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Many college students "mature out" of heavy drinking when they graduate. Yet, those who go onto graduate education report engaging in problematic drinking patterns. Drinking motives are one factor that uniquely predicts problematic drinking patterns in college students. Evidence suggests that these unique associations also generalize to individuals' post-college, specifically between drinking motives and specific alcohol-related consequences. However, no research to date has examined the association between drinking motives and alcohol-related consequences in graduate students. The current study aimed to examine the unique associations between drinking motives, and drinks per week and specific alcohol-related consequences. Participants included 330 graduate students from various universities in the United States, recruited through social media. The majority of participants were White (71.3%), 54.9% female identifying, with a mean age of 26. Results revealed that conformity motives were positively associated with drinks per week, self-control consequences, self-care consequences, risky consequences, academic/occupational consequences, and blackout consequences. Social motives were negatively associated with interpersonal consequences and academic/occupational consequences. Enhancement motives were negatively associated with drinks per week, and positively associated with academic/occupational consequences. However, coping motivation was not associated with any of the outcomes. These findings highlight the need to further understand how drinking motives influence specific types of alcohol-related consequences as these associations change post-college. Results can be used to better inform future prevention and interventions for this population., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Objectives: The Centers for Medicare and Medicaid Services Severe Sepsis and Septic Shock Management Bundle (SEP-1) assesses antibiotic administration, lactate measurement, and blood culture collection within 3 h of severe sepsis onset. The impact of the SEP-1 3-hour bundle among patients with severe sepsis is not extensively described. This investigation aimed to describe the impact of 3-hour bundle compliance on 28-day in-hospital mortality in patients with severe sepsis., Study Design: This was a retrospective, propensity adjusted, nested case-control study assessing the impact of compliance with a 3-hour sepsis bundle among patients with severe sepsis., Setting: This study was conducted at a large, academic, tertiary care medical center in Detroit, Michigan from July 1, 2017 to December 31, 2019., Patients: Cases were defined as those suffering 28-day in-hospital mortality. Controls were defined as those surviving at or discharged by 28 days. Patients were separated based on 3-hour bundle compliance or noncompliance. Nested and overall cohorts were assessed. Severe sepsis time zero was manually validated. Patients with shock, requiring vasopressors within 8 h of time zero, or those not meeting SEP-1 inclusion criteria were excluded., Intervention: The primary outcome was the propensity adjusted odds of 28-day in-hospital mortality among 3-hour bundle compliant versus noncompliant patients. Secondary outcomes included mortality for individual bundle element compliance, progression to septic shock, and predictors of mortality according to logistic regression., Results: A total of 325 compliant and 325 noncompliant patients were included. The median Sequential Organ Failure Assessment (SOFA) score was three in each group. There was no difference in propensity adjusted odds of mortality among those compliant versus noncompliant with the 3-hour bundle (odds-ratio [OR] 1.039; 95% CI: 0.721-1.497; p = 0.838) or with individual bundle elements. SOFA score and female sex were predictors of mortality., Conclusions: Three-hour bundle compliance did not impact 28-day in-hospital mortality in patients with severe sepsis. Further research is needed to understand the impact of 3-hour bundle compliance on mortality in severe sepsis., (© 2022 Pharmacotherapy Publications, Inc.)

There are thousands of rare genetic diseases and many genetic and nongenetic contributors to common genetic diseases. The evidence base that is currently available about the great majority of these conditions is limited to case studies and relatively small observational study sets derived from one or several institutions. Hence, the statistical power in any one study is usually quite limited. Further, in the absence of organized registries and data collection on particular patient groups, the information available is weak and the patient resources that are available are limited. It is only through organized and coordinated clinical investigation systems that a sufficient number of patients with these diseases can be accumulated to provide the statistical power needed to inform about clinical history of treated and untreated forms, provide the resources needed for clinical trials of new tests and treatments, provide a sufficiently powered evidence base for public health decision-making and other uses. The meeting in which these issues were raised resulted in a set of proposed principles and associated recommendations as to how best to achieve the vision of creating an extensive and comprehensive collaboration of professional and lay communities to enable translational research to improve clinical care and therapies for persons with rare genetic diseases.

Background: Root cause analysis (RCA), used to study the conditions leading to acute accidents, was adapted to analyze adverse events in chronic medical conditions., Methods: RCA was modified to investigate "trigger events"--markers of potential adverse events--in outpatient diabetes care. For 20 cases with the trigger event of hypoglycemia evidenced by an A1C of > or = 11%, a multidisciplinary team reviewed the findings of medical record abstractions, provider interviews, and patient interviews for each case. The RCA team identified active failures, error-producing conditions, latent conditions, and defenses leading to the trigger event in each case., Results: The methodology identified potential root causes of persistent hyperglycemia. Latent conditions, error-producing conditions, and active failures occurred at the assessment, planning, and implementation phases of a diabetes visit. Recurring failure modes were identified within and across cases., Conclusion: RCA can be used to study trigger events in medical care for chronic conditions. Although the data collection occurs months after the event, this methodology can identify variations in chronic care and stimulate discussion about potential solutions.

With Illinois' plan to embark on a statewide Medicaid managed care program, the impact of Medicaid resources on core public health responsibilities of local health departments (LHDs) was assessed and found to be substantial. A reduction of $330,000 in core public health activities would likely accompany each $1 million in Medicaid resources lost by these LHDs. Only by actively participating in the planning and implementation of these conversions can public health agencies maintain high productivity and efficiency in addressing core public health responsibilities in their communities.