The relationship of individual comorbid chronic conditions to diabetes care quality.

ObjectiveMultimorbidity affects 26 million persons with diabetes, and care for comorbid chronic conditions may impact diabetes care quality. The aim of this study was to determine which chronic conditions were related to lack of achievement or achievement of diabetes care quality goals to determine potential targets for future interventions.Research design and methodsThis is an exploratory retrospective analysis of electronic health record data for 23 430 adults, aged 18-75, with diabetes who were seen at seven Midwestern US health systems. The main outcome measures were achievement of six diabetes quality metrics in the reporting year, 2011 (glycated haemoglobin (HbA1c) control and testing, low-density lipoprotein control and testing, blood pressure control, kidney testing). Explanatory variables were 62 chronic condition indicators. Analyses were adjusted for baseline patient sociodemographic and healthcare utilization factors.ResultsThe 62 chronic conditions varied in their relationships to diabetes care goal achievement for specific care goals. Congestive heart failure was related to lack of achievement of cholesterol management goals. Obesity was related to lack of HbA1c and BP control. Mental health conditions were related to both lack of achievement and achievement of different care goals. Three conditions were related to lack of cholesterol testing, including congestive heart failure and substance-use disorders. Of 17 conditions related to achieving control goals, 16 were related to achieving HbA1c control. One-half of the comorbid conditions did not predict diabetes care quality.ConclusionsFuture interventions could target patients at risk for not achieving diabetes care for specific care goals based on their individual comorbidities

Nurses' support needs in providing high-quality palliative care to persons with dementia in the hospital setting:A cross-sectional survey study

Background  Since dementia is an irreversible progressive disease characterized by a decline in mental functions and overall health, a palliative care approach is recommended. Nevertheless, many persons with dementia experience burdensome hospitalizations in end-of-life care. Their quality of life during hospitalization can be improved by palliative nursing care that suits their fragile health.  Aim  To explore hospital nurses' perceived support needs while providing high-quality palliative care for persons with dementia and to identify differences between nurses in different ward types and at different educational levels.  Design  Cross-sectional, multicenter survey study. Method Between January 2021 and April 2021, a convenience sample of Dutch hospital nurses received a web-based questionnaire on the topics of palliative caregiving, communication, collaboration, and hospital admissions. The data were analyzed using descriptive statistics.  Results  The survey was completed by 235 nurses. The most frequently endorsed support needs were "communicating with persons with severe dementia" (58.3%), "appointing a permanent contact person in the care for persons with dementia" (53.6%), and "dealing with family disagreement in end-of-life care" (53.2%). If nurses had more time to provide care, 66.4% of them would prioritize providing personal attention. Most support needs identified by nurses were similar.  Conclusion  A heterogeneous group of nurses demonstrates overall similar support needs in providing palliative care for persons with dementia and their families in the hospital setting. Clinical Relevance Nursing practices should implement dementia-friendly interventions to improve the quality of dementia care in the hospital

Prey Records for the Eastern Indigo Snake (Drymarchon couperi)

Prey items for the federally protected Eastern Indigo Snake (Drymarchon couperi) were compiled from published and gray literature, field observations, necropsies, dissection of museum specimens, and personal communications from reliable sources. One hundred and eighty-six records were obtained for 48 different prey species. Anurans, Gopher Tortoises, snakes, and rodents comprised ca. 85% of the prey items. Most records (n = 143) that mentioned size were from adult indigos; 17 were from juveniles. Prey records were collected from 1940-2008 and were available for all months of the year. These data confirm that Eastern Indigo Snakes eat a wide assortment of prey of varying sizes. This strategy allows D. couperi to potentially forage successfully in many different types of habitats and under fluctuating environmental conditions, a valuable trait for a top-level predator that requires a large home range

Smoking, genetic polymorphisms of glutathione S-transferases and biological indices of inflammation and cellular adhesion in the STANISLAS study

A recent clinical study has focused on: 1- the interaction between genetic variants of glutathione S-transferases M1 and T1 (GSTM1 and GSTT1) and smoking on the risk of cardiovascular diseases, 2- the potential capacity of GSTM1 and T1 genotypes in modifying the effect of smoking on inflammation and endothelial function. In this study, we investigated whether carriage of these 2 polymorphisms altered the smoking impact on biological indices of inflammation and cellular adhesion. White blood cell count (WBC), albumin, C-reactive protein (CRP), interleukine-6 (IL-6), tumor necrosis factor-alpha (TNF-a), L-selectin, E-selectin, P-selectin and intracellular adhesion molecule-1 (ICAM-1) were measured in 189 non-smokers and 76 smokers (aged 20-55 years) genotyped for the GSTM1 and T1 polymorphisms. Accounting for age and sex, smokers lacking GSTM1 had a higher WBC count, CRP and ICAM-1 levels as compared to the other groups; interaction term between smoking and genotype being significant (p=0.05). Conversely, non-smokers lacking GSTM1 had a higher levels of TNF-a; the test for interaction being significant (p=0.05). No significant interaction was found between smoking and GSTT1 genotypes, considering the 9 biological indices. However, significantly lower levels of IL-6 were noticed for non-smokers with GSTT1-0 null allele (p=0.05). Our study confirms previous results showing that GSTM1 polymorphism could modulate the interrelationships between smoking and biological markers of inflammation and endothelial function

Application of Asymmetric IRT Modeling to Discrete-Option Multiple-Choice Test Items

Asymmetric IRT models have been shown useful for capturing heterogeneity in the number of latent subprocesses underlying educational test items (Lee and Bolt, 2018a). One potentially useful practical application of such models is toward the scoring of discrete-option multiple-choice (DOMC) items. Under the DOMC format, response options are independently and randomly administered up to the (last) keyed response, and thus the scheduled number of distractor response options to which an examinee may be exposed (and consequently the overall difficulty of the item) can vary. In this paper we demonstrate the applicability of Samejima's logistic positive exponent (LPE) model to response data from an information technology certification test administered using the DOMC format, and discuss its advantages relative to a two-parameter logistic (2PL) model in addressing such effects. Application of the LPE in the context of DOMC items is shown to (1) provide reduced complexity and a superior comparative fit relative to the 2PL, and (2) yield a latent metric with reduced shrinkage at high proficiency levels. The results support the potential use of the LPE as a basis for scoring DOMC items so as to account for effects related to key location

The role of endogenous versus exogenous sources in the exposome of putative genotoxins and consequences for risk assessment

The “totality” of the human exposure is conceived to encompass life-associated endogenous and exogenous aggregate exposures. Process-related contaminants (PRCs) are not only formed in foods by heat processing, but also occur endogenously in the organism as physiological components of energy metabolism, potentially also generated by the human microbiome. To arrive at a comprehensive risk assessment, it is necessary to understand the contribution of in vivo background occurrence as compared to the ingestion from exogenous sources. Hence, this review provides an overview of the knowledge on the contribution of endogenous exposure to the overall exposure to putative genotoxic food contaminants, namely ethanol, acetaldehyde, formaldehyde, acrylamide, acrolein, α,β-unsaturated alkenals, glycation compounds, N-nitroso compounds, ethylene oxide, furans, 2- and 3-MCPD, and glycidyl esters. The evidence discussed herein allows to conclude that endogenous formation of some contaminants appears to contribute substantially to the exposome. This is of critical importance for risk assessment in the cases where endogenous exposure is suspected to outweigh the exogenous one (e.g. formaldehyde and acrolein)

Abused Children Experience High Anger Exposure

Childhood maltreatment is a critical problem in the United States. Much attention has been paid to the negative outcomes suffered by victims of abuse. Less attention has been devoted to understanding the emotional environments of maltreated children. One assumption, which has stood without empirical test, is that abused children encounter a high degree of anger in their home environments. Anger exposure is thought to be a source of stress for children in abusive environments and a potential link between the experience of abuse and the development of health and behavioral problems. We tested this notion by assessing data on over 1,000 parents and guardians of 3- to 17-year-old children who were participants in child development studies. Abuse was measured via records from Child Protective Services regarding substantiated and unsubstantiated claims of abuse as well as parent/guardian report. We compared self-reported experiences of anger from parents/guardians of children who have experienced abuse with those who have not. We found support for the claim that caregivers of abused children experience and express high levels of anger. Better characterization of the emotional environments in which abused children develop is critical for understanding how and why abuse affects children and has important implications for informing interventions

The first 20 months of the COVID-19 pandemic: Mortality, intubation and ICU rates among 104,590 patients hospitalized at 21 United States health systems

Main objective: There is limited information on how patient outcomes have changed during the COVID-19 pandemic. This study characterizes changes in mortality, intubation, and ICU admission rates during the first 20 months of the pandemic. Study design and methods: University of Wisconsin researchers collected and harmonized electronic health record data from 1.1 million COVID-19 patients across 21 United States health systems from February 2020 through September 2021. The analysis comprised data from 104,590 adult hospitalized COVID-19 patients. Inclusion criteria for the analysis were: (1) age 18 years or older; (2) COVID-19 ICD-10 diagnosis during hospitalization and/or a positive COVID-19 PCR test in a 14-day window (+/- 7 days of hospital admission); and (3) health system contact prior to COVID-19 hospitalization. Outcomes assessed were: (1) mortality (primary), (2) endotracheal intubation, and (3) ICU admission. Results and significance: The 104,590 hospitalized participants had a mean age of 61.7 years and were 50.4% female, 24% Black, and 56.8% White. Overall risk-standardized mortality (adjusted for age, sex, race, ethnicity, body mass index, insurance status and medical comorbidities) declined from 16% of hospitalized COVID-19 patients (95% CI: 16% to 17%) early in the pandemic (February-April 2020) to 9% (CI: 9% to 10%) later (July-September 2021). Among subpopulations, males (vs. females), those on Medicare (vs. those on commercial insurance), the severely obese (vs. normal weight), and those aged 60 and older (vs. younger individuals) had especially high mortality rates both early and late in the pandemic. ICU admission and intubation rates also declined across these 20 months. Conclusions: Mortality, intubation, and ICU admission rates improved markedly over the first 20 months of the pandemic among adult hospitalized COVID-19 patients although gains varied by subpopulation. These data provide important information on the course of COVID-19 and identify hospitalized patient groups at heightened risk for negative outcomes. Trial registration: ClinicalTrials.gov Identifier:&nbsp;NCT04506528&nbsp;(https://clinicaltrials.gov/ct2/show/NCT04506528).</p

Not interesting enough to be followed by the NSA: An analysis of Dutch privacy attitudes

Open curtains and a careless attitude. The Dutch are described as holding an indifferent stance towards privacy in the aftermath of Snowden’s revelations of far-reaching government surveillance. But are Dutch reactions as aloof as often claimed? This study provides an in-depth overview of privacy attitudes in the Dutch debate about the National Security Agency (NSA) leaks, showing a greater variety of sentiments than anticipated. A qualitative frame analysis and a quantitative descriptive analysis resulted in six frames, which convey distinct privacy attitudes. Online and offline as well as professional and non-journalistic content in the debate displays a different distribution of frames. The frames, ranging from an “End justifies the means” attitude to an anxious fear of an “Orwellian dystopia”, are placed in a larger framework as the research demonstrates the connection to existing theories about privacy and surveillance. Dutch discussions about the NSA revelations often display a trade-off narrative balancing safety against privacy, and include (de)legitimisation strategies. These outcomes are in line with previous studies about mediated surveillance debates, which indicates that privacy attitudes transcend national boundaries. However, the inclusion of user-generated content adds an individual dimension to the existing body of research and reveals a personal perspective on surveillance issues

Specific Features of After-School Program Quality: Associations with Children’s Functioning in Middle Childhood

This longitudinal study examined associations between three after-school program quality features (positive staff–child relations, available activities, programming flexibility) and child developmental outcomes (reading and math grades, work habits, and social skills with peers) in Grade 2 and then Grade 3. Participants (n = 120 in Grade 2, n = 91 in Grade 3) attended after-school programs more than 4 days per week, on average. Controlling for child and family background factors and children’s prior functioning on the developmental outcomes, positive staff–child relations in the programs were positively associated with children’s reading grades in both Grades 2 and 3, and math grades in Grade 2. Positive staff–child relations also were positively associated with social skills in Grade 2, for boys only. The availability of a diverse array of age-appropriate activities at the programs was positively associated with children’s math grades and classroom work habits in Grade 3. Programming flexibility (child choice of activities) was not associated with child outcomes