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Background: Low food security and poor mental health are a persistent concern for college students. Objective: Examine how food security and mental health are associated with college student's grade point average (GPA). Methods: American College Health Association (ACHA)-National College Health Assessment III survey data Spring 2020 of students from 75 US universities (n = 48,103) were utilized to examine relationships among mental health, food security and academic performance (GPA). Results: The majority of the population self-reported high food security (58.3%) and moderate psychological distress (50.8%). Very low food security ([beta] = -0.523, OR = 0.59, p < 0.001) and moderate psychological distress ([beta] = -0.19, OR = 0.83, p < 0.001) were inversely associated with high GPA. Reduced food security was associated with worse mental health measures. Conclusions: Food security and mental health are negatively associated with GPA. To improve student success, universities must enhance services that address food insecurity and mental health.

Caleb J Banta-Green,1– 3 Mandy D Owens,1,4 Jason R Williams,1 Anthony S Floyd,1 Wendy Williams-Gilbert,1 Susan Kingston1 1Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington Seattle, Seattle, WA, USA; 2Department of Health Systems and Population Health, School of Public Health, University of Washington Seattle, Seattle, WA, USA; 3Department of Epidemiology, School of Public Health, University of Washington Seattle, Seattle, WA, USA; 4Department of Psychology, University of Washington, Seattle, WA, USACorrespondence: Caleb J Banta-Green, Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, NE Pacific St Box 356560, Seattle, WA, 98195, USA, Email calebbg@uw.eduPurpose: A large treatment gap exists for people who could benefit from medications for opioid use disorder (MOUD). People OUD accessing services in harm reduction and community-based organizations often have difficulty engaging in MOUD at opioid treatment programs and traditional health care settings. We conducted a study to test the impacts of a community-based medications first model of care in six Washington (WA) State communities that provided drop-in MOUD access.Participants and Methods: Participants included people newly prescribed MOUD. Settings included harm reduction and homeless services programs. A prospective cohort analysis tested the impacts of the intervention on MOUD and care utilization. Intervention impacts on mortality were tested via a synthetic comparison group analysis matching on demographics, MOUD history, and geography using WA State agency administrative data.Results: 825 people were enrolled in the study of whom 813 were matched to state records for care utilization and outcomes. Cohort analyses indicated significant increases for days’ supply of buprenorphine, months with any MOUD, and months with any buprenorphine for people previously on buprenorphine (all results p< 0.05). Months with an emergency department overdose did not change. Months with an inpatient hospital stay increased (p< 0.05). The annual death rate in the first year for the intervention group was 0.45% (3 out of 664) versus 2.2% (222 out of 9893) in the comparison group in the 12 months; a relative risk of 0.323 (95% CI 0.11– 0.94).Conclusion: Findings indicated a significant increase in MOUD for the intervention group and a lower mortality rate relative to the comparison group. The COVID-19 epidemic and rapid increase in non-pharmaceutical-fentanyl may have lessened the intervention impact as measured in the cohort analysis. Study findings support expanding access to a third model of low barrier MOUD care alongside opioid treatment programs and traditional health care settings.Keywords: opioid use disorder, medications for opioid use disorder, multi-site study, low-barrier care, harm reduction

Abstract Background Patient-reported outcome measures quantify outcomes from patients’ perspective with validated instruments. QuickDASH (Quick Disability of Arm, Shoulder and Hand, an upper extremity PROM) scores improve after completing instrument tasks, suggesting patient-reported outcome results can be modified. We hypothesized that performing lower extremity tasks on the knee injury and osteoarthritis outcome score for joint reconstruction (KOOS-JR) and hip disability and osteoarthritis outcome score for joint reconstruction (HOOS-JR) instruments would similarly improve the scores. Methods Forty seven hip and 62 knee osteoarthritis patients presenting to a suburban academic center outpatient osteoarthritis and joint replacement clinic were enrolled and randomized to an intervention or a control group. Inclusion criteria were age over 18 years and English competency. Patients completed a HOOS-JR or KOOS-JR instrument, completed tasks similar to those of the instrument (intervention) or the QuickDASH (control), and then repeated instruments again. Paired and unpaired t-tests were used to compare the intervention and control group scores before and after tasks. Results There was no significant difference in total or individual scores after task completion compared to baseline in either the HOOS-JR or the KOOS-JR groups. There was no significant difference in the scores between the intervention or control groups. Conclusions Disability may be less modifiable in the lower extremity than in the upper extremity, perhaps because upper extremity activities are more easily compensated by the contralateral limb, or because lower extremity activities are more frequent. Thorough evaluation of factors influencing patient-reported outcome measures is necessary before their extensive application to quality control and reimbursement models.

Introduction: Methamphetamine use is on the rise with increasing emergency department (ED) visits, behavioral health crises, and deaths associated with use and overdose. Emergency clinicians describe methamphetamine use as a significant problem with high resource utilization and violence against staff, but little is known about the patient’s perspective. In this study our objective was to identify the motivations for initiation and continued methamphetamine use among people who use methamphetamine and their experiences in the ED to guide future ED-based approaches.  Methods: This was a qualitative study of adults residing in the state of Washington in 2020, who used methamphetamine in the prior 30 days, met criteria for moderate- to high-risk use, reported recently receiving care in the ED, and had phone access. Twenty individuals were recruited to complete a brief survey and semi-structured interview, which was recorded and transcribed prior to being coded. Modified grounded theory guided the analysis, and the interview guide and codebook were iteratively refined. Three investigators coded the interviews until consensus was reached. Data was collected until thematic saturation.  Results: Participants described a shifting line that separates the positive attributes from the negative consequences of using methamphetamine. Many initially used methamphetamine to enhance social interactions, combat boredom, and escape difficult circumstances by numbing the senses. However, continued use regularly led to isolation, ED visits for the medical and psychological sequelae of methamphetamine use, and engagement in increasingly risky behaviors. Because of their overwhelmingly frustrating experiences in the past, interviewees anticipated difficult interactions with healthcare clinicians, leading to combativeness in the ED, avoidance of the ED at all costs, and downstream medical complications. Participants desired a non-judgmental conversation and linkage to outpatient social resources and addiction treatment. Conclusion: Methamphetamine use can lead patients to seek care in the ED, where they often feel stigmatized and are provided little assistance. Emergency clinicians should acknowledge addiction as a chronic condition, address acute medical and psychiatric symptoms adequately, and provide positive connections to addiction and medical resources. Future work should incorporate the perspectives of people who use methamphetamine into ED-based programs and interventions.

Research has shown that there has consistently been a lack of equity and accessibility to SARS-CoV-2 testing in underserved and disadvantaged areas in the United States. This study examines the distribution of Wastewater-Based Epidemiology (WBE) testing placement across the United States (US), particularly within the context of underserved communities, and explores an environmental equity approach to address the impact of WBE on future pandemics. The methods combined the Centers for Disease Control Social Vulnerability Index (CDC-SVI) data set at the county level in a geospatial analysis utilizing ArcGIS and multilinear regression analysis as independent variables to investigate disparities in WBE coverage in the US. The findings show that disparities exist between counties in the use of WBE nationwide. The results show that WBE is distributed inequitably on national and state levels. Considering the nationwide adoption of WBE and funding availability through the CDC National Wastewater Surveillance System, these findings underscore the importance of equitable WBE coverage for effective COVID-19 monitoring. These findings offer data to support that a focus on expanding WBE coverage to underserved communities ensures a proactive and inclusive strategy against future pandemics.

A simultaneous deployment of Doppler, temperature, and water-vapor lidars is able to provide profiles of molecular destruction rates and turbulent kinetic energy (TKE) dissipation in the convective boundary layer (CBL). Horizontal wind profiles and profiles of vertical wind, temperature, and moisture fluctuations are combined, and transversal temporal autocovariance functions (ACFs) are determined for deriving the dissipation and molecular destruction rates. These are fundamental loss terms in the TKE as well as the potential temperature and mixing ratio variance equations. These ACFs are fitted to their theoretical shapes and coefficients in the inertial subrange. Error bars are estimated by a propagation of noise errors. Sophisticated analyses of the ACFs are performed in order to choose the correct range of lags of the fits for fitting their theoretical shapes in the inertial subrange as well as for minimizing systematic errors due to temporal and spatial averaging and micro- and mesoscale circulations. We demonstrate that we achieve very consistent results of the derived profiles of turbulent variables regardless of whether 1 or 10 s time resolutions are used. We also show that the temporal and spatial length scales of the fluctuations in vertical wind, moisture, and potential temperature are similar with a spatial integral scale of ≈160 m at least in the mixed layer (ML). The profiles of the molecular destruction rates show a maximum in the interfacial layer (IL) and reach values of ϵm≃7×10-4 g2 kg−2 s−1 for mixing ratio and ϵθ≃1.6×10-3 K2 s−1 for potential temperature. In contrast, the maximum of the TKE dissipation is reached in the ML and amounts to ≃10-2 m2 s−3. We also demonstrate that the vertical wind ACF coefficient kw∝w′2‾ and the TKE dissipation ϵ∝w′2‾3/2. For the molecular destruction rates, we show that ϵm∝m′2‾w′2‾1/2 and ϵθ∝θ′2‾w′2‾1/2. These equations can be used for parameterizations of ϵ, ϵm, and ϵθ. All noise error bars are derived by error propagation and are small enough to compare the results with previous observations and large-eddy simulations. The results agree well with previous observations but show more detailed structures in the IL. Consequently, the synergy resulting from this new combination of active remote sensors enables the profiling of turbulent variables such as integral scales, variances, TKE dissipation, and the molecular destruction rates as well as deriving relationships between them. The results can be used for the parameterization of turbulent variables, TKE budget analyses, and the verification of large-eddy simulations.

Introduction: The present study aimed to assess the quality of training provided during Structured Spine Fellowships (SSF) and explore the expectations of candidates. The study sought to investigate the utility of SSFs and emphasized the importance of evaluating the fellowship center’s curriculum as well as trainees’ surgical and theoretical competency. Materials and Methods: A retrospective descriptive study was conducted on 100 spine surgeons, 66 from Fellow of the National Board and 34 from the Association of Spine Surgeons of India, using a questionnaire. The survey had three parts, assessing pre-fellowship demographics, feedback on the fellowship conducted, and post-fellowship settlement. Results: The hands-on experience was the most important factor affecting the choice of center, and the average work time was 14 h per day. Nearly 50% of fellows were doing independent cervical dorsal and lumbar surgeries by the end of the fellowship. Academics were mainly in the form of regular case presentations for 55% of fellows, and the average number of publications done was 1.6. Most fellows settled near their native city, practiced exclusive spine surgery, and did a mean of 2.6 additional fellowships. Conclusion: This study provides a comprehensive overview of the structured spine fellowship programs in India. The findings highlight the need for standardization and quality control measures in these programs to ensure that they provide a comprehensive and uniform education to the fellows. The study also underscores the importance of ongoing evaluation and assessment to improve the effectiveness of these programs in producing skilled and competent spine surgeons.

Background and Objectives: This research explores the correlation between estimated glomerular filtration rates (eGFR) obtained using the bedside Schwartz equation, and renal scintigraphy in children with congenital kidney and urinary tract abnormalities (CAKUT). The objective is to enhance understanding and management of renal health in this demographic by analyzing kidney size-function relationships. Methods: A retrospective observational analysis was performed on 94 pediatric CAKUT patients at the “Louis Turcanu” Emergency Hospital for Children, Timisoara. Kidney function data, extracted from medical records, were evaluated using the Schwartz equation, renal scintigraphy, and the gold standard iohexol clearance. Ethical approval was secured for the study, which employed descriptive and inferential statistical methods, including t-tests and correlation coefficients, to compare eGFR values. Results: Significant variances were found in eGFRs across different body surface area (BSA) percentiles. For instance, the eGFR for the right kidney in the 25th–50th BSA percentile (102.02 ± 41.52 mL/min/BSA) was notably higher than that of the left (35.60 ± 26.05 mL/min/BSA; p = 0.01). The overall sample reflected a higher eGFR in the right kidney (76.03 ± 40.91 mL/min/BSA) compared to the left (57.46 ± 35.91 mL/min/BSA; p = 0.02). Additionally, a strong positive Pearson correlation (r = 0.80, p = 0.02) was found between scintigraphy and ultrasound measures in the 50th–75th percentiles for left renal percentiles, demonstrating consistent patterns across different evaluations of kidney function. Conclusions: This comparison indicates a complex relationship between eGFR values and kidney size, suggesting potential inaccuracies in standard bedside eGFR measurements for pediatric CAKUT patients. The findings underscore the necessity for accurate diagnostic tools specifically designed for pediatric applications and advocate for the integration of multiple diagnostic techniques to improve clinical management.

We developed a remote lab experience where freshmen grew and analyzed the activity of sourdough starters as a means of engaging with chemical engineering concepts. This six-week hands-on activity was targeted due to its low-cost, non-hazardous materials, and ability to be conducted safely in a non-laboratory setting. By designing the lab to be guided inquiry, we embraced the inherent variability students would encounter running these experiments remotely to create a motivating learning experience.

As more chemical engineering students enter careers beyond the field, students need more guidance in applying their problem solving skills to a challenges beyond the plant or refinery. Since Fall 2019, we have implemented case-based learning across our Material and Energy Balances course to help students practice chemical engineering thinking as a transferable and useful skill beyond typical process calculation examples. We share our approach and examples so other instructors may try teaching with cases.

Abstract The urban heat island effect exacerbates independent climate change‐induced shifts toward longer, stronger, and more frequent heat extremes. Environmental inequity, driven by a history of racially motivated urban planning policies, has led particular demographics to bear the worst impacts of urban heat exposure and thus also climate change. These impacts cause adverse health outcomes in the form of heat emergencies. Through a novel demographic and spatial analysis of heat‐related illness Emergency Medical Services data from Richmond, Virginia, this study investigates the relationships between heat health emergencies and intra‐urban heat islands quantified through three heat exposure metrics. We also evaluate the accessibility of built refuge from urban heat in the form of public transit infrastructure, libraries, and government cooling centers in relation to these emergencies. We found that heat emergencies are inequitably distributed among racial, age, and socioeconomic groups in Richmond, particularly among residents identified as Male, Black or African American, 50+ years old, and experiencing mental health, intoxication, and/or homelessness. We found significant associations between the location of these heat emergencies and urban heat islands as estimated from remotely‐sensed surface and community science‐derived air temperature metrics, but not a co‐estimated heat index. We also found that available refuge facilities are insufficiently located to protect individuals with reduced mobility across areas with the highest number of heat‐related health emergencies. Community involvement in the mitigation and management of extreme heat threats, especially for those disproportionately impacted, is necessary to decrease the number of summertime heat illnesses.

IntroductionEmployment is recognized as a fundamental human right, which correlates with better physical and mental health. Importantly, well-designed work, which considers the physical, social, and psychological impacts of work, can serve to enhance the cognitive abilities of workers. Although often overlooked, work for individuals with disabilities, including cognitive impairments, is equally important for their physical and mental well-being. What has not been established, however, is whether well-designed work can also enhance the cognitive abilities of individuals with cognitive impairments.MethodsUsing a longitudinal study design, we investigated the impact of well-designed work on the cognitive abilities of 60 participants (operators) at the AMIPI Foundation factories, which employ individuals with cognitive impairments to produce electrical cables and harnesses for the automobile industry. The same operators were assessed at three different time points: upon hiring (n = 60), and after working in the factory for 1 year (n = 41, since 19 left the factory) and 2 years (n = 28, since 13 more left the factory). We used five cognitive tests evaluating: (1) finger and manual dexterity, bimanual dexterity, and procedural memory using the Purdue Pegboard; (2) sustained and selective attention using the Symbol Cancellation Task; (3) short- and long-term declarative verbal memory and long-term verbal recognition memory using Rey's Audio-Verbal Learning Test; (4) short- and long-term visual recognition memory using the Continuous Visual Memory Test; and (5) abstract reasoning using Raven's Standard Progressive Matrices.ResultsWe observed improvements in procedural memory, sustained and selective attention, and short- and long-term visual recognition memory after working in the factory for 1 or 2 years. We did not observe improvements in finger or manual dexterity or bimanual dexterity, nor short- or long-term declarative verbal memory or verbal recognition memory, nor abstract reasoning.DiscussionWe conclude that, in addition to improving physical and mental well-being, well-designed manufacturing work can serve as a training intervention improving some types of cognitive functioning in individuals with cognitive impairments.

The work carried out in this paper focused on “Machine learning models for the prediction of turbulent combustion speed for hydrogen-natural gas spark ignition engines”. The aim of this work is to develop and verify the ability of machine learning models to solve the problem of estimating the turbulent flame speed for a spark-ignition internal combustion engine operating with a hydrogen-natural gas mixture, then evaluate the relevance of these models in relation to the usual approaches. The novelty of this work is the possibility of a direct calculation of turbulent combustion speed with a good precision, using only machine learning model. The obtained models are also compared to each other by considering in turn as a comparison criterion: the precision of the result, calculation time, and the ability to assimilate original data (which has not undergone preprocessing). An important particularity of this work is that the input variables of the machine learning models were chosen among the variables directly measurable experimentally, based on the opinion of experts in combustion in internal combustion engines and not on the usual approaches to dimensionality reduction on a dataset. The data used for this work was taken from a MINSEL 380, a 380-cc single-cylinder engine. The results show that all the machine learning models obtained are significantly faster than the usual approach and Random Forest (R2: R-squared = 0.9939 and RMSE: Root Mean Square Error = 0.4274) gives the best results. With a forecasting accuracy of over 90 %, both approaches can make reasonable predictions for most industrial applications such as designing engine monitoring and control systems, firefighting systems, simulation, and prototyping tools.

Abstract Epidemiologic data on insecticide exposures and breast cancer risk are inconclusive and mostly from high-income countries. Using data from 1071 invasive pathologically confirmed breast cancer cases and 2096 controls from the Ghana Breast Health Study conducted from 2013 to 2015, we investigated associations with mosquito control products to reduce the spread of mosquito-borne diseases, such as malaria. These mosquito control products were insecticide-treated nets, mosquito coils, repellent room sprays, and skin creams for personal protection against mosquitos. Multivariable and polytomous logistic regression models were used to estimate odds ratios (ORadj) and 95% confidence intervals (CI) with breast cancer risk-adjusted for potential confounders and known risk factors. Among controls, the reported use of mosquito control products were mosquito coils (65%), followed by insecticide-treated nets (56%), repellent room sprays (53%), and repellent skin creams (15%). Compared to a referent group of participants unexposed to mosquito control products, there was no significant association between breast cancer risk and mosquito coils. There was an association in breast cancer risk with reported use of insecticide-treated nets; however, that association was weak and not statistically significant. Participants who reported using repellent sprays were at elevated risks compared to women who did not use any mosquito control products, even after adjustment for all other mosquito control products (OR = 1.42, 95% CI=1.15–1.75). We had limited power to detect an association with repellent skin creams. Although only a few participants reported using repellent room sprays weekly/daily or 0.25). Our analysis was limited when determining if an association existed with repellent skin creams; therefore, we cannot conclude an association. We found limited evidence of risk associations with widely used mosquito coils and insecticide-treated nets, which are reassuring given their importance for malaria prevention. Our findings regarding specific breast cancer risk associations, specifically those observed between repellent sprays, require further study.

Purpose The coronavirus disease 2019 pandemic has prompted the use of telemedicine as an alternative method for providing continuous epilepsy care. This study was conducted to validate and administer a web-based questionnaire to assess the knowledge, attitudes, and practices (KAP) regarding telemedicine among caregivers of children with epilepsy at the Philippine Children’s Medical Center (PCMC). Methods This cross-sectional study was conducted by a primary investigator from the child neurology section of PCMC between July 2022 and October 2022 and consisted of two phases. In phase 1, content validation and pre-testing of the Filipino version of the questionnaire were conducted with 29 caregivers. Phase 2 involved the web-based administration of the final version of the questionnaire to 89 caregivers. Results The resulting questionnaire comprised four main sections: demographics, KAP. Regarding caregivers’ knowledge, 70.8% had not heard of telemedicine before participating in teleconsultations at PCMC. However, most participants were able to correctly identify its purposes (86.4%), benefits (87.6%), and barriers (78.7%). All aspects of the caregivers’ attitudes demonstrated positive agreement with the Likert scale of attitudes, with P values of

Dual blockade of the PD-1 and TIGIT coinhibitory receptors on T cells shows promising early results in cancer patients. Here, we studied the mechanisms whereby PD-1 and/or TIGIT blockade modulate anti-tumor CD8+ T cells. Although PD-1 and TIGIT are thought to regulate different costimulatory receptors (CD28 and CD226), effectiveness of PD-1 or TIGIT inhibition in preclinical tumor models was reduced in the absence of CD226. CD226 expression associated with clinical benefit in patients with non-small cell lung carcinoma (NSCLC) treated with anti-PD-L1 antibody atezolizumab. CD226 and CD28 were co-expressed on NSCLC infiltrating CD8+ T cells poised for expansion. Mechanistically, PD-1 inhibited phosphorylation of both CD226 and CD28 via its ITIM-containing intracellular domain (ICD); TIGIT's ICD was dispensable, with TIGIT restricting CD226 co-stimulation by blocking interaction with their common ligand PVR (CD155). Thus, full restoration of CD226 signaling, and optimal anti-tumor CD8+ T cell responses, requires blockade of TIGIT and PD-1, providing a mechanistic rationale for combinatorial targeting in the clinic.

Abstract : We initiate the study of a new class of beyond the Standard Model states that we call “Loryons.” They have the defining characteristic of being non-decoupling, in the sense that their physical mass is dominated by a contribution from the vacuum expectation value of the Higgs boson. The stakes are high: the discovery of a Loryon would tell us that electroweak symmetry must be non-linearly realized in the effective field theory of the Standard Model. Loryons have their masses bounded from above by perturbative unitarity considerations and thus define a finite parameter space for exploration. After providing a complete catalog of Loryon representations under mild assumptions, we turn to examining the constraints on the parameter space from Higgs couplings measurements, precision electroweak tests, and direct collider searches. We show that most fermionic candidates are already ruled out (with some notable exceptions), while much of the scalar Loryon parameter space is still wide open for discovery.

IntroductionWe created a COVID-19 Research Patient and Community Advisory Board (PCAB) to provide patient and community input into clinical and translational research studies. The purpose of this article is to describe the PCAB creation, implementation, and evaluation.MethodsWe identified PCAB members who had participated in previous stakeholder engaged activities at our institution and invited their participation. We created a systematic consultation process where researchers could submit plain language research summaries and questions for the PCAB. A facilitated 1-hour virtual consultation was then held where PCAB members provided feedback. We assessed satisfaction of PCAB members and researchers who received consultations using surveys. We also reviewed video recordings of PCAB consultations and reflections from team meetings to identify key lessons learned.ResultsTwenty-seven PCAB members took part in 23 consultation sessions. Twenty-two completed an evaluation survey (81% response rate). Most members agreed or strongly agreed their opinions were valued (86%), it was a productive use of time (86%) and were satisfied (86%). Nineteen researchers completed an evaluation survey (83% response rate). Researchers reported positive experiences of working with the PCAB. Additional insights include limited funding in COVID-19 research for equitable community engagement, deficiencies in researcher communication skills, and a lack of cultural humility incorporated into study activities.ConclusionsPCAB members provided recommendations that maximized the patient-centeredness and health equity focus of COVID-19 research. The detailed description of the process of developing, implementing, and evaluating our PCAB can be used as a template for others wishing to replicate this engagement model.