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Complete issue of Georgia Journal of College Student Affairs, v.38, iss. 1

Complete issue of Georgia Journal of College Student Affairs, v.37, iss. 2

Complete issue of Georgia Journal of College Student Affairs, v.36, iss. 1

Complete issue for volume 35, number 1 (Fall 2019).

Complete issue

Complete issue

Complete issue

Background: Fluid overload (FO) in the intensive care unit (ICU) is common, serious, and may be preventable. Intravenous medications (including administered volume) are a primary cause for FO but are challenging to evaluate as a FO predictor given the high frequency and time-dependency of their use and other factors affecting FO. We sought to employ unsupervised machine learning methods to uncover medication administration patterns correlating with FO., Methods: This retrospective cohort study included 927 adults admitted to an ICU for ≥72 h. FO was defined as a positive fluid balance ≥7% of admission body weight. After reviewing medication administration record data in 3-h periods, medication exposure was categorized into clusters using principal component analysis (PCA) and Restricted Boltzmann Machine (RBM). Medication regimens of patients with and without FO were compared within clusters to assess their temporal association with FO., Results: FO occurred in 127 (13.7%) of 927 included patients. Patients received a median (interquartile range) of 31(13-65) discrete intravenous medication administrations over the 72-h period. Across all 47,803 intravenous medication administrations, 10 unique medication clusters, containing 121 to 130 medications per cluster, were identified. The mean number of Cluster 7 medications administered was significantly greater in the FO cohort compared with patients without FO (25.6 vs.10.9, p < 0.0001). A total of 51 (40.2%) of 127 unique Cluster 7 medications were administered in more than five different 3-h periods during the 72-h study window. The most common Cluster 7 medications included continuous infusions, antibiotics, and sedatives/analgesics. Addition of Cluster 7 medications to an FO prediction model including the Acute Physiologic and Chronic Health Evaluation (APACHE) II score and receipt of diuretics improved model predictiveness from an Area Under the Receiver Operation Characteristic (AUROC) curve of 0.719 to 0.741 (p = 0.027)., Conclusions: Using machine learning approaches, a unique medication cluster was strongly associated with FO. Incorporation of this cluster improved the ability to predict FO compared to traditional prediction models. Integration of this approach into real-time clinical applications may improve early detection of FO to facilitate timely intervention., (© 2025 Pharmacotherapy Publications, Inc.)

In the US, gay, bisexual, and other sexual minoritized men (GBSMM) remain disproportionately impacted by HIV, and continue to experience unmet needs for pre-exposure prophylaxis (PrEP). A growing body of literature has underscored the need to consider the geographic factors of HIV prevention, particularly beyond administrative boundaries and towards localized spaces that influence the accessibility and utilization of health-promoting resources. Therefore, the purpose of this study is to examine the associations of driving times from activity spaces to PrEP offering facilities and individual PrEP uptake. A total of 218 GBSMM (ages 18-34) from Connecticut and Georgia were sampled from a longitudinal cohort study. We used the getis-ord-gi statistic to examine the spatial clustering of PrEP offering facilities, and generalized estimating equations (GEE) and post-hoc moderation analyses to explore the state interactions on driving time and PrEP uptake. Our main findings suggest that for participants in Connecticut, state of residence was a significant moderator on driving time and ever hearing of PrEP and ever taking PrEP. Whereas for participants in Georgia, state of residence moderated the likelihood of returning to activity spaces of participants in both Connecticut and Georgia on PrEP uptake. These findings provide important direction for geographic inequities on PrEP use, but also a pragmatic method for co-creating and re-imagining place-health research. These results also offer an avenue to leverage the dynamic nuance of activity spaces as indicators to inform structural interventions for PrEP that are more equitable for GBSMM in small cities and towns in the U.S., Competing Interests: Declarations. Conflict of interest: All authors have no conflicts of interest to report. Ethical Approval: The University Institutional Review Board (IRB) involving human subjects at Yale University and the University of Georgia approved the research protocol and written informed consent was obtained prior to the participation in this study (IRB# 2000021580)., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Individuals with substance use disorders face many challenges in establishing and maintaining recovery, most notably from contextual factors such as people, locations, events, emotions, and other triggers of cravings that could spark return to use. We sought to understand how individuals experience and cope with locations as triggers., Methods: We conducted 31 semi-structured in-depth interviews with individuals who had recently been in substance use treatment and reported problem levels of alcohol and opioid use according to screening instruments. Interviews were designed to explore how individuals experience location-based triggers. We coded these interviews according to concepts outlined in Marlatt and Gordon's cognitive behavioral model and used thematic analysis to generate themes in participant experiences., Results: We found that participants described triggers as interrelated and associated with multiple people, locations, events, or emotions. Participants commonly identified 'home' as a trigger, one that is particularly difficult to cope with. Participants most commonly employed avoidance as a coping strategy. Finally, participants described an expectation that substance use was associated with more time spent outside of 'home' while recovery was associated with limited travel and more time spent at home., Conclusions: Location-based triggers represent a particularly challenging barrier to sustained substance use disorder recovery, partly due to the amorphous and interrelated nature of such triggers. The identification of 'home' as a primary trigger and common use of avoidance as a coping strategy suggest the need for additional recovery support and interventions. We plan to use these findings to develop and test an intervention promoting coping strategies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Developing adaptive coping skills for avoiding substance use is a proposed treatment mechanism of cognitive behavioral therapy (CBT) for substance use disorder (SUD). However, the generalizability of research on treatment mechanisms of CBT for SUD is limited by the underrepresentation of racial/ethnic minorities in clinical trials. In a secondary analysis of clinical trial data, we tested whether a culturally-adapted digital CBT program for Hispanics ("Spanish CBT4CBT") improved the quality of coping skills for avoiding substance use. We also tested whether coping skills' quality was associated with reductions in primary substance use., Methods: Participants were Spanish-speaking Hispanic adults seeking outpatient treatment for SUD (n = 85; 68 % male; primary substance type: 36 % cannabis, 33 % alcohol, 26 % cocaine, 5 % other). They were randomized to 8 weeks of outpatient treatment as usual (TAU) or TAU + Spanish CBT4CBT and assessed for 6 months after treatment. The study conducted separate analyses for the full sample (n = 85) and for those who engaged in at least 5 treatment sessions ("treatment exposed"; n = 64). Daily substance use and coping skills' quality were assessed repeatedly during the treatment and follow-up periods. Bayesian mixed models for repeated measures tested hypotheses., Results: Among treatment-exposed participants, those receiving TAU + Spanish CBT4CBT improved the quality of coping skills more than TAU alone during the treatment period (b = 0.77; 95 % CI[0.08, 1.47]), but this difference was not detected during the follow-up period. In the full sample and treatment exposed subsample, participants with higher quality coping skills during the study reported less primary substance use (b = -0.67; 95 % CI[-1.08, -0.26]). Among treatment-exposed participants only, within-person increases in the quality of coping skills were associated with reductions in future primary substance use (b = -0.18; 95 % CI[-0.36, -0.01])., Conclusions: Spanish-speaking Hispanics with SUD may improve the quality of their coping skills more when they are sufficiently exposed to a culturally-adapted digital CBT program during outpatient treatment. Coping skills' quality may be a mechanism of CBT for SUD among Hispanic populations. Spanish-speaking Hispanics' access to treatments that target mechanisms of behavior change may be expanded by digital therapeutics., Competing Interests: Declaration of competing interest Brian D. Kiluk is a consultant to CBT4CBT LLC, which makes CBT4CBT available to qualified clinical providers and organizations on a commercial basis. The conflict is managed through Yale University., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: The authors declare no competing interests.

Background: Phelipanche aegyptiaca is one of the most noxious parasitic weedy broomrapes in Xinjiang, China. Understanding its morphological polymorphism and genetic diversity can support effective control strategies. This study investigated the morphological and genetic diversity among and within populations from different geographical regions and host species across Xinjiang to characterize their relationships., Results: Thirteen ISSR primers were used, resulting in 173 clear bands, 172 of which (99%) were polymorphic. Significant genetic variations were observed within regional and host groups, while variation among groups was relatively low. Gene flow was frequent, with a significant correlation of 1.57 between geographic regions and 5.57 between host species groups. Morphological traits exhibited substantial variability, with diverse coefficients ranging from 16% to 50%. Canonical correspondence analysis indicated that samples primarily clustered by region, not by host species. There was a significant correlation between morphological and genetic diversity across geographical groups., Conclusion: The findings suggest that genetic and morphological diversity are key factors in the expansion of P. aegyptiaca's host-range and its spread. Morphological diversity appears to result from the interaction between genetic variation and environmental factors. This study offers new insights into the adaptation and evolution of P. aegyptiaca in relation to its genetic, morphological diversity and dissemination. © 2024 Society of Chemical Industry., (© 2024 Society of Chemical Industry.)

Neutrophil characteristics in peritoneal fluid (PF) may aid in diagnosing and treating specific colic lesions and complications. The objective of this retrospective study was to evaluate quantitative PF leukocyte values, as well as PF total protein (TP) and lactate, for associations with diagnosis, morbidity, and mortality in horses with acute colic. Three hundred and forty-two horses that presented to one institution between January 2010-2020 for the evaluation of acute colic were included. The PF total nucleated cell count (TNCC), % and total neutrophil counts, total protein (TP), and lactate were analyzed for associations with lesion location and type, the development of postoperative reflux (POR) or systemic inflammatory response syndrome (SIRS), and survival to discharge via Kruskal-Wallis testing. Horses with strangulating lesions had higher PF % neutrophils, neutrophil count, and TNCC compared to non-strangulating lesions. The development of SIRS or POR was associated with higher PF TNCC, total neutrophil count, TP, and lactate. Horses that did not survive to discharge had increased PF % neutrophils, neutrophil count, TP, lactate, and ratio of PF-to-systemic TP than those that survived via univariable analysis. Identified associations between increased PF neutrophils and the development of POR and SIRS warrant further investigation to better understand their role in the pathogenesis of equine colic and potential as targets for therapeutic intervention.

Background: Animal-borne sensors ('bio-loggers') can record a suite of kinematic and environmental data, which are used to elucidate animal ecophysiology and improve conservation efforts. Machine learning techniques are used for interpreting the large amounts of data recorded by bio-loggers, but there exists no common framework for comparing the different machine learning techniques in this domain. This makes it difficult to, for example, identify patterns in what works well for machine learning-based analysis of bio-logger data. It also makes it difficult to evaluate the effectiveness of novel methods developed by the machine learning community., Methods: To address this, we present the Bio-logger Ethogram Benchmark (BEBE), a collection of datasets with behavioral annotations, as well as a modeling task and evaluation metrics. BEBE is to date the largest, most taxonomically diverse, publicly available benchmark of this type, and includes 1654 h of data collected from 149 individuals across nine taxa. Using BEBE, we compare the performance of deep and classical machine learning methods for identifying animal behaviors based on bio-logger data. As an example usage of BEBE, we test an approach based on self-supervised learning. To apply this approach to animal behavior classification, we adapt a deep neural network pre-trained with 700,000 h of data collected from human wrist-worn accelerometers., Results: We find that deep neural networks out-perform the classical machine learning methods we tested across all nine datasets in BEBE. We additionally find that the approach based on self-supervised learning out-performs the alternatives we tested, especially in settings when there is a low amount of training data available., Conclusions: In light of these results, we are able to make concrete suggestions for designing studies that rely on machine learning to infer behavior from bio-logger data. Therefore, we expect that BEBE will be useful for making similar suggestions in the future, as additional hypotheses about machine learning techniques are tested. Datasets, models, and evaluation code are made publicly available at https://github.com/earthspecies/BEBE , to enable community use of BEBE., Competing Interests: Declarations. Ethics approval and consent to participate: All animal behavior datasets except the Crow dataset were reported in previous publications. Crow behavior data were collected in accordance with ASAB/ABS guidelines and Spanish regulations for animal research, and were authorized by Junta de Castilla y León (licence: EP/LE/681-2019). Competing interest: The authors declare no competing interests., (© 2024. The Author(s).)

Importance: Childhood vaccination rates have declined in recent years; there is also concern that resistance to COVID-19 vaccines could spill over to childhood vaccines., Objectives: To use local-level data to study trends in childhood vaccination rates and heterogeneity in local rates; including how many areas are below herd-immunity thresholds, and assess the association between COVID-19 vaccine hesitancy and childhood vaccination., Design: We report, for 11 states with available data, vaccination rates for measles, mumps, rubella (MMR), and diphtheria, tetanus, acellular pertussis (DTaP) vaccines, including percentage of schools/counties with rates ≥95 %, 90-95 %, 80-90 %, and < 80 %. We also study the association between county-level COVID-19 vaccination rates and change from 2019 to 2022 in MMR and DTaP vaccination rates., Exposure: School/county level vaccination rates; county-level COVID-19 vaccine hesitancy, proxied by the percent of the adult population in each county that did not complete primary COVID-19 vaccination., Main Outcomes: Percentage of school/counties with MMR/DTaP vaccination rates within specified ranges, mean vaccination rates, and change in MMR/DTaP vaccination rates between 2019 and 2022., Results: On average, childhood vaccination rates declined from 2019 to 2022 in states that allow non-medical exemptions, but with substantial heterogeneity within and across states. The largest declines were in already low-vaccination schools. COVID-19 vaccine hesitancy was associated with a somewhat larger 2019-to-2022 decline in childhood vaccination rates in rural counties and strongly Republican-leaning counties., Conclusion: Vaccination rates fell from 2019 to 2022, continuing a longer trend toward lower rates. For measles and pertussis, childhood vaccination rates are below herd-immunity levels in many local communities, sometimes substantially so. We used two proxies for potential spillover of COVID-19 vaccine hesitancy to childhood vaccines (rural indicator and Republican-leaning indicator); these proxies can explain a modest part of the decline childhood vaccination in rural and Republican-leaning counties, but most of the explanation lies elsewhere., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This paper was supported by the George Washington University Milken Institute School of Public Health Innovation Award. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Billions of dollars have been spent implementing regulations to reduce traffic-related air pollution (TRAP) from exhaust pipe emissions. However, few health studies have evaluated the change in TRAP emissions and associations with infant health outcomes. We hypothesize that the magnitude of association between vehicle exposure measures and adverse birth outcomes has decreased over time, parallelling regulatory improvements in exhaust pipe emissions., Methods: Using birth records in Texas from 1996 to 2016, we calculated residential exposure measures related to TRAP: nitrogen dioxide (NO2, a marker of the TRAP mixture), vehicle miles travelled within 500 m of homes (VMT500), a measure of traffic volume, and highway proximity. Using an accountability study framework, our analysis examined term birthweight, term low birthweight (TLBW) (<2500 g), preterm birth (PTB) (<37 weeks) and very preterm birth (VPTB) (<32 weeks). We implemented linear and logistic regression models to examine overall and time-stratified associations, including trends by race/ethnicity and socioeconomic groups., Results: Among exposures for 6 158 518 births, NO2 exposures decreased 59% over time but VMT500 remained relatively stable. TRAP-related exposure measures were persistently associated with harmful birth outcomes [e.g. OR1996-2016 of 1.07 (95% CI: 1.04, 1.08) for TLBW comparing the highest vs lowest NO2 quintile]. The magnitude of associations decreased for total VMT500 and TLBW (-60%, OR1996: 1.08 to OR2016: 1.03 for the highest vs lowest quintile) and PTB (-65%) and VTPT (-61%), but not for term birthweight., Conclusions: We observed evidence of small improvements in birth outcomes associated with reductions in exhaust pipe emissions over a 20-year period in Texas., (© The Author(s) 2025. Published by Oxford University Press on behalf of the International Epidemiological Association.)

The renin-angiotensin-aldosterone system (RAAS) has a well-established key pathophysiologic role in kidney diseases, and pharmacotherapy targeting this system is a mainstay of treatment of affected human beings, cats, and dogs. Several studies have evaluated the circulating RAAS in animals with spontaneous or experimentally induced kidney diseases. Evidence supporting the activation of this system has been demonstrated in some - but not all - studies and individuals, and the interindividual variability in circulating RAAS markers is high. Advances over the last few decades have expanded our understanding of the system, which now includes the existence of a counterbalancing "alternative" RAAS and tissular renin-angiotensin systems (RASs), the latter regulated independently of the circulating endocrine RAAS. The local RAS in the kidney, termed the intrarenal RAS, is currently recognized as an important regulator of kidney function and mediator of kidney disease. In general, information on the intrarenal RAS is lacking in cats and dogs with kidney diseases; however, existing limited data suggest its activation. Despite the inconsistent evidence for circulating RAAS activation in chronic kidney diseases, RAAS inhibitors have proven effective for the treatment of its common comorbidities, systemic arterial hypertension and renal proteinuria, in both cats and dogs. Further research of the circulating RAAS, the intrarenal RAS, and the interplay between these systems in the context of kidney diseases in companion animals might contribute to the development or refinement of future treatment strategies., Competing Interests: Declaration of Competing Interest Bianca Lourenço and Amanda Coleman have received research funding from Boehringer Ingelheim Vetmedica and the Translational RAAS Interest Group, which is sponsored by Ceva Animal Health., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To review the evidence and discuss use of pivmecillinam in uncomplicated acute cystitis., Data Sources: A literature search was conducted utilizing PubMed (from 2000 through August 2024) and ClinicalTrials.gov. Medical Subject Headings (MeSH) terms, such as mecillinam or pivmecillinam and urinary tract infections, were utilized. Additional references were identified by reviewing literature citations., Study Selection and Data Extraction: Articles were limited to English language publications evaluating the efficacy or safety of pivmecillinam for urinary tract infections (UTIs) in adult populations., Data Synthesis: Data from 6 randomized controlled trials support pivmecillinam for acute uncomplicated cystitis at doses of 200 to 400 mg 3 times daily for 3 to 7 days, with more consistent clinical and bacteriologic cure observed with 400 mg doses and longer therapy durations. Clinical evaluation of 400 mg 2 to 3 times daily is available with use more common in non-US Food and Drug Administration (FDA)-approved populations, such as men, pregnancy, and multidrug resistant infections. There are limited data supporting pivmecillinam for pyelonephritis; routine use is cautioned until further clinical data are available., Relevance to Patient Care and Clinical Practice in Comparison With Existing Drugs: As resistance to first-line antimicrobials rises, the need for safe and effective treatment options remains high. Pivmecillinam represents a new therapeutic option available in the United States for outpatient management of uncomplicated acute cystitis., Conclusion: Pivmecillinam could be a key agent for uncomplicated acute cystitis. Utilization will likely be cost driven, but the promise of low resistance encourages the place in therapy when other agents are not susceptible to infecting uropathogens., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time., Purpose: The medication regimen complexity intensive care unit (MRC-ICU) score has previously been associated with pharmacist workload and fluid overload. The purpose of this study was to determine the relationship of MRC-ICU score with pharmacist-driven fluid stewardship recommendations as a means of establishing its role in risk stratifying critically ill patients for pharmacist intervention., Methods: Adult patients admitted to the medical ICU and followed by the academic pharmacy team were included in this retrospective, single-center cohort study. Patient and pharmacist data were collected via electronic medical record and surveillance tool, respectively. MRC-ICU and sequential organ failure assessment (SOFA) scores were captured at ICU admission. The primary outcome was correlation between MRC-ICU score and number of pharmacist-driven fluid stewardship recommendations. Secondary outcomes included the relationships between MRC-ICU score, accepted recommendations, and patient outcomes (fluid overload and length of stay [LOS]). Descriptive statistics were calculated for each variable. Spearman's rank-order correlation was used., Results: Of 168 patients, 22 (13%) experienced fluid overload. Median MRC-ICU and SOFA scores were 13 and 7, respectively, and were higher for patients experiencing fluid overload than for those without fluid overload. MRC-ICU had a weakly positive correlation with the number of pharmacist-driven fluid stewardship recommendations (ρ = 0.200; P = 0.010), fluid overload (ρ = 0.167; P = 0.030), and ICU LOS (ρ = 0.354; P < 0.001). These relationships remained true when looking at only the fluid stewardship recommendations that were accepted by the team., Conclusion: MRC-ICU displayed a weakly positive correlation with pharmacist workload, suggesting its potential use in identifying patients likely to benefit from pharmacist intervention., (© American Society of Health-System Pharmacists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)