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Importance Substantial increases in both neonatal abstinence syndrome (NAS) and maternal opioid use disorder have been observed through 2014. Objective To examine national and state variation in NAS and maternal opioid-related diagnoses (MOD) rates in 2017 and to describe national and state changes since 2010 in the US, which included expanded MOD codes (opioid use disorder plus long-term and unspecified use) implemented inInternational Classification of Disease, 10th Revision, Clinical Modification. Design, Setting, and Participants Repeated cross-sectional analysis of the 2010 to 2017 Healthcare Cost and Utilization Project’s National Inpatient Sample and State Inpatient Databases, an all-payer compendium of hospital discharge records from community nonrehabilitation hospitals in 47 states and the District of Columbia. Exposures State and year. Main Outcomes and Measures NAS rate per 1000 birth hospitalizations and MOD rate per 1000 delivery hospitalizations. Results In 2017, there were 751 037 birth hospitalizations and 748 239 delivery hospitalizations in the national sample; 5375 newborns had NAS and 6065 women had MOD documented in the discharge record. Mean gestational age was 38.4 weeks and mean maternal age was 28.8 years. From 2010 to 2017, the estimated NAS rate significantly increased by 3.3 per 1000 birth hospitalizations (95% CI, 2.5-4.1), from 4.0 (95% CI, 3.3-4.7) to 7.3 (95% CI, 6.8-7.7). The estimated MOD rate significantly increased by 4.6 per 1000 delivery hospitalizations (95% CI, 3.9-5.4), from 3.5 (95% CI, 3.0-4.1) to 8.2 (95% CI, 7.7-8.7). Larger increases for MOD vs NAS rates occurred with newInternational Classification of Disease, 10th Revision, Clinical Modificationcodes in 2016. From a census of 47 state databases in 2017, NAS rates ranged from 1.3 per 1000 birth hospitalizations in Nebraska to 53.5 per 1000 birth hospitalizations in West Virginia, with Maine (31.4), Vermont (29.4), Delaware (24.2), and Kentucky (23.9) also exceeding 20 per 1000 birth hospitalizations, while MOD rates ranged from 1.7 per 1000 delivery hospitalizations in Nebraska to 47.3 per 1000 delivery hospitalizations in Vermont, with West Virginia (40.1), Maine (37.8), Delaware (24.3), and Kentucky (23.4) also exceeding 20 per 1000 delivery hospitalizations. From 2010 to 2017, NAS and MOD rates increased significantly for all states except Nebraska and Vermont, which only had MOD increases. Conclusions and Relevance In the US from 2010 to 2017, estimated rates of NAS and MOD significantly increased nationally and for the majority of states, with notable state-level variation.

In 2020, the COVID-19 pandemic and rise in racial injustices signaled the need to engage students in macro-level interventions to maximize their contributions to their schools, communities, and society. School social workers are uniquely positioned to elevate student voices, hone their critical thinking skills, and capitalize on their strengths and assets. Critical thinking skills can help students analyze the world around them by engaging them in addressing equity issues in their schools and communities. This article introduces the concept of transformative social and emotional learning (TSEL) within the context of youth-led participatory action research (YPAR) and a critical service learning (CSL) framework for school social workers to promote student empowerment. Through CSL, students cultivate advocacy skills by identifying, investigating, and taking action to address concerns. Authors include a case example demonstrating TSEL and YPAR, using CSL as a school social work intervention that recognizes and promotes students’ strengths and assets.

A fishy tale of long and short life span Fish have wide variations in life span even within closely related species. One such example are the rockfish species found along North Pacific coasts, which have life spans ranging from 11 to more than 200 years. Kolora et al . sequenced and performed a genomic analysis of 88 rockfish species, including long-read sequencing of the genomes of six species (see the Perspective by Lu et al .). From this analysis, the authors unmasked the genetic drivers of longevity evolution, including immunity and DNA repair–related pathways. Copy number expansion in the butyrophilin gene family was shown to be positively associated with life span, and population historical dynamics and life histories correlated differently between long- and short-lived species. These results support the idea that inflammation may modulate the aging process in these fish. —LMZ

Background: Symptom burden remains a critical concern for individuals with non-small cell lung cancer (NSCLC) following the completion of treatment. The most common symptom clusters, dyspnea (shortness of breath) and fatigue,can contribute to physical decline, reductions in quality of life, and a higher risk of comorbidities and mortality. Dyspnea is a primary limiter of exercise capacity in individuals with lung cancer, resulting in exercise avoidance and an accelerated physical decline. As such, designing resistance training with cluster sets to mitigate symptoms of dyspnea and fatigue may result in improved exercise tolerance. Thus, maintainingthe exercise stimulus via cluster sets, combined with improved tolerance of the exercise, could result in maintenance of physical function and quality of life. The purpose of this study is to investigate the feasibility and preliminary efficacy of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC. Methods: Individuals with NSCLC (n=15), within 12-months of completion of treatment will be recruited to participate in this single arm feasibility trial. Participants will complete 8-weeks of home-based resistance training designed to minimizedyspnea and fatigue. The hybrid-delivery of the program will include supervised sessions in the participants’ home, and virtual supervision via video conferencing. The primary outcome of feasibility will be quantifiedby recruitment rates, retention, acceptability, and intervention fidelity. Exploratory outcomes (dyspnea, fatigue, quality of life, physical function, and body composition) will be assessed pre- and post- intervention. Discussion: This study will provide important data on the feasibility of delivering this intervention and inform procedures for a future randomized controlled trial. Trial Registration: Record not yet public

Obstructive and central sleep apnea affects ~1 billion people globally and may lead to serious cardiovascular and neurocognitive consequences, but treatment options are limited. High loop gain (ventilatory instability) is a major pathophysiological mechanism underlying both types of sleep apnea and can be lowered pharmacologically with acetazolamide, thereby improving sleep apnea severity. However, individual responses vary and are strongly correlated with the loop gain reduction achieved by acetazolamide. To aid with patient selection for long‐term trials and clinical care, our goal was to understand better the factors that determine the change in loop gain following acetazolamide in human subjects with sleep apnea. Thus, we (i) performed several meta‐analyses to clarify how acetazolamide affects ventilatory control and loop gain (including its primary components controller/plant gain), and based on these results, we (ii) performed physiological model simulations to assess how different baseline conditions affect the change in loop gain. Our results suggest that (i) acetazolamide primarily causes a left shift of the chemosensitivity line thus lowering plant gain without substantially affecting controller gain; and (ii) higher controller gain, higher paCO2 at eupneic ventilation, and lower CO2 production at baseline result in a more pronounced loop gain reduction with acetazolamide. In summary, the combination of mechanistic meta‐analyses with model simulations provides a unified framework of acetazolamide’s effects on ventilatory control and revealed physiological predictors of response, which are consistent with empirical observations of acetazolamide's effects in different sleep apnea subgroups. Prospective studies are needed to validate these predictors and assess their value for patient selection., (a) Based on mechanistic meta‐analyses in patients with sleep apnea, acetazolamide primarily causes a left‐shift of the chemosensitivity line thus lowering plant gain without substantially affecting controller gain; the net effect is a relative reduction in overall loop gain similar to the reduction in plant gain. (b) Based on model simulations, a higher controller gain, higher paCO2 at eupneic ventilation, and lower CO2 production at baseline each result in a more pronounced loop gain reduction with acetazolamide, and thus may predict response to acetazolamide.

Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55–100 mmHg) patients (P = 0.47). Conclusions Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073

Machine learning has the potential to change the practice of medicine, particularly in areas that require pattern recognition (e.g. radiology). Although automated classification is unlikely to be perfect, few modern machine learning tools have the ability to assess their own classification confidence to recognize uncertainty that might need human review. Using automated single-channel sleep staging as a first implementation, we demonstrated that uncertainty information (as quantified using Shannon entropy) can be utilized in a “human in the loop” methodology to promote targeted review of uncertain sleep stage classifications on an epoch-by-epoch basis. Across 20 sleep studies, this feedback methodology proved capable of improving scoring agreement with the gold standard over automated scoring alone (average improvement in Cohen’s Kappa of 0.28), in a fraction of the scoring time compared to full manual review (60% reduction). In summary, our uncertainty-based clinician-in-the-loop framework promotes the improvement of medical classification accuracy/confidence in a cost-effective and economically resourceful manner.

Background The governmental public health workforce in the United States comprises almost 300,000 staff at federal, state, and local levels. The workforce is poised for generational change, experiencing significant levels of retirement. However, intent to leave for other reasons is also substantial, and diversity is lacking in the workforce. Methods Workforce perception data from 76,000 staff from Health and Human Services (HHS) including 14,000 from the Centers for Disease Control and Prevention were analyzed across 2014 and 2017. Additionally, data from 32,000 state and local health department staff in 46 agencies reporting in both years. Estimates were constructed accounting for survey design and non-response. Results In 2017, women made up 43% of the total US government workforce and 33% of supervisors or higher, compared to 73 and 68% generally in State Health Agencies (p p p p Conclusions While intent to leave fell at federal agencies from 2014 to 2017, it increased among staff in state and local health departments. Additionally, while public health is more diverse than the US government overall, significant underrepresentation is observed in supervisory positions for staff of color, especially women.

Purpose To reduce lung cancer mortality, individuals at high risk should receive a low-dose computed tomography screening annually. To increase the likelihood of screening, interventions that promote shared decision-making are needed. The goal of this study was to investigate the feasibility, acceptability, usability, and preliminary effectiveness of a computer-based decision aid. Methods Thirty-three participants were recruited through primary-care clinics in a small southeastern-US city. Participants used a computer-based decision aid (“Is Lung Cancer Screening for You?”) during a clinic appointment. Paper surveys collected self-reported feasibility, acceptability, and usability data. A research coordinator was present to observe each patient’s and health-care provider’s interactions, and to assess the fidelity of shared decision-making. Results The decision aid was feasible, acceptable for use in a clinic setting, and easy for participants to use. Patients had low decisional conflict following use of the decision aid and had high screening intention and actual screening rates. Shared decision-making discussions using the decision aid were nearly 6 minutes on average. Conclusion Computer-based decision aids are feasible for promoting shared lung cancer–screening decisions. A more robust study is warranted to measure the added value of a computer-based version of this aid versus a paper-based aid.

Background The COVID-19 pandemic has resulted in unprecedented disruptions, restrictions, and concerns about physical and mental health. Emerging adulthood, including the first year of college, is associated with declines in healthy eating and physical activity, as well as possible heightened distress. The impact of COVID-19 may exacerbate these concerns. Purpose The purpose of this study was to examine changes in health behaviors and perceived stress in emerging adults over the first year of college and to determine whether prepandemic health behaviors were protective for mental health and stress during the initial changes after the COVID-19 pandemic. Methods First-year college students (N = 234, 58.6% female) completed three surveys during their first year of school, the third being after the onset of COVID-19 and during a stay-at-home order. At Time 3, we also assessed symptoms of anxiety and depression. Results Using linear mixed modeling, sedentary time increased and physical activity decreased over time, but 20%–35% of students reported improvements in these behaviors. Dietary changes appeared mixed, with some improvements noted early during COVID-19. Perceived stress increased over time. Multiple regression indicated that of the health behaviors examined for protective effects on mental health and stress during the pandemic, only diet quality emerged as a significant predictor. Conclusions Although notable declines in some health habits were observed over time, including following COVID-19 disruptions, some students reported improved health behaviors. Efforts should be directed at identifying and intervening with students most at risk for poor functioning.

The genioglossus is a major upper airway dilator muscle. Our goal was to assess the efficacy of upper airway muscle training on Obstructive Sleep Apnea (OSA) as an adjunct treatment. Sixty-eight participants with OSA (AHI &gt, 10/h) were recruited from our clinic. They fall into the following categories: (a) Treated with Automatic Positive Airway Pressure (APAP), (n = 21), (b) Previously failed APAP therapy (Untreated), (n = 25), (c) Treated with Mandibular Advancement Splint (MAS), (n = 22). All subjects were given a custom-made tongue strengthening device. We conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with a 1:1 ratio over 3 months of treatment. In the baseline and the final visit, subjects completed home sleep apnea testing, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), SF-36 (36-Item Short Form Survey), and Psychomotor Vigilance Test (PVT). Intervention (muscle training) did not affect the AHI (Apnea-Hypopnea Index), (p-values &gt, 0.05). Based on PSQI, ESS, SF-36 scores, and PVT parameters, the changes between the intervention and sham groups were not significant, and the changes were not associated with the type of treatment (p-value &gt, 0.05). The effectiveness of upper airway muscle training exercise as an adjunct treatment requires further study.

BACKGROUND AND OBJECTIVES Hospital discharge records remain a common data source for tracking the opioid crisis among pregnant women and infants. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) transition from the International Classification of Diseases, Ninth Revision, Clinical Modification may have affected surveillance. Our aim was to evaluate this transition on rates of neonatal abstinence syndrome (NAS), maternal opioid use disorder (OUD), and opioid-related diagnoses (OUD with ICD-10-CM codes for long-term use of opioid analgesics and unspecified opioid use). METHODS Data from the 2013–2017 Healthcare Cost and Utilization Project’s National Inpatient Sample were used to conduct, interrupted time series analysis and log-binomial segmented regression to assess whether quarterly rates differed across the transition. RESULTS From 2013 to 2017, an estimated 18.8 million birth and delivery hospitalizations were represented. The ICD-10-CM transition was not associated with NAS rates (rate ratio [RR]: 0.99; 95% confidence interval [CI]: 0.90–1.08; P = .79) but was associated with 11% lower OUD rates (RR: 0.89; 95% CI: 0.80–0.98; P = .02) and a decrease in the quarterly trend (RR: 0.98; 95% CI: 0.96–1.00; P = .04). The transition was not associated with maternal OUD plus long-term use rates (RR: 0.98; 95% CI: 0.89–1.09; P = .76) but was associated with a 20% overall increase in opioid-related diagnosis rates including long-term and unspecified use (RR: 1.20; 95% CI: 1.09–1.32; P < .001). CONCLUSIONS The ICD-10-CM transition did not appear to affect NAS. However, coding of maternal OUD alone may not capture the same population across the transition, which confounds the interpretation of trend data spanning this time period.

Background: Patients experiencing acute neurological injury often receive hourly neurological assessments (“neurochecks”) to capture signs of deterioration. While commonly utilized in the intensive care unit (ICU) setting, little is known regarding practices (i.e., variations by age and ordering services) and patterns (i.e., duration and post-discontinuation plans) of hourly neurochecks. To inform future quality improvement intervention efforts, we performed an analysis of hourly neurochecks using an electronic health record-based dataset. Study Design and Methods: Our 75-month retrospective dataset consisted of all health system ICU patients who received hourly neurochecks. Variables included age, admission diagnosis category, ordering provider, post-discontinuation order, and discharge destination. Multivariable Cox regression was used to evaluate factors associated with hourly neurocheck duration. Results: We evaluated 9,513 first admission hourly neurocheck orders in 8,936 patients. The trauma, neurosurgery, and neurocritical care services were responsible for 4,067 (43%), 2,071 (22%) and 1,697 (18%) hourly neurocheck orders, respectively. Median (interquartile range) hourly neurocheck duration was 1.09 (0.69, 2.35) days, and was greater than 3 and 7 days, respectively, for 1,773 (19%) and 640 (7%) patients. Median hourly neurocheck duration ranged from 0.87 (0.65, 1.68) to 1.60 (0.83, 2.97) days for neurosurgical and non-neurological ICU services, respectively. Upon discontinuation, 2,225 (23%) of hourly neurochecks were transitioned to no neurochecks. Conclusion: Substantial differences exist between ICU services and practice patterns surrounding hourly neurochecks. Understanding these differences will help inform intervention efforts aimed at streamlining hourly neurocheck practices and outcomes for patients with acute neurological injury.

Citation:Malhotra A, Nokes B, DeYoung P, Owens R. Why do we sometimes ignore the chief complaint in patients evaluated for obstructive sleep apnea? J Clin Sleep Med. 2020;16(4):657–659.

To assess the efficacy of ramelteon in preventing delirium, an acute neuropsychiatric condition associated with increased morbidity and mortality, in the perioperative, ICU setting.Parallel-arm, randomized, double-blinded, placebo-controlled trial.Academic medical center in La Jolla, California.Patients greater than or equal to 18 years undergoing elective pulmonary thromboendarterectomy.Ramelteon 8 mg or matching placebo starting the night prior to surgery and for a maximum of six nights while in the ICU.Incident delirium was measured twice daily using the Confusion Assessment Method-ICU. The safety outcome was coma-free days assessed by the Richmond Agitation-Sedation Scale. One-hundred twenty participants were enrolled and analysis completed in 117. Delirium occurred in 22 of 58 patients allocated to placebo versus 19 of 59 allocated to ramelteon (relative risk, 0.8; 95% CI, 0.5-1.4; p = 0.516). Delirium duration, as assessed by the number of delirium-free days was also similar in both groups (placebo median 2 d [interquartile range, 2-3 d] vs ramelteon 3 d [2-5 d]; p = 0.181). Coma-free days was also similar between groups (placebo median 2 d [interquartile range, 1-3 d] vs ramelteon 3 d [2-4 d]; p = 0.210). We found no difference in ICU length of stay (median 4 d [interquartile range, 3-5 d] vs 4 d [3-6 d]; p = 0.349), or in-hospital mortality (four vs three deaths; relative risk ratio, 0.7; 95% CI, 0.2-3.2; p = 0.717), all placebo versus ramelteon, respectively.Ramelteon 8 mg did not prevent postoperative delirium in patients admitted for elective cardiac surgery.

Half of college student attrition occurs in the first year of college, so identifying factors that contribute to student satisfaction is an important target for research. Knowledge and use of one’s...

Traditionally, the presence and severity of obstructive sleep apnea (OSA) have been defined by the apnea–hypopnea index (AHI). Continuous positive airway pressure is generally first-line therapy despite low adherence, because it reliably reduces the AHI when used, and the response to other therapies is variable. However, there is growing appreciation that the underlying etiology (i.e., endotype) and clinical manifestation (i.e., phenotype) of OSA in an individual are not well described by the AHI. We define and review the important progress made in understanding and measuring physiological mechanisms (or endotypes) that help define subtypes of OSA and identify the potential use of genetics to further refine disease classification. This more detailed understanding of OSA pathogenesis should influence clinical treatment decisions as well as help inform research priorities and clinical study design. In short, treatments could be individualized on the basis of the underlying cause of OSA; patients could better understand which symptoms and outcomes will respond to OSA treatment and by how much; and researchers could select populations most likely to benefit from specific treatment approaches for OSA.

AIM: The geographic range and ecological niche of species are widely used concepts in ecology, evolution and conservation and many modelling approaches have been developed to quantify each. Niche and distribution modelling methods require a litany of design choices; differences among subdisciplines have created communication barriers that increase isolation of scientific advances. As a result, understanding and reproducing the work of others is difficult, if not impossible. It is often challenging to evaluate whether a model has been built appropriately for its intended application or subsequent reuse. Here, we propose a standardized model metadata framework that enables researchers to understand and evaluate modelling decisions while making models fully citable and reproducible. Such reproducibility is critical for both scientific and policy reports, while international standardization enables better comparison between different scenarios and research groups. INNOVATION: Range modelling metadata (RMMS) address three challenges: they (a) are designed for convenience to encourage use, (b) accommodate a wide variety of applications, and (c) are extensible to allow the research community to steer them as needed. RMMS are based on a metadata dictionary that specifies a hierarchical structure to catalogue different aspects of the range modelling process. The dictionary balances a constrained, minimalist vocabulary to improve standardization with flexibility for users to modify and extend. To facilitate use, we have developed an R package, rangeModelMetaData, to build templates, automatically fill values from common modelling objects, check for inconsistencies with standards, and suggest values. MAIN CONCLUSIONS: Range Modelling Metadata tools foster cross‐disciplinary advances in biogeography, conservation and allied disciplines by improving evaluation, model sharing, model searching, comparisons and reproducibility among studies. Our initially proposed standards here are designed to be modified and extended to evolve with research trends and needs.

Purpose: International clinical practice guidelines call for initial volume resuscitation of at least 30 mL/kg body weight for patients with sepsis-induced hypotension or shock. Although not considered in the guidelines, preexisting cardiac dysfunction may be an important factor clinicians weigh in deciding the quantity of volume resuscitation for patients with septic shock. Methods: We conducted a multicenter survey of clinicians who routinely treat patients with sepsis to evaluate their beliefs, behaviors, knowledge, and perceived structural barriers regarding initial volume resuscitation for patients with sepsis and concomitant heart failure with reduced ejection fraction (HFrEF) Results: A total of 317 clinicians at 9 US hospitals completed the survey (response rate 47.3%). Most respondents were specialists in either internal medicine or emergency medicine. Substantial heterogeneity was found regarding sepsis resuscitation preferences for patients with concomitant HFrEF. The belief that patients with septic shock and HFrEF should be exempt from current sepsis bundle initiatives was shared by 39.4% of respondents. A minimum fluid challenge of ∼30 mL/kg or more was deemed appropriate in septic shock by only 56.4% of respondents for patients with concomitant HFrEF, compared to 89.1% of respondents for patients without HFrEF ( P < .01). Emergency medicine physicians were most likely to feel that Conclusions: Clinical equipoise exists regarding initial volume resuscitation for patients with sepsis-induced hypotension or shock and concomitant HFrEF. Future studies and clinical practice guidelines should explicitly address resuscitation in this subpopulation.

Sleep is fundamental for everyday functioning, yet it is often negatively impacted in critically ill patients by the intensive care setting. With a focus on the neurological intensive care unit (NeuroICU), this narrative review summarizes methods of measuring sleep and addresses common causes of sleep disturbance in the hospital including environmental, pharmacological, and patient-related factors. The effects of sleep deprivation on the cardiovascular, pulmonary, immune, endocrine, and neuropsychological systems are discussed, with a focus on short-term deprivation in critically ill populations. Where evidence is lacking in the literature, long-term sleep deprivation studies and the effects of sleep deprivation in healthy individuals are also referenced. Lastly, strategies for the promotion of sleep in the NeuroICU are presented.

In this study, we examined the effects of a tiered teacher coaching intervention package, including video coaching and in situ coaching with use of the bug-in-ear technology, on the implementation fidelity of four general education teachers in supporting students with persistent off-task behaviors to self-monitor own behaviors in the general education setting. In addition, we evaluated the effects of teachers’ implementation on the on-task behavior of four target students. Results of the multiple probe across participants design showed that there was a functional relation between the tiered coaching intervention and the teachers’ implementation fidelity. There was also an overall improvement in all of the four students’ on-task behaviors. Limitations, suggestions for future research, and implications for practice are discussed.

As continental and global-scale paleoclimate model data become more readily available, biologists can now ask spatially explicit questions about the tempo and mode of past climate change and the impact of those changes on biodiversity patterns. In particular, researchers have focused on climate stability as a key variable that can drive expected patterns of richness, phylogenetic diversity and functional diversity. Yet, climate stability measures are not formalized in the literature and tools for generating stability metrics from existing data are nascent. Here we define “deviation” of a climate variable as the mean standard deviation between time slices over time elapsed; “stability” is defined as the inverse of this deviation. Finally, climate stability is the product of individual climate variable stability estimates. We also present an R package, climateStability, which contains tools for researchers to generate climate stability estimates from their own data.

African-Americans have prostate cancer mortality rates that are double their White counterparts. To reduce prostate cancer disparities, it is suggested that men engage in shared decision making about prostate cancer screening with their healthcare provider after learning about the benefits and harms of these screenings. While researchers have developed decision aids to support African-American’s screening decisions, there is some uncertainty whether these aids lead to shared decision making. The goal of the current study was to investigate the efficacy of iDecide, a computerized decision aid, for promoting African-American men’s engagement in shared decision making. Six months after their use of iDecide, a prostate cancer screening decision aid, 76 participants were surveyed to determine whether they spoke with a provider about screening, what this conversation entailed, and if shared decision making occurred. While iDecide is an effective tool for enhancing African-American’s intention to engage in shared decision making, there is no evidence this aid increased their likelihood of discussing prostate cancer with a provider or participation in shared decision making. Future research should employ stronger research designs and assess the various contexts that can affect the relationship between decision-aid use and shared decision making among African-Americans.

The effects of mixed-reality teaching experiences on participants’ perceptions of their classroom management ability are evaluated using a mixed-methods design. Mursion, a technology that enables virtual simulations, is used. Participants include 29 undergraduates pursuing a degree in special education for learners with mild or moderate/severe disabilities enrolled in a university-level course focused on developing skills in managing the learning environment. Participants teach three different scenarios in the Mursion lab over the semester and complete a 21-statement survey using a 5-point Likert-type scale (i.e., strongly agree–strongly disagree) and reflect about their experience into a video camera. Results indicate that some participant perceptions changed over time because of the Mursion experiences and that the academic program being pursued made no difference in the participants’ Mursion experience. Implications for practice with a focus on rural education and limitations of the study are also discussed.

PurposeThe purpose of this paper is to provide a review of law enforcement suicide research from 1997 to 2016.Design/methodology/approachThe PRISMA systematic review methodology was implemented. A SCOPUS search identified a total of 97 documents. After applying all exclusion criteria, the results included a list of 44 articles in the review.FindingsOverall, studies investigating law enforcement suicide rates show conflicting results, with some studies showing lower suicide rates among law enforcement, some showing higher rates, and some showing no difference to comparison populations. Recurring research themes were lack of an appropriate comparison group, and small statistical power, particularly for minority and female officers. Stressors related to suicide among police included lack of organizational support, traumatic events, shift work, stigma associated with asking for help, or problems associated with fitting in with the police culture. Problems associated with domestic relationships and alcohol use were commonly mentioned as precursors to suicide or as correlates of suicidal ideation and were hypothesized to arise from stressful working conditions.Research limitations/implicationsSome limitations in law enforcement suicide research include the lack of theory, under-reporting of suicides, and guarded survey responses from police officers. Future directions in police suicide research include investigating etiological factors such as past adverse life and family experiences, social-ecological variation in suicide, or differences in suicide rates within the law enforcement occupation.Practical implicationsPolice work, given chronic and traumatic stress, lack of support, danger, and close public scrutiny is a fertile occupation for increased suicide risk. Awareness of the scope of the problem and associated risk factors can help to initiate prevention programs.Originality/valueThis paper provides a long-term review of literature regarding police suicidality, with suggestions for research and prevention.

Linkage maps of muscadine grape generated using genotyping-by-sequencing (GBS) provide insight into genome collinearity between Muscadinia and Euvitis subgenera and genetic control of flower sex and berry color. The muscadine grape, Vitis rotundifolia, is a specialty crop native to the southeastern USA. Muscadine vines can be male, female, or perfect-flowered, and berry color ranges from bronze to black. Genetic linkage maps were constructed using genotyping-by-sequencing in two F1 populations segregating for flower sex and berry color. The linkage maps consisted of 1244 and 2069 markers assigned to 20 linkage groups (LG) for the ‘Black Beauty’ × ‘Nesbitt’ and ‘Supreme’ × ‘Nesbitt’ populations, respectively. Data from both populations were used to generate a consensus map with 2346 markers across 20 LGs. A high degree of collinearity was observed between the genetic maps and the Vitis vinifera physical map. The higher chromosome number in muscadine (2n = 40) compared to V. vinifera (2n = 38) was accounted for by the behavior of V. vinifera chromosome 7 as two independently segregating LGs in muscadine. The muscadine sex locus mapped to an interval that aligned to 4.64–5.09 Mb on V. vinifera chromosome 2, a region which includes the previously described V. vinifera subsp. sylvestris sex locus. While the MYB transcription factor genes controlling fruit color in V. vinifera are located on chromosome 2, the muscadine berry color locus mapped to an interval aligning to 11.09–11.88 Mb on V. vinifera chromosome 4, suggesting that a mutation in a different gene in the anthocyanin biosynthesis pathway determines berry color in muscadine. These linkage maps lay the groundwork for marker-assisted breeding in muscadine and provide insight into the evolution of Vitis species.

This paper describes a new vocational theory—the strengths-based inclusive theory of work (S-BIT of Work). This theory addresses the ever-changing, dynamic nature of the world of work and integrates counseling psychology’s core values of emphasizing vocational psychology, strengths-based perspectives, multiculturalism, and social justice. We aim to provide a holistic vocational theory to inform career and work counseling practice by increasing clinicians’ cultural responsivity, promoting clients’ strengths and optimal functioning, and addressing a variety of vocational challenges across developmental stages. This first article in the Major Contribution includes a discussion of the S-BIT of Work’s core assumptions and theoretical propositions, research supporting the development of the S-BIT of Work, as well as future directions. The second and third articles in this Major Contribution discuss a model of fulfulling work, and the infusion of positive psychology and cultural responsivity in work counseling practice, respectively.

Using the strengths-based inclusive theory of work as a framework, this paper describes how positive psychological interventions (PPIs) can be infused within career and work counseling for diverse populations. Exemplar constructs targeted in the interventions include hope, strengths, adaptability, and empowerment. First, we discuss research related to hope, strengths, adaptability, and empowerment interventions, particularly studies related to career counseling. Second, we describe considerations and recommendations related to adapting PPIs for diverse groups. Finally, a case vignette is shared to demonstrate how PPIs and adapted PPIs might be infused when working with a client seeking career counseling.

Previous research suggests that relatively few hospitalized patients with opioid-related conditions receive substance use treatment during their inpatient stay. Without treatment, these individuals may be more likely to have subsequent hospitalizations for continued opioid use disorder.To evaluate the relationship between receipt of inpatient drug detoxification and/or rehabilitation services and subsequent opioid-related readmission.This study used combined hospital inpatient discharge and emergency department visit data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. Our sample consisted of 329,037 patients from seven states with an opioid-related index hospitalization occurring between March 2010 and September 2013. Multivariate analysis was conducted to examine the relationship between opioid-related readmission and the receipt of inpatient drug detoxification and/or rehabilitation during the index visit.A relatively small percentage (19.4%) of patients with identified opioid-related conditions received treatment for drug use during their hospital inpatient stay. Patients who received drug rehabilitation, but not drug detoxification, during an opioid-related index hospitalization had lower odds of an opioid-related readmission within 90 days of discharge (odds ratio = 0.60, 95% confidence interval = 0.54-0.67) compared with patients with no inpatient drug detoxification or rehabilitation. Conclusions/Importance: A low percentage of patients receive inpatient services for drug use during an index stay involving an opioid-related diagnosis. Our findings indicate that receipt of drug rehabilitation services in acute care hospitals is associated with a lower 90-day readmission rate. Further research is needed to understand factors associated with the receipt of inpatient services and readmissions.

Summary Recent availability of biodiversity data resources has enabled an unprecedented ability to estimate phylogenetically based biodiversity metrics over broad scales. Such approaches elucidate ecological and evolutionary processes yielding a biota and help guide conservation efforts. However, the choice of appropriate phylogenetic resources and underlying input data uncertainties may affect interpretation. Here, we address how differences among phylogenetic source trees and levels of phylogenetic uncertainty affect these metrics and test existing hypotheses regarding geographic biodiversity patterns across the diverse vascular plant flora of Florida, US. Ecological niche models for 1,490 Florida species were combined with a “purpose-built” phylogenetic tree (phylogram and chronogram), as well as with trees derived from community resources (Phylomatic and Open Tree of Life). There were only modest differences in phylodiversity metrics given the phylogenetic source tree and taking into account the level of phylogenetic uncertainty; we identify similar areas of conservation interest across Florida regardless of the method used., Graphical Abstract, Highlights • Phylodiversity patterns of Florida show peaks of diversity in Northern peninsular areas • Different input trees and uncertainty had modest or little influence on phylodiversity • Chronogram or phylogram had a significant effect on the interpretation of phylodiversity • We highlight areas of high phylodiversity and how these results affect conservation, Spatial Phylogenetics; Plant Biology; Biogeography

OBJECTIVES A recently published simulation study suggested that women are inferior leaders of cardiopulmonary resuscitation efforts. The aim of this study was to compare female and male code leaders in regard to cardiopulmonary resuscitation outcomes in a real-world clinical setting. DESIGN Retrospective cohort review. SETTING Two academic, urban hospitals in San Diego, California. SUBJECTS One-thousand eighty-two adult inpatients who suffered cardiac arrest and underwent cardiopulmonary resuscitation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed whether physician code leader gender was independently associated with sustained return of spontaneous circulation and survival to discharge and with markers of quality cardiopulmonary resuscitation. Of all arrests, 327 (30.1%) were run by female physician code leaders with 251 (76.8%) obtaining return of spontaneous circulation, and 122 (37.3%) surviving to discharge. Male physicians ran 757 codes obtaining return of spontaneous circulation in 543 (71.7%) with 226 (29.9%) surviving to discharge. When adjusting for variables, female physician code leader gender was independently associated with a higher likelihood of return of spontaneous circulation (odds ratio, 1.36; 95% CI, 1.01-1.85; p = 0.049) and survival to discharge (odds ratio, 1.53; 95% CI, 1.15-2.02; p < 0.01). Additionally, the odds ratio for survival to discharge was 1.62 (95% CI, 1.13-2.34; p < 0.01) for female physicians with a female code nurse when compared with male physician code leaders paired with a female code nurse. Gender of code leader was not associated with cardiopulmonary resuscitation quality. CONCLUSIONS In contrast to data derived from a simulated setting with medical students, real life female physician leadership of cardiopulmonary resuscitation is not associated with inferior outcomes. Appropriately, trained physicians can lead high-quality cardiopulmonary resuscitation irrespective of gender.

Surveillance of severe maternal morbidity (SMM) is critical for monitoring maternal health and evaluating clinical quality improvement efforts.To evaluate national and state trends in SMM rates from 2012 to 2019 and potential disruptions associated with the transition to International Classification of Diseases, 10th Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) in October 2015.This repeated cross-sectional analysis examined delivery hospitalizations from 2012 through 2019 in the Healthcare Cost and Utilization Project's National Inpatient Sample and State Inpatient Databases, an all-payer compendium of hospital discharge records from community, nonrehabilitation hospitals. Trends were evaluated using segmented linear binomial regression models that allowed for discontinuities across the ICD-10-CM/PCS transition. Analyses were completed from April 2021 through March 2022.Time, ICD-10-CM/PCS coding system, and state.SMM rates, excluding blood transfusion, per 10 000 delivery hospitalizations, overall and by indicator.From 2012 to 2019, there were 5 964 315 delivery hospitalizations in the national sample representing a weighted total of 29.8 million deliveries with a mean (SD) maternal age of 28.6 (5.9) years. SMM rates increased from 69.5 per 10 000 in 2012 to 79.7 per 10 000 in 2019 (rate difference [RD], 10.2; 95% CI, 5.8 to 14.6) without a significant change across the ICD-10-CM/PCS transition (RD, -3.2; 95% CI, -6.9 to 0.6). Of 20 SMM indicators, rates for 10 indicators significantly increased while 3 significantly decreased; 5 of these changes were associated with ICD-10-CM/PCS transition. Acute kidney failure had the largest increase, from 6.4 to 15.3 per 10 000 delivery hospitalizations (RD, 8.9; 95% CI, 7.5 to 10.3) with no change associated with ICD transition (RD, -0.1; 95% CI, -1.2 to 1.1). Disseminated intravascular coagulation had the largest decrease from 31.3 to 21.2 per 10 000 (RD, 10.2; 95% CI, -12.8 to -7.5), with a significant drop associated with ICD transition (RD, -7.9; 95% CI, -10.2 to -5.6). State SMM rates significantly decreased for 1 state and significantly increased for 21 states from 2012 to 2019 and associations with ICD transition varied.In this cross-sectional study, overall US SMM rates increased from 2012 to 2019, which was not associated with the ICD-10-CM/PCS transition. However, data for certain indicators and states may not be comparable across coding systems; efforts are needed to understand SMM increases and state variation.

Variation in floral displays, both between and within species, has been long known to be shaped by the mutualistic interactions that plants establish with their pollinators. However, increasing evidence suggests that abiotic selection pressures influence floral diversity as well. Here we analyze the genetic and environmental factors that underlie patterns of floral pigmentation in wild sunflowers. While sunflower inflorescences appear invariably yellow to the human eye, they display extreme diversity for patterns of ultraviolet pigmentation, which are visible to most pollinators. We show that this diversity is largely controlled by cis-regulatory variation at a single MYB transcription factor, HaMYB111, through accumulation of UV-absorbing flavonol glycosides. As expected, different patterns of ultraviolet pigments in flowers have a strong effect on pollinator preferences. However, variation for floral ultraviolet patterns is also associated with environmental variables, especially relative humidity, across populations of wild sunflowers. Larger ultraviolet patterns, which are found in drier environments, limit transpiration, therefore reducing water loss. The dual role of floral UV patterns in pollination attraction and abiotic responses reveals the complex adaptive balance underlying the evolution of floral traits.

This case can be team-taught to combine the different elements of business education taught by individual faculty within a course in Project Management, as a partial, half credit module within a business curriculum. This case study is written to address the feedback from prospective employers that the fresh recruits are reticent and need a long period of “internship / training/ mentoring” before they are ready to be a part of the company’s internal team. The case depicting a real company undergoing substantial changes provides the students with opportunities to gain the analytical skills developed in the study of various business disciplines, while providing the opportunity for discussion and illustration of real-life scenarios, constraints, and roadblocks. Moreover, students practice team development and process efficiencies. Instructors will teach how marketing, sales, and procurement functions impact the accounting and finance components of the project so the project scope is managed within the resources, schedule, and budget.

Visual sensitivity and body pigmentation are often shaped by both natural selection from the environment and sexual selection from mate choice. One way of quantifying the impact of the environment is by measuring how traits have changed after colonization of a novel habitat. To do this, we studied Poecilia mexicana populations that have repeatedly adapted to extreme sulphidic (H2S containing) environments. We measured visual sensitivity using opsin gene expression, as well as body pigmentation and water transmission for populations in four independent drainages. Both visual sensitivity and body pigmentation showed significant parallel shifts towards greater medium wavelength sensitivity and reflectance in sulphidic populations. The light spectrum was only subtly different between environments and overall, we found no significant correlations between the light environment and visual sensitivity or body pigmentation. Altogether we found that sulphidic habitats select for differences in visual sensitivity and pigmentation; our data suggest that this effect is unlikely to be driven purely by the water’s spectral properties and may instead be from other correlated ecological changes.

In March 2020, at the onset of the coronavirus disease 2019 (COVID-19) pandemic in the United States, the Southern California Extracorporeal Membrane Oxygenation (ECMO) Consortium was formed. The consortium included physicians and coordinators from the 4 ECMO centers in San Diego County. Guidelines were created to ensure that ECMO was delivered equitably and in a resource effective manner across the county during the pandemic. A biomedical ethicist reviewed the guidelines to ensure ECMO use would provide maximal community benefit of this limited resource. The San Diego County Health and Human Services Agency further incorporated the guidelines into its plans for the allocation of scarce resources. The consortium held weekly video conferences to review countywide ECMO capacity (including census and staffing), share data, and discuss clinical practices and difficult cases. Equipment exchanges between ECMO centers maximized regional capacity. From March 1 to November 30, 2020, consortium participants placed 97 patients on ECMO. No eligible patients were denied ECMO due to lack of resources or capacity. The Southern California ECMO Consortium may serve as a model for other communities seeking to optimize ECMO resources during the current COVID-19 or future pandemics.

Purpose: Because older adults are at elevated risk of COVID-19-related adverse health outcomes, and staying at home is an effective strategy to avoid unnecessary exposures, the current formative study used the Reasoned Action Approach (RAA) to identify the beliefs underlying older adults' decision to stay home for the next month.Methods: The participants (weighted n = 206, age 65-94) for the current study were selected from a nationally representative online survey of US adults from April 10-20, 2020. We used multiple linear regression to estimate the relative contribution of the four RAA global constructs (instrumental attitude, injunctive norms, descriptive norms, and self-efficacy) in explaining intention to stay home after controlling for demographic covariates. We also conducted a content analysis to identify beliefs about advantages, disadvantages, and facilitators of staying home.Results: After controlling for demographic characteristics, injunctive norms (b = 0.208; SE = 0.059; B = 0.213, p < 0.01) and self-efficacy (b = 0.532; SE = 0.058; B = 0.537, p < 0.001) showed statistically significant independent associations with intention to stay home. The specific beliefs underlying the decision to stay home spanned across health and wellness dimensions and suggested interpersonal, mental health, and leisure/recreational facilitators.Conclusions: These findings suggest three public health intervention targets. First, self-efficacy building interventions could enhance older adults' perceptions of their ability to stay home to avoid unnecessary exposures. Second, health communication messages to address injunctive norms could emphasize that people important to older adults think they should stay home. Third, for the youngest of the older adults, health communication messages could emphasize the advantages of staying home.

Researching PrEP retention in adolescent sexual minority men (ASMM) is critical to increasing persistence of PrEP in this priority population, yet this research is lacking. ASMM (N = 1433) completed a baseline survey for an online HIV prevention program between 2018 and 2020. Open- and closed-ended survey items identified their beliefs about attending 3-month PrEP follow-up appointments and examined the association of Andersen’s Behavioral Model factors (predisposing, enabling, and need) and confidence to attend these appointments. Qualitative and quantitative findings show that perceived parental support is a salient factor in ASMM attending PrEP follow-up appointments. Participants did not want to have to go to the doctor and get bloodwork done trimonthly, and qualitative findings elucidated rationales for this, such as perceptions that follow-ups might be time-consuming, costly, and could out their sexuality to their parents. This study suggests that parents are gatekeepers for ASMM to initiate and sustain the PrEP care continuum.

Supplemental Digital Content is available in the text., Objectives: Due to a shortage of perfusionists and increasing utilization of extracorporeal membrane oxygenation in the United States, many programs are training nurses as bedside extracorporeal membrane oxygenation specialists (i.e., nurse-run extracorporeal membrane oxygenation). Our objective was to evaluate if a nurse-run extracorporeal membrane oxygenation program has noninferior survival to discharge and complication rates compared with a perfusionist-run extracorporeal membrane oxygenation program. Additionally, to sought to describe increases in extracorporeal membrane oxygenation capacity and the potential for cost savings by implementing a nurse-run extracorporeal membrane oxygenation program.

Periodic breathing (PB), including its subtype Cheyne-Stokes respiration, is a pattern of sleep-disordered breathing marked by cyclic modulations in tidal volume and respiratory rate. PB is commonly identified in patients with chronic heart failure (CHF), and portends a worse prognosis. Due to the impracticality of existing monitoring methods, no longitudinal data exist on whether individual patients may experience prognostically significant fluctuations in PB. Here, we present a novel tool enabling long-term in-home investigation of PB. By passively capturing respirations during sleep via mechanical sensors placed under the legs of a bed, the need for patient compliance is circumvented. PB events were identified by computing an amplitude modulation index, and features including respiratory rate, cycle length, and hyperpnea duration were extracted. To demonstrate viability for longitudinal studies, devices were installed in the homes of 25 CHF patients to continuously record respirations, 9 of whom were found to exhibit PB. In an illustrative case, ~15,000 cycles of PB were captured over 3 months in a patient discharged after hospitalization for heart failure with reduced ejection fraction. Bedscales documented the patient’s worsening tachypnea accompanied by changes in PB parameters (shortened cycle and hyperpnea durations). A chest X-ray showed evidence of pneumonia and antibiotics were prescribed, after which tachypnea improved and trends of PB parameters reversed. This case highlights the potential utility of Bedscales in detecting subtle deviations from an individual’s baseline respiratory signatures; future work is needed to assess the predictive power of these parameters. Taken together, these results demonstrate the feasibility of Bedscales as a low-cost, scalable tool for longitudinal population-level studies of PB in relation to chronic diseases such as CHF. Future research could examine whether such data might predict exacerbations and direct early intervention to prevent rehospitalization.

The strengths-based inclusive theory of work and psychology of working theory propose that fulfilling work is a key outcome of the vocational intervention. Scholars have further argued that fulfilling work is the holistic experience of well-being in the workplace and can be assessed with meaningful work, work engagement, workplace positive emotions, and job satisfaction. This theoretical perspective suggests a bifactor model would best explain the relations among these variables, but this claim remains untested. Therefore, the purpose of this study was to investigate whether a bifactor model best explained the relations among the four components of fulfilling work, in comparison to other plausible models. We also examined the concurrent and convergent validity of the fulfilling work construct, using other well-being variables, symptoms of distress, and contextual factor variables drawn from vocational theories. Supporting hypotheses, we found that a bifactor model best fit the data. We also found that fulfilling work positively related to eudaimonic work well-being, hedonic work well-being, and life satisfaction and negatively related to symptoms of distress. Finally, fulfilling work positively related to income and subjective social class. These findings offer conceptual and statistical implications of fulfilling work for research, counseling, organizations, and social advocacy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).