Search

PurposeTo develop a patient-reported outcome measure to assess the impact of glaucoma and treatment, including minimally invasive glaucoma surgery (MIGS).DesignObservational study before and after concomitant cataract and Food and Drug Administration-approved implantable MIGS device surgery.SettingSurvey administration was on a computer, iPad, or similar device.Patient population184 adults completed the baseline survey, 124 a survey 3 months after surgery, and 106 the 1-month test-retest reliability survey. The age range was 37 to 89 (average age = 72). Most were female (57%), non-Hispanic White (81%), and had a college degree (56%).Main outcome measuresThe Glaucoma Outcomes Survey (GOS) assesses functional limitations (27 items), vision-related symptoms (7 items), psychosocial issues (7 items), and satisfaction with microinvasive glaucoma surgery (1 item). These multiple-item scales were scored on a 0 to 100 range, with a higher score indicating worse health.ResultsInternal consistency reliability estimates ranged from 0.75 to 0.93, and 1-month test-retest intraclass correlations ranged from 0.83 to 0.92 for the GOS scales. Product-moment correlations among the scales ranged from 0.56 to 0.60. Improvement in visual acuity in the study eye from baseline to the 3-month follow-up was significantly related to improvements in GOS functional limitations (r = 0.18, P = .0485), vision-related symptoms (r = 0.19, P = .0386), and psychosocial concerns (r = 0.18, P = .0503). Responders to treatment ranged from 17% for vision-related symptoms to 48% for functional limitations.ConclusionsThis study supports using the GOS for ophthalmic procedures such as MIGS. Further evaluation of the GOS in different patient subgroups and clinical settings is needed.

Abstract The spread of carbapenemase-producing gram-negative pathogens, especially those producing metallo-β-lactamases (MBLs), has become a major health concern. MBLs are molecularly the most diverse carbapenemases, produced by a wide spectrum of gram-negative organisms, including the Enterobacterales, Pseudomonas spp., Acinetobacter baumannii, and Stenotrophomonas maltophilia, and can hydrolyze most β-lactams using metal ion cofactors in their active sites. Over the years, the prevalence of MBL-carrying isolates has increased globally, particularly in Asia. MBL infections are associated with adverse clinical outcomes including longer length of hospital stay, ICU admission, and increased mortality across the globe. The optimal treatment for MBL infections not only depends on the pathogen but also on the underlying resistance mechanisms. Currently, there are only few drugs or drug combinations that can efficiently offset MBL-mediated resistance, which makes the treatment of MBL infections challenging. The rising concern of MBLs along with the limited treatment options has led to the need and development of drugs that are specifically targeted towards MBLs. This review discusses the prevalence of MBLs, their clinical impact, and the current treatment options for MBL infections and their limitations. Furthermore, this review will discuss agents currently in the pipeline for treatment of MBL infections.

Difficulty in visualizing anatomical structures has been identified as a challenge in anatomy learning and the emergence of three-dimensional printed models (3DPMs) offers a potential solution. This study evaluated the effectiveness of 3DPMs for learning the arterial supply of the head and neck region. One hundred eighty-four undergraduate medical students were randomly assigned to one of four learning modalities including wet specimen, digital model, 3DPM, and textbook image. Posttest scores indicated that all four modalities supported participants' knowledge acquisition, most significantly in the wet specimen group. While the participants rated 3DPMs lower for helping correct identification of structures than wet specimens, they praised 3DPMs for their ability to demonstrate topographical relationships between the arterial supply and adjacent structures. The data further suggested that the biggest limitation of the 3DPMs was their simplicity, thus making it more difficult for users to recognize the equivalent structures on the wet specimens. It was concluded that future designs of 3DPMs will need to consider the balance between the ease of visualization of anatomical structures and the degree of complexity required for successful transfer of learning. Overall, this study presented some conflicting evidence of the favorable outcomes of 3DPMs reported in other similar studies. While effective for anatomy learning as a standalone modality, educators must identify the position 3DPM models hold relative to other modalities in the continuum of undergraduate anatomy education in order to maximize their advantages for students.

Abstract Background Interprofessional education (IPE) has the potential to shape students’ collaboration perception and interprofessional identity but remains understudied. This study aims to understand the effects of the IPE program as a contextual trigger to promote collaboration perception change and interprofessional identity formation among healthcare professional students. Methods Using concurrent triangulation mixed-methods, we examined the relationship between collaboration perception and interprofessional identity change among health profession students (N = 263), and explored their perspectives on how their IPE experiences influenced their perception and identity. Participants completed the Interdisciplinary Education Perception Scale and Extended Professional Identity Scale and responded to open-ended questions before and after the IPE intervention. Pearson’s correlation, t-tests, regression (quantitative), and thematic analysis (qualitative) were conducted. Results Teams with initially lower collaboration perception (M = 3.59) and lower interprofessional identity (M = 3.59) showed a significant increase in collaboration perception (M = 3.76, t = 2.63; p = .02) and interprofessional identity (M = 3.97, t = 4.86; p

Abstract Recent behavioral evidence suggests that the semantic relationships between isolated objects can influence attentional allocation, with highly semantically related objects showing an increase in processing efficiency. This semantic influence is present even when it is task-irrelevant (i.e., when semantic information is not central to the task). However, given that objects exist within larger contexts, i.e., scenes, it is critical to understand whether the semantic relationship between a scene and its objects continuously influence attention. Here, we investigated the influence of task-irrelevant scene semantic properties on attentional allocation and the degree to which semantic relationships between scenes and objects interact. Results suggest that task-irrelevant associations between scenes and objects continuously influence attention and that this influence is directly predicted by the perceived strength of semantic associations.

Premature dropout from posttraumatic stress disorder treatment (PTSD) hinders treatment response. Studies have primarily used quantitative methodology to identify factors that contribute to Veterans' premature dropout, which has yielded mixed results. Qualitative methods provide rich data and generate additional hypotheses about why Veterans discontinue PTSD treatment. This study aimed to understand Veterans' reasons for dropping out of prolonged exposure therapy (PE) and to examine if there are differences in reasons for dropout between three delivery modalities: in-home, in-person (IHIP), office-based telehealth (OBT), or home-based telehealth (HBT). Twenty-two Veterans who dropped out of PE from a parent randomized clinical trial participated in individual qualitative interviews about potential contextual and individual factors related to discontinuation. Team-based coding was used to conduct open and focused coding. Themes were generated that described factors that influenced Veterans' dropout from PE and constant comparison was used to explore differences in reasons between the three modalities. Most Veterans had multiple reasons for dropping out and reasons were similar across delivery modalities with few differences. Practical barriers (e.g., scheduling difficulties), attitudes toward mental health providers and therapy (e.g., stigma), psychological and physical health factors (e.g., perceived worsening of symptoms, pain), and the therapeutic context (e.g., disliking aspects of PE) contributed to Veterans' decisions to drop out from PE. Veterans in OBT reported more types of practical barriers than Veterans in HBT and IHIP. These findings can help generate hypotheses about interventions that may promote engagement and future studies should continue to study how to reduce dropout. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Families First Coronavirus Response Act (FFCRA) enacted in March 2020 prohibited states from redetermining Medicaid eligibility until March 31st, 2023. However, there has been little direct evidence on how the FFCRA affected coverage continuity, health care access and utilization among Medicaid beneficiaries. In this cross-sectional study, we employ data from the 2015 to 2022 National Health Interview Survey and a difference-in-differences design to study the FFCRA effects by comparing changes in outcomes between Medicaid and privately insured individuals over time. The sample is limited to non-elderly adults aged 19 to 64 years with income below 300% of the federal poverty level. We find that Medicaid beneficiaries experienced a decline in coverage interruptions in 2021 and 2022 relative to privately insured individuals. Additionally, Medicaid beneficiaries had improved access in 2021, with less reporting of unaffordable healthcare needs and delayed medical care due to cost. There were no discernable effects on hospitalizations, ED visits, and doctor/health professional visits. The continuous Medicaid coverage provision under the FFCRA was associated with enhanced coverage stability and improved access to care for Medicaid beneficiaries. Findings highlight potential benefits from new policy initiatives to improve Medicaid coverage continuity.

ObjectiveAlthough advanced stage epithelial ovarian cancer is widely considered life-threatening, 17% of women with advanced disease will survive long-term. Little is known about the health-related quality of life (QOL) of long-term ovarian cancer survivors, or how fear of recurrence might affect QOL.Methods58 long-term survivors with advanced disease participated in the study. Participants completed standardized questionnaires to capture cancer history, QOL, and fear of recurrent disease (FOR). Statistical analyses included multivariable linear models.ResultsParticipants averaged 52.8 years at diagnosis and had survived >8 years (mean:13.5); 64% had recurrent disease. Mean FACT-G, FACT-O, and FACT-O-TOI (TOI) scores were 90.7 (SD:11.6), 128.6 (SD:14.8), and 85.9 (SD:10.2) respectively. Compared to the U.S. population using T-scores, QOL for participants exceeded that of healthy adults (T-score (FACT-G) = 55.9). Overall QOL was lower in women with recurrent vs. non-recurrent disease though differences did not reach statistical significance (FACT-O = 126.1 vs. 133.3, p = 0.082). Despite good QOL, high FOR was reported in 27%. FOR was inversely associated with emotional well-being (EWB) (p

Atmospheric nitrogen (N) deposition is enriching soils with N across biomes. Soil N enrichment can increase plant productivity and affect microbial activity, thereby increasing soil organic carbon (SOC), but such responses vary across biomes. Drylands cover ~45% of Earth's land area and store ~33% of global SOC contained in the top 1 m of soil. Nitrogen fertilization could, therefore, disproportionately impact carbon (C) cycling, yet whether dryland SOC storage increases with N remains unclear. To understand how N enrichment may change SOC storage, we separated SOC into plant-derived, particulate organic C (POC), and largely microbially derived, mineral-associated organic C (MAOC) at four N deposition experimental sites in Southern California. Theory suggests that N enrichment increases the efficiency by which microbes build MAOC (C stabilization efficiency) if soil pH stays constant. But if soils acidify, a common response to N enrichment, then microbial biomass and enzymatic organic matter decay may decrease, increasing POC but not MAOC. We found that N enrichment had no effect on C fractions except for a decrease in MAOC at one site. Specifically, despite reported increases in plant biomass in three sites and decreases in microbial biomass and extracellular enzyme activities in two sites that acidified, POC did not increase. Furthermore, microbial C use and stabilization efficiency increased in a non-acidified site, but without increasing MAOC. Instead, MAOC decreased by 16% at one of the sites that acidified, likely because it lost 47% of the exchangeable calcium (Ca) relative to controls. Indeed, MAOC was strongly and positively affected by Ca, which directly and, through its positive effect on microbial biomass, explained 58% of variation in MAOC. Long-term effects of N fertilization on dryland SOC storage appear abiotic in nature, such that drylands where Ca-stabilization of SOC is prevalent and soils acidify, are most at risk for significant C loss.

Abstract Background The Veterans Health Administration (VHA) is the United States largest learning health system. The Diffusion of Excellence (DoE) program is a large-scale model of diffusion that identifies and diffuses evidence-informed practices across VHA. During the period of 2016-2021, 57 evidence-informed practices were implemented across 82 VHA facilities. This setting provides a unique opportunity to understand sustainment determinants and pathways. Our objective was to characterize the longitudinal pathways of practices as they transition from initial implementation to long-term sustainment at each facility. Methods A longitudinal, mixed-methods evaluation of 82 VHA facilities. Eighty-two facility representatives, chosen by leadership as points-of-contact for 57 DoE practices, were eligible for post-implementation interviews and annual sustainment surveys. Primary outcomes (implementation, sustainment), and secondary outcomes (institutionalization, effectiveness, anticipated sustainment) at four time-points were collected. We performed descriptive statistics and directed content analysis using Hailemariam et al.’s factors influencing sustainment. Results After approximately five years post-implementation (e.g., 2021 sustainment outcomes), of the 82 facilities, about one-third fully sustained their practice compared to one-third that did not fully sustain their practice because it was in a “liminal” stage (neither sustained nor discontinued) or permanently discontinued. The remaining one-third of facilities had missing 2021 sustainment outcomes. A higher percentage of facilities (70%) had inconsistent primary outcomes (changing over time) compared to facilities (30%) with consistent primary outcomes (same over time). Thirty-four percent of facilities with sustained practices reported resilience since they overcame implementation and sustainment barriers. Facilities with sustained practices reported more positive secondary outcomes compared to those that did not sustain their practice. Key factors facilitating practice sustainment included: demonstrating practice effectiveness/benefit, sufficient organizational leadership, sufficient workforce, and adaptation/alignment with local context. Key factors hindering practice sustainment included: insufficient workforce, not able to maintain practice fidelity/integrity, critical incidents related to the COVID-19 pandemic, organizational leadership did not support sustainment of practice, and no ongoing support. Conclusions We identified diverse pathways from implementation to sustainment, and our data underscore that initial implementation outcomes may not determine long-term sustainment outcomes. This longitudinal evaluation contributes to understanding impacts of the DoE program, including return on investment, achieving learning health system goals, and insights into achieving high-quality healthcare in VHA.

The climate crisis and loss of biodiversity, two closely related threats to human and planetary health, meet the criteria for the World Health Organization (WHO) to declare an international public health emergency, as occurred with COVID-19 (1), and urged by numerous scientific journals (2). Attaining decent work, understood as “opportunities for women and men to work in conditions of freedom, equity, security and human dignity” (3), in the context of the climate emergency, creates a paradox for worker health. Outdoor workers (notably those in agriculture and construction), many of them informal workers, are among the populations most vulnerable to climate-related hazards. Simultaneously, they are inevitably at risk of exposure due to their role in maintaining the economy and functioning of society. A similar situation happened during the pandemic with essential workers (4). The WHO declaration of a public health emergency helped manage that global crisis. A consequence of the industrial revolution The current climate crisis is a direct consequence of the Industrial Revolution where key processes emerged to explain the current situation: the appearance of wage labor and the working class, with consumerism as a basic economic driver, and the exploitation of natural resources – especially fossil fuels – in their own territories and in the colonies. The extension of this capitalist model of society to virtually the entire planet is a reality. Now, we see how this economic system has brought both great harm and significant benefits. Since its beginning, capitalism has wrought great suffering for people, masterfully described, among others, by Fredrich Engels in the Manchester of 1845 (5) or the London of 1838 in Charles Dickens` Oliver Twist (6). Although working conditions have since improved in many countries, there are still unbearable examples worldwide of worker exploitation and suffering. Among them, child labor, where 70% are working in agriculture (7) or some underregulated platform work (8), in a context of ever-increasing social inequalities (9). On the other hand, due to improved working and life conditions, there has also been an extraordinary increase in the world population, from one billion at the beginning of the 19th century to approximately eight billion today, leading to a linear increase in life expectancy at birth, which doubled globally between the beginning of the 20th century and the present. In 2015, the Lancet Commission on Planetary Health (10) pointed out that never before has humanity faced such an unintended paradox. While human well-being has been improving, the planet has been degrading. A contradiction that can no longer be sustained. We have lived as if our planet`s resources are unlimited. Based on comparisons to average temperature readings of the planet between 1850 and 1900, the United Nations International Panel on Climate Change estimated in its latest report that temperatures increased by 1.1° C between 2011 and 2020. This increase is very close to the 1.5° C established by the 2015 Paris Agreement as the limit beyond which climate impacts may become irreversible. Beyond any reasonable doubt, this is mostly attributable to the greenhouse effect produced by CO2 emissions, a consequence mainly of human activity and our way of living initiated by the Industrial Revolution. This global increase in temperature, with heat waves, floods and other extreme temperature events as its most obvious manifestations, is already having effects on worker health (12, 13). Climate change is also having effects on the economy and the labor market, both in the primary (agriculture and fishing) and services (tourism) sectors, with reductions in productivity and employment. Estimates from the European Commission reveal an average loss of 3% of GDP among EU countries between 1980 and 2020 (14). Simultaneously, we should not forget that the capitalist society that emerged from the Industrial Revolution is based, among other pillars, on full or near full employment. As such, wages represent the main economic resource for the majority of people, in addition to being the primary source of wealth generation for society, on whose income and taxes the welfare state was built. Of course, employment means much more than wage earning, as it plays a fundamental role in the social processes that sustain human dignity and social cohesion (15). However, only approximately 50% of the employed population, mainly in high-income countries, enjoy decent employment with a living wage and social rights (16). The resulting Gordian knot before us is enormous, with humanity facing the climate emergency and trying to move from fossil fuels to renewable energy sources, while simultaneously seeking to maintain and increase decent employment for all Earth`s inhabitants, boosting the welfare states at the same time (17). Controlling climate-related hazards and just green transition The alternatives proposed to escape this crossroads vary between those that propose a new paradigm, which radically changes the current economic model, betting on measures that break drastically from the capitalist economy (18), versus a gradual process, supported by mitigation, adaptation, and compensation policies (19). Favoring this second alternative, but without ruling out the need to profoundly change human consumption patterns with important repercussions on the productive system (energy, transportation, food, etc.), gradualist policies will also directly or indirectly impact employment and working conditions during the transition from carbon emission energy to green energy. To cope with this urgent situation, specific control measures have been proposed over the last few decades. Schulte and colleagues have systematically reviewed the literature (20, 21, 22), identifying new and exacerbated old climate-related hazards such as extreme temperatures, air pollution, ultraviolet radiation, natural disasters, biological hazards, indoor air quality, etc., and they also assessed the impact of employment transition and economic burden on occupational health equity and mental health. On this basis, the US National Institute for Occupational Safety and Health has elaborated recommendations to mitigate and control the impact of several climate-related hazards on worker health and well-being (23). Similarly, the EU Agency for Safety and Health at Work has published guidelines for heat at work (24). Going further, some governments, such as Spain, have begun regulating and enforcing specific measures (25). Implementation of these workplace preventive measures to mitigate the impact of climate change is the responsibility of employers, with full participation of workers. Devoting resources to hazard recognition; performing risk assessments to identify which workers are most vulnerable to climate change-related hazards; and implementing a control strategy with policies, procedures, equipment, and work organization changes aiming to eliminate or minimize the impact of these hazards can improve employer preparedness (26). Adaptation policies to reduce emissions of CO2 and other gases that are driving the greenhouse effect, still with limited results, could mean a loss of six million jobs worldwide, according to estimates of the International Labor Organization (ILO) (27). This same estimation predicts a promising creation of 24 million jobs, mainly in economies emphasizing recycling and reutilization of manufactured products (the so-called “circular economy”), infrastructure construction, development of renewables and energy efficiency. Also, during this transition, new forms of work will emerge (e.g., human-robot interfaces and artificial intelligence), and with them the need to train workers, both new and existing, to adapt to those new forms of work. While waiting for positive results from mitigation and adaptation policies, a just transition to a green economy must simultaneously incorporate compensation policies. To achieve this, it is essential to strengthen social protection systems, a cornerstone of decent employment. For example, there were measures adopted during the pandemic, such as temporary employment regulation for employees or benefits covering the cessation of activity of the self-employed. Similar compensation measures may help workers affected by mitigation and adaptation policies during a transition phase, possibly to a lesser degree than in the pandemic, but lasting longer. In summary, as was the case in the most recent public health emergency, the COVID-19 pandemic, declaring the climate emergency as an international public health emergency by the WHO could play a critical role in managing this new global health crisis. Research programs, supported by global occupational health surveillance systems, to monitor the effectiveness of mitigation, adaptation and compensation measures are urgent. Conflict of interest statement The authors report no conflicts of interest. References 1. WHO. International Health Regulations, 3rd edition. Geneva: WHO; 2016. Available on: https://www.who.int/publications/i/item/9789241580496. Accessed 4 February 2024. 2. Zielinski C. Time to treat the climate and nature crisis as one indivisible global health emergency. BMJ Open. 2023;13(10):e080907. https://doi.org/10.1136/bmjopen-2023-080907 3. International Labour Organization. Report of the Director-General: decent work. Paper presented at the 87th Annual International Labour Conference, Geneva, 1999. Available at: https://www.ilo.org/public/english/standards/relm/ilc/ilc87/rep-i.htm [Accessed March 9 2024]. 4. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health. 2020; 46(3):229-230. https://doi.org/10.5271/sjweh.3893 5. Engels, F. The condition of the working class in England (D. McLellan, Ed.). Oxford: Oxford University Press; 2009. https://doi.org/10.1093/owc/9780199554652.003.0151 6. Dickens C. Oliver Twist. London: Lacy; 1938. https://doi.org/10.1093/oseo/instance.00121337 7. Piketty, T. Capital in the twenty-first century (A. Goldhammer, Trans.). London: Belknap Press; 2017. https://doi.org/10.2307/j.ctvjnrvx9 8. International Labour Organization, Issue paper on child labour and climate change, Geneva: ILO; 2023. Available on: https://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_905673/lang--en/index.htm. 9. Eurofound. Back to the future: Policy pointers from platform work scenarios, New forms of employment series. Luxembourg: Publications Office of the European Union; 2020. 10. Whitmee S, Haines A, Beyrer C et al. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation-Lancet Commission on planetary health. Lancet. 2015;386(10007):1973-2028. https://doi.org/10.1016/S0140-6736(15)60901-1 11. Intergovernmental Panel on Climate Change (IPCC). Synthesis report (SYR) of the IPCC sixth assessment report (AR6). Available on: https://www.ipcc.ch/report/sixth-assessment-report-cycle. Accessed 4 February 2024. 12. Martínez-Solanas È, López-Ruiz M, Wellenius GA, Gasparrini A et. Evaluation of the impact of ambient temperatures on occupational injuries in Spain. Environ Health Perspect. 2018;126(6):067002. https://doi.org/10.1289/EHP2590 13. Johnson RJ, Wesseling C, Newman LS. Chronic kidney disease of unknown cause in agricultural communities. N Engl J Med. 2019;380(19):1843-1852. https://doi.org/10.1056/NEJMra1813869 14. European Environment Agency. Economic losses and fatalities from weather and climate-related events in Europe. Available on: https://www.eea.europa.eu/publications/economic-losses-and-fatalities-from#:~:text=Between%201980%20%20and%202020%2C%20total,of%20these%20losses%20were%20insured. Accessed 4 February 2024. 15. Budd JW. The thought of work. J Ind Rel. 2012;54(4):542-545. https://doi.org/10.1177/0022185612456331 16. Frank J, Mustard C, Smith P, Siddiqi A, Cheng Y, Burdorf A et al. Work as a social determinant of health in high-income countries: past, present, and future. Lancet. 2023 Oct 14;402(10410):1357-1367. https://doi.org/10.1016/S0140-6736(23)00871-1 17. Benavides FG, Serra C, Delclos GL. What can public health do for the welfare state? Occupational health could be an answer. J Epidemiol Community Health. 2019;73(12):1141-1144. https://doi.org/10.1136/jech-2018-211561 18. Saito K. El capital en la era del Antropoceno. Barcelona: Penguin Random House Grupo Editorial, 2022. 19. Eurofound. Impact of climate change and climate policies on living conditions, working conditions, employment and social dialogue: A conceptual framework. Luxembourg: Eurofound research paper, Publications Office of the European Union; 2023. 20. Schulte PA, Chun H. Climate change and occupational safety andhealth: establishing a preliminary framework. J Occup Environ Hyg. 2009; 6:9, 542-554. https://doi.org/10.1080/15459620903066008 21. Schulte PA, Bhattacharya A, Butler CR et al. Advancing the framework for considering the effects of climate change on worker safety and health. J Occup Environ Hyg. 2016;13(11):847-65. https://doi.org/10.1080/15459624.2016.1179388 22. Schulte PA, Jacklitsch LB, Bhattacharya A et al. Updated assessment of occupational safety and health hazards of climate change. J Occup Environ Hyg. 2023;20(5-6):183-206, https://doi.org/10.1080/15459624.2023.2205468 23. US Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health (NIOSH). Occupational safety and health and climate. Available on: https://www.cdc.gov/niosh/topics/climate/default.html. Accessed 6 February 2024. 24. European Agency for Safety and Health at Work. Heat at work - Guidance for workplaces. Available on: https://osha.europa.eu/en/publications/heat-work-guidance-workplaces. Accessed 7 February 2024. 25. Real Decreto-ley 4/2023, de 11 de mayo, por el que se adoptan medidas urgentes en materia de […] prevención de riesgos laborales en episodios de elevadas temperaturas. Available on: https://www.boe.es/eli/es/rdl/2023/05/11/4. Accessed at 7 February 2024. 26. Levy, Barry S, Cora Roelofs. Impacts of climate change on workers’ health and safety. Oxford Research Encyclopedia of Global Public Health. 2019. https://doi.org/10.1093/acrefore/9780190632366.013.39 27. International Labor Organization (ILO). World employment and social outlook 2018: Greening with jobs. Geneva: ILO; 2018. Available on: https://www.ilo.org/weso-greening/documents/WESO_Greening_EN_web2.pdf. Accessed at 7 February 2024.

Abstract Background Adults with sickle cell disease (SCD) suffer early mortality and high morbidity. Many are not affiliated with SCD centers, defined as no ambulatory visit with a SCD specialist in 2 years. Negative social determinants of health (SDOH) can impair access to care. Hypothesis: Negative SDOH are more likely to be experienced by unaffiliated adults than adults who regularly receive expert SCD care. Methods Cross-sectional analysis of the SCD Implementation Consortium (SCDIC) Registry, a convenience sample at 8 academic SCD centers in 2017–2019. A Distressed Communities Index (DCI) score was assigned to each registry member’s zip code. Insurance status and other barriers to care were self-reported. Most patients were enrolled in the clinic or hospital setting. Results The SCDIC Registry enrolled 288 Unaffiliated and 2110 Affiliated SCD patients, ages 15-45y. The highest DCI quintile accounted for 39% of both Unaffiliated and Affiliated patients. Lack of health insurance was reported by 19% of Unaffiliated versus 7% of Affiliated patients. The most frequently selected barriers to care for both groups were “previous bad experience with the healthcare system” (40%) and “Worry about Cost” (17%). SCD co-morbidities had no straightforward trend of association with Unaffiliated status. The 8 sites’ results varied. Conclusion The DCI economic measure of SDOH was not associated with Unaffiliated status of patients recruited in the health care delivery setting. SCDIC Registrants reside in more distressed communities than other Americans. Other SDOH themes of affordability and negative experiences might contribute to Unaffiliated status. Recruiting Unaffiliated SCD patients to care might benefit from systems adopting value-based patient-centered solutions.

Abstract Drivers and dynamics of initial human migrations across individual islands and archipelagos are poorly understood, hampering assessments of subsequent modification of island biodiversity. We developed and tested a new statistical-simulation approach for reconstructing the pattern and pace of human migration across islands at high spatiotemporal resolutions. Using Polynesian colonisation of New Zealand as an example, we show that process-explicit models, informed by archaeological records and spatiotemporal reconstructions of past climates and environments, can provide new and important insights into the patterns and mechanisms of arrival and establishment of people on islands. We find that colonisation of New Zealand required there to have been a single founding population of approximately 500 people, arriving between 1233 and 1257 AD, settling multiple areas, and expanding rapidly over both North and South Islands. These verified spatiotemporal reconstructions of colonisation dynamics provide new opportunities to explore more extensively the potential ecological impacts of human colonisation on New Zealand’s native biota and ecosystems.

What does Diverse: Issues In Higher Education mean to you? That might depend on what type of reader you are or your line of work. When the first edition of [...]