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Qualitatively understand the factors contributing to the decision of PEH to seek or accept STI testing.

Abstract Introduction Mild traumatic brain injury (mTBI) represents a major public health concern and affects millions of people worldwide every year. Diagnosis mainly relies on clinical criteria and computed tomography (CT) scans. GFAP (glial fibrillary acidic protein) and UCH-L1 (ubiquitin carboxyl-terminal hydrolase-L1) have been recently studied as potential biomarkers of mTBI. This study retrospectively evaluated the possible use of these combined biomarkers as negative predictors for excluding brain injuries in patients with suspected mTBI in the emergency department. Methods Adult patients (n = 130) enrolled at Tor Vergata University Hospital (Rome, Italy), consecutively registered at the triage of the emergency department between October 2022 and January 2023, with non-penetrating TBI and Glasgow Coma Scale (GCS) score of 13–15, were considered. All eligible patients underwent intracranial CT scans and blood tests, within 12 h after trauma, for GFAP and UCH-L1 serum concentrations. Results Intracranial CT detected injuries in only seven patients (5%); GFAP and UCH-L1 tested positive in 96 patients and negative in 34 patients (74% vs. 26%). Combined biomarkers had a sensitivity equal to 1.00 (95% CI 0.64-1.00) and a negative predictive value (NPV) of 1.00 (0.99-1.00) in mTBI diagnosis with a negative CT. Conclusions Combined laboratory tests for GFAP and UCH-L1 biomarkers might play a potential clinical role in avoiding unnecessary head CT scans after mTBI in emergency departments.

Abstract Background Benefit of adding a second‐line immunosuppressive drug to glucocorticoids for the treatment of non‐associative immune‐mediated hemolytic anemia (naIMHA) in dogs has not been defined prospectively. Hypothesis/Objectives Evaluate the effectiveness of different immunosuppressive protocols in naIMHA dogs. Animals Forty‐three client‐owned dogs. Methods Open label, randomized, clinical trial. Dogs were treated with methylprednisolone (M‐group), methylprednisolone plus cyclosporine (MC‐group) or methylprednisolone plus mycophenolate mofetil (MM‐group). Dogs were defined as responders by disappearance of signs of immune‐mediated destruction and hematocrit stabilization. Frequency of responders was compared between M‐group and combined protocols (MC and MM‐group evaluated together), and among the 3 different therapeutic groups at 14 (T14), 30 (T30), 60 (T60) days after admission. Frequency of complications, length of hospitalization and relapse were also compared. Death rate was evaluated at discharge, T60 and 365 (T365) days. Results Proportion of responders was not significantly different between M‐group and combined protocols (MC and MM‐groups), nor among the 3 therapeutic groups at T14, T30, and T60 (P > .17). Frequency of relapse, complications, and length of hospitalization were not significantly different between M‐group and dogs treated with combined protocols, nor among the 3 treatment groups (P > .22). Death was significantly more common only for MM‐group compared with MC‐group at T60 (+42.8%; 95% CI: 11.5–67.4; P = .009), and at T365 (+50%; 95% CI: 17.5–73.2; P = .003). Conclusions and Clinical Importance Combined immunosuppressive therapy did not improve hematological response in naIMHA.

Background: This study aimed to increase syphilis screening rates amongst unhoused residents of Yolo County, California, through the implementation of plan-do-study-act (PDSA) cycles. Yolo County has a strategic goal to eliminate congenital syphilis cases. Homelessness is a known risk factor for syphilis. Methods: The primary researcher was embedded in a street medicine team. Using quality improvement tools like stakeholder interviews, workflow diagrams, and best practices from literature, we outlined the team's workflow for syphilis screening and developed ideas to improve uptake and expand capacity. The most effective cycle implemented gift card incentives for syphilis screening. During the patient intake we offered the option to receive a syphilis test, informing the patient of the gift card incentive. Results: Prior to gift card incentives, the team screened 1.6 patients on average per clinic for a total of 30 patients screened in April to June of 2022. After the gift card incentive was implemented, the team screened 3.0 patients on average per clinic, screening a total of 223 patients from July 2022 to May 2023. The intervention produced an 87.5% increase in screening rates (P=0.0094). The data showed a significant increase in syphilis testing upon implementing the gift card incentive program. Conclusion: These findings contribute to evidence supporting the use of patient incentives for public health prevention measures. This model could be applied to other populations to increase health screening participation. More research is needed on the effect of gift card incentives on confirmatory testing and treatment rates for syphilis.

Abstract Background Non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) are implicated in the aetiology of non-communicable diseases. Our study aimed to evaluate associations between NAFLD and MetS with overall and cause-specific mortality. Methods We used dietary, lifestyle, anthropometric and metabolic biomarker data from a random subsample of 15,784 EPIC cohort participants. NAFLD was assessed using the fatty liver index (FLI) and MetS using the revised definition. Indices for metabolic dysfunction–associated fatty liver disease (MAFLD) were calculated. The individual associations of these indices with overall and cause-specific mortality were assessed using multivariable Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs). As a subobjective, risk associations with adaptations of new classifications of metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic and alcohol-related liver disease (MetALD) were also assessed. Results Among the 15,784 sub-cohort participants, a total of 1997 deaths occurred (835 due to cancer, 520 to CVD, 642 to other causes) over a median 15.6 (IQR, 12.3–17.1) years of follow-up. Compared to an FLI

The COVID-19 pandemic has posed considerable challenges to the health of lactating individuals. Vaccination remains one of the most important strategies for prevention of moderate to severe COVID-19 infection and is associated with protective benefits for lactating individuals and their breastfed infants with overall mild side effects. The current recommendations for COVID-19 treatment in lactating individuals includes remdesivir and dexamethasone for hospitalized patients and Paxlovid® (nirmatrelavir + ritonavir) as outpatient treatment in those with mild disease. As the pandemic continues to evolve with new COVID-19 variants, alternative therapeutic options are potentially needed, and it is critical to include lactating individuals in research to evaluate the safety and efficacy of COVID-19 treatment options in this population.

BackgroundUnhealthy alcohol use is a significant health issue for the US population. The US Preventive Services Task Force (USPSTF) recommends screening adults 18 years or older for unhealthy alcohol use during primary care visits.ObjectivesTo evaluate alcohol screening among ambulatory visits made by US adult primary care patients and identify characteristics predictive of alcohol screening.DesignA series of cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) data collected from 2014 to 2016 was used to examine US primary care providers' use of alcohol screening questionnaires and delivery of counseling on alcohol use.ParticipantsA total of 19,213 visits made by patients aged 18 years or older to a US primary care physician trained in family medicine or internal medicine.Main measuresAdministration of a validated alcohol screening questionnaire and counseling/education on alcohol use. Variation in alcohol screening by patient demographic characteristics, reason for office visit, length of office visit, chronic medical conditions, evaluation by assigned primary care physician, new patient to practice, and region.Key resultsAlcohol screening with a validated questionnaire occurred during 2.6% (95% Cl: 0.9%, 4.3%) of visits. Alcohol counseling, provided either by the physician or by referral, was documented in 0.8% (95% Cl: 0.3%, 1.3%) of visits. Screening was significantly more likely if patients were seen by their assigned primary care physician (adjOR 4.38 (95% Cl: 1.41, 13.61)), a new patient to the practice (adjOR 4.18 (95% Cl: 2.30, 7.79)), or had several chronic medical conditions (adjOR 3.40 (95% Cl: 1.48, 7.78)). Patients' sex, race/ethnicity, age group, or length of appointment time was not associated with screening for unhealthy alcohol use.ConclusionsScreening for unhealthy alcohol use using a validated questionnaire is uncommonly performed during US primary care visits. Interventions or incentives may be needed to increase uptake of USPSTF alcohol screening recommendations.

Background and Aims: Substance and tobacco use is associated with poor maternal and child health outcomes. Although these have each been linked to lower breastfeeding rates when examined separately, studies have yet to examine how the combination of tobacco and other substance use influences breastfeeding initiation and continuation. The aim of this study was to examine how the combination of smoking tobacco and use of illicit substances influences the odds of breastfeeding initiation and continuation. Materials and Methods: This retrospective cohort study (n = 15,634) used survey data from the 2016-2018 Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System from eight US states to examine the association of tobacco and illicit substance use with breastfeeding initiation and continuation (≥6 weeks). The odds of breastfeeding initiation and continuation for individuals with and without prenatal tobacco and illicit substance use, adjusting for maternal and infant characteristics, were estimated using weighted, multivariable logistic regression models. Results: The combination of prenatal tobacco and illicit substance use was associated with a 42% reduction in the odds of initiating breastfeeding (adjusted odds ratio [aOR] 0.58 [95% confidence interval, CI 0.39-0.87]) and a 39% reduction in the odds of breastfeeding for at least 6 weeks (aOR 0.61 [95% CI 0.41-0.92]) when compared with those without tobacco and substance use. Conclusion: The odds of breastfeeding initiation and continuation are significantly lower among individuals with both prenatal tobacco and illicit substance use. Future studies are needed to identify barriers to breastfeeding within this population, to inform patient-centered interventions aimed at overcoming these barriers.

Abstract Supercapacitors and transistors are two key devices for future electronics that must combine portability, high performance, easy scalability, etc. Graphene‐related materials (GRMs) are frequently chosen as active materials for these applications given their unique physical properties that are tunable via chemical functionalization. Up to date, among GRMs, only reduced graphene oxide (rGO) showed sufficient versatility and processability in mild media, rendering it suitable for integration in these two types of devices. Here, a sound alternative to rGO is provided, namely graphene acetic acid (GAA), whose physico‐chemical features offer specific advantages. In particular, the use of a GAA‐based cathode in a zinc hybrid supercapacitor (Zn‐HSC) delivers state‐of‐the‐art gravimetric capacitance of ≈400 F g−1 at a current density of 0.05 A g−1. Conversely, GAA‐based LGT, supported onto Si/SiO2, shows an ambipolar behavior in 0.1 m NaCl, featuring a clear p‐doping quantified by Dirac voltage higher than 100 mV. Such a device is successfully implemented in paper fluidics, thereby demonstrating the feasibility of real‐time monitoring.

Summary: Background: Altered lipid metabolism is a hallmark of cancer development. However, the role of specific lipid metabolites in colorectal cancer development is uncertain. Methods: In a case–control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined associations between pre-diagnostic circulating concentrations of 97 lipid metabolites (acylcarnitines, glycerophospholipids and sphingolipids) and colorectal cancer risk. Circulating lipids were measured using targeted mass spectrometry in 1591 incident colorectal cancer cases (55% women) and 1591 matched controls. Multivariable conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between concentrations of individual lipid metabolites and metabolite patterns with colorectal cancer risk. Findings: Of the 97 assayed lipids, 24 were inversely associated (nominally p

Creative potential is a set of multidimensional resources concerning the latent ability to produce original and adaptive work. Confluent theoretical models, in particular, stated that, in order to express creative potential in an effective way, resources should converge and interact efficiently. Within such a confluent framework, the present study explored whether the increase in specific cognitive resources defining creative potential during childhood, as induced through a newly developed training intervention based on the creation of fairy tales, could be affected by another constitutional dimension, that is, children's emotional resources and, in particular, their trait emotional intelligence (EI). A total of 410 children from 3rd to 5th grade of primary school was involved in the study, equally divided in a training group and in a control group. Results showed that the fairy tale-based training protocol was effective in increasing children's creative potential. More importantly, results showed that the training intervention was particularly effective in increasing the ability to generate original contents in children with low-to-medium trait EI levels. These findings showed that emotional intelligence is a central factor to be considered when exploring the efficacy of a training intervention aimed at increasing children's creative potential.

BackgroundFirearm injury and death are significant public health problems in the U.S. and physicians are uniquely situated to help prevent them. However, there is little formal training in medical education on identifying risk for firearm injury and discussing safe firearm practices with patients. This study assesses prior education, barriers to counseling, and needs for improved training on firearm safety counseling in medical education to inform the development of future education on clinical strategies for firearm injury prevention.MethodA 2018 survey administered to 218 residents and fellows at a large, academic medical center asked about medical training on firearm injury prevention, frequency of asking patients about firearm access, and perceived barriers.ResultsThe most common barriers cited were not knowing what to do with patients' answers about access to firearms (72.1%), not having enough time (66.2%), not feeling comfortable identifying patients at-risk for firearm injury (49.2%), and not knowing how to ask patients about firearm access (48.6%). Prior education on firearm injury prevention was more strongly associated with asking than was personal exposure to firearms: 51.5% of respondents who had prior medical education reported asking compared with who had not received such education (31.8%, p=0.004). More than 90% of respondents were interested in further education about interventions, what questions to ask, and legal mechanisms to separate dangerous people from their firearms.ConclusionsEducation on assessing risk for firearm-related harm and, when indicated, counseling on safe firearm practices may increase the likelihood clinicians practice this behavior, though additional barriers exist.

The search of active, stable and low costs catalysts for the oxygen reduction reaction (ORR) is crucial for the extensive use of fuel cells and metal–air batteries. The development of metal-free catalysts, instead of platinum-based materials, can dramatically reduce the cost and increase the efficiency of these devices. In this work, carbon nanohorns (CNHs) have been covalently functionalized with N-containing heterocycles by the Tour reaction protocol and tested as metal-free ORR catalysts. The insertion of N-functionalities favored the complete reduction of oxygen to hydroxyl ions, while their absence favored the production of hydrogen peroxide. With the aim of determining the N-species responsible for the ORR activity of CNHs, photoemission and electrochemical measurements were combined. Results suggest that protonated N is the main species involved in the ORR process, facilitating the adsorption of oxygen, with their consequent reduction to neutral hydrogenated N species.

This study addresses the modulatory role of individual mindset in explaining the relationship between response inhibition (RI) and divergent thinking (DT) using transcranial direct current stimulation (tDCS). Forty undergraduate students (22 male and 18 female), aged between 18 and 23 years (average age = 19 years, SD = 1.48), were recruited. Participants received either anodal tDCS of the right IFG coupled with cathodal tDCS of the left IFG (R + L−; N = 19) or the opposite coupling (R−L+; N = 21). We tested DT performance using the alternative uses task (AUT), measuring participants’ fluency, originality, and flexibility in the response production, as well as participants’ mindsets. Furthermore, we applied a go-no-go task to examine the role of RI before and after stimulating the inferior frontal gyrus (IFG) using tDCS. The results showed that the mindset levels acted as moderators on stimulation conditions and enhanced RI on AUT fluency and flexibility but not originality. Intriguingly, growth mindsets have opposite moderating effects on the change in DT, resulting from the tDCS stimulation of the left and the right IFG, with reduced fluency but enhanced flexibility. Our findings imply that understanding neural modulatory signatures of ideational processes with tDCS strongly benefits from evaluating cognitive status and control functions.

Context: Health plan disenrollment has been associated with higher mortality in patients with opioid use disorder. Insurance loss and health plan disenrollment might be downstream social consequences of opioid misuse and overdose that may heighten patient mortality risks during a period of heightened need for professional assistance. Objective: To test hypotheses that: 1) overdose events in patients prescribed long-term opioids are associated with subsequent health plan disenrollment; and 2) buprenorphine initiation after overdose would attenuate this association. Study Design: Retrospective cohort study. Setting and Dataset: Data from the Optum Labs Data Warehouse which includes de-identified medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees. The database contains longitudinal health information on patients, representing a mixture of ages, ethnicities, and geographical regions across the United States. Population studied: Adults (aged ≥18 years) prescribed stable, opioid therapy for a 6-month baseline period (≥90% of days covered,