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Background: Farm-to-University (Farm2U) programs make healthy eating accessible, easier, and the default option. Yet, few published studies have focused on Farm2U implementations in Historically Black Colleges and Universities (HBCUs) in conjunction with measurements of implementation barriers using the consolidated framework for implementation research (CFIR). Purpose: The purpose of this study was to assess the feasibility of delivering a Farm2U program in four HBCUs in North Carolina. Methods: Using a quasi-experimental pre-posttest design, four HBCUs were allocated to either the intervention or the control group. The program was administered over a 4-month period and data were collected at baseline and at post-program implementation. Results: With a target sample size of 128, we successfully recruited 351 participants, retaining 138 at follow-up, for a retention rate of 39%. Twelve CFIR constructs were measured, ten emerged as facilitators and two as mixed barriers/facilitators to program implementation. We observed an increase in local produce purchases and a significant increase in the daily intake of fruits for students. Discussion: This study demonstrated that a Farm2U program is feasible in HBCUs. Translation to Health Education Practice: Certified Health Education Specialists can use the findings to implement Farm2U programs that promote healthy food environments in school settings.

Introduction: Triage functions to quickly prioritize care and sort patients by anticipated resource needs. Despite widespread use of the Emergency Severity Index (ESI), there is still no universal standard for emergency department (ED) triage. Thus, it can be difficult to objectively assess national trends in ED acuity and resource requirements. We sought to derive an ESI from National Hospital Ambulatory Medical Care Survey (NHAMCS) survey items (NHAMCS-ESI) and to assess the performance of this index with respect to stratifying outcomes, including hospital admission, waiting times, and ED length of stay (LOS).Methods: We used data from the 2010-2015 NHAMCS, to create a measure of ED visit complexity based on variables within NHAMCS. We used NHAMCS data on chief complaint, vitals, resources used, interventions, and pain level to group ED visits into five levels of acuity using a stepwise algorithm that mirrored ESI. In addition, we examined associations of NHAMCS-ESI with typical indicators of acuity such as waiting time, LOS, and disposition. The NHAMCS-ESI categorization was also compared against the “immediacy” variable across all of these outcomes. Visit counts used weighted scores to estimate national levels of ED visits.Results: The NHAMCS ED visits represent an estimated 805,726,000 ED visits over this time period. NHAMCS-ESI categorized visits somewhat evenly, with most visits (42.5%) categorized as a level 3. The categorization pattern is distinct from that of the “immediacy” variable within NHAMCS. Of admitted patients, 89% were categorized as NHAMCS-ESI level 2-3. Median ED waiting times increased as NHAMCS-ESI levels decreased in acuity (from approximately 14 minutes to 25 minutes). Median LOS decreased as NHAMCS-ESI decreased from almost 200 minutes for level 1 patients to nearly 80 minutes for level 5 patients.Conclusion: We derived an objective tool to measure an ED visit’s complexity and resource use. This tool can be validated and used to compare complexity of ED visits across hospitals and regions, and over time.

Observational studies in adults suggest nasal methicillin-resistant Staphylococcus aureus (MRSA) swabs have a high negative predictive value (NPV) for ruling out MRSA pneumonia, however, pediatric data are limited. This retrospective study of 505 pediatric patients found a 99.8% NPV among children with suspected respiratory infections. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pembrolizumab and nivolumab are PD-1–blocking antibodies that are FDAapproved for a variety of malignancies. Previously, only 1 fixed dosing schedule was approved for these agents, with nivolumab dosed at 240 mg intravenously (IV) every 2 weeks and pembrolizumab dosed at 200 mg IV every 3 weeks. Recently, the FDA approved an alternate dosing schedule for nivolumab dosed at 480 mg IV every 4 weeks and pembrolizumab dosed at 400 mg IV every 6 weeks following the results of pharmacokinetic simulation models that showed a similar risk-benefit profile based on a relatively small sample size. OBJECTIVE: To compare the incidence of immune-related adverse events (irAEs) and infusion reactions of different FDA-approved dosing regimens for nivolumab and pembrolizumab. METHODS: This single-center, retrospective chart review included 171 adults with cancer who received at least 2 doses of nivolumab or pembrolizumab at either dosing schedule for any diagnosis of cancer at Duke University Health System between January 1, 2018, and June 30, 2021. The primary end point was the incidence of any-grade irAEs occurring in each of the 4 study groups (nivolumab 240 mg IV every 2 weeks, nivolumab 480 mg IV every 4 weeks, pembrolizumab 200 mg IV every 3 weeks, and pembrolizumab 400 mg IV every 6 weeks) within 6 months of treatment initiation. RESULTS: The incidence rates of any-grade irAEs were 40% for the patients who received nivolumab 240 mg IV every 2 weeks and 46% for the patients who received nivolumab 480 mg IV every 4 weeks. The rates of any-grade irAEs were 34% in the patients who received pembrolizumab 200 mg IV every 3 weeks and 47.6% in those who received pembrolizumab 400 mg IV every 6 weeks. Although the number of patients with irAEs was higher in the groups that received nivolumab 480 mg IV every 4 weeks or pembrolizumab 400 mg IV every 6 weeks, the incidence of irAEs was not significantly different between the group that received nivolumab 240 mg IV every 2 weeks versus nivolumab 480 mg IV every 4 weeks (P=.54, chi-square) and the group that received pembrolizumab 200 mg IV every 3 weeks versus pembrolizumab 400 mg IV every 6 weeks (P=.28, chi-square). The patients who received nivolumab 480 mg IV every 4 weeks had a higher incidence of infusion reactions than those who received nivolumab 240 mg IV every 2 weeks (10% vs 4%, respectively). Patients who received pembrolizumab 200 mg IV every 3 weeks had a higher incidence of infusion reactions than those who received pembrolizumab 400 mg IV every 6 weeks (6% vs 0%, respectively). CONCLUSION: The incidence of irAEs was not significantly different among patients receiving nivolumab or pembrolizumab at either dosing schedules. The incidence of infusion reactions was higher in the groups that received nivolumab 480 mg IV every 4 weeks or pembrolizumab 200 mg IV every 3 weeks than in the groups that received nivolumab 240 mg IV every 2 weeks or pembrolizumab 400 mg IV every 6 weeks. Further studies are warranted to validate these results. [ABSTRACT FROM AUTHOR]

Objectives: To describe population rate of hysterectomy for benign disease in the USA, including geographic variation across states and Hospital Service Areas (HSAs; areas defined by common patient flows to healthcare facilities). Design: Cross‐sectional study. Setting: Four US states including 322 HSAs. Population: A total of 316 052 cases of hysterectomy from 2012 to 2016. Methods: We compiled annual hysterectomy cases, merged female populations, and adjusted for reported rates of previous hysterectomy. We assessed small‐area variation and created multi‐level Poisson regression models. Main Outcome Measures: Prior‐hysterectomy‐adjusted population rates of hysterectomy for benign disease. Results: The annual population rate of hysterectomy for benign disease was 49 per 10 000 hysterectomy‐eligible residents, declining slightly over time, mostly among reproductive‐age populations. Rates peaked among residents ages 40–49 years, and declined with increasing age, apart from an increase with universal coverage at age 65 years. We found large differences in age‐standardised population rates of hysterectomy across states (range 42.2–69.0), and HSAs (range: overall 12.9–106.3; 25th–75th percentile 44.0–64.9). Among the non‐elderly population, those with government‐sponsored insurance had greater variation than those with private insurance (coefficient of variation 0.61 versus 0.32). Proportions of minimally invasive procedures were similar across states (71.0–74.8%) but varied greatly across HSAs (27–96%). In regression models, HSA population characteristics explained 31.8% of observed variation in annual rates. Higher local proportions of government‐sponsored insurance and non‐White race were associated with lower population rates. Conclusions: We found substantial variation in rate and route of hysterectomy for benign disease in the USA. Local population characteristics explained less than one‐third of observed variation. [ABSTRACT FROM AUTHOR]