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Study Objectives: To assess the effectiveness of continuous positive airway pressure (CPAP) management guided by CPAP machine downloads in newly diagnosed patients with obstructive sleep apnea (OSA) using electronic health record-derived health care utilization, biometric variables, and laboratory data., Methods: Electronic health record data of patients seen at the University of Utah Sleep Program from 2012-2015 were reviewed to identify patients with new diagnosis of OSA in whom CPAP adherence and residual apnea-hypopnea index as measured by a positive airway pressure adherence tracking device data for ≥ 1 year were available. Biometric data, laboratory data, and system-wide charges were compared in the 1 year before and after CPAP therapy. Subgroups were divided by whether patients met tracking criteria, mean nightly usage, and OSA severity., Results: 976 consecutive, newly diagnosed participants with OSA (median age 55 years, 56.6% male) met inclusion criteria. There was a mean decrease of systolic blood pressure (BP) of 1.2 mm Hg and diastolic BP of 1.0 mm Hg within a year of initiation of CPAP therapy. BP improvements in the subgroup meeting CPAP tracking targets were 1.36 mmHg (systolic) and 1.37 mmHg (diastolic). No significant change was noted in body mass index, glycated hemoglobin, or serum creatinine values within a year of starting CPAP therapy, and health care utilization increased (mean acute care visits 0.22 per year to 0.53 per year; mean charges of $3,997 per year to $8,986 per year)., Conclusions: An improvement in BP was noted within a year of CPAP therapy in newly diagnosed patients with OSA, with no difference in the magnitude of improvement between those meeting tracking system adherence targets., Citation: Locke BW, Neill SE, Howe HE, Crotty MC, Kim J, Sundar KM. Electronic health record-derived outcomes in obstructive sleep apnea managed with positive airway pressure tracking systems. J Clin Sleep Med . 2022;18(3):885-894., (© 2022 American Academy of Sleep Medicine.)

Background: Urgent and emergency care health services are overburdened, and the use of these services by acutely ill infants and children is increasing. A large proportion of these visits could be sufficiently addressed by other health care professionals. Uncertainty about the severity of a child's symptoms is one of many factors that play a role in parents' decisions to take their children to emergency services, demonstrating the need for improved support for health literacy. Digital interventions are a potential tool to improve parents' knowledge, confidence, and self-efficacy at managing acute childhood illness. However, existing systematic reviews related to this topic need to be updated and expanded to provide a contemporary review of the impact, usability, and limitations of these solutions., Objective: The purpose of this systematic review protocol is to present the method for an evaluation of the impact, usability, and limitations of different types of digital educational interventions to support parents caring for acutely ill children at home., Methods: The review will be structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and Population, Intervention, Comparator, and Outcome (PICO) frameworks. Five databases will be systematically searched for studies published in English during and after 2014: Medline, EMBASE, CINAHL, APA PsycNet, and Web of Science. Two reviewers will independently screen references' titles and abstracts, select studies for inclusion based on the eligibility criteria, and extract the data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer if necessary. Risk of bias of all studies will be assessed using the Mixed-Methods Appraisal Tool (MMAT), and a descriptive analysis will be used to evaluate the outcomes reported., Results: The systematic review will commence during 2021., Conclusions: This systematic review will summarize the impact, usability, and limitations of digital interventions for parents with acutely ill children. It will provide an overview of the field; identify reported impacts on health and behavioral outcomes as well as parental knowledge, satisfaction, and decision making; and identify the factors that affect use to help inform the development of more effective and sustainable interventions., International Registered Report Identifier (irrid): PRR1-10.2196/27504., (©Madison Milne-Ives, Sarah Neill, Natasha Bayes, Mitch Blair, Jane Blewitt, Lucy Bray, Enitan D Carrol, Bernie Carter, Rob Dawson, Paul Dimitri, Monica Lakhanpaul, Damian Roland, Alison Tavare, Edward Meinert, ASK SNIFF Consortium. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 30.06.2021.)

College students from diverse ethnic and socioeconomic backgrounds are at risk for poorer academic outcomes and greater psychopathology and it is important to identify factors that are amenable to intervention and enhance college outcomes. Recent literature has entertained happiness as a potential predictor of various success outcomes and it has been suggested that parsing the concept of happiness into hedonia (seeking pleasure and relaxation) and eudaimonia (seeking meaning) may be particularly useful. This study examined the relations between hedonic and eudaimonic motives for action and student outcomes; that is, academic achievement and their negative emotional states, in an ethnically and socioeconomically diverse urban college population. Undergraduate students (N=119; mean age=21.24 [SD=3.16] years; 59.7 % female) completed self-reported measures of hedonic and eudaimonic motives for action, and depression, anxiety, and stress. Semester GPA was collected from school records. Hedonic motives for action ("Hedonia") were not associated with GPA or students' negative emotional states. Eudaimonic motives for action ("Eudaimonia"), however, were significantly positively associated with GPA, Individuals with high levels of both Hedonia and Eudaimonia (the Full Life) had higher GPAs compared to individuals with low Eudaimonia, but did not differ from students with high Eudaimonia and low Hedonia (Eudaimonic Life). Eudaimonia was also significantly negatively associated with Depression and Stress, and individuals high in Eudaimonia had the lowest levels of both of these outcomes compared to those with low Eudaimonia. Eudaimonic motives may be important for more desirable college outcomes, and interventions that promote development of this domain may hold promise., Competing Interests: Conflict of Interest: The authors declare that they have no conflicts of interest

Purpose of Review: Our purpose is to describe aspiration pneumonia/pneumonitis as a spectrum of infectious/noninfectious diseases affecting the lung. We summarize diagnosis, risk factors, treatment, and strategies for prevention of aspiration., Recent Findings: Aspiration is present in normal individuals, and disease manifestation depends on the chemical characteristics, frequency, and volume of inoculum. Anaerobes, though present, are no longer the predominant microbes isolated in aspiration pneumonia. Targets for preventing aspiration including improved oral hygiene and positional feeding have had mixed results. Patients diagnosed by clinicians with aspiration pneumonia experience greater morbidity and mortality than patients with community-acquired pneumonia., Summary: Aspiration pneumonia and pneumonitis are part of the pneumonia continuum and share similarities in pathophysiology, microbiology, and treatment. Modern microbiology demonstrates that the lung is not sterile, and isolates in aspiration pneumonia frequently include aerobes or mixed cultures. Treatment for aspiration pneumonia should include antibiotic coverage for oral anaerobes, aerobes associated with community-acquired pneumonia, and resistant organisms depending on appropriate clinical context. Additional studies targeting prevention of aspiration and investigating the increased morbidity and mortality associated with aspiration pneumonia are warranted.

Objective: To identify the effectiveness of information resources to help parents decide when to seek medical care for an acutely sick child under 5 years of age, including the identification of factors influencing effectiveness, by systematically reviewing the literature., Methods: 5 databases and 5 websites were systematically searched using a combination of terms on children, parents, education, acute childhood illness. A narrative approach, assessing quality via the Mixed Methods Appraisal Tool, was used due to non-comparable research designs., Results: 22 studies met the inclusion criteria: 9 randomised control trials, 8 non-randomised intervention studies, 2 qualitative descriptive studies, 2 qualitative studies and 1 mixed method study. Consultation frequency (15 studies), knowledge (9 studies), anxiety/reassurance (7 studies), confidence (4 studies) satisfaction (4 studies) and antibiotic prescription (4 studies) were used as measures of effectiveness. Quality of the studies was variable but themes supported information needing to be relevant and comprehensive to enable parents to manage an episode of minor illness Interventions addressing a range of symptoms along with assessment and management of childhood illness, appeared to have the greatest impact on the reported measures. The majority of interventions had limited impact on consultation frequencies, No conclusive evidence can be drawn from studies measuring other outcomes., Conclusions: Findings confirm that information needs to be relevant and comprehensive to enable parents to manage an episode of minor illness. Incomplete information leaves parents still needing to seek help and irrelevant information appears to reduce parents' trust in the intervention. Interventions are more likely to be effective if they are also delivered in non-stressful environments such as the home and are coproduced with parents., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Context: Acute illness is a universal experience in early childhood. Parents find it difficult to determine whether or not their child requires medical care and seek information to inform their decision making. Little is known about parents' information seeking behaviour and what helps or hinders their decision making., Objective: This study aimed to explore parents' use of information resources during decision making in acute childhood illness at home., Design/method: This exploratory qualitative study used focus groups and interviews to collect data from parents of children under 5 years of age., Setting and Participants: Twenty-seven parents were recruited in the East Midlands, UK, in South Asian and Gypsy/Travelling communities, a Children's Centre and a private sector day nursery., Findings: Parents' pre-consultation information seeking was dominated by the internet, albeit with limited success. Parents liked easy to access, professionally validated and simple messages with access to more detailed information. Some parents always sought information through personal contact, whilst others did so when independent information seeking failed. When consulting a healthcare professional, parents liked to be given information to refer to later, although the information received varied. Importantly, neither hard copy nor the internet was accessible for parents with low levels of literacy., Discussion and Conclusions: Although there is a wealth of information parents can access independently, our findings indicate a need for easy access to clearly signposted, professionally validated resources and available in a range of formats provided through different delivery systems. One size does not fit all., (© 2014 John Wiley & Sons Ltd.)

Everyday thousands of children are presented to health care practitioners by concerned parents with the vast majority being simple self-limiting illness. However serious bacterial illness, chronic inflammatory conditions and mental health problems are repeatedly missed with significant morbidity, mortality, financial and social implications. A conceptual framework detailing the mechanism of effective Safety Netting has yet to be described however and there is increasing evidence parents want guidance on when to seek medical advice (a key part of safety netting) prior to initial consultation. This article explores current understanding of safety netting in relation to child health and argues there is a need to develop a more standardised approach.

Background: Parents with young children often worry about whether or not to seek medical help for a sick child. Previous research identified parents' anxieties surrounding help seeking from health services but did not explore or explain the underlying psychosocial processes taking place in families at these times., Objectives: This paper presents findings from a British grounded theory study on family management of acute childhood illness at home, which provide an explanation for parent's helping seeking behaviours., Design: Glaserian grounded theory methodology was used for the study., Setting: The sampling sites for the study were in two towns in the East Midlands with population profiles close to the national average for the UK., Participants: Initial purposeful and later theoretical sampling resulted in a sample of fifteen families with children aged between 1 month and 8 years of age., Methods: Four sets of data collection took place between 2001 and 2007. Unstructured family interviews were conducted with adult family members and a draw, write or tell technique was used to interview any children over 4 years of age. Theoretical sensitivity and constant comparative analysis were employed to achieve theoretical saturation around a core category., Findings: Felt or enacted criticism teaches parents informal social rules which direct how they are expected to behave. Their desire to avoid such criticism of their moral status as 'good' parents creates significant hidden anxiety about when to seek medical help. This anxiety sometimes leads to late consultation with potentially serious consequences for their child's health., Conclusion: The grounded theory indicates the need for significant investment in the training of nurses and other health professionals to reduce parents' (and other patients') experiences of felt or enacted criticism and the consequent hidden anxiety. When parents are worried about their child's health, they need to be able to seek help from health professionals without fear of criticism. These conclusions are primarily limited to universal health care environments., (Copyright © 2011 Elsevier Ltd. All rights reserved.)