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The present study sought to compare the efficacy of two MIPs in inducing arousal to investigate arousal's role in memory accuracy. This study used a 2 (Mood Induction Procedure: MIP) * 3 (Arousal State) between-subjects design to test how MIPs and arousal states interact to affect memory accuracy and false memory rates. One hundred and five college-age participants were assigned to one of three arousal conditions (low: sad, control: neutral, or high: fear). Half of the participants were induced via movie clips and half via guided imagery + music. Following mood induction, participants were instructed to memorize six wordlists and were tested with recall and recognition tasks. Arousal did not significantly change in any condition. There was no measurable effect of arousal state on memory. Results suggest MIP materials used in previous studies may be outdated and not effective. Keywords: mood induction procedures (MIPs), arousal state, guided imagery + music, DRM paradigm, false memory, Many years of investigation of memory and cognition have found that human memory is easily manipulated and prone to error. This error can have small day-to-day repercussions like misremembering a [...]

07.24.24 Rank: #1 (Last year: #2) $32.36 Billion Prior Fiscal: $31.23 Billion Percentage Change: +3.6% R&D Expenditure: $2.73B Best FY24 Quarter: Q4 $8.59B Latest Quarter: Q4 $8.59B No. of Employees: [...]

Post-Brexit, there has been some confusion about the future use of UKCA (UK Conformity Assessed) markings and when they must appear on products and packaging. This article offers insights on [...]

In an era when intricately woven global networks dictate the pulse of commerce, supply chain issues have ascended as a critical focal point--particularly within the medical device industry. The turn [...]

Human factors engineering (HFE) in the medical device industry is a well-established practice, a result of progressive international standards and U.S. Food and Drug Administration (FDA) guidance over the last [...]

Company leaders across various industries are incorporating artificial intelligence (AI) into their daily workflows. Like many technological advancements adopted by organizations within the past 20 years, AI is not a [...]

Screw pine root fibers are engineering fibers that have yet to be explored in terms of its chemistry with bio-rcsin in biodegradable composites to replace nonbiodegradable thermoplastics used in packaging, automobiles, furniture, and industrial sectors. Screw pine root fibers are reinforced with soy, polyvinyl alcohol), and soy-poly(vinyl alcohol) resin systems in this work to create a variety of compositcs. Composites demonstrated highest amount of tensile strength at around 39.7 MPa, 37.6 MPa of flexural property, along with an impact strength around 12.4 kJ/[m.sup.2]. The thermal solidity of the optimized materiai was determined to be 235:C. After 24 hours of immersion, the composite had the lowest water absorption of 18.4%. All composites were shown to be biodegradable, losing about 54.2%-72.9% of their original mass after 60 days in soil burial. Unique characteristics such as the use of low-cost agricultural materials, water-based resin, stable composite, and properties such as moderately strong, safe disposal after serv ice periods make these manufactured composites market feasible as consumer-friendlv/ecofriendly green products. Highlights * Screw pine root fibers were extracted from waste roots and used as reinforcement. * The tensile strength of the composite was achieved as 39.7 MPa. * The water absorption of hybrid composite was found 30.8% after 74 h. * After 60 days under soil burial, composite lost 67.5% of its original weight * Developed composites can be good alternant for nondcgradable thermoplastic. KEYWORDS biocomposite, green composite, polyvinyl alcohol), screw pine root liber, soy, 1 | INTRODUCTION Polymers are amazingly interconnected with human life in the world of today, supporting and facilitating it. The products we use every day, such as household appliances, packaging [...]

Reusing industrial waste is one of the new tactics being used to tight the dumping of solid waste for environmental protection. In the current work, the waste polyurethane (WPU) was ground to a fine powder and used for rein forcement of devulcanized waste rabber/styrene butadiene rubber (DWR/SRR) blends. DWR/SBR/WPU composites were prepared using (0. 3, 6, 9, 15, 30) phr (parts per hundred of rubber) of WPU. It was hypothesized that the treatment of WPU with trimethylolpropane triacrylate (TMPTMA) and irradiated at 10 kGy would improve its compatibility with the DWR/SBR blend and, consequently, its reinforcement efficacy. The incorporation of 30 phr of treated WPU (TWPU) improved ihe tensile strength (TS) by 47.7% and 8.6% compared to neat DWR/SBR and composites containing 30 phr of untreated WPU (UWPU). In addition, the incorporation of TWPU improved other mechanical characteristics such as tear strength, hardness, and abrasion resistance. As a result of increasing polarity and cross-link density' within the DWR/SBR blend after the addition of polar WPU, the resistance to motor oil was improved. The outcomes are encouraging from the standpoint of the circular economy and help produce high-performing, reasonably priced DWR/SBR composites for a range of industrial uses, especially in the iloor tiles application. Highlights * Waste polyurethane (WPU) was activated using gamma irradiation in the presence of TMPTMA. * The treatment of WPU improved its compatibility with DWR/SBR blend. * The impact of WPU treatment on the properties of DWR/SBR blend was investigated. * TWPU improved the mechanical properties of DWR/SBR blend more than UWPU. * TWPU increased the motor oil resistance of DWR/SBR blend more than UWPU. KEYWORDS gamma irradiation, mechanical properties, motor oil swelling, waste polyurethune, 1 | INTRODUCTION One of the most useful polymers for industry today is polyurethane (PU). Polyurethanes are categorized as condensation polymers produced from condensation polymerization between polyols and polyisocyanates. (1) [...]

Polymer adhesion promoters were formulated to improve the adhesion strength of lead frame/epoxy composites. The poly(itaconic acid-co-acrylamide) CIAcAAM) was synthesized via free radical polymerization to improve the interfacial adhesion between Ni and Cu lead frames and epoxy composites. IAcAAM was synthesized by setting itaconic acid (IA) and acrylamide (AAM) at molar ratios of 7:3, 5:5. and 3:7. The interfacial adhesion mechanism was investigated by introducing IAcAAM with three different comonomer molar ratios. The adhesion strength between EMC and Cu and Ni substrates to which each IAcAAM was applied was measured using a universal testing machine, and the effect of IAcAAM with various LA:AAM molar ratios on the surface energy of EMC was closely studied. As a result, the adhesion properties of Ni lead frame/epoxy composite and Cu lead frame/epoxy composite were improved as small amounts of all IAcAAM samples were added to the epoxy mixture. We confirmed that IAcAAM with an appropriate molar ratio can be used in the EMC process and has the potential to increase the adhesion of epoxy composites and metal lead frames. Highlights * A polymeric adhesive promoter was synthesized to enhance the adhesion strength of lead frame/epoxy composites. * Poly(itaconic acid-co-acrvlamide) (IAcAAM) was copolymeriz,ed from itaconic acid and acrylamide for this purpose. * The adhesion strength of lead frame/epoxy composites was compared for different IAcAAM monomer contents and with a commercial adhesive promoter. * IAcAAM showed superior adhesion strength in the Ni lead frame/epoxy composite material. * The highest adhesion strength was achieved at a monomer composition of 5:5. KEYWORDS adhesion promoter, adhesive strength, epoxy composite, epoxy molding compound, lead frame, 1 | INTRODUCTION An epoxy molding compound (EMC) is a composite material composed ol' ingredients such as silica, epoxy resin, phenolic resin, carbon black, and flame retardants. This compound is [...]

Heat shrink sleeves (IISS) are multilayer polymers that provide corrosion resistance for welding joints of steel pipes. Within the HSS structure, the adhesive layer is a blend of components, such as ethylene vinyl acetate (EVA) and linear low-density polyethylene (LLDPE). In this study, a systematic approach was employed to investigate the effect of the rheology and blend composition of the maleic anhydride modified EVA and maleic anhydride-modified LLDPE (EVA-g-MA/LLDPE-g-MA) adhesive layer, prepared by melt processing, on its adhesion properties. Various characterization techniques were employed to investigate the local morphology of the prepared blends at different zones. Peel strength tests were used to characterise the adhesion strength of the prepared adhesives. Our findings demonstrate that lhe local distribution of EVA-g-MA within LI,DPE-g-MA plays a crucial role in tire adhesion strength of the adhesive. The results show that the adhesion strength enhanced by nearly 45% as the composition of EVA-g-MA at the surface went up by 20%, shifting the failure location from the epoxy/adhesive interface to the bulk of the adhesive layer. Our hypothesis of the decrease of EVA-g-MA intrachain bonding and increase in the EVA-g-MA free chain amount in the presence of LLDPE-g-MA to improve the adhesion properties was corroborated through our catorimetry resulta where the relative EVA-g-MA crystallinity decreased as LLDPE-g-MA was introduced to the blend. The findings of our study highlight the importance of rheological behavior and blend composition in obtaining optimized performance of adhesives within the HSS structure. Highlights * Compression molding of EVA-g-MA/LLDPE-g-MA induces a layered morphology. * Local distribution EVA-g-MA/LLDPE-g-MA components influence their adhesion. * EVA-g-MA at the interface improves the adhesion of EVA-g-MA/LLDPEg-MA. * LLDPE-g-MA suppresses the EVA-g-MA cry stallinity. * EVA-g-MA/LLDPE-g-MA composition affects adhesion at different temperatures. KEYWORDS adhesion, EVA-g-MA/LLDPE-g-MA blends, morphology, phase separation, rheology, 1 | INTRODUCTION Multilayer polymers have gained widespread attention and popularity due to their numerous advantages over other polymeric composites. (1,2) Combining different polymers and the proper design of a [...]

Plastic recyclates can be contaminated with a variety of impurities due to their previous life, which cannot always be perfectly separated in recycling pretrcatment steps. Hence melt filtration is an important step in reprocessing plastic rccyclates to achieve material of sufficient purity, but it also leads to more stress on the material due to higher pressures and longer processing times. In our study, we investigated the influence of typical particulate impurities as may occur in recyclate on the mechanical and rheological properties of AP.S. Even low amounts of contaminations lowered the key properties. Melt filtration of post-consumer ABS recyclate with different mesh size melt screens showed little improvement of mcchanica! properties, but longer idle times and loss of material. Damage to the material caused by finer filtration could be shown by thermal measurements. Highlights * Determination of properties of ABS contaminated with 0.5-2.0 wt.% of selected impurities (wood and rubber particles). * Melt filtration of post-consumer ABS recyclate with different melt screens. * Investigation of process and properties of filtered ABS recyclate. KEYWORDS ABS lecyclate, mechanical properties, melt titration, melt screens, particulate contaminations, 1 | INTRODUCTION Recycling post-consumer waste is challenging, but inevitable to contribute to global waste and resource problems and to establish a true circular economy. One obstruction on the path [...]

Aiming at the problem of difficult to remove high-carbon u[alpha]-olefin in polyethylene, the influences of operation conditions and devolatilization additives on the devolatilization of LLDPE/1-octene system in an exhaust twin-screw extruder are studied by headspace gas chromatography. The results showed that the devolatilization efficiency increases with the devolatilization temperature and vacuum. With the screw rotational speed, the content of liquid additives and the gas velocity of gas additives increasing, the devolatilization efficiency first increases and then decreases. The devolatilization difficulty of different grades of polyethylene varies due to the difference of the viscosities. When the volatile content is high, the effect of devolatilization additives is anhydrous ethanol > surfactant > water > nitrogen. When the volatile content is low, the effect of nitrogen 011 devolatilization is obviously better than anhydrous ethanol and water. Finally, a novel devolatilization process is proposed, that is, an evacuation system (vacuum degree 0.08 -0.1 MPa) is set up in each stage of the devolatilization section, the anhydrous ethanol is introduced in the first stage, and high-purity nitrogen is introduced in the second, third, and fourth stages, which can ultimately reduce the VOC content of LLDPE products to less than the target value of 50 ppm. Highlights * The devolatilization process is used to remove high carbon [alpha]-olefins from LLDPE. * Each additive has an optimal injection value. * Ethanol is the most effective in the foam dominated devolatilization stage. * Nitrogen is the most effective in the diffusion-dominated devolatilization stage. * A new additive-enhanced twin-screw extruder devolatilization process is proposed. KEYWORDS additives, devolatilization, polyethylene, process enhancement, twin-screw extruder, 1 | INTRODUCTION Devolatilization plays an extremely important role in polymer processing and its main purpose is to separate the relatively low molecular weight components, often referred to as 'volatiles', [...]

The cavitation process of high-performance IIDPE/UHMWPE blends with a uniform dispersion of UHMWPE during cold stretching was investigated. It was observed that incorporating a small amount of UHMWPE into the HDPE matrix resin can serve as a nucleating agent, increasing the number of contact sites and accelerating the crystallization rate. This leads to the formation of thicker lamellar crystals and tethered molecules, ultimately enhancing the mechanical properties of the HDPE matrix. Furthermore, the relationship between the natural tensile ratio and strain-hardening modulus was confirmed. Microstructural changes within the blends were also explored. As the drawing tangles in the middle, the cavities subsequently evolve by collapsing and merging to align parallel to the tensile direction, culminating in tensile damage forming a large crack in the final macroscopic form. As a result, the presence of more tethered molecules in the later stages of stretching inhibits further cavity growth. Highlights * The HDPE/UHMWPE blends were prepared by solution blending and ultrasound-assisted twin-screw extrusion. * The mechanisms underlying the formation and evolution of cavities in HDPE/UHMWPE blends, which lead to stress whitening during tensile damage, were examined by using DSC and SAXS/WAXD. * The relationship between microstructure and mechanical properties was analyzed by cold-drawing the molded blended sheets at room temperature. KEYWORDS cavitation, cold drawing, HDPE, solution blending, UHMWPE, 1 | INTRODUCTION High-density polyethylene (HDPE) has outstanding heat and corrosion resistance, and simple processing performance, usually applied to the production of gas pipelines, but the comprehensive mechanical properties of [...]

This work presents an in-depth experimental study aimed at assessing the impact of natural weathering on the behavior of high-density polyethylene (HDPE) bottles. To this end, several analytical techniques were employed, including Fourier transform infrared spectroscopy (FTIR) to examine molecular changes, scanning electron microscopy (SEM) to study morphology, thermogravimetric analysis (TGA) to assess thermal properties, and tensile and compression tests to evaluate mechanical properties. The results obtained reveal significant changes in HDPE exposed to natural weathering. FTIR analysis enabled us to identify that the 1IDPE bottles had been subjected to an oxidation process initiated b) the absorption of solar radiation during natural weathering treatments, while SEM analysis showed the presence of holes resulting from the detachment of material fragments after exposure, TGA analysis confirms the impact of natural exposure time on the decrease in the average molecular weight and chemical degradation of HDPE macromolecules, through a reduction in the initial degradation temperature and the maximum thermodegradation temperature. However, tensile and compressive tests showed a reduction in the mechanical strength of HDPE after exposure to natural conditions, with notable variations depending on environmental conditions, making the material damaged. These results enabled us to calculate the damage caused by three damage laws. These results offer important insights into the mechanisms of HDPE degradation under the influence of natural climatic factors, paving the way for the development of more resistant and durable packaging materials in the face of variable environmental conditions. Highlights * The objective of this study is to analyze and describe the effects of natural weathering on high-density polyethylene bottles. This involves evaluating the deterioration of physicochemical, mechanical, and morphological properties. Additionally, three damage laws aBe employed to assess the extent of damage inflicted by this material. * Analytical techniques were used, including SEM, FT1R, and TGA, tensile and compressive test. KEYWORDS damage, FTIR, HDPE bottles, natural weathering, SEM, TGA, 1 | INTRODUCTION Growing demand in sectors such as packaging, automotive and construction has led to an exponential increase in global plastics consumption since the 1950s. (1,2) Packaging plays an [...]

Shear relaxation behavior for polymer melt exists in different processing techniques and influences the dimensional accuracy and production efficiency of polymer products. A micro physical and mathematical model based on microstructure of polymer chains and processing parameters was established and verified by experimental results obtained from a torque rheometer. The shear relaxation time of polypropylene degraded by di tert-butyl peroxide was characterized with torque rheometer. The effects of microstructure and processing parameters on the shear relaxation time was investigated. The results showed that a wider molecular weight distribution could result in a decrease in shear relaxation time and polypropylene chains with higher molecular weight were more sensitive to molecular weight distribution. The shear relaxation time declined exponentially with shear rate and increased with internal pressure. The temperature could enhance the movement of polymer chains and reduce the shear relaxation time linearly, but polypropylene with lower molecular weight was less sensitive to temperature. The insight obtained from the mathematical and experimental results can be profoundly applied in practical process control to manufacture product with better dimensional stability and production efficiency for viscoolastic polymer. Highlights * A physical and mathematical model based on microstmcture and processing parameters of molecular chains was established to explore the shear relaxation mechanism. * Shear relaxation time of polypropylene degraded by di-tert-butyl peroxide was characterized with the help of torque rheometer. * The effects of microstmcture and processing parameters on shear relaxation time was investigated to optimize the manufacturing of polypropylene products. KEYWORDS molding, molecular weight, polymer melt, shear relaxation, shear stress decay, 1 | INTRODUCTION Polymer and polymer composites were widely used in civil and industrial applications for its excellent mechanical performance and easy to process characteristics. The relaxation behavior takes an [...]

The ASM International Board of Trustees has named award program honorees for 2024. The awards program recognizes achievements of members of the materials science and engineering community. Awards will be [...]

Thixomolding is a method of molding thixotropic semi-solid magnesium alloy pellets in a machine that resembles an injection molding machine in physical appearance and operation. Thixomolding was derived from the [...]

As the aerospace industry has continued to evolve from the era of the Wright brothers, so too have aerospace structural materials. And it appears that a new inflection point requiring [...]

The conservation of critical materials is an increasing area of focus in the United States. In 2023, aluminum was added to the U.S. Department of Energy's (DOE) Final Critical Materials [...]

Injection molding is used to fabricate many medical products. It's a tried and tested manufacturing process that supports high-volume production while allowing low per-part costs. Injection molding also facilitates design [...]

Estimated at a value of $270 billion in 2023, the global drug delivery devices market is expected to grow at a compound annual growth rate (CAGR) of 5.83%, reaching about [...]

Small victories. Gradually, ever so slightly, fortunes are beginning to turn for residents of a gritty South Memphis neighborhood. The triumphs are sporadic, unpredictable, and often masked in the ordinary--legal [...]

Conor L. Evans of the Wellman Center for Photomedicine at Massachusetts General Hospital (Charlestown, Massachusetts) and associates, seeing a need for a new method of chemical imaging that delivers a quick acquisition time, low background, high resolution, and high chemical sensitivity recently published a study demonstrating sparse spectral sampling stimulated Raman scattering ([S.sup.4]RS). This new method is an extension of stimulated Raman scattering (SRS) microscopy that is particularly well suited for the imaging and quantification of active pharmaceutical ingredients (APIs). Evans will be receiving the Clara Craver Award, which was created by The Coblentz Society to recognize young invididuals who have made significant contributions in applied analytical vibrational spectroscopy, at this year's SciX conference that will be held from October 20 to October 25, in Raleigh, North Carolina. As part of an ongoing series of this year's SciX conference honorees, Conor spoke to us about the motivation behind this study, his findings, and the next steps in its development., In your paper (1), you discussed how chemical imaging (CI) has emerged as a crucial method for understanding the chemical and physical properties of pharmaceutical tablets. But you mention there [...]

Multilayer polymer films are engineered to accommodate a variety of requirements where polymer layers are fused together, with each polymer selected for a specific purpose. Specific analysis approaches can troubleshoot a defective film or allow us to reverse-engineer a film of unknown composition. Since the inception of Raman microscopy in the mid-1970s, it has been argued that a well designed confocal Raman microscope can analyze the composition of a multilayer film non-destructively. This is a powerful capability because it has the potential to provide information with optical resolution (better than 1 [micro]m) below sample surfaces non-destructively. However, because standard microscope optics do not maintain focus inside of a material with a finite index of refraction, and the errors become greater with increasing numerical aperture and increasing depth, we wanted to determine the quality of the information achieved by comparing a depth profile with a two dimensional map of a crosssection. In this article, we show a cross-sectional map of a film compared to a depth profile to evaluate the quality of depth profile measurements., In 2000, N eil Everall at the United Kingdom's Imperial Chemical Industries showed that a dry objective, which is standard in Raman microscopes, cannot maintain focus inside a material with [...]

The pandemic wreaked havoc on the world, across all industries and among those who became ill. While the loss experienced was beyond what anyone may have expected, there were also [...]

Home-use in-vitro diagnostics (IVD) allow people to test for some diseases or conditions without requiring a doctor's office visit. These tests are cost-effective, fast, and confidential. Some home IVD tests, [...]

As the impacts of COVID-19 continue to wane, including crippling supply chain disruptions, early-stage product development is on the rise. Startups, especially, have been subjected to heavy valuation pressure and [...]

PURPOSE Continuity of care is broadly associated with better patient health outcomes. The relative contributions of continuity with an individual physician and with a practice, however, have not generally been distinguished. This retrospective observational study examined the impact of continuity of care for patients seen at their main clinic but by different family physicians. METHODS We analyzed linked health administrative data from 2015-2018 from Alberta, Canada to explore the association of physician and clinic continuity with rates of emergency department (ED) visits and hospitalizations across varying levels of patient complexity. Physician continuity was calculated using the known provider of care index and clinic continuity with an analogous measure. We developed zero-inflated negative binomial models to assess the association of each with all-cause ED visits and hospitalizations. RESULTS High physician continuity was associated with lower ED use across all levels of patient complexity and with fewer hospitalizations for highly complex patients. Broadly, no (0%) clinic continuity was associated with increased use and complete (100%) clinic continuity with decreased use, with the largest effect seen for the most complex patients. Levels of clinic continuity between 1% and 50% were generally associated with slightly higher use, and levels of 51% to 99% with slightly lower use. CONCLUSIONS The best health care outcomes (measured by ED visits and hospitalizations) are associated with consistently seeing one's own primary family physician or seeing a clinic partner when that physician is unavailable. The effect of partial clinic continuity appears complex and requires additional research. These results provide some reassurance for part-time and shared practices, and guidance for primary care workforce policy makers. https://doi.org/10.1370/afm.3107, INTRODUCTION The ideal provision of primary care is based on a longitudinal relationship between a patient and a family physician (FP), referred to as relational continuity. (1) Research has shown [...]

There is great variation in the experiences of Latine/e/x/o/a, Hispanic, and/or Spanish origin (LHS) individuals in the United States, including differences in race, ancestry, colonization histories, and immigration experiences. This essay calls readers to consider the implications of the heterogeneity of lived experiences among LHS populations, including variations in country of origin, immigration histories, time in the United States, languages spoken, and colonization histories on patient care and academia. There is power in unity when advocating for community, social, and political change, especially as it pertains to equity, diversity, and inclusion (EDI; sometimes referred to as DEI) efforts in academic institutions. Yet, there is also a critical need to disaggregate the LHS diaspora and its conceptualization based on differing experiences so that we may improve our understanding of the sociopolitical attributes that impact health. We propose strategies to improve recognition of these differences and their potential health outcomes toward a goal of health equity. https://doi.org/10.1370/afm.3103, INTRODUCTION In this paper, Latine/e/x/o/a, Hispanic, and/or Spanish origin (LHS) family medicine faculty experts in equity, diversity, and inclusion (EDI; sometimes referred to as DEI) come together to unmask the [...]

I was recently diagnosed with prediabetes, based on slightly elevated glycemia and no other risk factors. To allay my confusion and anxiety, I applied my epidemiology and health services research [...]

Academic practices and departments are defined by a tripartite mission of care, education, and research, conceived as being mutually reinforcing. But in practice, academic faculty have often experienced these 3 missions as competing rather than complementary priorities. This siloed approach has interfered with innovation as a learning health system in which the tripartite missions reinforce each other in practical ways. This paper presents a longitudinal case example of harmonizing academic missions in a large family medicine department so that missions and people interact in mutually beneficial ways to create value for patients, learners, and faculty. We describe specific experiences, implementation, and examples of harmonizing missions as a feasible strategy and culture. 'Harmonized' means that no one mission subordinates or drives out the others; each mission informs and strengthens the others (quickly in practice) while faculty experience the triparate mission as a coherent whole faculty job. Because an academic department is a complex system of work and relationships, concepts for leading a complex adaptive system were employed: (1) a 'good enough' vision, (2) frequent and productive interactions, and (3) a few simple rules. These helped people harmonize their work without telling them exactly what to do, when, and how. Our goal here is to highlight concrete examples of harmonizing missions as a feasible operating method, suggesting ways it builds a foundation for a learning health system and potentially improving faculty well-being. https://doi.org/10.1370/afm.3108, INTRODUCTION Academic practices and departments are defined by a tripartite mission of care, education, and research, conceived as being mutually reinforcing. But in l practice, carrying out this tripartite mission [...]

PURPOSE The COVID-19 pandemic abruptly interrupted breast cancer screening, an essential preventive service in primary care. We aimed to evaluate the pandemic's impact on overall and follow-up breast cancer screening using real-world health records data. METHODS We retrospectively analyzed a cohort of women eligible for breast cancer screening through the study period from January 1, 2017 to February 28, 2022 using TriNetX Research Network data. We examined the temporal trend of monthly screening volume throughout the study period and compared the rate of adherence to follow-up screening within 24 months after the previous screening when the follow-up screening was due in the pre-COVID period vs the COVID period. To account for multiple screenings in the longitudinal data, we applied a logistic regression model using generalized estimating equations with adjustment for individual-level covariates. RESULTS Among 1,186,669 screening-eligible women, the monthly screening volume temporarily decreased by 80.6% from February to April 2020 and then rebounded to close to pre-COVID levels by June 2020. Yet, the follow-up screening rate decreased from 78.9% (95% CI, 78.8%-79.0%) in the pre-COVID period to 77.7% (95% CI, 77.6%-77.8%) in the COVID period. Multivariate regression analysis also showed a lower adherence to follow-up screening during the COVID period (odds ratio = 0.86; 0.86-0.87) and a greater pandemic impact among women aged 65 years and older and women of non-Hispanic 'other' race (Asian, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander). CONCLUSIONS The COVID-19 pandemic had a transient negative effect on breast cancer screening overall and a prolonged negative effect on follow-up screening. It also exacerbated gaps in adherence to follow-up screening, especially among certain vulnerable groups, requiring innovative strategies to address potential health disparities in primary care. https://doi.org/10.1370/afm.3098, INTRODUCTION Breast cancer is the second most common cancer among women in the United States. (1) Every 1 in 8 women nationally will develop this malignancy in their lifetime, (1) [...]

PURPOSE The experience of ethnically diverse parents of children with serious illness in the US health care system has not been well studied. Listening to families from these communities about their experiences could identify modifiable barriers to quality pediatric serious illness care and facilitate the development of potential improvements. Our aim was to explore parents' perspectives of their children's health care for serious illness from Somali, Hmong, and Latin-American communities in Minnesota. METHODS We conducted a qualitative study with focus groups and individual interviews using immersion-crystallization data analysis with a community-based participatory research approach. RESULTS Twenty-six parents of children with serious illness participated (8 Somali, 10 Hmong, and 8 Latin-American). Parents desired 2-way trusting and respectful relationships with medical staff. Three themes supported this trust, based on parents' experiences with challenging and supportive health care: (1) Informed understanding allows parents to understand and be prepared for their child's medical care; (2) Compassionate interactions with staff allow parents to feel their children are cared for; (3) Respected parental advocacy allows parents to feel their wisdom is heard. Effective communication is 1 key to improving understanding, expressing compassion, and partnering with parents, including quality medical interpretation for low-English proficient parents. CONCLUSIONS Parents of children with serious illness from Somali, Hmong, and Latin-American communities shared a desire for improved relationships with staff and improved health care processes. Processes that enhance communication, support, and connection, including individual and system-level interventions driven by community voices, hold the potential for reducing health disparities in pediatric serious illness. https://doi.org/10.1370/afm.3106, INTRODUCTION In the United States, nearly 500,000 children live with a serious or life-threatening illness, (1,2) defined by the Institute of Medicine as those who carry a substantial probability of [...]

This study characterized adult primary care medical assistant (MA) staffing. National Survey of Healthcare Organizations and Systems (n = 1,252) data were analyzed to examine primary care practice characteristics associated with MA per primary care clinician (PCC) staffing ratios. In 2021, few practices (11.4%) had ratios of 2 or more MAs per PCCs. Compared with system-owned practices, independent (odds ratio [OR] = 1.76, P https://doi.org/10.1370/afm.3100, INTRODUCTION Medical assistants (MAs) are among the fastest growing occupations within the US primary care workforce, (1) but little is known about organizational factors associated with MA support levels for [...]

PURPOSE Despite increased clinician awareness of systemic racism, lack of substantial action toward antiracism exists within health care. Clinical staff perspectives, particularly those of racial-ethnic minorities/persons of color (POC) who disproportionately occupy support staff roles with less power on the team, can yield insights into barriers to progress and can inform future efforts to advance diversity, equity, and inclusion (DEI, also referred to as EDI) within health care settings. This qualitative study explored the perspectives of staff members on race and role power dynamics within community health clinic teams. METHODS We conducted semistructured 45-minute interviews with staff members working in community health clinics in a large urban health care system from May to July 2021. We implemented purposeful recruitment to oversample POC and support staff and to achieve equal representation from the 13 community health clinics in the system. Interviews were audio recorded, transcribed, and analyzed over 6 months using a critical-ideological paradigm. Themes reflecting experiences related to race and role power dynamics were identified. RESULTS Our cohort had 60 participants: 42 (70%) were support staff (medical assistants, front desk clerks, care navigators, nurses) and 18 (30%) were clinicians and clinic leaders. The large majority of participants were aged 26 to 40 years (60%), were female (83%), and were POC (68%). Five themes emerged: (1) POC face hidden challenges, (2) racial discrimination persists, (3) power dynamics perpetuate inaction, (4) interpersonal actions foster safety and equity, and (5) system-level change is needed for cultural shift. CONCLUSIONS Understanding the race and role power dynamics within care teams, including experiences of staff members with less power, is critical to advancing DEI in health care. https://doi.org/10.1370/afm.3099, INTRODUCTION Team-based care, established as the gold standard model for providing care more than a decade ago, (1) allows integrated clinical teams with different and complementary skills and perspectives to [...]

PURPOSE To determine the effects of stratified primary care for low back pain (SPLIT program) in decreasing back-related disability for patients with low back pain (LBP) in primary care. METHODS We conducted a before-and-after study. We compared health-related outcomes for 2 sequential, independent cohorts of patients with LBP recruited at 7 primary care units in Portugal. The first prospective cohort study characterized usual care (UC) and collected data from February to September 2018. The second was performed when the SPLIT program was implemented and collected data from November 2018 to October 2021. Between cohorts, physical therapists were trained in the implementation of the SPLIT program, which used the STarT Back Screening Tool to categorize patients for matched treatment. We compared back-related disability (Roland-Morris Disability Questionnaire, 0-24 points), pain (Numeric Pain Rating Scale, 0-10 points), perceived effect of treatment (Global Perceived Effect Scale, -5 to +5 points), and health-related quality of life (EuroQoL 5 dimensions 3 levels index, 0-1 points). RESULTS We enrolled a total of 447 patients: 115 in the UC cohort (mostly treated with pharmacologic treatment) and 332 in the SPLIT cohort (all referred for a physical therapy intervention program). Over the study period of 6 months, patients in the SPLIT program showed significantly greater improvements in back-related disability ([beta], -2.94; 95% CI, -3.63 to -2.24; P[less than or equal to].001), pain ([beta], -0.88; 95% CI, -1.18 to -0.57; P[less than or equal to].001), perceived effect of treatment ([beta], 1.40; 95% CI, 0.97 to 1.82; P[less than or equal to].001), and health-related quality of life ([beta], 0.11; 95% CI, 0.08 to 0.14; P[less than or equal to].001) compared with UC. CONCLUSIONS Patients in the SPLIT program for LBP showed greater benefits regarding health-related outcomes than those receiving UC. https://doi.org/10.1370/afm.3104, INTRODUCTION Low back pain (LBP) is a high-burden health problem worldwide, and its management represents a serious challenge for health systems. (1-4) The burden caused by LBP is mainly explained [...]