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Introduction: Healthcare organizations are under increasing pressure from policymakers, payers, and advocates to screen for and address patients’ health-related social needs (HRSN). The emergency department (ED) presents several challenges to HRSN screening, and patients are frequently not screened for HRSNs. Predictive modeling using machine learning and artificial intelligence, approaches may address some pragmatic HRSN screening challenges in the ED. Because predictive modeling represents a substantial change from current approaches, in this study we explored the acceptability of HRSN predictive modeling in the ED.Methods: Emergency clinicians, ED staff, and patient perspectives on the acceptability and usage of predictive modeling for HRSNs in the ED were obtained through in-depth semi-structured interviews (eight per group, total 24). All participants practiced at or had received care from an urban, Midwest, safety-net hospital system. We analyzed interview transcripts using a modified thematic analysis approach with consensus coding.Results: Emergency clinicians, ED staff, and patients agreed that HRSN predictive modeling must lead to actionable responses and positive patient outcomes. Opinions about using predictive modeling results to initiate automatic referrals to HRSN services were mixed. Emergency clinicians and staff wanted transparency on data inputs and usage, demanded high performance, and expressed concern for unforeseen consequences. While accepting, patients were concerned that prediction models can miss individuals who required services and might perpetuate biases.Conclusion: Emergency clinicians, ED staff, and patients expressed mostly positive views about using predictive modeling for HRSNs. Yet, clinicians, staff, and patients listed several contingent factors impacting the acceptance and implementation of HRSN prediction models in the ED.

Abstract Introduction The United States food system mainly relies on monoculture farming, leading to negative impacts on human and environmental health. Transitioning to specialty crop production (fruits, vegetables, and tree nuts) could alleviate challenges. The goal of this scoping review was to understand environmental and health impacts of locally distributed specialty crops in the Midwest. Methods Researchers searched databases for peer-reviewed literature and agricultural websites for grey literature. Inclusion criteria were specialty crop production; environmental, economic, or health outcomes; Midwest location; and local distribution. Researchers charted data based on the reach, effectiveness, adoption, implementation, and maintenance framework. Results Grey (n = 9) and peer-reviewed (n = 19) sources met inclusion criteria. Sources reported specialty crops reached diverse populations through community gardens and farmers’ markets with positive impacts on nutritional intake. Effectiveness of production practices on soil and plant quality and greenhouse gas emissions was mixed. Conclusions Local specialty crop production shows promise, but more rigorous study designs with long-term follow-up are needed.

Background: To examine the efficacy and safety of patisiran, an RNA interference therapeutic, in patients from Taiwan with hereditary transthyretin-mediated (hATTR) amyloidosis with polyneuropathy. Methods: The APOLLO phase 3 trial included patients from Taiwan who received patisiran 0.3 mg/kg intravenously or placebo once every 3 weeks (q3w) for 18 months (18 M), followed by patisiran 0.3 mg/kg q3w in an ongoing global open-label extension (OLE) study. The primary endpoint was change from baseline in modified Neuropathy Impairment Score +7 (mNIS+7) at 18 M. Results: Eighteen Taiwanese patients were enrolled in APOLLO (patisiran, n = 8; placebo, n = 10; all A97S gene variant) and 14 continued in the global OLE. In this Taiwanese sub-population, beneficial treatment effects at 18 M were observed in mNIS+7 (least squares mean difference in change from baseline [patisiran-placebo], −26.5 points; 95% confidence interval: −45.5, −7.5). Patients who switched from placebo to patisiran demonstrated slowing of polyneuropathy progression at month 12 in the global OLE, while those who received patisiran in APOLLO maintained the beneficial treatment effects. Patisiran had an acceptable safety profile in the Taiwanese sub-population. Conclusion: This analysis suggests that patisiran is well tolerated and may provide a substantial clinical benefit for Taiwanese patients with hATTR amyloidosis with polyneuropathy. Trial registration information: The studies were registered on the ClinicalTrials.gov. The APOLLO study ClinicalTrials.gov identifier is NCT01960348 (https://clinicaltrials.gov/ct2/show/NCT01960348), with the registration date of October 10, 2013, and the first patient was enrolled on December 13, 2013. For the global OLE, the ClinicalTrials.gov identifier is NCT02510261 (https://clinicaltrials.gov/ct2/show/NCT02510261) with the registration date of July 29, 2015, and the first patient was enrolled on July 13, 2015. Classification of evidence: This study provides Class II evidence that treatment with patisiran is safe and efficacious in Taiwanese patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy.

Objective: To describe how veterans feel about disclosing their military status on campus and impacts on engagement with social and health-related services. Participants: Thirty-one university student veterans who participated in a student veterans' health study. Participants self-identified as White and male (90%) with an average age of 29.5 years and 6.7 years of military service. Methods: Qualitative interviews explored veterans' perceptions of belonging on campus and the impact of veteran identity on educational experiences. Data analysis used an inductive, content-based approach. Results: Themes included: (1) varied feelings around disclosing military service history, with many preferring not to disclose; (2) visibility of resources on campus; and (3) use of resources on campus for social engagement, mental, and physical health. Conclusions: Findings illustrate student veterans' complex experiences, and how feelings about disclosing veteran identity on campus relate to resource use. Campuses should acknowledge and explore this complexity with student veterans' input to ensure that supports meet their needs.

Abstract At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS.

BackgroundBlack/African Americans are receiving COVID-19 vaccines at much lower rates than whites. However, research is still evolving that explains why these vaccination rates are lower. The aim of this study was to examine the effects of the pandemic among older Black/African Americans, with an emphasis on trust and vaccine intention prior to vaccine development.MethodsData were collected between July and September 2020 from 8 virtual focus groups in Detroit, MI and San Francisco Bay Area, CA with 33 older African Americans and 11 caregivers of older African Americans with cognitive impairment, supplemented by one virtual meeting with the project's Community Advisory Board. Inductive/deductive content analysis was used to identify themes.ResultsFive major themes influenced the intention to be vaccinated: uncertainty, systemic abandonment, decrease in trust, resistance to vaccines, and opportunities for vaccination. The last theme, opportunities for vaccination, emerged as a result of interaction with our CAB while collecting project data after the vaccines were available which provided additional insights about potential opportunities that would promote the uptake of COVID-19 vaccination among older Black/African Americans. The results also include application of the themes to a multi-layer framework for understanding precarity and the development of an Integrated Logic Model for a Public Health Crisis.ConclusionsThese findings suggest that trust and culturally relevant information need to be addressed immediately to accelerate vaccine uptake among older Black/African Americans. New initiatives are needed to foster trust and address systemic abandonment from all institutions. In addition, culturally relevant public health campaigns about vaccine uptake are needed. Thus, systemic issues need immediate attention to reduce health disparities associated with COVID-19.

Writing Intensive (WR) High Impact Practice (HIP), which incorporates Transparency in Learning and Teaching (TILT), was applied to written assignments in Human Biology and Anatomy and Physiology II (A&P II) courses. As part of our study sponsored by the Association of American Colleges and Universities (AAC&U), certified AAC&U Valid Assessment of Learning in Undergraduate Education (VALUE) Institution rubric scorers assessed 100 assignments from students in two science courses for critical thinking using the critical thinking VALUE rubric. Students in A&P II, who had completed on average 75% of degree credits, had statistically significant higher distributions of critical thinking scores than those in Human Biology who will have completed on average 25% of degree credits at completion of the course. The distribution of scores between race and gender did not reveal any statistical differences. WR with TILT in written assignments promotes learning, equity and critical thinking.

BACKGROUND: Many states in the United States have progressed towards legalization of marijuana including decriminalization, medicinal and/or recreational use. We studied the impact of legalization on cannabis-related emergency department visits in states with varying degrees of legalization. METHODS: Seventeen healthcare institutions in fifteen states (California, Colorado, Connecticut, Florida, Iowa, Kentucky, Maryland, Massachusetts, Missouri, New Hampshire, Oregon, South Carolina, Tennessee, Texas, Washington) participated. Cannabinoid immunoassay results and cannabis-related International Classification of Diseases (ninth and tenth versions) codes were obtained for emergency department visits over a 3- to 8-year period during various stages of legalization: no state laws, decriminalized, medical approval before dispensaries, medical dispensaries available, recreational approval before dispensaries and recreational dispensaries available. Trends and monthly rates of cannabinoid immunoassay and cannabis-related International Classification of Diseases code positivity were determined during these legalization periods. RESULTS: For most states, there was a significant increase in both cannabinoid immunoassay and International Classification of Diseases code positivity as legalization progressed; however, positivity rates differed. The availability of dispensaries may impact positivity in states with medical and/or recreational approval. In most states with no laws, there was a significant but smaller increase in cannabinoid immunoassay positivity rates. CONCLUSIONS: States may experience an increase in cannabis-related emergency department visits with progression toward marijuana legalization. The differences between states, including those in which no impact was seen, are likely multifactorial and include cultural norms, attitudes of local law enforcement, differing patient populations, legalization in surrounding states, availability of dispensaries, various ordering protocols in the emergency department, and the prevalence of non-regulated cannabis products.

Introduction: Healthcare organizations are under increasing pressure from policymakers, payers, and advocates to screen for and address patients’ health-related social needs (HRSN). The emergency department (ED) presents several challenges to HRSN screening, and patients are frequently not screened for HRSNs. Predictive modeling using machine learning and artificial intelligence, approaches may address some pragmatic HRSN screening challenges in the ED. Because predictive modeling represents a substantial change from current approaches, in this study we explored the acceptability of HRSN predictive modeling in the ED. Methods: Emergency clinicians, ED staff, and patient perspectives on the acceptability and usage of predictive modeling for HRSNs in the ED were obtained through in-depth semi-structured interviews (eight per group, total 24). All participants practiced at or had received care from an urban, Midwest, safety-net hospital system. We analyzed interview transcripts using a modified thematic analysis approach with consensus coding. Results: Emergency clinicians, ED staff, and patients agreed that HRSN predictive modeling must lead to actionable responses and positive patient outcomes. Opinions about using predictive modeling results to initiate automatic referrals to HRSN services were mixed. Emergency clinicians and staff wanted transparency on data inputs and usage, demanded high performance, and expressed concern for unforeseen consequences. While accepting, patients were concerned that prediction models can miss individuals who required services and might perpetuate biases. Conclusion: Emergency clinicians, ED staff, and patients expressed mostly positive views about using predictive modeling for HRSNs. Yet, clinicians, staff, and patients listed several contingent factors impacting the acceptance and implementation of HRSN prediction models in the ED.

Over long stretches of the north-east coast of Qeqertarsuaq (Disko), the sediments in the Nuussuaq Basin and their relations to the volcanic rocks are concealed beneath numerous landslides. Two cores south of Qullissat drilled by Falconbridge Ltd in 1994, targeting a native-iron-bearing igneous body assumed to be a sill, present well-preserved sections through the hidden succession. We have dated the sediments in the cores palynologically. The lower part comprises 115 m of deltaic deposits, including coal seams, of the Cretaceous Atane Formation, Qilakitsoq Member (late Turonian to early Coniacian age), which has not been recorded on Disko before. The two cores and five short coastal cliff sections are mutually correlatable and correlate further to the coal seams earlier mined at Qullissat; the coals are hereby dated for the first time. The Cretaceous rocks are overlain by 15 m of marine deposits, mainly mudstones, of the Danian Eqalulik Formation, with a hiatus of c. 24 million years. The igneous body of native-iron-bearing basaltic andesite has a thick, red-oxidised, vesiculated and brecciated top zone and is interpreted as a subaerial lava flow belonging to the Asuk Member of the Vaigat Formation. The flow has run perhaps up to 20 km from the eruption site to the sea, where it ponded and attained a thickness of 138 m, the thickest lava flow in the West Greenland Basalt Group. The flow is overlain by 22 m of non-marine sandstones and mudstones of the Atanikerluk Formation. The core correlation indicates the existence of a fault with c. 90 m vertical displacement between the two drill sites. The structural relations of the various parts of the Atane Formation along the north-east coast of Disko necessitate the assumption of another hidden, prevolcanic fault south of Qullissaaqqat.

Abstract Introduction Hereditary transthyretin (ATTRv, v for variant) amyloidosis is a rare, progressive, fatal disease with multisystem manifestations, caused by pathogenic variants in the transthyretin (TTR) gene. Vutrisiran, an RNA interference therapeutic that results in rapid TTR knockdown, improved neuropathy and quality of life (QOL) versus external placebo in patients with ATTRv amyloidosis with polyneuropathy in the phase 3 HELIOS-A study (NCT03759379). This post hoc analysis evaluates the impact of baseline neuropathy severity on response to vutrisiran treatment. Methods Patients were randomized (3:1) to vutrisiran (n = 122; 25 mg subcutaneous injection once every 3 months) or patisiran (n = 42; 0.3 mg/kg intravenous infusion once every 3 weeks), which served as a reference group. In this post hoc analysis, patients were grouped into quartiles of increasing baseline Neuropathy Impairment Score (NIS): Quartile (Q)1 ≥ 5.0 to ≤ 20.5; Q2 > 20.5 to ≤ 44.1; Q3 > 44.1 to ≤ 73.1; Q4 > 73.1 to ≤ 127.0. Mean change from baseline to Month 18 was summarized by quartile for a range of efficacy endpoints. Results Across all baseline NIS quartiles, vutrisiran demonstrated benefit versus external placebo in measures of neuropathy severity (modified NIS + 7), QOL (Norfolk Quality of Life-Diabetic Neuropathy), disability (Rasch-built Overall Disability Scale), gait speed (10-m walk test), and nutritional status (modified body mass index). Overall, patients in lower versus higher NIS quartiles (less severe neuropathy) at baseline maintained better scores at Month 18. The external placebo group progressively worsened in all measures at Month 18. Conclusions Vutrisiran demonstrated benefit in neurologic function and other key efficacy measures versus external placebo across all four baseline neuropathy severity quartiles. Patients initiating vutrisiran earlier in their disease course retained the highest neurologic function level after 18 months, highlighting the importance of early diagnosis and treatment. Trial Registration Number ClinicalTrials.gov: NCT03759379.

Abstract Background Patient health-related social needs (HRSN) complicate care and drive poor outcomes in emergency department (ED) settings. This study sought to understand what HRSN information is available to ED physicians and staff, and how HRSN-related clinical actions may or may not align with patient expectations. Methods We conducted a qualitative study using in-depth semi-structured interviews guided by HRSN literature, the 5 Rights of Clinical Decision Support (CDS) framework, and the Contextual Information Model. We asked ED providers, ED staff, and ED patients from one health system in the mid-Western United Stated about HRSN information availability during an ED encounter, HRSN data collection, and HRSN data use. Interviews were recorded, transcribed, and analyzed using modified thematic approach. Results We conducted 24 interviews (8 per group: ED providers, ED staff, and ED patients) from December 2022 to May 2023. We identified three themes: (1) Availability: ED providers and staff reported that HRSNs information is inconsistently available. The availability of HRSN data is influenced by patient willingness to disclose it during an encounter. (2) Collection: ED providers and staff preferred and predominantly utilized direct conversation with patients to collect HRSNs, despite other methods being available to them (e.g., chart review, screening questionnaires). Patients’ disclosure preferences were based on modality and team member. (3) Use: Patients wanted to be connected to relevant resources to address their HRSNs. Providers and staff altered clinical care to account for or accommodate HRSNs. System-level challenges (e.g., limited resources) limited provider and staff ability to address patients HRSNs. Conclusions In the ED, HRSNs information was inconsistently available, collected, or disclosed. Patients and ED providers and staff differed in their perspectives on how HSRNs should be collected and acted upon. Accounting for such difference in clinical and administrative decisions will be critical for patient acceptance and effective usage of HSRN information.

Background: Higher malnutrition risk is associated with mortality among patients with heart failure and heart transplantation (HT). We investigated which malnutrition risk scores – geriatric nutrition risk index (GNRI), prognostic nutritional index (PNI), or controlling nutritional status (CONUT) – have the strongest mortality association for HT candidates, and whether they are prognostic at the time of HT listing or HT operation. Methods: We reviewed adults listed for primary HT at a single center 1987–March 2022, with survival follow-up to November 2022. We constructed Cox proportional hazards models and restricted cubic spline curves for each risk score at both HT listing and HT operation and inputted HT operation as a time-varying covariate for models commencing at listing. Risk scores were assessed as continuous and binary variables. Weight change between listing and HT was evaluated similarly. Results: The 1,024 patients [76% male; median age 55 (46–61) years; HT operation n = 656] had median follow-up of 4.6 (interquartile range 1.6–8.7) years. As a continuous variable, lower GNRI at HT listing (greater malnutrition risk) was independently associated with higher mortality. As binary variables, higher risk GNRI, PNI or CONUT scores at listing were all associated with higher mortality. Conversely, risk scores at time of HT operation were not associated with subsequent mortality. There was a non-significant trend towards higher mortality with greater weight loss between listing and HT operation. Conclusion: Malnutrition risk scores showed prognostic utility only at time of HT listing. As a continuous variable, GNRI at HT listing was independently associated with subsequent mortality.

PurposePrior to 2020, University of California, Los Angeles (UCLA) Library's research services spanned multiple service points. Multiple locations were staffed by Library Student Research Assistants (LSRAs) and each location was supervised independently. While efforts to increase collaboration had been underway, much of the work and services remained siloed and often duplicated training and service hours.Design/methodology/approachWith the onset of coronavirus disease 2019 (COVID-19), UCLA Library rapidly transitioned from entirely in-person to entirely online services. With multiple service points pivoting, UCLA was redundant to have multiple online desks providing Zoom appointments and that quickly became apparent. Moreover, transitioning in-person student work to remote work was paramount to providing both normal services to users and allowing LSRAs to keep jobs during a time of uncertainty and insecurity.FindingsWhile the authors' original consolidation of services and implementation of shared supervision was a result of the pandemic and primarily involved online services, the authors have maintained this shared approach and collaborative vision in returning to in-person services. For the past year, the authors have offered shared in-person (at two library locations) and online services. As subject-specific library locations begin to reopen their desks, the authors continue to identify ways to leverage shared supervision and a robust referral model for those on-site services while negotiating student staffing and the need for both general and subject-specific services.Originality/valueThe authors present a novel approach to peer-to-peer teaching and learning and research services and shared student worker supervision with services coordinated across multiple locations and disciplines within a large academic library serving a large student population.