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RationaleAge and sex are associated with differences in asthma prevalence and morbidity.ObjectivesTo determine if age and sex associate with distinct phenotypes and a variable response to therapy in subjects with mild to moderate asthma.MethodsWe used Asthma Clinical Research Network data to determine the impact of age and sex on phenotypes and treatment failures among subjects participating in 10 trials from 1993 to 2003.Measurements and main resultsA total of 1,200 subjects were identified (median age, 30.4 yr; male, 520 [43.3%]; female, 680 [56.7%]) and analyzed. A higher proportion of subjects greater than or equal to 30 years old experienced treatment failures (17.3% vs. 10.3%; odds ratio [OR], 1.82; confidence interval [CI], 1.30-2.54; P

Introduction: Coordination of the tasks of performing chest compressions and defibrillation can lead to communication challenges that may prolong time spent off the chest. The purpose of this study was to determine whether defibrillation provided by the provider performing chest compressions led to a decrease in peri-shock pauses as compared to defibrillation administered by a second provider, in a simulated cardiac arrest scenario.Methods: This was a randomized, controlled study measuring pauses in chest compressions for defibrillation in a simulated cardiac arrest model. We approached hospital providers with current CPR certification for participation between July, 2011 and October, 2011. Volunteers were randomized to control (facilitator-administered defibrillation) or experimental (compressor-administered defibrillation) groups. All participants completed one minute of chest compressions on a mannequin in a shockable rhythm prior to administration of defibrillation. We measured and compared pauses for defibrillation in both groups.Results: Out of 200 total participants, we analyzed data from 197 defibrillations. Compressor-initiated defibrillation resulted in a significantly lower pre-shock hands-off time (0.57 s; 95% CI: 0.47-0.67) compared to facilitator-initiated defibrillation (1.49 s; 95% CI: 1.35-1.64). Furthermore, compressor-initiated defibrillation resulted in a significantly lower peri-shock hands-off time (2.77 s; 95% CI: 2.58-2.95) compared to facilitator-initiated defibrillation (4.25 s; 95% CI: 4.08-4.43).Conclusion: Assigning the responsibility for shock delivery to the provider performing compressions encourages continuous compressions throughout the charging period and decreases total time spent off the chest. However, as this was a simulation-based study, clinical implementation is necessary to further evaluate these potential benefits. [West J Emerg Med. 2014;15(2):246–250.]

Background: Bacterial prophylaxis with a fluoroquinolone (FQ) during autologous stem cell transplant (ASCT) is common, although not standardized among transplant centers. The addition of doxycycline (doxy) to FQ prophylaxis was previously linked to reduced neutropenic fever and bacteremia in multiple myeloma (MM) patients undergoing ASCT although several confounders were present. We compared the incidence of neutropenic fever and bacteremia between MM patients variably receiving prophylaxis with FQ alone and FQ‐doxy during ASCT. Methods: Systematic retrospective chart review of MM patients who underwent ASCT between January 2016 and December 2021. The primary objective was to determine the effect of bacterial prophylaxis on neutropenic fever and bacteremia within 30 days of ASCT. Multivariable logistic regression for neutropenic fever and univariate logistic regression for bacteremia accounted for differences in subject characteristics between groups. Results: Among 341 subjects, 121 received FQ and 220 received FQ‐doxy for prophylaxis. Neutropenic fever developed in 67 (55.4%) and 87 (39.5%) subjects in the FQ and FQ‐doxy groups, respectively (p =.005). Bacteremia was infrequent, with 5 (4.1%) and 5 (2.3%) cases developing in the FQ and FQ‐doxy groups, respectively (p =.337). Among Gram‐negative bacteremia events, 7/7 Escherichia coli strains were FQ‐resistant, and 5/7 were ceftriaxone‐resistant. Conclusion: The FQ‐doxy prophylaxis group had fewer cases of neutropenic fever than the FQ group, however, there was no significant difference in bacteremia. High rates of antibiotic resistance were observed. An updated randomized controlled trial investigating appropriate prophylaxis for ASCT in the context of current oncology standards and changing antimicrobial resistance rates is warranted. [ABSTRACT FROM AUTHOR]

Background: The whole school, whole community, whole child (WSCC) model suggests wellness councils, ongoing review of wellness policy, and a plan for evaluating set objectives are some of the key features needed to support school wellness infrastructure. This study explored the relationship between implementation of these infrastructure features and overall school wellness environment assessment scores among a sampling of Pennsylvania schools. Methods: The Healthy Champions program provides Pennsylvania schools an opportunity to self‐assess their wellness environments across several school wellness topics. Staff enrolled their school in the program by completing a self‐report electronic assessment. Enrollment data from the 2020/2021 program year were analyzed using the Kruskal‐Wallis test and linear fixed model to identify the impact of varied implementation levels across 3 wellness infrastructure activities. Interactions between these variables and overall assessment score were also analyzed. Results: Of the 645 Pennsylvania schools enrolled and analyzed, we observed higher mean wellness environment assessment scores (∆ 0.74 95% CI 0.40‐1.07; p < 0.001) among schools that reported some frequency of all 3 wellness infrastructure activities, compared to schools that reported no frequency for the activities. Implications: Schools with existing policies and practices related to the 3 wellness infrastructure activities should consider the degree of implementation to best support overall wellness in their school setting. Additional research to explore implementation barriers and supports is needed. Conclusions: Analyses indicated that overall wellness environment assessment scores are impacted by implementation thresholds for wellness council meeting frequency, revision of wellness policy, and review of student health promotion objectives. [ABSTRACT FROM AUTHOR]

RationaleThe function of the P2X(7) nucleotide receptor protects against exacerbation in people with mild-intermittent asthma during viral illnesses, but the impact of disease severity and maintenance therapy has not been studied.ObjectivesTo evaluate the association between P2X(7), asthma exacerbations, and incomplete symptom control in a more diverse population.MethodsA matched P2RX7 genetic case-control was performed with samples from Asthma Clinical Research Network trial participants enrolled before July 2006, and P2X(7) pore activity was determined in whole blood samples as an ancillary study to two trials completed subsequently.Measurements and main resultsA total of 187 exacerbations were studied in 742 subjects, and the change in asthma symptom burden was studied in an additional 110 subjects during a trial of inhaled corticosteroids (ICS) dose optimization. African American carriers of the minor G allele of the rs2230911 loss-of-function single nucleotide polymorphism were more likely to have a history of prednisone use in the previous 12 months, with adjustment for ICS and long-acting β(2)-agonists use (odds ratio, 2.7; 95% confidence interval, 1.2-6.2; P = 0.018). Despite medium-dose ICS, attenuated pore function predicted earlier exacerbations in incompletely controlled patients with moderate asthma (hazard ratio, 3.2; confidence interval, 1.1-9.3; P = 0.033). After establishing control with low-dose ICS in patients with mild asthma, those with attenuated pore function had more asthma symptoms, rescue albuterol use, and FEV(1) reversal (P < 0.001, 0.03, and 0.03, respectively) during the ICS adjustment phase.ConclusionsP2X(7) pore function protects against exacerbations of asthma and loss of control, independent of baseline severity and the maintenance therapy.

Purpose: To compare Aevidum's school mental health curriculum vs the curriculum plus Aevidum clubs in a mixed-methods study including pre/post surveys, a randomized clinical trial, and qualitative interviews. Design: Concurrent mixed-methods: Aim 1) pre-post surveys evaluated curriculum only vs curriculum plus club schools separately regarding changes in knowledge, help-seeking, and school culture; Aim 2) randomized clinical trial compared curriculum only to curriculum plus club schools; Aim 3) qualitative school staff interviews enhanced understanding of school culture changes. Setting: Curriculum delivered to 9th graders at ten Pennsylvania high schools; 5 schools randomized to start clubs. Subjects: Students (surveys), staff (interviews). Intervention: Aevidum curriculum plus/minus club. Measures: Aim 1, mixed effects linear and logistic regression models for longitudinal data were used to analyze survey items at each time point. Aim 2, the same regression models were used, except models included a fixed-effect for group and group by time interaction effect. Aim 3, interviews were transcribed; a codebook was developed followed by thematic analysis. Results: Pre-survey 2557 respondents; 49% female, 86% non-Hispanic white. Post-survey 737 (29% response rate). Aim 1, pre-post (Likert responses, larger numbers favorable) demonstrated increased student knowledge to identify depression (4.26 [4.19-4.33] to 4.59 [4.47-4.71], P <.001) and help a friend access support (4.30 [4.21-4.38] to 4.56 [4.40-4.71], P =.001). Help-seeking increased for phone helplines (1.61 [1.57-1.66] to 1.78 [1.70-1.86], P <.001), crisis textlines (1.60 [1.55-1.64] to 1.78 [1.70-1.86], P <.001), internet/websites (1.80 [1.75-1.85] to 1.99 [1.90-2.08], P <.001), school counselors (P =.005) and teachers (.013). Aim 2, no significant differences in knowledge, help-seeking or culture between curriculum only vs curriculum plus club schools. Aim 3, staff (n = 17) interviews supported reduced stigma and increased mental health referrals. Conclusions: Aevidum's curriculum improved mental health knowledge and help-seeking; adding the club did not significantly change responses. Staff identified positive school culture impacts. Limitations include the lower post-survey response. [ABSTRACT FROM AUTHOR]

Medical education has traditionally relied on physician educators. With expanding Health Systems Science competencies, non-physician healthcare providers are required. To investigate preceptor-role types, communication frequency, and importance of preceptors in valueadded patient navigator roles (PN) and clinical preceptorships (CP). Using a mixed-methods approach, medical students participating in PN and CP during the first year of medical school (n=191) identified individuals with whom they communicated and communication frequency (1=never, 7=frequently), and importance of preceptors to work/education (1=not important, 7=extremely important; open-ended responses). Quantitative data were analyzed via repeated measures using a mixed-effects model and McNemar's test; effect size was calculated via Cohen's d or Cohen's h; qualitative data was analyzed using thematic analysis. Comparing ratings for non-physicians to physician healthcare professionals in PN, communication frequency (5.54 vs 3.65; p<0.001, d=1.18), importance to work (5.77 vs 4.28, p<0.001, d=0.89) and education (5.02 vs 4.12, p<0.001; d=0.49) were higher for non-physician educators. Comparing ratings for non-physicians to physician healthcare professionals in CP, communication frequency (4.93 vs. 6.48, p<0.001, d=1.33), importance to work (5.12 vs 6.61 vs, p<0.001, d=1.29) and education (4.32 vs 6.55, p<0.001, d=1.89) were higher for physician educators. Qualitative analysis indicated that non-physician healthcare providers in PN focused on Health Systems Science concepts, including social determinants of health and healthcare delivery. In PN, students observed collaboration from the perspective of multiple providers. In CP, healthcare providers, mainly physicians, focused on physician-centric clinical skills and interprofessional collaboration from the physician's perspective. Educational benefits of non-physician healthcare professionals related to Health Systems Science in workbased clinical settings - or Landscapes of Practice - can help students understand systemsbased concepts such as social determinants of health, healthcare delivery systems, and interprofessional collaboration. Differences in the educational value of non-physician healthcare educators perceived by students should be further explored. [ABSTRACT FROM AUTHOR]