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This article describes the implementation of an electronic health record system at an academic clinical simulation center of a pre-licensure nursing program and offers insight from the perspective of the sociotechnical systems theory that informs design considerations along the systems development lifecycle continuum. Key Words: Nursing informatics, electronic health record (EHR), implementation, nursing education, clinical simulation., Health information technology (IT) is ever-increasingly embedded into all aspects of healthcare delivery. The electronic health record (EHR) has fundamentally transformed the clinical practice of nurses (Hawkins et al., 2019; [...]

This article from Consumer Reports offers tips and strategies for booking travel effectively. It emphasizes the importance of making informed decisions to get the best experience and value for money. The article provides advice from travel experts and step-by-step guidance for planning a vacation, including tips for finding the best flights, hotels, cruises, and rental cars. It also discusses the option of hiring a travel agent for more complex trips. The article provides specific recommendations for searching and booking flights and hotels, as well as tips for getting perks and upgrades. It advises against bundling air, hotel, and car bookings, and recommends starting the search for cruises at least six months in advance. The article also provides tips for finding car rentals, including using websites like Booking.com and Expedia, and advises checking personal auto insurance and credit card coverage before declining rental car coverage. [Extracted from the article]

This article from Consumer Reports highlights the potential high costs of medical bills, even with Medicare coverage. It offers advice on how to protect oneself from these expenses, such as checking insurance coverage, considering supplemental plans, and exploring Medicare Advantage plans. The article emphasizes the importance of assessing individual situations and making informed decisions about healthcare coverage. It also discusses options for protecting assets from large medical bills, including setting up a Medicaid Asset Protection Trust. The article suggests tapping into life insurance policies, taking out a home equity loan, or seeking financial assistance from nonprofit hospitals. Additionally, it provides tips for negotiating and disputing medical bills to potentially reduce or eliminate costs. [Extracted from the article]

Diet and lifestyle factors have been linked to developing diverticulitis. However, it remains largely unknown whether the associations are mediated by metabolic disturbance, such as hyperinsulinemia and corresponding metabolomic perturbations.

Background One strategy for supporting a hospital or health system's board of directors (Board), with their quality oversight responsibility is to review the organization's performance on quality measures. But for large systems, the number of measures needing review is quite burdensome and makes priority setting difficult. Our goal was to develop a scoring method that summarizes multiple quality measures together, while still maintaining the Board's opportunity to examine individual measures where there are specific concerns.Methods We calculated an overall health system-level composite performance score using six publicly reported healthcare-associated infections reported by the Centers for Medicare and Medicaid Services on their Care Compare website [central-line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSIs) for colon surgery and abdominal hysterectomy, hospital-onset Methicillin-resistant Staphylococcus aureusbacteremia (MRSA), and hospital-onset Clostridioides difficile(C. diff)], where relative weights assigned to each infection type reflect the severity of patient harm. We also calculated a health-system composite performance target. For individual infection types, we calculated system-wide scores and targets and categorized individual hospital performance into three performance categories.Results The health system's composite score between 2015 and 2019 ranged from a high of 1.10 to a low of 0.71. The health system's composite score in 2017–2019 was better than the composite target. Of the 34 measures used to calculate the 2019 composite score, 20 were better than internal standardized infection ratio (SIR) targets, seven were between internal targets and SIR of 1.0, and seven were worse than SIR of 1.0.Discussion The Board communicated they find this composite score reporting approach helpful for streamlining their understanding of HAI performance, as compared to traditional approaches of reporting out individual performance measures. Approaches that streamline Board review of quality and safety performance are important as we hold Board members accountable for overseeing quality, seek greater engagement from the Board, and work to minimize measure review overload.

The purpose of the current study was to investigate the association between self-reported physical activity (minutes/week) and cognitive functioning in a sample of African American older adults living with HIV. A secondary analysis of baseline data collected from clinically stable African American older adults living with HIV (aged >50 years; N = 124) enrolled in the Rush Center of Excellence on Disparities in HIV and Aging study was conducted. Participants completed a battery of 19 cognitive function tests that were used to create summary scores of global cognition and five cognitive domains. Physical activity was measured using a modified self-report questionnaire derived from a national health survey. Average self-reported number of weekly minutes spent in light physical activity was 290.6 minutes and for moderate/vigorous physical activity was 314.67 minutes. Number of weekly minutes of light physical activity was significantly positively associated with visuospatial ability; however, no associations were found between moderate/vigorous physical activity and any cognitive domain. Contrary to expectations, our findings do not support a relationship between moderate/vigorous physical activity and cognitive function in African American older adults living with HIV. [Journal of Gerontological Nursing, 47(12), 27–34.], The population of older adults living with HIV in the United States is rapidly growing. Due to the efficacy of combination antiretroviral therapies (cART), HIV infection has transitioned from a [...]

The number of federal claims filed with the Equal Employment Opportunity Commission (EEOC) in the United States by alleged victims of workplace sexual assault increased following the #MeToo movement along with allegations of retaliation by employers against these victims for making formal claims of sexual discrimination. This study distinctively presents an examination, not of the number of EEOC claims, but instead those claims which became federal court cases over the last three years in which a claims of workplace retaliation were alleged because of sexual assault in the workplace. The study provides an empirical examination of numerous characteristics, related factors, and outcomes of such retaliation cases involving sexual assault in the contemporary #MeToo era. The implications of these diverse results are advanced along with recommendations for employers and employees alike.

Bermudagrass (Cynodon dactylon(L.) Pers.) is one of the primary perennial forages in the southeastern USA. Newer hybrid cultivars have superior production and nutritive value compared to common ecotypes. However, there are many challenges facing bermudagrass production in the region. First, the bermudagrass stem maggot (BSM; Atherigona reversuraVilleneuve) has severely damaged bermudagrass throughout the region. Strategically timed pyrethroid applications significantly reduce adult BSM populations, but efforts are needed to develop integrated pest management plans. Second, an increasing number of producers are noting challenges with green‐up following winter dormancy. This may be attributed to disease, unbalanced soil fertility, and weed pressure. Perhaps one of the most limiting factors for continued production is the deficit of sprigs and trained personnel to sprig hybrid bermudagrasses. This research is critically important as the need for cold‐tolerant bermudagrass is increasing as tall fescue (Lolium arundinaceum(Schreb.) S. J. Darbyshire) is declining due to changes in temperature and precipitation throughout the northern parts of the region. Plant breeders are investigating hybrid bermudagrass at latitudes >35° with respect to freeze or cold tolerance. Despite the many challenges facing hybrid bermudagrass in the southeastern USA, researchers are working to ensure its persistence, productivity, and availability for the future. The bermudagrass stem maggot is one of the most persistent pests in the southeastern USA. The damage is evident by chlorosis of the top two to three leaves of the pseudostem. Fine stem cultivars (left) are more susceptible than coarse stem cultivars (right).

Before 1937, industrial hemp was legal and used for clothing, paper, rope, and fuel. Hemp was grown by our forefathers--even required of early colonists. But in 1937, Congress passed the [...]

This article from Consumer Reports discusses the prevalence of hidden fees in various industries and provides tips on how to avoid them. The article highlights fees in areas such as airlines, restaurants and food delivery, car rentals, banking, hotels, broadband internet and pay television, and payment apps. It emphasizes the impact of these fees on consumers' budgets and the need for greater transparency and regulation. The article also mentions proposed rules and legislation aimed at limiting junk fees and increasing disclosure to consumers. [Extracted from the article]

This study examined the frequency of chronic traumatic encephalopathy-neuropathologic change (CTE-NC) and aging-related tau astrogliopathy (ARTAG) in community-dwelling older adults and tested the hypothesis that these tau pathologies are associated with a history of moderate-to-severe traumatic brain injury (msTBI), defined as a TBI with loss of consciousness >30 minutes. We evaluated CTE-NC, ARTAG, and Alzheimer disease pathologies in 94 participants with msTBI and 94 participants without TBI matched by age, sex, education, and dementia status TBI from the Rush community-based cohorts. Six (3%) of brains showed the pathognomonic lesion of CTE-NC; only 3 of these had a history of msTBI. In contrast, ARTAG was common in older brains (gray matter ARTAG = 77%; white matter ARTAG = 54%; subpial ARTAG = 51%); there were no differences in severity, type, or distribution of ARTAG pathology with respect to history of msTBI. Furthermore, those with msTBI did not have higher levels of PHF-tau tangles density but had higher levels of amyloid-β load (Estimate = 0.339, SE = 0.164, p = 0.040). These findings suggest that CTE-NC is infrequent while ARTAG is common in the community and that both pathologies are unrelated to msTBI. The association of msTBI with amyloid-β, rather than with tauopathies suggests differential mechanisms of neurodegeneration in msTBI.

IMPORTANCE: A healthy lifestyle is associated with better cognitive functioning in older adults, but whether this association is independent of the accumulation of dementia-related pathologies in the brain is uncertain. OBJECTIVE: To determine the role of postmortem brain pathology, including β-amyloid load, phosphorylated tau tangles, cerebrovascular pathology, and other brain pathologies, in the association between lifestyle and cognition proximate to death. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Rush Memory and Aging Project, a longitudinal clinical-pathologic study with autopsy data from 1997 to 2022 and up to 24 years of follow-up. Participants included 754 deceased individuals with data on lifestyle factors, cognitive testing proximate to death, and a complete neuropathologic evaluation at the time of these analyses. Data were analyzed from January 2023 to June 2023. EXPOSURES: A healthy lifestyle score was developed based on self-reported factors, including noncurrent smoking, at least 150 minutes of physical activity per week, limiting alcohol consumption, a Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet score higher than 7.5, and a late-life cognitive activity score higher than 3.2. The lifestyle score ranges from 0 to 5, with higher scores reflecting a healthier lifestyle. MAIN OUTCOMES AND MEASURES: The global cognitive score was derived from a battery of nineteen standardized tests. Brain pathology measures included β-amyloid load, phosphorylated tau tangles, global Alzheimer disease pathology, vascular brain pathologies, Lewy body, hippocampal sclerosis, and TAR DNA-binding protein 43. RESULTS: Of 586 included decedents, 415 (70.8%) were female, 171 (29.2%) were male, and the mean (SD) age at death was 90.9 (6.0) years. Higher lifestyle score was associated with better global cognitive functioning proximate to death. In the multivariable-adjusted model, a 1-point increase in lifestyle score was associated with 0.216 (SE = 0.036, P < .001) units higher in global cognitive scores. Neither the strength nor the significance of the association changed substantially when common dementia-related brain pathologies were included in the multivariable-adjusted models. The β estimate after controlling for the β-amyloid load was 0.191 (SE = 0.035; P < .001). A higher lifestyle score was associated with lower β-amyloid load in the brain (β = −0.120; SE = 0.041; P = .003), and 11.6% of the lifestyle-cognition association was estimated through β-amyloid load. CONCLUSIONS AND RELEVANCE: This study found that in older adults, a healthy lifestyle may provide a cognitive reserve to maintain cognitive abilities independently of common neuropathologies of dementia.

Background. Physical therapy, along with most health professions, struggles to describe clinical reasoning, despite it being a vital skill in effective patient care. This lack of a unified conceptualization of clinical reasoning leads to variable and inconsistent teaching, assessment, and research. Objective. The objective was to conceptualize a broad description of physical therapists' clinical reasoning grounded in the published literature and to unify understanding for future work related to teaching, assessment, and research. Design/Methods. The design included a systematic concept analysis using Rodgers' evolutionary methodology. A concept analysis is a research methodology in which a concept's characteristics and the relation between features of the concept are clarified. Results. Based on findings in the literature, clinical reasoning in physical therapy was conceptualized as integrating cognitive, psychomotor, and affective skills. It is contextual in nature and involves both therapist and client perspectives. It is adaptive, iterative, and collaborative with the intended outcome being a biopsychosocial approach to patient/client management. Limitations. Although a comprehensive approach was intended, it is possible that the search methods or reduction of the literature were incomplete or key sources were mistakenly excluded. Conclusions. A description of clinical reasoning in physical therapy was conceptualized, as it currently exists in representative literature. The intent is for it to contribute to the unification of an understanding of how clinical reasoning has been conceptualized to date by practitioners, academicians, and clinical educators. Substantial work remains to further develop the concept of clinical reasoning for physical therapy, including the role of movement in our reasoning in practice., Physical therapists are expected to be innovative, collaborative, patient-centered practitioners. (1) To engage in this high level of practice, therapists must possess the knowledge, skills, behaviors, and values to address [...]

"A great general has said that the only good Indian is a dead one, and that high sanction of his destruction has been an enormous factor in promoting Indian massacres. [...]

This collaborative, single‐case study explores the ways a social studies teacher candidate conceptualizes and applies disciplinary literacy (DL) teaching in practicum and student teaching experiences. Through qualitative inquiry of data collected at multiple points in the teacher education program, DL teaching was represented across six themes: skills‐based theory of literacy; deep engagement with content; flow verses disruption; responsiveness; placement impact; pandemic influence. Findings affirm research that teacher candidates can be successful at implementing culturally responsive DL instruction, even in post‐pandemic teaching contexts, with structured supervision. Implications for small programs of teacher education, secondary content area teacher preparation, and student teaching supervision are discussed.

Background: Although incidence and mortality of lung cancer have been decreasing, health disparities persist among historically marginalized Black, Hispanic, and Asian populations. A targeted literature review was performed to collate the evidence of health disparities among these historically marginalized patients with lung cancer in the U.S. Methods: Articles eligible for review included 1) indexed in PubMed®, 2) English language, 3) U.S. patients only, 4) real-world evidence studies, and 5) publications between January 1, 2018, and November 8, 2021. Results: Of 94 articles meeting selection criteria, 49 publications were selected, encompassing patient data predominantly between 2004 and 2016. Black patients were shown to develop lung cancer at an earlier age and were more likely to present with advanced-stage disease compared to White patients. Black patients were less likely to be eligible for/receive lung cancer screening, genetic testing for mutations, high-cost and systemic treatments, and surgical intervention compared to White patients. Disparities were also detected in survival, where Hispanic and Asian patients had lower mortality risks compared to White patients. Literature on survival outcomes between Black and White patients was inconclusive. Disparities related to sex, rurality, social support, socioeconomic status, education level, and insurance type were observed. Conclusions: Health disparities within the lung cancer population begin with initial screening and continue through survival outcomes, with reports persisting well into the latter portion of the past decade. These findings should serve as a call to action, raising awareness of persistent and ongoing inequities, particularly for marginalized populations.

Individuals with high‐functioning autism (HFA) have demonstrated they have many significant benefits that they can contribute to an employer. However, given their social and behavioral differences, many individuals find themselves unemployed or underemployed. Presented here is a phenomenological study consisting of 12 self‐identified HFA adults, which analyzes the lived experiences of these individuals specifically during a job interview. Four major themes emerged from this study: Interview Structure, Perceived Competency, Social Camouflaging, and Forced Normality. The findings of this study are clear that the standard interview processes used cause undue stress and anxiety for neurodivergent populations.

High-throughput digital pathology offers considerable advantages over traditional semiquantitative and manual methods of counting pathology. We used brain tissue from 5 clinical-pathologic cohort studies of aging; the Religious Orders Study, the Rush Memory and Aging Project, the Minority Aging Research Study, the African American Clinical Core, and the Latino Core to (1) develop a workflow management system for digital pathology processes, (2) optimize digital algorithms to quantify Alzheimer disease (AD) pathology, and (3) harmonize data statistically. Data from digital algorithms for the quantification of β-amyloid (Aβ, n = 413) whole slide images and tau-tangles (n = 639) were highly correlated with manual pathology data (r = 0.83 to 0.94). Measures were robust and reproducible across different magnifications and repeated scans. Digital measures for Aβ and tau-tangles across multiple brain regions reproduced established patterns of correlations, even when samples were stratified by clinical diagnosis. Finally, we harmonized newly generated digital measures with historical measures across multiple large autopsy-based studies. We describe a multidisciplinary approach to develop a digital pathology pipeline that reproducibly identifies AD neuropathologies, Aβ load, and tau-tangles. Digital pathology is a powerful tool that can overcome critical challenges associated with traditional microscopy methods.

The incorporation of legumes, specifically alfalfa (Medicago sativaL.), into bermudagrass (Cynodonspp.)‐based pasture systems in the southeastern United States has increased in recent years as an alternative to synthetic nitrogen (N) fertilization. A small plot evaluation was conducted in Shorter, Alabama, and Tifton, Georgia, USA, to evaluate the impact of harvest height (HH) and harvest frequency (HF) on agronomic characteristics of alfalfa+bermudagrass mixtures in southeastern United States. Results from both locations revealed that the longer the HF and the shorter the HH, the greater the alfalfa retention was in the stand (p< 0.01). HH did not impact any of the reported nutritive value parameters, while longer HF resulted in lower total digestible nutrients, lower crude protein, higher acid detergent fiber, and lower 48 h in vitro dry matter digestibility (p< 0.01). Both HH and HF impacted forage accumulation at both locations (p< 0.01). HH resulted in different trends at each location, while longer frequencies generally increased forage accumulation. This research confirmed recent findings from comparable evaluations in the southeastern United States, in that increasing HH and decreasing HF improved alfalfa retention while having a negligible effect on nutritive value or forage accumulation. Overview of research plots established in Tifton, GA. Photo credit: Jennifer Tucker.

AbstractSince the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitalsin 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect ∼1 of every 31 hospitalized patients,1leading to substantial morbidity, mortality, and excess healthcare expenditures,1and persistent gaps remain between what is recommended and what is practiced.The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes2in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.3The Compendium: 2022 Updatesdocument provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.

The article discusses the legal developments and trends in the cannabis industry in Texas and across the United States in 2023. Despite the failure of any cannabis-related laws to pass during the Legislative Session, there were significant legal actions in the court system. The article highlights specific topics such as the smokable hemp case, THC isomers and intoxicating cannabinoids, law enforcement intervention, hemp laws and lawsuits in other states, FDA's regulation of CBD, the Texas Compassionate Use Program, decriminalization and penalty reduction bills, and the potential federal rescheduling of marijuana. The article emphasizes the need for library patrons to stay informed about the evolving laws and regulations in Texas and beyond. [Extracted from the article]

THIS COULD MAKE OUR FOOD SAFER "No one involved in farming, food production, or the government wants people to get sick", says Brian Ronholm, director of food policy at CR. We focused on widely consumed foods, then ranked the recalls based on how many people died or became ill, how widespread the outbreaks were, the number of times a food was recalled, and the total amount of food recalled. ->GET HEAVY METALS OUT OF FOOD The FDA has set limits on heavy metals in only a few foods, such as inorganic arsenic in infant rice cereal and lead in candy. THE RISKY RECALLED FOODS LIST, EXPLAINED CR's food safety experts looked at food recalls and foodborne disease outbreaks from 2017 through 2022, analyzing data from the Centers for Disease Control and Prevention, the Food and Drug Administration, and the Department of Agriculture. [Extracted from the article]

AbstractA number of adverse outcomes are associated with emotion dysregulation, and ADHD secondary to emotion dysregulation is a frequent comorbidity that may result in poorer performance and quality of life among youth. Recent neuroimaging research has observed significant functional differences in youth with ADHD compared to healthy controls. Therefore, the aims of this systematic review were to summarize the literature on functional connectivity of emotion dysregulation in youth with ADHD, identify methodological challenges and limitations, and provide directions for future research. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed to conduct a systematic review across three databases, and 13 studies were identified for inclusion. Across the studies, 14 primary regions were examined; 12 of the 13 studies identified a significant association between functional connectivity of emotion dysregulation and youth with ADHD. Although studies varied in the structures investigated, the most notable differences appeared in the prefrontal cortex, orbitofrontal cortex, amygdala, and ventral striatum in ADHD participants. Future research concerning this topic may help contribute to the understanding of this association by utilizing longitudinal research designs, controlling for psychiatric comorbidities and emotion dysregulation severity, inclusion of more diverse samples and ensuring that studies are adequately powered.

AbstractThe aim of the present systematic review was to discuss the reported efficacy of executive functioning training techniques among adolescents. A systematic review of the literature was conducted to retrieve and consolidate findings from articles evaluating executive functioning training techniques among adolescents. A total of 26 articles were located that examined the role of executive functioning training techniques among adolescents (age 10–19 years). Articles retrieved enabled comparison across psychiatric and medical diagnoses including attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), as well as adolescents with physical health concerns. Results revealed that among typically developing adolescents, executive functioning training was non-significant or yielded small effect size improvements in executive functioning as measured by behavioral and neuroimaging tasks among 62.5% of studies reviewed. In contrast, in those with medical conditions, ASD, ADHD, and conduct disorder, all but two studies reviewed yielded a medium to large effect size, supporting the effectiveness of EF training. Future research is needed to identify the long-term efficacy of these treatments, as well as their generalizability to real-world conditions.

IMPORTANCE: Sex differences are established in associations between apolipoprotein E (APOE) ε4 and cognitive impairment in Alzheimer disease (AD). However, it is unclear whether sex-specific cognitive consequences of APOE are consistent across races and extend to the APOE ε2 allele. OBJECTIVE: To investigate whether sex and race modify APOE ε4 and ε2 associations with cognition. DESIGN, SETTING, AND PARTICIPANTS: This genetic association study included longitudinal cognitive data from 4 AD and cognitive aging cohorts. Participants were older than 60 years and self-identified as non-Hispanic White or non-Hispanic Black (hereafter, White and Black). Data were previously collected across multiple US locations from 1994 to 2018. Secondary analyses began December 2021 and ended September 2022. MAIN OUTCOMES AND MEASURES: Harmonized composite scores for memory, executive function, and language were generated using psychometric approaches. Linear regression assessed interactions between APOE ε4 or APOE ε2 and sex on baseline cognitive scores, while linear mixed-effect models assessed interactions on cognitive trajectories. The intersectional effect of race was modeled using an APOE × sex × race interaction term, assessing whether APOE × sex interactions differed by race. Models were adjusted for age at baseline and corrected for multiple comparisons. RESULTS: Of 32 427 participants who met inclusion criteria, there were 19 007 females (59%), 4453 Black individuals (14%), and 27 974 White individuals (86%); the mean (SD) age at baseline was 74 years (7.9). At baseline, 6048 individuals (19%) had AD, 4398 (14%) were APOE ε2 carriers, and 12 538 (38%) were APOE ε4 carriers. Participants missing APOE status were excluded (n = 9266). For APOE ε4, a robust sex interaction was observed on baseline memory (β = −0.071, SE = 0.014; P = 9.6 × 10−7), whereby the APOE ε4 negative effect was stronger in females compared with males and did not significantly differ among races. Contrastingly, despite the large sample size, no APOE ε2 × sex interactions on cognition were observed among all participants. When testing for intersectional effects of sex, APOE ε2, and race, an interaction was revealed on baseline executive function among individuals who were cognitively unimpaired (β = −0.165, SE = 0.066; P = .01), whereby the APOE ε2 protective effect was female-specific among White individuals but male-specific among Black individuals. CONCLUSIONS AND RELEVANCE: In this study, while race did not modify sex differences in APOE ε4, the APOE ε2 protective effect could vary by race and sex. Although female sex enhanced ε4-associated risk, there was no comparable sex difference in ε2, suggesting biological pathways underlying ε4-associated risk are distinct from ε2 and likely intersect with age-related changes in sex biology.

I rule with cunt power,' Inanna announces early in Judy Grahn's latest book. 'I see with cunt eyes.' Inanna is the 'goddess of erotic love,' protector of sex workers and [...]

This document is comprised of weekly newsletters, compiled by month, for family child care providers for the year 2003. Each theme-based four-page newsletter contains: (1) creative activities for use with mixed-age groups of 2- to 5-year-olds; (2) ideas on guiding behavior, organization tips, and Monthly Planning Calendar; (3) special sections for infants and after-school students; and (4) at-home learning activities for caregivers to earn continuing education and Child Development Associate credit. In addition, a reproducible two-page parent handout is included with each month of newsletters sharing with parents book titles, songs, activities, and recipes used in the family child care setting. Theme topics include: parent involvement, observing the Surgeon General's call to action to decrease obesity among children, ending the school year with style, helping children develop thinking skills and background knowledge, and reading aloud to children. (HTH)

This document is comprised of weekly newsletters for 2002, organized by month, for family child care providers. Each theme-based newsletter contains: (1) creative activities for use with mixed-age groups of 2- to 5-year-olds; (2) ideas on guiding behavior, organization tips, and a Monthly Planning Calendar; (3) special sections for infants and after-school students; and (4) at-home learning activities for caregivers to earn continuing education and Child Development Associate credit. In addition, a reproducible two-page parent handout, "Parents and Kids Together," is included with each month of newsletters sharing with parents book titles, songs, activities, and recipes used in the family child care setting. Theme topics include: the holiday spirit year round, surprises, weather, Earth Day, spring, gardening, outdoor art, vacations, and families. (KB)

This document is comprised of weekly newsletters for family child care providers for the year 2000. Each theme-based four-page newsletter contains: (1) creative activities for use with mixed-age groups of 2- to 5-year-olds; (2) ideas on guiding behavior, organization tips, and a Monthly Planning Calendar; (3) special sections for infants and after-school students; and (4) at-home learning activities for caregivers to earn continuing education and Child Development Associate credit. In addition, a reproducible two-page parent handout is included with each month of newsletters sharing with parents book titles, songs, activities, and recipes used in the family child care setting. Theme topics include: trees, Mother Goose, rainbows, rhythm and beat, bubbles, Memorial Day, and learning outdoors. (KB)

PROBLEM You must try - and fail - on other drugs before the insurer will cover your med Called step-therapy, your insurer may ask you to try a lower-cost alternative medication before it covers a pricey, brand-name drug. You could also try to turn in your receipt for prescription purchases to your insurer as an out-of-network cost so that it counts toward your drug or combined medical and drug deductible. These changes will help many people because even though most Americans have health insurance, high drug costs remain a big problem: Three in 10 adults reported not taking medicine as prescribed at some point in the past year because of the cost, according to a Kaiser Family Foundation March 2022 survey. [Extracted from the article]

Abstract and purposeThe intent of this document is to highlight practical recommendations in a concise format designed to assist physicians, nurses, and infection preventionists at acute-care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates the Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute-Care Hospitalspublished in 2014. It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission.

AbstractThis document introduces and explains common implementation concepts and frameworks relevant to healthcare epidemiology and infection prevention and control and can serve as a stand-alone guide or be paired with the “SHEA/IDSA/APIC Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2022 Updates,” which contain technical implementation guidance for specific healthcare-associated infections. This Compendium article focuses on broad behavioral and socio-adaptive concepts and suggests ways that infection prevention and control teams, healthcare epidemiologists, infection preventionists, and specialty groups may utilize them to deliver high-quality care. Implementation concepts, frameworks, and models can help bridge the “knowing-doing” gap, a term used to describe why practices in healthcare may diverge from those recommended according to evidence. It aims to guide the reader to think about implementation and to find resources suited for a specific setting and circumstances by describing strategies for implementation, including determinants and measurement, as well as the conceptual models and frameworks: 4Es, Behavior Change Wheel, CUSP, European and Mixed Methods, Getting to Outcomes, Model for Improvement, RE-AIM, REP, and Theoretical Domains.

Previously published guidelines have provided comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing efforts to prevent methicillin-resistant Staphylococcus aureus(MRSA) transmission and infection. This document updates the “Strategies to Prevent Methicillin-Resistant Staphylococcus aureusTransmission and Infection in Acute Care Hospitals” published in 2014.1This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

ABSTRACTThe presence and influence of university-based sales centers are growing at a substantial rate, with 61 universities having membership in the University Sales Center Alliance (USCA) as of 2021, up from 52 in 2020 and 8 in 2002. While the function and appeal of having an interface exist between sales students, sales faculty, and sales center partners are apparent, the value created by sales centers for these diverse stakeholders remains underexplored. The present research explores the value derived by these stakeholder groups by conducting and analyzing 41 depth interviews of students, university faculty and administration, and members of partnering firms who are currently involved with university-based sales centers. A 3 × 2 matrix of the perceived value derived from sales centers, consisting of other vs. self-oriented, intrinsic vs. extrinsic, and active vs. passive, is presented across these stakeholder groups. The results suggest that value stemming from university-based sales centers often differs between stakeholders, suggesting that sales center administrators should not assume that value derived from sales centers is static or universal across the stakeholder groups.

I. Civil RICO A. Introduction B. Civil RICO C. Colorado 1. The Tenth Circuit Decision 2. The Colorado Jury's Verdict D. Massachusetts E. Oregon F. California II. Breach of Contract [...]

AbstractSevere acute respiratory coronavirus virus 2 (SARS-CoV-2) transmissions among healthcare workers and hospitalized patients are challenging to confirm. Investigation of infected persons often reveals multiple potential risk factors for viral acquisition. We combined exposure investigation with genomic analysis confirming 2 hospital-based clusters. Prolonged close contact with unmasked, unrecognized infectious, individuals was a common risk.

Abstract and purposeThe intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their surgical-site infection (SSI) prevention efforts. This document updates the Strategies to Prevent Surgical Site Infections in Acute Care Hospitalspublished in 2014.1This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

Physical appearances are undertheorized in psychoanalysis. This paper discusses the multifaceted significance of appearances and the use of normative unconscious processes to think about appearances. The paper examines, moreover, how these dynamics intersect and interact with, inter alia, race, class, gender, and sexuality, and implicate politics, personal and otherwise. As psychoanalysis takes a Second Relational Turn, clinicians should consider the effects of appearances and acknowledge their impact, just as they acknowledge and explore the effects of factors such as race, class, sex, and gender; if clinicians do not explore patients’ appearances, they risk not recognizing them fully. The paper further discusses the connection between the psychic and the social in a clinical case, considering how a patient’s appearance informs her internal and external relational patterns, including how her “beauty” contributes to failures of recognition; affects her position within and among social hierarchies; and influences the transference and countertransference matrix of the therapeutic dyad.

In late 2012, the American Academy of Pediatrics (AAP) Section on Ophthalmology and Committee on Practice and Ambulatory Medicine joined the American Academy of Ophthalmology, the American Association for Pediatric [...]