically sampled, including submerged vegetation, roots, and overhanging banks. We compared observed richness, asymptotic richness, and assemblage dissimilarity between benthic samples alone and different combinations of benthic and edge samples to determine the magnitude of increased diversity and assemblage dissimilarity values with the addition of edge sampling. We also examined how differences in richness and assemblage composition varied across an aridity gradient. The addition of edge sampling significantly increased observed richness (median increase = 29%) and asymptotic richness (median increase = 173%). Similarly, median Bray–Curtis dissimilarity values increased by as much as 0.178 when benthic and edge samples were combined. Differences in richness metrics were generally higher in arid basins, but assemblage dissimilarity either increased or decreased across the aridity gradient depending on how benthic and edge samples were combined. Our results suggest that studies that do not sample stream edges may significantly underestimate reach diversity and misrepresent assemblage compositions, with effects that can vary across climates. We urge researchers to carefully consider sampling methods in field studies spanning climatic zones and the comparability of existing data sets when conducting data synthesis studies. [ABSTRACT FROM AUTHOR]

Objective: To describe insurance patterns and discontinuity during pregnancy, which may affect the experiences of the pregnant person: their timely access to care, continuity of care, and health outcomes. Data Sources and Study Setting: Data are from the PROMISE study, which utilizes data from community‐based health care organizations (CHCOs) (e.g., federally qualified health centers that serve patients regardless of insurance status or ability to pay) in the United States from 2005 to 2021. Study Design: This descriptive study was a cohort utilizing longitudinal electronic health record data. Data Collection/Extraction Methods: Insurance type at each encounter was recorded in the clinical database and coded as Private, Public, and Uninsured. Pregnant people were categorized into one of several insurance patterns. We analyzed the frequency and timing of insurance changes and care utilization within each group. Principal Findings: Continuous public insurance was the most common insurance pattern (69.2%), followed by uninsured/public discontinuity (11.8%), with 6.4% experiencing uninsurance throughout the entirety of pregnancy. Insurance discontinuity was experienced by 16.6% of pregnant people; a majority of these reflect people transitioning to public insurance. Those with continuous public insurance had the highest frequency of inadequate prenatal care (19.5%), while those with all three types of insurance during pregnancy had the highest percentage of intensive prenatal care (16.5%). The majority (71.7%–81.2%) of those with a discontinuous pattern experienced a single insurance change. Conclusions: Insurance discontinuity and uninsurance are common within our population of pregnant people seeking care at CHCOs. Our findings suggest that insurance status should be regarded as a dynamic rather than a static characteristic during pregnancy and should be measured accordingly. Future research is needed to assess the drivers of perinatal insurance discontinuity and if and how these discontinuities may affect health care access, utilization, and birth outcomes. [ABSTRACT FROM AUTHOR]

The t:slim X2 insulin pump with Control-IQ technology (Control-IQ) advanced hybrid closed-loop automated insulin delivery system was evaluated in this prospective single-arm trial. Thirty adults with type 2 diabetes using the Control-IQ system showed substantial glycemic improvement with no increase in hypoglycemia. Mean time in range (70–180 mg/dL) improved 15%, representing an increase of 3.6 hours/day, and mean glucose decreased by 22 mg/dL. [ABSTRACT FROM AUTHOR]

Racial disparities in hospice care are well documented for patients with cancer, but the existence, direction, and extent of disparity findings are contradictory across the literature. Current methods to identify racial disparities aggregate data to produce single-value quality measures that exclude important patient quality elements and, consequently, lack information to identify actionable equity improvement insights. Our goal was to develop an explainable machine learning approach that elucidates healthcare disparities and provides more actionable quality improvement information. We infused clinical information with engineering systems modeling and data science to develop a time-by-utilization profile per patient group at each hospital using US Medicare hospice utilization data for a cohort of patients with advanced (poor-prognosis) cancer that died April-December 2016. We calculated the difference between group profiles for people of color and white people to identify racial disparity signatures. Using machine learning, we clustered racial disparity signatures across hospitals and compared these clusters to classic quality measures and hospital characteristics. With 45,125 patients across 362 hospitals, we identified 7 clusters; 4 clusters (n = 190 hospitals) showed more hospice utilization by people of color than white people, 2 clusters (n = 106) showed more hospice utilization by white people than people of color, and 1 cluster (n = 66) showed no difference. Within-hospital racial disparity behaviors cannot be predicted from quality measures, showing how the true shape of disparities can be distorted through the lens of quality measures. This approach elucidates the shape of hospice racial disparities algorithmically from the same data used to calculate quality measures. [ABSTRACT FROM AUTHOR]

We describe hepatitis C testing of 47 (2%) of 2,266 children diagnosed with perinatal hepatitis C who were exposed during 2018-2020 in 7 jurisdictions in the United States. Expected frequency of perinatal transmission is 5.8%, indicating only one third of the cases in this cohort were reported to public health authorities. [ABSTRACT FROM AUTHOR]

In violent crime cases, aggravating factors in United States criminal codes, such as "heinous," "atrocious," or "depraved," are used to distinguish elements of the crime warranting more severe sentencing. These aggravating terms are vaguely defined and applied arbitrarily in violent cases. This paper details the development of a 25 item Depravity Standard to operationalize an evidence-based approach to distinguishing the worst of violent crimes. The items were applied to 393 detailed case files drawn from several American jurisdictions to develop and refine the item definitions, determine interrater reliability, and mine for the frequency of each item's occurrence. This information was combined with 1,590 participant responses ranking the relative depravity of each item to develop a straightforward scoring system for measuring depravity in violent cases. The Depravity Standard guide can seamlessly be applied to identify the worst violent crimes, and provide support for those cases that may deserve leniency or early-release. [ABSTRACT FROM AUTHOR]

Social network analysis has created a productive framework for the analysis of the histories of patient-physician interactions and physician collaboration. Notable is the construction of networks based on the data of “referral paths” – sequences of patient-specific temporally linked physician visits – in this case, culled from a large set of Medicare claims data in the United States. Network constructions depend on a range of choices regarding the underlying data. In this paper we introduce the use of a five-factor experiment that produces 80 distinct projections of the bipartite patient-physician mixing matrix to a unipartite physician network derived from the referral path data, which is further analyzed at the level of the 2,219 hospitals in the final analytic sample. We summarize the networks of physicians within a given hospital using a range of directed and undirected network features (quantities that summarize structural properties of the network such as its size, density, and reciprocity). The different projections and their underlying factors are evaluated in terms of the heterogeneity of the network features across the hospitals. We also evaluate the projections relative to their ability to improve the predictive accuracy of a model estimating a hospital’s adoption of implantable cardiac defibrillators, a novel cardiac intervention. Because it optimizes the knowledge learned about the overall and interactive effects of the factors, we anticipate that the factorial design setting for network analysis may be useful more generally as a methodological advance in network analysis. [ABSTRACT FROM AUTHOR]

The Comprehensive Test of Phonological Processing, 2nd Edition (CTOPP-2; Wagner et al., 2013) is commonly used in k-12 public schools to assess basic cognitive processing skills foundational for reading achievement. Psychometric support for its use with dual language learners (DLLs), a group representing over 10% of the school-aged population in the United States, is critical. This study tested the metric and scaler invariance of CTOPP-2 scores among school-aged children (n = 242; 41.3% Spanish-speaking DLL). Results indicate that the CTOPP-2's three-factor (i.e., Phonological Awareness, Phonological Memory, and Rapid Automatic Naming) measurement structure displays metric and scalar invariance for DLLs. Model fit was improved when the Phonological Awareness and Phonological Memory factors were combined. Implications for future research and the practice of psychoeducational diagnostic assessment with DLLs are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Many adults who smoke cigarettes use e-cigarettes to try to quit smoking, however some are not successful. Identifying factors that are associated with successfully quitting smoking using e-cigarettes is important for maximizing cigarette cessation.Methods: Online survey data were collected in 2021 from 857 adults in the U.S. who reported using e-cigarettes in a recent attempt to quit smoking. Survey items assessed patterns of e-cigarette use and device characteristics (flavors, device, nicotine) used when trying to quit smoking. Multivariable linear regression models examined characteristics associated with the longest duration of smoking abstinence when using e-cigarettes to try to quit.Results: The average duration of smoking abstinence when using e-cigarettes during a quit attempt was 65 days (SD=104). In the multivariable model, greater frequency of e-cigarette use when quitting and abruptly switching to e-cigarettes from cigarettes (vs. gradually reducing) were significantly associated with longer durations of abstinence (ps<.001). Preference for non-tobacco (relative to tobacco) flavors and nicotine concentration were not associated with duration of abstinence, although preference for rechargeable pod and mod device types (vs. cig-a-likes) was associated with longer durations of abstinence.Conclusions: Patterns of e-cigarette use were related to abstinence duration, which may provide guidance for adults who are using e-cigarettes to quit smoking to encourage complete substitution and maximize smoking cessation. Findings indicate non-tobacco e-cigarette flavors and nicotine strength are not related to longer durations of cessation success for adults, which may inform tobacco regulatory policies limiting these constituents to protect public health.Implications: This study provides important new information about characteristics of e-cigarettes used during an attempt to quit smoking among adults across the U.S. and identifies factors associated with quitting success. Patterns of e-cigarette use were associated with longer durations of abstinence. In contrast, few e-cigarette characteristics were associated with abstinence. Although preference for some pod and mod device types was associated with longer abstinence duration compared to earlier cig-a-like devices, preference for non-tobacco (vs. tobacco) flavor and nicotine concentration were not associated with abstinence. Findings may help inform guidance for adults using e-cigarettes to quit smoking and support tobacco regulatory policies. [ABSTRACT FROM AUTHOR]

Federal Motor Vehicle Safety Standard (FMVSS) 208 requires every passenger vehicle to provide an auditory signal lasting 4 to 8 seconds and a visual display lasting 60 seconds when the driver is unbelted at ignition. This requirement does not increase seat belt use. This paper summarizes the latest research on using vehicle technology to increase seat belt use and existing safety standards worldwide to support the strengthening of FMVSS 208. Studies of seat belt reminders and interlocks published in peer-reviewed journals, conference proceedings, or as technical reports were identified in online databases and reviewed along with current requirements worldwide. Results from past research were used to estimate the front- and rear-seat daytime belt use rate and the annual number of lives that could be saved by a persistent audible reminder at each seating position. Most motor vehicle occupants routinely buckle up. Those that do not typically forget, are going a short distance, or find belts uncomfortable. Seat belt reminders can remind or motivate occupants to buckle up. Enhanced reminders that exceed FMVSS 208 increase belt use by 6 percentage points. Reminders also can increase rear belt use, and although required throughout the world, are not required by FMVSS 208. More persistent reminders, like those required around the world, with a continuous, long-lasting audible signal increase belt use by 30% among drivers who do not routinely buckle up. If every vehicle in the U.S. had such a reminder at each seating position, then it was estimated that the daytime belt use rate in the U.S. would increase about 3 percentage points from 90.3% to 93.2% in the front row and by about 6 percentage points from 80% to 85.9% in the rear row. It was estimated that the increase in belt use from a continuous, long-lasting audible reminder could potentially save about 1,600 lives each year. Seat belt interlocks can increase belt use, but acceptance is a stumbling block. Public outcry ensued after interlocks were required in 1973, and public sentiment remains negative. Opinions toward front and rear reminders are more favorable. Furthermore, past research suggests interlocks may be no more effective for increasing seat belt use than persistent audible reminders. The effect of interlocks on rear belt use have not been explored. Persistent seat belt reminder systems that last at least 90 seconds can potentially save hundreds of U.S. motorists each year. Robust empirical evidence, successful exemplars from organizations throughout the world, and a clear public health benefit exists for strengthening FMVSS 208 to require more persistent audible reminders at every seating position. [ABSTRACT FROM AUTHOR]

Background and Objectives Dissemination-implementation.org outlines 110 theories, models, and frameworks (TMFs): we conducted a citation analysis on 83 TMFs, searching Web of Science and PubMed databases. Research Design and Methods Search terms were broad and included "aging," "older," "elderly," and "geriatric." We extracted each TMF in identified articles from inception through January 28, 2022. Included articles must have used a TMF in research or quality improvement work directly linked to older adults within the United States. Results We reviewed 2,681 articles of which 295 articles cited at least one of 56 TMFs. Five TMFs represented 50% of the citations: Reach, Effectiveness, Adoption, Implementation, and Maintenance 1.0, Consolidated Framework for Implementation Research, Greenhalgh Diffusion of Innovation in Service Organizations, Quality Enhancement Research Initiative, Community-Based Participatory Research, and Promoting Action on Research Implementation in Health Services. TMF application varied and there was a steady increase in TMF citations over time, with a 2- to 3-fold increase in citations in 2020–2021. We identified that only 41% of TMF use was meaningful. Discussion and Implications Our results suggest TMF utilization is increasing in aging research, but there is a need to more meaningful utilize TMFs. As the population of older adults continues to grow, there will be increasing demand for effective evidence-based practices and models of care to be quickly and effectively translated into routine care. Use of TMFs is critical to building such evidence and to identifying and evaluating methods to support this translation. [ABSTRACT FROM AUTHOR]

Data from the top 15 constituents by weight on the S&P 500 is assembled to identify trends among the policies these companies implemented in the United States during the COVID-19 pandemic. Some policies were fairly consistent across the board, especially in regard to remote work opportunities and health and safety measures for essential and/or in-person employees. Other policies, including vaccination requirements and vaccine incentives, varied across and within industries. Some companies that were examined went beyond the relevant federal, state, or local requirements in effect at the time, while other companies pushed back against public health guidance. [ABSTRACT FROM AUTHOR]

This article describes the evolution of the Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) and provides insight into the development and growth of a successful type 1 diabetes quality improvement (QI) program. Since its inception 8 years ago, the collaborative has expanded to include centers across the United States with varying levels of QI experience, while simultaneously achieving many tangible improvements in type 1 diabetes care. These successes underscore the importance of learning health systems, data-sharing, benchmarking, and peer collaboration as drivers for continuous QI. Future efforts will include recruiting additional small- to medium-sized centers focused on adult care and underserved communities to further the goal of improving care and outcomes for all people living with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Background: Ovarian clear cell carcinoma (OCCC) accounts for approximately 8–10% of epithelial ovarian cancers in the United States. Although it is rare, OCCC usually presents with treatment challenges and the overall prognosis is far worse than high grade serous ovarian cancer HGSOC. The objective of this study was to examine the therapeutic relevance of combining oncolytic virus with cisplatin for ovarian cancer clear cell carcinoma (OCCC). Results: We identified that TMEM205, a recently discovered transmembrane protein, contributes to chemoresistance in OCCC cells via the exosomal pathway. Mechanistically, TMEM205 undergoes ligand-independent constitutive endocytosis and co-localizes with Rab11 to contribute to the late recycling endosomes in a clathrin-independent manner. Further, we observed that oncolytic virus (oHSV) pretreatment followed by treatment with cisplatin decreases TMEM205 expression and sensitizes cells to cisplatin in a synergistic manner in OCCC cells. TMEM205 interacts with glycoprotein-C of oHSV post-infection; both of these proteins undergo ubiquitination and ultimately get shuttled outside the cell via exosomes. Thus, we demonstrate the mechanotransduction pathway of TMEM205-mediated chemoresistance along with targeting this pathway using oHSV and cisplatin as a powerful therapeutic strategy for OCCC. oHSV combination with cisplatin inhibits OCCC tumor growth in vivo in immunodeficient and immunocompetent mice models. Conclusion: Our results suggest that the combination of oHSV and cisplatin in immunocompetent as well as immune deficient OCCC tumor bearing mice reduces overall tumor burden as well as metastatic disease thereby providing survival benefit. Additionally, the detection of TMEM205 in exosomal cargo early in OCCC development has potential to be exploited as a biomarker. [ABSTRACT FROM AUTHOR]

At the end of life, individuals may re-engage with earlier life trauma as they reflect on life experiences and confront their mortality. As such, posttraumatic stress disorder (PTSD) symptoms at the end of life may worsen the quality of death experience. This is a concern for military veterans, who tend to have more trauma exposures and higher rates of PTSD, and particularly for veterans receiving care in rural areas where access to PTSD specialty services is limited. To better understand this issue, we conducted 10 focus groups with clinicians serving veterans in rural communities across five U.S. states. The aims of this project were to evaluate: (1) do hospice and palliative care providers/staff observe PTSD symptoms in veterans at the end of life? (2) if so, how are symptoms similar to and different from existing DSM-5 criteria for PTSD? We used qualitative content analysis with mixed deductive and inductive approaches to code 151 anonymized statements. Analyses found descriptions of PTSD symptoms aligned broadly with existing diagnostic nomenclature, but descriptions revealed specific presentations relevant to the end of life setting such as resistance to care, agitation, restlessness, and effects of delirium. In addition, some veterans expressed pride in service and openness to discussing military experiences. Further, clinicians noted that PTSD symptoms were relevant to family dynamics. Future research should further characterize these symptom differences through direct patient assessment and develop resources to improve quality of death experience for veterans with PTSD symptoms. [ABSTRACT FROM AUTHOR]

Objective: This study examined whether and how organizations participating in accountable care organization (ACO) contracts integrate primary care and treatment for patients with serious mental illness.Methods: This study used responses to the 2017–2018 National Survey of ACOs (55% response rate) to measure ACO-reported use of three integrated care strategies: care manager to address physical health treatment coordination or nonmedical needs (e.g., job support and housing), patient registries to track physical health conditions, and primary care clinician colocated in a specialty mental health setting. Logistic regression was used to determine associations between ACO characteristics and strategy use.Results: Of 399 respondents who answered questions on integration, 303 (76%) reported using at least one integrated care strategy in at least one location. Use of care managers (defined by the respondent) was most common (N=281, 70%), followed by use of a patient registry (N=146, 37%) and colocation of a primary care clinician in a specialty mental health setting (N=118, 30%). Respondents reporting that their largest Medicaid contract or largest commercial contract included quality measures specific to serious mental illness (e.g., antipsychotic adherence) were more likely to use each integrated care delivery strategy. Self-reported use of three collaborative care strategies (care management, patient registry, or mental health consulting clinician) for treatment of depression or anxiety was associated with use of integrated primary care and treatment for serious mental illness.Conclusions: In a national survey of ACOs, few respondents reported using either patient registries or primary care colocation to integrate primary care and treatment for serious mental illness. [ABSTRACT FROM AUTHOR]

Background: Over the last decade, primary care clinics in the United States have responded both to national policies encouraging clinics to support substance use disorders (SUD) service expansion and to regulations aiming to curb the opioid epidemic.Objective: To characterize approaches to SUD service expansion in primary care clinics with national reputations as workforce innovators.Methods: Comparative case studies were conducted to characterize different approaches among 12 primary care clinics purposively and iteratively recruited from a national registry of workforce innovators. Observational field notes and qualitative interviews from site visits were coded and analysed to identify and characterize clinic attributes.Results: Codes describing clinic SUD expansion approaches emerged from our analysis. Clinics were characterized as: avoidant (n = 3), contemplative (n = 5) and responsive (n = 4). Avoidant clinics were resistant to planning SUD service expansion; had no or few on-site behavioural health staff; and lacked on-site medication treatment (previously termed medication-assisted therapy) waivered providers. Contemplative clinics were planning or had partially implemented SUD services; members expressed uncertainties about expansion; had co-located behavioural healthcare providers, but no on-site medication treatment waivered and prescribing providers. Responsive clinics had fully implemented SUD; members used non-judgmental language about SUD services; had both co-located SUD behavioural health staff trained in SUD service provision and waivered medication treatment physicians and/or a coordinated referral pathway.Conclusions: Efforts to support SUD service expansion should tailor implementation supports based on specific clinic training and capacity building needs. Future work should inform the adaption of evidence-based practices that are responsive to resource constraints to optimize SUD treatment access. [ABSTRACT FROM AUTHOR]

Fifteen cases of Fetal Abduction by Maternal Evisceration (FAMAE) reported to the National Center for Missing and Exploited Children during 1987–2011 outline the findings from a review of the forensic psychiatric considerations and legal course of each of the cases. Most offenders confessed to law enforcement within a short time of being placed under arrest in statements reflecting a continued effort to manage impressions and minimize culpability. Psychiatric assessment is invariably central to the legal disposition of FAMAE cases, as the defendant's goal is to diminish the perception of culpability/criminal responsibility and mitigate sentencing. Of those sentenced in the United States, nine defendants received life without parole, two received the death penalty (one executed), and one received a minimum of 30 years. Two abductors committed suicide and were not sentenced. Proffered diagnoses at trial included psychogenic amnesia, pseudocyesis, dissociative disorder, and delusional disorder; however, these rarely stood up to court scrutiny. Psychiatric experts showed the greatest variance in diagnosis over what to call the feigned pregnancy. In addition to delusional disorder and dissociative disorder, pseudocyesis, factitious disorder/pregnancy, pseudopregnancy, schizophrenia, and PTSD were among the various diagnoses proposed. A differential diagnosis for many FAMAE offenders may also include borderline personality disorder. Future research accounting for those women claiming false pregnancy who do not become homicidal will clarify whether FAMAE is the extreme endpoint of a fertility identity disorder. [ABSTRACT FROM AUTHOR]

Aims: Theory‐driven, exploratory study to: (i) identify a reward drinking phenotype in young adults; (ii) evaluate this phenotype as a predictor of naltrexone response; and (iii) examine mechanisms of naltrexone in reward drinkers. Design Secondary analysis of a randomized controlled trial. Setting: USA. Participants: A total of 128 young adult (ages 18–25) heavy drinkers. Interventions: Naltrexone versus placebo. Measurements Daily surveys assessed affect, urge, drinking, and context. The Drinking Motives Questionnaire was used to identify phenotypes based on reward (enhancement motives) and relief (coping motives) drinking. Findings We identified three profiles: "Low reward/Low relief" (14.1%; low enhancement/low coping motives); "Reward drinkers" (62.2%; high enhancement/low coping motives); and "High reward/High relief" (22.7%; high enhancement/high coping motives). Among reward drinkers (versus low profile), naltrexone significantly reduced percent days drinking to intoxication (blood alcohol concentration [BAC] ≥0.08) (PDI) (d = 0.56; 95% CI [0.17, 0.96]) and percent high intensity drinking days (PHID) (8/10 drinks for women/men) (d = 0.32; 95% CI [0.01, 0.68]). Among the high reward/high relief profile drinkers (versus low profile), naltrexone reduced PHID (d = 0.69; 95% CI [0.02, 1.50]). Using profile‐informed cutoffs and observed scores (for clinical applicability): (i) among cutoff‐derived reward drinkers, we found a medium‐to‐large (d = 0.66; 95% CI [0.24, 1.16]) and small effect (d = 0.28; 95% CI [0.04, 0.72]) of naltrexone in reducing PDI and PHID, respectively; and (ii) among the cutoff‐derived high reward/high relief subgroup, we found a medium‐to‐large effect (d = 0.63; 95% CI [0.05, 1.1]) of naltrexone in reducing PHID. Among reward drinkers (not other profiles), naltrexone reduced drinking on days a drinking event occurred by weakening the within‐day association between positive affect and urges (P < 0.05). Conclusions: Naltrexone has pronounced effects in reducing risky drinking among young adult reward drinkers (high reward/low relief) by reducing urges on days when individuals have higher positive affect and are exposed to a drinking event. Naltrexone also appears to reduce risky drinking among young adult high reward/high relief drinkers, but not via the same mechanism. [ABSTRACT FROM AUTHOR]

Objective: Building on the original taxonomy of hospital-based health systems from 20 years ago, we develop a new taxonomy to inform emerging public policy and practice developments.Data Sources: The 2016 American Hospital Association's (AHA) Annual Survey; the 2016 IQVIA Healthcare Organizations and Systems (HCOS) database; and the 2017-2018 National Survey of Healthcare Organizations and Systems (NSHOS).Study Design: Cluster analysis of the 2016 AHA Annual Survey data to derive measures of differentiation, centralization, and integration to create categories or types of hospital-based health systems.Data Collection: Principal components factor analysis with varimax rotation generating the factors used in the cluster algorithms.Principal Findings: Among the four cluster types, 54% (N = 202) of systems are decentralized (-0.35) and relatively less differentiated (-0.37); 23% of systems (N = 85) are highly differentiated (1.28) but relatively decentralized (-0.29); 15% (N = 57) are highly centralized (2.04) and highly differentiated (0.65); and approximately 9 percent (N = 33) are least differentiated (-1.35) and most decentralized (-0.64). Despite differences in calculation, the Highly Centralized, Highly Differentiated System Cluster and the Undifferentiated, Decentralized System Cluster were similar to those identified 20 years ago. The other two system clusters contained similarities as well as differences from those 20 years ago. Overall, 82 percent of the systems remain relatively decentralized suggesting they operate largely as holding companies allowing autonomy to individual hospitals operating within the system.Conclusions: The new taxonomy of hospital-based health systems bears similarities as well as differences from 20 years ago. Important applications of the taxonomy for addressing current challenges facing the healthcare system, such as the transition to value-based payment models, continued consolidation, and the growing importance of the social determinants of health, are highlighted. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of sampling patients on descriptive characteristics of physician patient-sharing networks.Data Sources: Medicare claims data from 10 hospital referral regions (HRRs) in the United States in 2010.Study Design: We form a sampling frame consisting of the full cohort of patients (Medicare enrollees) with claims in the 2010 calendar year from the selected HRRs. For each sampling fraction, we form samples of patients from which a physician ("patient-sharing") network is constructed in which an edge between two physicians depicts that at least one patient in the sample encountered both of those physicians. The network is summarized using 18 network measures. For each network measure and sampling fraction, we compare the values determined from the sample and the full cohort of patients. Finally, we assess the sampling fraction that is needed to measure each network measure to specified levels of accuracy.Data Collection/extraction Methods: We utilized administrative claims from the traditional (fee-for-service) Medicare.Principal Findings: We found that measures of physician degree (the number of ties to other physicians) in the network and physician centrality (importance or prominence in the network) are learned quickly in the sense that a small sampling fraction suffices to accurately compute the measure. At the network level, network density (the proportion of possible edges that are present) was learned quickly while measures based on more complex configurations (subnetworks involving multiple actors) are learned relatively slowly with relative rates of learning depending on network size (the number of nodes).Conclusions: The sampling fraction applied to Medicare patients has a highly heterogeneous effect across different network measures on the extent to which sample-based network measures resemble those evaluated using the full cohort. Even random sampling of patients may yield physician networks that distort descriptive features of the network based on the full cohort, potentially resulting in biased results. [ABSTRACT FROM AUTHOR]

Background: Drivers behind the adoption of gene expression profiling in breast cancer oncology have been shown to include exposure to physician colleagues' use of a given genomic test. We examined adoption of the Oncotype DX 21‐gene breast cancer recurrence score assay (ODX) in the United States after its incorporation into clinical guidelines. The influence of patient‐sharing ties and co‐location with prior adopters and the role of these potential exposures across medical specialties on peers' adoption of the test were examined. Methods: We conducted a retrospective cohort study of women with incident breast cancer using a 100% sample of fee‐for‐service Medicare enrollee claims over 2008–2011. Peer networks connecting medical oncologists and surgeons treating these patients were constructed using patient‐sharing and geographic co‐location. The impact of peer connections on the adoption of ODX by physicians and testing of patients was modeled with multivariable hierarchical regression. Results: Altogether, 156,229 women identified with incident breast cancer met criteria for cohort inclusion. A total of 7689 ODX prescribing physicians were identified. Co‐location with medical oncologists who adopted the test in the early period (2008–2009) was associated with a 1.38‐fold increase in the odds of a medical oncologist adopting ODX in 2010–2011 (95% CI = 1.04–1.83), as was co‐location with early‐adopting surgeons (odds ratio [OR] = 1.25, 95% CI = 1.00–1.58). Patients whose primary medical oncologist was linked to an early‐adopting surgeon through co‐location (OR = 1.17, 95% CI = 1.04–1.32) or both patient‐sharing and co‐location (OR = 1.17, 95% CI = 1.03–1.34) were more likely to receive ODX. Conclusions: Exposure to surgeon early adopters through peer networks and co‐location was predictive of ODX uptake by medical oncologists and testing of patients. Interventions focused on the role of surgeons in molecular testing may improve the implementation of best practices in breast cancer care. [ABSTRACT FROM AUTHOR]

Lesbian, gay, and bisexual (LGB) youth are at risk for many negative behaviors associated with teen dating violence victimization (TDVV). This study describes the prevalence of physical and sexual TDVV by sexual identity and quantifies the increased risk for TDVV among LGB youth compared with heterosexual youth. The participants for this study were students in Grades 9 to 12 participating in the 2015 national Youth Risk Behavior Survey (YRBS) who responded to questions ascertaining sexual identity and both physical and sexual TDVV. Data were analyzed by sexual identity, stratified by sex, and controlled for race/ethnicity and grade in school. Frequencies of physical and sexual TDVV and prevalence of TDVV from a combined TDVV measure were calculated. Associations between these behaviors and sexual identity were identified. Generally, LGB youth had greater prevalence and frequency of TDVV compared with heterosexual youth. Prevalence of TDVV within sexual identity subgroups further differed by sex. Students who were not sure of their sexual identity had the highest risk of most categories of TDVV when adjusting for sex, race/ethnicity, and grade in school. These results are the first to use a nationally representative sample to describe frequency of TDVV and to determine prevalence of a combined physical and sexual TDVV measure by sexual identity among youth. Schools, communities, and families can help prevent teen dating violence and ameliorate the potential impacts of these victimizations. [ABSTRACT FROM AUTHOR]

Objective: We sought to understand how Affordable Care Act (ACA) Medicaid expansion insurance coverage gains are associated with changes in diabetes-related biomarkers.Research Design and Methods: This was a retrospective observational cohort study using electronic health record data from 178 community health centers (CHCs) in the ADVANCE (Accelerating Data Value Across a National Community Health Center Network) network. We assessed changes in diabetes-related biomarkers among adult patients with diabetes in 10 Medicaid expansion states (n = 25,279), comparing newly insured with continuously insured, discontinuously insured, and continuously uninsured patients pre- to post-ACA expansion. Primary outcomes included changes from 24 months pre- to 24 months post-ACA in glycosylated hemoglobin (HbA1c), systolic (SBP) and diastolic (DBP) blood pressure, and LDL cholesterol levels.Results: Newly insured patients exhibited a reduction in adjusted mean HbA1c levels (8.24% [67 mmol/mol] to 8.17% [66 mmol/mol]), which was significantly different from continuously uninsured patients, whose HbA1c levels increased (8.12% [65 mmol/mol] to 8.29% [67 mmol/mol]; difference-in-differences [DID] -0.24%; P < 0.001). Newly insured patients showed greater reductions than continuously uninsured patients in adjusted mean SBP (DID -1.8 mmHg; P < 0.001), DBP (DID -1.0 mmHg; P < 0.001), and LDL (DID -3.3 mg/dL; P < 0.001). Among patients with elevated HbA1c in the 3 months prior to expansion, newly insured patients were more likely than continuously uninsured patients to have a controlled HbA1c measurement by 24 months post-ACA (hazard ratio 1.25; 95% CI 1.02-1.54].Conclusions: Post-ACA, newly insured patients had greater improvements in diabetes-related biomarkers than continuously uninsured, discontinuously insured, or continuously insured patients. Findings suggest that health insurance gain via ACA facilitates access to appropriate diabetes care, leading to improvements in diabetes-related biomarkers. [ABSTRACT FROM AUTHOR]

Background: Reductions in World Health Organization (WHO) risk drinking levels have recently been shown to lower the risk of multiple adverse health outcomes, but prior work has not examined reductions in WHO risk drinking levels in relation to cardiovascular disease (CVD), the leading cause of death for men and women in the United States and of global mortality. This study examined associations between reductions in WHO risk drinking levels and subsequent risk for CVD. Methods: In a US national survey, 1,058 very‐high‐risk and high‐risk drinkers participated in Wave 1 interviews (2001 to 2002) and Wave 2 follow‐ups (2004 to 2005). Self‐reported CVD history that was communicated to the participant by a doctor or other healthcare professionals included arteriosclerosis, hypertension, angina, tachycardia, or myocardial infarction. We used logistic regression to estimate adjusted odds ratios (aOR) evaluating relationships between ≥2‐level reductions in WHO risk drinking levels from Wave 1 to Wave 2 and the risk of Wave 2 CVD, controlling for baseline characteristics. Results: Reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD in individuals who at Wave 1 were very‐high‐risk (aOR = 0.58 [0.41 to 0.80]) or high‐risk drinkers (aOR = 0.81 [0.70 to 0.94]). Interaction terms showed that this relationship varied by age. Among individuals >40 years old at Wave 1, reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD among very‐high‐risk drinkers (aOR = 0.42 [0.28 to 0.63]) but not high‐risk drinkers (p = 0.50). Among individuals ≤40 years old at Wave 1, reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD among high‐risk drinkers (aOR = 0.50 [0.37 to 0.69]) but not very‐high‐risk drinkers (p = 0.27). Conclusions: These results show that reductions in WHO risk drinking levels are associated with reduced CVD risk among very‐high‐risk and high‐risk drinkers in the US general population, and provide further evidence that reducing high levels of drinking provides important benefit across multiple clinical domains. [ABSTRACT FROM AUTHOR]

Despite the prevalence of vertical integration, data and research focused on identifying and describing health systems are sparse. Until recently, we lacked an enumeration of health systems and an understanding of how systems vary by key structural attributes. To fill this gap, the Agency for Healthcare Research and Quality developed the Compendium of U.S. Health Systems, a data resource to support research on comparative health system performance. In this article, we describe the methods used to create the Compendium and present a picture of vertical integration in the United States. We identified 626 health systems in 2016, which accounted for 70% of nonfederal general acute care hospitals. These systems varied by key structural attributes, including size, ownership, and geographic presence. The Compendium can be used to study the characteristics of the U.S. health care system and address policy issues related to provider organizations. [ABSTRACT FROM AUTHOR]

Background: Worksite wellness programs that target individual employees, rather than worksites, have demonstrated limited long-term success. The purpose of this overview was to describe the theoretical basis for implementing an effective worksite wellness initiative, WorkWell Kansas (WorkWell KS). WorkWell KS is not a traditional worksite wellness initiative, as its goal is to create healthy worksites, rather than target workers. Methods : The WorkWell KS Strategic Framework is based on academic research that identified successful worksite wellness elements that produce sustainably healthy worksites. The curricula were built around the 3-4-80: three modifiable behaviors (tobacco use, poor access to nutritious foods and beverages, and physical inactivity) contribute to at least four chronic diseases (heart disease, type II diabetes, lung disease, and some cancers), which in turn contribute to approximately 80% of the premature deaths in the United States. Findings : To properly address these modifiable behaviors, the WorkWell KS Strategic Framework was developed to guide worksites to first build a solid worksite wellness foundation, which consists of five elements: the wellness committee, exercising leadership, communications, incentives, and data. Once built, worksites are then encouraged to employ a socio-ecological approach to developing a comprehensive, multi-strategy (information, program, benefit design, policy, and environment) intervention, focusing on one health behavior at a time. Conclusions/Application to Practice : The goal of WorkWell KS was to create healthy worksites, which creates environments for employees to practice these healthy behaviors. Worksite wellness committees, occupational health professionals, and others interested in altering health behaviors at worksites have an opportunity to reframe their approach using this framework. [ABSTRACT FROM AUTHOR]

We develop methodology that allows peer effects (also referred to as social influence and contagion) to be modified by the structural importance of the focal actor's position in the network. The methodology is first developed for a single peer effect and then extended to simultaneously model multiple peer-effects and their modifications by the structural importance of the focal actor. This work is motivated by the diffusion of implantable cardioverter defibrillators (ICDs) in patients with congestive heart failure across a cardiovascular disease patient-sharing network of United States hospitals. We apply the general methodology to estimate peer effects for the adoption of capability to implant ICDs, the number of ICD implants performed by hospitals that are capable, and the number of patients referred to other hospitals by noncapable hospitals. Applying our novel methodology to study ICD diffusion across hospitals, we find evidence that exposure to ICD-capable peer hospitals is strongly associated with the chance a hospital becomes ICD-capable and that the direction and magnitude of the association is extensively modified by the strength of that hospital's position in the network, even after controlling for effects of geography. Therefore, interhospital networks, rather than geography per se, may explain key patterns of regional variations in healthcare utilization. [ABSTRACT FROM AUTHOR]

Background: Support for ongoing care management and coordination between office visits for patients with multiple chronic conditions has been inadequate. In January 2015, Medicare introduced the Chronic Care Management (CCM) payment policy, which reimburses providers for CCM activities for Medicare beneficiaries occurring outside of office visits.Objective: To explore the experiences, facilitators, and challenges of practices providing CCM services, and their implications going forward.Design: Semi-structured telephone interviews from January to April 2016 with 71 respondents.Participants: Sixty billing and non-billing providers and practice staff knowledgeable about their practices' CCM services, and 11 professional society representatives.Key Results: Practice respondents noted that most patients expressed positive views of CCM services. Practice respondents also perceived several patient benefits, including improved adherence to treatment, access to care team members, satisfaction, care continuity, and care coordination. Facilitators of CCM provision included having an in-practice care manager, patient-centered medical home recognition, experience developing care plans, patient trust in their provider, and supplemental insurance to cover CCM copayments. Most billing practices reported few problems obtaining patients' consent for CCM, though providers felt that CMS could better facilitate consent by marketing CCM's goals to beneficiaries. Barriers reported by professional society representatives and by billing and non-billing providers included inadequacy of CCM payments to cover upfront investments for staffing, workflow modification, and time needed to manage complex patients. Other barriers included inadequate infrastructure for health information exchange with other providers and limited electronic health record capabilities for documenting and updating care plans. Practices owned by hospital systems and large medical groups faced greater bureaucracy in implementing CCM than did smaller, independent practices.Conclusions: Improving providers' experiences with and uptake of CCM will require addressing several challenges, including the upfront investment for CCM set-up and the time required to provide CCM to more complex patients. [ABSTRACT FROM AUTHOR]

Background: Understanding the impact of health insurance is critical, particularly in the era of Affordable Care Act Medicaid expansion. The electronic health record (EHR) provides new opportunities to quantify health outcomes.Objective: To assess changes in biomarkers of chronic disease among community health center (CHC) patients who gained Medicaid coverage with the Oregon Medicaid expansion (2008-2011).Design: Prospective cohort. Patients were followed for 24 months, and rate of mean biomarker change was calculated. Time to a controlled follow-up measurement was compared using Cox regression models.Setting/patients: Using EHR data from OCHIN (a non-profit network of CHCs) linked to state Medicaid data, we identified three cohorts of patients with uncontrolled chronic conditions (diabetes, hypertension, and hyperlipidemia). Within these cohorts, we included patients who gained Medicaid coverage along with a propensity score-matched comparison group who remained uninsured (diabetes n = 608; hypertension n = 1244; hyperlipidemia n = 546).Main Measures: Hemoglobin A1c (HbA1c) for the diabetes cohort, systolic and diastolic blood pressure (SBP and DBP, respectively) for the hypertension cohort, and low-density lipoprotein (LDL) for the hyperlipidemia cohort.Key Results: All cohorts improved over time. Compared to matched uninsured patients, adults in the diabetes and hypertension cohorts who gained Medicaid coverage were significantly more likely to have a follow-up controlled measurement (hazard ratio [HR] =1.26, p = 0.020; HR = 1.35, p < 0.001, respectively). No significant difference was observed in the hyperlipidemia cohort (HR = 1.09, p = 0.392).Conclusions: OCHIN patients with uncontrolled chronic conditions experienced objective health improvements over time. In two of three chronic disease cohorts, those who gained Medicaid coverage were more likely to achieve a controlled measurement than those who remained uninsured. These findings demonstrate the effective care provided by CHCs and the importance of health insurance coverage within a usual source of care setting.Clinical Trials Registration: NCT02355132 [ https://clinicaltrials.gov/ct2/show/NCT02355132 ]. [ABSTRACT FROM AUTHOR]

Background: This descriptive study identified latent classes of longitudinal marijuana use from ages 18 through 50 among a national sample; examined covariate associations with class membership regarding use/non-use, use intensity, and use duration; and described associations between identified latent classes and age 50 health outcomes.Methods: The study involved collection and primary analysis of data from 9831 individuals first surveyed as 12th graders in the national Monitoring the Future study and followed through modal age 50. Repeated measures latent class analysis was used to identify latent classes based on self-reported past 12-month marijuana use.Results: Seven latent classes of marijuana use from ages 18 to 50 were identified including Non-users (44%), two classes characterized by shorter-term use patterns (totaling 28%), and four classes characterized by longer-term moderate or heavy use (totaling 28%). Use reduction appeared particularly likely during early and late 20s. Gender, parental education, alcohol/cigarette use, religious commitment, and marital status differentiated use/non-use, use intensity, and use duration after high school. In non-causal models controlling for covariates, longer-term marijuana use classes (where use extended into the late 20s or beyond) were associated with significantly higher odds of negative health outcomes at age 50.Conclusions: Approximately 28% of the national sample reported longer-term moderate/heavy marijuana use, which was associated with negative health outcomes at age 50. The early and late 20s may be especially important periods for marijuana use prevention and intervention efforts, which may be strengthened by recognition of characteristics that appear to have significant associations with persistent use. [ABSTRACT FROM AUTHOR]

Reintroductions are widely implemented as a means of reestablishing wild populations and genetic parentage methods can be used in concert with these efforts to monitor and evaluate efficacy. In addition to understanding demographic outcomes, reconstructed pedigrees, when combined with phenotypic data, can provide insight into the adaptive potential of reintroduced individuals. Here, we examined the heritability and evolvability of life-history traits and lifetime reproductive success in two threatened Chinook salmon populations undergoing reintroduction to historical habitats above dams in Oregon, USA, using previously-developed multigenerational genetic pedigrees. All of the examined life-history traits: length-at-maturity, age-at-maturity, and arrival timing to the spawning grounds, and lifetime reproductive success exhibited significant narrow-sense heritabilities and evolvabilities. There was also a detectable influence of parental effects (i.e., paternal or maternal effects) on life-history trait variation, suggesting that in addition to genetic effects, nongenetic inheritance mechanisms are influencing life-history diversity in the populations. Additionally, our analyses revealed evidence of natural selection on the date of reintroduction, although the form and intensity of selection differed between the two populations; the forms of selection also point to the potential for phenotype-environment mismatch under some conditions. Overall, our results suggest that these threatened Chinook salmon populations exhibit significant adaptive potential, a factor that should be important to the longer-term success of recovery efforts. [ABSTRACT FROM AUTHOR]

Background and Aims: Long‐term frequent marijuana use is associated with significant negative outcomes, yet little is known about the longitudinal course of marijuana use among those who start frequent use during adolescence. Objectives are (a) to identify latent patterns of within‐person marijuana use from ages 19–30 years among 12th graders reporting frequent marijuana use, (b) to examine if membership in identified patterns has changed across historical time and (c) to examine if key covariates differentiate class membership. Design, Setting, Participants: Longitudinal, national US panel data from 4423 individuals [53.4% of the eligible sample; 2744 (62%) males] who reported frequent marijuana use in 12th grade (modal age 18 years; senior year cohorts 1976–2006) followed biennially from ages 19/20 to 29/30. Measurements Self‐reported past 30‐day marijuana use (frequent use defined as use on 20+ occasions), demographics, college graduation, marriage and parenthood. Findings Repeated‐measures latent class analysis (RMLCA) identified five latent classes of past 30‐day marijuana use from ages 19/20 to 29/30: continued frequent users (estimated membership 23.4%); frequent to non‐frequent users (15.5%); consistent non‐frequent users (18.4%); non‐frequent users to discontinuers (19.5%); and discontinuers (23.2%). In multivariable models, membership in the highest‐risk latent class (continued frequent users) versus one or more of the lower‐risk latent classes was more likely for recent cohorts (P = 0.038 to <0.001), as well as those who did not marry (P = 0.039 to < 0.001) or become parents (P = 0.001) by modal age 29/30. Conclusions: Nearly one in four 12th grade (modal age 18 years) frequent marijuana users in the US continues to report high frequency use to age 30; the proportion continuing high frequency use across young adulthood has increased among more recent cohorts. [ABSTRACT FROM AUTHOR]

At the time of this writing, the richest 1 percent owns nearly 40 percent of private wealth in the United States. The bottom 50 percent owns just 1 percent of that same pie. Meanwhile, the median black family owns just ten cents for every dollar of wealth owned by white families. Women make up three-quarters of the low-wage workforce and 36 percent of low-wage workers are women of color. Thanks to movements like Occupy, Black Lives Matter, #MeToo, and the hard work of movement educators around the country, consciousness around economic, racial, and gender inequality is growing. And yet while more are aware these problems exist, few see the links between them or agree on how we can solve them. Pocket Political Education from United for a Fair Economy supports interactive dialogue that helps working people connect the dots between economic, racial, and gender inequality to inform their strategic action for change. The tool is highly adaptable so that organizers and educators working in diverse contexts can create spaces for consciousness-raising that move people and groups to action. [ABSTRACT FROM AUTHOR]

A speech is presented by judge Kathleen M. O'Malley at the New York University Civil Jury Project. Topics discussed include individual's right to trial by jury in all criminal and civil cases; jury system of the U.S.; and the laws governing trial by jury for criminal procedure under the Rule 50 of the Federal Rules of Civil Procedure.

Background: This study examined the extent to which the developmental pattern of prevalence of binge drinking in the past 2 weeks from ages 18 through 30 has changed across 29 cohorts of U.S. young adults, and whether the changes differed by gender. Methods: Analyses used national longitudinal data from 58,019 12th‐grade students (from graduating high school classes 1976 to 2004) participating in the Monitoring the Future study followed through modal age 30 (with age 29/30 data collected from 1987 to 2016). Weighted time‐varying effect modeling was used to model cohort group differences in age‐related patterns of binge drinking. Results: The age of peak binge drinking prevalence increased across cohorts (from age 20 in 1976 to 1985 to 22 in 1996 to 2004 for women, and from 21 in 1976 to 1985 to 23 in 1996 to 2004 for men). Historical change in the developmental pattern of binge drinking across all ages of young adulthood differed for men and women. Even after controlling for key covariates, women in the more recent cohort group reported significantly higher binge drinking prevalence than women in earlier cohorts from ages 21 through 30. Men in the more recent cohort group reported higher binge drinking prevalence at ages 25 to 26, but prevalence levels then converged to those seen in earlier cohort groups by age 30. Conclusions: An older age of peak binge drinking and a decreased rate of decline in the prevalence of binge drinking in later young adulthood among more recent cohorts have resulted in an extension of individual and societal risks associated with binge drinking, particularly for women, across young adulthood. High‐risk alcohol use prevention efforts are needed throughout at least the third decade of life. Age of peak binge drinking (5+ drinks per occasion) prevalence has increased from 20 to 22 for women and 21 to 23 for men among high school graduating classes from 1976 to 2004. Women from more recent cohorts reported significantly higher binge drinking prevalence from ages 21 to 30 than women in earlier cohorts. Increased age of peak binge drinking and a longer time period during which young adults are engaging in binge drinking likely confer greater risks. [ABSTRACT FROM AUTHOR]

Guitarist Eddie Lang used music to navigate the complexities of race and ethnicity in the 1920s. Like most musicians, he was caught in "the minstrel cycle," which typically had three phases. It began with white Americans appropriating African American culture in order to ridicule it. In stage two, African American performers reappropriated minstrel stereotypes for their own uses. In stage three, minstrel stereotypes were re-imagined as forms of racial authenticity. This article revises the trajectory of jazz and blues by rooting it in the commercial play of the minstrel cycle, rather than in folk authenticity. It ends by comparing Lang to Charlie Christian, who found a way to escape the minstrel cycle altogether. [ABSTRACT FROM AUTHOR]

Background: More than a decade of war has strained service members and their families and the psychological health of military spouses is a concern. This study uses data from the largest study of military families in the United States to examine the demographic, military-specific, and service member mental health correlates of probable diagnosis of major depressive disorder (MDD) among military spouses.Methods: Data were from service member-spouse dyads from all branches of the U.S. military. Demographic and military-specific factors were assessed using administrative personnel records and survey data.Results: Of the 9,038 spouses, 4.9% had a probable diagnosis of MDD. In unadjusted models, spouses of service members who deployed and experiencecd combat-related events, were enlisted, had a probable posttraumatic stress disorder (PTSD) diagnosis, or screened positive for alcohol misuse were more likely to screen positive for MDD. In adjusted models, only spouses married to enlisted service members or those with PTSD had increased risk for MDD. Other demographic and military-related factors associated with MDD in spouses included less educational attainment, unemployment, having four or more children, and having prior military service (although not currently serving in the military) in the adjusted models.Conclusions: Findings characterize demographic, military, and service member psychological health factors that are associated with depression among military spouses. These findings imply that deployment alone may not negatively affect military spouses, but rather it may be the mental health impact on the service member, especially PTSD that increases the odds for MDD among military spouses. [ABSTRACT FROM AUTHOR]