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Digital health technologies (DHTs) can transform neurological assessments, improving quality and continuity of care. In the United States, the Food & Drug Administration (FDA) oversees the safety and efficacy of these technologies, employing a detailed regulatory process that classifies devices based on risk and requires rigorous review and post-market surveillance. Following FDA approval, DHTs enter the Current Procedural Terminology, Relative Value Scale Update Committee, and Centers for Medicare & Medicaid Services coding and valuation processes leading to coverage and payment decisions. DHT adoption is challenged by rapid technologic advancements, an inconsistent evidence base, marketing discrepancies, ambiguous coding guidance, and variable health insurance coverage. Regulators, policymakers, and payers will need to develop better methods to evaluate these promising technologies and guide their deployment. This includes striking a balance between patient safety and clinical effectiveness versus promotion of innovation, especially as DHTs increasingly incorporate artificial intelligence. Data validity, cybersecurity, risk management, societal, and ethical responsibilities should be addressed. Regulatory advances can support adoption of these promising tools by ensuring DHTs are safe, effective, accessible, and equitable. [ABSTRACT FROM AUTHOR]

There is an increasing amount of research and discussion about the characteristics and learning needs of "Generation 1.5." These learners share characteristics of both first- and second-generation immigrants; they have grown up and been educated in the United States, but live in homes where English is not the primary language. They often have considerable fluency in social English but less fluency in academic language. To date, most research focused on the Generation 1.5 population has considered college and adult levels. However, the needs of Generation 1.5 high school students must be considered in light of how curriculum, learning strategies, and teaching strategies affect their literacy development. This article presents recommendations as a framework through which to develop a high school literacy program that meets the needs of the Generation 1.5 population. The nine recommendations are categorized within three areas of focus: curriculum centered, learner centered, and educator centered. (Contains 1 table.)

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

Subcounty housing unit counts are important for studying geo-historical patterns of (sub)urbanization, land-use change, and residential loss and gain. The most commonly used subcounty geographical unit for social research in the United States is the census tract. However, the changing geometries and historically incomplete coverage of tracts present significant obstacles for longitudinal analysis that existing datasets do not sufficiently address. Overcoming these barriers, we provide housing unit estimates in consistent 2010 tract boundaries for every census year from 1940 to 2010 plus 2019 for the entire continental US. Moreover, we develop an "urbanization year" indicator that denotes if and when tracts became "urbanized" during this timeframe. We produce these data by blending existing interpolation techniques with a novel procedure we call "maximum reabsorption." Conducting out-of-sample validation, we find that our hybrid approach generally produces more reliable estimates than existing alternatives. The final dataset, Historical Housing Unit and Urbanization Database 2010 (HHUUD10), has myriad potential uses for research involving housing, population, and land-use change, as well as (sub)urbanization. Measurement(s) human dwelling Technology Type(s) Geographic Information System Factor Type(s) housing units • urbanization Sample Characteristic - Organism Homo sapiens Sample Characteristic - Environment anthropogenic environment Sample Characteristic - Location contiguous United States of America [ABSTRACT FROM AUTHOR]

This group of portraits paints a picture of how educational policies across different regions of the United States afford varying experiences using arts disciplines pedagogically for SEL instruction. Each policy-supported portrait interfaces with SEL to teach competencies and report enhancement in personal emotional growth, social awareness, critical thinking, problem-solving, information management, global innovation, and artistic competency. Through reading these portraits, rationales emerge for the need to enhance interpersonal collaboration, verbal, non-verbal and esthetic communication, collaborative creativity, and cultural awareness in teacher education, in curricular design, and school-policy. [ABSTRACT FROM AUTHOR]

Data were collected from leaders who rated their interpersonal competencies, were rated by their direct reports on the same competencies, and then were asked to predict as accurately as possible how their direct reports rated them. Leader self-awareness was examined by analyzing self-other ratings and prediction-other ratings with a supervisor-rated measure of leader effectiveness. Results showed that prediction-other ratings explained a greater percentage of the variance in leader effectiveness than did self-other ratings. These results suggest that prediction-other rating comparison may be a viable additional way to measure self-awareness in organizational settings and may avoid some of the disadvantages when only using self-ratings or self-other ratings. [ABSTRACT FROM AUTHOR]

Dispersed development is often associated with negative externalities and ensuing external costs. As a consequence, there is a global need for informed decision making on issues of land-use change and conversion that includes the influences of differing urban forms on the costs of public services. In this paper we quantify a relationship between cost of services and urban form through the development of an econometric model for the provision of public safety for a county in the Mountain West of the USA. The research extends previous modeling of public services to include a spatial index representing urban form, the pattern of the built environment disaggregated by land use, as an explanatory variable for input cost. The use of an index allows quantifying and tracking changes in urban form over time. The index is based on the Moran's / measure of spatial autocorrelation. It is calculated using the dollar values of buildings aggregated spatially within grid cells. By leveraging Moran's /, the index captures local and global statistics representing the intensity of the built environment by land-use category. Local Moran's / statistics quantify the contribution of individual cells to overall clustering. Global Moran's / statistics are suitable for inclusion as a spatial index in time series regression analysis. Results suggest residential development is a statistically significant driver of local government expenditures on inputs to policing services. This paper contributes to the literature on fiscal impact analysis by incorporating a measure of urban form as a determinant of local government expenditures on services and, ultimately, on the level of service provision. This provides a direct link between urban form and the cost of public services. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented which discusses articles in the issue on African American involvement in sports, focusing on such topics as tennis player Arthur Ashe's activism, African Americans in rodeos, and African American gym owners and sparring masters.

spatially explicit degree-day model was used to evaluate the risk of Rift Valley fever virus (RVFV) transmission by mosquitoes to humans and livestock within five target states in the continental United States: California, Minnesota, Nebraska, New York, and Texas. A geographic information system was used to model potential virus transmission based on a 12-day moving window assessment of the extrinsic incubation period theorized for RVFV in the United States. Risk of potential virus transmission in each state was spatially evaluated on a 10-km grid using average historical daily temperature data from 1994 to 2003. The highest levels of transmission risk occur in California and Texas, with parts of these states at risk of RVFV transmission for up to 8 months per year. Northern Minnesota, central New York, and most of coastal and high-elevation California are at low to null risk. Risk of impact to the livestock industry is greatest in California, Texas, and Nebraska. A standard global climate model was used to evaluate future risk in the year 2030 in Nebraska, and showed an increase of transmission risk days from approximately 3 to 4 months per year. [ABSTRACT FROM AUTHOR]

The article focuses on the issues related to stem-cell-based products (SCBPs) and rare diseases. It outlines the ramifications of the U.S. 1983 Orphan Drug Act(ODA) with respect to advancing the field of investigational clinical research involving SCBPS. It discusses how to be eligible for the ODA programs.

Systemic therapy for advanced non-small cell lung cancer (NSCLC) has evolved over the last two decades, with modest improvements in quality of life and overall survival. A plateau has been reached with traditional chemotherapy, and efforts are now being directed at developing molecularly targeted agents. To date, three such agents have been found to improve overall survival in advanced NSCLC. Erlotinib, a small-molecule inhibitor of the epidermal growth factor receptor, was approved by the US FDA in 2004 as second- or third-line treatment for advanced NSCLC. Bevacizumab, an antibody to vascular endothelial growth factor, a key mediator of angiogenesis, received approval in 2006, after a randomized trial reported a median survival of 1 year when bevacizumab was added to first-line chemotherapy. More recently, cetuximab, an antibody to the epidermal growth factor receptor, was found to improve outcome when added to chemotherapy, and FDA approval is anticipated. Several additional agents are currently being evaluated in randomized trials, with encouraging results from early studies. These and other studies are prospectively investigating predictive clinical and molecular characteristics, with the ultimate goal of individualizing therapy in advanced NSCLC. [ABSTRACT FROM AUTHOR]

Problem: Explicitly prohibited from regulating the land use planning activities of municipal and county governments by the Clean Air Act (42 U.S.C. 131), the U.S. Environmental Protection Agency (EPA) has been forced to pursue an end-of-the-pipe approach to air quality management that has not proved successful in fully reducing ozone and fine particulate matter below health-based standards in many large U.S. cities. The persistence of these pollutants, in combination with a rapid rise in vehicle travel in recent decades, has raised concerns within the planning and public health communities about the long-term success of an air quality management program that is effectively divorced from the land use planning process. Purpose: This work, which is part of an EPA-sponsored study titled Projecting the Impact of Land Use and Transportation on Future Air Quality (PLUTO), was intended to assess the effectiveness of compact growth in improving air quality at a geographic scale compatible with secondary pollution formation and transport and over a planning horizon sufficient to capture the longer-term benefits of regional land use change. Methods: Future air quality is associated with alternative land development scenarios in this study through the integration of three separate and previously unrelated modeling components. These components consist of a set of standard population projection techniques, a household vehicle travel activity framework, and a mobile source emissions model (MOBILE 6) developed by the EPA. Results and conclusions: The results of our analysis find the median elasticity of vehicle travel with respect to density change over time to be -0.35, suggesting metropolitan areas can expect a 10% increase in population density to be associated with a 3.5% reduction in household vehicle travel and emissions. In addition, vehicle elasticities derived for urban and suburban census tracts across the 11 metro regions suggest density increments within urban zones (-0.43) to be more than twice as effective in reducing vehicle travel and emissions as density increments within suburban zones (-0.19). Takeaway for practice: We found compactness to be associated with greater reductions in vehicle travel than in previous studies, which suggests land use change can play a measurable role in improving regional air quality over time. Importantly, we found where compact growth occurs to be critically important to determining the extent to which higher density development reduces vehicle travel and emissions. We found the densification of urban zones to be more than twice as effective in reducing vehicle miles of travel and emissions as the densification of suburban zones, suggesting compact growth to be better for air quality than historical patterns of growth when densifying urban zones is given priority over non-urban zones. [ABSTRACT FROM AUTHOR]

West Nile virus (Flaviviridae: Flavivirus) is a serious infectious disease that recently spread across the North America continent. A spatial analysis tool was developed on the ArcMap 9.x platform to estimate potential West Nile virus activity using a spatially explicit degree-day model. The model identifies when the virus Extrinsic Incubation Period (EIP) is completed within the vector longevity during mid-summer months. The EIP is treated as a threshold indicator of the potential for virus emergence and activity. Comparing the number of West Nile virus cases in Wyoming reported from 2003 to 2005 with model results, actual cases and predicted events of West Nile virus activity match relatively well. The model represents a useful method for estimating potential West Nile virus activity in a large spatial scale. [ABSTRACT FROM AUTHOR]

This paper describes Princeton University's approach to the 2005 DARPA Grand Challenge, an off-road race for fully autonomous ground vehicles. The system, Prospect Eleven, takes a simple approach to address the problems posed by the Grand Challenge, including obstacle detection, path planning, and extended operation in harsh environments. Obstacles are detected using stereo vision, and tracked in the time domain to improve accuracy in localization and reduce false positives. The navigation system processes a geometric representation of the world to identify passable regions in the terrain ahead, and the vehicle is controlled to drive through these regions. Performance of the system is evaluated both during the Grand Challenge and in subsequent desert testing. The vehicle completed 9.3 miles of the course on race day, and extensive portions of the 2004 and 2005 Grand Challenge courses in later tests. © 2006 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Explores the implications of the No Child Left Behind Act (NCLB) on the literacy of multicultural families in the U.S. Benefits offered by the NCLB to English language learners and parents; Importance of parental involvement in children's literacy; Problems related to teaching and equity arising from the Title III, Section 3115 of the NCLB.

Aim The local distribution of woody vegetation affects most functional aspects of semiarid landscapes, from soil erosion to nutrient cycling. With growing concern about anthropogenic climate change, it has become critical to understand the ecological determinants of woody plant distribution in semiarid landscapes. However, relatively little work has examined the determinants of local variation in woody cover. Here we examine water balance controls associated with patterns of tree cover density in a topographically complex semiarid woodland. Location Los Pinos Mountains, Sevilleta National Wildlife Refuge LTER, New Mexico, USA. Methods To explore the relationship between local water balance variation and tree cover density, we used a combination of high-resolution (1 × 1 m), remotely sensed imagery and quantitative estimates of water balance variation in space and time. Regression tree analysis (RTA) was used to identify the environmental parameters that best predict variation in tree cover density. Results Using six predictor variables, the RTA explains 39% of the deviance in tree cover density over the landscape. The relationship between water balance conditions and tree cover density is highly contingent; that is, similar tree cover densities occur under very different combinations of water balance parameters. Thus, the effect of one environmental parameter on tree cover density depends on the values of other parameters. After tree cover density is adjusted for water balance conditions, residual variation is related to tree cover density in the neighbourhood of a particular location. Conclusion In semiarid landscapes, vegetation structure is largely controlled by water supply and demand. Results presented here indicate that localized feedbacks and site-specific historical processes are critical for understanding the responses of semiarid vegetation to climate change. [ABSTRACT FROM AUTHOR]

Case-mix adjustment methods are needed to account for differences between providers when the youth they treat have characteristics that adversely affect treatment success. This study explores variables for adjusting mental health treatment outcomes for adolescents and the differential effects of case-mix adjustment on providers' performance. Linear regression modeling was used to identify case-mix variables for five outcomes. Predictive equations for each outcome were developed for models based on intake clinical data alone, clinical data plus administrative data, and clinical data plus data describing youth history and family environment. Variance explained by intake clinical data alone did not increase appreciably with the addition of administrative data or data describing youth history and family environment. Adjusting outcomes changed the relative performance of certain individual providers substantially, but had a more moderate impact on the overall interpretation of providers' performance. [ABSTRACT FROM AUTHOR]

Objectives: To determine the comorbidity of lead poisoning and asthma in urban children, and to examine associated clinical factors. Methods: One-hundred-one patients at an inner-city clinic with blood lead levels (BLLs) of 25 µg/dL or higher (≥1.2 µmol/L) (BLL25 group) were randomly selected from a tracking lead database and matched on age, sex, and primary language to 101 randomly selected patients with a first BLL recorded in the database of lower than 5 µg/dL (<0.2 µmol/L) (BLL5 group) and no subsequent BLLs of 10 µg/dL or higher (≥0.5 µmol/L). Medical records were reviewed to determine diagnosis or symptoms of asthma or wheezing at any visit, immunization status, and number of visits. Analyses for matched pairs were conducted. Results: The BLL25 and BLL5 groups did not differ on age at diagnostic BLL (26.6 months vs 24.2 months), sex (54% male), or language (12% Spanish). The BLL25 and BLL5 groups had a similar number of subjects with a diagnosis of asthma (6% vs 11%; odds ratio, 0.5; 95% confidence interval, 0.2-1.6); 26% of BLL25 and 34% of BLL5 subjects had either a diagnosis or symptoms of asthma or wheezing (odds ratio, 0.7; 95% confidence interval, 0.4-1.3). Subjects with BLL25 were more likely to have delayed immunization and a first clinic visit when older than subjects with BLL5. Conclusions: There was no increased likelihood of asthma diagnosis or symptoms among young children with lead poisoning. Children with lead poisoning also had delayed medical care. These data may help guide interventions aimed at preventing or reducing the impact of lead poisoning and asthma. [ABSTRACT FROM AUTHOR]

We evaluated species-environment relationships within piñon-juniper woodlands in northern New Mexico (United States) using canonical correspondence analysis (CCA). The first CCA axis was associated primarily with elevation. Our results showed separation between piñon and juniper along the elevation gradient, as expected: piñon is relatively more dominant at higher sites, whereas juniper is relatively more dominant at lower sites. To examine how this pattern of dominance might emerge with time, we plotted the position of centroids for three piñon and juniper size classes along the first CCA axis. We found that small piñons and junipers were distributed relatively uniformly across the gradient, whereas large piñons and junipers were strongly segregated along the gradient, with intermediate-sized piñons and junipers intermediate on the CCA axis between small and large. This produced a pattern of increased divergence between the two species that increased with size. We suggest that this pattern emerges as a result of differential mortality between the species rather than as a result of differences in seedling establishment along the gradient. These differences between the species could result from differences in resource use (i.e., physiology) and resource acquisition (i.e., rooting patterns relative to plant available water) We present a conceptual model of how differences between the species in resource acquisition increase with size (age). We suggest that differences in resource acquisition between species, which increase as individuals mature, may play a greater role in determining species dominance along resource gradients than has been previously appreciated. [ABSTRACT FROM AUTHOR]

Examines the development and application of United States federal criminal statutes that govern offenses by or against financial institutions. Analysis on the Bank Fraud Statute; Review of the Financial Institutions Reform, Recovery, and Enforcement Act of 1989; Examination on the Bank Secrecy Act.

Investigates the software reuse by computer programmers in the United States. Focus of the study on abstract-data-type libraries; Worth of reusing candidate abstract data type for abstract-data-type requirement; Alteration of threshold values using software tools.

In recent years, the power and pervasiveness of prison gangs have posed substantial problems for prison officials. Inresponse, many states have adopted policies that segregate "known" prison gang members to highly restrictive "supermax" prisons such as California's Pelican Bay State Penitentiary. Federal courts have held that an inmate accused of gang affiliation is entitled to certain procedural safeguards before being transferred to a supermax prison facility. Specifically, alleged prison gang members are afforded the same procedural protections as prisoners facing temporary administrative transfers. This Comment argues that equating the procedural protections due in administrative transits with those of supermax prison transfers based on gang affiliation disregards the severity of confinement in a supermax facility and the purpose upon which such facilities were built. In response, the author argues that the Due Process Clause of the Fourteenth Amendment necessitates that segregation decisions be based upon evidence of an actual infraction of prison rules, rather than the mere "status" of gang affiliation. [ABSTRACT FROM AUTHOR]

Focuses on the National Study of Internal Medicine Manpower which examined the residency training of physicians in the U.S. from 1976 to 1977. Details of the study; Methodology of the study ; Results and discussion.

Background: The placement of mesh in the repair of all types of hernia has been reported to decrease recurrence rates. There are several well known complications related to mesh repairs, including infection, erosion, seroma, and pain. Lesser reported are cardiac injuries secondary to anchoring of the mesh to the diaphragm. Methods: We report 2 previously unreported, unpublished cases of cardiac tamponade after mesh fixation to the diaphragm and present a review of the literature and search of the US Food and Drug Administration’s Manufacturer and User Device Experience (MAUDE) database. Results: We reviewed a total of 10 cases of cardiac tamponade in hiatal hernia repair, 6 resulting in patient mortality, 5 cases in ventral hernia repair, 4 being fatal. Ten cases were caused by the helical tacker, 2 by sutures, 1 by the straight stapler, and in 1 case the cause was not identified. Conclusion: When anchoring mesh to the diaphragm, it is necessary to consider the risk of injury to the heart and cardiac tamponade, especially if the helical tacker is used in this region. Only with appropriate awareness and recognition can this catastrophic complication be avoided. [Copyright &y& Elsevier]

The purpose of this study was to explore the impact of authentically based instruction using the 5E model as the structure for lesson delivery on student emotions and the extent to which the students perceived that the teacher was facilitating mastery goals. Participants were 241 sophomore and junior biology students in three urban high schools in a large city in the Midsouth region of the United States. Two conditions occurred: a lesson designed using authentic 5E model, while the other was a text-based lesson on the topic of photosynthesis. The results suggest that the authentic 5E instruction increased interest and enjoyment and decreased anxiety, hopelessness, frustration, confusion, and boredom as compared to the text-based instruction. Furthermore, the students in the authentic group perceived that the teacher facilitated more mastery goals than the comparison group. Finally, we found that the change of student perception in teacher mastery had a predictive relationship with change in positive and negative emotions. Implications of this study are that authentic instruction can lead to positive academic outcomes and that perceived teacher mastery can have a positive influence on student emotions, which in turn can generate motivation and achievement in high school science courses. [ABSTRACT FROM AUTHOR]

Introduces a series of articles about U.S. political and social science.

OBJECTIVES: The 1983 US Orphan Drug Act (ODA) provided incentives to stimulate treatment product development for patients with rare disease. This article highlights a decade of ODA contributions to this goal for children with RDs. METHODS: An internal US Food and Drug Administration database was the information source for orphan designations, marketing approvals, and prevalence numbers for 2000 to 2009. Product categorization was based on the disease age of onset for which they received designation. Category 1 products were for diseases with onset exclusively in Childhood; Category 2 products were for diseases with onset at any age; and Category 3 products were for diseases with adult onset only. Disease prevalence distributions were analyzed by using population intervals of 20 000. RESULTS: From 2000 to 2009, 1138 orphan drugs were designated and 148 received marketing approval, of which 38 (26%) were for pediatric diseases. The proportion of approvals for pediatric products increased from 17.5% (10 of 57) in the first half of the decade, to 30.8% (28 of 91) in the second. More products received designation and marketing approval for pediatric diseases with prevalence numbers fewer than 20 000 than for any other prevalence subgroup. The median disease prevalence for all pediatric orphan designations that received marketing approval was 8972. Among the pediatric orphan drug approvals categorized by therapeutic class, the endocrine/metabolic drugs had the largest representation (39%). CONCLUSIONS: The ODA incentives have led to increased product availability for RDs overall, with an increasing number of marketing approvals for children this past decade. [ABSTRACT FROM AUTHOR]

Background The number of women in medicine has grown rapidly in recent years. Women constitute over 50% of medical school graduates and hold 38% of faculty positions at United States medical schools. Despite this, gender disparities remain prevalent in most surgical subspecialties, including plastic surgery. The purpose of this study was to analyze gender authorship trends. Materials and methods A cross-sectional study of academic plastic surgeons was performed. Data were collected from departmental websites and online resources. National Institute of Health (NIH) funding was determined using the Research Portfolio Online Reporting Tools database. Number of published articles and h-index were obtained from Scopus (Elsevier Inc, New York, NY). Statistical analysis was performed in SPSS (SPSS Inc, Chicago, IL). Results A total of 814 plastic surgeons were identified in the United States. Compared to men, women had significantly fewer years in practice ( P <0.001), lower academic ranks ( P <0.001), and published less ( P <0.001). There was no difference in the number of PhD degrees between genders; women with PhDs published less than men with PhDs ( P = 0.04). 5.1% of women and 6.9% of men received NIH funding during their career ( P = 0.57). There was no gender difference in scholarly output among NIH-funded surgeons. Overall, years in practice, academic rank, chief/program director title, advanced degrees, and NIH funding all positively correlated with academic productivity. Conclusions This study identifies significant gender disparities in scholarly productivity among plastic surgeons in academia. Future efforts should focus on improving gender equality and eliminating barriers to academic development. [ABSTRACT FROM AUTHOR]

Studies changes in CD4 T-cell differentiation phenotype during structured treatment interruption in patients with chronic HIV-1 infections in the U.S. Markers of maturation and activation measured on peripheral CD4 T-cells; Changes in overall CD T-cell percentage following interruptions in highly active antiretroviral therapy.

Background: Carpal tunnel release (CTR) is one of the most commonly performed procedures in hand surgery. Complications from surgery are a rare but significant patient dissatisfier. The purpose of this study was to determine whether insurance status is independently associated with complications after CTR., Methods: We retrospectively identified all patients undergoing CTR between 2008 and 2018 using the Indiana Network for Patient Care, a state-wide health information exchange, and built a database that included patient demographics and comorbidities. Patients were followed for 90 days to determine whether a postoperative complication occurred. To minimize dropout, only patients with 1 year of encounters after surgery were included., Results: Of the 26 151 patients who met inclusion criteria, 2662 (10.2%) had Medicare, 7027 (26.9%) had Medicaid, and 16 462 (62.9%) had commercial insurance. Compared with Medicare, Medicaid status ( P < .001) and commercial insurance status ( P < .001) were independently associated with postoperative CTR complications. The overall complication rate was 2.23%, with infection, wound breakdown, and complex regional pain syndrome being the most common complications. Younger age, alcohol use, diabetes mellitus, hypertension, and depression were also independently associated with complications., Conclusions: The incidence of complications after CTR is low. Insurance status, patient demographics, and medical comorbidities, however, should be evaluated preoperatively to appropriately risk stratify patients. Furthermore, surgeons can use these data to initiate preventive measures such as working to manage current comorbidities and lifestyle choices, and to optimize insurance coverage.

Objective: The primary objective was to determine the effect of the COVID-19 pandemic on volume, demographics, and mechanisms of injury (MOI) for patients seen at an urban multidisciplinary concussion center. During the first phase of the pandemic in the United States, stay-at-home orders led to decreased group activities and required cancellation of outpatient appointments or initiation of telemedicine visits., Methods: This study was a retrospective chart review of 3500 patient electronic medical records (EMR). Patients aged 1-99 years were eligible if they had been seen at New York University Langone Health Concussion Center during March 1-December 31, 2019 (control/pre-pandemic period) or during the same period in 2020 (pandemic period). Injury date, appointment date, age, sex, and MOI were captured; statistical analyses were performed using Stata17 (StataCorp, College Station, TX)., Results: There were 48% fewer visits during the COVID-19 pandemic period compared to the 2019 control period. There was a decreased proportion of pediatric patients (15% control, 6% pandemic; p = 0.007, chi-square test). Fewer concussions were related to team sports (21% control, 5% pandemic; p < 0.001), and a greater proportion were caused by bicycle accidents (4% control, 8% pandemic; p = 0.037) and assault/domestic violence (3% control, 9% pandemic; p < 0.001)., Conclusion: The relative proportions of concussion MOI, age distributions, and visit volumes were significantly associated with pre-pandemic vs. pandemic periods, suggesting that COVID-19 changed concussion epidemiology during the pandemic period. This study demonstrates how epidemiologic data may inform future resource allocation during public health emergencies., Competing Interests: Declaration of Competing Interest The remaining authors report no disclosures., (Copyright © 2022. Published by Elsevier B.V.)

Given the limited treatment options for trichotillomania (TTM), or Hair Pulling Disorder, this large randomized clinical trial evaluated the efficacy of acceptance-enhanced behavior therapy for TTM (AEBT-TTM) in reducing TTM severity relative to psychoeducation and supportive therapy (PST). Eighty-five adults (78 women) with TTM received 10 sessions (over 12 weeks) of either AEBT-TTM or PST. Independent evaluators masked to treatment assignment assessed participants at baseline (week 0), midpoint (week 6), and endpoint (week 12). Consistent with a priori hypotheses, 64% of the adults treated with AEBT-TTM were classified as clinical responders at post-treatment relative to 38% treated with PST. Clinical responders were identified by a score of 1 or 2 on the Clinical Global Impressions-Improvement (CGI-I) scale. Relative to the PST group, the AEBT-TTM group demonstrated significantly greater pre-to post-treatment reductions on the self-report Massachusetts General Hospital-Hairpulling Scale (MGH-HS) and the evaluator-rated National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS). There were no significant post-treatment group differences on the Clinical Global Impressions-Severity (CGI-S) scale, or rate of TTM diagnoses. Results suggest AEBT-TTM provides greater treatment benefit than PST. Future research should continue to investigate AEBT-TTM along with mediators and moderators of its efficacy., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: During online search queries, Google uses machine learning algorithms to provide frequently associated ("People Also Ask" [PAA]) questions with corresponding websites answering the question. We aimed to identify the most frequent questions about rhinoplasty asked online and the sources used to answer them. Materials and Methods: PAA questions were extracted for the terms "rhinoplasty," "nose surgery," and "nose job." Questions were categorized into specific topics. Websites were categorized by type and assessed for quality using Journal of the American Medical Association ( JAMA ) benchmark criteria. A search engine optimization tool determined search volume for individual questions and specific topics. Results: Internet searches for the PAA questions ( n  = 102) and associated websites were related to preoperative factors (46%), cost (35.7%), and recovery timeline (7.3%). Sources for the answers to PAA questions were single surgeon personal (39.3%) and medical practice (20.6%) websites. Conclusions: Surgeons may wish to emphasize specific patient education topics, including preoperative factors, cost, and recovery timeline, on their websites to address the most frequently sought-after information regarding rhinoplasty online.

Purpose: To assess the cost effectiveness of microwave ablation (MWA) and stereotactic body radiotherapy (SBRT) for patients with inoperable stage I non-small cell lung cancer (NSCLC)., Materials and Methods: A literature search was performed in MEDLINE with broad search clusters. A decision-analytic model was constructed over a 5-year period. The model incorporated treatment-related complications and long-term recurrence. All clinical parameters were derived from the literature with preference to long-term prospective trials. A healthcare payers' perspective was adopted. Outcomes were measured in quality-adjusted life years (QALYs) extracted from prior studies and U.S. dollars from Medicare reimbursements and prior studies. Base case calculations, probabilistic sensitivity analysis with 10,000 Monte Carlo simulations, and multiple 1- and 2-way sensitivity analyses were performed., Results: MWA yielded a health benefit of 2.31 QALYs at a cost of $195,331, whereas SBRT yielded a health benefit of 2.33 QALYs at a cost of $225,271. The incremental cost-effectiveness ratio was $1,480,597/QALY, indicating that MWA is the more cost-effective strategy. The conclusion remains unchanged in probabilistic sensitivity analysis with MWA being the optimal cost strategy in 99.84% simulations. One-way sensitivity analyses revealed that MWA remains cost effective when its annual recurrence risk is <18.4% averaged over 5 years, when the SBRT annual recurrence risk is >1.44% averaged over 5 years, or when MWA is at least $7,500 cheaper than SBRT., Conclusions: MWA appears to be more cost effective than SBRT for patients with inoperable stage I NSCLC., (Copyright © 2022. Published by Elsevier Inc.)

Purpose: To determine whether a brief leadership curriculum including high-fidelity simulation can improve leadership skills among resident physicians., Method: This was a double-blind, randomized controlled trial among obstetrics-gynecology and emergency medicine (EM) residents across 5 academic medical centers from different geographic areas of the United States, 2015-2017. Participants were assigned to 1 of 3 study arms: the Leadership Education Advanced During Simulation (LEADS) curriculum, a shortened Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum, or as active controls (no leadership curriculum). Active controls were recruited from a separate site and not randomized to limit any unintentional introduction of materials from leadership curricula. The LEADS curriculum was developed in partnership with the Council on Resident Education in Obstetrics and Gynecology and Council of Residency Directors in Emergency Medicine as a novel way to provide a leadership toolkit. Both LEADS and the abbreviated TeamSTEPPS were designed as six 10-minute interactive web-based modules.The primary outcome of interest was the leadership performance score from the validated Clinical Teamwork Scale instrument measured during standardized high-fidelity simulation scenarios. Secondary outcomes were 9 key components of leadership from the detailed leadership evaluation measured on 5-point Likert scales. Both outcomes were rated by a blinded clinical video reviewer., Results: One hundred ten obstetrics-gynecology and EM residents participated in this 2-year trial. Participants in both LEADS and TeamSTEPPS had statistically significant improvement in leadership scores from "average" to "good" ranges both immediately and at the 6-month follow-up, while controls remained unchanged in the "average" category throughout the study. There were no differences between LEADS and TeamSTEPPS curricula with respect to the primary outcome., Conclusions: Residents who participated in a brief structured leadership training intervention had improved leadership skills that were maintained at 6-month follow-up., (Copyright © 2021 by the Association of American Medical Colleges.)

Competing Interests: The authors report no conflicts of interest.

The COVID-19 pandemic is causing world-wide social dislocation, operational and economic dysfunction, and high rates of morbidity and mortality. Medical practices are responding by developing, disseminating, and implementing unprecedented changes in health care delivery. Telemedicine has rapidly moved to the frontline of clinical practice due to the need for prevention and mitigation strategies; these have been encouraged, facilitated, and enabled by changes in government rules and regulations and payer-driven reimbursement policies. We describe our neurology department's situational transformation from in-person outpatient visits to a largely virtual neurology practice in response to the COVID-19 pandemic. Two key factors enabled our rapid deployment of virtual encounters in neurology and its subspecialties. The first was a well-established robust information technology infrastructure supporting virtual urgent care services at our institution; this connected physicians directly to patients using both the physician's and the patient's own mobile devices. The second is the concept of one patient, one chart, facilitated by a suite of interconnected electronic medical record (EMR) applications on several different device types. We present our experience with conducting general teleneurology encounters using secure synchronous audio and video connections integrated with an EMR. This report also details how we perform virtual neurologic examinations that are clinically meaningful and how we document, code, and bill for these virtual services. Many of these processes can be used by other neurology providers, regardless of their specific practice model. We then discuss potential roles for teleneurology after the COVID-19 global pandemic has been contained., (© 2020 American Academy of Neurology.)

We conducted a systematic review and network meta-analysis to determine the comparative efficacy of antibiotics used to control bovine respiratory disease (BRD) in beef cattle on feedlots. The information sources for the review were: MEDLINE®, MEDLINE In-Process and MEDLINE® Daily, AGRICOLA, Epub Ahead of Print, Cambridge Agricultural and Biological Index, Science Citation Index, Conference Proceedings Citation Index - Science, the Proceedings of the American Association of Bovine Practitioners, World Buiatrics Conference, and the United States Food and Drug Administration Freedom of Information New Animal Drug Applications summaries. The eligible population was weaned beef cattle raised in intensive systems. The interventions of interest were injectable antibiotics used at the time the cattle arrived at the feedlot. The outcome of interest was the diagnosis of BRD within 45 days of arrival at the feedlot. The network meta-analysis included data from 46 studies and 167 study arms identified in the review. The results suggest that macrolides are the most effective antibiotics for the reduction of BRD incidence. Injectable oxytetracycline effectively controlled BRD compared with no antibiotics; however, it was less effective than macrolide treatment. Because oxytetracycline is already commonly used to prevent, control, and treat BRD in groups of feedlot cattle, the use of injectable oxytetracycline for BRD control might have advantages from an antibiotic stewardship perspective.

Background: To test if the 5-item compassion measure (a tool previously validated in the outpatient setting to measure patient assessment of clinician compassion) is a valid and reliable tool to quantify a distinct construct (i.e. clinical compassion) among patients evaluated in the emergency department (ED)., Methods: Cross-sectional study conducted in three academic emergency departments in the U.S. between November 2018 and April 2019. We enrolled adult patients who were evaluated in the EDs of the participating institutions and administered the 5-item compassion measure after completion of care in the ED. Validity testing was performed using confirmatory factor analysis. Cronbach's alpha was used to test reliability. Convergent validity with patient assessment of overall satisfaction questions was tested using Spearman correlation coefficients and we tested if the 5-item compassion measure assessed a construct distinct from overall patient satisfaction using confirmatory factor analysis., Results: We analyzed 866 patient responses. Confirmatory factor analysis found all five items loaded well on a single construct and our model was found to have good fit. Reliability was excellent (Cronbach's alpha = 0.93) among the entire cohort. These results remained consistent on sub-analyses stratified by individual institutions. The 5-item compassion measure had moderate correlation with overall patient satisfaction (r = 0.66) and patient recommendation of the ED to friends and family (r = 0.57), but reflected a patient experience domain (i.e. compassionate care) distinctly different from patient satisfaction., Conclusions: The 5-item compassion measure is a valid and reliable tool to measure patient assessment of clinical compassion in the ED.

Background: Anxiety disorders are one of the most common mental illnesses in children and associated with high healthcare utilization. We aimed to estimate 2-year cumulative incidence of mental health-related hospitalizations, treated self-harm, and emergency room (ER) visits in children newly diagnosed with anxiety disorders and, for context, in children without anxiety disorders., Methods: We identified commercially insured treatment naïve children (3-17 years) with a new office-based anxiety disorder diagnosis (ICD-9-CM) from 2005-2014 in the MarketScan claims database. We followed children for up to 2 years after diagnosis for the first of each event: mental health-related hospitalization, inpatient, treated self-harm, and ER visits (any, anxiety-related, injury-related). Children without anxiety diagnoses were included as comparators, matched on age, sex, date, and region. We estimated cumulative incidence of each event using Kaplan-Meier analysis., Results: From 2005-2014, we identified 198,450 children with a new anxiety diagnosis. One-year after anxiety diagnosis, 2.0% of children had a mental health-related hospitalization, 0.08% inpatient, treated self-harm, 1.4% anxiety-related ER visit, and 20% any ER visit; incidence was highest in older children with baseline comorbid depression. One-year cumulative incidence of each event was lower in the comparison cohort without anxiety (e.g., mental health-related hospitalizations = 0.5%, treated self-harm = 0.01%, and ER visits = 13%)., Conclusions: Given the prevalence of anxiety disorders, 2-year incidence estimates translate to a significant number of children experiencing each event. Our findings offer caregivers, providers, and patients information to better understand the burden of anxiety disorders and can help anticipate healthcare utilization and inform efforts to prevent these serious events., (© 2018 Wiley Periodicals, Inc.)

Background: Staphylococcus aureus is a human pathogen responsible for substantial morbidity and mortality through its ability to cause a number of human infections including bacteremia, pneumonia and soft tissue infections. Of great concern is the emergence and dissemination of methicillin-resistant Staphylococcus aureus strains (MRSA) that are resistant to nearly all β-lactams. The emergence of the USA300 MRSA genetic background among community associated S. aureus infections (CA-MRSA) in the USA was followed by the disappearance of USA400 CA-MRSA isolates., Results: To gain a greater understanding of the potential fitness advantages and virulence capacity of S. aureus USA300 clones, we performed whole genome sequencing of 15 USA300 and 4 USA400 clinical isolates. A comparison of representative genomes of the USA300 and USA400 pulsotypes indicates a number of differences in mobile genome elements. We examined the in vitro gene expression profiles by microarray hybridization and the in vivo transcriptomes during lung infection in mice of a USA300 and a USA400 MRSA strain by performing complete genome qRT-PCR analysis. The unique presence and increased expression of 6 exotoxins in USA300 (12- to 600-fold) compared to USA400 may contribute to the increased virulence of USA300 clones. Importantly, we also observed the up-regulation of prophage genes in USA300 (compared with USA400) during mouse lung infection (including genes encoded by both prophages ΦSa2usa and ΦSa3usa), suggesting that these prophages may play an important role in vivo by contributing to the elevated virulence characteristic of the USA300 clone., Conclusions: We observed differences in the genetic content of USA300 and USA400 strains, as well as significant differences of in vitro and in vivo gene expression of mobile elements in a lung pneumonia model. This is the first study to document the global transcription differences between USA300 and USA400 strains during both in vitro and in vivo growth.