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Background: Lipoprotein(a) [Lp(a)] is a low-density lipoprotein variant with atherogenic, thrombogenic, and pro-inflammatory properties that may have numerous pathologic effects, including dyslipidemia. Screening for Lp(a) is clinically significant, due to its causal role in atherosclerotic cardiovascular disease (ASCVD). Among clinicians, however, there remains a general lack of both clinical awareness of Lp(a) and adequate tools to track Lp(a) testing in patients. Objective: To study factors affecting Lp(a) screening by: i) determining the effectiveness of messaging providers at a large community health system about Lp(a) screening and measuring the subsequent percentage of Lp(a) tests requested; and ii) by determining the percentage of patients who obtained Lp(a) testing after being advised by the provider. Methods: From December 2022 through March 2023, messages detailing the need for Lp(a) screening were sent via the Epic EHR™ to providers of patients meeting criteria for Lp(a) testing in advance of scheduled patient appointments. In this prospective study, providers were randomized into 2 groups: those receiving the pre-appointment message (Group 1) and those not receiving the pre-appointment message (Group 2). Results: Sending pre-appointment messages correlated with more Lp(a) orders (16.6 % v. 4.7 %, P < 0.001) and consequently with more tests performed (10.2 % v. 3.7 %, p < 0.001). Among provider types, nurse practitioners and physician assistants had the highest number of Lp(a) results per order (Z = 16.40, P < 0.001), achieving 30.8–39.1 % more test results, even if they did not receive the pre-appointment message. Distribution of Lp(a) values in patients was 59.7 % ≤ 29 mg/dL; 9.7 % > 29 and < 50mg/dL; and 30.6 % ≥ 50 mg/dL. Conclusion: Providers who received pre-appointment messages via an EHR were associated with requesting more tests and consequently receiving more Lp(a) results, compared with providers who did not receive messages.

Recently, there has been discussion to reclassify pediatric Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) as drug-induced epidermal necrolysis (DEN), separating it from infectious etiologies and redefining pediatric mucocutaneous eruptions as either reactive infectious mucocutaneous eruption (RIME) or DEN. In this report, we describe a previously healthy 4-year-old girl with rapidly progressive mucocutaneous blistering involving four mucosal membranes and 37.5% of total body surface area (BSA) following a prodromal rhinovirus and enterovirus infection. The symptoms occurred in the absence of an inciting medication and improved with only supportive care. This case illustrates a rare occurrence of RIME with TEN-like BSA involvement, prompting a review of the literature exploring the relationship between BSA involvement in RIME and its influence on patient outcomes. Findings support the proposed reclassification of SJS/TEN as DEN and postinfectious mucocutaneous eruptions as RIME.

BackgroundYouth are arrested at high rates in the United States; however, long-term health effects of arrest remain unmeasured. We sought to describe the sociodemographic characteristics and health of adults who were arrested at various ages among a nationally representative sample.MethodsUsing the National Longitudinal Study of Adolescent to Adult Health, we describe sociodemographics and health status in adolescence (Wave I, ages 12-21) and adulthood (Wave V, ages 32-42) for people first arrested at age younger than 14 years, 14 to 17 years, and 18 to 24 years, compared to never arrested adults. Health measures included physical health (general health, mobility/functional limitations, death), mental health (depressive symptoms, suicidal thoughts), and clinical biomarkers (hypertension, diabetes). We estimate associations between age of first arrest and health using covariate adjusted regressions.ResultsAmong the sample of 10,641 adults, 28.5% had experienced arrest before age 25. Individuals first arrested as children (ie, age

During 2021-2023, UC Davis Human Rights Studies faculty, staff, and students collaborated with Kepler employees and student fellows to empower higher education access for over 2200 university-age refugee young people in Rwanda through the implementation of Article 26 Backpack (“Backpack”). This is a report of that project and includes key observations, findings and recommendations.

Unusually high oxidation states of manganese were stabilized within a cesium-barium silicate (CBS) glass system of extremely high optical basicity. The highest basicity was obtained for the metasilicate glass 40Cs2O–10BaO–50SiO2 (mol%) with an optical basicity of Λ = 0.81. The presence of Mn5+ (d2) as well as Mn6+ (d1) is confirmed by UV–Vis, photoluminescence, and Raman spectroscopy. The UV–Vis spectrum is dominated by the Mn3+ (d4) absorption at 526 nm for low-basicity glasses, which is replaced by a peak at 679 nm (Mn5+) and, finally, a band at 603 nm (Mn6+) in the glass with the highest basicity (Λ = 0.81). In this glass, the Mn5+/Mn6+ ratio varies with the melting conditions. Photoluminescence (PL) spectroscopy under 633 nm excitation confirms the presence of Mn5+, showing the narrow, forbidden 1E →3A2 transition located at 1191 nm with vibrational sidebands at 1245 nm and 1290 nm. The measured static fluorescence intensity due to Mn5+ grows exponentially with increasing optical basicity. The near infrared fluorescence decay was bi-exponential, with time constants of 14 and 51 μs. The absence of Mn4+ in CBS glasses was confirmed by PL and electron paramagnetic resonance (EPR) spectroscopy. Despite initial doping as MnO2, metastable Mn4+ disproportionates into lower and higher valent manganese species, followed by reduction or oxidation of manganese to a stable species as ruled by the basicity of the glass and oxygen availability during melting. A structural study of the glasses by Raman spectroscopy revealed a resonance enhancement effect for the symmetric stretching mode of MnO4-tetrahedra at ∼800 cm−1 with overtones observed at higher frequencies.

Summary: Although cancer cachexia is classically characterized as a systemic inflammatory disorder, emerging evidence indicates that weight loss also associates with local tissue inflammation. We queried the regulation of this inflammation and its causality to cachexia by exploring skeletal muscle, whose atrophy strongly associates with poor outcomes. Using multiple mouse models and patient samples, we show that cachectic muscle is marked by enhanced innate immunity. Nuclear factor κB (NF-κB) activity in multiple cells, including satellite cells, myofibers, and fibro-adipogenic progenitors, promotes macrophage expansion equally derived from infiltrating monocytes and resident cells. Moreover, NF-κB-activated cells and macrophages undergo crosstalk; NF-κB+ cells recruit macrophages to inhibit regeneration and promote atrophy but, interestingly, also protect myofibers, while macrophages stimulate NF-κB+ cells to sustain an inflammatory feedforward loop. Together, we propose that NF-κB functions in multiple cells in the muscle microenvironment to stimulate macrophages that both promote and protect against muscle wasting in cancer.

The length of a college president’s tenure is under six years, meaning that boards and institutions are increasingly grappling with the turnover associated with senior leaders. This turnover is seen in all sectors of higher education, especially in community colleges where the changing roles of these institutions are particularly pronounced. The purpose for conducting the study was to describe the professional development practices of community college presidents in hope of identifying efforts that might help to lengthen presidential tenures. Drawing on a national survey of 500 community college presidents, 159 usable responses were received and point toward the reliance on national conferences and self-direction as the primary methods that presidents use to remain current in their roles.

As one of the world's preeminent writers, Devi's work tests readers' ethics while crossing corporeal, linguistic, cultural, and national boundaries. Here, a professor of global francophone literature shares how she [...]

Cybersecurity challenges are increasing in the rail industry because of constant technological evolution that includes the Internet of Things, blockchains, automation, and artificial intelligence. Consequently, many railroads and supply chain stakeholders have implemented strategies and practices to address these challenges. However, the pace of cybersecurity implementation in the railroad industry is slow even as cyberthreats escalate. This study uniquely integrates bibliometric analysis with a systematic literature review to provide a holistic view of cybersecurity trends in rail freight. The study analyzes 70 articles focusing on cybersecurity practices in the rail freight industry, structured around four research questions relating to: (1) challenges, (2) measures, (3) emerging trends, and (4) innovations. Key findings are that implementing cybersecurity practices in the rail freight industry comes with numerous challenges and risks. The study concludes that new threats will constantly emerge with technological advancements. Therefore, there is a need for continuous human training, collaboration, and coordination with stakeholders. This study also highlights research gaps and recommends how stakeholders can most appropriately execute cybersecurity strategies and best coordinate them with the various technological functions in the rail freight industry.

The inefficiency of transporting goods contributes to reduced economic growth and environmental sustainability in a country. Autonomous trucks (ATs) are emerging as a solution, but the imbalance in the weight moved and ton-miles produced by long-haul and short-haul trucking creates a challenge in targeting initial deployments. This study offers a unique solution by presenting a robust method that combines data mining and geographic information systems (GISs) to identify the optimal routes for ATs based on a top-down approach to maximize business benefits. Demonstrated in a U.S. case study, this method revealed that despite accounting for only 16% of the weight moved, long-haul trucking produced 56% of the ton-miles, implying a high potential for ATs in this segment. The method identified eight key freight zones in five U.S. states that accounted for 27% of the long-haul weight and suggested optimal routes for initial AT deployment. Interstate 45 emerged as a pivotal route in the shortest paths among these freight zones. This suggests that stakeholders should seek to prioritize funding for infrastructure upgrades and maintenance along that route and the other routes identified. The findings will potentially benefit a broad range of stakeholders. Companies can strategically focus resources to achieve maximum market share, regulators can streamline policymaking to facilitate AT adoption while ensuring public safety, and transportation agencies can better plan infrastructure upgrades and maintenance. Users globally can apply the methodological framework as a reliable tool for decision-making about where to initially deploy ATs.

Background:. Although recent studies demonstrated resident satisfaction in the treatment of skin of color (SOC) related disease, comfort levels treating hair specific to populations within the SOC spectrum is unclear. Objective:. The purpose of this study is to assess dermatology residents comfort level in recognizing and treating various common hair conditions with a focus on those specific to SOC. Methods:. An Institutional Review Board-approved survey was distributed to United States residents of Accreditation Council for Graduate Medical Education-accredited dermatology programs. Data pertaining to hair care knowledge and treatment comfort levels were collected. Analysis was completed using equal variance 2-sample t tests and analysis of variance F tests, P < .05. Results:. Dermatology residents were relatively comfortable with common conditions such as androgenetic alopecia and alopecia areata, but uncomfortable with creating healthy hair regimens, discussing natural hair care products, and treating trichorrhexis nodosa. Resident self-identification as underrepresented in medicine significantly impacted resident knowledge of hair care and treatment in patients with SOC. Limitations:. This study was limited due to small sample size and potential recall bias. Conclusion:. This study highlights knowledge gaps in understanding hair-related care for patients with SOC, affirming the continued importance of diversifying dermatology programs as well as hair-specific training for residents.

The successful deployment of Advanced Air Mobility (AAM) requires the safe integration of electric vertical takeoff and landing (eVTOL) aircraft in non-segregated airspace. However, a lack of practical deployment demonstrations can slow the regulatory progress. This study presents a practical deployment framework for the integration of eVTOL aircraft into public airspace, in accordance with the Federal Aviation Administration (FAA) special airworthiness criteria. This study focused on a corporate use case to provide a comprehensive scenario for enhancing intra-company mobility. The scenario supports early implementation and demonstration goals by removing reliance on air traffic management systems or air traffic controller separation services. The practical deployment framework included facility selection, route planning, terrain mapping, collision avoidance, aircraft selection, infrastructure requirements, vertiport placement, electric chargers, ground handling, operational staff, and cost estimates. Planners can use the framework as a template to inform the implementation of real-world AAM services using eVTOL aircraft.

The Accreditation Council for Graduate Medical Education (ACGME) requires medical residents to learn key behavioral health competencies, including demonstrating 'knowledge of established and evolving social-behavioral sciences' and the ability to [...], Background: There is significant variability in how residency programs prepare the primary care workforce in behavioral health competencies. One approach that warrants further exploration is to have integrated behavioral health consultants (BHCs) capitalize on in vivo clinical teaching opportunities in the context of teambased care. This article presents preliminary results from the implementation of a pilot program wherein BHCs use warm handoffs and other clinical interactions to provide brief, targeted education to medical residents. Method: Twelve BHCs from five resident training clinics participated in a 1-hr training on "microteaching" skills that could be used in clinical teaching interactions. BHCs were asked to track instances of microteaching using an Excel spreadsheet. After 3 months, BHCs and residents responded to electronic surveys that assessed the acceptability and feasibility of this process. Results: In 3 months, BHCs provided 269 instances of microteaching with 66 residents (66.7%) across five clinics. These microteachings occurred within the context of various interactions, including warm handoffs (n = 138, 51.3%), curbside consultations (n = 78, 29.0%), debriefs (n = 46, 17.1%), and team huddles (n = 7, 2.6%). Roughly half (n = 149, 55.4%) of these encounters involved Level 1 microteaching (i.e., lasting 2 min or less), while half (n = 120, 44.6%) involved Level 2 (i.e., lasting 3-10 min). BHCs and residents rated the microteaching interactions as acceptable and feasible. Discussion: Leveraging embedded BHCs as clinical educators in integrated care environments may hold value for increasing behavioral health competencies among medical residents. Keywords: primary care behavioral health, clinical teaching, resident education, integrated care

Using Uncrewed Aerial Vehicles (UAVs) to monitor the condition of nodal transportation assets—airports, seaports, heliports, vertiports, and cargo terminals—presents a transformative approach to traditional inspection methods. The focus on nodal assets rather than linear assets like roads, railways, bridges, and waterways fills a gap in addressing the dynamic challenges specific to transportation hubs. This study reviews scholarly literature on applying UAV-based remote sensing (URS) techniques to assess the condition of various transportation hubs, which are critical junctures in global logistics networks. Utilizing a systematic literature review framework, this study reviewed 486 publications from 2015 to 2023 to extract insights from the evolving discourse on URS applications. The findings suggest that these emerging methods resulted in substantial enhancements in time saving, cost efficiency, safety, and reliability. Specifically, this study presents evidence on how URS approaches can overcome the constraints of conventional inspection methods by enabling rapid, high-precision mapping and surveillance in complex and constrained environments. The findings highlight the role of UAVs in enhancing operational workflows and decision making in transportation planning and maintenance. By bridging the gap between traditional practices and innovative technology, this research offers significant implications for stakeholders in the field, advocating for a shift towards more dynamic, cost-effective, and precise asset management strategies.

Our youth are in crisis, and it started long before the COVID-19 pandemic. As leaders within the Pediatrics Special Interest group in the nation's leading integrated care organization (Collaborative Family [...], The nation is facing a pediatric mental health crisis that is years in the making. The pandemic potentiated the crisis by isolating youth and compounding family stressors. In response, the US Surgeon General issued an advisory in late 2021 recommending actions that health care and other sectors should take to improve youth well-being. Integrated care has a critical role to play in both implementing and moving beyond the Surgeon General&apos;s recommendations. The Collaborative Family Healthcare Association&apos;s Pediatric Special Interest Group (SIG) meets monthly to provide support and learning experiences and to promote dissemination of innovations to address the pediatric mental health crisis. In this article, we share recommendations, informed by the conversations in the CHFA Pediatric SIG, to propel the Surgeon General&apos;s advice into actions. We prioritize and emphasize structural changes that are needed in the health care system and highlight practical and actionable steps individual providers can take to increase cross sector collaboration. Keywords: pediatrics, behavioral health, integrated care

Abstract Background People experiencing homelessness are uniquely susceptible and disproportionately affected by the impacts of the COVID-19 pandemic. Understanding context-specific challenges, responses, and perspectives of people experiencing homelessness is essential to improving pandemic response and mitigating the long-term consequences of the pandemic on this vulnerable population. Methods As part of an ongoing community-based participatory research study in partnership with a homeless service organization in Indiana, semi-structured interviews were conducted with a total of 34 individuals experiencing homelessness between January and July 2021. Guided by the NIMHD Health Disparities Research Framework, which builds on the socio-ecological model, data was thematically coded using Nvivo12 qualitative coding software and themes were organized by levels of influence (individual, interpersonal, community, societal) and domains of influence (biological, behavioral, physical/built environment, sociocultural environment, health care system). Results Narratives revealed numerous and compounding factors affecting COVID-19 risks and health outcomes among people experiencing homelessness across all levels and domains of influence. At the individual level, people experiencing homelessness face unique challenges that heightened their susceptibility to COVID-19, including pre-existing physical and mental health conditions, substance use and behavioral health risks, socioeconomic precarity, and low health literacy and COVID-related knowledge. At the interpersonal level, poor communication between people experiencing homelessness and service providers led to limited understanding of and poor compliance with COVID safety measures. At the community level, closures and service disruptions restricted access to usual spaces and resources to meet basic needs. At a policy level, people experiencing homelessness were disregarded in ways that made pandemic relief resources largely inaccessible to them. Conclusions Our findings reveal important and mitigable issues with ongoing pandemic response efforts in homeless populations through direct, first-hand accounts of their experiences during COVID-19. These insights offer opportunities for multilevel interventions to improve outreach, communication, and impact mitigation strategies for people experiencing homelessness. This study highlights the importance of centering the voices of vulnerable communities to inform future pandemic response for homeless and other underserved and marginalized populations.