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Purpose: Despite increasing interest and scholarship on authentic leadership, definitions of the construct remain contested. In addition, limited research exists on its enactment in practice and its sustainability in a global context. The purpose of this study was to explore the practice of authentic leadership and understand more about how it is cultivated and sustained. Design/methodology/approach: To address these issues, an international sample of leaders nominated by peers as exemplifying authenticity in their leadership was interviewed. This study used consensual qualitative research (CQR; Hill, 2012; Hill "et al.," 1997), a team-based, exploratory methodology, to conduct data analysis. Findings: This study describes the results of the analysis, highlighting leaders' beliefs, values and behaviors; their leadership development and the barriers and supportive factors they experienced as leaders. The findings from this exploratory analysis across all cases, including subgroups, may help contextualize the complexity of authentic and sustainable leadership and provide better understanding of authentic leadership development. Research limitations/implications: Additional research on social identities and training in leadership are critical. The results of this study suggest new directions in studying the development of authentic leaders as well as in researching the experiences of organizations and team members. Practical implications: This study provides insight and direction for individuals and organizations seeking to better understand the practice of authentic leadership, its development and how it can be sustained over time and across contexts and social identities. Originality/value: This exploratory approach involving interviews with leaders around the globe provides information about the direct lived experiences of leaders identified as authentic by their peers. This study further highlights the leaders' critical leadership beliefs and practices, as well as ways in which they cultivated and learned to sustain their leadership practices. This study also sheds light on ways in which experiences might differ across gendered and cultural contexts.

This study aimed to examine the trends in grants for STEM/STEAM education in Japan as well as Japanese students' perception of science learning and future careers. The grants were addressed through analysis of chronological trends, while student perceptions were reviewed through student questionnaires on Trends in International Mathematics and Science Study (TIMSS) 2011, 2015, and 2019. The results reflect ideas on not only STEM education, which is often treated in the context of workforce development and science/mathematics education in Japan, but also ideas on the rapid expansion of and changes to STEAM education around 2015, which seems to be intended the integration of multiple subjects. In contrast, the results showed that students' perceptions of science and engineering careers are improving, but there are still challenges. Since subject-integrated learning has already been conducted in Japan, we consider the further discussion required regarding specific objective of STEAM versus STEM education.

In the past decades, income inequality has risen in most developed countries. There is growing interest among economists in international comparisons of economic and educational mobility. This is aided by the availability of internationally comparable, large-scale data. The present paper aims to make three contributions. First, we introduce the Japan Child Panel Survey (JCPS), the first longitudinal survey of school-age children that includes cognitive and non-cognitive measures, and plentiful household information. The JCPS was developed to measure dynamic inter-relationships among children's academic and social outcomes, their family background, and local policy and environment, in a way that allows comparison of the results with international data. Second, based on JCPS data, we present selected results of the dynamics of inequality in multiple indicators of children's educational and behavioral outcomes. We found that changes in cognitive achievement across parental income groups, the degree of mobility of cognitive test scores, and the correlation between the difficulty score and parental education in Japan are similar to those of other countries, such as the United States, United Kingdom, Australia, and Germany. Finally we discuss issues underlying the globalization of education research based on our experiences with the JCPS. We discuss reasons and strategies for further globalization of education research in Japan, and propose suggestions as to how Japanese education research can move toward better international collaboration, particularly in research on economic and educational mobility.

Background The optimal timing of vaccination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines after cellular therapy is incompletely understood. The objectives of this study are to determine whether humoral and cellular responses after SARS-CoV-2 vaccination differ if initiated <4 months versus 4–12 months after cellular therapy. Methods We conducted a multicenter, prospective, observational study at 30 cancer centers in the United States. SARS-CoV-2 vaccination was administered as part of routine care. We obtained blood prior to and after vaccinations at up to 5 time points and tested for SARS-CoV-2 spike (anti-S) IgG in all participants and neutralizing antibodies for Wuhan D614G, Delta B.1.617.2, and Omicron B.1.1.529 strains, as well as SARS-CoV-2–specific T-cell receptors, in a subgroup. Results We enrolled 466 allogeneic hematopoietic cell transplantation (HCT) (n = 231), autologous HCT (n = 170), and chimeric antigen receptor T-cell (CAR-T-cell) therapy (n = 65) recipients between April 2021 and June 2022. Humoral and cellular responses did not significantly differ among participants initiating vaccinations <4 months versus 4–12 months after cellular therapy. Anti-S IgG ≥2500 U/mL was correlated with high neutralizing antibody titers and attained by the last time point in 70%, 69%, and 34% of allogeneic HCT, autologous HCT, and CAR-T-cell recipients, respectively. SARS-CoV-2–specific T-cell responses were attained in 57%, 83%, and 58%, respectively. Pre–cellular therapy SARS-CoV-2 infection or vaccination and baseline B-cell count were key predictors of post–cellular therapy immunity. Conclusions These data support mRNA SARS-CoV-2 vaccination prior to, and reinitiation 3 to 4 months after, cellular therapies with allogeneic HCT, autologous HCT, and CAR-T-cell therapy. [ABSTRACT FROM AUTHOR]

Background: Growing evidence suggests that informal helping (unpaid volunteering not coordinated by an organization or institution) is associated with improved health and well-being outcomes. However, studies have not investigated whether changes in informal helping are associated with subsequent health and well-being. Methods: This study evaluated if changes in informal helping (between t0;2006/2008 and t1;2010/2012) were associated with 35 indicators of physical, behavioral, and psychosocial health and well-being (at t2;2014/2016) using data from 12,998 participants in the Health and Retirement study — a national cohort of US adults aged > 50. Results: Over the four-year follow-up period, informal helping ≥ 100 (versus 0) hours/year was associated with a 32% lower mortality risk (95% CI [0.54, 0.86]), and improved physical health (e.g., 20% reduced risk of stroke (95% CI [0.65, 0.98])), health behaviors (e.g., 11% increased likelihood of frequent physical activity (95% CI [1.04, 1.20])), and psychosocial outcomes (e.g., higher purpose in life (β = 0.15, 95% CI [0.07, 0.22])). However, there was little evidence of associations with various other outcomes. In secondary analyses, this study adjusted for formal volunteering and a variety of social factors (e.g., social network factors, receiving social support, and social participation) and results were largely unchanged. Conclusions: Encouraging informal helping may improve various aspects of individuals' health and well-being and also promote societal well-being. [ABSTRACT FROM AUTHOR]

There are many pharmacologic therapies that are being used or considered for treatment of coronavirus disease 2019 (COVID-19), with rapidly changing efficacy and safety evidence from trials. The objective was to develop evidence-based, rapid, living guidelines intended to support patients, clinicians, and other healthcare professionals in their decisions about treatment and management of patients with COVID-19. In March 2020, the Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise to regularly review the evidence and make recommendations about the treatment and management of persons with COVID-19. The process used a living guideline approach and followed a rapid recommendation development checklist. The panel prioritized questions and outcomes. A systematic review of the peer-reviewed and grey literature was conducted at regular intervals. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Based on the most recent search conducted on 31 May 2022, the IDSA guideline panel has made 32 recommendations for the treatment and management of the following groups/populations: pre- and postexposure prophylaxis, ambulatory with mild-to-moderate disease, and hospitalized with mild-to-moderate, severe but not critical, and critical disease. As these are living guidelines, the most recent recommendations can be found online at: https://idsociety.org/COVID19guidelines. At the inception of its work, the panel has expressed the overarching goal that patients be recruited into ongoing trials. Since then, many trials were conducted that provided much-needed evidence for COVID-19 therapies. There still remain many unanswered questions as the pandemic evolved, which we hope future trials can answer. [ABSTRACT FROM AUTHOR]

Background: Stem cell research, particularly in the domain of induced pluripotent stem cell (iPSC) technology, has shown significant progress. The integration of artificial intelligence (AI), especially machine learning (ML) and deep learning (DL), has played a pivotal role in refining iPSC classification, monitoring cell functionality, and conducting genetic analysis. These enhancements are broadening the applications of iPSC technology in disease modelling, drug screening, and regenerative medicine. This review aims to explore the role of AI in the advancement of iPSC research. Methods: In December 2023, data were collected from three electronic databases (PubMed, Web of Science, and Science Direct) to investigate the application of AI technology in iPSC processing. Results: This systematic scoping review encompassed 79 studies that met the inclusion criteria. The number of research studies in this area has increased over time, with the United States emerging as a leading contributor in this field. AI technologies have been diversely applied in iPSC technology, encompassing the classification of cell types, assessment of disease-specific phenotypes in iPSC-derived cells, and the facilitation of drug screening using iPSC. The precision of AI methodologies has improved significantly in recent years, creating a foundation for future advancements in iPSC-based technologies. Conclusions: Our review offers insights into the role of AI in regenerative and personalized medicine, highlighting both challenges and opportunities. Although still in its early stages, AI technologies show significant promise in advancing our understanding of disease progression and development, paving the way for future clinical applications. [ABSTRACT FROM AUTHOR]

An under-explored strategy to increase youth mental health service uptake is pursuing a direct-to-consumer approach with parents; however, a prerequisite for informing and evaluating such efforts is a psychometrically sound measurement of parent beliefs that relate to their likelihood of youth service use. The Parental Attitudes Toward Psychological Services Inventory (PATPSI; Turner, 2012) was developed to assess parents' perspectives on youth services use across three reliable and valid factors (Help-Seeking Attitudes, Help-Seeking Intentions, and Stigmatization). Although the PATPSI has since been used to investigate parents' service-related attitudes and intentions in association with a variety of service use behaviors, no published studies have revisited the factor structure of the original, English-language PATPSI. This investigation conducted a confirmatory factor analysis on the PATPSI with a diverse community sample of 343 parents. Our results suggested that the three-factor model fit the data well, and internal consistencies for the three scales and the Total measure ranged from acceptable to good. For convergent validity, the Help-Seeking Intentions scale was significantly and positively associated with all three empowerment facets measured by the Family Empowerment Scale; the Stigmatization scale was significantly and negatively related with two of three empowerment scales; and we did not observe expected correlations between the Help-Seeking Attitudes and the empowerment scales. Furthermore, the associations between the PATPSI scales all performed significantly in the expected direction. Overall, this is the first study to replicate the PATPSI's factor structure, and evidence good reliability and validity, with a large, multiethnic United States sample. Highlights: The PATPSI's three-factor model of Help-Seeking Attitudes, Help-Seeking Intentions, and Stigmatization was supported within an ethnically diverse parent sample All three factors' internal consistency coefficients ranged from acceptable to good. Convergent validity findings varied by PATSPI scale, such that Help-Seeking Intentions and Stigmatization scales demonstrated greater convergent validity with the Family Empowerment Scale subscales compared to the PATPSI Help-Seeking Attitudes scale. The PATPSI may be a useful tool to assess diverse parents' perspectives during the help-seeking process for youth mental health services. [ABSTRACT FROM AUTHOR]

Social relationships contribute to well-being across the life course and may be especially vital resources for supporting healthy aging among older adults. This research examined associations between perceptions of social support and social strain from children assessed by older adult parents and 35 indicators of physical, behavioral, and psychosocial health and well-being. We utilized three waves of data from the Health and Retirement Study (HRS; N = 11,609), a diverse, national sample of U.S. adults over age 50. We found that increases in social support were associated with better subsequent outcomes on all psychological indicators (higher positive affect, life satisfaction, optimism, purpose in life, mastery, health mastery, financial mastery; lower depression, depressive symptoms, hopelessness, negative affect, perceived constraints) and most social factors (lower loneliness, greater likelihood of contact with children and other family) over the four-year follow-up period. Results also showed that increases in social strain were subsequently related to worse functioning across all indicators of psychological well-being and select social factors (i.e., higher loneliness) and psychological distress outcomes (i.e., higher hopelessness, negative affect, and perceived constraints). However, we did not find evidence that changes in social support and social strain were associated with physical health or health behavior outcomes. [ABSTRACT FROM AUTHOR]

Objective: We undertook this study to estimate changes in cell‐specific DNA methylation (DNAm) associated with methotrexate (MTX) response using whole blood samples collected from rheumatoid arthritis (RA) patients before and after initiation of MTX treatment. Methods: Patients included in this study were from the Rheumatoid Arthritis Medication Study (n = 66) and the University of California San Francisco Rheumatoid Arthritis study (n = 11). All patients met the American College of Rheumatology RA classification criteria. Blood samples were collected at baseline and following treatment. Disease Activity Scores in 28 joints using the C‐reactive protein level were collected at baseline and after 3–6 months of treatment with MTX. Methylation profiles were generated using the Illumina Infinium HumanMethylation450 and MethylationEPIC v1.0 BeadChip arrays using DNA from whole blood. MTX response was defined using the EULAR response criteria (responders showed good/moderate response; nonresponders showed no response). Differentially methylated positions were identified using the Limma software package and Tensor Composition Analysis, which is a method for identifying cell‐specific differential DNAm at the CpG level from tissue‐level ("bulk") data. Differentially methylated regions were identified using Comb‐p software. Results: We found evidence of differential global methylation between treatment response groups. Further, we found patterns of cell‐specific differential global methylation associated with MTX response. After correction for multiple testing, 1 differentially methylated position was associated with differential DNAm between responders and nonresponders at baseline in CD4+ T cells, CD8+ T cells, and natural killer cells. Thirty‐nine cell‐specific differentially methylated regions associated with MTX treatment response were identified. There were no significant findings in analyses of whole blood samples. Conclusion: We identified cell‐specific changes in DNAm that were associated with MTX treatment response in RA patients. Future studies of DNAm and MTX treatment response should include measurements of DNAm from sorted cells. [ABSTRACT FROM AUTHOR]

The present study investigated the qualitative nature of grammatical gender knowledge and processing in heritage speakers (HSs) of Spanish living in the United States. Forty-four adult Spanish HS bilinguals participated, completing a behavioral grammatical gender assignment task and a grammaticality judgment task (GJT) while their brain activity was recorded using electroencephalography (EEG). The EEG GJT task included grammatical and ungrammatical sentences with grammatical gender violations on inanimate nouns, where transparency of the morpho(phono)logical cue and markedness were manipulated. The results of this study revealed that grammatical gender violations elicited the typical P600 effect across all relevant conditions, indicating that the grammatical representations and processing of grammatical gender in HSs are qualitatively similar to those in Spanish-dominant native speakers. Given the experimental manipulation in this study, these findings also suggest that both morphological transparency and markedness play significant roles in how grammatical gender is processed. However, the results of this study differ from those reported in previous studies with Spanish-dominant native speakers, as the P600 effect found was accompanied by a biphasic N400 effect. This pattern of results is interpreted as further evidence that the bilingual experience of HSs modulates certain aspects of morphosyntactic processing, particularly conferring a greater reliance on morphology. Additionally, the results of this study highlight the importance of incorporating neurolinguistic online processing methods to better understand what underlies HS bilingual competence and processing outcomes. [ABSTRACT FROM AUTHOR]

Examine differences in multidimensional well-being from before (January 2020) to three timepoints during the COVID-19 pandemic (June 2020, January 2021, January 2022). Repeated cross-sectional design. Nationally representative cross-sectional cohorts of US adults completed the Secure Flourish Index before (January 2020 cohort: N = 1010) and during the COVID-19 pandemic (June 2020 cohort: N = 3020; January 2021 cohort: N = 3366; January 2022 cohort: N = 2598). We estimated differences in indicators, domains, and composite well-being between the January 2020 cohort and each of the subsequent cohorts. We also explored whether changes in well-being between January 2020 and January 2022 varied based on age, gender, and race/ethnicity. Initial declines in well-being observed by June 2020 were largely followed by a return to prepandemic levels in January 2022, with some exceptions. Notably, general declines in mental health have persisted through to January 2022. On the other hand, there was evidence of general improvements in character & virtue that exceeded prepandemic levels in January 2022. Young adults and racial/ethnic minorities reported lower financial & material stability in January 2022 compared to before the COVID-19 pandemic. Although there are promising signs that the well-being of US adults has mostly recovered to prepandemic levels, a coordinated response is urgently needed to support population mental health and the financial security of vulnerable groups. As society continues the journey toward postpandemic recovery, continued tracking of multidimensional well-being will be important for making informed decisions about public health priorities. [ABSTRACT FROM AUTHOR]

Chronic graft-versus-host disease (cGVHD) is a complication of allogeneic hematopoietic cell transplantation (allo-HCT) and is the main cause of late non-relapse mortality (NRM). Three new agents are now approved to treat cGVHD, of which belumosudil has a unique and dual mechanism of action of i) targeting the Rho-GTPase-associated coiled-coil kinase 2 (ROCK2) in T helper follicular cells (TFH) and TH17 cells, this results in downregulation of proinflammatory cytokines (interleukin −21 and 17), the former in a STAT3-dependent mechanism, ii) inhibition of tissue fibrosis by targeting stress-induced polymerization of G-actin fibrils by inhibiting the Rho-ROCK-MRTF pathway. In this review we describe the epidemiology of cGVHD, its cardinal symptoms, preventive and therapeutic options, including second-line approved therapies in the United States (US). Clinical trial data that led to approval of belumosudil is discussed, in addition to the clinical scenarios in which the approved drugs may be most applicable. Belumosudil is approved for treatment of adult and pediatric patients ≥ 12 years with cGVHD after failing two lines of therapy based on results of the ROCKstar study that showed high overall response rates (ORR), favorable adverse effect profiles, and low rates of severe infections. With the availability of three new agents for treatment of cGVHD, treating physicians have more therapeutic options for patients and have additional options of development new clinical trials using a combination of recently approved drugs. [ABSTRACT FROM AUTHOR]

Background Clinical differences between critical illness from influenza infection vs coronavirus disease 2019 (COVID-19) have not been well characterized in pediatric patients. Methods We compared demographics, clinical characteristics, and outcomes of US children (aged 8 months to 17 years) admitted to the intensive care or high-acuity unit with influenza or COVID-19. Using mixed-effects models, we assessed the odds of death or requiring life support for influenza vs COVID-19 after adjustment for age, sex, race and Hispanic origin, and underlying conditions including obesity. Results Children with influenza (n = 179) were younger than those with COVID-19 (n = 381; median, 5.2 years vs 13.8 years), less likely to be non-Hispanic Black (14.5% vs 27.6%) or Hispanic (24.0% vs 36.2%), and less likely to have ≥1 underlying condition (66.4% vs 78.5%) or be obese (21.4% vs 42.2%), and a shorter hospital stay (median, 5 days vs 7 days). They were similarly likely to require invasive mechanical ventilation (both 30.2%), vasopressor support (19.6% and 19.9%), or extracorporeal membrane oxygenation (2.2% and 2.9%). Four children with influenza (2.2%) and 11 children with COVID-19 (2.9%) died. The odds of death or requiring life support in children with influenza vs COVID-19 were similar (adjusted odds ratio, 1.30; 95% confidence interval,.78–2.15; P =.32). Conclusions Despite differences in demographics and clinical characteristics of children with influenza or COVID-19, the frequency of life-threatening complications was similar. Our findings highlight the importance of implementing prevention measures to reduce transmission and disease severity of influenza and COVID-19. [ABSTRACT FROM AUTHOR]

As our society ages and healthcare costs escalate, researchers and policymakers urgently seek potentially modifiable predictors of reduced healthcare utilization. We aimed to determine whether changes in 62 candidate predictors were associated with reduced frequency, and duration, of overnight hospitalizations. We used data from 11,374 participants in the Health and Retirement Study—a national sample of adults aged >50 in the United States. Using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 62 predictors over four years (between t0;2006/2008 and t1;2010/2012) were associated with subsequent hospitalizations during the two years prior to t2 (2012–2014 (Cohort A) or 2014–2016 (Cohort B)). After robust covariate-adjustment, we observed that changes in some health behaviors (e.g., those engaging in frequent physical activity had 0.80 the rate of overnight hospital stays (95% CI [0.74, 0.87])), physical health conditions (e.g., those with cancer had 1.57 the rate of overnight hospital stays (95% CI [1.35, 1.82])), and psychosocial factors (e.g., those who helped friends/neighbors/relatives 100–199 hours/year had 0.73 the rate of overnight hospital stays (95% CI [0.63, 0.85])) were associated with subsequent hospitalizations. Findings for both the frequency, and duration, of hospitalizations were mostly similar. Changes in a number of diverse factors were associated with decreased frequency, and duration, of overnight hospitalizations. Notably, some psychosocial factors (e.g., informal helping) had effect sizes equivalent to or larger than some physical health conditions (e.g., diabetes) and health behaviors (e.g., smoking). These psychosocial factors are mostly modifiable and with further research could be novel intervention targets for reducing hospitalizations. [ABSTRACT FROM AUTHOR]

Infidelity is a challenging but prominent issue in couple therapy. In addition to the negative outcomes, clinicians generally report that infidelity is the second most difficult problem to treat after intimate partner violence. The purpose of this study was to identify the recovery process in the betrayed (non-participating) partner. Specifically, we sought to identify the implications of online infidelity (infidelity that occurs through Internet modalities, such as social media messaging, direct messages, etc.) on the betrayed partner during recovery. Across three focus groups of those in dating relationships, we identified an eight-stage process through the lens of the betrayed partner: intuition, investigation, discovery, confrontation, response, forgiveness/limbo, termination, and new rules. Theoretical and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Pain is influenced by various factors, such as fear, anxiety, and memory. We previously reported that pain-like behaviors in mice can be induced by environmental cues in which a pain stimulus was previously presented, and that pain was reduced using fentanyl (an opioid). Although opioid analgesics are currently used to treat persistent pain, their inappropriate use causes a significant number of deaths in the United States. Thus, alternative medicines to opioids are needed. Here, we reported that SR 57227A, a serotonin type-3 receptor agonist, significantly reduced pain-like behaviors. The number of c-Fos positive cells increased by environmental cues in PFC was decreased by SR 57227A. Moreover, SR 57227A reduced pain-like behaviors of the formalin test, and restored reductions in paw withdrawal thresholds by acidic saline intramuscular injection and sciatic nerve ligation. Unlike opioids, SR 57227A induced no preference behaviors as measured by the conditioned place preference test. These data suggested that SR 57227A is an effective alternative pain reliever to opioids that targets chronic pain. • SR 57227A significantly inhibited pain caused by environmental cues. • SR 57227A reduced the number of activated cell induced by environmental cue in PFC. • SR 57227A restored mechanical pain thresholds in chronic pain animal models. • SR 57227A showed no addictive effects. [ABSTRACT FROM AUTHOR]

Flow experience is a psychological state characterized by simultaneous absorption, concentration, and enjoyment. Examining the change and continuity of the flow experience––an optimal state that contributes to well-being––is critical to the understanding of the lifelong trajectory of human flourishing. Nevertheless, to date there has been no systematic investigation of the relationship between age and flow experiences across adulthood. Developmental models of flow experiences suggest the continuity hypothesis that people are motivated to sustain a high level of flow experiences as long as conditions permit. We conducted two studies to investigate flow experiences among adults of different ages. Study 1 (N = 1,162; age range 30–80) used longitudinal data from the Midlife in the United States (MIDUS) project, investigating the changes in flow experiences at work over a 10-year span. Study 2 (N = 393; age range 20–82) was an online survey that examined age-related differences in flow experiences. Both studies revealed minimal relationships between age and flow experiences. Post-hoc analyses revealed no significant moderating effect of common demographics including gender, race, and education on the age–flow relationship. Taken together, these studies elucidate the "flow profile" in adulthood that is consistent with the continuity hypothesis. We discuss relations of the findings to the literature on flow experiences and well-being. [ABSTRACT FROM AUTHOR]

While growing evidence documents strong associations between volunteering and improved health and well-being outcomes, less is known about the health and well-being factors that lead to increased volunteering. Using data from 13,771 participants in the Health and Retirement Study (HRS)—a diverse, longitudinal, and national sample of older adults in the United States—we evaluated a large range of candidate predictors of volunteering. Specifically, using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (over a 4-year follow-up between t0; 2006/2008 and t1; 2010/2012) were associated with volunteer activity four years later (t2; 2014/2016). After adjusting for a rich set of covariates, certain changes in some health behaviors (e.g., physical activity ≥ 1x/week), physical health conditions (e.g., physical functioning limitations, cognitive impairment), and psychosocial factors (e.g., purpose in life, constraints, contact with friends, etc.) were associated with increased volunteering four years later. However, there was little evidence that other factors were associated with subsequent volunteering. Changes in several indicators of physical health, health behaviors, and psychosocial well-being may predict increased volunteering, and these factors may be novel targets for interventions and policies aiming to increase volunteering in older adults. [ABSTRACT FROM AUTHOR]

The "drug lag" (ie, the approval lag for new drugs) hinders patients' access to innovative new medicines. The drug lag was heavily debated in Japan from the late 2000s to the early 2010s. It consists of "development lag" (ie, the submission date lag for new drug applications) and "review lag" (ie, the difference in review periods). As the 2 lags have different causes and display significantly different recent trends in Japan, we focus on the development lag—in contrast with most previous literature—between Japan and the United States, based on a database we created for all new drugs from 2008 to 2018 using publicly available data sources. First, we found that Japan's development lag relative to the United States did not shrink in terms of the overall distribution rather than the median, which was the focus of most prior studies. Second, we examined the factors (product characteristics) that significantly affected the development lag and found that products that underwent multiregional clinical trials and those that were certified as "breakthrough therapies" in the United States had significantly shorter development lags with high robustness, whereas products receiving price premiums did not. Finally, we discussed the policy implications of these results. For instance, innovative new drugs that are presumed to receive price premiums require enhanced policy support for early application from the initial stages of clinical trials. It is also essential to promote information sharing regarding evaluations by foreign reviewing authorities for efficient use in the home country. [ABSTRACT FROM AUTHOR]

More than 30% of people in the United States (US) are classified as obese, and over 50% are considered significantly overweight. Importantly, obesity is a risk factor not only for the development of metabolic syndrome but also for many cancers, including pancreatic ductal adenocarcinoma (PDAC). PDAC is the third leading cause of cancer-related death, and 5-year survival of PDAC remains around 9% in the U.S. Obesity is a known risk factor for PDAC. Metabolic control and bariatric surgery, which is an effective treatment for severe obesity and allows massive weight loss, have been shown to reduce the risk of PDAC. It is therefore clear that elucidating the connection between obesity and PDAC is important for the identification of a novel marker and/or intervention point for obesity-related PDAC risk. In this review, we discussed recent progress in obesity-related PDAC in epidemiology, mechanisms, and potential cancer prevention effects of interventions, including bariatric surgery with preclinical and clinical studies. [ABSTRACT FROM AUTHOR]

Background It is unclear how acute coronavirus disease 2019 (COVID-19)-directed therapies are used in children with life-threatening COVID-19 in US hospitals. We described characteristics of children hospitalized in the intensive care unit or step-down unit (ICU/SDU) who received COVID-19-directed therapies and the specific therapies administered. Methods Between March 15, 2020 and December 27, 2020, children <18 years of age in the ICU/SDU with acute COVID-19 at 48 pediatric hospitals in the United States were identified. Demographics, laboratory values, and clinical course were compared in children who did and did not receive COVID-19-directed therapies. Trends in COVID-19-directed therapies over time were evaluated. Results Of 424 children in the ICU/SDU, 235 (55%) received COVID-19-directed therapies. Children who received COVID-19-directed therapies were older than those who did not receive COVID-19-directed therapies (13.3 [5.6-16.2] vs 9.8 [0.65-15.9] years), more had underlying medical conditions (188 [80%] vs 104 [55%]; difference = 25% [95% CI: 16% to 34%]), more received respiratory support (206 [88%] vs 71 [38%]; difference = 50% [95% CI: 34% to 56%]), and more died (8 [3.4%] vs 0). Of the 235 children receiving COVID-19-directed therapies, 172 (73%) received systemic steroids and 150 (64%) received remdesivir, with rising remdesivir use over the study period (14% in March/April to 57% November/December). Conclusion Despite the lack of pediatric data evaluating treatments for COVID-19 in critically ill children, more than half of children requiring intensive or high acuity care received COVID-19-directed therapies. [ABSTRACT FROM AUTHOR]

As of March 2022, over 78 million cases of COVID-19 and 900,000 deaths have been reported in the United States. The consequences in the acute phase due to the SARS-COV-2 infection are well defined. Beyond the direct effects of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) involving the lung parenchyma, the post-viral complications within the central nervous system are still largely unknown, and a comprehensive evaluation regarding the long-term neuropsychological sequelae from this disease is not well characterized. An increasing number of patients previously diagnosed with COVID-19 have now presented with ongoing symptoms of inattention, executive function, and memory difficulties. These symptoms are collectively and commonly known by the public as 'brain fog', with many expressing concerns over their inability to engage in the workplace due to these symptoms. Here, we describe three patients who were seen in the Memory Disorders Clinic at Duke University to characterize the long-term neuropsychological symptoms, neuropsychological test results and brain MRI findings after infection with SARS-CoV-2 in a cohort of patients under the age of 60. [ABSTRACT FROM AUTHOR]

A major hurdle in pediatric formulation development is the lack of safety and toxicity data on some of the commonly used excipients. While the maximum oral safe dose for several kinds of excipients is known in the adult population, the doses in pediatric patients, including preterm neonates, are not established yet due to the lack of evidence-based data. This paper consists of four parts: (1) country-specific perspectives in different parts of the world (current state, challenges in excipients, and ongoing efforts) for ensuring the use of safe excipients, (2) comparing and contrasting the country-specific perspectives, (3) past and ongoing collaborative efforts, and (4) future perspectives on excipients for pediatric formulation. The regulatory process for pharmaceutical excipients has been developed. However, there are gaps between each region where a lack of information and an insufficient regulation process was found. Ongoing efforts include raising issues on excipient exposure, building a region-specific database, and improving excipient regulation; however, there is a lack of evidence-based information on safety for the pediatric population. More progress on clear safety limits, quantitative information on excipients of concern in the pediatric population, and international harmonization of excipients' regulatory processes for the pediatric population are required. [ABSTRACT FROM AUTHOR]

Most content moderation approaches in the United States rely on criminal justice models that sanction offenders via content removal or user bans. However, these models write the online harassment targets out of the justice-seeking process. Via an online survey with US participants (N = 573), this research draws from justice theories to investigate approaches for supporting targets of online harassment. We uncover preferences for banning offenders, removing content, and apologies, but aversion to mediation and adjusting targets' audiences. Preferences vary by identities (e.g. transgender participants on average find more exposure to be undesirable; American Indian or Alaska Native participants on average find payment to be unfair) and by social media behaviors (e.g. Instagram users report payment as just and fair). Our results suggest that a one-size-fits-all approach will fail some users while privileging others. We propose a broader theoretical and empirical landscape for supporting online harassment targets. [ABSTRACT FROM AUTHOR]

Ceftriaxone is one of the most common antibiotics prescribed for hospitalized children in the United States. However, ceftriaxone is not dosed consistently. Sepsis/serious bacterial infection had high dosing variability. Dosing for central nervous system infection was frequently suboptimal. Future efforts should focus on optimizing and standardizing ceftriaxone dosing. [ABSTRACT FROM AUTHOR]

High amount of sedentary behavior (SB) has been associated with a multitude of adverse health events in older adults. There are limited data regarding SB in older adults living in retirement communities (RC). This study described the magnitude and composition of SB [non-screen sedentary time (NSST) and screen sedentary time (SST)] in older adults living in a RC and documented variation in this behavior as a function of demographic, health, health behavior and clinical variables. This cross sectional descriptive study enrolled and assessed 100 older males and females living a RC located in the Midwest region of United States. Participants completed a questionnaire for sample characterization and a SB questionnaire. Metric of SB (i.e., TST, NSST and SST) were analyzed overall and separated by the variables of interest. Participants reported on average 10 h/day of sedentary activity (65% on NSST and 35% on SST). Older adults reported to spend most of their awaking hours in activities such as reading, watching TV and computer use. Significant variations on NSST and SST were observed for gender, BMI, perceived health, mobility aid use and number of chronic diseases. These findings may help in the development of tailored strategies and interventions focusing on reducing SB in this particular under-researched subgroup. [ABSTRACT FROM AUTHOR]

The Kochen-Specker theorem is investigated for n spin-1/2 systems by using an inequality proposed in Nagata (J. Math. Phys. 46, 102101, 2005) on the basis on binary logic. A measurement theory based on the truth values (binary logic), i.e., the truth T (1) for true and the falsity F (0) for false is used. The values of measurement outcome are either + 1 or 0 (in ℏ / 2 unit). The quantum predictions by n-multipartite states violate the inequality by an amount that grows exponentially with n. The measurement theory based on the binary logic provides an exponentially stronger refutation of the existence of hidden-variable when the number of parties of the state increases more. It turns out that the Kochen-Specker theorem becomes a quite strong theorem when the dimension of the multipartite state highly increases, regardless of entanglement properties. [ABSTRACT FROM AUTHOR]

Deletion polymorphism of BCL-2-like protein 11 (BIM) is specifically found in East Asia. To explain some epidemiological discrepancies between Asian and Western countries, we analyzed a silent single nucleotide polymorphism (SNP) in exon 5 (c465C > T) and a deletion site (2903 bp) in intron 2 in 77 patients with follicular lymphoma by the Q-invader method using PCR. In females, 5-year progression-free survivals (PFS) were 20.0% in the BIM deletion group, 66.7% in the SNP group and 81.5% in the wild-type (WT) group (p =.0012). In the WT group, 5-year PFS was 40.4% in males (p =.0448 vs. female PFS). This tendency was strengthened in patients receiving rituximab (26.9% vs. 84.2%, p =.006). Superior PFS in the WT females in Japan was comparable with the results of cohort studies in the United States and Sweden. Favorable prognosis in Japanese females may be masked by the BIM deletion polymorphism. [ABSTRACT FROM AUTHOR]

Introduction: The American College of Sports Medicine and American Heart Association recommends resistance training involving 60-70% of 1-repetition maximum (1RM) for 8-12 repetitions on 2 or 3 nonconsecutive days per week for the elderly. The Borg 6-20 scale, Borg category ratio (CR-10) scale, and OMNI scale are used to determine the rating of perceived exertion (RPE) for resistance training. Areas covered: RPE scales for resistance training performed by elderly individuals are described. The RPE has been related to resistance training intensity, and the RPE scale was used to determine the resistance training intensity of elderly or ill individuals. Expert commentary: RPE scales can determine the resistance training intensity of elderly individuals and may be used at home or in nursing homes, if they do not have specific resistance training machines. RPE is simple and useful, and may improve skeletal muscle strength or other health-related issues. [ABSTRACT FROM AUTHOR]

This paper examines dynamic information losses associated with loan terminations. We assume that the aggregated returns of current borrowers contain information about the mean returns to future borrowers. In a competitive loan market, the value of this information is not fully internalized by individual borrowers and lenders, and loan decisions fail to be first best. Introducing heterogeneous borrowers, who know their own risk characteristics better than lenders, safer borrowers are less willing to borrow when risk premia rise. As they cease borrowing, the information generated in credit markets becomes noisier and this tends to increase risk premia. The model produces alternating and persistent periods of "tight" and "loose" credit. [ABSTRACT FROM AUTHOR]

We present estimates of monetary non-neutrality based on evidence from high-frequency responses of real interest rates, expected inflation, and expected output growth. Our identifying assumption is that unexpected changes in interest rates in a 30-minute window surrounding scheduled Federal Reserve announcements arise from news about monetary policy. In response to an interest rate hike, nominal and real interest rates increase roughly one-for-one, several years out into the term structure, while the response of expected inflation is small. At the same time, forecasts about output growth also increase—the opposite of what standard models imply about a monetary tightening. To explain these facts, we build a model in which Fed announcements affect beliefs not only about monetary policy but also about other economic fundamentals. Our model implies that these information effects play an important role in the overall causal effect of monetary policy shocks on output. [ABSTRACT FROM AUTHOR]

This study examined substance use (cigarette, alcohol, and illicit drug) among first- and second-generation Asian Indian women and men (n = 1,209; ages 18-34) living in the United States. Participants reported low rates of substance use compared to national averages. First-generation participants reported lower rates of substance use. Men were more likely to have used alcohol and tried cigarettes. Within the first generation, gender differences were only significant for alcohol, but within the second generation, gender differences were significant for all three substances. The findings support the resiliency of immigrants and highlight gender differences that occur among second-generation participants. [ABSTRACT FROM AUTHOR]

Health care delivery in the United States is experiencing a tumultuous present and uncertain future. In particular, behavioral health care for youth and their families is facing potentially large funding cuts. These complex changes conspire to sculpt an impending perilous future for children's behavioral health care. Despite these formidable challenges, there is reason to be optimistic about evidence-based mental health services for children and adolescents if the profession shakes off outdated orthodoxies, operating in silos, and engaging in tired practices. The field is loaded with empirically supported clinical applications for most young patients. The key is to get practitioners, patients, and payers to embrace evidence-based practices more fully. In this article, we present multiple recommendations for innovations that could disrupt the treatment- as-usual (TAU) marketplace. More specifically, we begin with a discussion of disruptive innovations and their precise connection to the dissemination and implementation of EBPs. Second, we present three broad suggestions for disruptive innovations including a call for improved use of social media as an interface for engaging practitioners and behavioral health consumers, an argument for bolder marketing efforts, stronger advocacy for business acumen within the profession as well as encouraging trainers to serve as "ambassadors" for EBPs. The article concludes with a synthesizing section offering implications for administrators and practitioners. [ABSTRACT FROM AUTHOR]

We investigate whether properties in mixed-use developments have overall better financial performance than single-use properties. We select four cases that represent recent mixed-use developments in the United States, and compare key financial indicators for properties within and outside a half-mile radius from the project boundaries. Using data from the National Council of Real Estate Investment Fiduciaries, our panel regression analysis shows that office and retail properties within the mixed-use geographies have 37% and 48% higher market values respectively than those outside. Total returns are also higher for office (67%) and retail (63%) within the radius. By contrast, we find no clear return premium for being located close to the mixed-use geographies for apartments. Our findings are mixed and probably support the developer and financier biases against the complexity of engaging in mixed-use projects. [ABSTRACT FROM AUTHOR]

The article talks about Shingon Buddhist priest Bishop Mitsumyo Tottori who unlike other Japanese Buddhist priests in Hawaii and the mainland, was never incarcerated for the duration of World War II. Topics discussed include Tottori's experience reflecting the inconsistencies in the extension of martial law policies and his religious services being fraught with danger as martial law represented the culmination of anti-Japanese and anti-Buddhist sentiment that had existed for years in Hawaii.

In contemporary education, there is increasing interest in the potential of mindfulness-based training to improve mental health, behavior, and school performance, as part of fostering contemplative pedagogy that can positively impact the lives of young children. However, practice-based knowledge is lacking about how to implement mindfulness-based training effectively at schools. Thus, the key question motivating our study was how we can create school-based educational programs that cultivate mindfulness in young people. The study, a retrospective, qualitative analysis of 188 letters written by 112 elementary students who participated in a classroom-based mindfulness-based training curriculum in the mid-1990s, provided an unique opportunity for gaining important insights into ways in which the students viewed the mindfulness-based training curriculum, themselves, and each other when undertaking that training. Applying the principles of qualitative analysis, each letter was coded, and codes were constantly compared, and from this five thematic categories emerged about central aspects of the process and implementation of that mindfulness-based training. They were: (1) Importance of a sense of place; (2) We are more of a community; (3) Actively taking it on; (4) How I relate to others; and (5) Getting in touch with the inner self. A key finding is that the mindfulness-based training program was a sustained process facilitating the cultivation of a range of students' skillsets, and not simply reduced to attentional techniques acquired in a finite time slot in an otherwise unchanging classroom. This finding has important implications for the way mindfulness-based training is conceptualized and implemented in contemporary school settings. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Lower respiratory infections (LRIs) are among the most common reasons for pediatric hospitalization and among the diagnoses with the highest number of readmissions. Characterizing LRI readmissions would help guide efforts to prevent them. We assessed variation in pediatric LRI readmission rates, risk factors for readmission, and readmission diagnoses. METHODS: We analyzed 2008-2009 Medicaid Analytic eXtract data for patients <18 years of age in 26 states. We identified LRI hospitalizations based on a primary diagnosis of bronchiolitis, influenza, or community-acquired pneumonia or a secondary diagnosis of one of these LRIs plus a primary diagnosis of asthma, respiratory failure, or sepsis/bacteremia. Readmission rates were calculated as the proportion of hospitalizations followed by ≥1 unplanned readmission within 30 days. We used logistic regression with fixed effects for patient characteristics and a hospital random intercept to case-mix adjust rates and assess risk factors. RESULTS: Of 150 590 LRI hospitalizations, 8233 (5.5%) were followed by ≥1 readmission. The median adjusted hospital readmission rate was 5.2% (interquartile range: 5.1%--5.4%), and rates varied across hospitals (P < .0001). Infants (patients <1 year of age), boys, and children with chronic conditions were more likely to be readmitted. The most common primary diagnoses on readmission were LRIs (48.2%), asthma (10.0%), fluid/electrolyte disorders (3.4%), respiratory failure (3.3%), and upper respiratory infections (2.7%). CONCLUSIONS: LRI readmissions are common and vary across hospitals. Multiple risk factors are associated with readmission, indicating potential targets for strategies to reduce readmissions. Readmission diagnoses sometimes seem related to the original LRI. [ABSTRACT FROM AUTHOR]

During World War II, authorities arrested and incarcerated Japanese on the island of Hawai'i due to racist fears. Many scholars skim over the details of the incarceration of residents of Hawai'i island and other islands as part of the larger narrative of O'ahu incarceration, where authorities held Japanese at sites like Sand Island and Honouliuli. However, these lives and experiences are meaningful to understanding the incarceration experience in Hawai'i and expanding the focus beyond O'ahu to encompass the neighbor islands and rural areas--two areas still in need of study in order to understand the history of Hawai'i's Japanese. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis patients demonstrate high interest in the role of diet on their skin condition. However, data are lacking to describe dietary interventions among psoriasis patients and associated outcomes. This study aims to identify common dietary habits, interventions and perceptions among patients with psoriasis, and to examine patient-reported skin outcomes in response to these interventions. Methods: We administered a 61-question survey to the National Psoriasis Foundation membership asking psoriasis patients about dietary habits, modifications, skin responses, and perceptions. Results: A total of 1206 psoriasis patients responded to the survey. Compared to age- and sex-matched controls, psoriasis patients consumed significantly less sugar, whole grain fiber, dairy, and calcium ( p < 0.001), while consuming more fruits, vegetables, and legumes ( p < 0.01). Eighty-six percent of respondents reported use of a dietary modification. The percentage of patients reporting skin improvement was greatest after reducing alcohol (53.8%), gluten (53.4%), nightshades (52.1%), and after adding fish oil/omega-3 (44.6%), vegetables (42.5%), and oral vitamin D (41%). Specific diets with the most patients reporting a favorable skin response were Pagano (72.2%), vegan (70%), and Paleolithic (68.9%). Additionally, 41.8% of psoriasis respondents reported that a motivation for attempting dietary changes was to improve overall health. Conclusion: This national survey is among the first to report the dietary behaviors of patients with psoriasis. The data provided from this large cohort may benefit patients and clinicians as they discuss the role of diet in managing both psoriasis and associated cardiometabolic comorbidities. [ABSTRACT FROM AUTHOR]

Introduction: Celiac disease is an autoimmune disease that results from exposure to gluten in genetically susceptible individuals and leads to a range of gastrointestinal and extraintestinal symptoms. Areas covered: In order to evaluate the literature with respect to burden associated with celiac disease in the U.S. and identify any knowledge gaps, we performed a literature review of journal articles published between 2000-2016. We note that celiac disease is a prevalent condition associated with a significant burden of disease through its impact on morbidity, quality of life, as well as through increased costs associated with its diagnosis and management. At the same time, knowledge gaps exist in our understanding of the precise epidemiologic burden in the U.S.; the trade-offs between burden and benefit of a gluten-free diet; and better estimation of the costs of diagnosis, treatment and management.Expert commentary: Additional research is necessary to better understand these gaps to be able to reduce burden of celiac disease, particularly the impact on health-related quality of life and the costs associated with inaccurate or delayed diagnoses and insufficient treatment of disease. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the neuroendocrine, autonomic, and metabolic system responses to suvorexant in psychiatric subjects with insomnia. Design: This prospective study was conducted in Kusatsu Hospital in Hiroshima, Japan and included 40 psychiatric inpatients treated with suvorexant from December 2014 to April 2016. Methods: Questionnaire of Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) scores were checked at baseline, Week 2, and Week 4, and fasting serum levels of prolactin, insulin, cortisol, noradrenaline, white blood cell count, and average pulse rate were measured at baseline and Week 4 and Week 8 after suvorexant initiation. Sequential change of the values were compared against baseline respectively. Results: Subjective sleep quality scores were significantly decreased at Weeks 2 and 4, and sleep duration, habitual sleep efficacy, and global scores were significantly decreased at Week 4 from baseline. Total scores on the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 significantly decreased at Week 4 from baseline. The levels of cortisol and white blood cell count were decreased, significantly at Week 8, and the levels of pulse rate were significantly decreased at Week 4 from baseline. The levels of noradrenaline decreased, although not significantly. The prolactin levels remained unchanged, and no trend was found in the insulin levels. Conclusion: Suvorexant treatment resulted in overall improvement in the quality of sleep and the severity of anxiety and depression. This dual orexin antagonist may be related to autonomic functions and neuroendocrine systems, especially in the hypothalamus-pituitaryadrenal axis in psychiatric subjects. [ABSTRACT FROM AUTHOR]

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Abstract: Over the course of the recent house price bubble in the United States, the price of homes rose rapidly from 1999 Q4 to 2005 Q4 (11.3% annually as measured by the Case-Shiller index, and 8.4% annually as measured by the Federal Housing Financing Agency) but slowly as measured by owner equivalent rents (3.4%), so measured core inflation remained relatively docile during this period, since only rents are used to measure inflation for housing services in the United States. Over the last several decades, the US Bureau of Labor Statistics (BLS) has experimented with both rental equivalence and user cost approaches for accounting for owner occupied housing (OOH) services in the CPI. We explain the basics of these approaches, and outline the BLS experiences with using them. This assessment leads us to conclude that the time has come to try a new approach: the opportunity cost approach. We argue this approach has advantages over both the conventional rental equivalence and user cost approaches, though it embeds components of the measures for both those approaches and builds solidly on the research of Verbrugge and others at the BLS. Also, we take up empirical issues that must be faced regardless of which of the approaches discussed is adopted. We explain how the repeat-sales and various hedonic regression methods can be placed in a common framework, thereby facilitating understanding of the properties of and the tradeoffs between the methods. We also consider measurement complications that arise because the land and structure components of properties depreciate at different rates. [Copyright &y& Elsevier]

Research to date on child and adolescent anxiety and depression have focused predominantly on major ethnic groups. Very few studies to date have been conducted on specific ethnic minority groups and the relatively few studies on these ethnic minority samples have produced mixed findings. The following question therefore still remains: Do specific ethnic subgroups differ with respect to their expression of anxiety and depression? And do these differences differ as a function of reporter type (i.e., youth versus parent)? If the expression of internalizing symptoms differs across specific ethnic subgroups, these differences could inform approaches to assessing and treating these populations. In the current study, we therefore examined ethnic differences in anxiety and depression symptoms in ethnic subgroups. A total of 629 children and adolescents from various public and private schools, aged 8-18 years ( M = 12.37, SD = 2.8) and their caregivers completed anxiety and depression scales. Multiple indicators, multiple causes confirmatory factor analysis revealed that the following specific ethic subgroups were associated with significantly greater anxiety and depression relative to Caucasian youth: Chinese American, Filipino American, Japanese American, and Native Hawaiian. These results were found only among parent (but not youth) reports. Age and low SES status was also associated with more internalizing problems among Chinese, Filipino, and Japanese American youth. Implications related to ethnic minority subgroup differences and the role of multi-informant reports in understanding the relationship between anxiety, depression and ethnic minority subgroups are discussed. [ABSTRACT FROM AUTHOR]

This study examines implementation facilitators and barriers of a statewide roll-out of a measurement feedback system (MFS) in a youth public mental health system. 76 % of all state care coordinators (N = 47) completed interviews, which were coded via content analysis until saturation. Facilitators (e.g., recognition of the MFS's clinical utility) and barriers (e.g., MFS's reliability and validity) emerged paralleling the Exploration, Adoption/Preparation, Implementation, and Sustainment framework outlined by Aarons et al. (Adm Policy Mental Health Mental Health Serv Res, 38:4-23, 2011). Sustainment efforts may leverage innovation fit, individual adopter, and system related facilitators. [ABSTRACT FROM AUTHOR]