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In the United States, maternal health inequities disproportionately affect Global Majority (e.g., Asian, Black, and Hispanic) populations. Despite a substantial body of research underscoring the influence of racism on these inequities, little research has examined how experiences of gendered racial microaggressions during pregnancy and birth impact racially and ethnically diverse Global Majority pregnant and birthing people in obstetric hospital settings. We evaluated the psychometric properties of an adapted version of Lewis & Neville's Gendered Racial Microaggressions Scale, using data collected from 417 Global Majority birthing people. Findings from our study indicate that our adapted GRMS is a valid tool for assessing the experiences of gendered racial microaggressions in hospital-based obstetric care settings among Global Majority pregnant and birthing people whose preferred languages are English or Spanish. Item Response Theory (IRT) analysis demonstrated high construct validity of the adapted GRMS scale (Root Mean Square Error of Approximation = 0.1089 (95% CI 0.0921, 0.1263), Comparative Fit Index = 0.977, Standardized Root Mean Square Residual = 0.075, log-likelihood c2 = -85.6, df = 8). IRT analyses demonstrated that the unidimensional model was preferred to the bi-dimensional model as it was more interpretable, had lower AIC and BIC, and all items had large discrimination parameters onto a single factor (all discrimination parameters > 3.0). Given that we found similar response profiles among Black and Hispanic respondents, our Differential Item Functioning analyses support validity among Black, Hispanic, and Spanish-speaking birthing people. Inter-item correlations demonstrated adequate scale reliability, α = 0.97, and empirical reliability = 0.67. Pearsons correlations was used to assess the criterion validity of our adapted scale. Our scale's total score was significantly and positively related to postpartum depression and anxiety. Researchers and practitioners should seek to address instances of gendered racial microaggressions in obstetric settings, as they are manifestations of systemic and interpersonal racism, and impact postpartum health. [ABSTRACT FROM AUTHOR]

Research evidence continues to reveal that using active learning methods in the classroom has a positive impact on student learning. Additionally, awareness by faculty and administrators of the importance and value of using active learning methods continues to grow in higher education. However, some faculty find the consistent implementation of active learning methods challenging. Many continue to teach the way they were taught, and the majority of terminal degree programs do not include training on learning theory and effective teaching. The study explored the internal and external barriers preventing faculty use of active learning methods in higher education across the United States and the relationship between the barriers and faculty demographics. A sample of one thousand full-time and part-time faculty teaching in private and public higher education institutions completed a twenty-four-item survey on perceived barriers to using active learning in the classroom. Results suggest that male and full professors identified more barriers than their counterparts and listed workload and competing demands high on their lists of barriers to utilizing active learning. The results also showed that training, mentoring, and professional development are vital components for supporting faculty in the utilization of active learning pedagogies and are instrumental in supporting faculty in their efforts to become better teachers of their discipline. Limitations of the study include the use of classroom observation or in-depth interview methodologies to contribute more in-depth data. [ABSTRACT FROM AUTHOR]

Background: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program designated bariatric surgery as a clinical pathway. Among the tiers of the Masters Program, revisional bariatric surgery is the highest tier of "mastery" within the pathway. This article presents the top 10 seminal studies representing the current landscape of revisional bariatrics. Methods: The literature was systematically searched and seminal articles designated by consensus agreement of the SAGES Metabolic and Bariatric Surgery committee using multiple criteria, including impact on the field, citation frequency, and expert opinion. Articles were reviewed by committee members and presented in summarized fashion. Results: The top 10 papers are presented in grouped thematic categories covering the early evolution of revisional bariatrics, changing criteria for reoperative bariatric surgery, divergence of revision versus conversion bariatric surgery, and recent technologic innovations in revisional bariatric surgery. Each summary is presented with expert appraisal and commentary. Conclusion: These seminal papers represent a snapshot of the dynamic field of revisional bariatric surgery and emphasize the need to not only remain current with contemporary trends but also keep a patient-oriented perspective on patient and intervention selection for optimal success. [ABSTRACT FROM AUTHOR]

Demographic shifts and the growth of diversity, equity, and inclusion (DEI) initiatives are occurring simultaneously on college campuses. This study seeks to understand their intersection by focusing on age in DEI initiatives on college campuses. Findings from six focus groups suggest that age is not given much attention in DEI initiatives. Participants acknowledge the issue of age; but in general, they strive to keep other identities, like race and gender, in the forefront, especially in the face of low resources. While it may be difficult to elevate age in DEI initiatives on campuses, interventions were identified. [ABSTRACT FROM AUTHOR]

Maltreatment survivors are at a heightened risk for revictimization during adulthood. Yet, existing work has specifically focused on sexual revictimization, and it is unclear what factors increase one's risk for revictimization more broadly. Posttraumatic stress symptoms (PTSS), anger, and substance use have been identified as factors associated with sexual revictimization; the function of these variables is ambiguous in the broader revictimization framework. There is also a lack of understanding regarding the roles of the DSM-5 posttraumatic stress disorder (PTSD) symptom clusters and revictimization. This study aimed to 1) examine the links between maltreatment and revictimization and three factors (i.e., PTSS, anger, and substance use), 2) determine whether there are indirect effects between maltreatment and revictimization through each factor, and 3) investigate whether PTSD clusters have indirect effects on the relationship between maltreatment and revictimization. The sample included 350 maltreated college women (Mage = 21.96, SD = 5.31; 54.2% White) from two universities. Findings indicated that maltreatment and revictimization were linked with PTSS (B = 4.65, B = 0.03, respectively). Only maltreatment was related to anger, B = 1.70, and revictimization was tied to substance use, B = 0.08. Only PTSS had an indirect effect on the link between maltreatment and revictimization (B = 0.13). Maltreatment was related to each of the four PTSD symptom clusters, but the clusters had no indirect effects on the association between maltreatment and revictimization. These findings indicate that PTSS may be uniquely important in increasing the risk for revictimization among women. [ABSTRACT FROM AUTHOR]

As overdose rates increase for multiple substances, policymakers need to identify geographic patterns of substance-specific deaths. In this study, we describe county-level opioid and psychostimulant overdose patterns and how they correlate with county-level social vulnerability measures. A cross-sectional observational study, we used nationwide 2016-2018 restricted access Centers for Disease Prevention and Control county-level mortality files for 1,024 counties. We estimated quartiles of opioid and psychostimulant overdose mortality and provided estimates of their association with county-level Social Vulnerability Index (SVI) percentile. There was high opioid and psychostimulant overdose mortality in the Middle Atlantic, South Atlantic, East North Central, and Mountain regions. The Central US had the lowest opioid and psychostimulant overdose mortality rates. Counties with higher SVI scores (i.e. higher social vulnerability) were significantly more likely to experience high opioid and high psychostimulant overdose (high-high) mortality. A 10-percentile increase in SVI score was associated with a 3.1 percentage point increase in the likelihood of being a high-high county (p < 0.001) in unadjusted models and a 1.5 percentage point increase (p < 0.05) in models adjusting for region. Our results illustrated the heterogenous geographic distribution of the growing concurrent opioid and psychostimulant overdose crisis. The substantial regional variation we identified highlights the need for local data to guide policymaking and treatment planning. The association of opioid-psychostimulant overdose mortality with social vulnerability demonstrates the critical need in impacted counties for tailored treatment that addresses the complex medical and social needs of people who use both opioids and psychostimulants. [ABSTRACT FROM AUTHOR]

Current quantitative methods to evaluate pavement conditions in the United States are most commonly focused on construction acceptance using the International Roughness Index (IRI). However, from an asset management perspective, qualitative visual inspection techniques are the most prevalent. Modern vehicles with factory-equipped sensors drive these roadways daily and can passively assess the condition of infrastructure at an accuracy level somewhere between qualitative assessment and rigorous construction acceptance techniques. This paper compares crowdsourced ride quality data with an industry standard inertial profiler on a 7-mile bi-directional construction zone. A linear correlation was performed on 14 miles of I-65 that resulted in an R2 of 0.7 and a p-value of <0.001, but with a modest fixed offset bias. The scalability of these techniques is illustrated with graphics characterizing IRI values obtained from 730,000 crowdsourced data segments over 5,800 miles of I-80 in April of 2022 and October 2022. This paper looks at the use of standard original equipment manufacturer (OEM) on-board sensor data from production vehicles to assess approximately 100 miles of roadway pavements before, during, and after construction. The completed construction projects observed IRI improvements of 10 in/mi to 100 in/mi. These results suggest that it is now possible to monitor pavement ride quality at a system level, even with a small proportion of connected vehicles (CV) providing roughness data. [ABSTRACT FROM AUTHOR]

Depression is a prevalent and debilitating mental health condition that poses significant challenges for healthcare providers, researchers, and policymakers. The diagnostic coding specificity of depression is crucial for improving patient care, resource allocation, and health outcomes. We propose a novel approach to assess risk-adjusted coding specificity for individuals diagnosed with depression using a vast cohort of over one million inpatient hospitalizations in the United States. Considering various clinical, demographic, and socioeconomic characteristics, we develop a risk-adjusted model that assesses diagnostic coding specificity. Results demonstrate that risk-adjustment is necessary and useful to explain variability in the coding specificity of principal (AUC = 0.76) and secondary (AUC = 0.69) diagnoses. Our approach combines a multivariate logistic regression at the patient hospitalization level to extract risk-adjusted probabilities of specificity with a Poisson Binomial approach at the facility level. This method can be used to identify healthcare facilities that over- and under-specify diagnostic coding when compared to peer-defined standards of practice. [ABSTRACT FROM AUTHOR]

Out-of-pocket (OOP) health care expenditures in the United States have increased significantly in the past 5 decades. Most research on OOP costs focuses on expenditures related to insurance and cost-sharing payments or on costs related to specific conditions or settings, and does not capture the full picture of the financial burden on patients and unpaid caregivers. The aim for this systematic literature review was to identify and categorize the multitude of OOP costs to patients and unpaid caregivers, aid in the development of a more comprehensive catalog of OOP costs, and highlight potential gaps in the literature. The authors found that OOP costs are multifarious and underestimated. Across 817 included articles, the authors identified 31 subcategories of OOP costs related to direct medical (eg, insurance premiums), direct nonmedical (eg, transportation), and indirect spending (eg, absenteeism). In addition, 42% of articles studied an expenditure that the authors did not label as "OOP." A holistic and comprehensive catalog of OOP costs can inform future research, interventions, and policies related to financial barriers to health care in the United States to ensure the full range of costs for patients and unpaid caregivers are acknowledged and addressed. [ABSTRACT FROM AUTHOR]

Viruses from a new species of piscichuvirus were strongly associated with severe lymphocytic meningoencephalomyelitis in several free-ranging aquatic turtles from 3 coastal US states during 2009-2021. Sequencing identified 2 variants (freshwater turtle neural virus 1 [FTuNV1] and sea turtle neural virus 1 [STuNV1]) of the new piscichuvirus species in 3 turtles of 3 species. In situ hybridization localized viral mRNA to the inflamed region of the central nervous system in all 3 sequenced isolates and in 2 of 3 additional nonsequenced isolates. All 3 sequenced isolates phylogenetically clustered with other vertebrate chuvirids within the genus Piscichuvirus. FTuNV1 and STuNV1 shared ≈92% pairwise amino acid identity of the large protein, which narrowly places them within the same novel species. The in situ association of the piscichuviruses in 5 of 6 turtles (representing 3 genera) with lymphocytic meningoencephalomyelitis suggests that piscichuviruses are a likely cause of lymphocytic meningoencephalomyelitis in freshwater and marine turtles. [ABSTRACT FROM AUTHOR]

Introduction: The integration of clinical oncology pharmacists into multidisciplinary healthcare teams is not well-described in the community practice setting. This study aims to analyze the clinical and financial impact of a remote-based clinical oncology pharmacist in four community oncology practices within The US Oncology Network. Methods: Oncology-trained clinical pharmacists electronically reviewed chemotherapy orders for clinical optimization and financial stewardship within four community oncology practices. Each pharmacist was appointed at 0.5 full-time equivalents per practice. Financial, clinical, and workload metrics were tracked to monitor the impact of pharmacist engagement. Results: Over 12 months, 5716 order reviews were completed with an intervention rate of 57%. The most common interventions identified by the pharmacists were interventions with clinical impact on the patient (36%), followed by dose rounding (35%) and therapeutic interchange (30%). Overall, interventions improved the cumulative practice margins by $1,455,033 and reduced total medication costs by $5,962,551. The average program return on investment was 415% (range 100–915%). Conclusion: Community oncology practices seek to provide high-value care in a lean, resource-constrained model. An oncology clinical pharmacist is a cost-effective and clinically invaluable care team member in community oncology practice. Pharmacists in this setting identified opportunities to improve medication safety and regimen optimization and demonstrated a significant tremendous financial impact on small-scale budgets in community oncology. [ABSTRACT FROM AUTHOR]

Methane emissions from solid waste may represent a substantial fraction of the global anthropogenic budget, but few comprehensive studies exist to assess inventory assumptions. We quantified emissions at hundreds of large landfills across 18 states in the United States between 2016 and 2022 using airborne imaging spectrometers. Spanning 20% of open United States landfills, this represents the most systematic measurement-based study of methane point sources of the waste sector. We detected significant point source emissions at a majority (52%) of these sites, many with emissions persisting over multiple revisits (weeks to years). We compared these against independent contemporaneous in situ airborne observations at 15 landfills and established good agreement. Our findings indicate a need for long-term, synoptic-scale monitoring of landfill emissions in the context of climate change mitigation policy. [ABSTRACT FROM AUTHOR]

Introduction: Traditionally, lower-limb prostheses are composed of passive components, which provide a fraction of the push-off power of the natural ankle-foot complex. In individuals with transtibial amputation (TTA), this leads to deviations and compensatory mechanisms. Studies have reported significant unloading of the sound limb and knee joint with a powered prosthetic ankle-foot. However, despite the promising biomechanical evidence on unloading, no study has yet investigated the impact of powered prosthetic ankle-foot on musculoskeletal pain. Methods: A total of 250 individuals fit with a powered prosthetic ankle-foot component were invited to participate in an institutional review board-approved cross-sectional study. Participants completed a survey, which collected typical prosthetic history information as well as Numerical Pain Rating Scales across different body regions, the Socket Comfort Score (SCS), the Activity of Daily Living domain of the Knee Injury and Osteoarthritis Outcome Score (KOOS-ADL), and the Oswestry Disability Index (ODI) for both their current and past prosthetic ankle-foot. The differences between results across the two ankle-feet were evaluated in subgroups dependent on the user's current foot. Results: A total of 57 individuals met the inclusion criteria after completion of the online survey. Forty-one subjects (71.9%) identified as current powered ankle-foot users. Sixteen subjects (28.1%) reported to have used a powered ankle-foot in the past but have since abandoned it. The current powered ankle-foot users' group saw no significant difference in SCSs. The current passive foot users reported significantly (P = 0.002) better socket comfort for the prosthesis with the passive foot. The original and recall-adjusted median ratings of pain in the group of 41 current powered ankle-foot users showed significantly less pain in all three body segments. In the group of 41 current powered ankle-foot users, both the original and recall-adjusted KOOS-ADL and ODI scores were significantly better for the powered ankle-foot. Conclusions: Individuals in active daily life with TTA may experience relief of sound knee, amputated side knee, and low-back pain, as well as pain-related restrictions in activities of daily living function with use of a powered ankle-foot mechanism. Clinical Relevance: Providing the right patient with a powered ankle-foot has the potential to decrease the individual's pain. The individual may also have fewer pain-related functional restrictions when attempting to achieve activities of daily living. [ABSTRACT FROM AUTHOR]