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Background Methods Results Conclusions Antipsychotic prescribing in United States nursing homes (NHs) has decreased since the Center for Medicare & Medicaid Service debuted the National Partnership to Improve Dementia Care in Nursing Homes (NP); however, reductions have stalled. To help explain persistent antipsychotic use despite the NP's reduction efforts, the perspectives of diverse NP stakeholders were qualitatively assessed. This study aimed to re‐evaluate these individual perspectives in combined thematic synthesis to discover NP improvement opportunities undetectable in single stakeholder assessments.Thematic synthesis. Through immersive crystallisation, original source coding results were organised into related descriptive themes. Similarities and differences were identified, and descriptive themes were regrouped into new, increasingly abstract, analytical themes. This cycle continued until variances were resolved and analytic themes sufficiently described and explained all initial descriptive themes.Three analytic themes emerged regarding NP improvement opportunities. The NP's positive impacts would be augmented by: (i) a deeper and expanded appreciation of stakeholder perspectives; (ii) more urgent and rapid adaptation to unintended adverse outcomes; and (iii) greater recognition of the contextual and environmental factors influencing decisions to prescribe or not prescribe antipsychotic medications. Stakeholder groups described: perspectives they perceived as inadequately considered by the NP; insufficient NP engagement with the stakeholders capable of creating evidenced, affordable, and available non‐pharmacologic therapies for dementia symptoms; recognition that dementia interventions effective for a specific individual at a specific time in a specific community may not generalise; and diverse ongoing undesirable outcomes from NP policies that could be mitigated by NP modifications.The NP has done much to advance dementia care in NHs. Notwithstanding, these results suggest the NP would only be improved through increasingly comprehensive inclusion of stakeholder perspectives, enhanced incorporation of individual contextual factors, and a more decisive mechanism for ongoing and continual adaptation. [ABSTRACT FROM AUTHOR]

Background/Aims: Molar pregnancy is a rare complication of pregnancy. Patients face surgery, human chorionic gonadotropin monitoring and potentially systemic treatment, resulting in unique support needs. This study's aim was to explore the impacts of gestational trophoblastic disease on embodied and emotional experience. Methods: This qualitative study considered stories of molar pregnancy from 20 women in the UK, US, Canada and Australia. These were drawn from 18 publicly available online blogs and eight semi-structured interviews, and analysed thematically. Results: Three themes were developed: 'loss', describing women's responses to their pregnancy ending; 'isolation', comprising 'rarity', 'lack of awareness' and support seeking; and 'alienation', capturing the unfamiliarity of diagnosis, 'failure' and barriers to 'moving forward'. Conclusions: Experiences are shaped by wider narratives of 'typical' pregnancy. Patient care requires an individualised and responsive approach, and non-specialist practitioners should feel confident in discussing molar pregnancy and have access to up-to-date guidance. [ABSTRACT FROM AUTHOR]

Background. A−β+ ketosis-prone diabetes (KPD) in adults is characterized by presentation with diabetic ketoacidosis (DKA), negative islet autoantibodies, and preserved β-cell function in persons with a phenotype of obesity-associated type 2 diabetes (T2D). The prevalence of KPD has not been evaluated in children. We investigated children with DKA at "T2D" onset and determined the prevalence and characteristics of pediatric A−β+ KPD within this cohort. Methods. We reviewed the records of 716 children with T2D at a large academic hospital and compared clinical characteristics of those with and without DKA at onset. In the latter group, we identified patients with A−β+ KPD using criteria of the Rare and Atypical Diabetes Network (RADIANT) and defined its prevalence and characteristics. Results. Mean age at diagnosis was 13.7 ± 2.4 years: 63% female; 59% Hispanic, 29% African American, 9% non-Hispanic White, and 3% other. Fifty-six (7.8%) presented with DKA at diagnosis and lacked islet autoantibodies. Children presenting with DKA were older and had lower C-peptide and higher glucose concentrations than those without DKA. Twenty-five children with DKA (45%) met RADIANT A−β+ KPD criteria. They were predominantly male (64%), African American or Hispanic (96%), with substantial C-peptide (1.3 ± 0.7 ng/mL) at presentation with DKA and excellent long-term glycemic control (HbA1c 6.6% ± 1.9% at follow-up (median 1.3 years postdiagnosis)). Conclusions. In children with a clinical phenotype of T2D and DKA at diagnosis, approximately half meet criteria for A−β+ KPD. They manifest the key characteristics of obesity, preserved β-cell function, male predominance, and potential to discontinue insulin therapy, similar to adults with A−β+ KPD. [ABSTRACT FROM AUTHOR]

Background: Traditional methods for benchmarking dietitian productivity are time‐consuming and fail to accurately measure the total time spent providing nutrition care. An electronic health record (EHR)‐based tool that allows for daily tracking of both face‐to‐face and patient care coordination time for dietitians was created. We assessed whether it provided consistent, continuous measurement of time and productivity. Methods: This tool was created in an independent paediatric academic healthcare system in the USA. Time spent by dietitians in face‐to‐face settings and care coordination were tracked. Changes in time spent between the years 2013–2016 versus 2018–2019 were also analysed. Results: The outpatient dietitian spent a mean total of 66.4 min per patient (37.8 ± 6.0 min in face‐to‐face care and 28.6 ± 5.2 min in care coordination). The total times and fractions spent on face‐to‐face and care coordination time varied by specialty. Comparison of the two periods of time revealed 75% more productivity on average of dietitians in different outpatient settings after including care coordination tracking. In addition, dietitians were more likely to document time spent in 5‐min increments after the institution of this methodology as opposed to 15‐min increments. Conclusions: An EHR‐based tool that facilitates the documentation of both face‐to‐face time and patient care coordination time is feasible and enables consistent, continuous measurement of time and productivity. The real‐time data from this tool can be used to support adequate dietitian staffing and be used to create a multicentre database to measure the actual time dietitians need to provide care and generate consistent staffing benchmarks. Key points: An electronic health record (EHR)‐based tool that facilitates the documentation of both face‐to‐face time and patient care coordination time is feasible and enables consistent, continuous measurement of time and productivity.Outpatient dietitians spend varying amounts of time on face‐to‐face care versus and care coordination depending on the specialty. [ABSTRACT FROM AUTHOR]

Background: In the United States, up to one-third of infants with a congenital anomaly require neonatal intensive care unit (NICU) hospitalization. Parents of these infants may have different decision-making priorities, which may be influenced by the timing of the infant's diagnosis. Purpose: (1) To compare the ranked importance of decision-making beliefs for parents of infants who received a prenatal versus postnatal congenital diagnosis and (2) explore how parents describe their decision-making beliefs. Methods: A cross-sectional, sequential mixed-methods pilot design was applied to collect quantitative data using the Good Parent Ranking Exercise and further explore parents' decision-making beliefs through qualitative interviews. Maximum difference scaling/hierarchical Bayes estimation and content analysis were used to analyze the quantitative and qualitative data, respectively. Results: Forty mothers completed the Good Parent Ranking Exercise and 20 mothers completed qualitative interviews. Four of the top 5 ranked parenting beliefs were shared by mothers in the prenatal and postnatal groups. Mothers in the postnatal group ranked "focusing on my child's quality of life" higher. Qualitative interviews revealed that previously identified decision-making beliefs were consistent in this NICU parent population, with 1 additional belief identified. Mixed-methods analysis revealed high concordance between the prenatal and postnatal groups. Implications for Practice: NICU nurses need to know that decision-making beliefs for parents who receive a prenatal versus postnatal congenital diagnosis, while largely similar, may have differences. Implications for Research: Future research should explore decision-making beliefs in demographically diverse parent groups (ie, fathers, partnered vs nonpartnered couples) and effective strategies for promoting NICU parents' decisionmaking beliefs. [ABSTRACT FROM AUTHOR]

The need for High-Interest Low-Readability books (Hi-Lo) has been acknowledged by reading specialists and teachers alike since the 1900s, yet there is a research gap regarding teacher knowledge of and access to these books. This study sought to understand teacher awareness of Hi-Lo books, access to them, and usage within classrooms in the United States. Utilizing a mixed methods survey shared via social media platforms, teachers gave their perceptions of and experiences with Hi-Lo texts. Findings point to knowledge of Hi-Lo books among teachers, but a lack of usage in the classrooms, which is influenced by stakeholders involved in curricular decision-making. [ABSTRACT FROM AUTHOR]

Accurate projections of streamflow, which have implications for flooding, water resources, hydropower, and ecosystems, are critical to climate change adaptation and require an understanding of streamflow sensitivity to climate drivers. The northeastern United States has experienced a dramatic increase in extreme precipitation over the past 25 years; however, the effects of these changes, as well as changes in other drivers of streamflow, remain unclear. Here, we use a random forest model forced with a regional climate model to examine historical and future streamflow dynamics of four watersheds across the Northeast. We find that streamflow in the cold season (November–May) is primarily driven by 3‐day rainfall and antecedent wetness (Antecedent Precipitation Index) in three rainfall‐dominant watersheds, and 30‐day rainfall, antecedent wetness, and 30‐day snowmelt in the fourth, more snowmelt‐dominated watershed. In the warm season (June–October), streamflow is driven by antecedent wetness and rainfall in all watersheds. By the end of the century (2070–2099), cold season streamflow depends on the importance placed on snow in the machine learning model, with changes ranging from −7% (with snow) to +40% (without snow) in a single watershed. Simulated future warm season streamflow increases in two watersheds (56% and 193%) due to increased precipitation and antecedent soil wetness, but decreases in the other two watersheds (−6% and −27%) due to reduced precipitation. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine whether social support mediated the relationship between economic abuse, a form of intimate partner violence, and mental health, specifically depression, among pregnant women. This cross‐sectional study used a sample of 193 pregnant women living in the United States who participated in an online Qualtrics panel survey in January 2021. Hayes Process Macro was used to assess a mediation model. Economic abuse was associated with increased odds of depressive sympto ms and fewer perceived social supports. Social support mediated the relationship between economic abuse and depression. Implications for research, policy, and practice are discussed. Notably, research focused on economic abuse and efforts to respond to it need to pay particularly close attention to the role that social supports may play in survivor's overall well‐being, as well as the impact that economic abuse may have on survivors' perceptions of social support. This may be particularly true for pregnant women experiencing economic abuse for whom social support‐related interventions have yielded positive health outcomes. Key points: Economic abuse was associated with increased odds of depression and fewer perceived social supports.Social supports nearly completely mediate the relationship between economic abuse and depression.Pregnant survivors may benefit especially from interventions that foster social supports. [ABSTRACT FROM AUTHOR]

It is unclear how online higher education faculty members perceive ethical behavior. Currently, there are no federal or state requirements for faculty to adhere to a set of ethical teaching standards in the United States. This basic qualitative study explored faculty perceptions of ethical behavior and the ethical use of interpersonal strengths in online higher education. The data analysis for this study was 229 written responses from the survey used in Or et al.'s (2022) quantitative study. The findings show that faculty members subjectively viewed ethicality and the related influences on and implications of ethical behavior. While interpersonal skills were viewed as essential to ethical behavior in online higher education, these skills are demonstrated by varying means and have different styles based on class context and the beliefs of students. [ABSTRACT FROM AUTHOR]

Background: Alcohol use has been linked to worse human immunodeficiency virus (HIV) immunologic/virologic outcomes, yet few studies have explored the effects of alcohol use disorder (AUD). This study assessed whether AUD severity is associated with HIV viral suppression and CD4 count in the three cohorts of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium. Methods: People with HIV (PWH) in Uganda (n = 301), Russia (n = 400), and Boston (n = 251), selected in‐part based on their alcohol use, were included in analyses. Logistic and linear regressions were used to assess the cross‐sectional associations between AUD severity (number of DSM‐5 diagnostic criteria) and (1) HIV viral suppression, and (2) CD4 count (cells/mm3) adjusting for covariates. Analyses were conducted separately by site. Results: The proportion of females was 51% (Uganda), 34% (Russia), and 33% (Boston); mean age (SD) was 40.7 (9.6), 38.6 (6.3), and 52.1 (10.5), respectively. All participants in Uganda and all but 27% in Russia and 5% in Boston were on antiretroviral therapy. In Uganda, 32% met criteria for AUD, 92% in Russia, and 43% in Boston. The mean (SD) number of AUD criteria was 1.6 (2.4) in Uganda, 5.6 (3.3) in Russia, and 2.4 (3.1) in Boston. Most participants had HIV viral suppression (Uganda 92%, Russia 57%, Boston 87%); median (IQR) CD4 count was 673 (506, 866), 351 (201, 542), and 591 (387, 881), respectively. In adjusted models, there were no associations between AUD severity and HIV viral suppression: adjusted odds ratios (AOR) (95%CI) per 1 additional AUD criterion in Uganda was 1.08 (0.87, 1.33); Russia 0.98 (0.92, 1.04); and Boston 0.95 (0.84, 1.08) or CD4 count: mean difference (95%CI) per 1 additional criterion: 5.78 (−7.47, 19.03), −3.23 (−10.91, 4.44), and −8.18 (−24.72, 8.35), respectively. Conclusions: In three cohorts of PWH, AUD severity was not associated with HIV viral suppression or CD4 count. PWH with AUD in the current era of antiretroviral therapy can achieve virologic control. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, global health education activities were disrupted. Transitioning to virtual options has allowed educators and trainees to continue global health education and partnerships, though the acceptability and implementation of this transition is unknown. To evaluate current and planned virtual global health education activities (VGHEAs) of a group of US global health educators during the COVID-19 pandemic and to assess perceived benefits and challenges of VGHEAs. A cross-sectional study of pediatric faculty and trainees involved in global health education from 8 institutions in the United States were surveyed anonymously about their global health education activities in 2021. Authors used representative convenience sampling and invited at least 1 faculty member and 2 trainees from each institution in the Midwest Consortium of Global Child Health Educators. All 8 institutions responded to the survey, with 38 faculty and trainee participants. Institutional implementation of virtual education activities was variable. Respondents reported that VGHEAs allowed them to maintain partnerships with low-middle income countries, though they noted that unreliable internet connections presented challenges. One program reported funding cuts to its global health program during the pandemic. The COVID-19 pandemic created challenges for global health education programs. Educators and trainees are interested in using potentially cost-saving VGHEAs to maintain international collaborations, continue global health education efforts, and even increase access to equitable educational activities despite pandemic disruptions. [ABSTRACT FROM AUTHOR]

This article presents findings from a qualitative study exploring how Israeli teacher educators prepare candidates to address multicultural issues. Background is presented regarding multicultural education in Israel along with a discussion concerning Israel's unique diversity-related challenges. Findings explore multicultural practices that are used by Israeli teacher educators designed to support development of multicultural sensitivity and create deeper understanding of different groups. Discussion of the data and recommendations for Israeli and American schools are presented.

This teacher recruitment study was conducted in one of the largest school districts in the United States. The participants (N = 152) were newly hired teachers. Findings revealed the participants considered economic (e.g., teacher salary schedule), school (e.g., location), and community (e.g., cultural opportunities) attributes important in their decision to accept a teaching job. Some hiring process attributes (e.g., ease of the application process) received low ratings. Score on a hiring process scale was the most powerful predictor of teacher satisfaction with the recruitment process and attraction to a teaching job in the district. Implications for practice and future research are discussed. (Contains 3 tables.)

OBJECTIVES: Hematologic malignancies (HMs) are life-threatening cancers that frequently entail aggressive, long, inpatient treatment protocols. This can result in numerous concurrent symptoms and decreased quality of life for patients and can affect family caregivers (FCs). This study examined the impact of an HM diagnosis on patients and on their FCs. SAMPLE & SETTING: A descriptive design was used to explore the experiences of 28 newly diagnosed patients and their FCs. All patients were receiving treatment on an inpatient acute oncology unit at a National Cancer Institute-designated cancer center. METHODS & VARIABLES: Semistructured, separate interviews with patients and FCs were recorded and transcribed verbatim. Textual and content analyses were conducted to generate common themes. RESULTS: Patients and FCs reported how diagnosis and treatment affected them physically, emotionally, logistically, and financially. They described the effects of their experiences with the health system and providers in areas such as diagnostic process, trust in the medical team, support needs, and hospitalization. IMPLICATIONS FOR NURSING: Understanding the parallel experiences of patients with HMs and their designated FCs allows researchers to develop targeted interventions and enables clinicians to provide personalized patient- and family-centered care. [ABSTRACT FROM AUTHOR]

Background: Both human immunodeficiency virus (HIV) infection and alcohol use predispose to autonomic/sensory neuropathy, imbalance symptoms, and cognitive impairment—conditions associated with a greater risk of falls—yet it is unclear how to identify people with HIV (PWH) whose drinking is associated with falls. Research on alcohol and falls using the same instruments in different countries could help to specify the level of alcohol use associated with fall risk. We examined whether a consumption‐based measure (the Alcohol Use Disorders Identification Test‐Consumption [AUDIT‐C]) and/or a symptom‐based measure (DSM‐5 criteria for alcohol use disorder [AUD]) are associated with sustaining a fall among PWH in St Petersburg, Russia and Boston, Massachusetts in the United States. Methods: Separate multivariate logistic regressions were used for each cohort to examine cross‐sectional associations for each alcohol measure predicting fall. Potential confounders included physical functioning, depressive symptoms, and other substance use (measured with the Addiction Severity Index). Results: A fall was reported by 35% (87/251) of the sample in Boston and 12% (46/400) in St Petersburg. Each additional AUD criterion—but not higher AUDIT‐C score—was significantly associated with a fall in both Boston (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.02, 1.18) and St Petersburg (adjusted OR AOR = 1.10; 95% CI 1.02, 1.18). Heavy alcohol use (>6 drinks/occasion, any vs. none) was associated with more than twice the odds of a fall (AOR = 2.24; 95% CI 1.21, 4.13) in Boston. Conclusions: These findings suggest that while fall risk may vary by setting and population, heavy alcohol use and AUD symptom severity are potential targets for interventions to prevent falls. Studies in diverse global settings advance our understanding of the relationship between alcohol and falls in PWH. [ABSTRACT FROM AUTHOR]

Climate change is affecting natural resources globally, altering ecosystems that support outdoor recreation. In the western United States, effects such as warming temperatures, increased drought, reduced snowpack, and widespread wildfires will change the outdoor recreation landscape. In this article, we synthesize the state of science regarding the effects of climate change on outdoor recreation in the western US and summarize adaptation options that can reduce the consequences of climate change, considering the adaptive capacities of recreationists and managers. We draw from a series of climate change assessments in which researchers and managers collaborated to understand recreation vulnerability to climate change and develop effective adaptations. We conclude that building climate resilience requires a shift in planning and resource allocation decisions, including (1) longer-term planning timeframes, (2) interdisciplinary teams, and (3) collaboration among agencies, recreation providers, and communities. Study Implications: Outdoor recreation in the western US is changing due to the effects of climate change. Organized by five recreational categories, this study describes the vulnerability of outdoor recreation to climate change and synthesizes strategies to adapt recreation management to these vulnerabilities. Multiple direct and indirect factors influence individual recreationists' and land managers' capacities to adapt to climate change, as we describe through a diagram. Climate-resilient land management requires long-term planning, integration of multiple resource areas, and collaboration across agencies, recreation providers, and communities. [ABSTRACT FROM AUTHOR]

Sudden unexpected infant death (SUID) disproportionately affects non-Hispanic Black (NHB) and American Indian/Alaskan Native infants, who have lower rates of breastfeeding than other groups. Using 13,077,880 live-birth certificates and 11,942 linked SUID death certificates from 2015 through 2018, we calculated odds ratios and adjusted risk differences of SUID in infants who were not breastfed across 5 racial/ethnic strata in the United States. We analyzed mediation by not breastfeeding in the race/ethnicity–SUID association. The overall SUID rate was 0.91 per 1,000 live births. NHB and American Indian/Alaskan Native infants had the highest disparity in SUID relative to non-Hispanic White infants. Overall, not breastfeeding was associated with SUID (adjusted odds ratio (aOR), 1.14; 95% confidence interval (CI): 1.10, 1.19), and the adjusted risk difference was 0.12 per 1,000 live births. The aOR of not breastfeeding for SUID was 1.07 (95% CI: 1.00, 1.14) in NHB infants and 1.29 (95% CI: 1.14, 1.46) in Hispanic infants. Breastfeeding minimally explained the higher SUID risk in NHB infants (2.3% mediated) and the lower risk in Hispanic infants (2.1% mediated) relative to non-Hispanic White infants. Competing risks likely explain the lower aOR seen in NHB infants of not breastfeeding on SUID, suggesting that social or structural determinants must be addressed to reduce racial disparities in SUID. [ABSTRACT FROM AUTHOR]

Groundwater extraction in the United States (US) is unsustainable, making it essential to understand the impacts of limited water use on irrigated agriculture. To improve this understanding, we integrated a gridded crop model with satellite observations, recharge estimates, and water survey data to assess the effects of sustainable groundwater withdrawals on US irrigated agricultural production. The gridded crop model agrees with satellite‐based estimates of evapotranspiration (R2 = 0.68), as well as survey data from the United States Department of Agriculture (R2 = 0.82–0.94 for county‐level production and 0.37–0.54 for county‐level yield). Using the optimistic assumption that groundwater extraction equals effective aquifer recharge rate, we find that sustainable groundwater use decreases US irrigated production of maize, soybean, and winter wheat by 20%, 6%, and 25%, respectively. Using a more conservative assumption of groundwater availability, US irrigated production of maize, soybean, and winter wheat decreases by 45%, 37%, and 36%, respectively. The wide range of simulated losses is driven by considerable uncertainty in surface water and groundwater interactions, as well as accounting for the many aspects of sustainability. Our results demonstrate the vulnerability of US irrigated agriculture to unsustainable groundwater pumping, highlighting the difficulty of expanding or even maintaining irrigated food production in the face of climate change, population growth, and shifting dietary demands. These findings are based on reducing pumping by fallowing irrigated farmland; however, alternate pumping reduction strategies or technological advances in crop genetics and irrigation could produce different results. Plain Language Summary: Irrigated agriculture in the United States (US) is depleting groundwater in some regions, which will eventually reduce the amount of water available for growing crops. We used a computer model to assess the impacts of sustainable water use on US irrigated agriculture. We first compared simulated crop production and water use with observed data over 5 years to evaluate the accuracy of the computer model. Simulated yield and crop water use were in good agreement with reported yields from the United States Department of Agriculture and satellite evapotranspiration estimates. We then modeled different water restriction scenarios and found that under the most optimistic scenario, US production of irrigated maize, soybean, and winter wheat decreases by 20%, 6%, and 25%, respectively. However, under the most pessimistic scenario, US production of these irrigated crops will decrease by 45%, 37%, and 36%, respectively. Overall, our simulations of different water restriction scenarios show the vulnerability of US irrigated agricultural production to reduced groundwater pumping, and highlight the difficulty of expanding or even maintaining irrigated food production across the country. Key Points: We integrate a crop model with satellite observations and survey data to simulate sustainable groundwater use for agricultureOptimistic sustainable groundwater use may decrease US irrigated production of maize, soybean, and winter wheat by 20%, 6%, and 25%Pessimistic sustainable groundwater use may decrease US irrigated production of maize, soybean, and winter wheat up to 45%, 37%, and 36% [ABSTRACT FROM AUTHOR]

We examined how racial‐ethnic identity centrality, or the importance of race/ethnicity in people's self‐perceptions, affected peoples' support for the Democratic and Republican candidates in the 2020 US election. We explored this association by examining the mediating role of trust in important social institutions. In Study 1, we examined these effects by comparing the pattern of relationships among people of color (POC) and white people, using a sample of 177 Amazon Mechanical Turk (MTurk) participants. In Study 2, we expanded our focus on different racial‐ethnic groups, by comparing effects for Black, Latinx, Asian American/Pacific Islander (AAPI), and white participants, using a sample of 530 MTurk workers. Although there were a few findings that ran contrary to our expectations, the two studies generally found that trust in institutions that challenge the status quo, such as the media, explained the relationship between identity centrality and support for candidates among POC, especially Black and Latinx participants. We also found that trust in institutions that uphold the status quo, such as police and courts, explained the relationship between racial‐ethnic identity centrality and support for candidates among white people. [ABSTRACT FROM AUTHOR]

The authors offer a response to reflections about their book "Reactionary Democracy: How Racism and the Populist Far Right Became Mainstream." Topics discussed include the relevance of the book amid political developments and crises in 2021, fragility of democracy in the U.S., and importance of research on gender and the role of white liberal feminists in the mainstreaming of reactionary politics.

Background: It is unclear whether late-effect risks among childhood cancer survivors vary internationally. We compared late mortality in the North American Childhood Cancer Survivor Study (CCSS) and British Childhood Cancer Survivor Study (BCCSS).Methods: Late mortality was assessed among 49 822 5-year survivors of childhood cancer diagnosed before 15 years of age from 1970 to 1999 (CCSS, n = 31 596; BCCSS, n = 18 226) using cumulative mortality probabilities (CM%) and adjusted ratios of the standardized mortality ratio.Results: The all-cause CM% at 10 years from diagnosis was statistically significantly lower in the CCSS (4.7%, 95% confidence interval [CI] = 4.5% to 5.0%) compared with the BCCSS (6.9%, 95% CI = 6.5% to 7.2%), attributable to a lower probability of death from recurrence or progression of the primary cancer, with statistically significant differences observed in survivors of leukemia, lymphoma, central nervous system tumors, and sarcoma. However, at 40 years from diagnosis, the CCSS had a greater CM% (22.3% vs 19.3%), attributable to a twofold higher risk of mortality from subsequent malignant neoplasms, cardiac and respiratory diseases, and other health-related causes. Differences increased when assessed by follow-up interval, with the CCSS faring worse as time-since-diagnosis increased. Finally, the gap in all-cause mortality widened more recently, with CCSS survivors diagnosed in 1990-1999 experiencing one-half the excess deaths observed in the BCCSS (ratios of the standardized mortality ratio = 0.5, 95% CI = 0.5 to 0.6).Conclusions: Our findings suggest that US survivors may have received more intensive regimens to achieve sustainable remission and cure, but the cost of this approach was a higher risk of death from late effects. Although the clinical impact of these differences is unclear, our results provide important evidence to aid the discussion of late effects management. [ABSTRACT FROM AUTHOR]

Objective: This study explored the relationship between body appreciation and discontinuing contraception due to concern about weight gain. Methods: A racially and ethnically diverse sample of women, from the United States, (n = 494) was recruited online. Binomial logistic regression was used for analysis. Results: Participants with higher body appreciation were less likely to stop taking birth control due to concern about weight gain (OR = 0.56, p =.002). These results suggest body appreciation may be a defense against concern about weight gain associated with contraceptive use. Conclusions: Interventions aimed at increasing women's body appreciation, body positivity, as well as decreasing weight stigma could improve contraception use. [ABSTRACT FROM AUTHOR]

BACKGROUND: The rise of social media has resulted in a dramatic change in citizen engagement in political processes. This raises the question of whether affordances of social network sites motivate alternative politics more than more conventional form of political engagement. OBJECTIVE: 1) identify differences in social media uses and gratifications among four political personality types (i.e., potential dissidents, allegiants, subordinates, and the alienated), and 2) examine the extent to which political personality types can be discerned using social media uses and gratifications. METHODS: 313 United States citizens above the age of 18 completed a survey using the revised MAIN model scale to measure social media uses and gratifications. Subjects were categorised into political personality types based on the Gamson Hypothesis and Paige's conceptualisation of actor types. We developed a multinomial logistic regression model to examine the relationship between predictors (uses and gratifications) and political personality types. RESULTS: Potential allegiants and dissidents are driven by a similar set of social media uses and gratifications as opposed to political subordinates and the alienated. CONCLUSION: Social media can provide more gratifications for potential dissidents and allegiants, 'favouring' personality types with high political efficacy. [ABSTRACT FROM AUTHOR]

Objectives: Adverse childhood experiences (ACEs) are associated with lasting health and behavioral effects. In this study, we assess the relationship between ACEs and gambling in the state of Nevada. Methods: Using 2018 Nevada Behavioral Risk Factor Surveillance System (BRFSS) data, we assessed the relationship between ACEs and gambling behavior among 2768 participants. A composite score was used to assess 10 commonly researched ACEs; this continuous score was additionally categorized into 0 ACEs, 1-2 ACEs, 3 or more ACEs. We used weighted logistic regression to assess the relationship between ACEs scores and frequency of gambling. Results: Approximately 9% of study participants reported frequently gambling (one or more times a month). There was a positive association between the continuous ACEs score and frequently gambling in the fully adjusted model (p = .026). The odds of frequently gambling was 69% higher among those exposed to ≥ 3 ACEs compared to those who had no ACEs exposure (adjusted OR = 1.69; 95% CI 1.00-2.84; p = .048). Conclusions: The results show a relationship between ACEs and gambling in Nevada. This research contributes to the existing understanding of ACEs and their impact. [ABSTRACT FROM AUTHOR]

Background: The prevalence of burnout and depressive symptoms is high among physician trainees.Research Question: What is the burden of burnout and depressive symptoms among fellows training in pulmonary and critical care medicine (PCCM) and what are associated individual fellow, program, and institutional characteristics?Study Design and Methods: We conducted a cross-sectional electronic survey of fellows enrolled in pulmonary, PCCM, and critical care medicine training programs in the United States to assess burnout and depressive symptoms. Burnout symptoms were measured using the Maslach Burnout Index two-item measure. The two-item Primary Care Evaluation of Mental Disorders Procedure was used to screen for depressive symptoms. For each of the two outcomes (burnout and depressive symptoms), we constructed three multivariate logistic regression models to assess individual fellow characteristics, program structure, and institutional polices associated with either burnout or depressive symptoms.Results: Five hundred two of the 976 fellows who received the survey completed it-including both outcome measures-giving a response rate of 51%. Fifty percent of fellows showed positive results for either burnout or depressive symptoms, with 41% showing positive results for depressive symptoms, 32% showing positive results for burnout, and 23% showing positive results for both. Reporting a coverage system in the case of personal illness or emergency (adjusted OR [aOR], 0.44; 95% CI, 0.26-0.73) and access to mental health services (aOR, 0.14; 95% CI, 0.04-0.47) were associated with lower odds of burnout. Financial concern was associated with higher odds of depressive symptoms (aOR, 1.13; 95% CI, 1.05-1.22). Working more than 70 hours in an average clinical week and the burdens of electronic health record (EHR) documentation were associated with a higher odds of both burnout and depressive symptoms.Interpretation: Given the high prevalence of burnout and depressive symptoms among fellows training in PCCM, an urgent need exists to identify solutions that address this public health crisis. Strategies such as providing an easily accessible coverage system, access to mental health resources, reducing EHR burden, addressing work hours, and addressing financial concerns among trainees may help to reduce burnout or depressive symptoms and should be studied further by the graduate medical education community. [ABSTRACT FROM AUTHOR]

Pediatric obesity is a growing health concern afflicting the United States. The treatment for pediatric obesity, as a health epidemic, costs billions of dollars to our nation, leaving providers and researchers searching for effective and sustainable ways to better manage the biological, psychological, and social health of individuals and families. While many assessments and interventions continue to emerge, researchers have predominately focused on intra-individual concerns among white non-Hispanic populations. This quantitative study was grounded in a relational theory (attachment theory), with a dyadic and primarily Hispanic sample. Evidence from our study supported that child attachment predicted child obesogenic behavior and that this relationship was mediated by child self-regulation. Children with insecure attachments had more obesogenic behaviors and lower self-regulation of eating than those with secure attachments. Family therapists should be on the frontlines of relational research and clinical interventions that interface with biopsychosocial health across diverse cultures and families. [ABSTRACT FROM AUTHOR]

The increase in nurse practitioners (NPs) in ambulatory medical and surgical specialty settings has prompted inquiry into their role and contribution to patient care. We explored the role and contribution of NPs in ambulatory specialty care through their activities outside of direct care and billable visits (referred to as service value activities), and how NPs perceive these activities enhance quality and efficiency of care, for both patients and the health care institution. This qualitative thematic analysis examined interviews from 16 NPs at a large academic medical center about their role and contribution to patient care quality and departmental efficiency beyond billable visits. Five categories of NP contribution were identified: promoting patient care continuity, promoting departmental continuity, promoting institutional historical and insider knowledge, addressing time-sensitive issues, and participating in leadership and quality improvement activities. As the role of NPs in specialty care grows and health care systems emphasize quality of care, it is appropriate to explore the quality- and efficiency-enhancing activities NPs perform in specialty care beyond direct patient care. [ABSTRACT FROM AUTHOR]

Background: Many studies have investigated passengers' willingness to fly (WTF) or ride in autonomous aircraft and vehicles. With the emergence of urban air mobility, it is important to consider consumer perceptions of autonomous air taxis and passengers' willingness to fly in various conditions. Therefore, the purpose of this study was to determine what external factors may influence consumers' willingness to fly on autonomous air taxis in various weather conditions, terrain, flight time, and population densities. Methods: Across two studies, 782 participants were presented with a definition of autonomous air taxis. Then a hypothetical scenario involving an air taxi that included four variables: rain versus no rain (Weather), 5-minute flight versus 30-minute flight (Flight Time), over land or water (Terrain), and over urban or rural areas (Population Density). Results: The data from the study suggest that both United States and Indian passengers were more willing to fly in good weather conditions versus rainy weather, over land versus over water, and on short flights versus longer flights. Conclusions: As urban air mobility becomes more well-known, it is important to understand consumer opinions and educate them on emerging technology. This, in turn, can aid industries in developing marketing strategies to help increase awareness of new technologies in the future. [ABSTRACT FROM AUTHOR]

Research suggests that body image is related to health behaviors and health care use, but possible mechanisms for this relationship remain unclear. The current study examined the presence of a relationship between body appreciation and avoiding the doctor to avoid being weighed, using a diverse sample of women (N = 499). Controlling for body size and determinants of health care utilization, logistic regression results suggested that women with higher body appreciation were less likely to avoid health care to avoid being weighed (odds ratio = 0.38, p <.001). In addition, differences in avoiding the doctor to avoid being weighed were found for the covariates (that is, age, race, body mass index, and socioeconomic status). These results inform knowledge regarding barriers to health care use and the relationship between body image and health care use. The article concludes with a discussion of the implications for future research, social work interventions, and social work education to promote women's health and well-being. [ABSTRACT FROM AUTHOR]

Patient perception research has failed to focus on burgeoning technology within the dental field. Specifically, researchers have yet to focus on developing robotic technologies which are being utilized by dentists to help perform certain procedures with added precision and route mapping. The current study attempts to fill the gap created by a lack of intersection between dental technology research, consumer perceptions research, and automation research. The current research takes a two-study approach, with study 1 investigating if gender or price of the procedure affects willingness to undergo a robotic dental procedure. Study 2 further investigates this phenomenon, identifying ten separate types of dental procedures (ranging from minimally invasive to extremely invasive) to further understand consumer perceptions. Results indicate that females are less willing to undergo a robotic dental procedure, and that participants in general are more willing to undergo a procedure if it is half price than if it full price. Willingness is influenced by gender and the type of procedure being performed – participants were less willing to undergo invasive procedures such as gum surgery than noninvasive procedures such as teeth whitening. These results, and their theoretical and practical significance are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Appropriate management of patients with Alzheimer's disease (AD) helps preserve their independence and time at home. We explored physician behavior in the management of AD, focusing on diagnosis.Methods: Online questionnaires and patient record forms (PRFs) were created by an independent market research agency and completed by participating physicians. Physicians were recruited from France, Germany, Japan, the UK, and the USA. A sample of 1086 physicians was recruited, including general practitioners, geriatricians, neurologists, and psychiatrists. Physicians completed an online interview and 2-3 PRFs based on randomly selected records of their patients with AD. Data on triggers and timing of diagnosis were captured. Data were assessed for all countries combined (global) and within each country and physician specialty.Results: A total of 3346 PRFs were submitted. Approximately half of patients received diagnosis within 6 months. There were large country differences. In France, only 35% of patients were diagnosed within 6 months compared to 65% in Japan. Physicians in France also reported diagnoses taking > 9 months for a substantial number of patients (39%) compared with other countries (16-29%). Caregivers were the main driver toward diagnosis. Physician suspicion of AD was a trigger for diagnosis in only 20% of cases, globally. Overall, referral rates were low (14-23%).Conclusion: This study suggests that detection and timely diagnosis of AD remains suboptimal. This highlights the importance of fostering awareness of early symptoms and education on the benefits of timely diagnosis, a critical step in initiating treatment as early as possible. [ABSTRACT FROM AUTHOR]

Objective: Timely initiation of Alzheimer's disease (AD)-specific treatment may postpone cognitive deterioration and preserve patient independence. We explored real-world physician behavior in the treatment of AD.Methods: Online questionnaires and patient record forms (PRFs) were completed by participating physicians. The physicians included general practitioners, neurologists, geriatricians and psychiatrists, recruited from France, Germany, Japan, the UK and the USA. Physicians completed an online interview and two to three PRFs based on selected records of their patients with AD. Data on treatment algorithms and key drivers for therapy were captured.Results: A total of 3346 PRFs were submitted and 1086 physicians interviewed. Overall, 44% of patients with mild cognitive impairment/prodromal AD, 71% of patients with mild disease and 76% of patients with moderate disease had already received therapy. The most common reasons for not prescribing therapy were patient refusal (35%) and early disease stage (26%). Except in the USA, the majority of physicians preferred to prescribe monotherapy. Almost 30% of patients at any stage of the disease did not receive AD-specific pharmacotherapy immediately after diagnosis.Conclusions: Physicians' attitudes toward AD treatment could be driven by limited awareness regarding the benefits of early intervention and the modest efficacy of currently available therapies. Efficacious therapies for AD, especially early AD, which could be used alone or in combination with current medications to maximize treatment benefit, are still needed. The availability of more efficacious therapies may improve time to treatment initiation, treatment rates and acceptance of treatment by patients, caregivers and physicians. [ABSTRACT FROM AUTHOR]

The 2014-2016 Ebola epidemic in West Africa influenced how public health officials considered migration and emerging infectious diseases. Responding to the public's concerns, the US government introduced enhanced entry screening and post-arrival monitoring by public health authorities to reduce the risk of importation and domestic transmission of Ebola while continuing to allow travel from West Africa. This case study describes a new initiative, the Check and Report Ebola (CARE+) program that engaged travelers arriving to the United States from countries with Ebola outbreaks. The Centers for Disease Control and Prevention employed CARE ambassadors, who quickly communicated with incoming travelers and gave them practical resources to boost their participation in monitoring for Ebola. The program aimed to increase travelers' knowledge of Ebola symptoms and how to seek medical care safely, increase travelers' awareness of monitoring requirements, reduce barriers to monitoring, and increase trust in the US public health system. This program could be adapted for use in future outbreaks that involve the potential importation of disease and require the education and active engagement of travelers to participate in post-arrival monitoring. [ABSTRACT FROM AUTHOR]

The US government moved to a private ownership model for providing affordable housing in the 1960s, which resulted in millions of housing units being developed and governed by affordability restrictions that expire at some later point. By 2010, thousands of tenants lived in properties where a private owner, or US Department of Housing and Urban Development, terminated the rental subsidy, and many more will face this reality going forward. Households in the project-based Section 8 programme are offered a voucher when the subsidy contract ends. This as of right voucher represents the only federal rental safety net programme in the USA. Despite this reality, little is known about what happens to tenants when a subsidy contract ends, including whether or how they use their vouchers. This paper creates a national census of every tenant who lived in a property in the USA where the project-based Section 8 subsidy ended through 2010 to analyse this event. The analysis includes a series of models that analyse what factors are associated with voucher use, moves, and opportunity moves. This paper finds that the voucher is not used by the majority of households, despite high levels of household demand for the subsidy. Those who use the voucher and move tend to move to lower poverty tracts. However, the subsidy offers the weakest safety net for households where the head is older than 62 or Black. [ABSTRACT FROM AUTHOR]

Creating environments that support healthy eating is important for successful aging, particularly in light of the growing population of older adults in the United States. There is an urgent need to identify innovative upstream solutions to barriers experienced by older adults in accessing and buying healthy food. FEAST (Food Environment Assessment STudy) is an effort that is part of the global Our Voice initiative, which utilizes a combination of technology and community-engaged methods to empower citizen scientists (i.e., community residents) to: (1) use the Healthy Neighborhood Discovery Tool (Discovery Tool) mobile application to collect data (geocoded photos, audio narratives) about aspects of their environment that facilitate or hinder healthy living; and (2) use findings to advocate for change in partnership with local decision and policy makers. In FEAST, 23 racially/ethnically diverse, low-income, and food-insecure older adults residing in urban, North San Mateo County, CA, were recruited to use the Discovery Tool to examine factors that facilitated or hindered their access to food as well as their food-related behaviors. Participants collectively reviewed data retrieved from the Discovery Tool and identified and prioritized important, yet feasible, issues to address. Access to affordable healthy food and transportation were identified as the major barriers to eating healthfully and navigating their neighborhood food environments. Subsequently, participants were trained in advocacy skills and shared their findings with relevant decision and policymakers, who in turn dispelled myths and discussed and shared resources to address relevant community needs. Proximal and distal effects of the community-engaged process at 3, 6, 12, and 24 months were documented and revealed individual-, community-, and policy-level impacts. Finally, FEAST contributes to the evidence on multi-level challenges that low-income, racially/ethnically diverse older adults experience when accessing, choosing and buying healthy foods. [ABSTRACT FROM AUTHOR]

Making and justifying capital expenditures can be a difficult part of a supervisory or managerial position. Understanding some basic tools for making estimates and calculating values can help simplify this process. Breaking down some of the most common accounting methods into a six-step, intuitive process allows everyone, even those with little or no accounting background, to use and understand the results of these tools. Accounting tools can seem complex when they are first used, but after walking through them step-by-step and practicing them, they can become an essential tool in working with executives and other administrators. [ABSTRACT FROM AUTHOR]

Context: Stigma related to body size reduces healthcare quality and leads to healthcare avoidance, particularly for women. Barriers include weight bias from providers, lack of appropriately sized equipment for larger bodies, and internalized weight stigma and shame by patients. Objective: To examine the relationship between body appreciation and refusal to be weighed and explore reasons for refusal. Study design. A cross-sectional online survey was conducted in January 2021 using a convergent mixedmethods approach. Population studied. Adult cisgender women in the United States speaking English as their first language were recruited through a convenience sample by sharing the survey link on social media. Methods: The dependent variable was a binary outcome asking if participants had ever refused to be weighed. The primary independent variable, body appreciation, was measured with the Body Appreciation Scale-2. Multivariate logistic regression was used, controlling for socioeconomic status, race, age, and BMI. Both thematic and content analyses were performed on qualitative data. Results: 384 women aged 19-65 responded to the survey, including 66.4% white, 25.8% black, and 7.8% other. Half of participants reported they thought it was okay to refuse to be weighed by a healthcare provider (50.1%) and almost a third reported ever refusing to be weighed by a provider (32.3%). After adjusting for covariates, body appreciation significantly predicted refusing to be weighed (OR =.60, CI=0.40-0.92), with higher body appreciation decreasing the odds of refusal. Qualitative results showed women most commonly reported refusing to be weighed because of its negative impact on their mental health (52%), including increased feelings of shame and anxiety. Almost a third (27%) stated they refused to be weighed because of concerns about the patient-provider relationship, including not trusting their provider (27%) and fearing their provider would laugh at them (9.5%). A quarter (24%) cited direct concerns about weight discrimination, based on prior negative experiences with providers, or anticipating weight discrimination. Conclusions: With obesity affecting 42% of US adults, there is an urgent need to identify modifiable factors to deliver weight-inclusive healthcare, particularly for primary care as the frontline of healthcare delivery. Competencies for weight-inclusive healthcare should include body appreciation and strengthening patient-provider relationships and trust. [ABSTRACT FROM AUTHOR]

Given the current professional behavioral health workforce shortage, nursing professional development practitioners require educational resources to fully support registered nurses across settings in responding to patients with behavioral health symptoms. Mental Health First Aid is an 8-hour training to help nonprofessional bystanders assess a mental health crisis, provide initial help, and connect to supports and self-help resources in the local community. Mental Health First Aid was acceptable and useful to 60 RNs and can be supplemented with additional content. [ABSTRACT FROM AUTHOR]

BACKGROUND: Simulation is widely used in graduate medical education. A prior survey showed that 80% of Neonatal-Perinatal Medicine (NPM) fellowship programs in the U.S. use simulation. There are multiple ways to provide simulation-based education. One such method is through intensive simulation-based education sessions held at the beginning of a training program, common called 'boot camps'. The aim of this study was to describe the use of simulation-based boot camps in NPM fellowship programs. METHODS: Survey study of Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowships in the U.S. RESULTS: Fifty-nine of 98 programs (60%) responded. Thirty six (61%) participated in 1st year fellow boot camps, which focused on procedural skills and newborn resuscitation. Nearly half of programs participated in regional boot camps. Most boot camps were one or two days long. Eleven programs (19%) held 2nd or 3rd year fellow boot camps, which focused on advanced resuscitation and communication. Barriers included lack of faculty protected time (57%), funding (39%), and lack of faculty experience (31%). CONCLUSIONS: A majority of ACGME accredited NPM fellowships participate in 1st year fellows' boot camps. Many participate in regional boot camps. A few programs have 2nd or 3rd year fellow boot camps. Lack of time, funding, and faculty experience were common barriers. [ABSTRACT FROM AUTHOR]