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This study describes medical interpreters' experiences with behavioral health (BH) services in a primary care clinic. Focus group data with medical interpreters representing multiple languages was analyzed using hybrid inductive-deductive thematic analysis. Themes related to interpreter roles were: (1) case management, (2) patient-interpreter relationship, and (3) patient-provider liaison. Themes related to barriers and facilitators to interpreter-mediated BH care were: (1) cultural factors, (2) patient-provider interactions, (3) BH-specific considerations, and (4) clinic factors. Results illustrate ways that interpreters directly (e.g. interpreter-mediated services) and indirectly (e.g. relationship building) support care. The interpreter-patient relationship reportedly helped improve patient attitudes and buy-in for BH. [ABSTRACT FROM AUTHOR]

This Article places the impact of the Voting Rights Act (“VRA”) in historical and futuristic context. There is no gainsaying that the VRA has had a tremendously positive impact in reversing or, at least, buffering the impact of discrimination throughout United States history. This is particularly—and sadly—manifest in the actions taken by some states to restrict access to the polls and voter registration in the wake of the Supreme Court’s Shelby County decision. A healthy democracy requires free and fair elections. Therefore, it is necessary to roll back such discriminatory laws. Yet, the battle over voting rights now takes place in a political universe that is vastly larger than it was at the time of the VRA’s passage. Accordingly, while measures such as the VRA have—and will continue to have—clear, positive impacts on the functioning of elections, it is important to note that elections play less of a governing role in an era in which the successful democratization of political power has led to its privatization and, correspondingly, to its lack of accountability [ABSTRACT FROM AUTHOR]

Healthcare-associated infections (HAIs) remain a significant patient safety problem that can lead to illness and death, despite the implementation of clinical bundles to prevent HAIs. Management practices can support HAI prevention, but their role in HAI performance monitoring and feedback is not well understood. To address this knowledge gap, we previously conducted semi-structured interviews with staff at 18 hospitals to examine the role of management practices around the prevention of central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). Interview transcripts were analyzed to identify themes related to HAI performance monitoring and feedback. The current analysis focuses on 10 higher-performing hospitals that were successful in preventing CLABSIs and CAUTIs. These institutions had robust practices including timely event analysis, leadership engagement, and multidisciplinary participation in HAI reviews. Across these sites, we found common goals including investigating HAIs without blame and identifying opportunities for improvement. Management practices such as timely analysis of HAIs, collaboration between facility leadership and multidisciplinary team members, and a focus on identifying the failure of a procedure or protocol, rather than the failure of staff members, are all approaches that can support infection prevention efforts. These management practices may be especially important as hospitals attempt to address increases in CLABSI and CAUTI rates that may have occurred during the coronavirus pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Chronic pain is a prevalent issue among older adults in the United States that impairs quality of life. Physical activity has emerged as a costeffective and non-pharmacological treatment for chronic pain, offering benefits such as improved physical functioning, weight loss, and enhanced mood. However, promoting physical activity in older individuals with chronic pain is challenging, given the cyclical relationship between pain and sedentary behavior. The Mobile Intervention to Reduce Pain and Improve Health (MORPH) trial was designed as an innovative, mobile health (mHealth) supported intervention to address this issue by targeting daylong movement, weight loss, and mindfulness to manage pain in older adults with chronic multisite pain. The objective of this paper is to provide the result of a qualitative analysis conducted on post-intervention interviews with MORPH participants. Methods: At the conclusion of the MORPH study, 14 participants were interviewed regarding their experience with the program. All interviews were conducted by phone before being transcribed and verified. A codebook of significant takeaways was created based on these accounts. Summaries were further synthesized into themes using the principles of thematic analysis. Results: Three key themes of the MORPH intervention emerged from the qualitative interviews: MORPH technology (smart scales, Fitbit, MORPH Companion App) facilitated program adherence and accountability; MORPH intervention components (food tracking and mindfulness activities) facilitated program adherence and awareness, respectively; and, group meetings provided motivational support and accountability. Mobile health technologies, including a dedicated MORPH app, facilitated self-monitoring strategies, helped to break the cycle of old habits, and provided participants with immediate feedback on successes; however, technical issues required timely support to maintain engagement. Food tracking contributed to adherence and accountability for weight loss. Mindfulness activities increased participants' awareness of anxiety provoking thoughts and pain triggers. Finally, social support via group meetings and connection, played a crucial role in behavior change, but participants noted consistency in the delivery medium was essential to fostering genuine connections. Conclusion: Overall, the study results highlight the key considerations related to program technology, intervention components, and the value of social support that can help to guide the development of future interventions similar to MORPH. [ABSTRACT FROM AUTHOR]

A total of 29.5 million people aged 12 and older met the diagnostic criteria for alcohol use disorder (AUD) in the United States in 2021, which presents a significant social and economic burden to modern society. Impaired nutritional status has been frequently documented in patients with AUDs and could contribute to escalated alcohol consumption and behavioral impairments commonly observed in AUD. Interestingly, increased highly palatable food intake during recovery has been reported in patients with AUD, suggesting the importance of understanding the relationship between palatable food and problematic alcohol drinking. We have previously shown that patterned feeding of a palatable diet attenuated alcohol drinking in Long Evans rats. The present study evaluated the impact of patterned feeding on high and low alcohol drinking. Individually housed male high-drinking (P), moderate-drinking (Long Evans), and low-drinking (Wistar) rats received intermittent access (24 h, Tuesdays, and Thursdays) to a nutritionally complete high-fat diet (Int-HFD) or standard chow (controls). Normal chow and water were available ad libitum to all groups of rats. Intermittent HFD access induced a feeding pattern in which the Int-HFD group of rats escalated their caloric intake on Tuesdays and Thursdays. Two weeks of Int-HFD pre-exposure preceded any alcohol access, after which all rats were given unsweetened alcohol (20% v/v) in their home cages via a two-bottle choice paradigm of voluntary alcohol drinking. Alcohol was available for 24 h on chow-only days (Mondays, Wednesdays, and Fridays) while Int-HFD feeding continued. Long Evans rats receiving the Int-HFD displayed a significant ~50% reduction in alcohol drinking when compared to controls. The Int-HFD group of P rats also reduced their alcohol intake significantly (p < 0.05) by ~20%, in comparison to respective controls. Interestingly, alcohol drinking in Wistar rats was not affected (p > 0.05) by intermittent HFD exposure. These data highlight rat strain-specific differences in alcohol intake following patterned feeding of a palatable diet and identify Long Evans rats as an ideal model to evaluate the impact of palatable diet on alcohol drinking. [ABSTRACT FROM AUTHOR]

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

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

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

Environmental relationships can differ across the geographic range of species, especially for widespread generalists. Because habitat specialists are more vulnerable to environmental changes, incorrect assumptions about consistent habitat associations could hinder strategic conservation efforts. We used species distribution models (SDMs) to evaluate intraspecific variation in habitat associations for a habitat specialist of conservation concern, the pygmy rabbit (Brachylagus idahoensis), which is endemic to the sagebrush biome of the western United States. Our goal was to model habitat associations for pygmy rabbits across a portion of their range to evaluate regional variation and contrast predictions with results from a model developed at the rangewide extent. We created inductive SDMs using maximum entropy methods within five ecological regions that encompassed about 20% of the species rangewide distribution and spanned diverse environmental gradients. We included a suite of environmental predictor variables representing topography, vegetation, climate, and soil characteristics. Results of the regional models identified substantial variation in habitat associations across the five regions, with each retaining a unique set of environmental predictors. Bioclimatic variables were the most influential environmental parameters in all five regions, but the specific variables differed. The models developed at regional extents predicted smaller areas of habitat (an average of 15% less for suitable habitat and 80% less for primary habitat) than predictions generated from a model developed at the rangewide extent. Because bioclimatic variables were effective in discriminating areas used by pygmy rabbits, they also provided an opportunity to assess potential changes in habitat distribution by incorporating future climate projections. Distributions modeled under two mid‐century emission scenarios projected substantial reductions in suitable habitat for pygmy rabbits across most regions and pronounced variation among regions in the magnitude and direction of the climate effects. Collectively, results of this work underscore the need to incorporate regional variation in habitat associations into planning for current and future conservation and management strategies. [ABSTRACT FROM AUTHOR]

This study examined age-related patterns in exposure and affective reactivity to daily stressors across a 20-year time span among adults who were between 22 and 77 years old at their baseline interview. Longitudinal data from the National Study of Daily Experiences (NSDE) consisted of three bursts of eight consecutive nightly interviews of stress and affect. Analyses made use of all available data from a U.S. National sample of respondents who participated in any of the three NSDE bursts (N = 2,845; number of daily assessments = 33,688). Findings revealed increasing age-related benefits. Younger adults (<30 years) reported the highest levels of stressor exposure and reactivity, but their stress profile improved with age. Over time, adults averaged an 11% reduction in the occurrence of stressor days, and the younger adults exhibited an even steeper decline (a 47% reduction) in their levels of stressor reactivity. For people in midlife and old age, stressor occurrence continued to decrease over time, yet among adults aged 54 years or older at baseline, stress reactivity remained stable across time. [ABSTRACT FROM AUTHOR]

This article presents new quantitative results on the distribution of residential green space for people with disabilities in the United States, building on and bridging scholarly research in two distinct domains: one involving approaches that quantify disparities in green space access among racialized minorities and socioeconomically disadvantaged groups, and the other using qualitative methods that demonstrate that most green spaces remain inaccessible and unwelcoming to disabled visitors. Using generalized additive models (GAMs) that controlled for demographic factors and climatological characteristics, we find that residential areas with more green space generally have a higher proportion of disabled residents. The statistical results run counter to expectations from the literature, thus complicating the prevailing narrative and indicating a need for mixed-methods research to examine multiple dimensions of access and environmental justice. Using cluster analysis to assess spatial trends, we detect residential clusters of high disability and low green space and find that they are located in predominantly non-White, urban, and more socioeconomically disadvantaged neighborhoods compared to clusters of high disability and high green space. Cluster analysis results suggest that there are inequities in green space access at the intersection of disability, race, and class, as well as across the urban–rural continuum. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has profoundly affected the lives of almost every individual in every nation, with numbers of infections continuing to grow. Across these nations, first responders are essential in their roles addressing emergencies, despite their risk of exposure to COVID-19 in the course of their work. We sought to understand the impacts of the COVID-19 pandemic on the lives of volunteer firefighters in the United States, an understudied group of these first responders. Interviews were conducted with volunteer firefighters between September and November 2021. Interviews were analyzed using deductive dominant thematic analysis. Thirty-three firefighters were interviewed who had an average of 22 years of service and a mean age of 52 years. Interviewees described pandemic-related challenges including the fear of COVID exposure and frustrations with work and personal relationships. They also identified unexpected work-related benefits including a deepened commitment to serve and improvements to training and safety. Further, some volunteers noted personal benefits such as developing stronger connections with others, having a new outlook on life, and observing goodwill. Our findings provide insight into the multifaceted and complex impact of the COVID-19 pandemic on volunteer firefighters. [ABSTRACT FROM AUTHOR]

Purpose. To determine the incidence and outcomes in patients who underwent penetrating keratoplasty (PK) resulting from complications related to contact lens (CL) use and laser in situ keratomileusis (LASIK) in a metropolitan area of the United States. Methods. Population data was obtained from the United States Census Bureau and the Centers for Disease Control. A retrospective, cross-sectional chart review was performed on all patients who underwent keratoplasty in a specific metropolitan geographic area over a ten-year period. The main outcome was best-corrected visual acuity (BCVA) at 2 years in patients who underwent PK secondary to complications related to CL use and LASIK. The secondary outcome was the relative risk of undergoing PK secondary to a complication related to CL use versus LASIK. Results. The study's geographic area had 46,545 CL users in one or both eyes during any given year and 10,285 patients who underwent LASIK in one or both eyes during the study interval. There were 24 CL users (0.52 per 1,000) and 3 post-LASIK patients (0.29 per 1,000) who underwent PK secondary to complications during the study interval (OR 1.77 [0.53–5.87, 95% CI]; p = 0.35). BCVA at 2 years was 1.45 [1.0–1.90] logMAR (20/564 Snellen) in the CL using cohort and 0.07 [−1.19–1.33] logMAR (20/23 Snellen) in post-LASIK cohort following PK (p = 0.04). Conclusions. Patients who underwent PK secondary to complications related to CL use had worse visual outcomes at 2 years compared to those related to LASIK. Complications leading to PK were rare in both cohorts, but the incidence of undergoing PK secondary to CL use trended higher than LASIK. [ABSTRACT FROM AUTHOR]

Purpose. To analyze the perspectives of practicing refractive surgeons regarding the implementation of Immediate Sequential Bilateral Cataract Surgery (ISBCS) in the United States (US) and to compare their perspectives with those of European colleagues. Setting. Online refractive surgery forum. Design. A survey-based questionnaire. Methods. An electronic survey was emailed to all surgeon members of the Refractive Surgery Alliance (RSA) in the US. Participants were prompted to score their impressions regarding various aspects regarding ISBCS. Responses were compared to published reports conducted among European surgeons. Results. The electronic link to the survey was emailed to US-based surgeon members of the RSA, where 107 participated (44.6%). Twenty-seven (25.2%) reported that they currently perform ISBCS. Twenty-three (22.5%) of the respondents indicated they felt ISCBCS should be offered as a standard of care for routine cataract surgery. For surgeons that do not perform ISBCS, the most important factors were related to medicolegal issues and decreased reimbursement, whereas evidence of effectiveness and complications related to ISBCS were less important. Compared to practitioners abroad, 67.2% of European ophthalmic surgeons, compared to 25.2% of US surgeons, perform ISBCS (p < 0.0001). Conclusions. While US refractive surgeons often perform bilateral corneal procedures, many significant barriers exist to the widespread adoption of ISBCS. Concerns reported by US surgeons mirror those reported by surgeons in Europe. The majority of the US refractive surgeons in this survey indicate that ISBCS should not be the standard of care in routine cases, with the prevailing reason being concerns about decreased physician reimbursement and potential medicolegal issues, not safety. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate gender differences in determinants of bystander intervention (BI) participation among undergraduate students using the Reasoned Action Approach (RAA). Students (n = 291) were recruited via an online survey disseminated in general education courses at two US universities. The survey evaluated intentions, attitudes, perceived norms, and perceived behavioral control toward participating in BI. Two linear regression models (man/woman) were used to understand how constructs of RAA regressed on intentions. Students, 18–24 years old, were mostly women (60.1%) and lowerclassmen (80.4%). While both models were significant, the model better predicted intentions among women (adjusted R2 =.598) compared to men (adjusted R2 =.479). Women had significantly higher intentions, attitudes, and perceived behavioral control to engage in BI compared to men (p <.05). Results show that men and women have different views on BI, and ways to promote BI may be better if they were tailored by gender. This provides insight into the role gender plays in BI to prevent sexual assault and could enhance health education approaches on campuses. [ABSTRACT FROM AUTHOR]

Emerging adults experience increased morbidity as a result of psychological distress and risky sexual behavior. This study examines how sexual behaviors (e.g., condom use inconsistency and past year STI history) differ among emerging adults with low, moderate, and high psychological distress. Participants are 251,254 emerging adults attending colleges and universities in the United States who participated in the National College Health Assessment (NCHA). Findings suggest a dose-response relationship between psychological distress, condom use inconsistency, and past STI history, such that an association between greater psychological distress and condom use inconsistency and/or past year history of sexually transmitted infections (STIs). [ABSTRACT FROM AUTHOR]

Fungi produce a wealth of pharmacologically bioactive secondary metabolites (SMs) from biosynthetic gene clusters (BGCs). It is common practice for drug discovery efforts to treat species' secondary metabolomes as being well represented by a single or a small number of representative genomes. However, this approach misses the possibility that intraspecific population dynamics, such as adaptation to environmental conditions or local microbiomes, may harbor novel BGCs that contribute to the overall niche breadth of species. Using 94 isolates of Aspergillus flavus, a cosmopolitan model fungus, sampled from seven states in the United States, we dereplicate 7,821 BGCs into 92 unique BGCs. We find that more than 25% of pangenomic BGCs show population-specific patterns of presence/absence or protein divergence. Population-specific BGCs make up most of the accessory-genome BGCs, suggesting that different ecological forces that maintain accessory genomes may be partially mediated by population-specific differences in secondary metabolism. We use ultra-high-performance high-resolution mass spectrometry to confirm that these genetic differences in BGCs also result in chemotypic differences in SM production in different populations, which could mediate ecological interactions and be acted on by selection. Thus, our results suggest a paradigm shift that previously unrealized population-level reservoirs of SM diversity may be of significant evolutionary, ecological, and pharmacological importance. Last, we find that several population-specific BGCs from A. flavus are present in Aspergillus parasiticus and Aspergillus minisclerotigenes and discuss how the microevolutionary patterns we uncover inform macroevolutionary inferences and help to align fungal secondary metabolism with existing evolutionary theory. [ABSTRACT FROM AUTHOR]

Background Outcomes of patients with severe pulmonary blastomycosis requiring mechanical ventilation (MV) are not well understood in the modern era. Limited historical case series reported 50–90% mortality in patients with acute respiratory distress syndrome caused by blastomycosis. The objective of this large retrospective cohort study was to describe the risk factors and outcomes of patients with severe pulmonary blastomycosis. Methods We performed a retrospective cohort analysis utilizing the Nationwide Inpatient Sample from 2006–2014. Patients aged >18 years with a diagnosis of blastomycosis who received MV were included. Results There were 1848 patients with a diagnosis of blastomycosis included in the study. Of these, 219 (11.9%) underwent MV with a mortality rate of 39.7% compared with 2.5% in patients not requiring ventilatory support (P <.01). The median (IQR) time to death for patients requiring MV was 12 (8–16) days. The median length of hospital stay for survivors of MV was 22 (14–37) days. The rate of MV was higher for patients treated in teaching hospitals (63.4% vs 57.2%, P =.05) and lower for those receiving care at a rural hospital (12.3% vs 17.2%, P =.04). In a multivariate model, female gender was associated with increased risk of mortality (OR, 1.84; 95% CI, 1.06–3.20; P =.03) as was increasing patient age (10-year age increase OR, 1.64; 95% CI, 1.33–2.02; P <.01). Conclusions In the largest published cohort of patients with blastomycosis, mortality for patients on MV is high at ~40%, 16-fold higher than those without MV. [ABSTRACT FROM AUTHOR]

Objective: Racial/ethnic minorities experience more severe outcomes of coronavirus disease 2019 (COVID‐19) in the general US population. This study was undertaken to examine the association between race/ethnicity and COVID‐19 hospitalization, ventilation status, and mortality in people with rheumatic disease. Methods: US patients with rheumatic disease and COVID‐19 were entered into the COVID‐19 Global Rheumatology Alliance physician registry between March 24, 2020 and August 26, 2020 were included. Race/ethnicity was defined as White, African American, Latinx, Asian, or other/mixed race. Outcome measures included hospitalization, requirement for ventilatory support, and death. Multivariable regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) adjusted for age, sex, smoking status, rheumatic disease diagnosis, comorbidities, medication use prior to infection, and rheumatic disease activity. Results: A total of 1,324 patients were included, of whom 36% were hospitalized and 6% died; 26% of hospitalized patients required mechanical ventilation. In multivariable models, African American patients (OR 2.74 [95% CI 1.90–3.95]), Latinx patients (OR 1.71 [95% CI 1.18–2.49]), and Asian patients (OR 2.69 [95% CI 1.16–6.24]) had higher odds of hospitalization compared to White patients. Latinx patients also had 3‐fold increased odds of requiring ventilatory support (OR 3.25 [95% CI 1.75–6.05]). No differences in mortality based on race/ethnicity were found, though power to detect associations may have been limited. Conclusion: Similar to findings in the general US population, racial/ethnic minorities with rheumatic disease and COVID‐19 had increased odds of hospitalization and ventilatory support. These results illustrate significant health disparities related to COVID‐19 in people with rheumatic diseases. The rheumatology community should proactively address the needs of patients currently experiencing inequitable health outcomes during the pandemic. [ABSTRACT FROM AUTHOR]

Background: The United States Food and Drug Administration is investigating possible diet‐associated dilated cardiomyopathy (DCM) in dogs and cats. Objectives: To retrospectively review DCM cases for signalment, diet information, echocardiographic changes, and survival. Animals Client‐owned dogs (n = 71). Methods: Medical records of dogs diagnosed with DCM between January 1, 2014 and September 30, 2018 were reviewed. Dogs were grouped into "traditional" or "nontraditional" diet categories and whether or not diet was changed after diagnosis. Results: For dogs eating nontraditional diets, those that had their diets changed had a larger percentage decrease in normalized systolic left ventricular internal dimension (P =.03) and left atrial:aorta ratio (P <.001) compared to those that did not have their diets changed. Survival time was significantly longer for dogs with DCM eating nontraditional diets that had their diets changed (median survival, 337 days; range, 9‐1307 days) compared to dogs eating nontraditional diets that did not have their diets changed (median survival, 215 days; range, 1‐852 days; P =.002). Conclusions and Clinical Importance: Dogs with DCM eating nontraditional diets can experience improvement in cardiac function after diet change but additional research is needed to examine possible associations between diet and DCM. [ABSTRACT FROM AUTHOR]

Background: End-of-life doulas are emerging as a potentially important new form of community-based caregiving in the global North, yet we know little about this form of care. The aim of our study was to solicit the perspective of key stakeholders and early innovators in community-based end-of-life care about the development and practices of end-of-life doulas. Methods: We conducted 22 semi-structured interviews with participants in four countries where end-of-life doulas are most active: Australia, Canada, the United States, and the United Kingdom. Findings: This article focuses on participants' description of the end-of-life doula role and attendant practices, and our findings provide the first detailed taxonomy of the end-of-life doula role and specific services on the basis of the perspective of subject experts in four countries. We situate our findings within literature on the professionalization of caregiving, with particular attention to nomenclature, role flexibility and boundary blurring, and explicit versus tacit knowledge. We also discuss the importance of jurisdictional considerations as the end-of-life doula movement develops. Discussion: We speculate that the end-of-life doula role is potentially experiencing common developmental antecedents similar to other now-professionalized forms of caregiving. Our findings contribute substantial new information to the small body of empirical research about the end-of-life doula role and practices, provide critical firsthand insight as the movement develops, and are the first research to explore end-of-life doulas from a comparative international perspective. [ABSTRACT FROM AUTHOR]

Background: This study recruited older adults to explore physical and psychosocial conditions and other health outcomes associated with hearing loss (HL) and hearing aid use. Method: Survey data were used to categorize 20,244 participants into five groups: no HL, unaided mild HL, aided mild HL, unaided severe HL, and aided severe HL. Results: Individuals with unaided severe HL were more likely to report poor-fair self-rated health and were less likely to leave the home, or exercise 4 to 7 days per week, while there were no such associations for those with aided mild or severe HL. In addition, those with aided hearing were less likely to report depression, low social support, or mobility limitations. Discussion: In several instances, hearing aid use reduced associations between HL and negative psychosocial and physical characteristics, and health outcomes. More research using longitudinal study designs is needed to better understand the true implications of these findings. [ABSTRACT FROM AUTHOR]

Rationale: Whether critical care improvements over the last 10 years extend to all hospitals has not been described.Objectives: To examine the temporal trends of critical care outcomes in minority and non-minority-serving hospitals using an inception cohort of critically ill patients.Measurements and Main Results: Using the Philips Health Care electronic ICU Research Institute Database, we identified minority-serving hospitals as those with an African American or Hispanic ICU census more than twice its regional mean. We examined almost 1.1 million critical illness admissions among 208 ICUs from across the United States admitted between 2006 and 2016. Adjusted hospital mortality (primary) and length of hospitalization (secondary) were the main outcomes. Large pluralities of African American (25%, n = 27,242) and Hispanic individuals (48%, n = 26,743) were cared for in minority-serving hospitals, compared with only 5.2% (n = 42,941) of white individuals. Over the last 10 years, although the risk of critical illness mortality steadily decreased by 2% per year (95% confidence interval [CI], 0.97-0.98) in non-minority-serving hospitals, outcomes within minority-serving hospitals did not improve comparably. This disparity in temporal trends was particularly noticeable among African American individuals, where each additional calendar year was associated with a 3% (95% CI, 0.96-0.97) lower adjusted critical illness mortality within a non-minority-serving hospital, but no change within minority-serving hospitals (hazard ratio, 0.99; 95% CI, 0.97-1.01). Similarly, although ICU and hospital lengths of stay decreased by 0.08 (95% CI, -0.08 to -0.07) and 0.16 (95% CI, -0.16 to -0.15) days per additional calendar year, respectively, in non-minority-serving hospitals, there was little temporal change for African American individuals in minority-serving hospitals.Conclusions: Critically ill African American individuals are disproportionately cared for in minority-serving hospitals, which have shown significantly less improvement than non-minority-serving hospitals over the last 10 years. [ABSTRACT FROM AUTHOR]

Academic libraries have undergone an evolutionary change as emerging technologies have impacted operations and services during the past two decades. For much of this period, increasing budgets have enabled libraries to keep pace with needed change. For the past two years, many academic libraries have lost significant funding due to the economic recession. This article argues that it is not a time for retrenchment and timidity but for expansion and boldness for academic libraries. The library that thrives, even in the midst of a recession, will be the one which seizes the opportunity to redesign itself for the future. [ABSTRACT FROM PUBLISHER]

Explores issues related to the selection and purchase of digital library content. Components of digital library; Criteria for selection of major research libraries; Information on the digital library of various universities in the U.S.; Complexities of shaping digital library content in terms of licensing and purchasing electronic resources.

Focuses on the Gateway Service Center for Chinese Academic Journal Publications inaugurated by the University of Pittsburgh's libraries system in Pennsylvania in 1998. Operations of the gateway center; Implications for the global virtual library; Limitations to the global document delivery and resource-sharing project.

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Species distribution modeling often involves high‐dimensional environmental data. Large amounts of data and multicollinearity among covariates impose challenges to statistical models in variable selection for reliable inferences of the effects of environmental factors on the spatial distribution of species. Few studies have evaluated and compared the performance of multiple machine learning (ML) models in handling multicollinearity. Here, we assessed the effectiveness of removal of correlated covariates and regularization to cope with multicollinearity in ML models for habitat suitability. Three machine learning algorithms maximum entropy (MaxEnt), random forests (RFs), and support vector machines (SVMs) were applied to the original data (OD) of 27 landscape variables, reduced data (RD) with 14 highly correlated covariates being removed, and 15 principal components (PC) of the OD accounting for 90% of the original variability. The performance of the three ML models was measured with the area under the curve and continuous Boyce index. We collected 663 nonduplicated presence locations of Eastern wild turkeys (Meleagris gallopavo silvestris) across the state of Mississippi, United States. Of the total locations, 453 locations separated by a distance of ≥2 km were used to train the three ML algorithms on the OD, RD, and PC data, respectively. The remaining 210 locations were used to validate the trained ML models to measure ML performance. Three ML models had excellent performance on the RD and PC data. MaxEnt and SVMs had good performance on the OD data, indicating the adequacy of regularization of the default setting for multicollinearity. Weak learning of RFs through bagging appeared to alleviate multicollinearity and resulted in excellent performance on the OD data. Regularization of ML algorithms may help exploratory studies of the effects of environmental factors on the spatial distribution and habitat suitability of wildlife. [ABSTRACT FROM AUTHOR]

Abstract The potato psyllid, Bactericera cockerelli (Šulc) (Hemiptera: Triozidae) is a vector of the pathogen (Candidatus Liberibacter solanacearum) that causes zebra chip in potato. The insect and the disease are managed solely through insecticide applications. One of the primary insecticide chemistries used to suppress the psyllid includes various formulations of neonicotinoid (group 4A) insecticides and their frequent use across Southwest U.S., where potato psyllids and zebra chip are prevalent, has raised concerns of widespread insecticide resistance. Potato psyllids collected from California and the Lower Rio Grande Valley (LRGV) of Texas have been previously shown to be resistant to these insecticides, but the psyllid susceptibility to neonicotinoid insecticides across Southwest U.S. has not been established. To test the extent of neonicotinoid resistance, we collected potato psyllids from Colorado, New Mexico, and from two major potato-producing regions of Texas. We exposed immature progeny of these field-collected potato psyllids to several doses of two neonicotinoids, imidacloprid and thiamethoxam. Survival of the psyllids was compared to a control colony of B. cockerelli , which was collected prior to widespread use of neonicotinoid insecticides and was known to be susceptible to them. Our results indicated that the psyllids were resistant to both insecticides. The degree of resistance depended on the geographic location of each psyllid population and on the insecticide, with imidacloprid resistance most prominent in psyllids from LRGV. These outcomes emphasize the need to diversify and integrate tactics used to suppress the psyllids and lessen dependence on insecticides to manage the insect and the disease. Highlights • Potato psyllids across the Southwest are resistant to imidacloprid and thiamethoxam. • Origin of the psyllids had an effect of degree of resistance. • Resistance ratios were particularly high for imidacloprid. • Resistance to neonicotinoids should be considered in management programs for potato psyllid. [ABSTRACT FROM AUTHOR]

The article presents research extensions into previous work outlining theories of unexpected money supply change impacts on real variables through the rational expectations model. A review of the preceding studies is given, citing limitations needing to be addressed. Particular attention is given regarding possible endogeneity within the money supply. Elements used in this study include the utilization of the base money supply for aggregate data, a sample period between 1920-1983, and the use of unemployment as a real variable to measure against.

This article presents information on the impact that interest rates have on the demand for currency. The authors support pervious research that argued that any increase in the interest rate that is expected to last for a significant period of time will impact investments and lower the demand for money. The author extend this research by empirically examining the impact that interest rates increases have on the demand for currency. They discuss some of the policy implications of their findings and suggest how the U.S. Federal Reserve can counteract the impact of a decreasing demand for money.

Significant financial changes occurred in the electric utility industry during the 1960's and early 1970's. For example, Federal Power Commission data indicate that firms in the industry became more highly levered, suffered declines in coverage ratios, and exhibited more variable equity returns in recent years. The investment community also showed increased concern over changing bond quality as reflected in declining bond ratings. These developments were paralleled by an increased interest in applying systematic risk or beta concepts to utility common stocks. However, the impact of trends and changes in financial characteristics on systematic risk has not been previously examined in the finance literature. Prior studies suggest the existence of an empirical link between systematic risk and financial data, i.e., a portion of the variation in the level of betas can be explained by differences in financial characteristics. However, these studies were limited, to cross-sectional "point-in-time" analyses. This paper utilizes a multivariate statistical approach in an attempt to explain changes in systematic risk. Furthermore, since bond ratings traditionally have been viewed as representing a composite indicator of firm risk (financial and business risk), relationships between systematic risk and electric utility bond ratings also are examined. [ABSTRACT FROM AUTHOR]

Objective: Associations between low socioeconomic status (SES) and poor health outcomes have been demonstrated in a variety of conditions. However, the relationship in patients with sepsis is not well described. We investigated the association of lower household income with in-hospital mortality in patients with sepsis across the United States. Methods: Retrospective nationwide cohort analysis utilizing the Nationwide Inpatient Sample (NIS) from 2011. Patients aged 18 years or older with sepsis were included. Socioeconomic status was approximated by the median household income of the zip code in which the patient resided. Multivariate logistic modeling incorporating a validated illness severity score for sepsis in administrative data was performed. Results: A total of 8 023 590 admissions from the 2011 NIS were examined. A total of 671 858 patients with sepsis were included in the analysis. The lowest income residents compared to the highest were younger (66.9 years, standard deviation [SD] = 16.5 vs 71.4 years, SD = 16.1, P < .01), more likely to be female (53.5% vs 51.9%, P < .01), less likely to be white (54.6% vs 76.6%, P < .01), as well as less likely to have health insurance coverage (92.8% vs 95.9%, P < .01). After controlling for severity of sepsis, residing in the lowest income quartile compared to the highest quartile was associated with a higher risk of mortality (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.03-1.08, P < .01). There was no association seen between the second (OR: 1.02, 95% CI: 0.99-1.05, P = .14) and third (OR: 0.99, 95% CI: 0.97-1.01, P = .40) quartiles compared to the highest. Conclusion: After adjustment for severity of illness, patients with sepsis who live in the lowest median income quartile had a higher risk of mortality compared to residents of the highest income quartile. The association between SES and mortality in sepsis warrants further investigation with more comprehensive measures of SES. [ABSTRACT FROM AUTHOR]

The article examines the continuing failure of litigants to adequately argue state constitutional claims in the U.S. The authors describe the roles of state and federal constitutional law in federalism's diffusion of power and identifies the factors that contribute to the individual identities of state constitutions. They encourage practicing lawyers, law professors and state court judges to advocate and embrace the role of state constitutional law as a guarantor of rights.

The article focuses on economic competition between China and the U.S. with emergence of economic globalization and explosive technological innovation. Topics discussed include autocracy with a state-protected economic system challenging an established democracy with a free-market economic system, profound interdependence wielding tariff threats, standard-setting, technology theft, financial power, and infrastructure investment for advantage and international financial instruments are an important weapon in peacetime economic great power competition. It mentions advocacy for special drawing rights at the International Monetary Fund (IMF) and investment in new global credit rating agencies for sovereign debt.

Objectives: To describe the incidence and prevalence of type 1 diabetes among pediatric dependents of the US Department of Defense. Methods: The Military Health System (MHS) data repository was used to identify pediatric patients (≤17 years of age) with type 1 diabetes from January 1, 2007 to December 31, 2012. Annual incidence, annual prevalence and adjusted incidence were calculated and stratified by sex, age group, and region of residence. Results: Within a 6‐year study period from 2007 to 2012, 5616 pediatric patients with type 1 diabetes were identified; 57% male, mean (SD) age of 10.9 (4.2) years. Annual type 1 diabetes incidence (per 100 000 persons) over the 5‐year time period ranged from 20.7/100 000 to 21.3/100 000. Incidence for each year was highest in the 10 to 14 years age group and ranged from 30.9/100 000 in 2008 to 35.2/100 000 in 2011. Annual type 1 diabetes prevalence (per 1000 persons) remained stable throughout the study period at 1.5/1000. Adjusted incidence for males was significantly higher compared to females (21.0/100 000 vs 18.1/100 000; P = .001). During the study period, annual incidence remained steady (test for trend, P = .984). Conclusions: The incidence of type 1 diabetes among children appears to plateau during the study period, suggesting a steady state of type 1 diabetes within this pediatric population. The MHS provides an accurate and up to date look at incidence of type 1 diabetes and may reflect broader trends of incidence of pediatric disease for the United States as a whole. [ABSTRACT FROM AUTHOR]

Zivotofsky v. Kerry (2015) highlighted the constitutional tension surrounding the use of executive signing statements, especially with regard to the president's power to conduct foreign affairs. Critics contend that signing statements come perilously close to having the effect of line‐item vetoes, which the Supreme Court declared unconstitutional in Clinton v. City of New York. I suggest that signing statements are simply written manifestations of practices that naturally occur in a system of checks and balances and in a system where executive branch officials may and must interpret the text of legislation. While signing statements may raise the specter of a president who ignores the express will of Congress, this also is a manifestation of the workings of a constitutional system in which Congress and the president share lawmaking power. [ABSTRACT FROM AUTHOR]

This study assessed the prevalence of sexual behaviors among a nationally representative sample of Latino men and women in the United States (US) (N = 432) including Spanish language data collection. Prior studies of sexual health among US Latinos have consisted of convenience samples, and focused mainly on assessing risk behaviors. We consider a broader range of sexual behaviors, subjective sexual experiences (e.g. pleasure and arousal), and STI testing behaviors. Analyses by language dominance and gender indicate a higher variability in sexual behaviors for English-dominant participants and a link between overall STI testing to regular medical examinations, especially women. Higher rates of pleasure, orgasms and arousal was reported by Spanish-dominant men and women, relative to the English-dominant group. Results represent a nuanced examination of internal differentiation among US Latinos and provides applicable data for reducing sexual health disparities in this population. [ABSTRACT FROM AUTHOR]

Objectives: Our aim was to describe patient characteristics and trends in the use of extracorporeal membrane oxygenation (ECMO) for the treatment of acute respiratory distress syndrome (ARDS) in the United States from 2006 to 2011. Methods: We used the Nationwide Inpatient Sample to isolate all patients aged 18 years who had a discharge International Classification of Diseases, Ninth Revision diagnosis of ARDS, with and without procedure codes for ECMO, between 2006 and 2011. Results: We examined a total of 47 911 414 hospital discharges, representing 235 911 271 hospitalizations using national weights. Of the 1 479 022 patients meeting the definition of ARDS (representing 7 281 206 discharges), 775 underwent ECMO. There was a 409% relative increase in the use of ECMO for ARDS in the United States between 2006 and 2011, from 0.0178% to 0.090% (P = .0041). Patients treated with ECMO had higher in-hospital mortality (58.6% vs 25.1%, P < .0001) and longer hospital stays (15.8 days vs 6.9 days, P < .0001). They were also younger (47.9 vs 66.4 years, P < .0001) and more likely to be male (62.2% vs 49.6%, P < .0001). The median time to initiate ECMO from the time of admission was 0.5 days (interquartile range [IQR] 4.9 days). Conclusion: There has been a dramatic increase in ECMO use for the treatment of ARDS in the United States. [ABSTRACT FROM AUTHOR]

Background: Thrombolysis for the treatment of pulmonary embolism (PE) has received significant attention in the literature over the past 10 years.Objective: Our primary objective was to examine the trend in thrombolysis use in the United States from 2006 to 2011. Secondary objectives include examining patient and hospital characteristics associated with receiving thrombolysis and rates of complications associated with thrombolysis.Methods: In this retrospective cohort study, we used the Nationwide Inpatient Sample from 2006 to 2011 to identify patients with a diagnosis of PE who received or did not receive thrombolytic agents.Results: Examining the records of 47,911,414 hospital discharges identified a cohort of 1,317,329 patients with PE; of these patients, 10,617 received thrombolysis. During the study period, there was a 30% relative increase in the use of thrombolysis, from 0.68% (95% confidence interval [CI] 0.64-0.73%) to 0.89% (95% CI 0.83-0.95%; p < 0.01). After controlling for all factors in the model, factors associated with decreased access to thrombolysis were increasing age (odds ratio [OR] 0.981 [95% CI 0.980-0.982]; p < 0.01), female sex (OR 0.78 [95% CI 0.75-0.81]; p < 0.01), Black race (OR 0.86 [95% CI 0.81-0.91]; p < 0.01), Hispanic race (OR 0.78 [95% CI 0.71-0.86]; p < 0.01), other race (OR 0.72 [95% CI 0.59-0.88]; p = 0.02), and rural hospital location (OR 0.48 [95% CI 0.43-0.52]; p < 0.01).Conclusions: The use of thrombolysis increased between 2006 and 2011 in the United States. Patients who receive thrombolysis tend to be white men, live in higher-income ZIP codes, and receive the therapy at large academic teaching hospitals. [ABSTRACT FROM AUTHOR]

Objective: The use of electroencephalogram (EEG) has been demonstrated to have diagnostic and prognostic value in cardiac arrest patients. The use of this modality across the United States in this population is unknown.Methods: The Nationwide Inpatient Sample (NIS) is a federal database capturing 20% of all US hospital admissions. A cohort of patients who suffered both in and out of hospital cardiac arrests from the 2006 to 2012 NIS datasets was created.Results: The records of 55,208,382 hospitalizations were analyzed, of which 207,703 patients suffered a cardiac arrest. There were 2952 (1.42%) patients who also had an EEG. Patients who had an EEG compared to those who did not were: younger (62.2 years SD 16.6 vs 66.9 years SD 16.2, p<0.01), were less likely to have insurance coverage (89.9% vs 91.6%, p=0.03) and had significantly longer length of stay (8.6days IQR 3.7-17.1 vs 4.1days IQR 1.0-10.5, p<0.01). Patients treated at urban teaching hospitals were more likely to receive an EEG than patients treated at urban non-teaching and rural hospitals (p<0.01). The rate of EEG in survivors of cardiac arrest increased from 1.03% in 2006 to 2.16% in 2012, a relative increase of 110% (p<0.02). The median time to performance of an EEG was 1.6days IQR 0.33-4.53 days.Conclusion: EEG is performed on approximately 2% of patients who suffer cardiac arrest in the United States. The treatment hospital and patient characteristics of those who received an EEG different from those who did not. [ABSTRACT FROM AUTHOR]

Background: To investigate the use of palliative care (PC) in patients with end-stage COPD receiving home oxygen hospitalized for an exacerbation.Methods: A retrospective nationwide cohort analysis was performed, using the Nationwide Inpatient Sample. All patients ≥ 18 years of age with a diagnosis of COPD, receiving home oxygen, and admitted for an exacerbation were included.Results: A total of 55,208,382 hospitalizations from the 2006-2012 Nationwide Inpatient Sample were examined. There were 181,689 patients with COPD, receiving home oxygen, and admitted for an exacerbation; 3,145 patients (1.7%) also had a PC contact. There was a 4.5-fold relative increase in PC referral from 2006 (0.45%) to 2012 (2.56%) (P < .01). Patients receiving PC consultations compared with those who did not were older (75.0 years [SD 10.9] vs 70.6 years [SD 9.7]; P < .01), had longer hospitalizations (4.9 days [interquartile range, 2.6-8.2] vs 3.5 days [interquartile range, 2.1-5.6]), and more likely to die in hospital (32.1% vs 1.5%; P < .01). Race was significantly associated with referral to palliative care, with white patients referred more often than minorities (P < .01). Factors associated with PC referral included age (OR, 1.03; 95% CI, 1.02-1.04; P < .01), metastatic cancer (OR, 2.40; 95% CI, 2.02-2.87; P < .01), nonmetastatic cancer (OR, 2.75; 95% CI, 2.43-3.11; P < .01), invasive mechanical ventilation (OR, 4.89; 95% CI, 4.31-5.55; P < .01), noninvasive mechanical ventilation (OR, 2.84; 95% CI, 2.58-3.12; P < .01), and Do Not Resuscitate status (OR, 7.95; 95% CI, 7.29-8.67; P < .01).Conclusions: The use of PC increased dramatically during the study period; however, PC contact occurs only in a minority of patients with end-stage COPD admitted with an exacerbation. [ABSTRACT FROM AUTHOR]

In May 2014, a short-term study-abroad experience was conducted in Finland through a course offered at Indiana State University (ISU). Students and faculty from ISU and Eastern Illinois University participated in the experience, which was created to facilitate a cross-cultural comparison of long-term-care settings in the United States and Finland. With its outstanding system of caring for the health and social needs of its aging populace, Finland is a logical model to examine when considering ways to improve the quality of life for older adults who require care in the United States . Those participating in the course visited a series of long-term-care facilities in the region surrounding Terre Haute, Indiana, then travelled to Lappeenranta, Finland to visit parallel sites. Through limited-participation observation and semistructured interviews, similarities and differences in experiences, educations, and policies affecting long-term care workers in the United States and Finland were identified and are described here. [ABSTRACT FROM AUTHOR]