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Abstract Background In the United States (US), hepatitis C virus (HCV) screening is not covered by payers in settings outside of primary care. A non-traditional, emergency department (ED)-based HCV screening program can be cost-effective and identify infection in vulnerable populations with a high HCV risk. This study examined the long-term cost-effectiveness of routine HCV screening and linkage-to-care for high-risk patients in the ED from the payer’s perspective. Methods The University of Illinois Hospital and Health Sciences System (UIH) implemented Project HEAL (HIV & HCV Screening, Education, Awareness, Linkage-to-Care). Under this initiative, patients who presented to the ED received opt-out HCV screening if they were at high risk for HCV infection (birth cohort between 1945 and 1964, persons who inject drugs, and HIV infection) with subsequent linkage-to-care if infected. Using the summary data from Project HEAL, a hybrid decision-analytic Markov model was developed based on the HCV screening procedure in the ED and the natural history of HCV. A 30-year time horizon and 1-year cycle length were used. All patients who received the ED-based HCV screening were referred for treatment with direct-acting antiviral (DAA) regardless of their fibrosis stage. Results When unscreened/untreated patients received DAA treatment at F1, F2, F3, and compensated cirrhosis stages, the incremental cost-effectiveness ratio (ICER) ranged from $6,084 to $77,063 per quality-adjusted life year (QALY) gained. When unscreened/untreated patients received DAA treatment at the decompensated cirrhosis stage, no HCV screening was dominated. Conclusion ED-based HCV screening and linkage-to-care was cost-effective at the willingness-to-pay (WTP) threshold of $100,000/QALY in all scenarios. A reduction in infected persons in the community may provide additional benefits not evaluated in this study.

Purpose: The purpose of this study was to bring library practitioners and researchers together to develop two co-designed tools for helping library practitioners gain a more holistic understanding of families in underserved groups and identify their values with the goal of developing more relevant learning experiences for them. The co-designed tools were then tested with Master's of Library and Information Science (MLIS) students at two universities, whose feedback yielded several valuable findings and informed revisions to the tools. Design/methodology/approach: A participatory, design-based approach was used throughout the study, both with engaging library practitioners in the co-design of different tools and processes introduced in the Toolkit, and to help MLIS students and library practitioners test the tools and provide feedback on the tool revisions. Findings: Students indicated that the tools helped them develop a deeper understanding of underserved groups and their values and gave the students the time and space to reflect on their understanding of the socio-cultural and value contexts of their communities and the values they hold. Originality/value: This study can help libraries more effectively design strengths-based learning experiences that are meaningful and relevant to underserved groups and their values, particularly for children and families from underserved communities.

Objective: This study expands the literature on risk taking among college students by exploring anti-racism action as a form of positive risk taking. Participants: 346 Black (64%) and Latinx (36%) college students (85% female) ages 18-27 years (M = 18.75, SD = 1.31). Methods: Participants responded to questionnaires on anti-racism action, health-risk taking, and college functioning. Latent class analysis identified behavioral profiles of risk takers. Indicators of profile membership and associations with college functioning were examined. Results: Three profiles emerged: moderate overall risk taking, high health-risk taking, and high anti-racism action. Personal experience with discrimination was associated with a greater likelihood of health-risk taking. Students in the high anti-racism profile evinced greater educational functioning than those in the high-health risk taking profile. Conclusions: Risky behavior on college campuses is not homogeneous. Specific interventions and support networks are necessary to support students falling within specific risk profiles.

Our goal is to determine whether our objective 9-point Self-Assessment Skin Tone Palette (SASTP) is correlated with a colorimeter’s assessment of a melanin index, so that Hispanic and Black people can be included in skin cancer research where scales were developed for White populations. Subjects were asked to self-identify their skin tones using the SASTP. This study assessed the criterion validity of the SASTP by measuring a range of skin colors compared to a melanin index reported from a colorimeter for the upper-inner arm (non-sun-exposed skin color), and the outer forearm (sun-exposed). Among 188 non-artificial tanners, 50% were White, 30% were Hispanic or White-Hispanic, and 20% were other racial categories. Meanwhile, 70% were female (30% male) and 81% were age 18–29 (19% age 30+). The mean melanin of the upper-inner arm decreased with lighter skin color and stronger tendency to burn. The SASTP in comparison to melanin index values was correlated for both the upper-inner arm (r = 0.81, p < 0.001) and the outer forearm (r = 0.77, p < 0.001). The SASTP provides a 9-point scale that can be considered as an alternative, less expensive method that is comparable to the objective colorimeter melanin index, which may be useful in studies on skin cancer among White, non-White, and Hispanic peoples.

The Emotional Well-Being and Economic Burden (EMOT-ECON) Research Network is one of six research networks funded by the National Institutes of Health (NIH) to advance research about emotional well-being (EWB), and the only one that focuses on addressing how economic burden due to disease or illness affects EWB. The network convened researchers, patients, patient advocates, health care providers and other stakeholders from across the US to discuss the significance of addressing the impact of the economic burden of disease on EWB, the complexity of this prevalent problem for patients and families, and the research gaps that still need to be studied to ultimately develop strategies to reduce the impact of economic burden of disease on EWB and health. Participants identified some important future areas of research as those investigating: (i) prevalent and relevant emotions for patients experiencing economic burden of disease and financial hardship, and how their broader outlook on life is impacted; (ii) constructs and contexts that influence whether the economic burden is stressful; (iii) strategies to deal and cope and their positive or negative effects on EWB and health; and (iv) multi-level and multi-stakeholder interventions to address economic factors (e.g., costs, ability to pay), administrative burdens, education and training, and especially patients’ emotional as well as financial status.

CASE SERIES SUMMARY:Described are 13 cats diagnosed with deep ulcerative keratitis and successfully managed medically without grafting procedures. Typical treatment involved frequent topical application of serum and antibiotics (usually a fluoroquinolone and a cephalosporin). Seven cats also received systemic antibiotics. Analgesia was achieved using various combinations of topical atropine and systemic buprenorphine, robenacoxib or corticosteroids. Six cats were hospitalized for a median (range) period of 2.5 (1-8) days, typically because of frequent medication administration. Median (range) follow-up time was 41.5 (9-103) days. Median (range) number of recheck examinations was 4 (2-6). Median (range) time to corneal re-epithelialization was 21 (9-103) days. Median (range) topical antibiotic course was 29.5 (16-103) days. Median (range) duration of Elizabethan collar use was 28 (13-73) days. At the time of writing, no further recheck examinations were recommended for 10 cats; median (range) time between initial to final examinations in these cats was 35 (20-103) days. All cats retained the affected globes and were apparently comfortable and visual at the latest recheck examination. RELEVANCE AND NOVEL INFORMATION:These cases reveal that aggressive medical management is highly successful in select cats with deep ulcerative keratitis, and can result in a cosmetically acceptable, apparently comfortable and visual globe. However, therapy is intensive with frequent administration of multiple topical and sometimes systemic medications, and requires multiple veterinary visits over many weeks. Referral to a veterinary ophthalmologist for consideration of surgical stabilization is recommended, as not all cases may be amenable to the medical therapy described here.

An opportunistic investigation into ecosystem instability in Kachemak Bay (KBay), Alaska, has led us to investigate exposure to toxic algae in sea otters. We used gene expression to explore the physiological health of sea otters sampled in KBay in May 2019. We found altered levels of gene transcripts in comparison with reference sea otters from clinically normal, oil-exposed, and nutritionally challenged populations sampled over the past decade. KBay sea otters were markedly divergent from the other groups for five genes, which indicated the involvement of neurological, cardiac, immune, and detoxification systems. Further, analyses of urine and fecal samples detected domoic acid in the KBay sea otters. In combination, these results may point to chronic, low-level exposure to an algal toxin, such as domoic acid. With a warming climate, the frequency and severity of harmful algal blooms in marine environments is anticipated to increase, and novel molecular technologies to detect sublethal or chronic exposure to algal toxins will help provide an early warning of threats to the stability of populations and ecosystems.

Objective To facilitate replication and future intervention design of web-based multibehavior lifestyle interventions, we describe the rationale, development, and content of the A i M , P lan, and act on LIF est Y les (AMPLIFY) Survivor Health intervention which provides healthy eating and exercise behavior change support for older cancer survivors. The intervention promotes weight loss, improvements in diet quality, and meeting exercise recommendations. Methods The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a comprehensive description of the AMPLIFY intervention, consistent with CONSORT recommendations. Results A social cognitive theory web-based intervention founded on the core components of efficacious print and in-person interventions was conceptualized and developed through an iterative collaboration involving cancer survivors, web design experts, and a multidisciplinary investigative team. The intervention includes the AMPLIFY website, text and/or email messaging, and a private Facebook group. The website consists of: (1) Sessions (weekly interactive e-learning tutorials); (2) My Progress (logging current behavior, receiving feedback, setting goals); (3) Tools (additional information and resources); (4) Support (social support resources, frequently asked questions); and (5) Home page. Algorithms were used to generate fresh content daily and weekly, tailor information, and personalize goal recommendations. An a priori rubric was used to facilitate intervention delivery as healthy eating only (24 weeks), exercise only (24 weeks), or both behaviors concurrently over 48 weeks. Conclusions Our TIDieR-guided AMPLIFY description provides pragmatic information helpful for researchers designing multibehavior web-based interventions and enhances potential opportunities to improve such interventions.

A pyloric gland adenoma is a rare neoplasm that occurs most frequently in the stomach and should be removed because of its precancerous potential. Although there have been case reports of pyloric gland adenomas in extragastric areas such as the duodenum, pancreas, and bile duct, esophageal pyloric gland adenoma has never been reported in Korea. Herein, we report a case of esophageal pyloric gland adenoma that was successfully treated by endoscopic submucosal dissection.

Abstract Background The spatial ecology of individuals often varies within a population or species. Identifying how individuals in different classes interact with their environment can lead to a better understanding of population responses to human activities and environmental change and improve population estimates. Most inferences about polar bear (Ursus maritimus) spatial ecology are based on data from adult females due to morphological constraints on applying satellite radio collars to other classes of bears. Recent studies, however, have provided limited movement data for adult males and sub-adults of both sexes using ear-mounted and glue-on tags. We evaluated class-specific movements and step selection patterns for polar bears in the Chukchi Sea subpopulation during spring. Methods We developed hierarchical Bayesian models to evaluate polar bear movement (i.e., step length and directional persistence) and step selection at the scale of 4-day step lengths. We assessed differences in movement and step selection parameters among the three classes of polar bears (i.e., adult males, sub-adults, and adult females without cubs-of-the-year). Results Adult males had larger step lengths and less directed movements than adult females. Sub-adult movement parameters did not differ from the other classes but point estimates were most similar to adult females. We did not detect differences among polar bear classes in step selection parameters and parameter estimates were consistent with previous studies. Conclusions Our findings support the use of estimated step selection patterns from adult females as a proxy for other classes of polar bears during spring. Conversely, movement analyses indicated that using data from adult females as a proxy for the movements of adult males is likely inappropriate. We recommend that researchers consider whether it is valid to extend inference derived from adult female movements to other classes, based on the questions being asked and the spatial and temporal scope of the data. Because our data were specific to spring, these findings highlight the need to evaluate differences in movement and step selection during other periods of the year, for which data from ear-mounted and glue-on tags are currently lacking.

Abstract Background Scalable, multiple behavior change interventions are needed to address poor diet, inactivity, and excess adiposity among the rising number of cancer survivors. Efficacy-tested diet (RENEW) and exercise (BEAT Cancer) programs were adapted for web delivery among middle-aged and older cancer survivors for the AMPLIFI study, a National Cancer Institute-funded, multi-site, program project. Methods Throughout the continental U.S., survivors of several obesity-related cancers are being recruited for three interconnected randomized controlled trials (RCTs). Projects 1 and 2 test 6-month diet or exercise interventions versus a wait-list control condition. Upon completion of the 6-month study period, the intervention participants receive the next behavior change sequence (i.e., diet receives exercise, exercise receives diet) and the wait-list control arm initiates a 12-month combined diet and exercise intervention. Project 3 tests the efficacy of the sequential versus simultaneous interventions. Assessments occur at baseline and semi-annually for up to 2-years and include: body mass index, health behaviors (diet quality, accelerometry-assessed physical activity/sleep), waist circumference, D3 creatine-assessed muscle mass, physical performance, potential mediators/moderators of treatment efficacy, biomarkers of inflammation and metabolic regulation, health care utilization, cost, and overall health. Four shared resources support AMPLIFI RCTs: 1) Administrative; 2) Adaptation, Dissemination and Implementation; 3) Recruitment and Retention; and 4) Assessment and Analysis. Discussion Representing a new generation of RCTs, AMPLIFI will exclusively use remote technologies to recruit, intervene and assess the efficacy of the newly-adapted, web-based diet and exercise interventions and determine whether sequential or combined delivery works best for at-risk (older, rural, racial minority) cancer survivors. Trial registration ClinicalTrials.gov , NCT04000880 . Registered 27 June 2019.

Background: Essential workers across multiple industries faced a disproportionate burden of morbidity and mortality during the COVID‐19 pandemic. The effects were especially severe for agricultural and food processing workers, many of whom are members of the structurally vulnerable Latine community. Under current U.S. federal laws, children under 12 years old can legally work in agriculture, one of the most hazardous U.S. industries. Many of these working youth are Latine and experience health and educational inequities. Methods: Using a community‐based participatory research approach and a qualitative design, we conducted semi‐structured in‐depth interviews in North Carolina in 2022, with service providers in health, education, and advocacy fields (n = 10) and Latine youth farmworkers aged 10–17 (n = 24). We used participatory qualitative analysis methods and a reflexive thematic analysis to understand and describe the work experiences of these youth during the first 2 years of the pandemic. Results: Amidst precarious economic and school situations exacerbated by the COVID‐19 pandemic, many youths described an increased need to work to support their families. While aware and sometimes fearful of the added occupational health risks of COVID‐19, youth and their families felt they had few other options. Service providers and youth described minimal employer‐provided safety protocols or equipment, yet some workers organized their own attempts at safety protocols. Youth narratives imply limited knowledge of basic workplace safety requirements. Conclusions: Study findings emphasize the urgent need to address structural vulnerabilities shaping workplace policies and norms to protect Latine youth farmworkers to support their healthy development. [ABSTRACT FROM AUTHOR]

Objective This scoping review of reviews aims to describe the current landscape of measures of emotional well-being (EWB).Methods Following established practices for scoping reviews, we searched the PsycInfo, ERIC, Scopus and PubMed databases in June and July 2021 for reviews of measures of EWB that described their review methods and psychometric properties of included measures. From each eligible article, two coders independently extracted the authors’ (1) definition of EWB, (2) purpose for the review, (3) methods (eg, search terms, inclusion and exclusion criteria), (4) identified measures (including any noted adaptations) and (5) the scope of psychometric information presented. Descriptive and content analyses were used to examine data.Results Forty-nine reviews were included in this scoping review. Reviews included anywhere between 1 and 34 measures of EWB and 135 unique EWB measures were captured across all reviews. We found that there was no consistent definition of EWB, identified measures varied widely and reviews were published in a range of disciplines. Psychometric evidence varied as did authors’ purposes for conducting the reviews.Conclusions Overall, these reviews suggest that literature on EWB measurement is disjointed and diffuse. Conceptual integration and harmonisation of measures is needed to advance knowledge of EWB and its measurement.Trial registration numbers 10.17605/OSF.IO/BQDS7 and 10.17605/OSF.IO/WV8PF.

Purpose: Radiation treatment interruption associated with unplanned hospitalization remains understudied. The intent of this study was to benchmark the frequency of hospitalization-associated radiation therapy interruptions (HARTI), characterize disease processes causing hospitalization during radiation, identify factors predictive for HARTI, and localize neighborhood environments associated with HARTI at our academic referral center. Methods and Materials: This retrospective review of electronic health records provided descriptive statistics of HARTI event rates at our institutional practice. Uni- and multivariable logistic regression models were developed to identify significant factors predictive for HARTI. Causes of hospitalization were established from primary discharge diagnoses. HARTI rates were mapped according to patient residence addresses. Results: Between January 1, 2015, and December 31, 2017, 197 HARTI events (5.3%) were captured across 3729 patients with 727 total missed treatments. The 3 most common causes of hospitalization were malnutrition/dehydration (n = 28; 17.7%), respiratory distress/infection (n = 24; 13.7%), and fever/sepsis (n = 17; 9.7%). Factors predictive for HARTI included African-American race (odds ratio [OR]: 1.48; 95% confidence interval [CI], 1.07-2.06; P = .018), Medicaid/uninsured status (OR: 2.05; 95% CI, 1.32-3.15; P = .0013), Medicare coverage (OR: 1.7; 95% CI, 1.21-2.39; P = .0022), lung (OR: 5.97; 95% CI, 3.22-11.44; P < .0001), and head and neck (OR: 5.6; 95% CI, 2.96-10.93; P < .0001) malignancies, and prescriptions >20 fractions (OR: 2.23; 95% CI, 1.51-3.34; P < .0001). HARTI events clustered among Medicaid/uninsured patients living in urban, low-income, majority African-American neighborhoods, and patients from middle-income suburban communities, independent of race and insurance status. Only the wealthiest residential areas demonstrated low HARTI rates. Conclusions: HARTI disproportionately affected socioeconomically disadvantaged urban patients facing a high treatment burden in our catchment population. A complementary geospatial analysis also captured the risk experienced by middle-income suburban patients independent of race or insurance status. Confirmatory studies are warranted to provide scale and context to guide intervention strategies to equitably reduce HARTI events.

Abstract Background Policy-makers are increasingly seeking rigorous evidence on the impact of programs that go beyond typical health care settings to improve outcomes for low-income families during the critical period around the transition to parenthood and through early childhood. Methods This study is a randomized controlled trial evaluating the impact of the Nurse-Family Partnership’s expansion in South Carolina. The scientific trial was made possible by a “Pay for Success” program embedded within a 1915(b) Waiver from Medicaid secured by the South Carolina Department of Health and Human Services. This protocol describes study procedures and defines primary and secondary health-related outcomes that can be observed during the intervention period (including pregnancy through the child’s first 2 years of life). Primary study outcomes include (1) a composite indicator for adverse birth outcomes including being born small for gestational age, low birth weight (less than 2500 g), preterm birth (less than 37 weeks’ gestation), or perinatal mortality (fetal death at or after 20 weeks of gestation or mortality in the first 7 days of life), (2) a composite outcome indicating health care utilization or mortality associated with major injury or concern for abuse or neglect occurring during the child’s first 24 months of life, and (3) an indicator for an inter-birth interval of

Abstract Background Although evidence-based interventions for increasing exercise among cancer survivors (CSs) exist, little is known about factors (e.g., implementation facilitators) that increase effectiveness and reach of such interventions, especially in rural settings. Such factors can be used to design implementation strategies. Hence, our study purpose was to (1) obtain multilevel perspectives on improving participation in and implementation of a multicomponent exercise behavior change intervention for rural women CSs and (2) identify factors important for understanding the context using the Consolidated Framework for Implementation Research (CFIR) for comparison across three levels (CSs, potential interventionists, community/organizational stakeholders). Methods We conducted three nominal group technique meetings with rural women CSs, three with community/organizational stakeholders, and one with potential interventionists. During each meeting, participants were asked to respond silently to one question asking what would make a multicomponent exercise intervention doable from intervention participation (CSs) or implementation (potential interventionists, stakeholders) perspectives. Responses were shared, discussed to clarify meaning, and prioritized by group vote. Data was deductively coded using CFIR. Results Mean age of CSs (n = 19) was 61.8 ± 11.1 years, community stakeholders (n = 16) was 45.9 ± 8.1 years, and potential interventionists (n = 7) was 41.7 ± 15.2 years. There was considerable consensus among CSs, potential interventionists, and stakeholders in terms of CFIR domains and constructs, e.g., “Design quality and packaging” (Innovation Characteristics), “Patients needs and resources” (Outer Setting), “Available resources” (Inner Setting), and “Engaging” (Process). However, participant-specific CFIR domains and constructs were also observed, e.g., CSs endorsed “Knowledge and beliefs about the intervention,” “Individual stage of change,” and “Self-efficacy” (Characteristics of Individuals); potential interventionists valued “Tension for change” (Inner Setting) and “Innovation participants” and “Key stakeholder” (Process); stakeholders emphasized “Goals and feedback” and “Network and communication” (Inner Setting), and “Planning” (Process). How the three participant levels conceptualized the CFIR constructs demonstrated both similarities and differences. Conclusions Multilevel input yielded diversity in type, relative priority, and conceptualization of implementation facilitators suggesting foci for future implementation strategy development and testing. Findings also reinforced the importance of multilevel implementation strategies for increasing exercise in an underserved, at-risk population.

BackgroundWith the increasing number of older cancer survivors, it is imperative to optimize the reach of interventions that promote healthy lifestyles. Web-based delivery holds promise for increasing the reach of such interventions with the rapid increase in internet use among older adults. However, few studies have explored the views of middle-aged and older cancer survivors on this approach and potential variations in these views by gender or rural and urban residence. ObjectiveThe aim of this study was to explore the views of middle-aged and older cancer survivors regarding the features of web-based healthy lifestyle programs to inform the development of a web-based diet and exercise intervention. MethodsUsing a qualitative descriptive approach, we conducted 10 focus groups with 57 cancer survivors recruited from hospital cancer registries in 1 southeastern US state. Data were analyzed using inductive thematic and content analyses with NVivo (version 12.5, QSR International). ResultsA total of 29 male and 28 female urban and rural dwelling Black and White survivors, with a mean age of 65 (SD 8.27) years, shared their views about a web-based healthy lifestyle program for cancer survivors. Five themes emerged related to program content, design, delivery, participation, technology training, and receiving feedback. Cancer survivors felt that web-based healthy lifestyle programs for cancer survivors must deliver credible, high-quality, and individually tailored information, as recommended by health care professionals or content experts. Urban survivors were more concerned about information reliability, whereas women were more likely to trust physicians’ recommendations. Male and rural survivors wanted information to be tailored to the cancer type and age group. Privacy, usability, interaction frequency, and session length were important factors for engaging cancer survivors with a web-based program. Female and rural participants liked the interactive nature and visual appeal of the e-learning sessions. Learning from experts, an attractive design, flexible schedule, and opportunity to interact with other cancer survivors in Facebook closed groups emerged as factors promoting program participation. Low computer literacy, lack of experience with web program features, and concerns about Facebook group privacy were important concerns influencing cancer survivors’ potential participation. Participants noted the importance of technology training, preferring individualized help to standardized computer classes. More rural cancer survivors acknowledged the need to learn how to use computers. The receipt of regular feedback about progress was noted as encouragement toward goal achievement, whereas women were particularly interested in receiving immediate feedback to stay motivated. ConclusionsImportant considerations for designing web-based healthy lifestyle interventions for middle-aged and older cancer survivors include program quality, participants’ privacy, ease of use, attractive design, and the prominent role of health care providers and content experts. Cancer survivors’ preferences based on gender and residence should be considered to promote program participation.

Abstract Wildlife managers often rely on analyses conducted prior to the widespread adoption of hierarchical models which can lead to questions about the accuracy of previous inferences. Hierarchical models allow observed data to be partitioned into factors that influenced the collection of the data such as detectability of animals (i.e., observation processes) and factors that influence the ecology of a population such as features that affect the distribution of animals (i.e., ecological processes). Population surveys for sea otters in the Aleutian Islands, Alaska, have historically been conducted by conflating the observation and ecological processes potentially leading to inaccurate population estimates. Based on boat and plane‐based sea otter survey data collected in 2017, we sought to overcome many problems of previous sea otter surveys in southwestern Alaska. We developed a spatially explicit hierarchical distance sampling model to estimate the abundance of sea otters in the Eastern Aleutians Management Unit while explicitly accounting for factors that affect the ability to detect sea otters during surveys (i.e., group size, ocean conditions). We also sought to account for the environmental factors leading to the non‐uniform distribution of sea otter groups by identifying relationships between otter group abundance and environmental attributes (i.e., ocean depth, presence of kelp, underwater substrate). Detection of sea otter groups was related to group size, and ocean conditions (e.g., ocean swell size). After accounting for detection, we estimated a mean population size of 8593 individual sea otters (95% CI: 7450–9984) which is considerably higher than previous estimates, although comparisons are difficult given divergent methodologies. Sea otter group density was negatively related to ocean depth and the presence of rock and gravel as underwater substrates. Conversely, sea otter group density was positively related to the presence of kelp and mud as an underwater substrate. Our hierarchical distance sampling model accounted for the observation process which allowed better estimates of the environmental attributes affecting otter abundance. Our research can serve as a template for other study systems requiring spatially explicit density estimates from a distance sampling framework and can help provide a new baseline for managers to gauge future population changes in sea otters.

Abstract Background Little is known about the prevalence of healthy lifestyle (HLS) discussions between providers and older cancer survivors. Methods We utilized cross‐sectional data from older cancer survivors (≥65 years) seen at 12 southeastern cancer centers during 2013‐2015. Data on demographics, time since diagnosis, weight, height, and healthy behaviors were collected. Respondents were asked if providers (oncologists, other physicians, and/or nurses) discussed exercise, healthy diet, weight management, and/or smoking cessation during clinical encounters. Descriptive statistics and bivariate associations between HLS topics and survivor characteristics were calculated. Results Among 1460 cancer survivors, mean age was 74 years (SD 6), most were white (81%), and >1 year postdiagnosis (84%). The majority (71%) reported discussing at least one of three HLS topics (exercise 49%, healthy diet 53%, vegetable consumption 28%); 17% received counseling on all three. Weight loss was recommended to 33% of overweight/obese survivors and smoking cessation to 85% of current smokers. Oncologists and nurses discussed HLS less frequently compared to other physicians. Younger survivors (65‐74 years) received recommendations for exercise, weight loss, and tobacco cessation more often than older survivors (≥75 years). Compared to white respondents, minorities reported discussions on all topics more often except for tobacco cessation. Excluding tobacco cessation, survivors with recent cancer diagnoses (1 year postdiagnosis. Conclusion Despite the American Cancer Society's recommendations, older survivors reported a low prevalence of HLS discussions with their providers, with some variation by demographic groups. Strategies are needed to promote these important discussions in this population.

BackgroundRefugee resettlement offices are the first point of contact for newly arrived refugees and play a significant role in helping refugees acclimate and settle into life in the United States. Available literature suggests that refugee women are vulnerable to poor sexual and reproductive health (SRH) outcomes, including sexually transmitted infections and HIV infections as well as adverse pregnancy outcomes, but little is known about the role that refugee resettlement offices play in supporting refugee women's SRH. This study examines the capacity and interest of resettlement offices in providing SRH information and referrals to newly arrived refugees.Methods and findingsThe research team conducted an online survey of staff members at refugee resettlement offices throughout the US in 2018 to determine (1) available SRH resources and workshops; (2) referrals to and assistance with making appointments for SRH and primary care appointments; (3) barriers to addressing SRH needs of clients; and (4) interest in building the capacity of office staff to address SRH issues. The survey was created for this study and had not been previously used or validated. Survey data underwent descriptive analysis. A total of 236 resettlement offices were contacted, with responses from 100 offices, for a total response rate of 42%. Fifteen percent (N = 15) of refugee resettlement agencies (RRAs) who responded to the survey provide materials about SRH to clients, and 49% (N = 49) incorporate sexual health into the classes they provide to newly arrived refugee clients. Moreover, 12% (N = 12) of responding RRAs screen clients for pregnancy intention, and 20% (N = 20) directly refer to contraceptive care and services. This study is limited by the response rate of the survey; no conclusions can be drawn about those offices that did not respond. In addition, the survey instrument was not validated against any other sources of information about the practices of refugee resettlement offices.ConclusionsIn this study, we observed that many resettlement offices do not routinely provide information or referrals for SRH needs. Responding offices cite lack of time and competing priorities as major barriers to providing SRH education and referrals to clients.

Introduction: Hepatitis C virus (HCV), the leading cause of advanced liver disease, has enormous economic burden. Identification of patients at risk of treatment failure could lead to interventions that improve cure rates.Objectives: Our goal was to develop and evaluate a prediction model for HCV treatment failure.Methods: We analyzed HCV patients initiating direct-acting antiviral therapy at four United States institutions. Treatment failure was determined by lack of sustained virologic response (SVR) 12 weeks after treatment completion. From 20 patient-level variables collected before treatment initiation, we identified a subset associated with treatment failure in bivariate analyses. In a derivation set, separate predictive models were developed from 100 bootstrap samples using logistic regression. From the 100 models, variables were ranked by frequency of selection as predictors to create four final candidate models, using cutoffs of ≥80%, ≥50%, ≥40%, and all variables. In a validation set, predictive performance was compared across models using area under the receiver operating characteristic curve.Results: In 1,253 HCV patients, overall SVR rate was 86.1% (95% CI = 84.1%, 88.0%). The AUCs of the four final candidate models were: ≥80% = 0.576; ≥50% = 0.605; ≥40% = 0.684; all = 0.681. The best performing model (≥40%) had significantly better predictive ability than the ≥50% (p = 0.03) and ≥80% models (p = 0.02). Strongest predictors of treatment failure were older age, history of hepatocellular carcinoma, and private (vs. government) insurance.Conclusion: This study highlighted baseline factors associated with HCV treatment failure. Treatment failure prediction may facilitate development of data-driven clinical tools to identify patients who would benefit from interventions to improve SVR rates.

In its pedagogical context, multicultural literature is defined as an instrument for multicultural education that seeks to include and raise the voices of historically silenced and invisible minorities in the school curriculum. The contemporary American definition of multicultural literature emphasizes #OwnVoices and elevates authentic stories from insider perspectives, while in Denmark, no clear line is drawn between the author’s background and the literary content when categorizing multicultural literature that depicts minorities’ experiences. In this article, an African American scholar and a Danish scholar will put Danish and African American children’s literary histories in dialogue with one another and ask what Danish multicultural literature can learn from existing definitions within American multicultural and African American children’s literature, formulated by Rudine Sims Bishop, Mingshui Cai, and Michelle H. Martin. They will also address what literary movements and practices might be adapted to facilitate a more welcoming space for minority stories in Danish literature. In the United States, lively conversations are occurring about insiders vs. outsiders, #OwnVoices, and stereotypes; what are the implications for Danish children’s literature? The writers will analyze recently published works from each country that depicts the lives of minoritized people such as Özlem Cekic and Dorte Karrebæk’s Ayse får en lillebror (2018) and Derrick Barnes and Gordon C. James’s Crown: An Ode to the Fresh Cut (2017). This comparative analysis will highlight how marginalized and silenced voices bring new perspectives and fresh ideas into the cultural conversations of each country that would otherwise go unrepresented in children’s literature.

Animal structural body size and condition are often measured to evaluate individual health, identify responses to environmental change and food availability, and relate food availability to effects on reproduction and survival. A variety of condition metrics have been developed but relationships between these metrics and vital rates are rarely validated. Identifying an optimal approach to estimate the body condition of polar bears is needed to improve monitoring of their response to decline in sea ice habitat. Therefore, we examined relationships between several commonly used condition indices (CI), body mass, and size with female reproductive success and cub survival among polar bears (Ursus maritimus) measured in two subpopulations over three decades. To improve measurement and application of morphometrics and CIs, we also examined whether CIs are independent of age and structural size-an important assumption for monitoring temporal trends-and factors affecting measurement precision and accuracy. Maternal CIs and mass measured the fall prior to denning were related to cub production. Similarly, maternal CIs, mass, and length were related to the mass of cubs or yearlings that accompanied her. However, maternal body mass, but not CIs, measured in the spring was related to cub production and only maternal mass and length were related to the probability of cub survival. These results suggest that CIs may not be better indicators of fitness than body mass in part because CIs remove variation associated with body size that is important in affecting fitness. Further, CIs exhibited variable relationships with age for growing bears and were lower for longer bears despite body length being related to cub survival and female reproductive success. These results are consistent with findings from other species indicating that body mass is a useful metric to link environmental conditions and population dynamics.

Abstract Background Satellite telemetry studies provide information that is critical to the conservation and management of species affected by ecological change. Here we report on the performance and retention of two types (SPOT-227 and SPOT-305A) of ear-mounted Argos-linked satellite transmitters (i.e., platform transmitter terminal, or PTT) deployed on free-ranging polar bears in Eastern Greenland, Baffin Bay, Kane Basin, the southern Beaufort Sea, and the Chukchi Sea during 2007–2013. Results Transmissions from 142 out of 145 PTTs deployed on polar bears were received for an average of 69.3 days. The average functional longevity, defined as the number of days they transmitted while still attached to polar bears, for SPOT-227 was 56.8 days and for SPOT-305A was 48.6 days. Thirty-four of the 142 (24%) PTTs showed signs of being detached before they stopped transmitting, indicating that tag loss was an important aspect of tag failure. Furthermore, 10 of 26 (38%) bears that were re-observed following application of a PTT had a split ear pinna, suggesting that some transmitters were detached by force. All six PTTs that were still on bears upon recapture had lost the antenna, which indicates that antenna breakage was a significant contributor to PTT failure. Finally, only nine of the 142 (6%) PTTs—three of which were still attached to bears—had a final voltage reading close to the value indicating battery exhaustion. This suggests that battery exhaustion was not a major factor in tag performance. Conclusions The average functional longevity of approximately 2 months for ear-mounted PTTs (this study) is poor compared to PTT collars fitted to adult female polar bears, which can last for several years. Early failure of the ear-mounted PTTs appeared to be caused primarily by detachment from the ear or antenna breakage. We suggest that much smaller and lighter ear-mounted transmitters are necessary to reduce the risk of tissue irritation, tissue damage, and tag detachment, and with a more robust antenna design. Our results are applicable to other tag types (e.g., iridium and VHF systems) and to research on other large mammals that cannot wear radio collars.

AimsNumerous healthcare decisions are faced by persons with advanced cancer from diagnosis to end-of-life. The family caregiver role in these decisions has focused on being a surrogate decision-maker, however, little is known about the caregiver's role in supporting upstream patient decision-making. We aimed to describe the roles of family caregivers in assisting community-dwelling advanced cancer patients with healthcare decision-making across settings and contexts.MethodsQualitative study using one-on-one, semi-structured interviews with community-dwelling persons with metastatic cancer (n = 18) and their family caregivers (n = 20) recruited from outpatient oncology clinics of a large tertiary care academic medical center, between October 2016 and October 2017. Transcribed interviews were analyzed using a thematic analysis approach.FindingsCaregivers averaged 56 years and were mostly female (95%), white (85%), and the patient's partner/spouse (70%). Patients averaged 58 years and were mostly male (67%) in self-reported "fair" or "poor" health (50%) with genitourinary (33%), lung (17%), and hematologic (17%) cancers. Themes describing family member roles in supporting patients' upstream healthcare decision-making were: 1) seeking information about the cancer, its trajectory, and treatments options; 2) ensuring family and healthcare clinicians have a common understanding of the patient's treatment plan and condition; 3) facilitating discussions with patients about their values and the framing of their illness; 5) posing "what if" scenarios about current and potential future health states and treatments; 6) addressing collateral decisions (e.g., work arrangements) resulting from medical treatment choices; 6) originating healthcare-related decision points, including decisions about seeking emergency care; and 7) making healthcare decisions for patients who preferred to delegate healthcare decisions to their family caregivers.ConclusionsThese findings highlight a previously unreported and understudied set of critical decision partnering roles that cancer family caregivers play in patient healthcare decision-making. Optimizing these roles may represent novel targets for early decision support interventions for family caregivers.