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This study examined a conjugate approach for evaluating auditory stimulus preference for 81 participants using force as a continuous response dimension. First, the researchers used a verbal preference assessment to evaluate each participant's preference for listening to five genres of music. This process identified high‐preference and low‐preference music for each participant. Thereafter, the researchers exposed each participant to the five music genres in a randomized order while using a hand dynamometer to measure their response force to increase the auditory clarity of the music. The results indicate (a) 63% of the participants' high‐preference music genres corresponded to the genre for which they exerted the highest mean force and (b) most participants' low‐preference music genres corresponded to the genre for which they exerted the lowest mean force. These findings are consistent with those from Davis et al. (2021) and further support using conjugate preparations for measuring the relative value of some stimulus events.

ObjectiveWe evaluated whether people who had not completed a faecal immunochemical test (FIT) for colorectal cancer (CRC) screening would complete a blood-based testing option if offered one during health encounters. Blood-based screening tests for CRC could add to the total number of people screened for CRC by providing another testing alternative.DesignStudy participants were patients aged 45–75 years at a large, integrated health system who were offered but did not complete an FIT in the prior 3–9 months and were scheduled for a clinical encounter. Individuals were randomised (1:1) to be offered a commercially available CRC blood test (Shield, Guardant Health) versus usual care. We compared 3-month CRC screening proportions in the two groups.ResultsWe randomised 2026 patients; 2004 remained eligible following postrandomisation exclusions (1003 to usual care and 1001 to blood draw offer; mean age: 60, 62% female, 80% non-Hispanic white). Of the 1001 allocated to the blood test group, 924 were recruited following chart-review exclusions; 548 (59.3%) were reached via phone, of which 280 (51.1%) scheduled an appointment with the research team. CRC screening proportions were 17.5 percentage points higher in the blood test group versus usual care (30.5% vs 13.0%; OR 2.94, 95% CI 2.34 to 3.70; p<0.001).ConclusionAmong adults who had declined prior CRC screening, the offer of a blood-based screening test boosted CRC screening by 17.5 percentage points over usual care. Further research is needed on how to balance the favourable adherence with lower advanced adenoma detection compared with other available tests.Trial registration numberNCT05987709.

Ethnographic research on Connecticut farms reveals that workers in the agricultural sector experience a wide range of working and living conditions. While legal precarity, poverty, and oppressive social dynamics confine all farmworkers to positions of structural vulnerability, some acquire a kind of “structural agency” that enables them to exert influence over their conditions of work in ways that are meaningful to their everyday experiences. Several key variables are at play in producing structural vulnerability and structural agency, including agricultural subsector, farm size, type of work, immigration status of workers, workplace interpersonal dynamics, racial and ethnic hierarchies, individual farm cultures, and local and state approaches to im/migration and labor policy enforcement. Ethnography of agricultural labor must take seriously the diversity of farm work experiences and incorporate the perspectives of individuals at multiple levels of farm hierarchies. A new concept linked to structural vulnerability, “structural agency,” can facilitate analyses of how people in broader contexts of marginalization work toward positive outcomes for themselves and others.

IMPORTANCE: Emergency department (ED) pediatric readiness is associated with improved survival among children. However, the association between geographic access to high-readiness EDs in US trauma centers and mortality is unclear. OBJECTIVE: To evaluate the association between the proximity of injury location to receiving trauma centers, including the level of ED pediatric readiness, and mortality among injured children. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used a standardized risk-adjustment model to evaluate the association between trauma center proximity, ED pediatric readiness, and in-hospital survival. There were 765 trauma centers (level I-V, adult and pediatric) that contributed data to the National Trauma Data Bank (January 1, 2012, through December 31, 2017) and completed the 2013 National Pediatric Readiness Assessment (conducted from January 1 through August 31, 2013). The study comprised children aged younger than 18 years who were transported by ground to the included trauma centers. Data analysis was performed between January 1 and March 31, 2022. EXPOSURES: Trauma center proximity within 30 minutes by ground transport and ED pediatric readiness, as measured by weighted pediatric readiness score (wPRS; range, 0-100; quartiles 1 [low readiness] to 4 [high readiness]). MAIN OUTCOMES AND MEASURES: In-hospital mortality. We used a patient-level mixed-effects logistic regression model to evaluate the association of transport time, proximity, and ED pediatric readiness on mortality. RESULTS: This study included 212 689 injured children seen at 765 trauma centers. The median patient age was 10 (IQR, 4-15) years, 136 538 (64.2%) were male, and 127 885 (60.1%) were White. A total of 4156 children (2.0%) died during their hospital stay. The median wPRS at these hospitals was 79.1 (IQR, 62.9-92.7). A total of 105 871 children (49.8%) were transported to trauma centers with high-readiness EDs (wPRS quartile 4) and another 36 330 children (33.7%) were injured within 30 minutes of a quartile 4 ED. After adjustment for confounders, proximity, and transport time, high ED pediatric readiness was associated with lower mortality (highest-readiness vs lowest-readiness EDs by wPRS quartiles: adjusted odds ratio, 0.65 [95% CI, 0.47-0.89]). The survival benefit of high-readiness EDs persisted for transport times up to 45 minutes. The findings suggest that matching children to trauma centers with high-readiness EDs within 30 minutes of the injury location may have potentially saved 468 lives (95% CI, 460-476 lives), but increasing all trauma centers to high ED pediatric readiness may have potentially saved 1655 lives (95% CI, 1647-1664 lives). CONCLUSIONS AND RELEVANCE: These findings suggest that trauma centers with high ED pediatric readiness had lower mortality after considering transport time and proximity. Improving ED pediatric readiness among all trauma centers, rather than selective transport to trauma centers with high ED readiness, had the largest association with pediatric survival. Thus, increased pediatric readiness at all US trauma centers may substantially improve patient outcomes after trauma.

The future career autobiography (FCA) is a narrative, discovery‐based career intervention designed to assess individuals’ career hopes and dreams. In total, 134 low‐income, ethnically and racially diverse middle school students participated in an FCA intervention through a yearlong grant‐funded career development initiative. Using content analysis, we analyzed participants’ FCAs for socioeconomic status factors and lifestyle indicators. We found that participants articulated occupational and lifestyle factors more than education and income, and that there were differences based on biological sex, race, and ethnicity. We present pertinent results and discuss implications for counseling practice and future research.

Scant literature exists assessing the effectiveness of video modeling (VM) alone in the sports literature. Further evaluations of VM to improve sports skills is warranted because VM is an accessible and efficient procedure that has successfully improved skills in other fields of practice (e.g., staff training, medical procedures). Additionally, behavior analysts have not evaluated interventions for improving goalkeeping skills for individual soccer players. Therefore, we replicated the 1 behavior‐analytic sports study on VM (Quinn et al., 2020), using a multiple baseline design across behaviors to evaluate the effects of VM and VM + video feedback (VF) to train 3 goalkeeper skills to two 9‐year‐old soccer players. The results showed that, although VM had some effect on performance compared to baseline, VM + VF resulted in the robust outcomes necessary for proficient performance of the goalkeeper skills. We discuss the results and limitations.

IMPORTANCE: The National Pediatric Readiness Project is a US initiative to improve emergency department (ED) readiness to care for acutely ill and injured children. However, it is unclear whether high ED pediatric readiness is associated with improved survival in US trauma centers. OBJECTIVE: To evaluate the association between ED pediatric readiness, in-hospital mortality, and in-hospital complications among injured children presenting to US trauma centers. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 832 EDs in US trauma centers in 50 states and the District of Columbia was conducted using data from January 1, 2012, through December 31, 2017. Injured children younger than 18 years who were admitted, transferred, or with injury-related death in a participating trauma center were included in the analysis. Subgroups included children with an Injury Severity Score (ISS) of 16 or above, indicating overall seriously injured (accounting for all injuries); any Abbreviated Injury Scale (AIS) score of 3 or above, indicating at least 1 serious injury; a head AIS score of 3 or above, indicating serious brain injury; and need for early use of critical resources. EXPOSURES: Emergency department pediatric readiness for the initial ED visit, measured through the weighted Pediatric Readiness Score (range, 0-100) from the 2013 National Pediatric Readiness Project ED pediatric readiness assessment. MAIN OUTCOMES AND MEASURES: In-hospital mortality, with a secondary composite outcome of in-hospital mortality or complication. For the primary measurement tools used, the possible range of the AIS is 0 to 6, with 3 or higher indicating a serious injury; the possible range of the ISS is 0 to 75, with 16 or higher indicating serious overall injury. The weighted Pediatric Readiness Score examines and scores 6 domains; in this study, the lowest quartile included scores of 29 to 62 and the highest quartile included scores of 93 to 100. RESULTS: There were 372 004 injured children (239 273 [64.3%] boys; median age, 10 years [interquartile range, 4-15 years]), including 5700 (1.5%) who died in-hospital and 5018 (1.3%) who developed in-hospital complications. Subgroups included 50 440 children (13.6%) with an ISS of 16 or higher, 124 507 (33.5%) with any AIS score of 3 or higher, 57 368 (15.4%) with a head AIS score of 3 or higher, and 32 671 (8.8%) requiring early use of critical resources. Compared with EDs in the lowest weighted Pediatric Readiness Score quartile, children cared for in the highest ED quartile had lower in-hospital mortality (adjusted odds ratio [aOR], 0.58; 95% CI, 0.45-0.75), but not fewer complications (aOR for the composite outcome 0.88; 95% CI, 0.74-1.04). These findings were consistent across subgroups, strata, and multiple sensitivity analyses. If all children cared for in the lowest-readiness quartiles (1-3) were treated in an ED in the highest quartile of readiness, an additional 126 lives (95% CI, 97-154 lives) might be saved each year in these trauma centers. CONCLUSIONS AND RELEVANCE: In this cohort study, injured children treated in high-readiness EDs had lower mortality compared with similar children in low-readiness EDs, but not fewer complications. These findings support national efforts to increase ED pediatric readiness in US trauma centers that care for children.

We investigated how counselors (N= 157) perceived social class and socioeconomic status (SES) via a mixed‐methods design. Among other findings, the results revealed participants provided limited or SES‐only responses when they defined social class. We describe counseling practice and training implications from a culturally informed, humanistic perspective.

Social “difficulties” associated with ASD may be a product of neurotypical-autistic differences in emotion expression and recognition. Research suggests that neurotypical and autistic individuals exhibit expressive differences, with autistic individuals displaying less frequent expressions that are rated lower in quality by non-autistic raters. Autistic individuals have difficulties recognizing neurotypical facial expressions; neurotypical individuals have difficulties recognizing autistic expressions. However, findings are mixed. Task-related factors (e.g., intensity of stimuli) and participant characteristics (e.g., age, IQ, comorbid diagnoses) may contribute to the mixed findings. The authors conclude by highlighting important areas for future research and the clinical implications of the discussed findings.

Social “difficulties” associated with ASD may be a product of neurotypical-autistic differences in emotion expression and recognition. Research suggests that neurotypical and autistic individuals exhibit expressive differences, with autistic individuals displaying less frequent expressions that are rated lower in quality by non-autistic raters. Autistic individuals have difficulties recognizing neurotypical facial expressions; neurotypical individuals have difficulties recognizing autistic expressions. However, findings are mixed. Task-related factors (e.g., intensity of stimuli) and participant characteristics (e.g., age, IQ, comorbid diagnoses) may contribute to the mixed findings. The authors conclude by highlighting important areas for future research and the clinical implications of the discussed findings.

AbstractWe conducted a qualitative, systematic content analysis of articles from 2 counseling journals (N = 636), Counselor Education and Supervisionand Counseling and Values,to understand social class and socioeconomic status (SES) term usage and operationalization. Through PRISMA procedures, electronic text data mining, and consensual coding processes, we found a high number of social class and SES terms (N = 537) present; however, terms were used infrequently and problematically, including term conflation and term misuse. Additionally, we uncovered high rates of problematic social class and SES term use and variable application (86.67%) in the empirical article subsample. Variable application issues in the empirical subsample were related to data analysis, data collection, data reporting, or term operationalization. Based on the study findings, we offer recommendations to counseling researchers to strengthen their social class and SES terminology usage and variable operationalization and suggest how such strengthening has the capacity to affect counselor education research and counseling practice.

Benzodiazepine-refractory, or established, status epilepticus is thought to be of similar pathophysiology in children and adults, but differences in underlying aetiology and pharmacodynamics might differentially affect response to therapy. In the Established Status Epilepticus Treatment Trial (ESETT) we compared the efficacy and safety of levetiracetam, fosphenytoin, and valproate in established status epilepticus, and here we describe our results after extending enrolment in children to compare outcomes in three age groups.

We assess the productivity, outcomes, and experiences of participants in the National Institutes of Health/National Heart, Lung, and Blood Institute–funded K12 institutional research training programs in emergency care research.

In recent years there has been an increasing tendency to use wastes in manufacturing construction material. Some of the studies were dedicated to recycling hazardous waste in a manner that is safe and protective of human health and the environment. The aim of this work is to study the possibility of using clinical waste as the aggregates for manufacturing construction materials. For that purpose, firstly a technology of initial sterilization with combustion of clinical waste was considered. Secondly as along as the clinical waste became sterile and environmentally safe, non-hazardous fractionated products of clinical waste combustion were proposed as aggregate for concretes. This study reports the results of the experiment when different concrete compositions with such aggregate were obtained, investigated and tested using samples (100 mm cubes). Physic-chemical properties of the material were described; its environmental impact was assessed. Thirdly, the potential of the big city in clinical waste generation and subsequent use of fractionated products of clinical waste combustion in construction materials manufacturing was evaluated. As a result of the use of ArcGIS ESRI geoinformation system, a visual representation of the information has been provided. The results of this study show the possibility of using non-hazardous clinical wastes combustion products in manufacturing construction materials and also in road construction.

Health systems across the United States are adopting intensive care unit telemedicine programs to improve patient outcomes. Research demonstrates the potential for decreased mortality and length of stay for patients of these remotely monitored units. Financial models and studies point to cost-effectiveness and the possibility of cost savings in the face of abundant startup costs. Questions remain as to the true financial implications of these programs and targeted populations that may see the greatest benefit. Despite recent growth, widespread adoption may be limited until these unknowns are answered.

ABSTRACTSocial class is an intersecting identity factor that affects clients, counselors, and all counseling specialties. Although an important component of ethical counseling practice, counseling scholars rarely publish research in this area. This study was designed to determine how often, when, and in what context social class was examined as the focus of counseling publications via a 17-year content analysis of 21 American Counseling Association (ACA) and ACA division journals. Implications and recommendations for counseling and counseling research are provided.

Pump thrombosis (PT) is a severe complication of left ventricular assist device (LVAD) support. This study evaluated PT and bleeding after LVAD placement in patients responsive to a standard aspirin dose of 81 mg using platelet inhibition monitoring compared with initial nonresponders who were then titrated upward to achieve therapeutic response. Patients ≥ 18 years of age with initial placement of HeartMate II LVAD at our institution and at least one VerifyNow Aspirin test performed during initial hospitalization were included. The primary endpoints were bleeding and PT compared between initial aspirin responders and nonresponders. Of 85 patients, 19 (22%) were nonresponsive to initial aspirin therapy. Responders and nonresponders showed similar survival (p= 0.082), freedom from suspected/confirmed PT (p= 0.941), confirmed PT (p= 0.273), bleeding (p= 0.401), and incidence rates in PT and bleeding. Among the initial responders (<500 vs. 500–549 aspirin reaction units), there were no significant differences in survival (p= 0.177), freedom from suspected/confirmed PT (p= 0.542), confirmed PT (p= 0.159), bleeding (p= 0.879), and incidence of PT and bleeding. Platelet function testing may detect resistance to standard aspirin regimens used in LVAD patients. Dose escalation in initially nonresponsive patients to achieve responsiveness may confer a similar PT risk to patients initially responsive to standard aspirin dosing without increased bleeding risk.

While the multiple endocrine neoplasia type 1 (MEN1) gene functions as a tumor suppressor in a variety of cancer types, we explored its oncogenic role in breast tumorigenesis. The MEN1gene product menin is involved in H3K4 trimethylation and co-activates transcription. We integrated ChIP-seq and RNA-seq data to identify menin target genes. Our analysis revealed that menin-dependent target gene promoters display looping to distal enhancers that are bound by menin, FOXA1 and GATA3. In this fashion, MEN1co-regulates a proliferative breast cancer-specific gene expression program in ER+cells. In primary mammary cells, MEN1exerts an anti-proliferative function by regulating a distinct expression signature. Our findings clarify the cell-type-specific functions of MEN1and inform the development of menin-directed treatments for breast cancer.

IMPORTANCE: Despite a large rural US population, there are potential differences between rural and urban regions in the processes and outcomes following trauma. OBJECTIVES: To describe and evaluate rural vs urban processes of care, injury severity, and mortality among injured patients served by 9-1-1 emergency medical services (EMS). DESIGN, SETTING, AND PARTICIPANTS: This was a preplanned secondary analysis of a prospective cohort enrolled from January 1 through December 31, 2011, and followed up through hospitalization. The study included 44 EMS agencies transporting to 28 hospitals in 2 rural and 5 urban counties in Oregon and Washington. A population-based, consecutive sample of 67 047 injured children and adults served by EMS (1971 rural and 65 076 urban) was enrolled. Among the 53 487 patients transported by EMS, a stratified probability sample of 17 633 patients (1438 rural and 16 195 urban) was created to track hospital outcomes (78.9% with in-hospital follow-up). Data analysis was performed from June 12, 2015, to May 20, 2016. EXPOSURES: Rural was defined at the county level by 60 minutes or more driving proximity to the nearest level I or II trauma center and/or rural designation in the Centers for Medicare & Medicaid Services ambulance fee schedule by zip code. MAIN OUTCOMES AND MEASURES: Mortality (out-of-hospital and in-hospital), need for early critical resources, and transfer rates. RESULTS: Of the 53 487 injured patients transported by EMS (17 633 patients in the probability sample), 27 535 were women (51.5%); mean (SD) age was 51.6 (26.1) years. Rural vs urban sensitivity of field triage for identifying patients requiring early critical resources was 65.2% vs 80.5%, and only 29.4% of rural patients needing critical resources were initially transported to major trauma centers vs 88.7% of urban patients. After accounting for transfers, 39.8% of rural patients requiring critical resources were cared for in major trauma centers vs 88.7% of urban patients. Overall mortality did not differ between rural and urban regions (1.44% vs 0.89%; P = .09); however, 89.6% of rural deaths occurred within 24 hours compared with 64% of urban deaths. Rural regions had higher transfer rates (3.2% vs 2.7%) and longer transfer distances (median, 97.4 km; interquartile range [IQR], 51.7-394.5 km; range, 47.8-398.6 km vs 22.5 km; IQR, 11.6-24.6 km; range, 3.5-97.4 km). CONCLUSIONS AND RELEVANCE: Most high-risk trauma patients injured in rural areas were cared for outside of major trauma centers and most rural trauma deaths occurred early, although overall mortality did not differ between regions. There are opportunities for improved timeliness and access to major trauma care among patients injured in rural regions.

The promoter-proximal pausing of RNA polymerase II (Pol II) plays a critical role in regulating metazoan gene transcription. Despite the prevalence of Pol II pausing across the metazoan genomes, little is known about the in vivo effect of Pol II pausing on vertebrate development. We use the emergence of hematopoietic stem cells (HSCs) in zebrafish embryos as a model to investigate the role of Pol II pausing in vertebrate organogenesis. Disrupting Pol II pausing machinery causes a severe reduction of HSC specification, a defect that can be effectively rescued by inhibiting Pol II elongation. In pausing-deficient embryos, the transforming growth factor β (TGFβ) signaling is elevated due to enhanced transcription elongation of key pathway genes, leading to HSC inhibition; in contrast, the interferon-γ (IFN-γ) signaling and its downstream effector Jak2/Stat3, which are required for HSC formation, are markedly attenuated owing to reduced chromatin accessibility on IFN-γ receptor genes. These findings reveal a novel transcription mechanism instructing HSC fate by pausing-mediated differential regulation of key signaling pathways.

The promoter-proximal pausing of RNA polymerase II (Pol II) plays a critical role in regulating metazoan gene transcription. Despite the prevalence of Pol II pausing across the metazoan genomes, little is known about the in vivo effect of Pol II pausing on vertebrate development. We use the emergence of hematopoietic stem cells (HSCs) in zebrafish embryos as a model to investigate the role of Pol II pausing in vertebrate organogenesis. Disrupting Pol II pausing machinery causes a severe reduction of HSC specification, a defect that can be effectively rescued by inhibiting Pol II elongation. In pausing-deficient embryos, the transforming growth factor β (TGFβ) signaling is elevated due to enhanced transcription elongation of key pathway genes, leading to HSC inhibition; in contrast, the interferon-γ (IFN-γ) signaling and its downstream effector Jak2/Stat3, which are required for HSC formation, are markedly attenuated owing to reduced chromatin accessibility on IFN-γ receptor genes. These findings reveal a novel transcription mechanism instructing HSC fate by pausing-mediated differential regulation of key signaling pathways.

Because of the complexities associated with anticoagulation in temporary percutaneous ventricular assist device (pVAD) recipients, a lack of standardization exists in their management. This retrospective analysis evaluates current anticoagulation practices at a single center with the aim of identifying an optimal anticoagulation strategy and protocol. Patients were divided into two cohorts based on pVAD implanted (CentriMag (Thoratec; Pleasanton, CA) / TandemHeart (CardiacAssist; Pittsburgh, PA) or Impella (Abiomed, Danvers, MA)), with each group individually analyzed for bleeding and thrombotic complications. Patients in the CentriMag/TandemHeart cohort were subdivided based on the anticoagulation monitoring strategy (activated partial thromboplastin time (aPTT) or antifactor Xa unfractionated heparin (anti-Xa) values). In the CentriMag/TandemHeart cohort, there were five patients with anticoagulation titrated based on anti-Xa values; one patient developed a device thrombosis and a major bleed, whereas another patient experienced major bleeding. Eight patients received an Impella pVAD. Seven total major bleeds in three patients and no thrombotic events were detected. Based on distinct differences between the devices, anti-Xa values, and outcomes, two protocols were created to guide anticoagulation adjustments. However, anticoagulation in patients who require pVAD support is complex with constantly evolving anticoagulation goals. The ideal level of anticoagulation should be individually determined using several coagulation laboratory parameters in concert with hemodynamic changes in the patient’s clinical status, the device, and the device cannulation.

High school redesign (HSR) efforts currently focus on helping schools prepare all students to be college and career ready. As these initiatives are provided within the context of high schools, students with Individualized Education Programs are impacted by any effort to reform high schools. As a result, policies designed to improve the college and a career readiness (CCR) of all students should simultaneously improve the CCR of students with disabilities. The purpose of this article is to briefly describe current broad initiatives in high school reform and discuss implications for federal, state, and local policy to enable students with disabilities to fully participate in high school reforms designed to ensure that all students graduate college and are career ready.

This article presents the findings of a grounded theory study of 3 graduate students' lived experience of cultural immersion. Results indicated that participants experienced 3 phases (goal setting, interaction, and evaluation) and 4 themes (bias, gender, barriers, and self‐awareness) during immersion. Recommendations for the implementation of immersion experiences are discussed.

A variety of G-protein–coupled receptor (GPCR) screening technologies have successfully partnered a number of GPCRs with their cognate ligands. GPCR-mediated β-arrestin recruitment is now recognized as a distinct intracellular signaling pathway, and ligand-receptor interactions may show a bias toward β-arrestin over classical GPCR signaling pathways. We hypothesized that the failure to identify native ligands for the remaining orphan GPCRs may be a consequence of biased β-arrestin signaling. To investigate this, we assembled 10 500 candidate ligands and screened 82 GPCRs using PathHunter β-arrestin recruitment technology. High-quality screening assays were validated by the inclusion of liganded receptors and the detection and confirmation of these established ligand-receptor pairings. We describe a candidate endogenous orphan GPCR ligand and a number of novel surrogate ligands. However, for the majority of orphan receptors studied, measurement of β-arrestin recruitment did not lead to the identification of cognate ligands from our screening sets. β-Arrestin recruitment represents a robust GPCR screening technology, and ligand-biased signaling is emerging as a therapeutically exploitable feature of GPCR biology. The identification of cognate ligands for the orphan GPCRs and the extent to which receptors may exist to preferentially signal through β-arrestin in response to their native ligand remain to be determined.