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Abstract The COVID‐19 pandemic disrupted prostate‐specific antigen (PSA) screening and prostate biopsy procedures. We sought to determine whether delayed screening and diagnostic workup of prostate cancer (PCa) was associated with increased subsequent rates of incident PCa and advanced PCa and whether the rates differed by race. We analyzed data from the Veterans Health Administration to assess the changes in the rates of PSA screening, prostate biopsy procedure, incident PCa, PCa with high‐grade Gleason score, and incident metastatic prostate cancer (mPCa) before and after January 2020. While the late pandemic mPCa rate among White Veterans was comparable to the pre‐pandemic rate (5.4 pre‐pandemic vs 5.2 late‐pandemic, p = 0.67), we observed a significant increase in incident mPCa cases among Black Veterans in the late pandemic period (8.1 pre‐pandemic vs 11.3 late‐pandemic, p

Background: While diabetes, hypertension, and hyperlipidemia each are associated with increased risk of cognitive decline, little is known regarding how nonadherence to medications for these conditions is associated with cognitive decline risk. Methods: We identified patients enrolled in a Medicare Advantage Prescription Drug plan who were eligible for inclusion in the CMS Star Medication Adherence quality measures for diabetes, hypertension, and hyperlipidemia in 2018, 2019, and 2020. To achieve an adherence quality measure, patients had to meet 80% of the proportion of days for the medication. We used propensity score with inverse probability of treatment weighting to balance outcomes for baseline characteristics and logistic regression models to compare odds of cognitive decline outcomes across patient groups. Results: The study population of 99,774 individuals had a mean age of 71.0 years and was 49.1% female, 73.9% White, and 17.8% Black, with 62.0% living in an urban setting. Compared with patients who missed zero adherence measures, those who missed one measure had 23%–33% increased odds of cognitive decline (any decline OR = 1.23; dementia OR = 1.33; Alzheimer's disease OR = 1.27; all P values

Abstract Background Globally, 700 000 people die every year by suicide. Health care consultation patterns the period before suicide could be one potential way to identify people at risk for suicide. Therefore, this study examines health care patterns up to one year prior to the suicide by age, sex and prior diagnoses and specifically investigates if and how this differs from the general population of Skåne, Sweden. Methods This cohort study includes all individuals, aged 15 and older, that died by suicide in Region Skåne, Sweden from 2004 to 2015 (n = 1653). The individuals were identified through the Cause of death register and then linked to the Skåne healthcare register. Health care data was analyzed as proportions consulting different types of health care the month and year preceding the suicide, we also investigated the impact of age, sex and the occurrence of prior psychiatric and pain diagnoses. Additionally, we compared the proportion of consulting care among the suicide victims and the general population of Skåne. Results In the month before their death, 53% of the suicide victims had any health care consultation, compared with 20% in the general population of Skåne, a given month (p

Building from previous research showing a bilingual advantage in school, the present study investigated the link between bilingualism and academic motivation. We asked whether bilingual students would exhibit higher levels of intrinsic or extrinsic motivation than their monolingual peers, how intrinsic and extrinsic motivation would change over time, and the extent to which those forms of motivation would be in tension with one another. Relative to their monolingual peers, we expected bilingual students to (1) report higher levels of both intrinsic and extrinsic forms of motivation, and (2) show a weaker negative correlation between intrinsic and extrinsic forms of motivation. Bilingual status, intrinsic motivation, and extrinsic motivation were measured at two time points in a diverse sample of 1047 3rd-grade through 8th-grade students (851 monolingual, 196 bilingual). Bilingual students reported significantly higher levels of both intrinsic and extrinsic motivation than monolingual students. They also showed a sharper decline in intrinsic motivation from fall to spring. Intrinsic and extrinsic forms of motivation were negatively correlated for monolinguals, but unrelated for bilinguals, suggesting that the two motive types may be less antagonistic among students who speak a language other than English at home. These differences may be driven by both cognitive (e.g., executive functioning skills) and cultural (e.g., family cohesion, interdependent orientation) factors, and may inform educators who wish to support learning for students from diverse groups.

This article explores the multifaceted dimensions of Black Trans Education Spaces (BTES) within higher education, highlighting the unique experiences, challenges, and transformative potential of these spaces for Black transgender students. This article acknowledges that Black education spaces may perpetuate trans-antagonism due to a lack of awareness, understanding, or intentional inclusivity. Drawing from narratives of 20 Black transgender students both currently and formerly enrolled in U.S. colleges and universities, this research investigates the existence of BTES both within and outside traditional educational structures. Findings indicate five dimensions of BTES: community determination, community actualization, community efficacy, community sustainability, and community reliance. These dimensions encompass the empowerment, identity affirmation, and collective support that Black transgender students derive from BTES. The narratives reveal the capacity of BTES in meeting the basic needs of Black transgender students, providing and sustaining spaces for retreat and empowerment, and nurturing communities of care. The implications of these findings emphasize the importance of recognizing and honoring BTES, fostering greater solidarity, and addressing intersecting oppressions. While BTES play a crucial role in supporting these students, broader inclusivity and understanding are needed in all educational spaces to ensure that all Black transgender individuals can thrive within higher education.

Objective: Growing evidence suggests digital interventions may provide neurocognitive benefits for children with ADHD. This study aimed to investigate the efficacy of a digital attention intervention in children with ADHD. Method: In this double-blind randomized controlled trial 55 children with ADHD (5-9 years) were allocated to the intervention (N=28) or control program (N=27). Both programs were delivered via touchscreen tablets at home 5 days a week for 5 weeks. The primary outcome was change in the Test of Variables of Attention (TOVA) Attention Comparison Score (ACS) from pre- to post-intervention. Results: Participants who received the intervention had significantly greater improvements in the TOVA ACS from pre- to post-intervention than those in the control (p<0.044). No intervention effects were observed on secondary outcomes assessing executive functioning, ADHD symptoms, or functional impairment. Conclusion: Collectively these findings provide insufficient evidence for the implementation of digital attention interventions for children with ADHD.

In order to create and foster learning spaces that build upon children's knowledge and experiences, we must respect and value their ways of knowing and being, including their play. Accordingly, this study highlights the ways that young children (re)imagined spaces, materials, and identities through their digital play in an analog (containing no physical, digital-based toys/materials) preschool classroom. This qualitative study utilized a framework of children's play as murmuration (a transmodal assemblage), to analyze and discuss the children's various digital play engagements. Three main themes were identified within/across these engagements, including the ways the children: (re)imagined the digital, drew from popular digital culture and media to make connections and construct meaning, and composed digital identities. Insights highlight the ways the children set aside perceived rules for materials, objects, spaces, and identities and created space for critically (re)envisioned ideas, concepts, realities, and futures to emerge. We encourage educators to continue to create and foster classroom spaces that value and build upon children's playful ways of knowing, being, and becoming in the digital world.

This study aims to evaluate the effectiveness of our outreach program “The ImportANTs of ANTs” in communicating scientific topics to elementary school children, using ants as example organisms. In this program’s first phase, we focused on the concepts of native and invasive species and how invasive species affect ecosystems. The program included various active learning approaches, including presentations, handouts, crafts, and live colony viewings. At two schools (one in rural and one in suburban areas), 210 students from 5th grade were assessed using short, anonymous pre- and post-surveys. We analyzed the students’ responses to questions from the following categories: general feelings about ants, ant knowledge, general care for the environment, general impact knowledge, and native/invasive species knowledge. The school populations displayed distinct opinion changes and knowledge gains; however, there was a significant increase in knowledge of native and invasive species in both populations. Our study demonstrates that ants are good models to teach children about the impact of invasive species. The project aims to drive universal responsibility by forging proactive attitudes toward protecting the environment and native species early.

Purpose: Telemedicine approaches to autism (ASD) assessment have become increasingly common, yet few validated tools exist for this purpose. This study presents results from a clinical trial investigating two approaches to tele-assessment for ASD in toddlers. Methods: 144 children (29% female) between 17 and 36 months of age (mean = 2.5 years, SD = 0.33 years) completed tele-assessment using either the TELE-ASD-PEDS (TAP) or an experimental remote administration of the Screening Tool for Autism in Toddlers (STAT). All children then completed traditional in-person assessment with a blinded clinician, using the Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behavior Scales, 3rd Edition (VABS-3), and Autism Diagnostic Observation Schedule (ADOS-2). Both tele-assessment and in-person assessment included a clinical interview with caregivers. Results: Results indicated diagnostic agreement for 92% of participants. Children diagnosed with ASD following in-person assessment who were missed by tele-assessment (n = 8) had lower scores on tele- and in-person ASD assessment tools. Children inaccurately identified as having ASD by tele-assessment (n = 3) were younger than other children and had higher developmental and adaptive behavior scores than children accurately diagnosed with ASD by tele-assessment. Diagnostic certainty was highest for children correctly identified as having ASD via tele-assessment. Clinicians and caregivers reported satisfaction with tele-assessment procedures. Conclusion: This work provides additional support for the use of tele-assessment for identification of ASD in toddlers, with both clinicians and families reporting broad acceptability. Continued development and refinement of tele-assessment procedures is recommended to optimize this approach for the needs of varying clinicians, families, and circumstances.

In recent years, the number of autistic people entering university has increased in Australia and worldwide. While an encouraging trend, autistic students' completion rates remain much lower than non-autistic students in Australia. Perhaps unsurprisingly, numerous studies investigating autistic people's experiences at universities have identified stigma and discrimination as a significant barrier facing autistic people in higher education. In this study, our team of autistic co-researchers and non-autistic researchers co-produced an in-depth qualitative study to understand the contexts and circumstances in which autistic people felt stigmatised or experienced discrimination at universities in Australia. We interviewed 21 autistic people who either had completed at least one university course, or were studying a university course, or had enrolled in but discontinued at least one university course in Australia. Using reflexive thematic analysis, we identified four themes: (1) 'My disability is something that people just don't have a clue about', (2) 'the system is really stacked against you', (3) the onus is on autistic students, and (4) 'grit and stubbornness'. Based on these findings, we suggested implementing Universal Design for Learning, neurodiversity-affirming and trauma-informed practices, together with a participatory approach to better design university curricula, processes, and support services for autistic students.

Recent attacks on critical race theory (CRT) aim to limit discussion and understanding of race (and its intersection with class, gender, and power). Racial dialogues can be uncomfortable for those who benefit from power, suggesting that resistance to CRT or any discussion of race and power in education is rooted in emotions. This study examines the role of racialized emotions in public policy discourse that surrounds CRT bans in education that have been proposed, and in many cases, passed across the United States. Focusing on four early-adopting states of the bans, the findings reveal how emotionalities of whiteness are tacitly endorsed, invited, and animated within racialized politics, as well as how these emotionalities might be disrupted.

Welcome to the 25th anniversary edition of PLEXUS, UC Irvine School of Medicine’s annual student-organized Journal of Medical Humanities & Arts. To mark this celebratory milestone, it is with great pleasure that I present to you NAVIGATE. In the ever-evolving landscape of medicine, the ability to navigate through challenges and unforeseen obstacles is paramount. NAVIGATE serves as a timely invitation for our colleagues to reflect on the distances traversed and to envision the new horizons that lie ahead. We sought to highlight the constellation of tools utilized when we feel lost and to acknowledge the beacons that steer our actions. The subsequent pages offer its readers profoundinsights into the extraordinary journeys undertaken by the greater UCI Health community. We hope it delivers a sense of direction, solace, and clarity to all readers.As we celebrate our 25th anniversary, wehonor the visionaries, contributors, and readers that have propelled us forward on this remarkable voyage. Their collective support fuels our efforts to serve as a creative outlet for the community, catalyze meaningful discussions, and apply the tenets of medical humanities to foster a cohort of compassionate healers.We extend our deepest gratitude to our faculty advisors Dr. Juliet McMullin and Dr. TanNguyen for their invaluable guidance and for sharing their expertise within the field. We thank the UCISOM Medical Humanities & Arts Program and the UCI Department of Family Medicine for their unwavering support. I invite you to embark on this exploration with us, and witness the intricate tapestry of our contributors’ lived experiences that defines our shared journey in healthcare.Bon voyage,Christopher SahagianEditor-in-ChiefCreative Review — Caroline GeeCreative Review — Huan NguyenCreative Review — Sana ShahDesign — Nicole ParkerDesign — Britney WengFaculty Advisor — Dr. Juliet McMullinFaculty Advisor — Dr. Tan NguyenStaff Advisor — Leonora Naser-Saravia{Front Cover): NEW HEIGHTS Britney Weng, MS1San Pedro de Atacama, Chile(Inner Cover): TRAVERSING  Britney Weng, MS1Chile Route 23

BackgroundThe risk factors associated with the stages of Coronavirus Disease-2019 (COVID-19) disease progression are not well known. We aim to identify risk factors specific to each state of COVID-19 progression from SARS-CoV-2 infection through death.Methods and resultsWe included 648,202 participants from the Veteran Affairs Million Veteran Program (2011-). We identified characteristics and 1,809 ICD code-based phenotypes from the electronic health record. We used logistic regression to examine the association of age, sex, body mass index (BMI), race, and prevalent phenotypes to the stages of COVID-19 disease progression: infection, hospitalization, intensive care unit (ICU) admission, and 30-day mortality (separate models for each). Models were adjusted for age, sex, race, ethnicity, number of visit months and ICD codes, state infection rate and controlled for multiple testing using false discovery rate (≤0.1). As of August 10, 2020, 5,929 individuals were SARS-CoV-2 positive and among those, 1,463 (25%) were hospitalized, 579 (10%) were in ICU, and 398 (7%) died. We observed a lower risk in women vs. men for ICU and mortality (Odds Ratio (95% CI): 0.48 (0.30-0.76) and 0.59 (0.31-1.15), respectively) and a higher risk in Black vs. Other race patients for hospitalization and ICU (OR (95%CI): 1.53 (1.32-1.77) and 1.63 (1.32-2.02), respectively). We observed an increased risk of all COVID-19 disease states with older age and BMI ≥35 vs. 20-24 kg/m2. Renal failure, respiratory failure, morbid obesity, acid-base balance disorder, white blood cell diseases, hydronephrosis and bacterial infections were associated with an increased risk of ICU admissions; sepsis, chronic skin ulcers, acid-base balance disorder and acidosis were associated with mortality.ConclusionsOlder age, higher BMI, males and patients with a history of respiratory, kidney, bacterial or metabolic comorbidities experienced greater COVID-19 severity. Future studies to investigate the underlying mechanisms associated with these phenotype clusters and COVID-19 are warranted.

Introduction While total knee arthroplasty (TKA) is a successful treatment for debilitating arthritis, up to 20% of patients may be dissatisfied with their outcome. One hypothesis for dissatisfaction is the distortion of native knee kinematics following sacrifice of the anterior cruciate ligament (ACL) during TKA. The purpose of this study was to determine the impact of ACL status at the time of surgery in patients undergoing Posterior Stabilized (PS) TKA for osteoarthritis (OA). Methods A consecutive prospective series of patients undergoing TKA by a single surgeon underwent prospective intraoperative assessment of their ACL status divided into three different groups:1) intact, 2) attenuated, or 3) deficient. Demographic, preoperative, intraoperative, and postoperative data were collected for each patient by two blinded, independent observers. Outcomes included patient satisfaction and Knee Society Score for Pain (KSS) and Function (KSF), Kellgren and Lawrence (K&L), UCLA Activity Score (UCLA), Short Form-12 (SF12), EuroQol (EQ5D) and patient satisfaction. Results: Of 116 patients, 33 (28.4%) patients had an ACL deficient knee, 40 (34.5%) patients had an attenuated ACL, and 43 (37.1%) patients had an intact ACL. Those with absent ACL were significantly more likely to have a higher BMI (p=.007) and be male (p=.003). Patient with a deficient ACL had significantly lower preoperative KSF and higher K&L scores (p=.009, p=1.26 x 10-7). Attenuated and deficient groups had the greatest change in SF12PCS scores at their one-year follow-up with increases of 9.9 (±10.0) and 10.8 (±8.0), respectively (p=.037). No significant differences in overall postoperative KSS, KSF and satisfaction scores based on ACL status (p=.574 and p=.529, respectively) were found. Conclusion In a relatively large series, patient with ACL deficiency were more likely to have worse pre-operative outcome scores and similar or better post-operative outcome scores. This suggests that those with ACL insufficiency may experience more subjective improvement from TKA. ACL status can be used as an additional surgical marker to help orthopaedic surgeons identify which patients would most benefit from TKA.

Summary: AT-rich interactive domain-containing proteins 1A and 1B (ARID1A and ARID1B) are mutually exclusive subunits of the chromatin remodeler SWI/SNF. ARID1A is the most frequently mutated chromatin regulator across all cancers, and ovarian clear cell carcinoma (OCCC) carries the highest prevalence of ARID1A mutations (∼57%). Despite evidence implicating ARID1A in tumorigenesis, the mechanism remains elusive. Here, we demonstrate that ARID1A binds active regulatory elements in OCCC. Depletion of ARID1A represses RNA polymerase II (RNAPII) transcription but results in modest changes to accessibility. Specifically, pausing of RNAPII is severely impaired after loss of ARID1A. Compromised pausing results in transcriptional dysregulation of active genes, which is compensated by upregulation of ARID1B. However, a subset of ARID1A-dependent genes is not rescued by ARID1B, including many p53 and estrogen receptor (ESR1) targets. Our results provide insight into ARID1A-mediated tumorigenesis and unveil functions of SWI/SNF in modulating RNAPII dynamics. : Trizzino et al. show that ARID1A regulates RNA polymerase II promoter-proximal pausing in ovarian clear cell carcinoma. Conversely, ARID1A depletion has modest effects on accessibility. Following ARID1A loss, upregulation of ARID1B restores physiological polymerase II dynamics, rescuing transcription. However, multiple p53 and estrogen target genes are strictly dependent on ARID1A. Keywords: SWI/SNF, ovarian clear cell carcinoma, transcription, RNAPII, pausing, ARID1B, ARID1A

BACKGROUND: Long-COVID is a condition post SARS-CoV-2 infection with persistent or recurring symptoms affecting multiple organs, and may involve viral persistence, changes to the microbiome, coagulopathies, and alterations to neuro-immune interactions. These factors can disrupt the Gut-Brain Axis, which is a complex system involving bidirectional communication between the central nervous system and the gastrointestinal (GI) system. As a result of these disruptions, individuals with long-COVID may develop post-infectious functional GI disorders, which can cause a range of symptoms affecting the digestive system. AIM: To understand frequency of GI manifestations of Long-COVID and to determine association with sleep or neurological symptoms in a predominantly minority population. METHODS: We included patients with positive SARS-CoV-2 PCR (n = 747) who were hospitalized from Feb. 2020 to May 2021 at Howard University Hospital and followed between 6 and 12 months from discharge. GI, sleep, and neurological symptoms (via the Montreal Cognitive Assessment (MoCA) scoring system) were assessed using a standardized questionnaire. Linear regression analysis, χ2 and Fishers exact test were utilized to determine the statistical significance of correlations of GI/Neuro/COVID. RESULTS: The mean age of patients was 58, with 51.6% females and a predominant African American ethnicity (73.6%, n = 550). A total of 108 patients died during their initial hospital stay, with the remaining 639 patients followed-up. Three hundred fifty (350) patients responded to the questionnaire (57 patients died during the follow-up period). Overall, 39 (13.3%) patients reported GI-related symptoms, out of which 19 (6.4%) had persistent symptoms and 20 (6.8%) developed new onset GI symptoms. Nausea and vomiting were the most common 24/39 (61.5%), followed by abdominal pain 7/39 (18%), diarrhea 5/39 (12.8%), and others 3/39 (7.6%). Patients who presented with vomiting during acute SARS-CoV-2 infection were more likely to have Long-COVID GI manifestations (P = 0.023). Use of ACE inhibitors, abnormal lymphocyte count and elevated ferritin are other variables that showed significant associations with Long-COVID GI manifestations (P = 0.03, 0.006 and 0.03, respectively). During follow-up, a total of 28 (9.5%) patients reported difficulty with sleep and 79 (27%) patients had abnormal MoCA assessment. With further analysis, there was a trend between presentation of GI symptoms on admission with abnormal MoCA assessment, and an association between abnormal LFTs and history of liver disease during hospitalization with subsequent sleep problems. Baseline characteristics, clinical comorbidities, other laboratory values, hospital length of stay, mechanical ventilation, medications during hospitalization, re-admission and Flu or COVID-19 vaccination have not shown any association with Long-COVID GI symptoms in our cohort. CONCLUSION: Dyspeptic symptoms were common GI manifestations in the acute and post COVID periods. GI symptoms, abnormal LFTs and a history of liver disease during the acute infectious phase associates with abnormal MoCA and sleep problems during follow-up. Further large population studies are needed to determine if COVID-19 leads to a GI symptoms-associated Long-COVID phenotypes and other symptoms through the Gut-Brain-Axis.

PurposeDevelopmental assessment is part of a comprehensive autism evaluation. During in-person evaluations, developmental assessment is completed via direct testing by an examiner. In telehealth evaluations, developmental assessment relies on caregiver-report instruments. This study examined correspondence between caregiver report and direct testing of developmental skills.MethodsParticipants were 93 children, aged 18-42 months, undergoing evaluation for possible autism spectrum disorder (ASD). Caregivers were interviewed with the Developmental Profile, 4th edition (DP-4) via telehealth platform and children were tested in person 2-4 weeks later using the Mullen Scales of Early Learning (MSEL).ResultsCorrelations between the DP-4 and MSEL were high (ranging from 0.50 to 0.82) across standard scores, age equivalents, and functional categories, as well as across individual subtests and overall composite scores.ConclusionThe high convergent validity found in this study suggests that the DP-4 provides a suitable proxy for direct developmental testing using the MSEL in the context of telehealth evaluations for ASD in young children, delivering a good estimate of both developmental functioning and presence of delays.Trial registrationData were obtained from registered clinical trial NCT05047224, date of registration 2021-09-07.

The purpose of this paper is to identify key characteristics and forms that both research approaches use within the applied field of education. In this paper, we ask--how are CPAR and IS-GR similar and different? And, can tools or propositions from each be used in tandem within a research project? We invite readers to consider useful frameworks created to address problems of practice. Drawing strength from our diverse backgrounds (fields of study and professional roles), we aim to identify clear overlaps and divergent perspectives between the two approaches to aid scholarly practitioners in making informed decisions about the research frameworks they choose to take up to address pressing problems of practice in education.

The purpose of this article is to examine ways in which the COVID-19 pandemic impacted the adoption and perception of virtual programs in Indiana public school districts. This mixed-methods sequential explanatory study focuses on beliefs held by Indiana public school superintendents and virtual program administrators regarding the growth of virtual education during the COVID-19 pandemic. Subjects received surveys regarding their views surrounding virtual education. Subjects who volunteered participated in semi-structured interviews conducted in web-based meetings. This study provides a snapshot of the state of virtual education in Indiana, including the perceptions held by school administrators at the end of the 2020-21 school year. COVID-19 significantly affected virtual education in Indiana. Participants cited a need to provide educational options during a pandemic as the primary reason for implementing a virtual program. Additionally, participants noted significant challenges of virtual education while acknowledging an overwhelming need to maintain district enrollment during the pandemic through the utilization of a virtual program. This study identifies factors that will impact school districts should enrollment in virtual education programs remain strong. This provides an opportunity for districts to address these areas and ensure effective virtual education programming.