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Provision of services for autism spectrum disorder (ASD) and developmental disabilities (DD) in Nigeria has been influenced by US and international research and awareness efforts. Forces that impact progress include Nigerian cultural beliefs and family involvement, societal attitudes, inadequate infrastructure and resources, and inconsistent policy and enforcement of disability laws. These forces can impact families both positively and negatively. A lack of standardised teacher training and accreditation programs limit access for students with disabilities to individualised education programs (IEPs) and classroom inclusion. Effective treatments for those with ASD/DD are well-documented, however these effective interventions often do not reach more rural, low-income, or less developed nations or rural, low socioeconomic US schools. The focus of this paper is to thoroughly analyse the evolution of special education and inclusion in Nigeria and the United States and to highlight how US progression influenced Nigeria and the importance of advocating for culturally relevant, low-cost, research-based interventions and outreach African nations such as Nigeria.

Black Womxn in Mathematics Education (BWXME) is an international nonprofit organization that creates a brave and safe space for professional Black women in mathematics education. BWXME members are eminent mathematics PK-12 teachers, university and college professors, mathematicians, published authors, mathematics consultants, entrepreneurs, educational advocates, and graduate students from the United States and Canada. The organization's greatest strength lies in the intellectual caliber of its members and the extensive range of expertise they bring to the virtual community. To further its work, BWXME recruits members who reflect excellence in mathematics education and leadership. Its diverse membership structure encourages members to share their interesting perspectives and insights, sharpening one another in this process. BWXME cultivates an environment of excellence where Black womxn share their wisdom and creativity and support each other through the complexities of life. In this article, the authors introduce BWXME's purpose and the steps taken to create it, correlating this work with "Principles to Actions'" (NCTM, 2014) elements of professionalism and access and equity. They also share the components of a professional collaborative support network (P-CSN).

In this article we theorize the concept of altermundos literacies as they are enacted by parents in transborder families. We demonstrate how these parents, participants in an ethnographic study with mixed-status families in rural Puebla, México, write speculative narratives for their children's futures in ways that reject mononational norms. Altermundos literacies involve the activation of subaltern knowledges across mononational systems and complex literacy practices across papeles to dream-into-action a future designed by and for their lives. We draw on scholars of Black, Indigenous, Chicana, and Latinx futurity to demonstrate how families' altermundos challenge educational practices across borders and dream new possibilities into being. Our findings show how families' dreams navigate constraints imposed by systems of oppression within both the United States and México to varying degrees of success. Regardless, these families' altermundos literacies are invitations for all of us to co-dream futures beyond borders. Implications for researchers, school-based practitioners, and policymakers are discussed.

US education is hardly divorced from systemic societal inequalities. Utilizing the cases of the English-speaking Caribbean and post-apartheid South Africa decolonization efforts, we engage the settler coin concept to interrogate the popular notion that we can achieve systemic change in the US without fundamentally transforming the education system. What lessons might the US glean from other decolonization efforts in the Caribbean and South Africa? How have the instrumental ideas and work of Caribbean and South African scholars and educators shaped and advanced a decolonization vision? Answering these questions requires considering the overall goals of the US education system relative to advancing a larger decolonization project.

Drawing from an ethnography with mixed-status families residing in Mexico, we examine what we term transborder literacies of (in)visibility, or diasporic people's innovative interactions around texts that prepare them to move across incompatible mononational institutions divided by borders. Through close attention to the literacy practices families engaged in as they applied for their children's U.S. passports from Mexico, we demonstrate how these literacies were not just about expanding authentic ways of reading and writing to include both U.S. and Mexican ways, but instead required unique transborder literacies across mutually unintelligible, racializing mononational systems so that children could (re)access their rights on both sides of the border. We argue that recognizing families' complex transborder literacy practices of (in)visibility could offer a novel anti-oppressive lens to transform how educators make sense of the complexity of immigrant families' literacies, movements, and educational supports across borders and national schooling systems.

Objective: Schools are important settings for health promotion. In schools, children and adolescents can be reached regardless of their social background, which represents a unique opportunity for promoting health. Several studies have demonstrated the importance of school leadership in initiating and sustaining health promotion; however, efforts to systematically review the influence of school leadership on school health promotion are still lacking. Hence, this paper analyses empirical studies published in scientific journals on school leadership and health promotion in schools. Design: Systematic literature review. Method: Informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a review was conducted using two main databases: Web of Science and Scopus, which retrieved 51 eligible articles. Results: The review of these articles resulted in the identification of seven main themes -- school leaders' health; attitudes, knowledge and behaviour; accountability; support from school leaders; shared leadership approaches; capacity building and parent engagement. Conclusion: This systematic literature review expands the literature by highlighting the school leadership factors that promote school health promotion in Oceania, Europe, North America, South America, Africa and Asia continents. Future systematic literature reviews could explore studies and different aspects of health promotion by teachers, especially in the Asian context.

Previous research on bilingual mathematics education has proposed that as children "language mathematics" they use multiple sources of meaning. In this paper, we focus on lexical inventions--bilingual children's made up words that are not formally defined or used but follow the phonology and morphology of a language--as a source of meaning. Consistent with tenets from translanguaging, we recognize lexical inventions as a creative language practice defying idealized language norms. A raciolinguistic theoretical perspective informs our interpretation of children, teachers, and researchers as listening subjects. The purpose of this paper is to explore how mathematical lexical inventions can prompt a translanguaging space where children, teachers, and researchers resist listening subject positions that predispose them to listen for predetermined language practices. Drawing on two lesson transcripts, one from a fourth-grade English-immersion classroom in Colombia and one from a third-grade Spanish-immersion classroom in the United States, we used moment analysis in translanguaging spaces to identify spontaneous and critical moments where lexical inventions prompted mathematical explorations. We argue for adopting listening subject positions as learners of transgressive language practices that are part of interactions between children and mathematics.

This study explored caregivers' experiences of virtual Godly Play in the United States, South Korea, and the UK during COVID-19 lockdowns. Thematic analysis of thirty-three caregiver surveys and six semi-structured interviews revealed four themes: support/community, intergenerational Godly Play, spiritual maintenance and growth for the family, and the gift of wonder. This study shows that the experience of Godly Play at home during the pandemic benefited caregivers. As the pandemic subsides and we return to child-centered programming in churches, this study highlights the importance of including and equipping caregivers in nurturing their children's spirituality.

A recent Registered Replication Report (RRR) of the development of verbal rehearsal during serial recall revealed that children verbalized at younger ages than previously thought, but did not identify sources of individual differences. Here, we use mediation analysis to reanalyze data from the 934 children ranging from 5 to 10 years old from the RRR for that purpose. From ages 5 to 7, the time taken for a child to label pictures (i.e. isolated naming speed) predicted the child's spontaneous use of labels during a visually presented serial reconstruction task, despite no need for spoken responses. For 6- and 7-year-olds, isolated naming speed also predicted recall. The degree to which verbalization mediated the relation between isolated naming speed and recall changed across development. All relations dissipated by age 10. The same general pattern was observed in an exploratory analysis of delayed recall for which greater demands are placed on rehearsal for item maintenance. Overall, our findings suggest that spontaneous phonological recoding during a standard short-term memory task emerges around age 5, increases in efficiency during the early elementary school years, and is sufficiently automatic by age 10 to support immediate serial recall in most children. Moreover, the findings highlight the need to distinguish between phonological recoding and rehearsal in developmental studies of short-term memory.

Adequate sleep is crucial for elite athletes' recovery, performance readiness, and immune response. Establishing reference ranges for elite athletes enables appropriate contextualization for designing and targeting sleep interventions. Purpose: To establish sleep-quality reference ranges for Olympic and Paralympic cohorts using the Pittsburgh Sleep Quality Index (PSQI) and explore differences based on sex and sport types. Methods: Team USA athletes (men = 805, women = 798) completed the PSQI as part of a health-history questionnaire. Descriptive statistics were used to create reference ranges and linear models, and χ2 test of independence determined differences in PSQI global and component scores between sex, games, season, and participation. Results: Six hundred thirty-two (39.43%) athletes reported poor sleep (PSQIGlobal ≥ 5). Men displayed later bedtimes (P =.006), better global PSQI scores, shorter sleep latency, less sleep disturbance, and less use of sleep medication than women (all P <.001). Winter Games participants had later bedtime (P =.036) and sleep offset time (P =.028) compared with Summer Games athletes. Team-sport athletes woke earlier than individual-sport athletes (P <.001). Individual-sport athletes were more likely to have low (P =.005) and mild (P =.045) risk for reduced sleep duration than team-sport athletes. Conclusion: These data provide PSQI-specific reference ranges to identify groups at greatest risk for poor sleep, who may benefit most from targeted sleep interventions. [ABSTRACT FROM AUTHOR]

Purpose: Postpartum mood disorders affect many women following childbirth. Prescribing medication for depression and anxiety is one strategy for the effective treatment of postpartum mood disorders. Left untreated, mothers experiencing these disorders and their infants face increased risks of adverse health outcomes. Little is known about how diagnosis and treatment of postpartum mood disorders changed during COVID-19. Methods: We used a retrospective pooled cross-sectional design in a sample of privately-insured postpartum women in U.S. claims data from January 1, 2016 to December 31, 2020. We measured changes in diagnoses of anxiety and depression and changes in prescription fills and days supplied of classes of medications used to treat these conditions (antidepressants, benzodiazepines, and z-drugs). We used ordinary least squares (OLS) regression for each outcome variable during the pre-pandemic period and forecast expected outcomes the observation period. Forecasted and actual values of the outcomes were then compared. Results: Following the onset of the COVID-19 pandemic in March 2020, diagnoses of depression and anxiety were not significantly higher among privately insured postpartum women in the United States. The proportion of privately-insured postpartum women filling a benzodiazepine prescription increased by 15.2%. Conclusions: We find diagnosis of postpartum mood disorders did not increase after the onset of the COVID-19 pandemic, however, fills of benzodiazepines increased among privately-insured postpartum women. Given prior evidence of increased depressive and anxiety symptoms among postpartum women during COVID-19, this suggests increased barriers to appropriate diagnoses and treatment for depression during this period. [ABSTRACT FROM AUTHOR]

Background: Chronic vulvovaginal pain (CVVP), an umbrella term encompassing several gynecological pain conditions (e.g., vulvodynia, vaginismus), has a prevalence rate of 7–8% in the USA and is characterized by considerable diagnostic delay in patient experience research. Furthermore, current research in this area focuses largely on the experiences of white women, while the experiences of women of color are underrepresented. Method: In the present cross-sectional study (N = 488), we surveyed women of color (i.e., Asian, Black, and/or Hispanic/Latinx women) with CVVP about their perceptions and experiences with medical mistrust, healthcare seeking, and healthcare avoidance. Results: Using the suspicion subscale of the Group-Based Medical Mistrust Scale, we found significant racial and ethnic differences in medical suspicion scores, with non-Black Hispanic/Latinx women reporting the highest suspicion scores and non-Hispanic/Latinx Black women reporting the lowest scores. Racial differences disappeared, however, after examining medical mistrust and perceived discrimination as predictors for various healthcare outcomes related to the journey to diagnosis and healthcare avoidance behaviors. We found that while suspicion was a reliable predictor of increased diagnostic delay and healthcare avoidance in many contexts, the results for perceived discrimination were more varied, suggesting considerable nuance in the relationship between medical mistrust, perceived discrimination, and healthcare seeking outcomes. Conclusion: These findings point to shared experiences of medical mistrust via suspicion that broadly characterize women of color's experiences in seeking CVVP-related care—future research is needed to examine nuances within racial and ethnic groups regarding their healthcare seeking experiences in the CVVP context. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol use (AU) and disorders (AUDs) have been increasing among women over the past decade, with the largest increases among women of child-bearing age. Unprecedented stressors during the COVID-19 pandemic may have impacted AU for women with and without children. Little is known about how these trends are impacting women in the military. Methods: Cross-sectional study of active-duty service women (ADSW) in the U.S. Army, Air Force, Navy, and Marine Corps during fiscal years (FY) 2016–2021. We report the prevalence of AU and AUD diagnoses by FY, before/during the COVID-19 pandemic (2016–2019; 2020–2021, respectively), and by parental status. Log-binomial and logistic regressions examined associations of demographics, military, and family structure characteristics, with AU and AUD, during pre-COVID-19 and COVID-19 timeframes. Results: We identified 281,567 ADSW in the pre-COVID-19 period and 237,327 ADSW in the during COVID-19 period. The prevalence of AU was lower during the COVID-19 period (47.9%) than during the pre-COVID-19 period (63.0%); similarly, the prevalence of AUD was lower during the COVID-19 period (2.7%) than during the pre-COVID period (4.0%). ADSW with children had larger percentage decreases during the COVID-19 period. ADSW with children had a consistently lower prevalence and odds of AUD compared with ADSW without children in the pre- and during COVID-19 periods. Conclusion: Decreasing trends in AU and AUD among ADSW were unexpected. However, the prevalence of AU and AUD may not have been accurately captured during the COVID-19 period due to reductions in access to care. Continued postpandemic comparison of AU/AUD among women by parental status and demographic factors may guide targeted health efforts. [ABSTRACT FROM AUTHOR]

Background: Previous research has reported higher rates of both injury and illness among Paralympic athletes compared with Olympic athletes during the Winter Olympic and Paralympic Games, but no studies have directly compared injury and illness incidence between Olympic and Paralympic athletes competing in a Summer Games. Purpose: To compare injury and illness rates between Olympic and Paralympic Team USA athletes competing in the Tokyo 2020 Olympic and Paralympic Games. Study Design: Descriptive epidemiology study. Methods: All injuries and illnesses that occurred among the Team USA athletes competing in the Tokyo 2020 Summer Olympic or Paralympic Games were documented. A total of 701 Team USA athletes (53.6% female) competed in the Tokyo 2020 Summer Olympic Games, across 34 different sports. For the Tokyo 2020 Summer Paralympic Games, a total of 245 athletes (51.6% female) competed across 20 sports. Incidence rates (IRs) per 1000 athlete-days were calculated according to sex, sport, anatomic location, and illness type. IR ratios (IRRs) were calculated to compare IRs between male and female athletes and between Olympic and Paralympic athletes. Results: Overall, there were no differences in injury incidence (IRR, 1.18; 95% CI, 0.84-1.68) or illness incidence (IRR, 0.68; 95% CI, 0.41-1.15) between Olympic and Paralympic athletes. Male Paralympic athletes were less likely to sustain an illness compared with female Paralympic athletes (IRR, 0.35; 95% CI, 0.11-0.90). Conclusion: There were no differences in injury or illness rates between Olympic and Paralympic Team USA athletes competing at the Tokyo 2020 Summer Games, contrary to previous comparisons among winter sport athletes. These results challenge the prevailing notion that Summer Paralympic athletes are at greater injury and illness risk, suggesting that factors beyond Olympic or Paralympic Games participation influence health concerns. [ABSTRACT FROM AUTHOR]

Advocates for internationalisation of the undergraduate psychology curriculum anticipate a variety of beneficial outcomes strongly associated with forms of intellectual growth -- including critical thinking, appreciation for diversity, and global awareness -- that are the defining purpose of a university education. As a prelude to an intervention to internationalise an introductory psychology course, we examined relationships between measures of these anticipated benefits in an online survey of 107 undergraduate students enrolled in an introductory psychology course at a public research university in the US. Results indicated moderately strong relationships among measures of anticipated benefits of internationalisation but little relationship with conventional measures of academic performance. These results raise doubts about any necessary connection between anticipated benefits of internationalisation and conventional understandings of educational success. Accordingly, results motivate greater reflection among both proponents of internationalisation and psychologists in general about the learning outcomes that inform conventional approaches to undergraduate education in psychology.

Aim: Efforts to understand how pollinating insect diversity is distributed across large geographic areas are rare despite the importance of such work for conserving regional diversity. We sought to relate the diversity of bees (Hymenoptera: Apoidea), hover flies (Diptera: Syrphidae), and butterflies (Lepidoptera) to ecoregion, landscape context, canopy openness, and forest composition across southeastern U.S. forests. Location: Nineteen experimental forests across nine states in the southeastern U.S. Methods: We established 5–7 plots on each experimental forest. In each, we sampled pollinators monthly (March–September) using coloured pan traps, and collected data on local forest characteristics. We used the National Land Cover Database (NLCD) to quantify surrounding landcover at different spatial scales. Results: Bee richness was negatively correlated with both the amount of conifer (pine) forest and the extent of wetlands in the surrounding landscape but was positively correlated with canopy openness. Hover flies and butterflies were less sensitive to landscape context and stand conditions. Pollinator communities differed considerably among ecoregions, with those of the Central Appalachian and Coastal Plain ecoregions being particularly distinct. Bee richness and abundance peaked 2 months earlier in Central Appalachia than in the Coastal Plain and Southeastern Mixed Forest ecoregions. Main Conclusions: Our findings reveal ecoregional differences in pollinator communities across the southeastern U.S. and highlight the importance of landscape context and local forest conditions to this diverse fauna. The closed broadleaf forests of Appalachia and the open conifer‐dominated forests of the Coastal Plain support particularly distinct pollinator communities with contrasting seasonality. Our results suggest pine forests may reduce pollinator diversity in regions historically dominated by broadleaf forests. However, efforts to create more open canopies can help improve conditions for pollinators in planted pine forests. Research exploring associations between forest pollinators and different broadleaf tree taxa is needed to better anticipate the impacts of various management activities. [ABSTRACT FROM AUTHOR]

In this essay, Joanna Dreby, Sarah Gallo, Florencia Silveira, and Melissa Adams-Corral use a transnational frame to explore the meanings of US citizenship for binational children and its importance to experiences of belonging. Drawing on interviews with children ages six to fourteen living with their Mexican-born parents in rural Puebla, their analysis shows that children view US citizenship as signaling their social location in a historically based migratory system and that the meaning of this social location on children's daily lives differs given their transnational experiences, specifically the extent of US schooling they received. Migration thus engenders understanding of power and privilege among young children and influences how they negotiate among their peers. The authors argue that young children may exhibit "critical postures" arising from their migratory experiences. They conclude that schools on both sides of the border can view migrant children's experiences and critical perspectives as assets that may provide more flexible spaces for learning and belonging.

Background Buprenorphine, a partial opioid agonist, has emerging evidence as an alternative to full agonist opioids for treatment of acute pain. This systematic review aimed to evaluate the safety and efficacy of buprenorphine for acute pain in older adults. Methods PubMed Medline, Embase, Cochrane Central Register of Controlled Trials, CINHAL, Web of Science database, and Google Scholar were searched. We included articles that reported buprenorphine as an intervention to treat acute pain among patients 60 years or older. Primary outcome was difference in pain scores for patients treated with buprenorphine compared to other analgesia. Secondary outcomes included adverse events, opioid consumption, and patient satisfaction. Meta-analysis was conducted on difference in pain scores and differences in nausea and vomiting. Results Twenty-two studies were included (n  = 2610). Buprenorphine was administered as nerve blocks in 6 studies, transdermal in eight, intravenous or intramuscular in 5, sublingual in 2 studies, and both intravenous and sublingual in one study. 10 out of 20 (50%) studies found improved pain control in buprenorphine groups. Meta-analysis found no significant difference in pain scores between buprenorphine and control analgesia at 24 hours [Cohen's d  = −0.29 (95% confidence interval (CI) −0.85 to 0.27)] and 7 days [Cohen's d  = −0.89 (95% CI −2.66 to 0.88)]. Six studies (54.5%) found reduced opioid consumption in patients receiving buprenorphine. There was no difference in adverse effects in most studies. Conclusions This review did not find buprenorphine to be superior to alternative analgesia; however, the mixed results provide scientific rationale for future studies testing buprenorphine in older populations. [ABSTRACT FROM AUTHOR]

We adapted the Sexual Experiences Survey (SES) to be more inclusive of transgender, nonbinary, and gender-expansive people and undertook preliminary validation of the measure. We added gender-neutral language, assault types thought to be more common and more emotionally impactful among these individuals, and coercion tactics specific to transgender, nonbinary, and gender-expensive people. We piloted this Gender-Inclusive SES (GI-SES) with an online survey of transgender and gender-expansive undergraduates who experienced campus sexual assault. We assessed acceptability via rapid qualitative analysis of feedback. We gathered preliminary evidence of validity by calculating the agreement in assault type and coercion tactic between open-ended descriptions of the assault and the GI-SES response, as well as by testing four hypotheses about the relative frequency and severity of different types of assaults within the sample. Three hundred eighty-eight transgender, nonbinary, and gender-expensive students completed the survey. Qualitative responses indicated that participants felt the GI-SES was inclusive and respectful. Results were partially consistent with hypotheses supporting validity, and there was 90.9% agreement in assault type and 85.9% agreement in coercion tactics between GI-SES responses and written narratives. The GI-SES provides researchers, clinicians, and service providers with a tool, preliminarily validated with a trans and gender-diverse college sample, to capture the unique experiences of transgender, nonbinary, and gender-expensive sexual assault survivors. [ABSTRACT FROM AUTHOR]

Researchers in environmental psychology celebrate the potential for state and national parks to inspire civic engagement in the issue of climate change. Yet, prevailing conceptions of nature may reflect ongoing colonial concerns, such that parks may represent a space to avoid thinking about—rather than reckon with—escalating ecological crises. In this paper, we approach the topic of climate change in state parks from a perspective informed by decolonial theory. In particular, we report a mixed‐methods study with (N = 51) employees at parks in Kansas and throughout the United States regarding the extra‐individual factors that impact their tendency to subjectively attribute extreme weather to climate change. Findings indicate that park employees were less likely to attribute extreme weather to climate change in parks with (1) less institutional support for climate change mitigation, and (2) increased presence of white conservatives. Responses to a question about the purpose of parks and open‐ended reflections reveal that employees conceive of parks as a space for recreation wherein their primary role in relation to visitors is to supply "fun" and "natural" experiences for consumption. We reflect on conceptions of parks and nature and discuss a conception of parks better suited to confront the escalating ecological crisis. [ABSTRACT FROM AUTHOR]

* OBJECTIVE: To examine whether there was a racial disparity among Medicare beneficiaries in the likelihood of using outpatient physical therapy (PT) services following a hip fracture. * METHODS: Our retrospective descriptive cohort study analyzed administrative claims data for 51 781 Medicare beneficiaries post hip fracture. We examined the association between race and PT use within the first 6 months post fracture using hierarchical logistic regression, adjusting for demographics, medical complexity, and socioeconomic factors. We used Poisson regression to examine the association between race and the number of PT visits. * RESULTS: Only 31% of beneficiaries used outpatient PT after hip fracture with significant racial disparities. After controlling for demographics, medical complexity, and socioeconomic factors, Black beneficiaries had 42% lower odds of using PT (adjusted odds ratio [aOR], 0.58; 95% confidence interval [CI]: 0.51, 0.66) compared to White beneficiaries. Among PT users, Black beneficiaries received fewer visits than White beneficiaries (rate ratio [RR], 0.85; 95% CI: 0.82, 0.88) with this disparity persisting after adjustments (RR, 0.88; 95% CI: 0.85, 0.91). * CONCLUSION: Even after adjusting for demographic, medical, and socioeconomic factors, Black beneficiaries were less likely to use outpatient PT following hip fractures. Conditional on an initial PT evaluation, Black beneficiaries received fewer sessions. J Orthop Sports Phys Ther [ABSTRACT FROM AUTHOR]

Background: We aimed to examine ACP in older adults in the U.S. across different sociodemographic characteristics and cognition levels (N = 17,698). Methods: We utilized two legal documents from the Health and Retirement Study survey: a living will and durable power of attorney for healthcare (DPOAH). We established the baseline trends from 2014 to assess if trends in 2024 have improved upon future data availability. Logistic regression models were fitted with outcome variables (living will, DPOAH, and both) stratified by cognition levels (dementia/impaired cognition versus normal cognition). Results: Age, ethnicity, race, education, and rurality were significant predictors of ACP (having a living will, DPOAH, and both the living will and DPOAH) across cognition levels. Participants who were younger, Hispanic, black, less educated, or resided in rural areas were less likely to complete ACP. Conclusion: Examining ACP and its linkages to specific social determinants is crucial for understanding disparities and developing effective educational and interventional strategies to enhance ACP uptake among diverse population groups. Future studies are needed to assess whether disparities have improved over the last decade, particularly as 2024 data become available. Addressing ACP disparities is essential for healthcare professionals to advance research and promote effective practices in geriatric care and aging services. [ABSTRACT FROM AUTHOR]

Background: Experiential learning (EL) experiences are an important component of a university education, positively impacting career-related attitudes, knowledge, and skills. Students also require EL opportunities to gain experiences required for admission to competitive graduate and professional programs. Students with disabilities face barriers accessing and benefiting from such opportunities. Purpose: This study examined the degree to which demographic factors, type and severity of disability, dispositional factors, and overall adjustment and well-being are predictive of the quality of EL experiences among university students with disabilities. Methodology/approach: A survey was distributed to undergraduate students with disabilities who have participated in EL courses. The results were analyzed using multiple linear regression. Findings/conclusions: Dispositional and adjustment and well-being variables, including the environmental mastery dimension of their psychological well-being rather than demographic factors, such as gender or type and severity of disability, are significant predictors of the quality of EL experiences among students with disabilities. Implications: For students with disabilities to have academically and professionally successful EL experiences, post-secondary institutions must continue to provide appropriate accommodations and educate instructors about the diverse and complex needs of this student group. This must include an understanding of the uniqueness of each individual student's needs. [ABSTRACT FROM AUTHOR]

Simple Summary: This study examined the link between different metabolic and bariatric surgery (MBS) procedures and cancer incidence by linking the statewide bariatric surgery registry with the cancer registry (1979–2018) for 27,092 adult patients. Four types of surgeries were compared: Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch (BPD-DS). Over a follow-up period averaging 167 months, cancer incidence was 6.4% for RYGB, 4.6% for AGB, 1.6% for SG, and 5.9% for BPD-DS. We found that patients who underwent AGB and BPD-DS were more likely to develop cancer compared to those who had RYGB. These findings highlight that cancer hazards differ by MBS procedure, and there may be the need for further research with more data to better understand the differences observed in our study. Background/Objectives: Metabolic and bariatric surgery (MBS) is known to reduce cancer risk. However, the association between specific bariatric procedures and cancer incidence is not well-studied. This study examined the association between four different MBS procedures and cancer incidence. Methods: Bariatric surgery registry data were linked with statewide cancer registry data from 1979 to 2018. The study included 27,092 adult subjects (aged ≥ 18 years old at surgery) who underwent MBS (BMI ≥ 30 kg/m2 at surgery) from 1979 to 2017. Cancer records were linked to MBS patient records, resulting in 1547 cancer cases. Cox proportional hazards regression was used to examine the association between MBS procedure types and cancer incidence. Results: Of all patients, 75% underwent Roux-en-Y gastric bypass (RYGB), 9% adjustable gastric banding (AGB), 10% sleeve gastrectomy (SG), and 6% duodenal switch (BPD-DS). The overall cancer incidence during the follow-up period was 6.4% for RYGB, 4.6% for AGB, 1.6% for SG, and 5.9% for BPD-DS. The mean follow-up duration from surgery to cancer incidence or censoring was 167 months (standard deviation = 121 months). Compared to RYGB, patients who underwent AGB (Hazard Ratio [HR] = 1.26, p = 0.03) and BPD-DS (HR = 1.91, p < 0.01) had a significantly higher hazard of developing cancer, while SG (HR = 1.17, p = 0.33) showed no significant difference. Conclusions: These findings suggest that AGB and BPD-DS may be associated with higher cancer risks compared to RYGB. Additional large population studies are needed to better understand the long-term cancer risks and mechanisms associated with different MBS types. [ABSTRACT FROM AUTHOR]

Provision of services for autism spectrum disorder (ASD) and developmental disabilities (DD) in Nigeria has been influenced by US and international research and awareness efforts. Forces that impact progress include Nigerian cultural beliefs and family involvement, societal attitudes, inadequate infrastructure and resources, and inconsistent policy and enforcement of disability laws. These forces can impact families both positively and negatively. A lack of standardised teacher training and accreditation programs limit access for students with disabilities to individualised education programs (IEPs) and classroom inclusion. Effective treatments for those with ASD/DD are well-documented, however these effective interventions often do not reach more rural, low-income, or less developed nations or rural, low socioeconomic US schools. The focus of this paper is to thoroughly analyse the evolution of special education and inclusion in Nigeria and the United States and to highlight how US progression influenced Nigeria and the importance of advocating for culturally relevant, low-cost, research-based interventions and outreach African nations such as Nigeria. [ABSTRACT FROM AUTHOR]

Objectives: The risk for mpox virus (MPXV) transmission in most workplaces has not been thoroughly assessed in the context of the 2022 global mpox outbreak. Our objectives were to describe mpox case patients who worked while infectious and the subsequent workplace contact tracing efforts, risk assessments, and outcomes. Methods: The Centers for Disease Control and Prevention requested information from health departments in the United States in September 2022 to identify people with confirmed or probable mpox who worked outside the home while infectious, either before or after diagnosis, from June 1 through August 31, 2022. We collected and summarized data on demographic, clinical, and workplace characteristics of case patients and workplace contact investigations. We stratified data by industry and occupation categories. Results: In total, 102 case patients were reported by 6 jurisdictions. The most common industries were accommodation and food services (19.8%) and professional business, management, and technical services (17.0%). Contact investigations identified 178 total contacts; 54 cases (52.9%) had no contacts identified. Of 178 contacts, 54 (30.3%) were recommended to receive postexposure prophylaxis (PEP) and 18 (10.1%) received PEP. None of the contacts developed a rash or were tested for orthopox or mpox, and none were reported to have confirmed or probable mpox. Conclusion: Data from 6 jurisdictions suggest that the risk of MPXV transmission from workers to others in workplace settings in many industries is low. These findings might support future updates to exposure risk classifications and work activity recommendations for patients. These findings also demonstrate the importance of collecting and analyzing occupation and industry data in case reports to better understand risks in workplaces. [ABSTRACT FROM AUTHOR]

Phenomenon: Students become physicians not only by mastering medical knowledge, but also through a process of Professional Identity Formation (PIF). In this study, we used the conceptual framework of Jarvis-Selinger et al. to explore the impact of COVID, as a major public health crisis, on the PIF of preclinical medical students in our country. Approach: At two U.S. medical schools, we interviewed 28 medical students twice as they moved from first to second year during the 2020-2021 COVID pandemic and explored the impact of COVID-19 on PIF. We coded the transcribed interviews and identified themes using constructivist thematic analysis. Findings: We identified three themes: 1) mental health and wellness impacts; 2) inhabiting identity as a health professional during COVID; and 3) questioning the role of physicians in society. Routines and support systems were disrupted, undermining wellness and confidence in professional choices. Students noted the need to be public health role models, and COVID prompted feelings of pride, while also causing them to question expectations of self-sacrifice amid a new politicization of medicine. Students felt that physicians must be increasingly engaged in public health and political communication. Insights: Our findings inform medical educators seeking to build a scaffolding to support PIF during a public health crisis, and highlight the importance of current events and politics on PIF. Our recommendations include the need for student support, longitudinal mentorship, curricular space to discuss the impact of sociopolitical factors on PIF, and revisiting foundational concepts such as professionalism to take into account the social and political context. Our findings add to understanding of PIF during the COVID pandemic, but are also relevant to teaching and learning during future public health crises. [ABSTRACT FROM AUTHOR]

Native Americans (Indigenous Americans) have high rates of serious illness in the United States. Informal caregivers are heavily relied on in caring for patients in low-resource settings. The needs of caregivers residing on reservations are sorely underreported. Therefore, our objective was to examine relationships between facilitators (communal mastery, cultural identity, and spirituality) and barriers (depression, anxiety, stress, and burden) with supportive care needs among adult informal caregivers in 1 reservation- based community. A cross-sectional survey was distributed in July and August 2022 as part of a larger multimethod, community-based participatory research study. We used descriptive statistics and linear regression models to examine relationships against the primary outcome, the Supportive Care Needs Assessment Tool for Indigenous People. Overall, 127 participants were included; mostwere female (n = 92, 72.4%), were between 30 and 49 years (n = 57, 44.9%), and had 6 months or less of caregiving experience (n = 41, 32.5%). Higher depression, anxiety, stress, and burden were significantly associated with higher Supportive Care Needs Assessment Tool for Indigenous People scores. Overall, mental health is a significant barrier that may indicate greater supportive care needs among informal caregivers, although further work is needed to differentiate symptoms and their impact on caregiving froma cultural perspective. [ABSTRACT FROM AUTHOR]

The history of special education in the United States and Thailand has followed a similar path in many ways. Both countries made compulsory education mandatory to move in a positive direction in providing special education services to children with disabilities including the provision of services for children with ASD or Autism. In Thailand, monitoring of compliance with disability law, and negative attitudes by society overall toward individuals with disabilities hamper enforcement of law, distribution of resources, family involvement, and access to individualized education programs and inclusion of students with disabilities. While effective treatments for autism have been documented in the US, this knowledge and training on effective interventions is often not filtered to more rural US schools or outside US borders. Increased collaborations within and between countries to increase knowledge and expertise is recommended. Research based interventions should be taught and implemented in countries such as Thailand and other nations. (Contains 5 tables.)

Introduction: Digital health technologies (DHTs) have the potential to alleviate challenges experienced in clinical trials through more objective, naturalistic, and frequent assessments of functioning. However, implementation of DHTs come with their own challenges, including acceptability and ease of use for study participants. In addition to acceptability, it is also important to understand device proficiency in the general population and within patient populations who may be asked to use DHTs for extended periods of time. We thus aimed to provide an overview of participant feedback on acceptability of DHTs, including body-worn sensors used in the clinic and a mobile application used at-home, used throughout the duration of the Wearable Assessments in the Clinic and at Home in Parkinson's Disease (WATCH-PD) study, an observational, longitudinal study looking at disease progression in early Parkinson's Disease (PD). Methods: 82 participants with PD and 50 control participants were enrolled at 17 sites throughout the United States and followed for 12 months. We assessed participants' general device proficiency at baseline, using the Mobile Device Proficiency Questionnaire (MDPQ). The mean MDPQ score at Baseline did not significantly differ between PD patients and healthy controls (20.6 [2.91] vs 21.5 [2.94], p = .10). Results: Questionnaire results demonstrated that participants had generally positive views on the comfort and use of the digital technologies throughout the duration of the study, regardless of group. Discussion: This is the first study to evaluate patient feedback and impressions of using technology in a longitudinal observational study in early Parkinson's Disease. Results demonstrate device proficiency and acceptability of various DHTs in people with Parkinson's does not differ from that of neurologically healthy older adults, and, overall, participants had a favorable view of the DHTs deployed in the WATCH-PD study. [ABSTRACT FROM AUTHOR]

Monkeypox virus (MPXV) can spread among humans through direct contact with lesions, scabs, or saliva; via respiratory secretions; and indirectly from fomites; via percutaneous injuries; and by crossing the placenta to the fetus during pregnancy. Since 2022, most patients with mpox in the United States have experienced painful skin lesions, and some have had severe illness. During 2021-2022, CDC initiated aircraft contact investigations after receiving reports of travelers on commercial flights with probable or confirmed mpox during their infectious period. Data were collected 1) during 2021, when two isolated clade II mpox cases not linked to an outbreak were imported into the United States by international travelers and 2) for flights arriving in or traveling within the United States during April 30-August 2, 2022, after a global clade II mpox outbreak was detected in May 2022. A total of 113 persons (100 passengers and 13 crew members) traveled on 221 flights while they were infectious with mpox. CDC developed definitions for aircraft contacts based on proximity to mpox cases and flight duration, sent information about these contacts to U.S. health departments, and received outcome information for 1,046 (68%) of 1,538 contacts. No traveler was found to have acquired mpox via a U.S. flight exposure. For persons with mpox and their contacts who had departed from the United States, CDC forwarded contact information as well as details about the exposure event to destination countries to facilitate their own public health investigations. Findings from these aircraft contact investigations suggest that traveling on a flight with a person with mpox does not appear to constitute an exposure risk or warrant routine contact tracing activities. Nonetheless, CDC recommends that persons with mpox isolate and delay travel until they are no longer infectious. [ABSTRACT FROM AUTHOR]

Longitudinal Integrated Clerkships (LICs) prioritise longitudinal relationships with faculty, patients, and place. Research shows that LICs benefit students and faculty, but most medical schools have limited LIC programmes. This is likely due to perceptions that LICs are more costly and complex than traditional block rotations (TBRs). The perceived cost versus evidence-based value related to clerkship education has not been examined in detail. Until recently, no 'All-LIC' medical school exemplars existed in the US, limiting the value of this model as well as the ability to examine relative cost and complexity. In this paper, we draw on our experience launching three 'All-LIC' medical schools in the United States – schools in which the entire clerkship class participates in a comprehensive clerkship-year LIC. We propose that the known benefits of LICs coupled with cost-mitigation strategies related to running an 'All LIC' model for core clinical clerkships, rather than block and LIC models simultaneously, results in a higher value for medical schools. [ABSTRACT FROM AUTHOR]

The National Comprehensive Cancer Control Program, a Centers for Disease Control and Prevention funded program, supports cancer coalitions across the United States (US) in efforts to prevent and control cancer including development of comprehensive cancer control (CCC) plans. CCC plans often focus health equity within their priorities, but it is unclear to what extent lesbian, gay, bisexual, transgender, queer/questioning, plus (LGBTQ+) populations are considered in CCC plans. We qualitatively examined to what extent LGBTQ+ populations were referenced in 64 U.S. state, jurisdiction, tribes, and tribal organization CCC plans. A total of 55% of CCC plans mentioned LGBTQ+ populations, however, only one in three CCC plans mentioned any kind of LGBTQ+ inequity or LGBTQ+ specific recommendations. Even fewer plans included mention of LGBTQ+ specific resources, organizations, or citations. At the same time almost three fourths of plans conflated sex and gender throughout their CCC plans. The findings of this study highlight the lack of prioritization of LGBTQ+ populations in CCC plans broadly while highlighting exemplar plans that can serve as a roadmap to more inclusive future CCC plans. Comprehensive cancer control plans can serve as a key policy and advocacy structure to promote a focus on LGBTQ+ cancer prevention and control. [ABSTRACT FROM AUTHOR]

Objective: To assess rates of traversing barriers to care to access optimal clinical outcomes in people with migraine internationally. Background: People in need of medical care for migraine should consult a health care professional knowledgeable in migraine management, obtain an accurate diagnosis, and receive an individualized treatment plan, which includes scientific society guideline-recommended treatments where appropriate. Methods: The Chronic Migraine Epidemiology and Outcomes-International (CaMEO-I) Study was a cross-sectional, web-based survey conducted from July 2021 through March 2022 in Canada, France, Germany, Japan, the United Kingdom, and the United States (US). Respondents who met modified International Classification of Headache Disorders, 3rd edition, criteria for migraine and had Migraine Disability Assessment Scale (MIDAS) scores of ≥ 6 (i.e., mild, moderate, or severe disability) were deemed to need medical care and were included in this analysis. Minimally effective treatment required that participants were currently consulting a health care professional for headache (barrier 1), reported an accurate diagnosis (barrier 2), and reported use of minimally appropriate pharmacologic treatment (barrier 3; based on American Headache Society 2021 Consensus Statement recommendations). Proportions of respondents who successfully traversed each barrier were calculated, and chi-square tests were used to assess overall difference among countries. Results: Among 14,492 respondents with migraine, 8,330 had MIDAS scores of ≥ 6, were deemed in need of medical care, and were included in this analysis. Current headache consultation was reported by 35.1% (2926/8330) of respondents. Compared with the US, consultation rates and diagnosis rates were statistically significantly lower in all other countries except France where they were statistically significantly higher. Total appropriate treatment rates were also statistically significantly lower in all other countries compared with the US except France, which did not differ from the US. All 3 barriers were traversed by only 11.5% (955/8330) of respondents, with differences among countries (P < 0.001). Conclusions: Of people with migraine in need of medical care for migraine, less than 15% traverse all 3 barriers to care. Although rates of consultation, diagnosis, and treatment differed among countries, improvements are needed in all countries studied to reduce the global burden of migraine. Trial registration: NA. [ABSTRACT FROM AUTHOR]

In the United States, the scope of practice of pharmacists is determined primarily at the state level. Not all state laws expressly permit or prohibit pharmacists from providing certain services; in between is a grey area of legal silence. Does legal silence permit pharmacists to perform a service that is not specifically permitted, but not expressly prohibited? Point-of-care testing provides a useful case study in legal silence: there are 1536 pharmacies currently holding a CLIA-waiver to administer tests in states reporting that pharmacists are not expressly permitted to administer tests. Legal silence may even provide a better framework for pharmacy based testing as it is naturally inclusive of any point-of-care test and no laws need updated when a new test comes to the market. Other health professions navigate this legal silence by governing according to a "standard of care." Rather than specifying a list of services a health professional can or cannot provide in law, it provides a flexible framework for the health professional to provide any service that other similarly situated health professionals would provide in the same or similar situation. A standard of care regulatory framework should thus be the target of the pharmacy profession in order to advance patient care. [ABSTRACT FROM AUTHOR]

The purpose of this study is to address a significant gap in knowledge on firearm ownership rates and storage characteristics in a national sample of college students. We used 2021–2022 survey data from the Healthy Minds Study, which included approximately 88,500 students at over 100 US colleges and universities. We conducted analyses using descriptive statistics and two-sample proportion tests. About 4% of respondents reported having a firearm on or around campus. Among firearm owners, 68.8% reported storing firearms at their permanent address within an hour's drive from campus, and 43.1% reported storing their firearms unloaded and locked. Firearm ownership rates were significantly higher for respondents who were positive for specific risk factors (i.e., in a relationship, suicide ideation, recent binge drinking, and having been physically assaulted) versus those who were negative. These findings support the need for targeted messaging and firearm safety training for college students to reduce firearm-related risks. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic affected child health behaviors, leading to worse physical health. Given the importance of good family health in improved child health outcomes, this secondary cohort analysis tested the hypothesis that family health would improve from baseline to 12-week follow-up after participation in a novel family nutrition program. Methods: Diverse parent-child dyads participated in a home-based virtual Teaching Kitchen Outreach (vTKO) program (11 weekly healthy, low-cost recipes, cooking videos, and associated groceries delivered). The primary outcome was the Family Healthy Lifestyle Subscale (FHLS). Secondary outcomes were parent and child nutrition, and food insecurity. Statistical testing and modeling were used to evaluate pre-post outcomes. Results: Of 123 enrolled dyads, 114 (93%) had sufficient data for analysis. Participants were 11% Hispanic, 54% Black, and 28% White; 31% completed high school or less; and 30% indicated food insecurity. Cohort mean pre-post FHLS scores significantly increased (25.5 vs. 27.3; p < 0.001). There were significant improvements in parent nutrition (p < 0.001) and child nutrition (p = 0.02 to < 0.001), but not in food security. After adjusting for baseline covariates, tobit regression found statistically significant pre-post FHLS differences (2.3; 95% CI=[1.4, 3.3]; p < 0.001). Discussion: Participants in the novel home-based vTKO program reported improved family health over 12 weeks. Significance: While nutrition programs can improve individuals' behavior, it is not known how they impact the health of the family unit. This home-based virtual nutrition program provided groceries and taught food management skills to underserved families, examining family health differences over time. Family health is a proximal social determinant of health that predicts risk or resilience during times of stress. This is the first study to examine a change in family health over time. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess family‐related predictors of self‐management trajectories in youth with spina bifida (SB). Participants with SB completed the Adolescent/Young Adult Self‐Management and Independence Scale (AMIS II) interview across four time points. Family functioning, family‐related stress, and perceived family support were assessed by multiple reporters and multiple methods. Growth in AMIS II total self‐management and the AMIS II subscales (Condition and Independent Living) were estimated using linear mixed effect models as a function of family factors, after controlling for socio‐demographic, condition‐related, and neuropsychological variables that had been found to be significant predictors of self‐management in prior studies. Model fit and parsimony were assessed using Akaike's information criterion (AIC). This diverse community sample included 99 respondents aged 18–27 years old. About half were female (52.5%) and White (52.5%); 15.2% were Black, and 32.3% were Hispanic/Latino. Observed family cohesion at baseline was associated with all self‐management scales at age 18 (all p < 0.05). Growth in self‐management was associated with parent‐reported number of family stress events. For growth in total self‐management, the best model included age, race/ethnicity, family income, shunt status, lesion level, neuropsychological function, observed family cohesion, and an age‐by‐number of family stress events interaction effect. The study findings suggested that family factors were important predictors of self‐management trajectories, even after controlling for socio‐demographic, condition‐related, and neuropsychological covariates. Risk and protective factors identified in families of youth with SB can inform family‐focused interventions for self‐management. [ABSTRACT FROM AUTHOR]

Using a qualitative methodology, 14 women experiencing food insecurity were interviewed to explore their experiences with engaging in healthy eating to manage their weight. Data was collected using semi-structured interviews and evaluated using content analysis methods. Resilience factors situated throughout the social environment altered the path from exposure to risk (food insecurity) to poor outcomes (unhealthy eating behaviors/obesity). Resilience factors included social safety net programs, transportation, stretching the food budget, nutritional knowledge, and motivation. Study results can be used to develop strength-based policies and interventions to address obesity among women with low incomes. [ABSTRACT FROM AUTHOR]

• Metabolic syndrome (MetS), a major global problem, predisposes to both T2DM and ASCVD. • There is a paucity of data on the TG-glucose (TyG) index in the US population,despite it being a very reliable marker of insulin resistance in other countries. • We compared the TyG index to HOMA-IR as a discriminant of MetS in the US population (NHANES data). • It is a superior predictor of MetS than HOMA-IR in the US population and is more cost-effective. Metabolic syndrome (MetS) is a cluster of cardio-metabolic features portending an increased risk for both type 2 diabetes mellitus (T2DM) and premature atherosclerotic cardiovascular disease (ASCVD). Homeostasis model assessment of insulin resistance (HOMA-IR) is a widely used surrogate measure of insulin resistance. The triglyceride-glucose (TyG) index is another validated measure of insulin resistance that predicts both diabetes and cardiovascular disease in low and medium-income countries, but only diabetes in high income countries. Due to the paucity of data on the TyG index in the US population, we compared the validity of the TyG index and HOMA-IR in predicting MetS. Data from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018 on Non-Hispanic White (NHW), Hispanic American (HA), and African American (AA) individuals (n = 5380) aged 20–80 years were used for analysis. Individuals were classified as having MetS based on three or more of its components. HOMA-IR and the TyG index were determined from fasting samples. Both the TyG index and HOMA-IR were significantly increased in MetS and increased significantly with increasing severity of the syndrome. Also both indices correlated significantly with all 5 features of MetS, hsCRP and non-HDL-C. ROC-AUC analysis for TyG index was significantly greater than that of HOMA-IR in predicting MetS: 0.87 (95 % CI 0.85–0.88) versus 0.82 (95 % CI 0.81–0.83) respectively, p < 0.0001. This was not evident for the small AA subgroup. The TyG index outperformed HOMA-IR in predicting MetS, a proxy for both T2DM and ASCVD, in a general US population and is a valuable biomarker. [ABSTRACT FROM AUTHOR]

Background: Physical agent modalities (PAMs) are used by occupational therapists to prepare for or facilitate participation in purposeful activities. However, little has been published in the last quarter century regarding how U.S. occupational therapists use and are prepared to use of PAMs in contemporary clinical practice. In this study, U.S.-based occupational therapists were surveyed regarding their use of PAMs, preparation for use, and perceptions of that preparation. Methods: Survey data was collected from a purposive sample of 141 U.S.-based occupational therapists and occupational therapy assistants as part of this exploratory-descriptive, mixed-methods study. Thematic and descriptive statistical analyses were completed using quantitative and qualitative data. Results: Quantitative data provided a current profile of types, frequency, and settings in which PAMs are used, along with sources and perceptions of training. Qualitative data yielded three themes, including (a) benefit of experiential learning, (b) benefit of continuing education, and (c) relative adequacy of entry-level training. Conclusions: Findings from this study serve as an initial step in understanding contemporary use of PAMs in clinical occupational therapy practice. Further study is needed to expand the knowledge base in the profession and support an evidence-informed approach to care. [ABSTRACT FROM AUTHOR]

Background: The purpose of this report is to provide insight and details regarding the development and implementation of an injury and illness surveillance (IIS) system for the United States Olympic and Paralympic Committee (USOPC). Methods: The development and deployment of the IIS employed a multiphase approach. First, researchers determined variables to include in the IIS using the recommendations from the 2020 IOC consensus statement for reporting sport epidemiological data. Second, the hosting and deployment platforms were comprehensively evaluated for their suitability, ease of use, flexibility, and backend data structure (for both capture and aggregation). Third, focus groups consisting of the Sports Medicine department leadership and clinicians piloted the IIS system and revisions were made based on their feedback. Pilot testing of the IIS and follow-up focus groups were then conducted among all departmental clinicians to solicit additional feedback and drive further revisions. Finally, the IIS system was piloted among providers working during the 2023 Pan American and Parapan American Games to refine the system for future Games. After reviewing all potential software platform options (electronic medical record [EMR] system, athlete management systems, secure data collection platforms), Qualtrics (Qualtrics, Provo, UT, USA) was selected to host the IIS system. This choice was made due to the inability of the EMR and athlete-management systems to make frequent updates, modify existing questions, and provide the necessary form logic for the variety of scenarios in which the IIS system would be deployed. Feedback from the department's leadership and clinicians resulted in a number of changes, most notably being the ability to enter multiple diagnoses for a single injury event. Additionally, clinician feedback resulted in the creation of additional diagnostic codes not currently present in the OSIICS v14.0 diagnostic coding system, adding "non-sport" as an additional variable for injury setting, and developing a system for reporting return-to-sport date for time-loss injuries. Discussion: A multi-stage process of extensive planning, stakeholder feedback, and ongoing updates is required in order to successfully develop and implement an IIS system within a National Olympic and Paralynpic Committee. This process can be used to inform the development and implementation of IIS systems in other sporting organizations. [ABSTRACT FROM AUTHOR]

Further research is urgently needed to address the disproportionately high rates of eating disorders (EDs) among transgender, gender diverse, and intersex (TGDI) individuals in comparison to cisgender, endosex (non-intersex) populations. As TGDI advocates, academics, and clinicians with lived/living experience with EDs, we propose a set of recommendations to guide ethical research specifically about EDs and disordered eating behaviors in TGDI populations. The guidelines included here aim to educate non-TGDI researchers and support TGDI researchers seeking to carry out such research. Considerations for study design, planning, data collection, and dissemination are included. [ABSTRACT FROM AUTHOR]

Simple Summary: Immune checkpoint inhibitors (ICIs) are a type of immunotherapy used to treat a variety of cancers by helping a patient's own immune system to kill cancer cells. ICIs received their regulatory approval based on the results of large, randomized clinical trials. However, certain patient groups were excluded from these trials, so their outcomes are unknown. We performed a multicenter, retrospective study of real-world data in the United States in patients who had received at least one cycle of ICI treatment to evaluate the efficacy and safety of ICIs in patient groups underrepresented in clinical trials. Unique patient groups included age > 75 years, non-White race, positive smoking history, poor performance status, obesity, autoimmune diseases, chronic viral infections, multiple previous cancer therapies, or >three metastatic sites. Overall, ICIs were safe and efficacious in these patient groups. We noted that poor performance status and a history of multiple cancer therapies were associated with poor ICI efficacy, and Black patients, compared to White patients, experienced fewer immune-related adverse events. Regulatory approval of immune checkpoint inhibitors (ICIs) was based on results of large, randomized clinical trials, resulting in limited outcomes data in patient cohorts typically underrepresented in such trials. The objective of this study was to evaluate the efficacy and safety of ICIs in these unique patient cohorts. This is a multicenter, retrospective analysis of real-world data at six academic and community clinics in the United States from 1 January 2011 to 1 April 2018. Patients were included if they had received at least one cycle of ICI treatment. Unique patient cohorts included age > 75 years, non-White race, positive smoking history, ECOG performance status (PS) ≥ 2, BMI ≥ 30 kg/m2, autoimmune diseases (AIDs), chronic viral infections (CVI), extensive prior lines of therapy (LOTs), or >three metastatic sites. Immune-related adverse events (irAEs), overall survival (OS), and time to treatment failure were evaluated in the entire cohort and in NSCLC patients treated with PD-(L)1 monotherapy. Outcomes and their association with unique patient cohorts were compared on univariate analysis and multivariate analysis to those without a particular characteristic in the entire NSCLC PD-(L)1 monotherapy cohorts. In total, 1453 patients were included: 56.5%—smokers, 30.4%—non-White, 22.8%—elderly, 20.8%—ECOG PS ≥ 2, 15.7%—history of AIDs, and 4.7%—history of CVI. The common ICIs were nivolumab (37.1%) and pembrolizumab (22.2%). Black patients, compared to White patients, experienced fewer irAEs (OR 0.54, p < 0.001). An ECOG PS of ≥2 (HR = 2.01, p < 0.001) and an increased number of previous LOTs were associated with poor OS (the median OS of 26.2 vs. 16.2 vs. 9.6 months for one vs. two vs. three prior LOTs, p < 0.001). The above results were confirmed in anti-PD-(L)1 monotherapy non-small cell lung cancer patients (n = 384). Overall, ICIs were safe and efficacious in these typically underrepresented patient cohorts. We noted ECOG PS ≥ 2 and an increased prior LOTs were associated with poor ICI efficacy, and Black patients, compared to White patients, experienced fewer irAEs. [ABSTRACT FROM AUTHOR]

Projected changes to spring phenological indicators (such as first leaf and first bloom) are of importance to assessing the impacts of climate change on ecosystems and species. The risk of false springs (when a killing freeze occurs after plants of interest bloom), which can cause ecological and economic damage, is also projected to change across much of the United States. Given the coarse nature of global climate models, downscaled climate projections have commonly been used to assess local changes in spring phenological indices. Few studies that examine the influence of the sources of uncertainty sources in the downscaling approach on projections of phenological changes. This study examines the influence of sources of uncertainty on projections of spring phenological indicators and false spring risk using the South Central United States. The downscaled climate projections were created using three statistical downscaling techniques applied with three gridded observation datasets as training data and three global climate models. This study finds that projections of spring phenological indicators and false spring risk are primarily sensitive to the choice of global climate models. However, this study also finds that the formulation of the downscaling approach can cause errors representing the daily low‐temperature distribution, which can cause errors in false spring risk by failing to capture the timing between the last spring freeze and the first bloom. One should carefully consider the downscaling approach used when using downscaled climate projections to assess changes to spring phenology and false spring risk. [ABSTRACT FROM AUTHOR]