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The purpose of this study was to expand our understanding of fear of childbirth (FOC) by examining the interplay between individual, provider, identity, and culture among women historically underrepresented in FOC research to develop a deeper understanding of FOC. Purposive sampling was used to recruit 22 participants into three different focus groups, each with a unique demographic makeup. The results provide evidence that people's birth experiences and their experiences with fear surrounding childbirth are affected by many other social mechanisms, including relationships with providers, birth setting, race, class, gender, sexual orientation, and ethnicity. [ABSTRACT FROM AUTHOR]

National forest law enforcement officers regularly encounter "nonrecreational" campers whose tenure exceeds established stay limits (generally 2 weeks). Some long-term occupants are homeless and seek use of the forest as a temporary or long-term residence. Long-term nonrecreational campers present myriad concerns for forest officials, who seek to balance public access and resource conservation. In addition to biophysical impacts because of waste, disposal of chemicals, soil compaction, and damage to vegetation, nonrecreational campers can alter the social environment being shared with other forest visitors. For this exploratory study, US Forest Service law enforcement officers (n = 290) were surveyed to assess officer perceptions of the frequency of encounters, trends, and types of nonrecreational campers. We provide a descriptive summary of major findings and point out regional variations and trends. Officers perceive regional variations in the frequency of encounters with nonrecreational or homeless campers as well as types of campers encountered. [ABSTRACT FROM AUTHOR]

The article examines the human resource (HR) practice of benchmarking in the United States. Benchmarking HR practices empowers a company to measure how it is delivering HR practices. It also enables a company to learn from other, and can be used to create a need for change. On the downside, benchmarking may be utilized to limit a company's performance. Two companies, namely, Digital Equipment Corp. and United Technologies Corp. provide different approaches to the uses, processes, and outcomes of HR benchmarking.

The article focuses on the legal status of fake news in the U.S. Topics include background of defamation law; N.Y. Times Co. v. Sullivan court case established the actual malice standard; and sticking balance between First Amendment rights to U.S. Constitution namely freedom of speech and individual's right to recover for unlawful harm of the reputation.

Breast carcinoma in young women aged less than 40 years attracts a high level of mainstream media coverage, and there is a gap between societal perceptions of the disease as a growing problem and epidemiological trends. Several population studies have reported that the overall incidence of breast carcinoma in young women is stable, while one recent article suggested that the relative proportion of breast carcinoma in young women that is metastatic at diagnosis is growing. We sought to establish whether these trends were apparent at our institution. In this study, the clinical database at a breast carcinoma tertiary center was reviewed in terms of clinicopathologic data on patient age, diagnosis, clinical and pathologic stage, hormone receptor status, and HER-2 overexpression status for the period 2000-2011. Over the study period, young patients represented a decreasing proportion of all breast carcinoma cases (10.8% [2000-2003] to 8.7% [2008-2011]; p < 0.0001) treated at our institution. Young patients were more likely than patients aged 40 years or older to present with metastatic (M1) disease (5.4% versus 4.4%; p = 0.009), to be triple negative (21.6% versus 13%; p < 0.001), or to be HER-2 positive (24.3% versus 14.8%; p < 0.01). Young patients with HER-2-positive cancers were significantly more likely to present with metastatic disease (8.3% versus 4.8%; p = 0.004). This study showed no demonstrable increase in the relative proportion of breast cancer occurring in patients aged <40 years over the 12-year period 2000-2011 and no increase in the proportion of young patients presenting with metastatic disease. [ABSTRACT FROM AUTHOR]

Objectives: On December 2013, the US FDA proposed a rule stating that manufacturers must provide data to demonstrate that antibacterial soap is more effective than plain soap or water. The objective of the present study was to examine the in vitro and in vivo bactericidal effect of triclosan (the most widely used antiseptic agent in soap) in soap.Methods: Twenty bacterial strains (proposed by the FDA) were exposed to plain and antibacterial soaps (the same formulation as plain soap, but containing 0.3% triclosan) for 20 s at 22°C (room temperature) and 40°C (warm temperature). The temperature and time were selected to simulate the hand washing conditions and procedures used by consumers. The triclosan concentration of 0.3% is the maximum allowed by law. The decontamination efficacy of plain soap and antibacterial soap was also examined in vivo: the hands of volunteers were artificially inoculated with Serratia marcescens.Results: There was no significant difference (P > 0.05) in bactericidal activity between plain soap and antibacterial soap at either test temperature. However, antibacterial soap showed significantly greater bactericidal effects after 9 h. These results suggest that although triclosan-containing soap does have antibacterial activity, the effects are not apparent during the short time required for hand washing.Conclusions: Antibacterial soap containing triclosan (0.3%) was no more effective than plain soap at reducing bacterial contamination when used under 'real-life' conditions. The present study provides practical information that may prove useful for both industry and governments. [ABSTRACT FROM AUTHOR]

The author reflects on the pan-Asian American social movement to free Chol Soo Lee, a Korean-American immigrant wrongfully convicted of murder in the 1970s. Particular focus is given to the author's role in the movement as an investigative reporter and to his admiration for young Asian-American activists such as Ranko Yamada who played key roles in creating the coalition that helped to overturn Chol Soo Lee's conviction.

Research and development involving intelligent vehicles of today is geared to safe, driver-friendly and sensitive vehicles that provide a driver with a pleasant and convenient driving environment while preventing him or her from possible risks of accident. In developing convenient and safe vehicles, research on drivers' driving patterns, reactions and state characteristics depending on road conditions in actual field is essential in order to devise more driver-friendly intelligent vehicles. This paper describes how a driver-vehicle interaction (DVI) field database is built in order to obtain a driver's input in normal road driving condition on highways, country roads, and city roads, and his or her state information, as well as data on the vehicle and traffic conditions. And the newly built database is compared with the RDCW FOT database established by UMTRI of the US for analysis to suggest that the driving tendencies of drivers in Korea and the road driving conditions are not the same as those in the US, reconfirming the need to establish a DVI field database, which will be used for the development of intelligent vehicles suitable for the Korean environment. The DVI data collected from actual driving in field are anticipated to be widely utilized as basic data for research on various intelligent driving safety systems, advanced driver assistance systems (ADAS) and human-vehicle interface (HVI) that are suitable for the driving environment in Korea. [ABSTRACT FROM AUTHOR]

National Kidney Disease Education Program has initiated a serum creatinine standardization program. Glomerular filtration rate (GFR) can be re-estimated from standardized serum creatinine measurements. How the standardized estimated GFR (eGFR) influences hypertension prevalence has not been evaluated. In this study, cross-sectional data from 21 205 participants aged 18 years in the National Health and Nutrition Examination Survey 1999-2006 were analyzed. The differences between standardized and non-standardized eGFRs in the prevalence of hypertension and low eGFR were evaluated. Multiple logistic regression models were conducted to determine the association of standardized eGFR with hypertension prevalence. The prevalence of low eGFR estimated from standardized eGFR was higher than that from non-standardized eGFR (all P<0.01), except for the 2005-2006 survey. The prevalence of hypertension under standardized eGFR was not significantly different from that under non-standardized eGFR in both groups of participants with eGFR>60 and eGFR60 ml min−1 per 1.73 m2. Adjusted for age, education, gender, race/ethnicity, smoking, serum cholesterol and diabetes mellitus, the participants with standardized eGFR60 ml min−1 per 1.73 m2 had 56.1% more chance to be hypertensive patients than those with normal eGFR (P<0.0001). The difference in the relationship to hypertension prevalence between standardized and non-standardized eGFR was not found significant. [ABSTRACT FROM AUTHOR]

Interdisciplinary (ID) teams were created by the US Forest Service in response to environmental legislation. In 2008, we surveyed ID team leaders for National Environmental Policy Act (NEPA) analysis of 106 recreation-related projects conducted between 2005 and 2008. Results were compared with current workforce data and previous studies of ID team leadership and composition for NEPA assessments. ID teams were large in size and diverse in composition, with representatives of a broad range of disciplines and functional areas. The composition of ID teams may be changing from traditional natural resource management to more discipline-specific expertise. The role of social scientists and other human dimension specialists remains modest, despite the importance of social science questions inherent in recreation projects. Results reflect changes in agency hiring practices in the last 20 years and raise questions about the interdisciplinary nature of US Forest Service ID teams. [ABSTRACT FROM AUTHOR]

Interdisciplinary teamwork has become a foundation of natural resources planning and management in the US. Yet, we know little about the degree of interdisciplinary collaboration of natural resource planning teams. We conducted 10 case studies of Forest Service NEPA (National Environmental Policy Act) teams working on projects related to the 2005 Travel Management Rule. Although teams' critical tasks were similar, we found wide variation in interdisciplinary teamwork approaches. We propose three typologies of teamwork processes and discuss relationships between teams' work approaches and process outcomes. Rather than being easily labelled as holistically 'collaborative' or 'non-collaborative', teams may more typically move in and out of different modes of collaboration (or non-collaboration) throughout the different stages of teamwork processes. Results suggest that greater external pressure may lead teams to adopt a more internally collaborative approach and that empowering leadership styles may enhance the success of more collaborative approaches in terms of perceived outcomes. Future research on the relationships between extra-team context, team collaboration, and leadership styles may provide insight into the drivers of outcomes in natural resource planning teams. [ABSTRACT FROM AUTHOR]

The National Environmental Policy Act (NEPA) and its accompanying regulations provide a spectrum of alternative analytical pathways for federal agencies proposing major actions that might significantly impact the human environment. Although guidance from the President's Council on Environmental Quality suggests the decision to develop an environmental impact statement (EIS), which requires the most rigorous level of analysis, should be based on the likelihood of significant environmental impacts, findings from an Internet survey with US Forest Service project leaders suggest that the decision may more commonly be based on process-related risks, including the threat of litigation, perceived defensibility in court, and the level of public and political interest in the agency's proposed action. An analysis of judicial decisions in NEPA-related litigation reveals that EISs do not appear to be more defensible than environmental assessments in the courts, suggesting that current decisionmaking about NEPA documentation may be misguided, leading to unnecessary project expenditures and delays. [ABSTRACT FROM AUTHOR]

The author analyzes the medical care impact of the decision by the U.S. Centers for Medicare and Medicaid Services (CMS) to impose additional reimbursement rules for the use of positive airway pressure (PAP) equipment in treating obstructive sleep apnea beyond 90 days. Clinicians are concerned about the burden imposed on them and on providers of durable medical equipment and on the impact of the rules on patients. The author also discuss local coverage determinations (LCD) and the use of compliance cards by Medicare beneficiaries.

This study looks at the effect of news images and race on the attribution of responsibility for the consequences of Hurricane Katrina. Participants, Black and White, read the same news story about the hurricane and its aftermath, manipulated to include images of White victims, Black victims, or no images at all. Participants were then asked who they felt was responsible for the humanitarian disaster after the storm. White respondents expressed less sense of government responsibility when the story included victims' images. For Black respondents this effect did not occur. Images did not affect attribution of responsibility to New Orleans' residents themselves. These findings are interpreted to support the expectations of framing theory with the images serving as episodic framing mechanisms. [ABSTRACT FROM AUTHOR]

Promotion of effective science exchange between government scientists and managers requires thoughtful arrangement and operation of research and management functions. The US. Forest Service was established at the peak of the Progressive Era, when science exchange was designed to occur between researchers and resource managers who worked in distinct arms of the agency, but shared similar goals of effective forest management. In this article, the authors explore the implications of diminished agency capacity for science exchange interactions between researchers and managers in recreation management. Managers and researchers identified their current interactions, their perceptions of ideal interactions, and barriers to achieving those ideals. Reductions in agency capacity for recreation management have resulted in the erosion of interactions between managers and researchers. However, effective science exchange does occur, but requires innovative and adaptive approaches. [ABSTRACT FROM AUTHOR]

We used the National Institutes of Health (NIH) criteria for the diagnosis, classification and scoring of chronic GVHD (cGVHD) to reevaluate patients with cGVHD originally diagnosed using classic criteria. We retrieved data from 236 patients diagnosed with cGVHD on the basis of classic criteria. Excluding 20 ‘liver-alone’ patients, we re-categorized 216 patients in keeping with the NIH criteria. Twenty patients were reclassified as having acute GVHD and 196 patients as having cGVHD (170 ‘classic chronic’ (Cl-Ch) and 26 ‘overlap chronic’ (Ov-Ch)). The 5-year GVHD-specific survival (GSS) was significantly different between the two cGVHD subtypes, specifically 87.3% for Cl-Ch vs 70.2% for Ov-Ch (P=0.006). The NIH severity criteria were effective in expecting 5-year GSS rates at both the onset (93.5, 81.3 and 79.7% (P=0.047)) and peak intensity of the disease (100, 89.7 and 78.7% (P=0.004) for the mild, moderate and severe grade, respectively). Multivariate analysis showed that NIH severity criteria were independently significant prognostic factors for GSS (mild vs moderate, HR 4.35, P=0.036; mild vs severe, HR 5.25, P=0.020). Our results support the role of the NIH criteria in classifying cGVHD and in assessing the severity of the disease to predict patient prognosis of cGVHD. [ABSTRACT FROM AUTHOR]

Optical diffuse reflectance spectroscopy (DRS) has been used to estimate soil physical and chemical properties, but much of the previous work has been limited to surface soils or to samples obtained from a restricted geographic area. Our objectives in this research were: (1) to assess the accuracy of DRS for estimating variation in several important surface and profile soil properties across a wide range of soils from the U.S. Corn Belt, and (2) to determine the wavelength ranges and/or specific wavelengths that should be included in a DRS soil property sensor Soil cores were obtained to a 120 cm depth from ten fields, two each in Missouri, Illinois, Michigan, South Dakota, and Iowa. Cores were segmented by pedogenic horizon and samples (n = 165 for the surface soil horizon, n = 697 for all soil horizons in the profile) were analyzed for texture fractions, cations (calcium, magnesium, and potassium) and cation exchange capacity (CEC), pH, total and organic carbon, and total nitrogen using standard laboratory procedures. Spectra were obtained on sieved, air-dried soils from 350 to 2500 nm using a commercial three-detector spectrometer Reflectance data were related to soil properties using partial least squares (PLS) regression and stepwise multiple linear regression (SMLR). Calibration accuracies varied among the different soil properties, but for a given soil property, similar accuracies were generally obtained with PLS and SMLR. The most accurate estimates, with R2 values above 0.8, were obtained for organic carbon, clay, CEC, and calcium. When data from each of the three spectrometer detector ranges were analyzed separately with PLS, the third detector range (1770 to 2500 nm) provided results similar to those obtained using the complete spectral range. Discrete wavelength models that described 90% or more of the variance described by a full model were obtained using eight or fewer wavelengths for the profile dataset and six or fewer wavelengths for the surface dataset. Several wavelengths and wavelength ranges common to models for multiple soil properties were identified: 2070 nm, 1870 to 1915 nm, and 2220 to 2410 nm. Because additional wavelengths important for individual soil properties were dispersed across the 1770 to 2500 nm spectral range, a full-spectrum sensing approach is recommended for simultaneous estimation of multiple soil properties. A discrete-waveband sensor could be practical for estimating one or two individual soil properties. [ABSTRACT FROM AUTHOR]

The article discusses a report on the link between neonatal deaths and congenital heart defects in the U.S. between 2003 and 2006, published in the 2010 issue of the "Morbidity and Mortality Weekly Report." The report summarized a study which analyzed the causes of neonatal deaths in the country. Such study showed that 4.2 percent of all neonatal deaths are due to congenital heart disease. The report revealed that the overall neonatal mortality rate due to congenital heart defects is not related to race. The limitations of the report are discussed, along with factors that need to be considered for research on neonatal mortality.

This article investigates relationships between public nature and health for unsheltered homeless populations. It examines perceptions of health benefits and harms for people living in public natural areas including local, state, and national forests and parks in the Seattle metropolitan area (USA). Interviews with environmental, social service, and law enforcement professionals who regularly interact with this vulnerable population were conducted and thematically analyzed to understand perceptions of physical and mental health outcomes. Results show professionals' perspectives on the health benefits and detriments of time spent in natural environments and the contextual factors perceived to influence health. Interviewees' observations about the variability of personal circumstances and biophysical, social, and weather conditions encourage the nuanced consideration of how contingent therapeutic landscapes provide deeply needed benefits, but for a population with a diminished capacity to adapt when conditions change. We conclude with insights for future research that directly assesses homeless populations' exposures and health outcomes of living in public natural areas. • Professionals observe benefits and harms of natural area use for homeless populations. • Perceived harms include increased environmental exposures and social vulnerability. • Perceived benefits include privacy, desired social conditions, and reduced stress. • Relationships between nature and health were seen as variable and context dependent. [ABSTRACT FROM AUTHOR]

Examines the implication of trends and racial differences for the incidence of congenital diaphragmatic hernia (CDH) in the United States. Decline in the neonatal mortality rate from other disorders; Incidence of CDH in African-American infants; Frequency of CDH in female infants.

The article presents a medical protocol in examining the specimens of breast cancer patients offered by the College of American Pathologists in the U.S. It notes that the protocol is applicable to all invasive carcinomas of the breast which include ductal carcinoma in situ (DCIS) with microinvasion. Moreover, it also provides instructions, explanatory notes, and images that further explain the protocol.

Background: Peripartum cardiomyopathy (PPCM) outcomes have been previously linked to demographic and social factors. The social vulnerability index (SVI) is a measure of social vulnerability in the United States. We explored PPCM disparities and the impact of SVI on PPCM mortality., Methods and Results: Mortality from 1999 to 2020, SVI, and demographic data were obtained from CDC databases. County-specific SVI rankings were linked to PPCM age-adjusted mortality rates (AAMRs), allowing for a comparative analysis of AAMRs across both cumulative populations and subpopulations to identify disparities. All US counties were then stratified into low- and high-SVI groups, facilitating comparison of SVI rankings by estimation of excess-deaths per 1 000 000 person-years attributable to greater social vulnerability and rate ratios (RR) through univariable Poisson regression. We identified a total of 1026 deaths related to PPCM between 1999 and 2020. Overall AAMR increased from 0.180 in 1999 to 0.326 in 2020. Black populations (AAMR: 1.081) and Southern US counties (AAMR: 0.444) had the highest AAMRs compared with other racial and US census groups, respectively. Higher SVI accounted for 0.172 excess deaths per 1 000 000 person-years (RR=1.800). Among Black and White populations, higher SVI also accounted for 0.248 and 0.071 excess deaths per 1 000 000 person-years, respectively. Similar impacts of greater social vulnerability were observed when comparing the US census regions (Northeast RR=1.609, Midwest RR=1.819, South RR=1.934, West RR=1.776)., Conclusions: PPCM mortality disparities exist across racial and geographic populations in the United States. A greater burden of social vulnerability is associated with higher PPCM mortality on a national level.

COVID-19 case rates in the US wax and wane in wave-like patterns over time, but the spatial patterns of these temporal epidemic waves have not been well characterized. By analyzing state- and county-level COVID-19 case rate data for spatiotemporal decomposition modes and oscillatory patterns, we demonstrate that the transmission dynamics of COVID-19 feature recurrent spatiotemporal patterns. In addition to the well-recognized national-level annual mid-winter surges, we demonstrate a prominent but previously unrecognized six-month north-south oscillation in the eastern US (Eastern US COVID-19 Oscillator-EUCO) that gives rise to regional sub-epidemics and travelling epidemic waves. We also demonstrate a second less prominent pattern that oscillates east-west in the northern US (Northern US COVID-19 Oscillator-NUCO). The drivers of these newly recognized oscillatory epidemic patterns remain to be elucidated., (© 2024. The Author(s).)

This study examined racial disparities in Head Start's impact on health outcomes for families with young children in poverty. Research questions were as follows: (a) are there racial disparities in health outcomes among low-income families? (b) Does Head Start participation promote better health outcomes? And (c) does Head Start's impact on health outcomes differ by race and ethnicity? Logistic regression analysis found that African American and Hispanic children experience lower health outcomes than their white peers, including lower rates of dental screening, more frequent injury-related care, lower overall health status, and lower rates of health insurance coverage. In comparison to White parents, African American and Hispanic parents reported lower levels of cigarette smoking. Children enrolled in Head Start received significantly more dental screening than their non-Head Start peers, regardless of race and ethnicity. The positive impacts of Head Start were particularly pronounced for African American and Hispanic children when compared to White children. Families that do not speak English as their primary language and those with lower household incomes experienced worse health outcomes. The positive impact of Head Start on the health outcomes of marginalized populations highlights the need for continued expansion of Head Start programs, as they strive to provide equal opportunities for improvements in academic, socio-emotional, and health outcomes for children and their parents in low-income households. The recruitment and enrollment process for Head Start should provide eligibility and application information in multiple languages for families in deep poverty., Competing Interests: Declarations Ethics Approval This article does not contain any studies with human participants or animals performed by any of the authors. Consent for Publication I consent for publishing this article if accepted. Conflict of Interest The author declares no competing interests., (© 2023. W. Montague Cobb-NMA Health Institute.)

Introduction: Inflammatory bowel disease (IBD) is linked to immune-mediated pathogenesis and a pro-inflammatory state, leading to accelerated atherosclerosis. This earlier onset of clinical cardiovascular disease poses significant morbidity and mortality. We sought to identify IHD mortality trends in individuals with IBD in the United States (US)., Methods: Mortality due to ischemic heart diseases (IHD) as the underlying cause of death with the IBD as a contributor of death were queried from death certificates using the CDC database from 1999 to 2020. Yearly crude mortality rates (CMR) were estimated by dividing the death count by the respective population size, reported per 100,000 persons. Mortality rates were adjusted for age using the Direct method and compared by demographic subpopulations. Log-linear regression models were utilized to assess temporal variation (annual percentage change [APC]) in mortality., Results: Age-adjusted mortality rates (AAMR) decreased from 0.11 in 1999 to 0.07 in 2020, primarily between 1999 and 2018 (APC -4.41, p < 0.001). AAMR was higher among male (AAMR 0.08) and White (AAMR 0.08) populations compared to female populations (AAMR 0.06) and Black (AAMR 0.04) populations, respectively. No significant differences were seen when comparing mortality between urban (AAMR 0.07) and rural (AAMR 0.08) regions. Southern US regions (AAMR 0.06) had the lowest mortality rates when compared to the other US census regions: Northeastern (AAMR 0.08), Midwestern (AAMR 0.08), and Western (AAMR 0.08)., Conclusion: Disparities in IHD mortality exist among individuals with IBD in the US based on demographic factors, with an overall decline in mortality during the 22-year period. Further investigation is warranted to confirm these findings and evaluate for contributors to the observed disparities., Competing Interests: Declaration of competing interest Authors have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Psoriasis patients experience physical and emotional burdens, which may lead to work-related productivity loss. This loss carries professional and financial repercussions. It is unknown whether the extent of psoriasis affects work absenteeism., Objective: This study aims to compare work absenteeism between employed adults with mild versus moderate-to-severe psoriasis., Methods: A national, cross-sectional study using the 2009 to 2019 Medical Expenditure Panel Survey evaluated 5,209,956 (weighted) adults aged &ge; 22 years. Work absenteeism was compared between adults with mild (4,521,687 weighted) and moderate-to-severe psoriasis (688,269 weighted)., Results: Work absenteeism, as measured by the average number of episodes per year that someone was absent from work for at least a half day, was significantly higher in patients with moderate-to-severe psoriasis than in patients with mild disease (4.4 episodes vs 2.8 episodes, P=0.002). Multivariable logistic regression models showed moderate-to-severe patients were 2.68 times more likely (95% CI:1.72-4.21; P&lt;0.001) to take a half-day or more off from work than those with mild disease after adjusting for age, sex, race, ethnicity, poverty, cognitive limitations, insurance, education, and comorbidities., Conclusion: Disease severity directly impacts work absenteeism in psoriasis patients. Early diagnosis and treatment with appropriate therapies are needed to reduce disease severity and limit economic loss and professional ramifications associated with psoriasis. J Drugs Dermatol. 2024;23(8):640-644.&nbsp; doi:10.36849/JDD.7550.

Introduction: Disparities in stroke outcomes, influenced by the use of systemic thrombolysis, endovascular therapies, and rehabilitation services, have been identified. Our study assesses these disparities in mortality after stroke between rural and urban areas across the United States (US)., Methods: We analyzed the CDC data on deaths attributed to cerebrovascular disease from 1999 to 2020. Data was categorized into rural and urban regions for comparative purposes. Age-adjusted mortality rates (AAMR) were computed using the direct method, allowing us to examine the ratios of rural to urban deaths for the cumulative population and among demographic subpopulations. Linear regression models were used to assess temporal changes in mortality ratios over the study period, yielding beta-coefficients (β)., Results: There was a total of 628,309 stroke deaths in rural regions and 2,556,293 stroke deaths within urban regions. There were 1.13 rural deaths for each one urban death per 100,000 population in 1999 and 1.07 in 2020 (β = -0.001, p trend = 0.41). The rural-urban mortality ratio in Hispanic populations decreased from 1.32 rural deaths for each urban death per 100,000 population in 1999 to 0.85 in 2020 (β = -0.011, p trend < 0.001). For non-Hispanic populations, mortality remained stagnant with 1.12 rural deaths for each urban death per 100,000 population in 1999 and 1.07 in 2020 (β = -0.001, p trend = 0.543). Regionally, the Southern US exhibited the highest disparity with a urban-rural mortality ratio of 1.19, followed by the Northeast (1.13), Midwest (1.04), and West (1.01)., Conclusions: Our findings depict marked disparities in stroke mortality between rural and urban regions, emphasizing the importance of targeted interventions to mitigate stroke-related disparities., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Objective: Radiation-induced carotid artery stenosis (RICS) is a well-described phenomenon seen after head and neck cancer radiation. Previously published literature suggests that, compared with atherosclerotic disease, RICS may result in worse long-term outcomes and early restenosis. This study aims to evaluate the effect of radiation on long-term outcomes after various carotid revascularization techniques using a multi-center registry database., Methods: Patients in the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) registry for carotid artery intervention (carotid endarterectomy [CEA]; transfemoral carotid artery stenting [CAS]; transcarotid artery revascularization [TCAR]), who are 65 years or older were included in the study. VQI Vascular Implant Surveillance and Interventional Outcomes Network (VISION) Medicare-linked database was used to obtain long-term procedure-specific outcomes. Primary endpoints were 3-year death, stroke, and reintervention. We performed propensity matching between patients with prior radiation and those without. Kaplan-Meier analysis and a multivariate logistic regression model were used to analyze the outcome variables., Results: A total of 56,472 patients had undergone carotid revascularization (CEA, n = 48,307; TCAR, n = 4593; CAS, n = 3572), 1244 patients with prior radiation and 54,925 patients without prior radiation. The prior radiation group was more likely to be male (71.9% vs 60.3%; P < .01), to receive a stent (47.5% vs 13.5%; P < .01), and to be on P2Y12 inhibitor (55.2% vs 38.3%; P < .01). Propensity matching was performed on 1223 patients (CEA, n = 655; TCAR, n = 292; CAS, n = 287). There were no significant differences in 30-day outcomes for death, stroke, or major adverse cardiovascular events for all three procedures. The prior radiation group had higher rates of cranial nerve injury (3.7% vs 1.8%; P = .04) and 90-day readmission (23.5% vs 18.3%; P = .01) after CEA. For long-term outcomes, prior radiation significantly increased mortality risk for CEA and CAS (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.38-2.27 and HR, 1.56; 95% CI, 1.02-2.36, respectively). The 3-year risk of stroke for CEA in radiated patients was also significantly higher (HR, 1.47; 95% CI, 1.03-2.09) compared with non-radiated patients. Prior radiation did not significantly affect death and stroke in patients undergoing TCAR. Prior radiation also did not impact the rates of short and long-term reintervention after CEA, CAS, or TCAR., Conclusions: Prior head and neck radiation significantly increases the risk for mortality and stroke for CEA and the risk for mortality after CAS. Long-term outcomes for TCAR are not significantly affected by prior radiation. TCAR may be the preferred treatment modality for patients with radiation-induced carotid stenosis., (Published by Elsevier Inc.)

Background: Antigenic similarity between vaccine viruses and circulating viruses is crucial for achieving high vaccine effectiveness against seasonal influenza. New non-egg-based vaccine production technologies could revise current vaccine formulation schedules. We aim to assess the potential benefit of delaying seasonal influenza vaccine virus selection decisions., Methods: We identified seasons where season-dominant viruses presented increasing prevalence after vaccine formulation had been decided in February for the Northern Hemisphere, contributing to their antigenic discrepancy with vaccine viruses. Using a SEIR (susceptible-exposed-infectious-recovered) model of seasonal influenza in the United States, we evaluated the impact of updating vaccine decisions with more antigenically similar vaccine viruses on the influenza burden in the United States., Results: In 2014-2015 and 2019-2020, the season-dominant A(H3N2) subclade and B/Victoria clade, respectively, presented increasing prevalence after vaccine decisions were already made for the Northern Hemisphere. Our model showed that the updated A(H3N2) vaccine could have averted 5000-65 000 influenza hospitalizations in the United States in 2014-2015, whereas updating the B/Victoria vaccine component did not substantially change influenza burden in the 2019-2020 season., Conclusions: With rapid vaccine production, revising current timelines for vaccine selection could result in substantial epidemiological benefits, particularly when additional data could help improve the antigenic match between vaccine and circulating viruses., Competing Interests: Potential conflicts of interest. S. G. S. reports honoraria from CSL Seqirus, Evo Health, Moderna, and Pfizer. All other authors report no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Immigrant students and families experience disproportionate exposure to trauma, immigration-related stress, structural inequities, and poor access to mental health and social services which can lead to mental health inequities. Immigrant students and their families also have many strengths that can buffer potential negative mental health outcomes. Schools, which address social and emotional development in addition to academic achievement, are critical institutions that can play a unique role in enhancing the strengths and responding to the needs of immigrant students and families. In this review, we adapt the Behavioral Model for Vulnerable Populations to acknowledge the contextual and macro-level factors (e.g., relevant policies, environmental influences, and structural factors) and the predisposing, enabling, and need factors that immigrant students and families experience and impact access to school mental health and social services. We discuss school-based interventions that show efficacy for improving mental health outcomes and focus on addressing acculturative stress among immigrant students. We also discuss models to address social determinants of health need among immigrant students and families within schools, including the community schools model applied to immigrant students and families. We conclude this review by providing recommendations and strategies for pediatricians and schools to transform school-based supports for immigrant students and families and promote equitable outcomes. Our recommendations include incorporating multi-level school supports for addressing mental health, social need, and acculturative stress among immigrant students, along with reinforcing the strengths of immigrant students, and promoting school collaborations with pediatricians, school-based health centers, and trusted community partners., Competing Interests: Declaration of Competing Interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Dr. Roya Ijadi-Maghsoodi and Dr. Sheryl Kataoka received funding from the Rare Impact Fund, NIMH 1U01MH131827-01, the Los Angeles County Department of Mental Health, and are consultants to the Los Angeles Unified School District. They previously received funding from the UCLA David Geffen School of Medicine COVID-19 Research Award. Dr. Jocelyn Meza received grant funding from the American Psychological Association and received salary support for this work as a Co-Investigator from the Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness (ALACRITY) Research Center Grant (P50 MH126337-01A1) and the Patient-Centered Outcomes Research Institute (PCORI; SP-2020C3-21078). Dr. Lilian Bravo was supported by the National Clinician Scholars Program at UCLA. Ms. Kungeun Lee received funding from the Rare Impact Fund, NIMH 1U01MH131827-01, and the UCLA David Geffen School of Medicine COVID-19 Research Award. The content and views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the US Department of Veterans Affairs, the National Institutes of Health, or the United States Government. This article was published as part of a supplement sponsored by the Robert Wood Johnson Foundation., (Published by Elsevier Inc.)

Background and Aim: In this study, we used a national cohort of patients with Wilson's disease (WD) to investigate the admissions, mortality rates, and costs over the captured period to assess specific subpopulations at higher burden., Methods: Patients with WD were selected using 2016-2019 National Inpatient Sample (NIS). The weighted estimates and patient data were stratified using demographics and medical characteristics. Regression curves were graphed to derive goodness-of-fit for each trend from which R2 and P values were calculated., Results: Annual total admissions per 100 000 hospitalizations due to WD were 1075, 1180, 1140, and 1330 ( R2  = 0.75; P  = 0.13) from 2016 to 2019. Within the demographics, there was an increase in admissions among patients greater than 65 years of age ( R2  = 0.90; P  = 0.05) and White patients ( R2  = 0.97; P  = 0.02). Assessing WD-related mortality rates, there was an increase in the mortality rate among those in the first quartile of income ( R2  = 1.00; P  < 0.001). The total cost for WD-related hospitalizations was $20.90, $27.23, $24.20, and $27.25 million US dollars for the years 2016, 2017, 2018, and 2019, respectively ( R2  = 0.47; P  = 0.32). There was an increasing total cost trend for Asian or Pacific Islander patients ( R2  = 0.90; P  = 0.05). Interestingly, patients with cirrhosis demonstrated a decreased trend in the total costs ( R2  = 0.97; P  = 0.02)., Conclusion: Our study demonstrated that certain ethnicity groups, income classes and comorbidities had increased admissions or costs among patients admitted with WD., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Conflict of Interest Funding and support listed here did not support development of this document unless included in the acknowledgments section. Noura S. Abul-Husn is an equity holder of 23andMe; serves as a scientific advisory board member for Allelica; received personal fees from Genentech, Allelica, and 23andMe; received research funding from Akcea; and was previously employed by Regeneron Pharmaceuticals. Laura M. Amendola is a shareholder of Illumina, Inc. Wendy K. Chung is a member of the scientific advisory board of Regeneron Genetics Center and on the Board of Directors of Prime Medicine and Rallybio. Douglas R. Stewart is supported by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics of the National Cancer Institute, Rockville, MD and also performs contract clinical telehealth services for Genome Medical, Inc in accordance with relevant NCI ethics policies. All other authors have no conflicts to disclose.

Background: Adverse outcomes of cirrhosis remain a top priority., Aims: We examined the distribution of cirrhosis causes, HCC incidence and mortality and related changes over time in a nationwide U.S., Methods: A retrospective study of a national sample of commercially insured patients with cirrhosis from Optum's de-identified Clinformatics® Data Mart Database (CDM)., Results: A total of 628,743 cirrhosis cases were identified with 45% having NAFLD, 19.5% HCV, and 16.3% ALD. African Americans had the highest rate of decompensation (60.6%), while Asians had the highest rate of HCC (2.4%), both p < 0.001. African Americans more frequently had HCV (28.4%) while Hispanic/Latinos more frequently had NAFLD (49.2%, p < 0.001). Patients in the 2014-2021 cohort were significantly older (63.0 ± 12.8 vs. 57.0 ± 14.3), less frequently decompensated (54.5% vs. 58.3%) but more frequently had HCC (1.7% vs. 0.6%) and NAFLD (46.5% vs. 44.2%), all p < 0.001. The overall annual incidence of HCC was 0.76% (95% CI: 0.75-0.77) with a 5-year cumulative incidence of 4.03% (95% CI: 3.98-4.09), with significant variation by sex, race/ethnicity, and cirrhosis aetiology. The overall median years of survival were 11.4 (95% CI: 11.3-11.5) with a 5-year cumulative survival of 73.4% (95% CI: 73.3%-73.6%), also with significant disparities in similar subgroups (lowest in cryptogenic cirrhosis and worse in 2014-2021 vs. 2003-2013). The 2014-2021 period was independently associated with worse survival (aHR: 1.14, 95% CI: 1.08-1.20)., Conclusions: HCC incidence and survival vary by aetiology among patients with cirrhosis, with cryptogenic cirrhosis having the lowest survival and lower survival in the more recent time period., (© 2024 John Wiley & Sons Ltd.)

Objectives: This longitudinal study applied the integrated model of self-determination theory (SDT) and the theory of planned behaviour (TPB) to explain COVID-19 preventive behaviours among parents of young children in the United States., Design: The study adopted a two-wave longitudinal study design. Parents ( N  = 681) completed self-report questionnaires related to measures of SDT and the TPB constructs and behavioural adherence at baseline and after one month. We used standardised residual change scores to test the structural relationships of the integrated model., Results: The parameter estimates of the model (CFI > .96, TLI > .86, RMSEA = .05, SRMR = .03) fit acceptably well to the data. Psychological need support was positively and significantly linked to autonomous and controlled motivation and amotivation. Autonomous motivation was positively and significantly correlated with TPB factors, and intention. Intention was a significant and positive predictor of behavioural adherence., Conclusion: The integrated model of SDT and the TPB appeared to be applicable to the explanation of COVID-19 prevention among the U.S. parents. Longitudinal data showed that a psychological need supportive social environment was related to favourable motivation, social cognition beliefs, intention and behavioural adherence to the preventive behaviours of parents protecting their young children from COVID-19.

Background: A growing literature documents how primary care practices adapted to the COVID-19 pandemic. We examine a topic that has received less attention-how participants in an advanced alternative payment model perceive the model influenced their ability to meet patients' care needs during the pandemic., Methods: Analysis of closed- and open-ended questions from a 2021 survey of 2496 practices participating in the Comprehensive Primary Care Plus (CPC+) model (92% response rate) and a 2021 survey of 993 randomly selected primary care physicians from these practices (55% response rate). Both surveys asked whether respondents agreed or disagreed that they or their practice was "better positioned to meet patients' care needs during the coronavirus pandemic" because of participation in CPC+. Both also included an open-ended question about CPC+'s effects., Results: Half of practices and one-third of physicians agreed or strongly agreed that participating in CPC+ better positioned them to meet patients' care needs during the pandemic. One in 10 practices and 2 in 10 physicians, disagreed or strongly disagreed, while 4 in 10 practices and slightly more than half of physicians neither agreed nor disagreed (or, for physicians, didn't know). The most commonly identified CPC+ activities that facilitated meeting patient care needs related to practices' work on care management (e.g., risk stratification), access (e.g., telehealth), payment outside of fee-for-service (FFS), and staffing (e.g., supporting care managers)., Conclusions: Most CPC+ practices and physicians were positive or neutral about participating in CPC+ in the context of COVID-19, indicating more benefit than risk to payment alternatives to FFS., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Genna Cohen reports financial support was provided by U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Nancy Duda reports financial support was provided by U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Katie Morrison Lee reports financial support was provided by U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Kaylyn Swankoski reports financial support was provided by U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Gillian Giudice reports financial support was provided by U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Maya Palakal reports financial support was provided by U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Caroline Mack reports financial support was provided by U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Ann S. O'Malley reports financial support was provided by U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To determine the positivity rate of congenital cytomegalovirus (cCMV) testing among universal, hearing-targeted CMV testing (HT-cCMV) and delayed targeted dried blood spot (DBS) testing newborn screening programs, and to examine the characteristics of successful HT-cCMV testing programs., Study Design: Prospective survey of birth hospitals performing early CMV testing., Setting: Multiple institutions., Methods: Birth hospitals participating in the National Institutes of Health ValEAR clinical trial were surveyed to determine the rates of cCMV positivity associated with 3 different testing approaches: universal testing, HT-cCMV, and DBS testing. A mixed methods model was created to determine associations between successful HT-cCMV screening and specific screening protocols., Results: Eighty-two birth hospitals were surveyed from February 2019 to December 2021. Seven thousand six hundred seventy infants underwent universal screening, 9017 infants HT-cCMV and 535 infants delayed DBS testing. The rates of cCMV positivity were 0.5%, 1.5%, and 7.3%, respectively. The positivity rate for universal CMV screening was less during the COVID-19 pandemic than that reported prior to the pandemic. There were no statistically significant drops in positivity for any approach during the pandemic. For HT-cCMV testing, unique order sets and rigorous posttesting protocols were associated with successful screening programs., Conclusion: Rates of cCMV positivity differed among the 3 approaches. The rates are comparable to cohort studies reported in the literature. Universal CMV prevalence decreased during the pandemic but not significantly. Institutions with specific order set for CMV testing where the primary care physician orders the test and the nurse facilitates the testing process exhibited higher rates of HT-cCMV testing., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Introduction: The period of time before an elective operation may be an opportune time to engage older adults in advance care planning (ACP). Past interventions have not been readily incorporated into surgical workflows leaving a need for ACP tools that are generalizable, easy to implement, and effective. Design: This is a qualitative study. Setting and Subjects: Older adults with a history of cancer and a recent major operation were recruited through their surgical oncologist at a tertiary medical center in the United States. Interviews were conducted to determine how to adapt the validated PrepareForYourCare.org ACP program with electronic health record prompts for the perioperative setting and openness to introducing ACP during a presurgical visit. We used qualitative content analysis to determine themes. Results: Eight themes were identified: (1) ACP as static and private, (2) people expected a prompt, (3) family trusted to do the "right" thing, (4) lack of relationship or comfort with providers, (5) a team-based approach can be helpful, (6) surgeon's expertise (e.g., prognosis and surgical risk), (7) ACP belongs on the surgical checklist, and (8) patients would welcome a conversation starter. Discussion: Older surgical patients are interested in engaging with ACP, particularly if prompted, and believe it has a place on the preoperative "checklist." Conclusions: To effectively engage patients with ACP, a combination of routine prompts by the health care team and patient-centered follow-up may be required.

Background: Hypertensive disorders of pregnancy are a leading cause of maternal mortality. Racial disparities in maternal outcomes such as maternal mortality in the United States (US) are well-documented, but the relationship of racism and/or discrimination with one's risk of developing a hypertension during pregnancy (HDP) is not well-studied., Methods: Data from 17 sites that asked questions regarding experiences with racism and/or discrimination during pregnancy via the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 (2016-2020) was used. Logistic regression models were used compare the potential of stress induced HDP from perceived experiences of racism and/or discrimination versus the effect of systemic racism and/or discrimination (in healthcare settings and generally) on racial disparities in HDP diagnosis., Results: Among 9,907 live births, 18% of participants reported they were diagnosed with hypertension during pregnancy, with non-Hispanic Black individuals having the highest rate (21.8%). Regarding experiences of racism and/or discrimination, 76.4% of participants responded "yes", with all races/ethnicities studied here except non-Hispanic White individuals responding "yes" at rates higher than 89%. Perceived experiences of racism and/or discrimination did not statistically significantly affect one's odds of being diagnosed with HDP (OR = 0.94, CI: 0.74, 1.20). The disparity in odds of having hypertension during pregnancy between Non-Hispanic Black individuals and non-Hispanic White individuals was not statistically significant when perceived experiences of racism and/or discrimination were included in the model., Conclusions: Experiences of racism and/or discrimination drive racial disparities in hypertensive disorders in pregnancy., Public Health Implications: It is vital to eliminate racist and discriminatory practices and behaviors to reduce maternal morbidity and mortality., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study examined the association between insurance type and suicidal ideation and attempts among adults in the United States, incorporating a comparative analysis of the pre- and post-Affordable Care Act (ACA) periods. We used a nationally representative, cross-sectional, population-based survey of individuals aged 18 years and older from the 2010-2019 National Survey on Drug Use and Health. The higher rates of suicidal ideation and attempts among Medicaid and uninsured groups compared with those with private insurance. After implementation of the ACA policy, the difference-in-differences analysis showed a significantly reduced risk of suicide in the Medicare group compared with the privately insured group, with no significant differences observed in the other groups. These findings highlight the importance of improving access to mental health services, particularly for those with lower levels of insurance coverage, such as Medicaid and Medicare., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)