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This process evaluation of the Rural Elder Awareness of Medication Safety (REAMS) program provided identification of successful and unsuccessful elements along with barriers to and facilitators of this home-based pilot program. The REAMS program was developed to assist rural older adults aged >65 years and community health care organizations with strategies to improve health literacy related to medications. Recruitment of older adults, rurality of the program's setting, time constraints, and the onset of the COVID-19 pandemic were the greatest barriers. The collaborative relationship developed with community health care partners was the greatest facilitator. This relationship promoted shared ideas and adjustments in program design to achieve the outcome goals. The lessons learned from process evaluation may benefit future researchers or community health promotion planners with designing community-based programs for older adults in rural areas. Future research should focus on expanding recruitment opportunities in acute care, primary care, and home health with the inclusion of all established health care providers in the community. [Journal of Gerontological Nursing, 47(4), 7–12.], Rural older adults face many health disparities when compared to urban and suburban residents. Approximately 19% of the U.S. population resides in rural geographical areas and 20% of these individuals [...]

This article discusses how rising student enrollment and a projected wave of teacher retirements will affect the teacher corps. It describes the possible shortage of teachers in the upcoming years as a problem more of specialization than outright shortage. Math and science teachers and special-education teachers will be hardest to find, as will be teachers from minority groups. Some possible remedies to these difficulties include linking teacher standards with salaries, creating national recruitment initiatives, and expanding teacher-education programs in high-need fields. The paper focuses on teacher quality and its vital importance in education. High-quality teachers must have basic skills, must pass licensure tests, and must possess experience. Finding high-quality teachers begins with the hiring process. The best hiring systems identify the teacher skills most wanted in the classroom and validate the selection process to ensure it is effective. Once hired, teachers must be given professional development to help them excel in the classroom and encourage them to remain a teaching professional. School leaders should see staff development as an ongoing process and should enable teachers to become self-directed in a culture that values professional collegial interaction. (Contains 16 references.) (RJM)

Evidence for the efficacy of cardiac resynchronization therapy (CRT) in pediatric and congenital heart disease (CHD) has been limited to surrogate outcomes.

In our inaugural year as JAACAP Open, we are proud to support the dissemination of some of the highest quality research being conducted in our field. Choosing the “best” among stars is a tall order and most certainly misses the many ways articles make an impact: is the “best” the most interesting, most surprising, most educational, most important, most provocative, or most enjoyable? How to decide? This time around, we made some picks based on those that were methodologically rigorous and clinically salient. It is our pleasure to give a special “hats off” to the 2023 articles that we think deserve your attention or at least a second read!

Introduction Best-practice guidelines recommend that patients are followed-up to check if they have recovered following a mild traumatic brain injury (mTBI) and to refer to concussion services, if needed. However, in New Zealand, rates of follow-up are low and access to concussion services can be delayed. Aim We aimed to improve rates of follow-up and access to concussion services for mTBI patients aged ≥8 years by the implementation of a supported health pathway and test its success. Methods The pathway included a decision support tool, funded follow-up appointments, clinician training and a patient education resource. Sociodemographics, injury details and proportions of patients receiving a follow-up by type and time were extracted from the Accident Compensation Corporation (ACC) database between 18 May 22 and 30 June 23 and compared to national ACC data prior to implementation. Results Data were extracted for 220 patients, with a mean age of 31.5 years, 51.4% female and 21.4% Māori and Pacific. There was an increase in the proportion of patients receiving a follow-up from 36% pre-implementation to 56.8% post-implementation. Sixty-three patients (28.6%) accessed a concussion service post-implementation compared to 10% pre-implementation. Time to concussion service reduced from an average of 55 (s.d. = 65.4) to 37 days (29.5). Discussion Risk factor criteria within the decision support tool need to be weighted to improve specificity of referrals. Timing from injury to medical review in primary care needs to be considered. This quality improvement project provides preliminary evidence for implementation of a supported health care pathway for mTBI.

AbstractBackground:The transition from residency to paediatric cardiology fellowship is challenging due to the new knowledge and technical skills required. Online learning can be an effective didactic modality that can be widely accessed by trainees. We sought to evaluate the effectiveness of a paediatric cardiology Fellowship Online Preparatory Course prior to the start of fellowship.Methods:The Online Preparatory Course contained 18 online learning modules covering basic concepts in anatomy, auscultation, echocardiography, catheterisation, cardiovascular intensive care, electrophysiology, pulmonary hypertension, heart failure, and cardiac surgery. Each online learning module included an instructional video with pre-and post-video tests. Participants completed pre- and post-Online Preparatory Course knowledge-based exams and surveys. Pre- and post-Online Preparatory Course survey and knowledge-based examination results were compared via Wilcoxon sign and paired t-tests.Results:151 incoming paediatric cardiology fellows from programmes across the USA participated in the 3 months prior to starting fellowship training between 2017 and 2019. There was significant improvement between pre- and post-video test scores for all 18 online learning modules. There was also significant improvement between pre- and post-Online Preparatory Course exam scores (PRE 43.6 ± 11% versus POST 60.3 ± 10%, p < 0.001). Comparing pre- and post-Online Preparatory Course surveys, there was a statistically significant improvement in the participants’ comfort level in 35 of 36 (97%) assessment areas. Nearly all participants (98%) agreed or strongly agreed that the Online Preparatory Course was a valuable learning experience and helped alleviate some anxieties (77% agreed or strongly agreed) related to starting fellowship.Conclusion:An Online Preparatory Course prior to starting fellowship can provide a foundation of knowledge, decrease anxiety, and serve as an effective educational springboard for paediatric cardiology fellows.

Objective: The initial posttransplant period is high-risk in terms of susceptibility to rejection episodes and poor medical outcomes for pediatric solid organ transplant (SOT) patients. Psychologists play an important role on transplant medical teams to support patients and families in improving adherence and graft outcomes. This article describes a new psychology-integrated preventative care model implemented in 2019 and examines trends in service delivery pre- and postimplementation.Method: Universal health and behavior assessment and intervention were delivered to SOT (heart, liver, and kidney) patients according to a structured method of service delivery that identified distinct time points for follow-up within the first 3-year posttransplantation.Results: Preimplementation, the SOT psychology service delivered intervention and assessment services to 44% of patients who were transplanted during the preimplementation period; postimplementation, 97% of this patient population were seen by SOT psychology. Mean psychology contacts increased significantly postimplementation (M= 2.55) of this new preventative care model, compared to preimplementation (M= 1.59).Conclusions: Psychology support is an essential component of comprehensive pediatric SOT care. Increased psychology services posttransplantation can effectively identify and target psychosocial needs for patients and families.Implications for Impact Statement This article describes a new integrated preventative care model of psychology service delivery within pediatric solid organ transplant that greatly increased assessments and interventions during the vulnerable first 3-year posttransplant. This preventative care model allows pediatric psychologists to address adherence, behavioral and emotional concerns, and coping with illness to support optimal posttransplant psychological and medical outcomes.

Research provides ample evidence that positive social relations and access to knowledge are supportive for educational change. However, few studies have examined how personnel turnover and restructuring in school districts influence these processes, specifically as they relate to leaders’ access to research evidence and perception of organizational learning and culture. In this longitudinal exploratory mixed-methods case study, we examine the changes in social networks and organizational learning among school and district leaders during a 3-year district restructuring process. Our study uses social network analysis, bivariate analyses, and qualitative coding. We surveyed district and school leaders about their districts’ capacity for organizational learning, organizational culture, and social ties around research evidence. Our results suggest a decrease in the district’s capacity to diffuse ideas from research between Years 1 and 3, which may inhibit efforts for improvement. Further, the data on school and district leaders who did not leave the district indicates a decrease in the perception of organizational learning and culture in school sites, but not in the district with differences between principals and central office staff. Qualitative findings support an association between the restructuring and changes in organizational learning and social structures and provide further reasons for the changes (e.g., lack of communication, time to maintain/build relationships, and opportunities for professional development). These findings speak to the importance of leaders focusing on the social side of change during times of churn, including strengthening trust, fostering collective values and beliefs, and countering division.

A critical piece in the launch of JAACAP Openis the establishment of a high-quality and robust peer review process for incoming submissions. Indeed, peer review is the backbone of our scientific process. Here, we will discuss the importance of peer review, describe the process as we are expanding the JAACAPjournal family, and explain why and how you can be involved in the peer review process.

In our second year as JAACAP Open, which is now available on PubMed Central, we are proud to support the dissemination of among the highest quality research being conducted in our field. Choosing the “best” among stars is always a tall order and most certainly misses the many ways that articles make an impact: is the “best” the most interesting, the most surprising, the most educational, the most important, the most provocative, or the most enjoyable? How do we decide? This time around, our team made some picks based on those that were methodologically sophisticated, attuned to the complexity of childhood-onset psychopathology, and clinically salient. It is our pleasure to give a special “hats off” to the 2024 articles that we think deserve your attention or at least a second read!

Technology education teachers assist students in becoming technologically literate through teaching hands-on applications of technology and designing curriculum and learning activities that follow Standards for Technological Literacy: Content for the […]

Assessing the reliability of used components for remanufacturing is a difficult and unexplored process. A comprehensive two-step approach in assessing used components is presented. C omponent behavior wa s studied using Weibull analysis, then the degradation and condition monitoring data are analyzed using an artificial neural network model.

Eastern Village Cohousing (EVC) in Montgomery County, Md., proudly opened its doors in 2004. Besides achieving LEED-NC Silver Certification, ECV has won numerous awards (list below). Perhaps most importantly though, [...]

While consumers traditionally dispose of products at the end of their life cycle, product take-back legislations introduced by governments shift this responsibility from consumers to manufacturers. As a result manufacturers have to collect products at the end-of-life (EOL) and control their recovery or disposal. Product recovery, which encompasses reuse, remanufacturing and materials recycling, requires a structured reverse logistic network in order to collect products efficiently at the end of their life cycle. This paper presents a simulation model of a reverse logistics networks for collecting EOL appliances in the Sydney Metropolitan Area. The simulation results show that the model presented in this paper calculates the collection cost in a predictable manner. Moreover, it provides a tool to understand how the system behaves by carrying out 'what-if' assessments and to identify which factors are most important for further more detailed analysis. Keywords: Reverse logistics: Reuse: Recycling; Simulation modelling

Objectives and Goal: The objectives of this study were to examine the association between individual and partnership characteristics with condom use, sexual concurrency, and discordance in monogamy perceptions among out-of-treatment, young adult, drug-involved couples to gain a better understanding of how discordance in monogamy beliefs may influence HIV/sexually transmitted infection risk. Study Design: Data were collected from 94 predominantly black heavy alcohol and/or drug users (AOD) and their steady partners recruited through street outreach in Durham, North Carolina, and a methadone clinic in Raleigh, North Carolina. Results: One third was wrong about partners' monogamy intentions. Greater lifetime number of substances, longer relationship duration, and at least weekly relationship conflict were associated with inconsistent condom use, and discordant monogamy beliefs were associated with consistent condom use. Conclusions: Many individuals misperceive their partners' monogamy intentions, although this misperception may be reflective of greater HIV/sexually transmitted infection protection. Interventions for couples should focus on strategies appropriate for committed long-term relationships, including increasing awareness of partner risk behavior, negotiating safety, and conflict resolution skills.

Research on microaggression has primarily focused on the experiences of adults, as researchers have yet to extensively examine the experiences of school-age children. The few studies that exist suggest that microaggressions are problematic well before young people reach college or the working world. The current study adds to the microaggression literature through an examination of the experiences of adolescents holding minoritized racial and sexual orientation identities at a Midwestern public high school. Participants in the study completed a survey that assessed their experiences with microaggressions, the degree to which they found them offensive, and their experiences with peers and school personnel. Results of the study suggest that these microaggressive exchanges are relevant for high school students and that individual differences exist in the way that adolescents notice and label microaggressive verbalizations as offensive. Future research directions are discussed, as well as implications for those working directly with students in schools.

AbstractIntroduction:Paediatric cardiology fellows, tasked with studying a large and dynamic field, may benefit from a quick-access digital resource that reflects contemporary practice. The objective of this study was to evaluate the effectiveness of a paediatric cardiology handbook smartphone app in enhancing the accessibility of information such as guidelines and recommendations for paediatric cardiology fellows.Materials and methods:The Peds Cardiology Handbook app (iOS) was designed using XCode and Swift programming. A pre-app survey and download instructions were sent to the US paediatric cardiology fellows, followed by a post-app survey. Fellows were asked to rate the ease of rapid access to various types of information. Responses were compared pre- and post-app using McNemar’s test and Wilcoxon signed-rank test.Results:Two-hundred and thirty paediatric cardiology fellows were contacted; 23% (n = 53) completed both the pre- and post-app surveys and were included for analysis. After using the app, fellows found it easier to quickly access information in eight out of nine domains evaluated (p < 0.05). All fellows found the app easy to use (100%), most felt that the app was well-organised (98%), contained reliable information (92%), and was useful for finding quick answers to clinical questions (87%).Discussion:The Peds Cardiology Handbook iPhone app is a useful, reliable tool that provides quick access to high-yield information, including guidelines and references. Overall, paediatric cardiology fellows found it easier to rapidly access clinically relevant information after using the app. Future studies may be necessary to evaluate long-term use and impact on evidence-based practice.

Despite the meteoric rise of social media, little is known about how clinical social workers and other mental health professionals respond to this new form of communication. This study used classic (Glaserian) grounded theory methodology to explore the experiences and concerns of mental health professionals on social networking websites such as Facebook, Twitter, and LinkedIn. The main concern that emerged out of research interviews with 26 mental health professionals was a loss of control over others’ perceptions and the loss of ability to compartmentalize the different parts of identities associated with personal and professional selves. Participants resolved these concerns through the author-identified basic social process of “managing digital identities.” This study highlights practice implications for professionals as they manage online identity.

From January 1, 2018, through October 9, 2019, 82 HIV diagnoses occurred among people who inject drugs (PWID) in Cabell County, West Virginia. Increasing the use of HIV preexposure prophylaxis (PrEP) among PWID was one of the goals of a joint federal, state, and local response to this HIV outbreak. Through partnerships with the local health department, a federally qualified health center, and an academic medical system, we integrated PrEP into medication-assisted treatment, syringe services program, and primary health care settings. During the initial PrEP implementation period (April 18–May 17, 2019), 110 health care providers and administrators received PrEP training, the number of clinics offering PrEP increased from 2 to 15, and PrEP referrals were integrated with partner services, outreach, and testing activities. The number of people on PrEP increased from 15 in the 6 months before PrEP expansion to 127 in the 6 months after PrEP implementation. Lessons learned included the importance of implementing PrEP within existing health care services, integrating PrEP with other HIV prevention response activities, adapting training and material to fit the local context, and customizing care to meet the needs of PWID. The delivery of PrEP to PWID is challenging but complements other HIV prevention interventions. The expansion of PrEP in response to this HIV outbreak in Cabell County provides a framework for expanding PrEP in other outbreak and non-outbreak settings.

AbstractIn view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.

Epidural hemostasis needs to use small, adapted material in minimally invasive surgery, including bilateral decompression via a unilateral approach for lumbar spinal stenosis. Most surgeons avoid external material for hemostasis because of possible neural tissue damage or complications. We compared epidural hemostasis in minimally invasive surgery by fat graft versus gelatin sponge.

ABSTRACTRespiratory Syncytial Virus (RSV) causes lower respiratory tract infections that can be severe and sometimes fatal. The risk for severe RSV infection is highest in infants and older adults. A safe and effective RSV vaccine for older adults represents a serious unmet medical need due to higher morbidity and mortality in this age group. In this randomized, partially double-blind, placebo-controlled, phase 1 dose-escalation study, we evaluated the safety, tolerability and immunogenicity of an investigational messenger ribonucleic acid (mRNA) vaccine encoding the RSV fusion protein (F) stabilized in the prefusion conformation. The study was conducted in healthy younger adults (ages ≥18 and ≤49 years) and healthy older adults (ages ≥60 and ≤79 years). Participants received mRNA-1777 (V171) or placebo as a single intramuscular dose. For each dose level, three sentinel participants were administered open-label mRNA-1777 (V171). Seventy-two younger adults were randomized and administered 25, 100, or 200 µg mRNA-1777 (V171) or placebo, and 107 older adults were randomized and administered 25, 100, 200 or 300 µg mRNA-1777 (V171) or placebo. Primary objectives were safety and tolerability and secondary objectives included humoral and cell-mediated immunogenicity. All dose levels of mRNA-1777 (V171) were generally well tolerated and no serious adverse events related to the vaccine were reported. Immunization with mRNA-1777 (V171) elicited a humoral immune response as measured by increases in RSV neutralizing antibody titers, serum antibody titers to RSV prefusion F protein, D25 competing antibody titers to RSV prefusion F protein, and cell-mediated immune responses to RSV-F peptides.

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infection and related morbidity and mortality in infants. Passive immunization with an RSV‐neutralizing antibody can provide rapid protection to this vulnerable population. Proof‐of‐concept for this approach has been demonstrated by palivizumab; however, the use of this antibody is generally restricted to the highest‐risk infants due to monthly dosing requirements and its cost. To address the large unmet medical need for most infants, we are evaluating MK‐1654, a fully human RSV‐neutralizing antibody with half‐life extending mutations targeting site IV of the fusion protein. In this 2‐part, placebo‐controlled, double‐blind, first‐in‐human study, 152 healthy adults were randomized 3:1 to receive a single dose of MK‐1654 or placebo in 5 cohorts (100 or 300 mg as an intramuscular dose or 300, 1000, or 3000 mg as an intravenous dose). Safety, pharmacokinetics, antidrug antibodies, and RSV serum‐neutralizing antibody titers were evaluated through 1 year. MK‐1654 serum concentrations increased proportionally with dose and resulted in corresponding elevations in RSV serum‐neutralizing antibody titers. The antibody displayed a half‐life of 73 to 88 days and an estimated bioavailability of 69% at the 300‐mg dose. The overall safety profile of MK‐1654 was similar to placebo, and treatment‐emergent antidrug antibodies were low (2.6%) with no associated adverse events. These data support the continued development of MK‐1654 for the prevention of RSV disease in infants.

This study empirically examines the stability of the long-run relationship between tourism and economic growth for Puerto Rico using annual data for 1960–2016. Robust results across several model specifications support the existence of a long-run equilibrium relationship between real GDP, real tourism receipts, and real exchange rate. Contrary to many previous studies that either explicitly or implicitly assume the stability of the cointegrated vector, the authors apply formal stability tests developed by Hansen and Johansen to investigate the long-run parameter constancy issue. Tests for long-run parameter stability reveal that the hypothesis of stable long-run parameters could not be rejected. The results indicate that tourism is a stable source of economic growth for Puerto Rico and Granger causality tests based on the error-correction model indicate a unidirectional causality from tourism receipts to real GDP.

In vitromodels of the human central nervous system (CNS), particularly those derived from induced pluripotent stem cells (iPSCs), are becoming increasingly recognized as useful complements to animal models for studying neurological diseases and developing therapeutic strategies. However, many current three-dimensional (3D) CNS models suffer from deficits that limit their research utility. In this work, we focused on improving the interactions between the extracellular matrix (ECM) and iPSC-derived neurons to support model development. The most common ECMs used to fabricate 3D CNS models often lack the necessary bioinstructive cues to drive iPSC-derived neurons to a mature and synaptically connected state. These ECMs are also typically difficult to pattern into complex structures due to their mechanical properties. To address these issues, we functionalized gelatin methacrylate (GelMA) with an N-cadherin (Cad) extracellular peptide epitope to create a biomaterial termed GelMA-Cad. After photopolymerization, GelMA-Cad forms soft hydrogels (on the order of 2 kPa) that can maintain patterned architectures. The N-cadherin functionality promotes survival and maturation of single-cell suspensions of iPSC-derived glutamatergic neurons into synaptically connected networks as determined by viral tracing and electrophysiology. Immunostaining reveals a pronounced increase in presynaptic and postsynaptic marker expression in GelMA-Cad relative to Matrigel, as well as extensive colocalization of these markers, thus highlighting the biological activity of the N-cadherin peptide. Overall, given its ability to enhance iPSC-derived neuron maturity and connectivity, GelMA-Cad should be broadly useful for in vitro studies of neural circuitry in health and disease.

There is growing evidence on an interconnection between the venous and lymphatic systems in venous leg ulceration, and the possible effects of prolonged oedema and lymphatic impairment in delayed wound healing. Compression therapy is a widely accepted treatment for venous and lymphatic disorders, as it decreases recurrence rates and prolongs the interval between recurrences. Compression bandages improve venous return, increase the volume and rate of venous flow, reduce oedema and stimulate anti-inflammatory processes. The pressure at the interface (IP) of the bandage and the skin is related to the elastic recoil of the product used and its resistance to expansion. The pressure difference between the IP in the supine and standing positions is called the static stiffness index (SSI). Elastic materials provide little resistance to muscle expansion during physical activity, resulting in small pressure differences between resting and activity, with an SSI <10mmHg. Stiff, inelastic materials with a stretch of <100% resist the increase of muscle volume during physical activity, producing higher peak pressures, an SSI of >10mmHg and a greater haemodynamic benefit than elastic systems. UrgoK2 is a novel dual-layer high-compression system consisting of an inelastic (short stretch) and elastic (long stretch) bandage, resulting in sustained tolerable resting pressure and elevated working pressures over extended wear times. It is indicated for the treatment of active venous leg ulcers and the reduction of chronic venous oedema. Each bandage layer has a visual aid to enable application at the correct pressure level. Published European studies have assessed this compression system, exploring its consistency of application, tolerability and efficacy. This article presents the first reports of health professionals' clinical experience of using the compression system in the US, where it has been recently launched. Initial feedback is promising.

ABSTRACTRespiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection in young children and older adults. Currently, no licensed vaccine is available, and therapeutic options are limited. The primary target of neutralizing antibodies to RSV is the surface fusion (F) glycoprotein. Understanding the recognition of antibodies with high neutralization potencies to RSV F antigen will provide critical insights in developing efficacious RSV antibodies and vaccines. In this study, we isolated and characterized a panel of monoclonal antibodies (mAbs) with high binding affinity to RSV prefusion F trimer and neutralization potency to RSV viruses. The mAbs were mapped to previously defined antigenic sites, and some that mapped to the same antigenic sites showed remarkable diversity in specificity, binding, and neutralization potencies. We found that the isolated site III mAbs shared highly conserved germline V-gene usage, but had different cross-reactivities to human metapneumovirus (hMPV), possibly due to the distinct modes/angles of interaction with RSV and hMPV F proteins. Furthermore, we identified a subset of potent RSV/hMPV cross-neutralizing mAbs that target antigenic site IV and the recently defined antigenic site V, while the majority of the mAbs targeting these two sites only neutralize RSV. Additionally, the isolated mAbs targeting site Ø were mono-specific for RSV and showed a wide range of neutralizing potencies on different RSV subtypes. Our data exemplify the diversity of anti-RSV mAbs and provide new insights into the immune recognition of respiratory viruses in the Pneumoviridaefamily.

Arrhythmias are a leading cause of death in adults with congenital heart disease (ACHD). While 24‐48‐hour monitors are often used to assess arrhythmia burden, extended continuous ambulatory rhythm monitors (ECAM) can record 2 weeks of data. The utility of this device and the arrhythmia burden identified beyond 48‐hour monitoring have not been evaluated in the ACHD population. Additionally, the impact of ECAM has not been studied to determine management recommendations. To address the preliminary question, we hypothesized that clinically significant arrhythmias would be detected on ECAM beyond 48 hours and this would lead to clinical management changes. A single center retrospective cohort study of ACHD patients undergoing ECAM from June 2013 to May 2016 was performed. The number and type of arrhythmias detected within and beyond the first 48 hours of monitoring were compared using Kaplan‐Meier curves and Cox proportional hazard models. Three hundred fourteen patients had monitors performed [median age 31 (IQR 25‐41) years, 61% female). Significant arrhythmias were identified in 156 patients (50%), of which 46% were noted within 48 hours. A management change based on an arrhythmia was made in 49 patients (16%). ECAM detects more clinically significant arrhythmias than standard 48‐hour monitoring in ACHD patients. Management changes, including medication changes, further testing or imaging, and procedures, were made based on results of ECAM. Recommendations and guidelines have been made based on arrhythmias on 48‐hour monitoring; the predictive ability and clinical consequence of arrhythmias found on ECAM are not yet known.

The increasing prevalence of fentanyl and its analogues as contaminating materials in illicit drug products presents a major hazard to first responder and law enforcement communities. Electrochemical techniques have the potential to provide critical information to these personnel via rapid, facile field detection of these materials. Here we demonstrate the use of cyclic square wave voltammetry (CSWV) with screen-printed carbon electrodes (SPCE), modified with the room temperature ionic liquid (RTIL) 1-butyl-1-methylpyrrolidinium bis(trifluoromethylsulfonyl)imide [C4C1pyrr][NTf2], toward such rapid “on-the-spot” fentanyl detection. This CSWV-based disposable sensor strip system provides an information-rich electrochemical fingerprint of fentanyl, composed of an initial oxidation event at +0.556 V (vs Ag/AgCl) and a reversible reduction and oxidation reaction at −0.235 and −0.227 V, respectively. The combined current and potential characteristics of these anodic and cathodic fentanyl peaks, generated using two CSWV cycles, thus lead to a distinct electrochemical signature. This CSWV profile facilitates rapid (1 min) identification of the target opioid at micromolar concentrations in the presence of other cutting agents commonly found in illicit drug formulations. The new protocol thus holds considerable promise for rapid decentralized fentanyl detection at the “point of need”.

Adolescent substance use is common with 11% to 31% of adolescents in 8th through 12th grade reporting illicit substance use.1Of particular concern is the increasing rate of overdose deaths among adolescents.2The likelihood of developing a substance use disorder (SUD) is linearly associated with frequency of use and inversely associated with age, such that young people with early onset of use are the most susceptible for later dependence.3,4This is of concern as early regular substance use is associated with psychosocial consequences that increase burden of illness and decrease functional outcome, including increased likelihood of other illicit drug use, poorer academic outcomes, justice and medical system involvement, psychiatric comorbidity, and unemployment.5This is especially true for the 60% to 88% of adolescents with an SUD who have a comorbid psychiatric illness.6Of concern, rates of comorbidity are highest among adolescents younger than 15 years of age. These youth with dual diagnoses are at even greater risk of dependence and poor health and psychosocial outcomes related to substance use.7While current government initiatives highlight the reduction of adolescent substance use as a priority, data on consistently efficacious interventions that lead to maintained abstinence are lacking. Further, adolescent-focused interventions for SUD are scarce, and very few, if any, target the varied methods and modes of use, which may be linked to different patterns of use, types of users, and outcomes.5As such, approaches to increase intervention dissemination and effectiveness are needed. Only about 7% of youth with substance use receive treatment, and only about 50% of adolescent mental health programs offer substance use–specific treatment.8Further, randomized controlled trials of interventions for adolescent SUD show moderate effect sizes for motivational enhancement therapy, cognitive-behavioral therapy, contingency management, and others,9but few maintain abstinence through follow-up, which is especially true for adolescents with psychiatric comorbidities, who demonstrate the highest rates of relapse.

The US National HIV/AIDS Strategy (NHAS) is a comprehensive plan that outlines specific goals for Ending the HIV Epidemic in the United States (EHE) by 2025. The strategy also provides specific strategies to prevent new HIV infections and improve health outcomes for people with HIV. The EHE is a companion document which focuses on achieving the goals of the NHAS in specific US jurisdictions where the HIV epidemic is concentrated. This article provides an overview of the NHAS and EHE and provides examples of programs and strategies that can be used to end the HIV epidemic in the United States.

Our intent was to access trends in outcomes of care and costs of goods and services supplied to a population of 148 patients with diabetes who received primary care from [...]

District leaders are facing challenging conditions across the country, including increased accountability, reduced budgets and limited community support, while also trying to bring about educational improvements at all levels of [...]

The close connection between transportation and housing affordability has gained widespread recognition in recent years, largely in response to two related concerns. Yet, the ways we typically measure housing affordability have received very little critical attention, particularly as it relates to transportation decision-making. This study addresses this gap by critically reviewing the two most common measures, which I suggest are limited due to their inability to account for the large effects of household income and characteristics, as well as variations in transportation costs (in the case of one approach). In light of these shortcomings, I introduce an alternate measure – the location-sensitive residual income (LSRI) approach – which reflects the realities facing households more fully by incorporating differences associated with household income, composition, childcare requirements, and residential location. An application of the LSRI approach in the Denver metro suggests that measures generated using LSRI and more typical approaches result in very different findings, and therefore, very different implications about the challenges faced by households with limited means. Findings demonstrate that conclusions about the social impacts of transportation infrastructure and service on housing affordability are highly dependent on the measures used. I argue that the LSRI approach offers a substantially more nuanced means of evaluating the impacts and benefits associated with transportation decisions, and in particular, how decisions promote – or perhaps challenge – social justice among vulnerable populations.

This study sought to characterize risk in children with Wolff-Parkinson-White (WPW) syndrome by comparing those who had experienced a life-threatening event (LTE) with a control population.

Although the country is becoming increasingly diverse, our schools remain racially and economically segregated. High poverty schools with large proportions of students of color often have less experienced teachers, more [...]

As the world's population continues to increase so too does the demand for energy. The problem with this is that most countries’ energy comes from carbon based sources, which accounts for more than a third of the world's greenhouse gas emissions. Manufacturing of products is one of the largest contributors to environmental impacts such as CO2emissions. Designers and manufacturers play a significant part in determining a products environmental footprint. New methods are needed to assist designers to shift from the traditional method of design, which is cradle-to-gate to the whole product life cycle of cradle-to-grave. This paper presents a framework to assist designers in determining the energy consumption of product concept(s) at the early conceptual design stage. The presented methodology can help designers to understand the impact a decision has in the design stage on the whole product life cycle.