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Background: Intersection of gender and race and/or ethnicity in academic medicine is understudied; we aim to understand these factors in relation to scholarly achievements for neurology faculty. Methods: Faculty from 19 US neurology departments completed a survey (2021–2022) to report rank, leadership positions, publications, funded projects, awards, and speaker invitations. Regression analyses examined effects of gender, race, and their intersectionality on these achievements. Women, Black/Indigenous/People of Color (BIPOC), and BIPOC women were comparator groups. Results: Four hundred sixty-two faculty responded: 55% women, 43% men; 31% BIPOC, 63% White; 21% BIPOC women, 12% BIPOC men, 36% White women, 31% White men. Men and White faculty are more likely to be full professors than women and BIPOC faculty. The number of leadership positions, funded projects, awards, and speaker invitations are significantly greater in White compared to BIPOC faculty. Relative to BIPOC women, the number of leadership positions is significantly higher among BIPOC men, White women, and White men. Publication numbers for BIPOC men are lower, number of funded projects and speaker invitations for White women are higher, and number of awards among White men and White women is higher compared to BIPOC women. Discussion: Our study highlights that inequities in academic rank, award number, funded projects, speakership invitations, and leadership roles disproportionately impacted BIPOC women. More studies are needed to evaluate gender and race and/or ethnicity intersectionality effects on faculty achievements, reasons for inequities, recognition, and potential solutions. [ABSTRACT FROM AUTHOR]

U.S. Veterans and people living with HIV (PWH) experience higher rates of unhealthy alcohol and tobacco/nicotine use than non-Veterans and people without HIV (PWoH). Both groups are susceptible to adverse health outcomes associated with alcohol and tobacco/nicotine use. We explored awareness of alcohol- and tobacco/nicotine-related cancer and immune health risks among Veterans Health Administration (VA) patients with and without HIV. Among a sample of 41 (46% PWH; 73% male; 39% Black) purposively-selected VA patients receiving care 2020–2021 we conducted semi-structured interviews via telephone; interviews were recorded, transcribed and analyzed using a Rapid Assessment Process. Purposive selection was based on HIV status, alcohol and/or tobacco/nicotine use, and demographics. Among participants, 66% reported current smoking, and most screened positive for unhealthy alcohol use. Participants had high awareness of cancer and other health risks related to smoking but low awareness of synergistic risks and cancer risks associated with alcohol use despite awareness of a range of other alcohol-related risks. Awareness of alcohol and/or tobacco/nicotine's impacts on the immune system was variable. Findings did not distinctly differ between PWH and PWoH. Low awareness of alcohol-related cancer risk, risks of co-occurring use, and varying awareness of the impacts of alcohol and tobacco/nicotine on the immune system suggest a need for improved messaging regarding substance use-related cancer and immune risk. This may be especially important among PWH, for whom the prevalence and adverse effects of alcohol and tobacco use, and immune dysfunction are higher. [ABSTRACT FROM AUTHOR]

The dependence of seismic wave speeds on propagation or polarization direction, called seismic anisotropy, is a relatively direct indicator of mantle deformation and flow. Mantle seismic anisotropy is often inferred from measurements of shear-wave splitting. A number of standard techniques to measure shear-wave splitting have been applied globally; for example, *KS splitting is often used to measure upper mantle anisotropy. In order to obtain robust constraints on anisotropic geometry, it is necessary to sample seismic anisotropy from different directions, ideally using different seismic phases with different incidence angles. However, many standard analysis techniques can only be applied for certain epicentral distances and source–receiver geometries. To search for new ways to detect mantle anisotropy, instead of focusing on the sensitivity of individual phases, we investigate the wavefield as a whole: we apply a 'wavefield differencing' approach to (systematically) understand what parts of the seismic wavefield are most affected by splitting due to seismic anisotropy in the mantle. We analyze differences between synthetic global wavefields calculated for isotropic and anisotropic input models, incorporating seismic anisotropy at different depths. Our results confirm that the seismic phases that are commonly used in splitting techniques are indeed strongly influenced by mantle anisotropy. However, we also identify less commonly used phases whose waveforms reflect the effects of anisotropy. For example, PS is strongly affected by splitting due to seismic anisotropy in the upper mantle. We show that PS can be used to fill in gaps in global coverage in shear-wave splitting data sets (for example, beneath ocean basins). We find that PcS is also a promising phase, and present a proof-of-concept example of PcS splitting analysis across the contiguous United States using an array processing approach. Because PcS is recorded at much shorter distances than *KS phases, PcS splitting can therefore fill in gaps in backazimuthal coverage. Our wavefield differencing results further hint at additional potential novel methods to detect and characterize splitting due to mantle seismic anisotropy. [ABSTRACT FROM AUTHOR]

The United States has granted reparations for a variety of historical injustices, from imprisonment of Japanese Americans during the Second World War to the Tuskegee syphilis experiments. Yet the nation has never considered reparations for 150 years of discriminatory immigration and citizenship policies that excluded millions based on race, gender, and political opinion--including some who are alive today. This Article argues that the United States can atone for these transgressions by granting "reparative citizenship" to those individuals and their descendants, following the lead of several European countries who have recently provided such relief for those wrongly expelled or excluded in the past. Reparative citizenship could take many different forms. The executive branch could unilaterally implement a narrow version of reparative citizenship by instructing immigration officials to loosen evidentiary standards and grant discretionary remedies to victims of discriminatory policies. A more expansive version would require amending the Immigration and Nationality Act to re-allocate to historically excluded groups the 50,000 green cards currently given out through a lottery system. Austria, France, Germany, Greece, Poland, Portugal, and Spain have adopted similar approaches in granting citizenship to the descendants of Jewish citizens expelled in the past, as well as to individuals denied citizenship based on gender or political opinion. The United States should do the same. [ABSTRACT FROM AUTHOR]

This research aims to illuminate health disparities between people with depression and those without. A sample of 27,164 people without depression and 3,797 people with self-reported depression were selected from the 2013 BRFSS. The results indicate that people with depression have higher odds of having chronic diseases and smoking but lower odds of eating fruits. Despite a higher insured rate of people with depression, more of them experienced financial barriers to health care due to the cost. People with depression had a higher odds of having health insurance, having a healthcare provider, and experiencing financial barriers to healthcare [ABSTRACT FROM AUTHOR]

Newman, E.D.; Rowland, J.B.; Hammer, T.G.; Frost, L.A.; Lumibao, C.Y., and Henning, J.A. 2024. Trade-offs in arbuscular mycorrhizal fungal responses to drought and salinity stress in Panicum amarum (United States Gulf Coast). Journal of Coastal Research, 40(1), 51–63. Charlotte (North Carolina), ISSN 0749-0208. Arbuscular mycorrhizal fungi (AMF) are soil and plant root-inhabiting fungi that form symbiotic associations with approximately 95% of terrestrial vascular plants and can aid in survival, growth, and stress tolerance of colonized plants. Coastal dune plants face constant environmental stress from high temperatures, sand burial, low moisture and nutrient retention, and frequent saltwater inundation. Instances of both drought and saltwater inundation stress are predicted to increase as sea levels rise and tropical storm frequency, intensity, and duration increases, with more intense periods of drought between storms. To determine whether native AMF from the United States Gulf Coast improve drought or saltwater inundation tolerance of Panicum amarum, a common Gulf Coast dune grass, a manipulative, crossed-factor greenhouse experiment was conducted by growing P. amarum with and without native AMF under drought or across a gradient of saltwater inundation concentrations: 0.25%, 0.50%, 1.00%, and 1.50%. Under 0.25% salinity, P. amarum grown with native AMF had roughly 47% greater survival, although there were no significant differences in biomass of P. amarum between live and sterile sand treatments. Under drought conditions, plants grown with native AMF had 47% lower survival and three times less biomass than those without native AMF communities. Growth differences between sand treatments were diminished under control conditions, and P. amarum grown with and without native AMF had similar survival and biomass. Despite AMF colonization, P. amarum survival was drastically reduced as salinity concentrations surpassed 0.25%. In conclusion, United States Gulf Coast dune AMF improve salinity inundation tolerance of P. amarum at low salt concentrations; however, the results emphasize the context-dependency of plant responses to AMF colonization. [ABSTRACT FROM AUTHOR]

Obesity remains a US national health crisis and a growing concern worldwide. Concerningly, individuals who are obese are at an increased risk for comorbid diseases that include, but are not limited to, hypertension, diabetes, cardiovascular disease, and cancer. Beyond the risk for developing these conditions, obesity may also impact the pharmacological activity of the therapies being used to treat them and other disease states. The pharmacokinetics (PK), pharmacodynamics (PD), safety, and efficacy of therapies, both currently marketed and under clinical development, may be directly impacted by the physiological alterations that occur secondary to the occurrence of chronic excess body weight. The increased prevalence of this disease should not be ignored. Both private and federal institutions involved in drug research and development should consider, as appropriate, a greater inclusion of individuals who are obese in clinical trials throughout the entirety of drug development, and leverage the available PK, PD, safety, and efficacy data to make more informed dosing recommendations. [ABSTRACT FROM AUTHOR]

Copyright of Infant Mental Health Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

It has been hypothesized that menthol in cigarettes increases dependence. Several studies suggest that menthol and non-menthol smokers have similar or lower levels of dependence, but those studies are not without limitations. The Heaviness of Smoking Index (HSI) is a widely accepted, validated measure of cigarette dependence. This report aims to provide further evidence regarding dependence among menthol and non-menthol smokers, as indicated by daily smoking and as measured by the HSI. Survey data from 27,131 adult smokers were analyzed to compare the percent of menthol and non-menthol smokers who are daily smokers, and the percentage who are low or high HSI dependence. Logistic regressions were also conducted to determine if menthol use predicts daily smoking, and low or high dependence after controlling for demographic differences. Comparisons among weighted samples of adult smokers demonstrate that menthol smokers were consistently more likely to be non-daily smokers, more likely to be in the low dependence category, and less likely to be in the high dependence category on the HSI as compared to non-menthol smokers. Logistic regression confirmed that when controlling for age, gender, race/ethnicity, and education, relative to non-menthol smokers, menthol smokers had no difference in odds of being in the low dependence HSI category and significantly lower odds of being a daily smoker, and of being in the high dependence category. These analyses support the conclusion that, based on the HSI, menthol smokers are not more cigarette dependent than non-menthol smokers, and may be less dependent. [ABSTRACT FROM AUTHOR]

Research in the United States and Australia acknowledges the potential of non-government social and community service organizations (SCSOs) for reaching socially disadvantaged smokers. This study aimed to describe SCSO smoking policies and practices, and attitudes of senior staff towards smoking and cessation. It also investigated factors associated with positive tobacco control attitudes. In 2009, a cross-sectional telephone survey was undertaken of senior staff in Australian SCSOs, 149 respondents representing 93 organizations completed the survey (response rate = 65%; 93/142). Most service clients (60%) remained in programs for 6 months plus, and 77% attended at least weekly. Although 93% of respondents indicated they had an organizational smoking policy, it often did not include the provision of smoking cessation support. Most respondents indicated that client smoking status was not recorded on case notes (78%). Attitudes were mostly positive towards tobacco control in SCSOs, with a mean (standard deviation) score of 8.3 (2.9) of a possible 13. The practice of assessing clients' interest in quitting was the only statistically significant factor associated with high tobacco control attitude scores. The results suggest that SCSOs are appropriate settings for reaching socially disadvantaged smokers with cessation support. Although generally receptive to tobacco control, organizations require further support to integrate smoking cessation support into usual care. In particular, education, training and support for staff to enable them to help their clients quit smoking is important. (Contains 1 figure and 4 tables.)

The goal of this study is to understand the extent to which a diverse group of sexual and gender minorities understood the landmark Supreme Court ruling in favor of marriage equality as personally impacting them. Prominent lesbian, gay, bisexual, transgender, and queer (LGBTQ) figures have argued that marriage is an oppressive institution and that legalizing same‐sex marriage would not benefit the most marginalized members of the community, particularly Black people. Until now, there have been few resources for comparing these claims of scholars and activists with those of members of the communities they claim to represent. Guided by Critical Race Theory and intersectionality, this study centered LGBTQ people of color's lived experiences. A purposive sample of 99 LGBTQ people in Chicago, New York City, and San Francisco were asked whether and how the Supreme Court's decision in Obergefell v. Hodges (2015) personally impacted them. Most participants described an emotional impact. Relatively few criticized marriages as "heteronormative" or unfit for LGBTQ people. Black participants were less likely than participants of other races to criticize marriage as an institution. Moreover, Black and Latinx participants articulated a more expansive, equality‐focused understanding of the right to marry than the Court itself articulated. They described the marriage decision as carrying the potential to empower and elevate their identities in various contexts. For these people, the marriage equality movement was centrally about equality rather than marriage. [ABSTRACT FROM AUTHOR]

Just two decades ago, the United States was the epicenter of wealth and philanthropy. U.S. fundraisers seemed justified in sticking close to home, since most of the prospects were in their own backyard. Now more than ever, fundraisers in the United States and other mature philanthropic marketplaces need to look beyond their own national and psychological borders. Why have so many educational institutions found global fundraising so difficult? One practical reason is the lack of prospect research. Absent solid information about where opportunities exist or what they look like, fundraisers lack the tools and confidence to take action. Fortunately, the explosion of global philanthropy and the proliferation of information resources on the Internet have made it possible for organizations to delve into international prospect research. In the world of fundraising, prospect research helps determine the destination and the best possible route for reaching it. It can mean the difference between raising significant revenue and failing to do so, simply by identifying major fundraising opportunities that would have been ignored otherwise. This article discusses how international prospect research can guide educational institutions to out-of-this-world fundraising opportunities.

The purpose of this investigation was to examine comparable dimensions and linkages between child temperament and parenting styles with samples from Beijing, China and the western United States. Participants included 404 mothers and fathers from Beijing, China and 325 mothers and fathers from the western United States. Both mothers and fathers completed Buss and Plomin's (1984) EAS Temperament Scale as well as a spousal-report measure of parenting styles. Structural equation modelling was used to identify invariant (statistically comparable) factors for child temperament and parenting styles. Within-culture gender comparisons showed that Chinese fathers (relative to mothers) viewed their sons as being more active and sociable than daughters while US mothers (relative to fathers) rated their sons as being more active. Across-culture differences revealed that US parents (relative to Chinese parents) viewed children as more emotional while Chinese fathers (relative to US fathers) rated their children as more active. Similar and differential cultural patterns of linkages were also found between parenting styles and child temperament. Child emotionality was positively associated with authoritarian parenting in both cultures while child activity level was linked to more authoritative and less authoritarian parenting styles, but only in the Chinese sample. Finally, child sociability was found to be negatively linked to cross-gender patterns of authoritarian parenting in the US while mothers' and fathers' authoritarian parenting in China was linked to lower sociability in daughters only. (Contains 3 tables.)

Background and Aims: The COVID‐19 pandemic disrupted health‐care provision in the United States and prompted increases in telehealth‐delivery of care. This study measured alcohol use disorder (AUD) treatment trends across visit modalities before and during COVID‐19. Design, Setting, Participants and Measurements: We conducted a national, retrospective cohort study with interrupted time‐series models to estimate the impact of COVID‐19 on AUD treatment in the Veterans Health Administration (VHA) in the United States during pre‐COVID‐19 (March 2019 to February 2020) and COVID‐19 (March 2020 to February 2021) periods. We analyzed monthly trends in telephone, video and in‐person visits for AUD treatment and compared patient and treatment characteristics of patients receiving AUD treatment between the pre‐COVID‐19 and COVID‐19 periods. AUD was defined using International Classification of Diseases, 10th revision (ICD‐10) codes for alcohol abuse (F10.1) and alcohol dependence (F10.2), which have previously been used to study AUD in VHA. Findings: The predicted percentage of VHA patients with an AUD diagnosis receiving any AUD treatment at the beginning of the pre‐COVID period was 13.8% (n = 49 494). The predicted percentage decreased by 4.3% (P = 0.001) immediately at the start of the COVID‐19 period due to a decline in AUD psychotherapy. Despite an increase of 0.3% per month (P = 0.026) following the start of COVID‐19, the predicted percentage of VHA patients with an AUD diagnosis receiving any AUD treatment at the end of the study period remained below the pre‐COVID‐19 period. In February 2021, AUD psychotherapy visits were primarily delivered by video (50%, 58 748), followed by in‐person (36.6%, 43 251) and telephone (13.8%, 16 299), while AUD pharmacotherapy visits were delivered by telephone (38.9%, 3623) followed by in‐person (34.3%, 3193) and video (26.8%, 2498) modalities. Characteristics of VHA patients receiving AUD treatment were largely similar between pre‐COVID‐19 and COVID‐19 periods. Conclusions: Despite increased telehealth use, the percentage of United States Veterans Health Administration patients with an alcohol use disorder (AUD) diagnosis receiving AUD treatment declined during COVID‐19 (March 2020 to February 2021) mainly due to a decrease in psychotherapy. [ABSTRACT FROM AUTHOR]

Smoking prevalence and its association with pulmonary arterial hypertension (PAH) outcomes have not been described in patients in the United States. Using the US-based Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL), the prevalence, demographics, and outcomes in ever- versus never-smokers with PAH were determined. Ever-smoking status was more prevalent in males (61.7%) than in females (42.9%) enrolled in REVEAL. Ever-smokers were older than never-smokers at the time of PAH diagnosis and REVEAL enrollment. The time to first hospitalization, transplant-free survival, and survival did not differ between ever- and never-smokers overall; however, in newly diagnosed males, ever-smoking was associated with earlier death (hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.1–3.0; p = 0.0199), the composite of transplant or death (HR 2.2, 95% CI 1.4–3.6; p = 0.0008), and first hospitalization (HR 1.8, 95% CI 1.2–2.7; p = 0.0063), though smoking exposure (pack-years) did not differ between newly and previously diagnosed males. REVEAL PAH data demonstrate that smoking prevalence in male PAH patients is disproportionate. The prevalence of cigarette smoking was significantly higher in males than females enrolled in REVEAL. Ever-smoking status was associated with increased age at PAH diagnosis and, in newly diagnosed male PAH patients, earlier time to hospitalization and shorter survival after PAH diagnosis. [ABSTRACT FROM AUTHOR]

Background: Chlamydia trachomatis and Neisseria gonorrhea are the most reported sexually transmitted infections in the United States. Testing rates remain suboptimal and may be subject to implicit bias. We evaluated the effectiveness of an opt-out chlamydia and gonorrhea testing program for adolescents and young adults in improving testing rates and promoting equity. Methods: An opt-out testing program that standardized testing to once annually for 14 to 24-year-old patients was implemented across 28 federally qualified health centers spanning 4 specialties. A quasi-experimental design using interrupted time series analyses evaluated testing and infection rates between baseline, intervention, and pandemic-associated test shortage periods. Reduction in testing inequities based on sex, race, ethnicity, insurance, and language preference were also examined. Results: A total of 57 452 encounters during the baseline, 17 320 during the intervention, and 26 993 during the test supply shortage periods were included. Testing increased from 66.8% to 81.0% (14.2% absolute increase) between baseline and intervention periods. Pediatric clinics demonstrated the largest improvement compared to other settings (absolute increase 30.9%). We found significant reductions in testing inequities for language preference (P <.001), and un-insured and public insured individuals (P <.001). More cases of chlamydia and gonorrhea were detected in the intervention period (chlamydia-29.7; gonorrhea-7.4 per 1000 patients) than in the baseline period (chlamydia-20.7; gonorrhea-4.4 per 1000 patients; P <.001). Conclusions: An opt-out approach increased testing, reduced inequities between some groups and detected more infections than a risk-based approach. Opt-out testing should be considered as an approach to increase detection of chlamydia and gonorrhea and promote equity. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic presents a continued public health challenge. Veterinary diagnostic laboratories in the United States use RT-rtPCR for animal testing, and many laboratories are certified for testing human samples; hence, ensuring that laboratories have sensitive and specific SARS-CoV2 testing methods is a critical component of the pandemic response. In 2020, the FDA Veterinary Laboratory Investigation and Response Network (Vet-LIRN) led an interlaboratory comparison (ILC1) to help laboratories evaluate their existing RT-rtPCR methods for detecting SARS-CoV2. All participating laboratories were able to detect the viral RNA spiked in buffer and PrimeStore molecular transport medium (MTM). With ILC2, Vet-LIRN extended ILC1 by evaluating analytical sensitivity and specificity of the methods used by participating laboratories to detect 3 SARS-CoV2 variants (B.1; B.1.1.7 [Alpha]; B.1.351 [Beta]) at various copy levels. We analyzed 57 sets of results from 45 laboratories qualitatively and quantitatively according to the principles of ISO 16140-2:2016. More than 95% of analysts detected the SARS-CoV2 RNA in MTM at ≥500 copies for all 3 variants. In addition, for nucleocapsid markers N1 and N2, 81% and 92% of the analysts detected ≤20 copies in the assays, respectively. The analytical specificity of the evaluated methods was >99%. Participating laboratories were able to assess their current method performance, identify possible limitations, and recognize method strengths as part of a continuous learning environment to support the critical need for the reliable diagnosis of COVID-19 in potentially infected animals and humans. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This systematic review and meta‐analysis reports the seroprevalence of SARS‐CoV‐2 antibodies among nurses. Background: With a growing body of literature reporting the positive serology for SARS‐CoV‐2 antibodies among healthcare workers, it remains unclear whether staff at the point of direct patient care are more prone to developing and transmitting the virus. Given nurses make up the majority of the global health workforce, outbreaks among these workers could severely undermine a health system's capability to manage the pandemic. We aimed to summarise and report the seroprevalence of SARS‐CoV‐2 antibodies among nurses globally. Design: Systematic review and meta‐analyses. Methods: This systematic review was developed, undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. We searched the electronic medical literature databases: MEDLINE; CINAHL; and EMBASE for studies reporting the seroprevalence of SARS‐CoV‐2 antibodies among nursing staff. Studies that reported nursing specific data were included in this review. Study quality was evaluated using the Joanna Briggs Institute checklist for studies reporting prevalence data. Studies were stratified according to the World Health Organisation region classifications, and results were presented using forest plots and summary prevalence and variance was estimated using a random effects model. Results: Our electronic search identified 1687 potential studies, of which 1148 were screened for eligibility after duplicates were removed, and 51 of the studies were included in our meta‐analysis. The overall seroprevalence of SARS‐CoV‐2 antibodies among nurses was estimated to be 8.1% (95% CI 6.9%–9.4%) among the 60,571 participants included in the studies. Seropositivity was highest in the African region (48.2%, 95% CI 39.2%–57.3%), followed by the European region (10.3%, 95% CI 8.0%–12.5%), the Region of the Americas (8.4%, 95% CI 6.0%–10.7%), the South‐East Asia region (3.0%, 95% CI 0.00%–6.5%) and the Western Pacific region (0.5%, 95% CI 0.0%–1.0%). Pooled estimates were unable to be calculated in the Eastern Mediterranean region due to insufficient studies. Conclusion: The seroprevalence of SARS‐CoV‐2 antibodies among nurses is comparable to other healthcare workers, and possibly similar to the general population. Early adoption and adherence to personal protective equipment and social distancing measures could explain these similarities, meaning the majority of staff contracted the virus through community transmission and not in a healthcare setting. Relevance to clinical practice: Fear and uncertainty have been features of this pandemic, including among nurses. This meta‐analysis should provide some comfort to nurses that risks are similar to community exposure when adequate PPE is available and there is an adherence to infection control measures. [ABSTRACT FROM AUTHOR]

Closeness is often considered synonymous with better quality romantic relationships. However, individual differences exist in the degree of closeness people desire in their relationships. This study examined the implications that discrepancies between actual and ideal closeness have for relationship quality in romantic couples. A questionnaire was administered to a sample of 103 cohabiting couples (N = 206) in the United States, who were randomly selected from a nationally representative survey panel. Dyadic analysis using actor–partner interdependence models with latent outcomes revealed that internal discrepancies between actual and idealized closeness were associated with poorer relationship quality for both individuals and their partners. These associations persisted above and beyond the effects of actual closeness and dyad-level differences in actual and ideal closeness. The association between closeness and relationship quality may be more individual than dyadic in nature, warranting renewed attention to the idiographic experience of closeness and its association with relational well-being. [ABSTRACT FROM AUTHOR]

Background: Cesarean birth, especially repeat cesarean, is associated with significantly higher morbidity than vaginal birth. Appropriately counseling women who are candidates for labor after cesarean (LAC) has the potential to confer significant health benefits for women. Little guidance exists about optimal counseling techniques, especially for Latina women. The aim of this study was to evaluate satisfaction among Latinas about how LAC counseling is performed, specifically as it relates to shared decision making. Methods: We conducted a qualitative study of pregnant women at several clinics in a Federally Qualified Health Center system in Utah. We interviewed eleven Latina women about satisfaction with recent LAC counseling with a specific aim of obtaining rich, personal narratives rather than reaching data saturation. A codebook representing the most common themes was developed. Results: Three major themes emerged related to LAC counseling including influences on satisfaction, influences on the birth decision process, and preferences surrounding method and timing of counseling. Women experienced greater satisfaction from providers who used jargon‐free communication, were perceived as trustworthy, cared about her experiences, and empowered her to make an informed decision. Women's decisions were influenced by prior birth experiences, desire for a safe delivery and easy recovery, and future family planning. Conclusions: Understanding the aspects of LAC counseling that are most meaningful for Latina women can promote effective communication between patient and provider and improve patient satisfaction. Globally, our findings highlight the importance of evaluating the experiences and preferences of minority groups; majority populations cannot be assumed to speak for minority populations. [ABSTRACT FROM AUTHOR]

Background: The relationship between post‐traumatic stress disorder (PTSD) and suicidal thoughts and behaviors (STB) has been extensively studied but explanatory mechanisms remain inconclusive. Entrapment is one variable that evinces a mechanistic relationship with PTSD and STB. The current study examined the indirect effect of PTSD screen on suicide ideation (SI), planning, and likelihood of future suicide attempt through internal (IE) and external entrapment (EE), moderated by levels of fearlessness about death (FAD). Method: The cross‐sectional sample consisted of military service members and civilians recruited from primary care clinics across the United States (N = 2690). Results: Moderated mediation models indicated an indirect relationship between a positive PTSD screen, past‐month SI, and past‐month suicide planning through IE but not EE at low, moderate, and high levels of FAD. These relationships were replicated for the association between positive PTSD screen and concurrent self‐rated likelihood of a future suicide attempt through both IE and EE at moderate and high levels of FAD. Conclusions: Phenomenological implications are discussed, including IE as a mechanism of action in the PTSD/SI pathway and FAD as necessary to potentiate suicidal planning for those experiencing IE. [ABSTRACT FROM AUTHOR]

Rural residents in the United States are less likely to have dental insurance and more likely to face environmental and geographic barriers to oral health and dental care. This article discusses oral health inequity, evidence of oral health's influence on overall health, and why the primary care workforce is well positioned to provide prevention, screening, and referrals for oral health and dental care. Six strategies by which oral health and dental care are integrated into primary care delivery streams can help mitigate rural health inequity. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Preventing HIV transmission is a crucial step in ending the HIV epidemic. Safe and effective pre-exposure prophylaxis (PrEP) has been available in the United States since 2012. We set out to determine if persons at greatest risk for HIV acquisition were receiving HIV PrEP. HIV-negative individuals from the Observational Pharmaco-Epidemiology Research & Analysis (OPERA) cohort who were prescribed daily PrEP were contrasted with newly diagnosed HIV persons without PrEP use between July 16, 2012 and October 31, 2020 to determine if the PrEP prescriptions reached the populations who were seroconverting. Poisson regression was used to estimate incidence rates of seroconversion to HIV among PrEP initiators, as well as new diagnoses of sexually transmitted infections among both the PrEP group and the newly HIV+ group. Out of the 14,598 PrEP users and 3558 persons newly diagnosed with HIV in OPERA, demographics varied widely. Older individuals, those of non-Black race, men, nonintravenous (IV) drug users, and those with commercial insurance were proportionally overrepresented among those prescribed PrEP compared to persons newly diagnosed with HIV during the same time period. Over 82% of new HIV+ individuals received care in the southern United States compared to only 45% of PrEP users. Seroconversion to HIV among PrEP users was generally uncommon, although more frequent among those who identified as Black individuals, especially in the 13–25 years old age range. In conclusion, providers need innovative programs to better identify, educate, and link those at greatest risk of HIV acquisition, especially young people, women, Black individuals, and IV drug users, to PrEP. [ABSTRACT FROM AUTHOR]

Background: Sexual minority populations in the United States have persistently higher rates of cigarette use than heterosexuals, partially driven by exposure to minority stressors (e.g., discrimination and victimization). Little is known about cigarette use across cohorts of sexual minority adults who came of age in distinctly different sociopolitical environments.Purpose: To examine cigarette use and minority stressors across three age cohorts of U.S. sexual minority adults.Methods: We used data from the Generations Study, a nationally representative sample (N = 1,500) of White, Black, and Latino/a sexual minority adults in three age cohorts (younger: 18-25 years; middle: 34-41 years; and older: 52-59 years). Survey data were collected from March 2016 to March 2017. We used sex-stratified logistic regression models to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between age cohort, minority stressors (discrimination and victimization), and two indicators of cigarette smoking (lifetime use and current use).Results: Prevalence of current cigarette use in each age cohort was high (younger: 20%; middle: 33%; and older: 29%). Relative to the younger cohort, men and women in the middle- and older-age cohorts had significantly higher odds of lifetime and current smoking (e.g., men, current, aOR [95% CI]: middle = 2.47 [1.34, 4.52], older = 2.85 [1.66, 4.93]). Minority stressors were independently associated with higher odds of current smoking; when victimization was included, the magnitude of the association between age cohort and current smoking was diminished but remained significant.Conclusions: Smoking cessation interventions must consider the role of minority stress and the unique needs of sexual minority people across the life course. [ABSTRACT FROM AUTHOR]

Objective: To examine patient and caregiver opinions and "receptivity" regarding generic drug educational material in terms of content, format and design, delivery channel, and level of satisfaction.Methods: Interviewer-administered surveys were conducted with patients and caregivers who were clients of a regional medication management program or pharmacy services clinic to gather perceptions about generic drugs and input on a generic drug educational handout developed by the U.S. Food and Drug Administration (FDA). Survey questions were developed by the investigators and pretested before use. Data were analyzed using descriptive statistics, and responses to open-ended questions were assessed using qualitative content analysis. Survey psychometrics were examined using exploratory factor analysis (EFA).Results: Of the 100 survey participants, most (93%) had positive perceptions about generic drug safety and effectiveness after reading the handout. Most participants were satisfied or very satisfied with the handout's content (87%) as well as format and design (92%). However, more than 20% of participants were still unsure about the benefits and risks of generic drugs compared with those of brand drugs, and more than 15% were still unsure about which benefits and risks mattered most to them. The participants' preferred source for the handout was a pharmacy (49%) or doctor's office (27%). In an EFA of the survey instrument, 2 factors emerged related to the educational handout's content: (1) generic drug information, a 7-item factor (Cronbach alpha = 0.882); and (2) personal relevance, a 3-item factor (Cronbach alpha = 0.692).Conclusion: The findings indicate an overall positive "receptiveness" toward generic drug informational materials from patients and caregivers, which highlights the feasibility and importance of educational outreach programs about generic drugs targeted toward this population. Future studies may focus on more diverse populations and tailor materials to the needs of specific patient and caregiver subgroups and health literacy levels. [ABSTRACT FROM AUTHOR]

During the past 50 years, there have been marked improvement in the social and legal environment of sexual minorities in the United States. Minority stress theory predicts that health of sexual minorities is predicated on the social environment. As the social environment improves, exposure to stress would decline and health outcomes would improve. We assessed how stress, identity, connectedness with the LGBT community, and psychological distress and suicide behavior varied across three distinct cohorts of sexual minority people in the United States. Using a national probability sample recruited in 2016 and 2017, we assessed three a priori defined cohorts of sexual minorities we labeled the pride (born 1956–1963), visibility (born 1974–1981), and equality (born 1990–1997) cohorts. We found significant and impressive cohort differences in coming out milestones, with members of the younger cohort coming out much earlier than members of the two older cohorts. But we found no signs that the improved social environment attenuated their exposure to minority stressors—both distal stressors, such as violence and discrimination, and proximal stressors, such as internalized homophobia and expectations of rejection. Psychological distress and suicide behavior also were not improved, and indeed were worse for the younger than the older cohorts. These findings suggest that changes in the social environment had limited impact on stress processes and mental health for sexual minority people. They speak to the endurance of cultural ideologies such as homophobia and heterosexism and accompanying rejection of and violence toward sexual minorities. [ABSTRACT FROM AUTHOR]

Objectives: Childcare is an important setting for nutrition; nearly half of young children in the United States participate in licensed childcare, where they consume up to two-thirds of their daily dietary intake. We compared state regulations for childcare with best practices to support breastfeeding and healthy beverage provision. Methods: We reviewed regulations for childcare centers (centers) and family childcare homes (homes) in effect May–July 2016 and rated all 50 states for inclusion (1 = not included, 2 = partially included, 3 = fully included) of 12 breastfeeding and beverage best practices. We calculated average ratings for 6 practices specific to infants aged 0-11 months, 6 practices specific to children aged 1-6 years, and all 12 practices, by state and across all states. We assessed significant differences between centers and homes for each best practice by using McNemar–Bowker tests for symmetry, and we assessed differences across states by using paired student t tests. Results: States included best practices in regulations for centers more often than for homes. Average ratings (standard deviations) in regulations across all states were significantly higher in centers than in homes for infant best practices (2.1 [0.5] vs 1.8 [0.5], P <.001), child best practices (2.1 [0.6] vs 1.8 [0.6], P =.002), and all 12 best practices combined (2.1 [0.5] vs 1.8 [0.6], P <.001). Conclusions: Although best practices were more consistently included in regulations for centers than for homes, many state childcare regulations did not include best practices to support breastfeeding and the provision of healthy beverages. Findings can be used to inform efforts to improve regulations and to reduce differences between centers and homes. [ABSTRACT FROM AUTHOR]

Background: The treatment, genotyping, and phenotyping of patients with World Health Organization Group 1 pulmonary arterial hypertension (PAH) have evolved dramatically in the last decade.Research Question: The United States Pulmonary Hypertension Scientific Registry was established as the first US PAH patient registry to investigate genetic information, reproductive histories, and environmental exposure data in a contemporary patient population.Study Design and Methods: Investigators at 15 US centers enrolled consecutively screened adults diagnosed with Group 1 PAH who had enrolled in the National Biological Sample and Data Repository for PAH (PAH Biobank) within 5 years of a cardiac catheterization demonstrating qualifying hemodynamic criteria. Exposure and reproductive histories were collected by using a structured interview and questionnaire. The biobank provided genetic data.Results: Between 2015 and 2018, a total of 499 of 979 eligible patients with clinical diagnoses of idiopathic PAH (IPAH) or familial PAH (n = 240 [48%]), associated PAH (APAH; n = 256 [51%]), or pulmonary venoocclusive disease/pulmonary capillary hemangiomatosis (n = 3 [1%]) enrolled. The mean age was 55.8 years, average BMI was 29.2 kg/m2, and 79% were women. Mean duration between symptom onset and diagnostic catheterization was 1.9 years. Sixty-six percent of patients were treated with more than one PAH medication at enrollment. Past use of prescription weight loss drugs (16%), recreational drugs (27%), and oral contraceptive pills (77%) was common. Women often reported miscarriage (37%), although PAH was rarely diagnosed within 6 months of pregnancy (1.9%). Results of genetic testing identified pathogenic or suspected pathogenic variants in 13% of patients, reclassifying 18% of IPAH patients and 5% of APAH patients to heritable PAH.Interpretation: Patients with Group 1 PAH remain predominately middle-aged women diagnosed with IPAH or APAH. Delays in diagnosis of PAH persist. Treatment with combinations of PAH-targeted medications is more common than in the past. Women often report pregnancy complications, as well as exposure to anorexigens, oral contraceptives, and/or recreational drugs. Results of genetic tests frequently identify unsuspected heritable PAH. [ABSTRACT FROM AUTHOR]

This study explored familiarity with, attitudes toward, uptake and discontinuation of PrEP (Pre-exposure prophylaxis) among a national probability sample of gay and bisexual men. PrEP is one of the most effective biomedical HIV prevention strategies; however, use among gay and bisexual men remains low within the United States. This study used a national probability sample of gay and bisexual men from three age cohorts of men (18–25, 34–41, and 52–59 years at wave 1) who completed three annual surveys between March 2016 and March 2018 (N at wave 1 = 624). Recruitment occurred through a Gallup dual-frame sampling procedure; results for this study came from eligible individuals who consented to be part of the self-administered online or mailed survey questionnaire. We used descriptive data with sampling weights to understand trends in PrEP familiarity, PrEP attitudes and PrEP use across all three time points. Next, PrEP uptake and discontinuation were assessed among men completing all three surveys and who remained eligible for PrEP at all three time points (N = 181). PrEP familiarity increased considerably between 2016 and 2018 among those eligible for PrEP (from 59.8% from wave 1 to 92.0% at wave 3). Favorable attitudes toward PrEP increased more modestly (from 68.3% at wave 1 to 72.7% at wave 3). While PrEP use increased by 90% between the two time points (from 4.1% in 2016 to 7.8% in 2018), this represented a small percentage of overall uptake among eligible participants across time (6.6%). Among respondents who reported PrEP use at wave 1 or wave 2, 33.3% subsequently discontinued PrEP use at a later wave. Findings indicate modest increases in PrEP use between 2016 and 2018 in a national probability sample of sexually-active gay and bisexual men. PrEP discontinuation was high and suggests the need for further research into gay and bisexual men's PrEP discontinuation and persistence. [ABSTRACT FROM AUTHOR]

Long ago Texas lawmakers introduced a quirky feature into the state's court structure, one that would change both its design and its output. The seemingly innovative move laid the groundwork for a system that undercuts stare decisis, diminishing treasured rule-of-law benefits. The quirky feature, unique to Texas, creates disparate outcomes for litigants in like circumstances. It weakens the adjudicative process. And, it brings uncertainty to the law. For decades, Texans and the courts that serve them have experienced firsthand these and other unintended (and unwelcome) consequences of the flawed design. In this Article, a court insider who has studied the troubling effects on the delivery of justice unpacks the problem, examines the options, and makes the case for a simple solution. [ABSTRACT FROM AUTHOR]

This mixed methods study examined the relationship between the college social experience and subjective well-being in autistic students in the Midwestern United States. An online survey focused on social connectedness, social participation, social support, and subjective well-being. A semi-structured interview discussed transition, supports received, and social participation. Correlations and a hierarchical regression were used to examine the relationship between social experience variables and subjective well-being from the survey. Inductive thematic analysis was used to identify interview themes. Theme counts for students who reported higher and lower subjective well-being were examined. Social connectedness, time spent with friends, and perceived social support were positively correlated with students' subjective well-being, with social connectedness explaining unique variance. Common themes included challenges navigating a new social environment and the importance of family, friends, and professors in providing social support. Students with lower subjective well-being more frequently discussed struggles to make social connections and the trade-off between socializing and succeeding academically, whereas students with higher subjective well-being more frequently described college as providing opportunities to develop meaningful social connections. This study adds new perspectives on the college experience for autistic students and highlights the important role that social connections and support play in their subjective well-being. An increasing number of autistic students are enrolling in college and university. These students are at high risk for negative social experiences, including stigma, social isolation, and low levels of support from friends or family. These negative experiences may adversely affect these students' levels of self-reported well-being (i.e. "subjective well-being"). In addition, few studies have looked at the positive social experiences of autistic college students. This study examined the relationship between autistic college students' social experiences and their subjective well-being. We recruited autistic college students to participate in an online survey and optional follow-up interview. Data from surveys and interviews showed that students who were socially connected, who spent time with friends, and who had the support of family, friends, and school staff had higher levels of subjective well-being. Students often had difficulty with the transition to college, but family, friends, and professors were key in providing social support. Autistic students who had lower subjective well-being discussed their struggle to make friends and balance school work with their social lives. However, students with higher subjective well-being reported that attending college allowed them to connect with others. In summary, social connections and supports are closely linked to the subjective well-being of autistic college students. Teaching these students how to self-advocate, how to meet friends, and how to balance school work with a social life may be helpful to their social experiences and their levels of subjective well-being. [ABSTRACT FROM AUTHOR]

Objective: Underutilization of palliative care (PC) among racial/ethnic minorities remains consistent despite projected demand. The purpose of this study was to examine knowledge of palliative care and advanced care planning (ACP) and potential variations among subgroups of Asian Americans.Design: A survey was conducted to collect information about awareness, knowledge, and perspective of PC and ACP in the southwestern region of the United States, from October 2018 to February 2019. A total of 212 surveys were collected from the general public at such places as health fairs, New Year celebration events, church, and community centers; 154 surveys were included in the descriptive and multivariate data analysis.Results: About 46.1% and 40.3% participants reported having heard of palliative care and advanced care planning, respectively. The average score of the Knowledge of Care Options Instrument (KOCO) was 6.03 out of 11 and the average score of the Palliative Care Knowledge Scale (PaCKS) was 4.38 out of 13. Among those who have heard of PC, both Chinese (odds ratio (OR) .19 [CI, .05, .73]) and Vietnamese (.22 [.06, .84]) were less likely to have heard of palliative care compared with Filipinos (1.00). Among those who have ever heard of advanced care planning, age (.60 [.43, .84]) was negatively and education level (1.91 [1.18, 3.08]) was positively associated with awareness about advanced care planning. The majority of survey participants preferred family members to serve as their power attorneys.Conclusion: The low levels of palliative care and advanced care planning awareness and knowledge in the diverse Asian groups living in the United States raise concerns and shed light on the critical need for culturally appropriate education programs. [ABSTRACT FROM AUTHOR]

This article reports the results of baseline cardiopulmonary resuscitation (CPR) skills performance measurements from 467 nursing students. All participants had completed a CPR course. Baseline measurements were compared to performance after one 10-minute refresher training session on the Resuscitation Quality Improvement system. Significant improvements were made after the computer- and practice-based refresher. Findings suggest that staff developers should evaluate the use of audio and visual feedback devices to improve the quality of CPR provided by clinical staff. [ABSTRACT FROM AUTHOR]

Objective: In July 2018 the Academy of Nutrition and Dietetics released a benchmark encouraging early care and education (ECE) programs, including child care centers and family child care homes, to incorporate cultural and religious food preferences of children into meals. We examined the extent to which states were already doing so through their ECE licensing and administrative regulations prior to the release of the benchmark. This review may serve as a baseline to assess future updates, if more states incorporate the benchmark into their regulations. Methods: For this cross-sectional study, we reviewed ECE regulations for all 50 states and the District of Columbia (hereafter states) through June 2018. We assessed consistency with the benchmark for centers and homes. We conducted Spearman correlations to estimate associations between the year the regulations were updated and consistency with the benchmark. Results: Among centers, eight states fully met the benchmark, 11 partially met the benchmark, and 32 did not meet the benchmark. Similarly for homes, four states fully met the benchmark, 13 partially met the benchmark, and 34 did not meet the benchmark. Meeting the benchmark was not correlated with the year of last update for centers (P = 0.54) or homes (P = 0.31). Conclusions: Most states lacked regulations consistent with the benchmark. Health professionals can help encourage ECE programs to consider cultural and religious food preferences of children in meal planning. And, if feasible, states may consider additional regulations supporting cultural and religious preferences of children in future updates to regulations. [ABSTRACT FROM AUTHOR]

The authors discuss the expansion of pharmacists' prescribing authority in Oregon through a precautionary methodology. Topics mentioned include the two primary categories of pharmacist prescriptive authority in the U.S., the statute on pharmacist-administered immunization revised by U.S. Senate Bill (SB) 520, and prescription of self-administered hormonal contraceptives.

Objective: Lupus disease measures such as the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the British Isles Lupus Assessment Group (BILAG) index are challenging to interpret. The Lupus Foundation of America-Rapid Evaluation of Activity in Lupus (LFA-REAL) is intended to provide an efficient application of anchored visual analog scores, each representing the individual severity of active symptoms, with the sum of individual scores deriving an overall disease activity assessment. Our objective was to compare the performance of LFA-REAL to systemic lupus erythematosus disease activity assessments and compare scores between trained lupus clinical investigators and clinicians.Methods: Investigators scored the SLEDAI, BILAG, physician's global assessment (PGA), and LFA-REAL, while the clinicians scored the LFA-REAL. The level of agreement between physicians and instruments was determined.Results: The study included 99 patients (93% women, 31% white, mean ± SD ages 43.4 ± 13.2 years). At the first visit, the mean ± SD SLEDAI score was 5.5 ± 4.5, BILAG score 6.7 ± 7.8, and PGA score 33.6 ± 24.5. The mean ± SD investigator LFA-REAL score was 46.2 ± 42.9, and clinician LFA-REAL score 56.1 ± 53.6. At the second visit, the mean ± SD investigator LFA-REAL score was 41.3 ± 36.7, and clinician LFA-REAL score 48.3 ± 42.6. Total LFA-REAL scores correlated positively with PGA, SLEDAI, and BILAG (ρ = 0.58-0.88, P < 0.001). LFA-REAL scores produced correlation coefficients of ρ > 0.7 for musculoskeletal, mucocutaneous, and renal BILAG domains. The intraclass correlation coefficient between the LFA-REAL scores of investigators and clinicians was 0.79 for visit 1 (P < 0.001) and 0.86 for visit 2 (P < 0.001).Conclusion: The LFA-REAL provides a reliable surrogate for more complicated disease activity measures when used by lupus clinical investigators or clinicians. [ABSTRACT FROM AUTHOR]

This comparative study examines survey data from 464 call centers in the United States, 167 in the United Kingdom, and 387 in Canada to explore two questions: whether institutional differences shape employers' choices of ways to improve work force flexibility, both numerical and functional; and whether strategies for numerical flexibility and functional flexibility are related. The results suggest that institutional differences across these liberal market economies--specifically, in dismissal regulations and union strength--did affect how employers chose to achieve work force flexibility. For example, the use of part-time workers was more common in countries with more stringent rules regulating dismissals. Organizational characteristics also mattered, with outsourced firms being more likely than in-house firms to use part-time workers. Evidence also suggests that managers used numerical flexibility and functional flexibility strategies as substitutes: higher employee job discretion was associated with both lower dismissal rates and a lower likelihood of temporary use. [ABSTRACT FROM AUTHOR]

This study assesses the validity of widespread criticisms of the large, "nationally recognized" credit rating agencies (CRAs). The accounting scandals of 2000-02, in particular the highly publicized failure of Enron in December 2001, led many to question their competence and the value of their ratings. This paper evaluates important criticisms of the CRAs discussed in a recent Securities and Exchange Commission (SEC) staff report by using evidence from empirical research studies, and suggests many promising subjects for future research. The analysis given in this paper, and the results to the suggested research (when available), should be of particular interest to lawmakers and regulators who are responsible for determining whether and to what extent the credit rating industry should be subject to statutory and regulatory oversight. Although little rigorously gathered empirical evidence supports the criticisms, many issues remain unresolved. Powerful tests related to potential conflicts of interest and alleged unfair practices are exceptionally difficult to design, and the alleged deficiencies of rating agencies' disclosure practices have yet to be analyzed. Finally, many criticisms are based on subjective benchmarks that are difficult to quantify and open to question. To date, however, accounting researchers have played only a minor role in the debate. Because they are well-versed in such areas as disclosure analysis, capital market tests, and the operation of financial intermediaries and external auditors, these researchers potentially have much to add in this regard. [ABSTRACT FROM AUTHOR]

Labor-management cooperation has been regarded for many years as a panacea for organizations' competitive woes. The academic and popular presses have lauded the joint efforts of companies and their unionized workforces to come together to solve companies' competitive problems while saving employees' jobs. Moreover, research on and examples of labor-management cooperation have found that through joint efforts, unions and firms can improve organizational performance and employee outcomes. Increasingly, however, it appears that cooperation is often but a short-lived phenomenon. This article examines a major initiative of labor-management cooperation that was undertaken to facilitate the fundamental restructuring of the health care delivery system in Minneapolis/St. Paul, Minnesota. For 10 years, management of more than a dozen hospitals and representatives of the Minnesota Nurses' Association came together to negotiate and manage the process of system integration, rationalization, and delivery improvement. The results were remarkable. Yet, just a few years later, despite the success, only remnants of labor-management cooperation remain in these hospitals. This article examines the reasons for cooperation's demise and provides lessons for those engaged in cooperative undertakings that may help extend the life of those initiatives. [ABSTRACT FROM AUTHOR]

A 2‐year long, multisite research study that evaluated cardiopulmonary resuscitation skill decay among nursing students was conducted at 10 schools of nursing across the United States. The study was conducted in two phases and required carefully timed sessions for skill performance. Multisite studies in nursing education need to be carefully planned. Time delays should be anticipated with processes and Institutional Review Board protocols across sites. All team members were trained and consistently supported during the entire study. While challenges and obstacles were identified, innovative solutions were implemented that assisted the research team to successfully complete the study. The use of new and existing technology allowed the team to surmount many of the challenges encountered in this study. The purpose of this article is to describe the logistics, processes, challenges, and lessons learned related to conducting a complex multisite study. Take‐away Key Points: 1.A shared mental model at the outset of the execution of the study promoted smooth day‐to‐day operations.2.Utilizing applicable technology to enhance communication was valuable to successful execution of the objectives of the study.3.Anticipate for staff turnover and participant retention issues.4.Anticipate and plan for continuous and rigorous IRB compliance administrative workload.5.A multisite study is not a starting point for a novice researcher. Begin with smaller pilot studies and then progress to more complex, multisite studies. [ABSTRACT FROM AUTHOR]

Highlights: Economic precarity was associated with poorer health among LGBTQ & GNC youth.This association was partially explained by minority stress and activism.Minority stress was linked to poorer heath, but also heightened activism.Engagement in activism was associated with fewer health problems.These associations varied based on intersections of both gender and race/ethnicity. Lesbian, gay, bisexual, transgender, queer, and gender non‐conforming (LGBTQ & GNC) youth experience more economic hardship and social stress than their heterosexual and cisgender peers. However, the ways that LGBTQ & GNC youth resist these damaging social factors and the corresponding implications for their health have not been addressed. Data were analyzed from a national participatory survey of LGBTQ & GNC youth ages 14–24 (N = 5,860) living in the United States. Structural equation models indicated that economic precarity was associated with experiences of health problems. This association was mediated by the negative influence of minority stress on health as well as by activism, which had a positive association with health. Findings suggest that minority stress explanations of health inequalities among LGBTQ & GNC youth can benefit from including a focus on economic precarity; both in terms of its deleterious impact on health and its potential to provoke resistance to structural oppression in the form of activism. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR), one of the major and long-term microvascular complications of diabetes, is the most common cause of vision loss and blindness in the working population of the world. Even with the management of diabetes, most patients will develop some forms of DR after approximately 20 years. However, DR is a treatable disease throughout the disease progression. To provide appropriate DR management, the USA and European countries have successfully implemented systematic early DR screening programs. At the same time, some computer-aided DR screening systems, which combine advanced DR detection algorithms and telemedicine technology, have also been developed for early-stage DR detection. Some of them have been tested in the DR screening programs. In this paper, we focus on a review of the major automatic DR screening systems which have performed large-scale evaluation rather than give an extensive review of all published DR grading algorithms. We first present the structures of the automatic systems and their supporting algorithms developed by the research groups, as well as the practices of the systems in their screening programs. We further present a more detailed review of the DR lesion detection algorithms in each system and reveal how the DR screening systems successfully practiced in clinical trials or large-scale screening programs. We also review recently new research areas as well as deep learning-based DR screening systems and compare them with the traditional lesion detection-based DR screening systems. The performances of the systems in the trials are summarized by considering the specificity and sensitivity with respect to the scale of testing datasets. At last, we will discuss future challenges. [ABSTRACT FROM AUTHOR]

Case management is a standard practice for assisting people living with HIV in the United States. While HIV case management has resulted in positive outcomes for clients and their families, clients still face challenges. As part of an evaluation of Utah's Ryan White Part B Program, the Utah Department of Health and researchers from the University of Utah assessed the use of a tiered approach for case management in eight other states to determine the feasibility and potential effectiveness of this approach. Through review of publicly available materials and interviews with health department employees, we examined each state's 1) definitions of tiers, 2) acuity scales, 3) services provided within the tiers, 4) qualifications of case managers, and 5) how evaluations were conducted. This article summarizes how these various features might be combined to create a model that states could use for tiered case management. We developed a three-tiered model using a numeric summary for nine items to assess acuity, with levels defined as maintenance outreach support services, brief-contact management, and medical/non-medical management. Since none of the states reviewed had an existing formal evaluation tool, we propose areas to be covered in an annual formal evaluation. [ABSTRACT FROM AUTHOR]

Introduction: In order to understand adolescent girls' and young women's use of contraceptive services, this paper examines trends in receipt of contraceptive services, focusing on provider type and payment source.Methods: The analysis uses nationally representative data from females aged 15-25 years in the 2002, 2006-2010, and 2011-2015 National Surveys of Family Growth. In 2018, summary measures for receipt of any contraceptive service, the type of provider visited and payment used were created and compared across survey years and age groups (15-17 and 18-25 years).Results: From 2002 to 2011-2015, the proportion of adolescent girls aged 15-17 years relying on publicly funded clinics for contraceptive care fell from 47% to 24% (95% CI=38.4%, 55.0% and 95% CI=19.0%, 29.9%), whereas the proportion relying on private providers increased from 49% to 69% (95% CI=40.7%, 57.1% and 95% CI=61.6%, 76.2%). A significant, but smaller, shift away from clinics occurred among women aged 18-25 years. Over the same period, use of health insurance to pay for contraceptive services among all females aged 15-25 years increased from 68% to 81% (95% CI=64.7%, 71.3% and 95% CI=78.5%, 83.8%), whereas the proportion who had private insurance during the year, but did not use it to pay for contraceptive care, declined from 21% to 9% (95% CI=18.3%, 23.5% and 95% CI=6.8%, 10.7%).Conclusions: Private providers now provide the bulk of contraceptive services to adolescent girls and young women, with reduced reliance on publicly funded clinics. Supporting private practices in providing confidential and comprehensive family planning services must be a priority. Publicly funded clinics remain an important safety-net provider of contraceptive care for adolescent girls and young women. [ABSTRACT FROM AUTHOR]