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Background. Transfusion of blood products is a frequent and often necessary lifesaving intervention. While changes to blood bank practices over the past several decades have reduced the infectious complications associated with transfusions, risks still exist. Septic transfusion reactions caused by bacterial contamination of blood products, especially platelets, still occur relatively frequently. Unfortunately, clinical recognition of septic transfusion reactions is difficult due to significant symptom, exam, and laboratory abnormality overlap between different types of transfusion reactions, as well as other conditions. Novel methods have been developed to detect blood product contamination but have yet to be widely implemented in the United States. Case Report. A 67-year-old male with chronic thrombocytopenia was transfused with platelets prior to a planned procedure. Shortly afterwards, he developed fever and hypotension. He was transferred to the intensive care unit where he was treated with aggressive fluid resuscitation and broad-spectrum antibiotics. The patient went on to develop progressively worsening shock and profound disseminated intravascular coagulation. Blood cultures from the patient and the transfused platelets grew an Acinetobacter species. Despite aggressive resuscitative efforts and appropriate antibiotics, the patient died approximately 48 hours following the transfusion reaction. Conclusion. We report a fatal case of septic shock associated with Acinetobacter bacteremia caused by platelet transfusion. Our review of the literature revealed only one other documented platelet transfusion associated fatality caused by Acinetobacter species. Novel pathogen reduction and contamination detection methods have been developed but have yet to be widely adopted in the United States. [ABSTRACT FROM AUTHOR]

BackgroundPatients with anxiety disorders suffer marked functional impairment in their activities of daily living. Many studies have documented that improvements in anxiety symptom severity predict functioning improvements. However, no studies have investigated how improvements in functioning simultaneously predict symptom reduction. We hypothesized that symptom levels at a given time point will predict functioning at the subsequent time point, and simultaneously that functioning at a given time point will predict symptom levels at a subsequent time point.MethodPatients were recruited from primary-care centers for the Coordinated Anxiety Learning and Management (CALM) study and were randomized to receive either computer-assisted cognitive-behavioral therapy and/or medication management (ITV) or usual care (UC). A cross-lagged panel design examined the relationship between functional impairment and anxiety and depression symptom severity at baseline, 6-, 12-, and 18-month follow-up assessments.ResultsProspective prediction of functioning from symptoms and symptoms from functioning were both important in modeling these associations. Anxiety and depression predicted functioning as strongly as functioning predicted anxiety and depression. There were some differences in these associations between UC and ITV. Where differences emerged, the UC group was best modeled with prospective paths predicting functioning from symptoms, whereas symptoms and functioning were both important predictors in the ITV group.ConclusionsTreatment outcome is best captured by measures of functional impairment as well as symptom severity. Implications for treatment are discussed, as well as future directions of research. [ABSTRACT FROM PUBLISHER]

Background. Anxiety disorders are the most prevalent mental health disorders and are associated with substantial disability and reduced well-being. It is unknown whether the relative impact of different anxiety disorders is due to the anxiety disorder itself or to the co-occurrence with other anxiety disorders. This study compared the functional impact of combinations of anxiety disorders in primary care out-patients. Method. A total of 1004 patients with panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD) or post-traumatic stress disorder (PTSD) provided data on their mental and physical functioning, and disability. Multivariate regressions compared functional levels for patients with different numbers and combinations of disorders. Results. Of the patients, 42% had one anxiety disorder only, 38% two, 16% three and 3% all four. There were few relative differences in functioning among patients with only one anxiety disorder, although those with SAD were most restricted in their work, social and home activities and those with GAD were the least impaired. Functioning levels tended to deteriorate as co-morbidity increased. Conclusions. Of the four anxiety disorders examined, GAD appears to be the least disabling, although they all have more in common than in distinction when it comes to functional impairment. A focus on unique effects of specific anxiety disorders is inadequate, as it fails to address the more pervasive impairment associated with multiple anxiety disorders, which is the modal presentation in primary care. [ABSTRACT FROM AUTHOR]

Pesticides have a role in public health as part of sustainable integrated mosquito management. Other components of such management include surveillance, source reduction or prevention, biological control, repellents, traps, and pesticide-resistance management. We assess the future use of mosquito control pesticides in view of niche markets, incentives for new product development, Environmental Protection Agency registration, the Food Quality Protection Act, and improved pest management strategies for mosquito control. [ABSTRACT FROM AUTHOR]

Features the exhibition 'German Expressionist Sculpture,' organized by the Los Angeles County Museum of Art in California. Examples of German sculpture on display; Famous German sculptors.

Features the exhibition 'The Quest for Unity: American Art between World's Fairs 1876-93,' held at the Detroit Institute of Arts in Michigan, from August 24 to October 30, 1983. Organizational goal of the exhibition; Examples of American art on display; Range of themes and moods of the American art.

Features the Washington, D.C.-based Freer Gallery of Art's exhibition 'Studies in Connoisseurship, 1923-1983,' a selection of sixty objects originally acquired by Charles Freer. Examples of ceramic objects displayed; Chinese paintings exhibited; Case of the small hanging scroll by Kenko Shokei.

Focuses on an exhibition titled 'Art and Social Change, U.S.A.,' held at the Allen Memorial Art Museum in Oberlin, Ohio in 1983. Acknowledgment of Oberlin's tradition of social awareness; Performance of Candace Hill-Montgomery; Video art of Nancy Buchanan; Showcasing of the work of younger artists within a thematic context.

Focuses on an exhibition titled 'Nuremberg: A Renaissance City, 1500-1618,' held at the University of Texas at Austin in 1983. Role of the German city of Nuremberg as the most important artistic center in the German-speaking lands; Ways in which the epoch of Durer was a high point for art in Nuremberg.

Focuses on an exhibition titled 'Art of Aztec Mexico: Treasures of Tenochtitlan,' held at the National Gallery of Art in Washington D.C. from 1983 to 1984. Showcasing of pre-Columbian art; Works that combined various dramatically modeled forms in three dimensions with complex low-relief imagery; Objects that plead the cause of the Aztecs in the name of art as a universal form of human expression.

Reports on 'The Futurist Imagination: Word + Image' exhibition which features futurist paintings of F.T. Marinetti, held at the Yale University Art Gallery in New Haven, Connecticut. Organization of materials in the catalog; Arrangement of the exhibition; Description of featured paintings.

Reports on the 'Painting in Naples From Caravaggio to Giordano' exhibition which features 17th century paintings, held at the National Gallery of Art in Washington, D.C. on February 13-May 1, 1983. Aim of the exhibition; Organization of materials in the catalog; Description of the art installations; Description of featured paintings.

Reports on the problems encountered by organizers of the 'Silk Route and the Diamond Path' exhibition which features art works from the Western Himalayas, held at the National Museum of Man of the Smithsonian Institution in Washington, D.C. on April 28-June 30, 1983. Manner of arrangement and lighting of the art objects; Quality of the organization of materials found in the exhibition catalog.

Presents the schedule of the exhibition 'El Greco of Toledo' at various U.S. art museums from April 1982 to February 1983. Historical and interpretive misconceptions; Development of critical literature; Conformity of religious imagery with aims of Counter-Reformation.

Highlights a traveling exhibition of the works of French painter Jules Breton, held in the United States in 1983. Acquisition of Breton's paintings by American millionaires during the late nineteenth century; Breton's production of paintings and prose about the joys of rural life; Connections between Breton's art and modern civilization.

Highlights a memorial exhibition of the works of eighteenth century American artist John Trumbull held at the Yale University Art Gallery in 1983. Paintings which revealed Trumbull's ambition to become a history painter; Execution of traditional paintings based on Scripture; Importance of Trumbull's landscape paintings.

Highlights a retrospective exhibition of the works of seventeenth century painter Jusepe de Ribera, held at the Kimbell Art Museum in Fort Worth, Texas in 1983. Controversy on whether de Ribera should be considered as a Spanish or Italian painter; Spanish heritage seen as the root of de Ribera's naturalism and spiritual intensity; Fascination with oddities and the grotesque.

Highlights the exhibition 'Reflections of Reality in Japanese Art,' held at the Cleveland Museum in Ohio in 1983. Ceramic sculptures of the pre- and proto-historical periods; Animal art of the Jomon and Yayoi-Tumulus peoples; Cultural meaning of 'haniwa' figures; Showcasing of 'emaki,' or painted handscrolls from the twelfth through fourteenth centuries.

Reports that the National Gallery of Art in Washington, D.C. and the Reunion de Musees Nationaux in Paris, France, have mounted a comprehensive exhibition of the arts of Claude Lorrain. Aim to commemorate the third centenary of Lorrain's death in 1682; Noted paintings, prints and drawings presented at the exhibit; Artistic styles and themes.

Reports on the staging of the exhibition titled 'The Last Flowering: French Painting in Manuscripts, 1420-1530,' held at the Pierpont Morgan Library in New York City from November 18, 1982, to January 30, 1983. Noted works presented during the exhibit; Detached leaves and manuscripts from American collections; Aim to trace the course of book illumination during the period.

Describes the exhibition of precisionist painting and modern photography at the San Francisco Museum of Modern Art in California. Artworks that incorporate architectural and mechanistic subjects; Lyrical painting from 1953; Paintings of Ralston Crawford and Georgia O'Keeffe; Photographs of Paul Strand and Ansel Adams.

Describes the exhibition of French paintings that depicts orientalism in art at the Memorial Art Gallery of the University of Rochester in New York State. Paintings of Leon Belly, Alexandre Cabanel, Jean-Leon Gerome and Prosper Marilhat; Depiction of both violence and sex; Artworks that use water colors as a medium.

Describes the exhibition of paintings of Elisabeth Louise Vigee Le Brun at the Kimbell Art Museum in Fort Worth, Texas. Documentation of the life of Le Brun; Le Brun's female portraits; Excellent skills of Le Brun as colorist and a delineator of fabrics.

Describes the exhibition of Spanish painting of the late Baroque in the Art Museum, Princeton University in New Jersey. Valuable contribution of scholarly catalogue on the Spanish art; Paintings of Mateo Cerezo, Juan Cerreno de Miranda, Claudio Cello; Alonso Cano's canvasses; Two great Sevillian painters.

Describes a major exhibition of seventeenth-century French paintings at the Metropolitan Museum in New York. Contribution of artist Pierre Rosenberg to the study of French art in America and to seventeenth-century French art history; Artworks of Nicolas Poussin, Georges de la Tour, Simon Vouet and Eustache Le Sueur; Paintings of French Caravaggists.

Presents the schedule of the exhibition 'The Engravings of Marcantonio Raimondi' at various U.S. art museums from November 1981 to June 1982. Essays on artist's art; Conception of originality; Relation of prints to 16th-century Central Italian notion of artistic invention.

Presents the exhibition of art of Cameroon at the Dartmouth College in New Hampshire. Polychrome traditions of the coastal forest area; Sculptures from the grasslands area; Diversity and wealth of Cameroon art.

Features the exhibition 'Design Since 1945,' organized by the Philadelphia Museum of Art in Pennsylvania. Eight categories of the exhibition; Sizes o the items shown; Factors that underlie the geography of design; Exhibitors.

Features the exhibition of Paul Klee's prints organized by the Edith C. Blum Art Institute of Bard College in Annandale-on-Hudson, New York, from October 23-December 28, 1983. Three important exhibitions of Klee's prints; Exhibition's catalogue on Klee's prints; Examples of Klee's prints on display.

Describes a retrospective exhibition of drawings, paintings and sculpture by Louise Bourgeois at the Museum of Modern Art in New York City in 1982 to 1983. Forms invented by Bourgeois; Argument that the works of Bourgeois are as logical as the geometry of Port-Royal; Method of drawing construction; Continuity in the artist's work.

Focuses on an exhibition of the works of twentieth century artist Grant Wood, organized by the Minneapolis Institute of Arts in Minnesota in 1983. Aesthetic and educational value of the exhibition as a whole; Art's reinforcement of the Modernist bias; Showcasing of Wood's landscapes, decorations, illustrations and narrative paintings.

Features the exhibition 'Milton Avery,' organized by the Whitney Museum of American Art in New York City to showcase the paintings of Avery. Noted works included in the exhibition; Artistic style and themes.

Presents the schedule of the exhibition 'Nam June Paik Retrospective' at various U.S. art museums from April to October 1982. Alteration of mechanism of television; Use of magnet on television monitors; Externalization of images.

Presents the schedule of the exhibition 'Treasures of Ancient Nigeria' at various U.S. art museums from January 1980 to August 1984. Sculptures in terra cotta or cast metal; Central focus of exhibit; Restatement of African art scholar Frank Willett's thesis on use of Ife heads.

Comments on 'Collaboration: Artists and Architects,' an exhibition mounted by the Architectural League of New York to give an historical overview of one hundred years of architectural and artistic collaboration. Reduced format; Visionary program of the show; Direction for future collaboration; Contents and forms; Architects and artists featured in the exhibition.

Comments on 'Seventeen Artists in the Sixties,' an exhibition of art works by Los Angeles, California artists in the 1960s. Quality of the exhibit; Artists included and excluded by the exhibit organizers; Concept of the L.A. look.

Features the exhibition of the art of Juan Gris, organized by the University Art Museum in Berkeley, California. Intensity of Gris' commitment to vanguard art and to Cubism in particular; Examples of Gris' art on display.

Presents the exhibition of a selection of prints by contemporary sculptors at the art gallery of Connecticut, New Haven-based Yale University from May 18 to August 31, 1982. Human experience of art and object; Vitality of Renaissance geometric form; Sense of satire in artist Richard Artschwager's lithographs of functionless furniture.

Comments on the challenging implications of the exhibit 'Renaissance of Islam: Art of the Mamluks,' which opened in May 1981 at the Smithsonian Institution's National Museum of Natural History in Washington, D.C. Mamluk period; Mamluk arts in general; Techniques and themes; Difficulty in identifying and defining a Mamluk period style.

Objective: Although it has long been established that age and sex play a role in blood pressure levels across the lifespan, the extent to which educational attainment moderates these relationships has been understudied. Thus, the purpose of this study was to assess educational differences in SBP, DBP, and pulse pressure (PP) trajectories among men and women through the midlife years., Method: We conducted an analysis of pooled data from the 1999 to 2018 National Health and Nutrition Examination Survey to assess whether education moderates blood pressure measurements among men and women over the midlife years. Statistical analyses were performed using survey-weighted linear and quadratic regressions to assess these trajectories., Results: During midlife, women with at least a college degree maintained the lowest average level of SBP compared to men at all education levels and women with a high school diploma or less. They also maintained the lowest level of PP, though not different from men with at least a college degree and women with less than a college degree. However, no educational differences were observed in DBP between men and women during the midlife years., Conclusion: Our study shows clear delineation in the trajectories of PP and SBP by education such that a 4-year education is more protective than some college and a high school degree, particularly among women. These results highlight the need to consider upstream policy interventions (education policy initiatives) that could reduce population-wide elevated blood pressure., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose of Review: This paper reviews options for including community health accountability metrics for child healthcare systems, international and regional experience with such metrics, and some specific candidates for metric consideration., Recent Findings: The inclusion of community metrics in child health accountability systems requires expanded accountability frameworks and re-education of clinicians. Most of the experience with use of community metrics in accountability systems comes from international settings. Lessons learned in these settings include the importance of linking the metrics to various policy and practice implementation measures while balancing the incentives for such 'horizontal' or communitywide indicators with current incentives. The Accountable Communities for Health movement may be the best-known example of US community health indicators for accountability. Four new papers suggest specific child metrics for consideration as child metrics, but only infant mortality rates and high school graduation rates are sufficiently standardized and nationally reported to be useful for such efforts., Summary: Healthcare accountability for child community health is an important next step, but the coordination with existing accountability systems, data collection systems, and financial incentives require more research to be effective in helping children. Infant mortality rates and high school graduation rates have the most potential as cross system accountability metrics., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Oral Pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission. However, despite high rates of HIV risk behaviors among people who inject drugs (PWID), this population remains underserved by current HIV prevention efforts in the United States. To address this challenge, we conducted an in-depth exploration of perspectives on using oral PrEP among PWID engaged in the HIV Prevention Trials Network (HPTN) 094 INTEGRA Study., Methods: Guided by the Practical, Robust, Implementation, and Sustainability Model (PRISM), our qualitative study drew on semi-structured interviews conducted as part of the embedded implementation science evaluation of HPTN 094 INTEGRA. Seventy-seven PWID participants from five sites across New York City, Houston, Los Angeles, Philadelphia, and Washington DC were interviewed to assess intervention delivery, care access, and engagement sustainability. Audio files were transcribed verbatim and analyzed via an inductive and deductive thematic approach., Results: Most participants (n = 46, 59.7%) discussed oral PrEP during their interview, though not directly prompted. Participants discussing PrEP had a mean age of 41.6 years and were predominantly white (54.3%) and cisgender men (60.9%). Among these, 15 participants described using PrEP. All participants had facilitated access to oral PrEP. Yet, the choice to use PrEP was influenced by personal risk perceptions, (mis)information about PrEP, and external factors (i.e. housing, financial security), which, for some, limited the autonomy to use PrEP. Two key themes emerged among participants using PrEP: ease of access and perceptions of high HIV risk. Those not using PrEP described two themes: low risk perception and prioritizing more urgent needs. Among participants not using PrEP a subgroup commonly described ambivalent interest, PrEP knowledge gaps, and PrEP readiness (i.e., contemplation)., Conclusions: Qualitative findings highlight that facilitated PrEP access was insufficient to motivate use for many participants. Rather, PrEP decision-making process (i.e., choice) was linked to risk perception and individuals' capability to leverage PrEP as a resource based on their circumstances (i.e., autonomy). Participants' descriptions of the centrality of choice and autonomy for PrEP use underscore that ease of access is a necessary pre-condition, but person-centered interventions should also address housing, financial stability, and urgent medical conditions to promote PrEP utilization among PWID., Clinical Trial Registration: NCT04804027., Competing Interests: Declarations. Ethics approval: This trial was approved for all sites by a central institutional review board (Advarra), and specific to the implementation science sub-study University of Toronto Research Ethics Board approval was also obtained. All participants provide written informed consent prior to initiation of any study activities. This manuscript’s content is solely the author’s responsibility and does not necessarily represent the official views of the NIH. JEL has receives research support from Gilead Sciences and Zydus and is a consultant to CytoDyn and Theratechnologies. Competing interests: None to declare., (© 2024. The Author(s).)

Background: Alcohol withdrawal is a common reason for admission to acute care hospitals. Prescription of medications for alcohol-use disorder (AUD) and close outpatient follow-up are commonly recommended, but few studies report their effects on postdischarge outcomes., Objectives: The objective of this study is to evaluate the effects of medications for AUD and follow-up appointments on readmission and abstinence., Methods: This retrospective cohort study evaluated veterans admitted for alcohol withdrawal to medical services at 19 Veteran Health Administration hospitals between October 1, 2018 and September 30, 2019. Factors associated with all-cause 30-day readmission and 6-month abstinence were examined using logistic regression., Results: Of the 594 patients included in this study, 296 (50.7%) were prescribed medications for AUD at discharge and 459 (78.5%) were discharged with follow-up appointments, including 251 (42.8%) with a substance-use clinic appointment, 191 (32.9%) with a substance-use program appointment, and 73 (12.5%) discharged to a residential program. All-cause 30-day readmission occurred for 150 patients (25.5%) and 103 (17.8%) remained abstinent at 6 months. Medications for AUD and outpatient discharge appointments were not associated with readmission or abstinence. Discharge to residential treatment program was associated with reduced 30-day readmission (adjusted odds ratio [AOR]: 0.39, 95% confidence interval [95% CI]: 0.18-0.82) and improved abstinence (AOR: 2.50, 95% CI: 1.33-4.73)., Conclusions: Readmission and return to heavy drinking are common for patients discharged for alcohol withdrawal. Medications for AUD were not associated with improved outcomes. The only intervention at the time of discharge that improved outcomes was discharge to residential treatment program, which was associated with decreased readmission and improved abstinence., (Published 2024. This article is a US Government work and is in the public domain in the USA.)

Background: Single-arm clinical trials (SAT) are common in drug and biologic submissions for rare or life-threatening conditions, especially when no therapeutic options exist. External control arms (ECAs) improve interpretation of SATs but pose methodological and regulatory challenges., Objective: Through narrative reviews and expert input, we developed a framework for considerations that might influence regulatory use and likelihood of regulatory acceptance of an SAT, identifying non-oncology first indication approvals as an area of interest. We systematically analyzed FDA and EMA approvals using SATs as pivotal evidence. The framework guided outcome abstraction on regulatory responses., Methods: We examined all non-oncology FDA and EMA drug and biologic approvals for first indications from 2019 to 2022 to identify those with SAT as pivotal safety or efficacy evidence. We abstracted outcomes, key study design features, regulator responses to SAT and (where applicable) ECA design, and product label content., Results: Among 20 SAT-based FDA approvals and 17 SAT-based EMA approvals, most common indications were progressive rare diseases with high unmet need/limited therapeutic options and a natural history without spontaneous improvement. Of the types of comparators, most were natural history cohorts (45% FDA; 47% EMA) and baseline controls (40% FDA; 47% EMA). Common critiques were of non-contemporaneous ECAs, subjective endpoints, and baseline covariate imbalance between arms., Conclusion: Based on recent FDA and EMA approvals, the likelihood of regulatory success for SATs with ECAs depends on many design, analytic, and data quality considerations. Our framework is useful in early drug development when considering SAT strategies for evidence generation., (© 2024. The Author(s).)

Objectives. To characterize cannabis-related disorder medical encounter trends in the US Medicare population during 2017 to 2022. Methods. We conducted a descriptive study, which included 56 624 432 beneficiaries aged 65 years or older and 10 247 953 aged 18 to 64 years with disability. All were continuously enrolled in Medicare (Fee-for-Service or Advantage) for 183 or more days before the first day of the calendar year. We identified cannabis-related disorder encounters using International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes and computed annual encounter rates per 10 000 beneficiaries. We used the Mann-Kendall test to analyze trends over time. Results. Annual cannabis-related disorder encounter trends among beneficiaries aged 65 years or older ranged from 15.9 (95% confidence interval [CI] = 15.8, 16.0) to 39.3 (95% CI = 39.1, 39.5) per 10 000. Rates among beneficiaries aged 18 to 64 years with disability ranged from 274.8 (95% CI = 273.6, 276.0) to 373.7 (95% CI = 372.3, 375.2) per 10 000. Rates increased over time across both groups, with average annual increases of 4.3 (95% CI = 3.3, 5.3; P  = .01) and 17.1 (95% CI = 11.0, 23.2; P  = .02) per 10 000, respectively. Conclusions. Further work is needed to explore the impact of coexisting medical conditions on outcomes that result from cannabis-related disorders. ( Am J Public Health . 2024;114(S8):S694-S697. https://doi.org/10.2105/AJPH.2024.307729).

Objectives. To assess multilevel factors associated with variation in COVID-19 vaccination rates in a US network of community health centers. Methods. Using multilevel logistic regression with electronic health record data from ADVANCE (Accelerating Data Value Across a National Community Health Center Network; January 1, 2022-December 31, 2022), we assessed associations between health care delivery site-level (n = 1219) and patient-level (n = 1 864 007) characteristics and COVID-19 primary vaccine series uptake. Results. A total of 1 337 440 patients completed the COVID-19 primary vaccine series. Health care delivery site characteristics were significantly associated with lower series completion rates, including being located in non-Medicaid expansion states and isolated or rural communities and serving fewer patients. Patient characteristics associated with significantly lower likelihood of completing the vaccine series included being Black/African American or American Indian/Alaska Native (vs White), younger age, lower income, being uninsured or publicly insured (vs using private insurance), and having fewer visits. Conclusions. Both health care delivery site- and patient-level factors were significantly associated with lower COVID-19 vaccine uptake. Community health centers have been a critical resource for vaccination during the pandemic. ( Am J Public Health . 2024;114(11):1242-1251. https://doi.org/10.2105/AJPH.2024.307773).

Objectives: To co-construct a sports medicine and exercise science research and translational agenda with Team USA elite female athletes serving as the experts on their health, performance and well-being., Methods: 40 Team USA female athletes across sports disciplines participated in an online, anonymous, modified Delphi survey by ranking topics on a Likert scale (1='strongly disagree' and 5='strongly agree') and providing qualitative justification regarding whether they believed having more information and research on each topic would support their athletic performance, health and well-being. After each Delphi round, quantitative rankings of topics and qualitative justifications were analysed, informing revisions to the list of topics for review in the subsequent round. Researchers provided athletes with a detailed report of findings and revisions following each round., Results: The final list contained 14 ranked topics. The top five were menstrual cycle symptoms (4.58±0.74), recovery (4.58±0.59), birth control (4.55±0.89), mental health (4.50±0.55) and fueling and the menstrual cycle (4.43±0.74). New topics originating from athletes included recovery, menstrual cycle symptoms, fueling and the menstrual cycle, mental health and sports performance, team dynamics, and institutionalised sexism., Conclusion: This is the first study to co-construct a research and translational agenda with Team USA elite female athletes. The list of sports science research topics developed by focusing on elite female athletes' voices lays the foundation for future research and provides valuable insight into the specific needs of female athletes., Competing Interests: Competing interests: KEA is a Deputy Editor of the BJSM and an Associate Editor of the BJSM IPHP., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Federally Qualified Community Health Centers (FQHCs) are on the frontline of efforts to improve healthcare equity and reduce disparities exacerbated by the COVID-19 pandemic. This study assesses the provision and equity of preventive care and chronic disease management by FQHCs before, during, and after the pandemic., Methods: Using electronic health record data from 210 FQHCs nationwide and employing segmented regression in an interrupted time series design, preventive screening and chronic disease management were assessed for 939,053 patients from 2019 to 2022. Care measures included cancer screenings, blood pressure control, diabetes control, and childhood immunizations; patient-level factors including race and ethnicity, language preference, and multimorbidity status were analyzed for equitable care provision. Analyses were conducted in 2023-2024., Results: Cancer screening rates and blood pressure control initially declined after the onset of the pandemic but later rebounded, while diabetes control showed a slight increase, later stabilizing. Racial and ethnic disparities persisted, with Asian individuals having a higher prevalence of screenings and blood pressure control, and Black/African American individuals facing a lower prevalence for most screenings but a higher prevalence for cervical cancer screening. Hispanic/Latino individuals had a higher prevalence of various screenings and diabetes control. Disparities persisted for Native Hawaiian/Other Pacific Islander and American Indian/Alaska Native individuals and were observed based on language and multimorbidity status., Conclusions: While preventive screening and chronic disease management in FQHCs have largely rebounded to pre-pandemic levels following an initial decline, persistent disparities highlight the need for targeted interventions to support FQHCs in addressing healthcare inequities., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Importance: Few suicide risk identification tools have been developed specifically for American Indian and Alaska Native populations, even though these populations face the starkest suicide-related inequities., Objective: To examine the accuracy of existing machine learning models in a majority American Indian population., Design, Setting, and Participants: This prognostic study used secondary data analysis of electronic health record data collected from January 1, 2017, to December 31, 2021. Existing models from the Mental Health Research Network (MHRN) and Vanderbilt University (VU) were fitted. Models were compared with an augmented screening indicator that included any previous attempt, recent suicidal ideation, or a recent positive suicide risk screen result. The comparison was based on the area under the receiver operating characteristic curve (AUROC). The study was performed in partnership with a tribe and local Indian Health Service (IHS) in the Southwest. All patients were 18 years or older with at least 1 encounter with the IHS unit during the study period. Data were analyzed between October 6, 2022, and July 29, 2024., Exposures: Suicide attempts or deaths within 90 days., Main Outcomes and Measures: Model performance was compared based on the ability to distinguish between those with a suicide attempt or death within 90 days of their last IHS visit with those without this outcome., Results: Of 16 835 patients (mean [SD] age, 40.0 [17.5] years; 8660 [51.4%] female; 14 251 [84.7%] American Indian), 324 patients (1.9%) had at least 1 suicide attempt, and 37 patients (0.2%) died by suicide. The MHRN model had an AUROC value of 0.81 (95% CI, 0.77-0.85) for 90-day suicide attempts, whereas the VU model had an AUROC value of 0.68 (95% CI, 0.64-0.72), and the augmented screening indicator had an AUROC value of 0.66 (95% CI, 0.63-0.70). Calibration was poor for both models but improved after recalibration., Conclusion and Relevance: This prognostic study found that existing risk identification models for suicide prevention held promise when applied to new contexts and performed better than relying on a combined indictor of a positive suicide risk screen result, history of attempt, and recent suicidal ideation.

Importance: Centers for Disease Control and Prevention guidelines advocate reduced opioid prescribing for chronic pain, yet research on their implementation remains limited., Objective: To compare 4 deimplementation strategies to promote guideline-concordant opioid prescribing., Design, Setting, and Participants: This cluster randomized clinical trial was performed at 32 primary care clinics from 2 US health care systems from February 2020 to March 2022, using a hybrid type 3 sequential multiple-assignment design focused on patient outcomes. Clinics were recruited through volunteer sampling, including 268 clinicians and 8978 patients. Data were analyzed from September 2020 to March 2022., Intervention: Deimplementation strategies were targeted at the system, clinic, and prescriber levels. All clinics received a system-level strategy consisting of quarterly educational meetings with monthly audit and feedback (EMAF) reports. At month 3, half the clinics were randomized to receive practice facilitation (PF), a clinic-level strategy that targets clinic workflows. At month 9, half the clinics were again randomized to add prescriber peer consulting (PPC), a prescriber-level strategy focused on challenging patient cases., Main Outcomes and Measures: The primary outcome was change in mean morphine milligram equivalent (MME) dose in clinics receiving the least intensive bundle of deimplementation strategies (EMAF) vs the most intensive (EMAF plus PF plus PPC). Secondary outcomes included adherence to guideline metrics aimed at mitigating opioid risk., Results: Among the 8978 patients included in the analysis, 5142 (57.3%) were female; 42 (0.5%), American Indian or Alaska Native; 74 (0.8%), Asian or Pacific Islander; 411 (4.6%), Black; 187 (2.1%), Hispanic or Latino; 8127 (90.5%), White; and 137 (1.5%), other or unknown. Mean (SD) age was 58.3 (14.3) years. Eight clinics (including 66 prescibers and 2044 patients) assigned the most intensive strategy (EMAF plus PF plus PPC) had statistically significant effects on the primary outcome compared with 7 clinics (including 60 clinicians and 2427 patients) receiving the least intensive strategy (EMAF); clinics in the high-intensity group decreased the mean MME dose by 2.4 (95% CI, -4.3 to -0.5) mg/d more than the EMAF group (P = .02), representing a 6% reduction, and increased screening for pain severity, enjoyment of life, and general activity by 5.4% (95% CI, 0.4%-10.4% [P = .04]) more. Compared with EMAF, the most intensive strategy resulted in statistically significant decreases in urine drug screening (difference, -7.3% [95% CI, -11.5% to -3.0%]; P < .001) and use of treatment agreements (difference, -6.7% [95% CI, -11.1 to -2.3%]; P = .003), in the opposite direction of the hypothesis. There were no significant differences between groups in benzodiazepine coprescribing, mental health screening, or patients receiving an MME dose greater than or equal to 90.0 mg/d., Conclusions and Relevance: In this cluster randomized clinical trial, a high-intensity deimplementation strategy targeted at prescribers significantly decreased the MME dose and increased screening for pain intensity and pain-related interference while reducing use of treatment agreements and urine drug screening. Providing clinic- and prescriber-level deimplementation strategies may help health systems take positive steps toward reducing reliance on opioid medications for chronic pain management in primary care settings., Trial Registration: ClinicalTrials.gov Identifier: NCT04044521.