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Purpose: The purpose of this meta-analytic study was to identify clinical characteristics, defined as child factors that can be assessed by a speech-language pathologist as part of a routine speech-language evaluation that may differentiate children who persist in stuttering from children who eventually recover from stuttering. Clinical characteristics explored included sex, age at onset, family history of stuttering, stuttering frequency and severity, speech-language skills, and temperament. Method: Studies were identified through electronic databases, journals, and reference lists of relevant reports (e.g., research articles). Eligible studies followed young children who stutter (i.e., under 6 years old) for at least 24 months, assessed a potential clinical marker at study entry, and determined talker group classification (i.e., persistent or recovered) at study completion. Sex and family history differences were estimated using risk ratios; all other differences were estimated using Hedges's "g." Heterogeneity and methodological differences among studies were evaluated. Results: Eleven studies (41 reports) met eligibility criteria. Persistent children were older at stuttering onset and exhibited higher frequencies of stuttering-like disfluencies, lower speech sound accuracy, and lower expressive and receptive language skills than recovered children. Males and children with a family history of stuttering were also more likely to persist. Conclusions: Clinical characteristics were identified that are associated with increased risk for stuttering persistence. Future studies have the potential to translate these clinical characteristics into prognostic markers for stuttering persistence risk.

I use the definition of "populism as a discursive frame" to consider the extent to which the politics of school choice in the United States have been populist. This analysis offers a novel way to understand how political actors have forged coalitions to support school choice and suggests how they may remake their positions in an evolving political context. Populist approaches in the politics of school choice have been muted over the past three decades, as the contemporary educational reform movement has relied on political rhetoric that would foster and maintain broad-based coalitional support for its agenda. This is revealed by the dominant framing of school choice in the contemporary reform era, and by its contrast with more populist discourses throughout the politics of school choice. While populist sentiments are rising in the United States, political elites largely still rely on the contemporary reform movement's weakly populist or elitist discourse surrounding school choice. Social and geographic divisions within and between political constituencies remain obstacles to a populist turn in the politics of school choice.

We discuss oral history interviews with academics who laid the foundation of research and pedagogies in daycare for under three-year-olds in Europe and North and South America since the 1970s. Their work is clearly embedded in the social-political context of their country: the left-wing programmes for disadvantaged families in the U.S.A.; neoliberal policy and daycare because of employment of mothers in the U.S.A.; social-democratic policy and family support in Sweden; and state-controlled institutions for education in socialist-communist East Germany. The interviewees acknowledge the risk of infant daycare for emotional security. Related to values and social context in their country, the interviewees contributed to different interpretations of attachment theory, attachment policies and innovative insights such as multiple attachments, friendship between one-year-olds, group sensitivity, professional love and home-to-centre and vice versa transitions. All are convinced that today we have the knowledge to offer high-quality daycare, but that infant daycare can be a risk when economic demands are too dominant.

Complex motor stereotypies are rhythmic, repetitive, fixed, and non-goal directed movements (e.g., bilateral flapping/waving movements of the hands/arms). Movements typically begin in early childhood and can occur in otherwise normally developing ("primary") or autistic ("secondary") children. Stereotypies persist, occur multiple times a day, have prolonged durations, can be socially stigmatizing, and may lead to bullying and isolation. Prior behavioral treatment studies have focused on older children (ages 6–12) and report modest reductions in stereotypy (i.e., between 14% and 33%). The current study involves the functional assessment and treatment of five children with Primary Complex Motor Stereotypy using a modified awareness training procedure, differential reinforcement of other behavior, and schedule thinning in a nonconcurrent multiple baseline design. Results suggest a 99% reduction of motor stereotypy from baseline across all participants. [ABSTRACT FROM AUTHOR]

Background: Palliative care demands in the United States are growing amid a comparatively small workforce of palliative care clinicians and researchers. Therefore, determining research and clinical practice priorities is essential for streamlining initiatives to advance palliative care science and practice. Objectives: To identify and rank palliative care research and clinical practice priority areas through expert consensus. Design: Using a modified Delphi method, U.S. palliative care experts identified and ranked priority areas in palliative care research and clinical practice. Priorities were thematically grouped and analyzed for topic content and frequency; univariate analysis used the median of each priority item ranking, with a cutoff median of ≤8 indicating >76% agreement for an item's ranking. Results: In total, 27 interdisciplinary pediatric and adult palliative care experts representing 19 different academic institutions and medical centers participated in the preliminary survey and the first Delphi round, and 22 participated in the second Delphi round. The preliminary survey generated 78 initial topics, which were developed into 22 priority areas during the consensus meeting. The top five priorities were (1) access to palliative care, (2) equity in palliative care, (3) adequate financing of palliative care, (4) provision of palliative care in primary care settings, and (5) palliative care workforce challenges. Conclusions: These expert-identified priority areas provide guidance for researchers and practitioners to develop innovative models, policies, and interventions, thereby enriching the quality of life for those requiring palliative care services. [ABSTRACT FROM AUTHOR]

The Gratitude Network, a nonprofit based in Pleasanton, California, has a unique and interesting approach to strengthening education for children globally. The organization accelerates the growth of high-impact social enterprises, both for-profit and nonprofit, working to improve the lives of children and youth around the world, primarily through novel, educational approaches. Through a 12-month leadership development Fellowship for children- and youth-focused social entrepreneurs, The Gratitude Network seeks to expand the leadership capacity of the organization's executive team. The ultimate goal of Gratitude's Fellowship is to help the organization scale and therefore impact and educate increasing numbers of children and youth. To date, Gratitude has worked with more than 100 organizations in over 40 countries, collectively impacting approximately 30 million children.

Historically Black Colleges and Universities (HBCUs) have made notable social, cultural, and economic contributions to the African Diaspora, particularly since their inception in the United States. Being that HBCU athletic programs account for a small proportion of the intercollegiate athletic industry, these unique entities are often examined in the same vein as their Historically White Institution counterparts without a full account of the intergenerational adverse impacts of systemic racism. Since HBCUs are situated within the distinct context of Blackness, the researchers offer a reconceptualization through the theoretical lens of Black Critical Theory. This manuscript illuminates linkages across extant literature, while also presenting a budding theoretical framework in the study of sport, and sport organizations, that have deeply embedded relationships with communities, for example, HBCUs and the Black community, stickball and lacrosse within Indigenous communities, and the relationship between women and womens' sports leagues. Implications of this work are centered on promoting more critical reconceptualizations of sporting spaces that reflect the full diversity of the societies in which they exist. [ABSTRACT FROM AUTHOR]

Recombinant zoster vaccine has been recommended by the US Advisory Committee on Immunization Practices (ACIP) for the prevention of herpes zoster (HZ) in immunocompetent adults aged at least 50 years since 2018. In January 2022, this was extended to immunodeficient/immunosuppressed adults aged at least 19 years. Key study objectives were to assess specialists' knowledge of the ACIP HZ vaccination recommendations, their attitudes toward HZ vaccination, and HZ vaccination practices/barriers. This cross-sectional, web-based survey (conducted in March 2022) included US dermatologists, gastroenterologists, infectious disease specialists, oncologists, and rheumatologists who treat patients with psoriasis, inflammatory bowel disease, human immunodeficiency syndrome, solid tumors/hematological malignancies, and rheumatoid arthritis, respectively. Although most of the 613 specialists correctly identified the ACIP HZ vaccination recommendations for adults aged at least 50 years (84%) and immunodeficient/immunosuppressed adults aged at least 19 years (67%), only 29% knew that recombinant zoster vaccine is recommended for individuals who have previously received zoster vaccine live, and only 18% knew all current ACIP recommendations. For patients with the diseases listed, 84% of specialists thought that HZ is a serious risk, 75% that HZ vaccination is extremely/very important, and 69% were extremely/very likely to recommend HZ vaccination. Only 36% administer vaccines themselves, mainly because patients receive vaccinations from others. Barriers to vaccination included more urgent/acute issues, insufficient time, and lack of patient motivation/willingness. Full knowledge of the ACIP HZ vaccination recommendations among the surveyed specialists was low. There may be a need to educate specialists to improve adherence to these recommendations. [ABSTRACT FROM AUTHOR]

Simple Summary: Brain metastases (BMs), the most common type of cerebral tumor, are primarily associated with lung cancer, breast cancer, and melanoma. Patients typically present to the emergency department (ED) with insidious symptoms such as headaches, focal neurological deficits, seizures, and signs of increased intracranial pressure. Key symptomatic treatment in the ED includes corticosteroids to manage peritumoral edema, and carefully selected antiepileptic medications for tumor-related epileptic conditions. After stabilization, the treatment philosophy for BMs should prioritize effective yet minimally toxic options to maximize quality of life. Surgery is recommended for accessible BMs in patients with good performance status. Radiation therapy and systemic treatments, including chemotherapy, targeted therapy, and immunotherapy, are available options for managing disease progression. Given that over half of patients with BMs in the ED are admitted, a better understanding of avoidable hospitalizations is essential to differentiate those who can be safely discharged from those needing observation or hospitalization. Brain metastases (BMs) are the most prevalent type of cerebral tumor, significantly affecting survival. In adults, lung cancer, breast cancer, and melanoma are the primary cancers associated with BMs. Symptoms often result from brain compression, and patients may present to the emergency department (ED) with life-threatening conditions. The goal of treatment of BMs is to maximize survival and quality of life by choosing the least toxic therapy. Surgical resection followed by cavity radiation or definitive stereotactic radiosurgery remains the standard approach, depending on the patient's condition. Conversely, whole brain radiation therapy is becoming more limited to cases with multiple inoperable BMs and is less frequently used for postoperative control. BMs often signal advanced systemic disease, and patients usually present to the ED with poorly controlled symptoms, justifying hospitalization. Over half of patients with BMs in the ED are admitted, making effective ED-based management a challenge. This article reviews the epidemiology, clinical manifestations, and current treatment options of patients with BMs. Additionally, it provides an overview of ED management and highlights the challenges faced in this setting. An improved understanding of the reasons for potentially avoidable hospitalizations in cancer patients with BMs is needed and could help emergency physicians distinguish patients who can be safely discharged from those who require observation or hospitalization. [ABSTRACT FROM AUTHOR]

Background Vasospasm and delayed cerebral ischemia (DCI) are the leading causes of morbidity and mortality after intracranial aneurysmal subarachnoid hemorrhage (aSAH). Vasospasm detection, prevention and management, especially endovascular management varies from center to center and lacks standardization. We aimed to evaluate this variability via an international survey of how neurointerventionalists approach vasospasm diagnosis and endovascular management. Methods We designed an anonymous online survey with 100 questions to evaluate practice patterns between December 2021 and September 2022. We contacted endovascular neurosurgeons, neuroradiologists and neurologists via email and via two professional societies -- the Society of NeuroInterventional Surgery (SNIS) and the European Society of Minimally Invasive Neurological Therapy (ESMINT). We recorded the physicians' responses to the survey questions. Results A total of 201 physicians (25% [50/201] USA and 75% non-USA) completed the survey over 10 months, 42% had >7 years of experience, 92% were male, median age was 40 (IQR 35-46). Both high-volume and low- volume centers were represented. Daily transcranial Doppler was the most common screening method (75%) for vasospasm. In cases of symptomatic vasospasm despite optimal medical management, endovascular treatment was directly considered by 58% of physicians. The most common reason to initiate endovascular treatment was clinical deficits associated with proven vasospasm/DCI in 89%. The choice of endovascular treatment and its efficacy was highly variable. Nimodipine was the most common first- line intra-arterial therapy (40%). Mechanical angioplasty was considered the most effective endovascular treatment by 65% of neurointerventionalists. Conclusion Our study highlights the considerable heterogeneity among the neurointerventional community regarding vasospasm diagnosis and endovascular management. Randomized trials and guidelines are needed to improve standard of care, determine optimal management approaches and track outcomes. [ABSTRACT FROM AUTHOR]

Background and Objectives The coronavirus disease 2019 pandemic placed unprecedented stress on older adults. Resiliency could mitigate deleterious effects of pandemic stressors. We described trends in resilience among U.S. adults aged 50–80 years approximately one and a half years after the onset of the pandemic, compared with before the pandemic, and evaluated associations between relationships and resilience. Research Design and Methods Data were from the National Poll on Healthy Aging (N = 2,100) in August 2021. Respondents rated their resiliency as compared with before the pandemic (more, about the same, or less) and different types of relationships (spouse/partner, friends, and neighbors) as sources of joy and/or stress during the pandemic (a lot, some, very little, and not at all). Multinomial logistic regressions (complete-case analysis) estimated the relationships between each joyful and stressful relationships and resiliency. Results Most participants reported feeling as resilient as before the pandemic (70.6%) with 14.5% feeling less resilient. More women than men felt less resilient than before the pandemic (16.7% vs 12.8%, p =.006). Feeling a lot of stress from one's spouse or neighbors was associated with increased likelihood of feeling less resilient than before the pandemic (odds ratio [OR] = 3.7; 95% confidence interval [CI]: 1.8, 7.7 and OR = 4.5; 95% CI: 1.5, 13.9, respectively), which was stronger among women (OR = 15.1; 95% CI: 4.8, 45.6) than men (OR = 1.03; 95% CI: 0.4, 2.7). Discussion and Implications Social relationships may have been more important for women than for men in supporting resiliency during the pandemic. Understanding patterns of resiliency can help to inform policymaking and support the well-being of older adults. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is characterized by progressive neuroinflammation and neurodegeneration from disease onset that, if left untreated, can result in the accumulation of irreversible neurological disability. Early intervention with high-efficacy therapies (HETs) is increasingly recognized as the best strategy to delay or mitigate disease progression from the earliest stages of the disease and to prevent long-term neurodegeneration. Although there is growing clinical and real-world evidence supporting early HET intervention, foregoing this strategy in favor of a traditional escalation approach prioritizing lower-efficacy disease-modifying therapies remains a common approach in clinical practice. This review explores potential health care professional- and patient-related barriers to the early use of HETs in patients with MS in the United States. Barriers can include regulatory and reimbursement restrictions; knowledge gaps and long-term safety concerns among health care professionals; and various individual, cultural, and societal factors affecting patients. Potential strategies for overcoming these barriers and encouraging early HET use are proposed. [ABSTRACT FROM AUTHOR]

This manuscript is a consensus document of an expert panel on the Evaluation and Treatment of Gastrointestinal Bleeding in Patients Taking Anticoagulants Presenting to the Emergency Department, sponsored by the American College of Emergency Physicians. [ABSTRACT FROM AUTHOR]

Background Two prefusion F protein-based vaccines, Arexvy and Abrysvo, have been authorized by the US Food and Drug Administration for protecting older adults against respiratory syncytial virus (RSV)-associated lower respiratory tract illness. We evaluated the health benefits and cost-effectiveness of these vaccines. Methods We developed a discrete-event simulation model, parameterized with the burden of RSV disease including outpatient care, hospitalization, and death for adults aged 60 years or older in the United States. Taking into account the costs associated with these RSV-related outcomes, we calculated the net monetary benefit using quality-adjusted life-year (QALY) gained as a measure of effectiveness and determined the range of price-per-dose (PPD) for Arexvy and Abrysvo vaccination programs to be cost-effective from a societal perspective. Results Using a willingness-to-pay of $95 000 per QALY gained, we found that vaccination programs could be cost-effective for a PPD up to $127 with Arexvy and $118 with Abrysvo over the first RSV season. Achieving an influenza-like vaccination coverage of 66% for the population of older adults in the United States, the budget impact of these programs at the maximum PPD ranged from $6.48 to $6.78 billion. If the benefits of vaccination extend to a second RSV season as reported in clinical trials, we estimated a maximum PPD of $235 for Arexvy and $245 for Abrysvo, with 2-year budget impacts of $11.78 and $12.25 billion, respectively. Conclusions Vaccination of older adults would provide substantial direct health benefits by reducing outcomes associated with RSV-related illness in this population. [ABSTRACT FROM AUTHOR]

Purpose: This work aims to assess the association of sleep duration with cardiometabolic risk (adiposity, blood pressure, lipids, albuminuria and A1C) and to investigate lifestyle factors (physical activity, light exposure, caffeine consumption and sugar consumption) associated with sleep duration in children. Methods: A nationally representative sample of 3907 children ages 6–17 years enrolled in NHANES from 2011 to 2014 was included in this cross‐sectional study. Sleep duration was defined as the daily average time spent sleeping over 7 days as measured by a physical activity monitor (PAM). Participants without valid sleep data for ≥95% of the study were excluded. Regression models were adjusted for age, sex, race, body mass index (BMI) Z score, physical activity and light exposure. Results: In adjusted regression models, longer sleep duration was associated with lower systolic blood pressure index (β = −3.63 * 10−5, 95% CI −6.99 * 10−5, −2.78 * 10−6, p = 0.035) and BMI Z score (β = −0.001, 95% CI −0.001, 0.000, p = 0.002). In logistic regression models, longer sleep duration was associated with lower odds of obesity (OR = 0.998, 95% CI 0.997, 0.999, p < 0.001) and overweight status (OR = 0.998, 95% CI 0.997, 0.999, p = 0.004). Greater light exposure (β = 6.64 * 10−5, 95% CI 3.50 * 10−5, 9.69 * 10−5, p < 0.001) and physical activity (β = 0.005, 95% CI 0.004, 0.006, p < 0.001) were associated with longer sleep. Conclusion: Longer sleep duration was associated with lower blood pressure and adiposity measures in children. Improving sleep quality by increasing physical activity and light exposure in childhood may decrease the lifetime risk of cardiometabolic disease. [ABSTRACT FROM AUTHOR]

Background: COVID-19's heavy toll on human health, and its concentration within specific at-risk groups including the socially vulnerable and individuals with comorbidities, has made it the focus of much syndemic discourse. Syndemic theory recognizes that social factors create the conditions that support the clustering of diseases and that these diseases interact in a manner that worsens health outcomes. Syndemics theory has helped to facilitate systems-level approaches to disease as a biosocial phenomenon and guide prevention and treatment efforts. Despite its recognized value, reviews of syndemics literature have noted frequent misuse of the concept limiting its potential in guiding appropriate interventions. Objective: To review how the term 'syndemic' is defined and applied within peer-reviewed literature in relation to COVID-19. Design: A scoping review of definitions within COVID-19 literature published between January 1, 2020 to May 15, 2023 was conducted. Searches took place across six databases: Academic Search Premier, CINAHL, JSTOR, MEDLINE/Pubmed, PsycINFO and Scopus. PRISMA-ScR guidelines were followed. Results: Content analysis revealed that COVID-19 has varied clustered configurations of communicable–non-communicable diseases and novel communicable disease interactions. Spatial analysis was presented as a new strategy to evidence syndemic arrangements. However, syndemics continue to be regarded as universal, with continued misunderstanding and misapplication of the concept. Conclusion: This review found that current applications of syndemics remain problematic. Recommendations are made on the design of syndemic studies. A syndemic framework offers an opportunity for systems-level thinking that considers the full complexity of human-disease interactions and is useful to inform future pandemic preparations and responses. [ABSTRACT FROM AUTHOR]

Background: For many years, United States' dietary policy recommended limiting egg intake to no more than 3/wk in the belief that restricting dietary cholesterol would lower plasma cholesterol levels and thereby reduce the risk of cardiovascular disease. The evidence supporting these recommendations is controversial. Objectives: To examine the impact of eggs, a major contributor to dietary cholesterol intake, on lipid levels and to determine whether these egg effects are modified by other healthy dietary factors in adults. Methods: Males and females aged 30-64 y with available 3-d diet record data, without cardiovascular disease and not taking lipid- or glucose-lowering medications in the prospective Framingham Offspring cohort were included (n = 1852). Analysis of covariance models were used to compare mean follow-up lipid levels adjusting for age, sex, BMI, and dietary factors. Cox proportional hazard's models were used to estimate risk for elevated lipid levels. Results: Consuming -5 eggs/wk was not adversely associated with lipid outcomes. Among men, consuming -5 (compared with <0.5) eggs/wk was associated with an 8.6 mg/dL lower total cholesterol level and a 5.9 mg/dL lower LDL cholesterol level, as well as lower triglycerides. Overall, higher egg intake combined with higher dietary fiber (compared with lower intakes of both) was associated with the lowest total cholesterol, LDL cholesterol, and LDL cholesterol-to-HDL cholesterol ratio. Finally, diets with higher (compared with lower) egg intakes in combination with higher total fish or fiber intakes, respectively, were associated with lower risks of developing elevated (>160 mg/dL) LDL cholesterol levels (hazard ratio: 0.61; 95% confidence interval: 0.44, 0.84; and HR: 0.70; 95% confidence interval: 0.49, 0.98, respectively). Conclusions: Higher egg intakes were beneficially associated with serum lipids among healthy adults, particularly those who consumed more fish and dietary fiber. [ABSTRACT FROM AUTHOR]

Building conditions, outdoor climate, and human behavior influence residential concentrations of fine particulate matter (PM2.5). To study PM2.5 spatiotemporal variability in residences, we acquired paired indoor and outdoor PM2.5 measurements at 3,977 residences across the United States totaling >10,000 monitor-years of time-resolved data (10-min resolution) from the PurpleAir network. Time-series analysis and statistical modeling apportioned residential PM2.5 concentrations to outdoor sources (median residential contribution = 52% of total, coefficient of variation = 69%), episodic indoor emission events such as cooking (28%, CV = 210%) and persistent indoor sources (20%, CV = 112%). Residences in the temperate marine climate zone experienced higher infiltration factors, consistent with expectations for more time with open windows in milder climates. Likewise, for all climate zones, infiltration factors were highest in summer and lowest in winter, decreasing by approximately half in most climate zones. Large outdoor-indoor temperature differences were associated with lower infiltration factors, suggesting particle losses from active filtration occurred during heating and cooling. Absolute contributions from both outdoor and indoor sources increased during wildfire events. Infiltration factors decreased during periods of high outdoor PM2.5, such as during wildfires, reducing potential exposures from outdoor-origin particles but increasing potential exposures to indoor-origin particles. Time-of-day analysis reveals that episodic emission events are most frequent during mealtimes as well as on holidays (Thanksgiving and Christmas), indicating that cooking-related activities are a strong episodic emission source of indoor PM2.5 in monitored residences. [ABSTRACT FROM AUTHOR]

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Multi-sector efforts to address the structural drivers of health inequities faced by racial and ethnic minority communities in the USA often ignore the potential of action by for-profit businesses, perhaps due to skepticism about the role of business in such efforts. However, given the need to harness diverse forms of capital to address structural harms, and recent calls to identify oft-ignored systemic pathways to health, we examined the role of business – specifically small, locally-owned businesses – in promoting community health and well-being. This study explored the role of small, locally owned businesses in community health, and local understandings of the value of such action, in the context of Roxbury, Massachusetts, a historically Black community with a substantial Latinx population. We conducted 20 semi-structured interviews between June and November 2021 with small business owners and staff, as well as leaders and staff from local non-profit organizations, anchor institutions, and one large business. Constructivist and critical perspectives guided the work. We used a team-based, thematic analysis approach; the team included residents and a small local business owner. Participants described pride in the neighborhood and emphasized small businesses' contribution to long-term community well-being by investing social, cultural, human, and financial capital. Business owners saw their work as a way of giving back and did so in ways reflecting their deep understanding of community needs, aspirations, and identity. Public health efforts should engage pro-social small businesses embedded in marginalized communities, thereby supporting and amplifying businesses' existing contributions to advancing equitable community health. [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: 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]

In this paper, we investigate the potential consumer savings to U.S. home broadband consumers in cable modem monopoly markets, should fixed wireless access technologies become available as a competitive alternative. We use a Choice-Based Conjoint survey and Hierarchical Bayes estimation to calculate the proportion of home broadband consumers that would switch to a fixed wireless access option if it was made available in a cable modem monopoly market. We then utilize a monopoly pricing model to estimate the downward pricing pressure this competition would place on incumbent cable modem monopoly prices. We find that fixed wireless entry at current prices would convert 18 percent of cable-only households and lead to a 37 percent reduction in the price of cable modem service. We also find entry into non-monopoly markets where a fiber-optic broadband alternative already exists, and find muted conversion rates and price reductions. Our results indicate that the deployment of fixed-wireless access would generate substantial consumer savings in cable modem monopoly markets, which constitute 30 precent all cable modem subscribers in the United States. [ABSTRACT FROM AUTHOR]

Introduction: Patients with psoriasis (PsO) are at increased risk of herpes zoster (HZ), but recent data on the incidence of HZ among patients with PsO and the impact of HZ on healthcare resource use (HRU) and costs for patients with PsO have not been described. Methods: This retrospective, longitudinal, cohort study estimated HZ incidence in cohorts of adults with vs without PsO (PsO + vs PsO–) and HRU and costs among those with PsO, with vs without HZ (PsO + /HZ + vs PsO + /HZ–) using Optum's de-identified Clinformatics Data Mart Database during 2015–2020. Patients with psoriatic arthritis were excluded from all four cohorts. Comparisons between cohorts used generalized linear models to adjust outcomes based on various baseline characteristics. Results: The incidence rate of HZ was significantly higher in the PsO + (n = 144,115) vs PsO– (n = 23,837,237) cohorts at 11.35 vs 7.67 per 1000 patient-years; adjusted incidence rate ratio (aIRR): 1.21, 95% confidence interval (CI): 1.16–1.25. HRU (outpatient, emergency department, and inpatient) was significantly higher in the PsO + /HZ + (n = 1859) vs PsO + /HZ– (n = 78,664) cohorts during 1 month and 3 months after HZ diagnosis (e.g., outpatient visits during month: 2.83 vs 1.30 per patient; aIRR: 1.96; 95% CI 1.86–2.06). Mean all-cause costs were also significantly higher in the PsO + /HZ + vs PsO + /HZ– cohort during both month ($5020 vs $2715 per patient; adjusted cost difference: $1390; 95% CI $842–$1964) and 3 months ($12,305 vs $8256; adjusted cost difference: $1422; 95% CI $280–$2889) after HZ diagnosis. Conclusion: These findings show the increased incidence of HZ among patients with PsO and the clinical and economic burdens of HZ in this population. Considering the high prevalence of PsO, insights into the impact of HZ in these patients provide valuable evidence to inform clinical decision-making. Plain Language Summary: Psoriasis is an inflammatory condition that causes flaky, scaly skin. Herpes zoster (shingles) causes a painful rash, usually on the abdomen. However, recent data on the proportion of patients with psoriasis who develop herpes zoster is lacking. Furthermore, little is known about the healthcare resources that are used or the costs of care for patients with psoriasis who develop herpes zoster. We found that patients with psoriasis were 21% more likely to have herpes zoster than patients without psoriasis. Among patients with psoriasis, those who developed herpes zoster had twice as many doctor's visits, 3 times as many emergency department visits, and twice as many inpatient hospital stays during the month after a herpes zoster diagnosis as patients without herpes zoster. This resulted in an additional cost of $1390 per patient with psoriasis and herpes zoster compared with those with psoriasis but without herpes zoster. Overall, patients with psoriasis are at increased risk of developing herpes zoster and the healthcare resource use and associated cost of treating herpes zoster in patients with psoriasis is substantial. [ABSTRACT FROM AUTHOR]

Objectives: Autism spectrum disorder (autism) is a heterogeneous condition that poses challenges in describing the needs of individuals with autism and making prognoses about future outcomes. We applied a newly proposed definition of profound autism to surveillance data to estimate the percentage of children with autism who have profound autism and describe their sociodemographic and clinical characteristics. Methods: We analyzed population-based surveillance data from the Autism and Developmental Disabilities Monitoring Network for 20 135 children aged 8 years with autism during 2000-2016. Children were classified as having profound autism if they were nonverbal, were minimally verbal, or had an intelligence quotient <50. Results: The percentage of 8-year-old children with profound autism among those with autism was 26.7%. Compared with children with non–profound autism, children with profound autism were more likely to be female, from racial and ethnic minority groups, of low socioeconomic status, born preterm or with low birth weight; have self-injurious behaviors; have seizure disorders; and have lower adaptive scores. In 2016, the prevalence of profound autism was 4.6 per 1000 8-year-olds. The prevalence ratio (PR) of profound autism was higher among non-Hispanic Asian/Native Hawaiian/Other Pacific Islander (PR = 1.55; 95 CI, 1.38-1.73), non-Hispanic Black (PR = 1.76; 95% CI, 1.67-1.86), and Hispanic (PR = 1.50; 95% CI, 0.88-1.26) children than among non-Hispanic White children. Conclusions: As the population of children with autism continues to change, describing and quantifying the population with profound autism is important for planning. Policies and programs could consider the needs of people with profound autism across the life span to ensure their needs are met. [ABSTRACT FROM AUTHOR]

One prominent, well-debated issue in the American higher education system is whether university officials should remove the names of individuals with racist pasts from campus buildings/structures that bear their namesake. The purpose of this study was to analyze basketball and football facilities at Division I Football Bowl Subdivision institutions to explore the racialized history of the people whom these facilities are named after. Utilizing a collective case study approach, the authors identified 18 facilities that were named after athletic administrators, coaches, and philanthropists who engaged in racist activities or harbored racist views. The authors argue, using critical race theory and systemic racism theory as interpretative lenses, that naming buildings after racist persons legitimizes their legacies, rationalizes systemic racism, and continues to unjustly enrich this particular group. [ABSTRACT FROM AUTHOR]

Objective: To estimate the incremental healthcare resource utilization (HRU) and cost burden posed by herpes zoster (HZ) in adult patients with rheumatoid arthritis (RA) in the United States. Methods: A retrospective cohort study was conducted using an administrative claims database containing commercial and Medicare Advantage with Part D data, between October 2015 and February 2020. Patients with RA and HZ (RA+/HZ+) or RA without HZ (RA+/HZ−) were identified based on diagnosis codes and relevant medications. Outcomes measured included HRU and medical, pharmacy, and total costs at month 1, quarter 1, and year 1 after the index date (HZ diagnosis for RA+/HZ+ cohort, randomly assigned for RA+/HZ− cohort). Generalized linear models incorporating propensity scores and other covariates were used to estimate differences in outcomes between cohorts. Results: A total of 1866 patients from the RA+/HZ+ cohort and 38,846 patients from the RA+/HZ− cohort were included. Hospitalizations and emergency department visits occurred more frequently in the RA+/HZ+ than the RA+/HZ− cohort, especially in the month after HZ diagnosis (adjusted incidence rate ratio [95% confidence interval (CI)] for hospitalizations: 3.4 [2.8; 4.2]; emergency department visits: 3.7 [3.0; 4.4]). Total costs were also higher in the month after HZ diagnosis (mean adjusted cost difference [95% CI]: $3404 [$2089; $4779]), with cost differences driven by increased medical costs ($2677 [$1692; $3670]). Conclusions: These findings highlight the high economic burden of HZ among individuals with RA in the United States. Strategies to reduce the risk of HZ in patients with RA (such as vaccination) may serve to reduce this burden. 5XaYxHPE7TWLkoqv3bZsDY Video abstract [ABSTRACT FROM AUTHOR]

Purpose: Nearly all schools in the United States closed in spring 2020, at the onset of the COVID-19 pandemic. We analyze traditional public and charter school reopenings for the 2020–21 school year in five urban districts. We provide a rich and theoretically grounded description of how and why educational leaders made reopening decisions in each of our case districts. Research Methods: We used data from a multiple-case study from March 2020 to July 2021. The research team conducted 56 interviews with school, district, and system-level leaders; triangulated with publicly available data; and also drew on interview data from a subsample of parents and guardians in each of our sites. We analyzed these data through qualitative coding and memo writing and conducted detailed single- and cross-case analyses. Findings: School system leaders in our case sites generally consulted public health authorities, accounted for state-level health and educational guidance, and engaged with and were responsive to the interests of different stakeholders. Districts' adherence to and strategic uses of public health guidance, as well as a combination of union-district relations and labor market dynamics, influenced reopening. Parents, city, and state lawmakers, and local institutional conditions also played a role, helping to explain differences across cases. Implications: In contrast to the "politics or science" framing that has dominated research and public discourse on school reopening, we show that local pandemic conditions and local political dynamics both mattered and in fact were interrelated. Our findings have some implications for how educational leaders might navigate future crises. [ABSTRACT FROM AUTHOR]

Background and Objectives: Abaloparatide (ABL) significantly increases bone mineral density in men with osteoporosis similar to what was reported in postmenopausal women with osteoporosis. The cost effectiveness of sequential treatment with ABL followed by alendronate (ALN) in men at high fracture risk was compared to relevant alternative treatments. Methods: A Markov-based microsimulation model based on a lifetime US healthcare decision maker perspective was developed to evaluate the cost (expressed in US$2021) per quality-adjusted life-years (QALYs) gained of sequential ABL/ALN. Comparators were sequential treatment unbranded teriparatide (TPTD)/ALN, generic ALN monotherapy, and no treatment. Discount rates of 3% were used. Consistent with practice guidelines, patients received 18 months of ABL or TPTD followed by ALN for 5 years, or 5 years of ALN monotherapy. Analyses were conducted in high-risk men aged over 50 years defined as having a bone mineral density T-score ≤−2.5 and a recent fracture. Time-specific risk of subsequent fracture after a recent fracture, incremental costs up to 5 years following fractures, real-world medication adherence, and mostly US men-specific data were included in the model. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of results. Results: Over the full age range, sequential ABL/ALN led to more QALYs for lower costs than sequential unbranded TPTD/ALN, while no treatment was dominated (more QALYs, lower costs) by ALN monotherapy. The costs per QALY gained of sequential ABL/ALN were lower than the US threshold of US$150,000 versus generic ALN monotherapy. The probabilities that sequential ABL/ALN was cost effective compared to ALN monotherapy were estimated at 51% in men aged 50 years and between 88 and 90% in those aged ≥ 60 years. Conclusions: Sequential therapy using ABL/ALN may be cost effective compared with generic ALN monotherapy in US men aged ≥ 50 years at high fracture risk, especially in those aged ≥ 60 years. Unbranded TPTD/ALN and no treatment were dominated interventions (less QALY, more costs) compared with ABL/ALN or ALN monotherapy. [ABSTRACT FROM AUTHOR]

Rationale: Low and high body mass index (BMI) are associated with increased mortality after lung transplantation. Why extremes of BMI might increase risk of death is unknown. Objectives: To estimate the association of extremes of BMI with causes of death after transplantation. Methods: We performed a retrospective study of the United Network for Organ Sharing database, including 26,721 adults who underwent lung transplantation in the United States between May 4, 2005, and December 2, 2020. We mapped 76 reported causes of death into 16 distinct groups. We estimated cause-specific hazards for death from each cause using Cox models. Results: Relative to a subject with a BMI of 24 kg/m², a subject with a BMI of 16 kg/m² had 38% (hazard ratio [HR], 1.38; 95% confidence interval [95% CI], 0.99–1.90), 82% (HR, 1.82; 95% CI, 1.34–2.46), and 62% (HR, 1.62; 95% CI, 1.18–2.22) increased hazards of death from acute respiratory failure, chronic lung allograft dysfunction (CLAD), and infection, respectively, and a subject with a BMI of 36 kg/m² had 44% (HR, 1.44; 95% CI, 0.97–2.12), 42% (HR, 1.42; 95% CI, 0.93–2.15), and 185% (HR, 2.85; 95% CI, 1.28–6.33) increased hazards of death from acute respiratory failure, CLAD, and primary graft dysfunction, respectively. Conclusions: Low BMI is associated with increased risk of death from infection, acute respiratory failure, and CLAD after lung transplantation, whereas high BMI is associated with increased risk of death from primary graft dysfunction, acute respiratory failure, and CLAD. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, transgender, queer/questioning, and other sexual and gender minority (LGBTQ+) asylum seekers are exposed to high rates of persecution. This study aimed to identify the forms of ill treatment and the impact of these experiences on the mental health of 66 self‐identified LGBTQ+ asylum seekers from 24 nations through the analysis of human rights program intakes, sworn declarations, and pro bono forensic psychological evaluation affidavits. The results indicate that participants experienced physical assault (92.4%), harassment and intimidation (84.8%), and sexual assault (56.1%). Psychological sequelae included symptoms of posttraumatic stress disorder (PTSD; 83.3%), depression (72.7%), and anxiety (57.6%). LGBTQ+ asylum seekers faced additional hazards upon arrival in the United States. Still, these asylum seekers experienced resilience as they leveraged internal and external support. The results can serve to inform clinical professionals about the range and impact of exposures to harm experienced by LGBTQ+ asylum seekers as well as possible strategies for support and advocacy for this diverse community. [ABSTRACT FROM AUTHOR]

In Pacific Rim countries parents of children with developmental disabilities have organized peer support organizations. One form of peer support is Parent to Parent based on one to one connections between two parents. The movements to create and sustain peer support in the U.S., New Zealand, China, and Korea are described. Qualitative evidence from interviews in the US indicates several reasons why Parent to Parent is effective for some of the people who obtain social provisions from the organizations. Peer support helps parents resist social stigma, gain hope, and obtain persuasive guidance. They are able to exchange situated knowledge from their lived experiences with children with disabilities (Brown, Collins & Duguid, 1989). This kind of information may not be available through other sources.

Many teacher education programs in the United States (US) face increasing demands to better prepare teachers for entry into and retention in urban schools. Through a US Department of Education grant, a university-school partnership was formed to develop a community-based model of teacher preparation that placed pre-service teachers in urban schools for a full year. Based on questionnaires and interviews with university teacher education faculty, and both pre-service and novice classroom teachers who took their first jobs in urban schools, this research considers the common concerns and disparate roles that the three groups considered paramount in preparing new teachers for urban schools.

Public policy aimed at supporting the caregiving capacity of families has risen to prominence on the public agenda in the United States. Initiatives at the state and federal levels have created some initial services. Three trends that are pushing the issue of family caregiving to the surface are discussed, including large-scale social, demographic, and economic changes. The pressures on women from increased caregiving demands are discussed, along with the taken-for-granted cultural value placed on the home as a locus of care for family members who need assistance with common daily activities. Experiments at the state level with consumer-directed care and capitated wrap-around services are described. The authors argue that support for caregiving families is likely to remain a prominent concern of the public and policy makers for the foreseeable future.

Family members provide the majority of care for individuals with disabilities in the United States. There is growing recognition that family caregiving deserves and may require societal support, and evidence-based practices have been established for reducing stress associated with caregiving. A substantial research literature on family support has developed, but researchers, advocates, and professionals have often worked in separate categorical domains such as family support for caregiving for the frail elderly, for individuals with mental illnesses, and for people with developmental disabilities. This article considers the merits of a cross-categorical analysis of family support. Examples of concepts from one domain of family support are applied to other domains to illustrate the potential benefits of a broader exchange of ideas.

The British novelist Nicky Singer talks about becoming a writer, the role of editors and about who decides what can--and what cannot--be published on either side of the Atlantic. Her three novels explore territory which can make publishers nervous: "Feather Boy" (initiation rites and domestic violence), "Doll" (self-harm) and "The Innocent's Story" (terrorist suicide bombing). The sharply contrasting responses from publishers in the United Kingdom and the United States are described. Through Nicky Singer's sometimes extraordinary experiences with publishers runs the implicit question, perhaps as important now as it has ever been: What constraints should there be on what is explored in books for young readers?

This study utilized critical race theory (CRT) as an epistemological framework and theoretical tool for understanding African American male student-athletes' perceptions of racism and the potential impact racism might have on their educational experiences and overall development. This qualitative case study included a single focus group and in-depth interviews with four African American male football players in a big-time college sport program at a predominantly White institution (PWI) in the Midwestern United States. These males felt that racism manifested itself in terms of African Americans (1) being denied access to leadership and major decision-making opportunities in college and professional sport, and (2) being treated differently than their White counterparts. These findings point to the need for further studies that are inclusive of the voices of this particular group and other groups of African American student-athletes. Further, these results have implications for administrators, coaches, academic support personnel, and other educators at American universities and colleges with big-time college sport programs.

In this article, the author discusses the contradictory goals of several groups and individuals that are waging war against social studies and the historians' attitudes in response to this war. He stresses that he is not claiming that these "strange bedfellows," as he comes to call them, that are attacking social studies are working in collusion or that they even think of themselves as allies. Their relationship is probably closer to what Derrick Bell describes as an "interest convergence." The leaders of the current attack on social studies are a loosely structured, diverse coalition, with contradictory political goals, which is funded by foundations and think tanks with strong right-wing ideological leanings. Although there is no single policy board directing the attack on social studies, there is a series of interlocking directorships and memberships that mirror the interlocking relationships used to avoid antitrust laws by corporations. This coalition includes: (1) wealthy corporate leaders, who are promoting patriotic history for profit; (2) "new" Left academics from the sixties who have become a dominant voice in professional historians' organizations and defenders of a new, broader, historical canon; (3) neoconservatives, for whom the war on social studies is part of a general attack on the institution of public education; (4) veterans of the 1980s battle against multicultural education, who view social studies curricula as bastions of "ethnic nationalism" and "cultural particularism;" (5) traditional conservatives, who argue for content-based instruction and rigorous assessment; (6) groups from the "religious right" who blame the social studies approach for undermining religious and moral values in American society; and (7) Chester Finn and the Fordham Foundation, who sponsored the book "Where Did Social Studies Go Wrong?." The author also addresses the four underlying problems with the way historians have functioned in the war against social studies: (1) arrogance; (2) compartmentalization; (3) a depressed job market; and (4) the fact that historians do not get any respect.

Background: Collaboration between clinical and community-based social service organizations is increasingly seen as vital for preventing and managing chronic diseases but has been challenging to establish and sustain. Purpose: The aim of this study was to identify organizational barriers and facilitators for clinic–community collaboration. Methodology/Approach: We employed multiple methods to study a national sample of nonprofit community-based organizations that each collaborated with local clinical organizations for diabetes prevention in the United States. We used qualitative data collected longitudinally through 65 semistructured interviews from 2016 to 2017 at seven of these organizations and their clinical collaborators to understand their relationships. We employed survey data (N = 247 with 73% response rate) to measure and explore relationships among qualitatively identified themes and collaboration performance. Results: We documented three levels of organizational challenges to community–clinic collaboration. Interorganizational challenges pertain to facing only weakly aligned interests across organizations. Interpersonal challenges pertain to misperceptions and miscommunications that occur as frontline employees from differing organizations seek to work together. Task-related challenges pertain to the inadequacy of current processes to effectively link services across clinical and community settings. We found that bridging leadership , provisional teamwork, and learning processes helped to overcome these challenges by enabling iterative progress. Follow-up national survey results indicated that these facilitators were significantly associated with collaboration performance. Conclusions: Because community–clinic collaboration presents substantial interorganizational, interpersonal, and task-related challenges, financial incentives alone are likely insufficient for success. Practice Implications: Resources that help develop capacity to work across community and clinical settings may be vital and warrant dedicated funding. [ABSTRACT FROM AUTHOR]

The article highlight the flaws and racism inherent in the child welfare system in the U.S. It aims to center the voices of those most affected by the system and offer insights into alternative ways of working with families that do not tear them apart. It also sheds light on the limitations of legal solutions and highlights the need for systemic change to address the root causes of poverty, homelessness, and child removals.

The current study replicated Wang and Singer's ([2021]. A cross-cultural study of self-defining memories in Chinese and American college students. Frontiers in Psychology, 11. ) finding that Chinese college students from the People's Republic of China (PRC) recalled more self-defining memories (SDMs) focused on high school academic stress than their American counterparts. Seventy-eight American students from a private 4-year liberal arts college and 96 Chinese students from 13 different Chinese universities recalled two SDMs and rated them for affect, recall frequency, and importance. Once again, Chinese college students were more likely than American students to recall academic stress SDMs, but also expressed more redemptive themes in these memories. Overall, Chinese students rated their SDMs as more positive than the Americans, while the American sample tended to recall their negative memories more frequently. Contrasting the SDMs, American students self-reported higher levels of stress about their high school workload and less academic self-confidence. Regressions linked more negative affect in American SDMs to these work load and self-confidence concerns. Chinese students' SDM negative affect was most strongly predicted by perceived academic stress linked to parental and teachers' expectations. The discussion highlights the potential influence of Confucian values in the Chinese students' responses to past academic stress and their internalisation of academic stress memories in their narrative identity. [ABSTRACT FROM AUTHOR]

The sucrose and Alanine (Ala) content in edamame beans significantly impacts the sweetness flavor of edamame-derived products as an important attribute to consumers' acceptance. Unlike grain-type soybeans, edamame beans are harvested as fresh beans at the R6 to R7 growth stages when beans are filled 80-90% of the pod capacity. The genetic basis of sucrose and Ala contents in fresh edamame beans may differ fromthose in dry seeds. To date, there is no report on the genetic basis of sucrose and Ala contents in the edamame beans. In this study, a genome-wide association study was conducted to identify single nucleotide polymorphisms (SNPs) related to sucrose and Ala levels in edamame beans using an association mapping panel of 189 edamame accessions genotyped with a SoySNP50K BeadChip. A total of 43 and 25 SNPs was associated with sucrose content and Ala content in the edamame beans, respectively. Four genes (Glyma.10g270800, Glyma.08g137500, Glyma.10g268500, and Glyma.18g193600) with known effects on the process of sucrose biosynthesis and 37 novel sucroserelated genes were characterized. Three genes (Gm17g070500, Glyma.14g201100 and Glyma.18g269600) with likely relevant effects in regulating Ala content and 22 novel Ala-related genes were identified. In addition, by summarizing the phenotypic data of edamame beans from three locations in two years, three PI accessions (PI 532469, PI 243551, and PI 407748) were selected as the high sucrose and high Ala parental lines for the perspective breeding of sweet edamame varieties. Thus, the beneficial alleles, candidate genes, and selected PI accessions identified in this study will be fundamental to develop edamame varieties with improved consumers' acceptance, and eventually promote edamame production as a specialty crop in the United States. [ABSTRACT FROM AUTHOR]

The article discusses modern childbirth experiences in the U.S. and the benefits of doula services to pregnant persons, infants and families. Topics include an overview of maternal and infant mortality in the U.S., guidance to health insurance plan providers on how to regulate and reimburse coverage of doula services, the role of doulas and the impact of doula services in improving maternal and infant outcomes, and coverage of doula services both in the public and private sector.

Background: Healthcare fragmentation may lead to adverse consequences and may be amplified among older, sicker patients with mental health (MH) conditions.Objective: To determine whether older Veterans with MH conditions have more fragmented outpatient non-MH care, compared with older Veterans with no MH conditions.Design: Retrospective cohort study using FY2014 Veterans Health Administration (VHA) administrative data linked to Medicare data.Participants: 125,481 VHA patients ≥ 65 years old who were continuously enrolled in Medicare Fee-for-Service Parts A and B and were at high risk for hospitalization.Main Outcome and Measures: The main outcome was non-MH care fragmentation as measured by (1) non-MH provider count and (2) Usual Provider of Care (UPC), the proportion of care with the most frequently seen non-MH provider. We tested the association between no vs. any MH conditions and outcomes using Poisson regression and fractional regression with logit link, respectively. We also compared Veterans with no MH condition with each MH condition and combinations of MH conditions, adjusting for sociodemographics, comorbidities, and drive-time to VHA specialty care.Key Results: In total, 47.3% had at least one MH condition. Compared to those without MH conditions, Veterans with MH conditions had less fragmented care, with fewer non-MH providers (IRR = 0.96; 95% CI: 0.96-0.96) and more concentrated care with their usual provider (OR = 1.08 for a higher UPC; 95% CI: 1.07, 1.09) in adjusted models. Secondary analyses showed that those with individual MH conditions (e.g., depression) had fewer non-MH providers (IRR range: 0.86-0.98) and more concentrated care (OR range: 1.04-1.20). A similar pattern was observed when examining combinations of MH conditions (IRR range: 0.80-0.90; OR range: 1.16-1.30).Conclusions: Contrary to expectations, having a MH condition was associated with less fragmented non-MH care among older, high-risk Veterans. Further research will determine if this is due to different needs, underuse, or appropriate use of healthcare. [ABSTRACT FROM AUTHOR]

Given the complexity of antimicrobial resistance and the dire implications of misusing antimicrobials, it is imperative to identify accurate and meaningful ways to understand and communicate the realities, challenges, and opportunities associated with antimicrobial utilization and measurement in all sectors, including in animal agriculture. The objectives of this article are to (i) describe how antimicrobials are regulated and used in US animal agriculture and (ii) highlight realities, challenges, and opportunities to foster multidisciplinary understanding of the common goal of responsible antimicrobial use. Recognition of the realities of medicine, practice, and policy in the agricultural setting is critical to identify realistic opportunities for improvement and collaboration. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare prevalence of JUUL use and JUUL risk perceptions between adolescents living in an urban area versus Appalachian areas of the U.S. Data were drawn from a prospective cohort study of adolescent males (the Buckeye Teen Health Study, or BTHS); our cross-sectional analysis used data from one timepoint, collected between January and December 2019 (N = 873). Chi-square tests and multivariable logistic regression compared JUUL use prevalence and risk perceptions between participants in an urban Ohio county and nine predominantly rural Appalachian Ohio counties. Over a quarter of the sample (29.2%) had ever used JUUL. In the unadjusted model, prevalence of JUUL use was similar between regions but Appalachian participants perceived JUUL as more harmful (p <.001) and more addictive (p =.04) than urban participants. In the adjusted model, region was not significantly related to current JUUL use (OR: 1.20, 95% CI: 0.77, 1.87) or ever JUUL use (OR: 1.15, 95% CI: 0.83, 1.60). JUUL use was similar between urban and Appalachian participants despite regional differences in risk perceptions. Interventions that only target risk perceptions may not be sufficient to prevent adolescent e-cigarette use, particularly in rural communities. [ABSTRACT FROM AUTHOR]

Health and well‐being are promoted when primary care teams partner with patients and provide care coordination to mitigate risks and promote optimal health. Identification of patients for care coordination is typically based on claim‐driven risk assessments. Evidence shows that social determinants of health (SDOH) drive risk for adverse health outcomes but are omitted from existing risk tools. Missed opportunities for care coordination contribute to increased healthcare costs, poorer health outcomes and reduced patient well‐being. To address the gap of risk‐informed care coordination that includes SDOH, the aim of this project was to implement process improvement of a system's care coordination program through refined patient selection and customised engagement in intensive care coordination. A non‐randomised care coordination quality improvement project was conducted at a community health centre in 2020. Inclusion criteria (i.e. presence of risk attribution score, SDOH questionnaire completed) resulted in 540 patients being offered care coordination services; Patients having at least one month of care coordination were included in the analysis (N = 216). Analysis included the 216 patients that chose participation and the 324 patients that maintained usual care. Descriptive statistics were generated to distinguish patient demographics, frequency of care coordination contact, and specific SDOH insecurities for both the study and comparison groups. Paired t‐tests were incorporated to evaluate statistical significance of the intervention group. Impact on well‐being, SDOH barriers, appointment adherence and health outcomes were assessed in both conditions. Intervention condition patients reported improvement in well‐being [feeling anxious (t = 4.051; p < 0.000)] and reduced SDOH barriers [food access (t = 4.662; p < 0.000); housing (t = 2.203; p = 0.008)] that were significantly different from the usual care condition in the expected directions. Care coordination based on factors including SDOH risks shows promise in improving patient well‐being. Future research should refine this approach for comprehensive risk assessment to intervene and support patient health and well‐being. [ABSTRACT FROM AUTHOR]