Attainment Rates Research Articles

When and how to discuss about palliative care and advance care planning with cancer patients: A mixed-methods study.

To identify the patients who are most likely to participate in discussions about palliative care (PC) and advance care planning (ACP), and to determine their preferred timing and approach of discussion. The study included women aged 18-75years diagnosed with breast cancer. In the quantitative phase, sociodemographic and clinical characteristics, knowledge, decision-making, and stigmas were evaluated. The qualitative phase included questions about patients' understanding, timing, and method of discussing PC and ACP, which were analyzed by Bardin's content analysis. In Phase 1, a total of 115 participants were included, with 53.04% completing both phases and 46.96% declining further participation. Those who completed both phases exhibited higher rates of marriage and educational attainment, while those who declined Phase 2 had a higher prevalence of advanced-stage cancer and palliative treatment. Completion of both phases was associated with a greater knowledge of reality and increased awareness of PC and ACP. Furthermore, the qualitative analysis revealed 5 convergent themes: timing, demystification, patient empowerment, misconception elimination, and open communication. These themes informed the development of a conceptual model that provides a framework for discussing PC and ACP with patients at different stages of cancer diagnosis and treatment, highlighting appropriate and inappropriate approaches and timing. Early discussion is beneficial, but withholding information or infringing on autonomy should be avoided. The study reveals that married and highly educated individuals tend to be more receptive to these discussions. However, patients with late-stage cancer tend to decline participation. Patients value open communication, demystification of PC, and empowering discussions that eliminate misunderstandings. Efforts should be made to reach patients with limited familiarity, particularly those with late-stage cancer, to increase their receptiveness to enable well-informed decision-making.

Community gardens and the 15-minute city: Scenario analysis of garden access in New York City

Community gardens are a form of green infrastructure that provides social and environmental benefits for garden users and the surrounding area. However, little is known about who has walking access to community gardens in most cities today and how this may change in the future. To address this gap, we examine 15-minute walking access to community gardens in New York City (NYC), and how land-use and investment decisions will impact the future of NYC as a 15-minute garden city. Our results indicate that more than half of the city’s residents have this access to a community garden, and that neighborhoods with lower income, lower proportions of white residents and homeowners, and higher rates of educational attainment have better access. Optimization modeling indicates that universal 15-minute access is unlikely, though more than 70% of NYC residents could have walking access with as few as 50 additional community gardens. Supporting new community gardens on vacant land and parking lots is the most efficient way to expand access, though siting community gardens on a range of land use types is required to maximize access. By mapping community gardens, analyzing their distribution, and modeling how to scale-up urban agriculture, this paper presents a scenario-based process for exploring how and where to expand urban amenities.

Patients who suffer a first atherosclerotic cardiovascular event while taking statins are often far off of lipid targets

Background and aimsDespite considerable evidence that lipid-lowering therapies (LLTs) afford clinical benefit, the control of low-density lipoprotein cholesterol (LDL-C) is suboptimal, and available LLTs are underused, especially in patients at high and very high cardiovascular (CV) risk. This study assesses the real-world LDL-C target attainment rate in patients on LLT before experiencing a first major acute cardiovascular event (MACE). Methods and resultsThe HEARTBEAT was a retrospective, multicentre observational study. From March to June 2021 a total of 334 patients on LLT who had a first MACE while being on statins were included in the study. Of these patients, 83.2 % had a high (40.7 %) or very high CV risk (29.0 %) prior to MACE. Overall, 87.5 % and 89.7 % of the patients at high and very high CV risk, respectively, failed to reach the LDL-C target. Regarding LLTs, only 11.8 % and 19.6 % of the patients at high and very high risk had received high-intensity LLTs prior to MACE. It was estimated that if these patients had reached their recommended LDL-C targets, the risk of MACE may have been reduced by a median of 24.5 % and 23.2 % in patients at high and very high risk respectively. ConclusionsPatients who suffer a first MACE while on statin therapy often were at high/very high CV risk. Despite their risk, LDL-levels and being on statins they are undertreated, and too far from lipid targets. A proper use of high-intensity LLTs led to an increase attainment of LDL targets and lower CV events.

Educational Attainment and US Drug Overdose Deaths

Educational attainment in the US is associated with life expectancy. As the opioid crisis worsens, it is critical to understand how overdose death rate trends evolve across education groups. To investigate the association between educational attainment and overdose death rates, with emphasis on trends during the COVID-19 pandemic. This cross-sectional study used National Vital Statistics System Mortality Multiple Cause-of-Death data describing overdose death rates in the US by educational attainment from January 1, 2000, to December 31, 2021, with a focus on 2018 to 2021. Overdose deaths were aggregated by year and educational level for decedents aged 25 years or older. Educational attainment, categorized as no high school (HS) diploma, HS diploma (or General Educational Development) but no college, some college but no bachelor's degree, and bachelor's degree or more. The main outcomes were rates of all overdose deaths, overdose deaths involving opioids, and overdose deaths involving synthetic opioids. Of 912 057 overdose deaths with education information from 2000 to 2021 (mean [SD] age at death, 44.9 [12.3] years; 64.1% male), there were 625 400 deaths (68.6%) among individuals with no college education and 286 657 deaths (31.4%) among those with at least some college. The overdose death rate was 19.9 per 100 000 population. From 2018 to 2021, there were 301 557 overdose deaths, including 58 319 (19.3%) among individuals without an HS diploma, 153 603 (50.9%) among people with an HS diploma, 64 682 (21.4%) among individuals with some college, and 24 953 (8.3%) among individuals with a bachelor's degree. There were 3324 overdose deaths (1.1%) among American Indian or Alaska Native individuals, 2968 (1.0%) among Asian American or Pacific Islander individuals, 49 152 (16.3%) among Black individuals, 31 703 (10.5%) among Hispanic individuals, 211 359 (70.1%) among White individuals, and 3051 (1.0%) among multiracial individuals. From 2018 to 2021, the overdose death rate was 33.4 per 100 000 population, the opioid-related overdose death rate was 24.2 per 100 000 population, and the synthetic opioid overdose death rate was 19.1 per 100 000 population. From 2018 to 2021, the overdose death rate for those without a HS diploma increased by 35.4 per 100 000 population compared with 1.5 per 100 000 population for those with a bachelor's degree. This differential growth was primarily due to increased rates of death involving synthetic opioids. In this cross-sectional study, lower educational attainment was found to be associated with higher growth in overdose deaths. As the opioid crisis has transitioned to fentanyl and polysubstance use, overdose deaths have become more prevalent in groups with lower socioeconomic status, potentially exacerbating existing life-expectancy disparities.

Rural secondary school leaver attainment inequities for students entering medical programmes in Aotearoa New Zealand

ABSTRACT The education literature suggests that there are rural–urban differences in educational achievement. Lower educational achievement in rural schools may impact entry into highly competitive medical programmes and disadvantage rural students. Within this study, the National Certificate of Educational Achievement (NCEA) and University Entrance (UE) attainment rates are compared across Aotearoa New Zealand secondary schools for 2012–2021. High schools were classified as urban or rural according to the two rural admission schemes used in the medical programmes at the University of Otago and the University of Auckland. Descriptive statistics were calculated and regression models created to adjust for a range of variables. The data demonstrates that rural high schools have lower NCEA and UE attainment. Lower Māori student NCEA and UE attainment, greater socioeconomic disadvantage and differing characteristics account for the majority of differences between rural and urban schools. The lower UE attainment rate for rural schools will likely mean that rural students will have greater difficulty in entering medical programmes and that this inequity is worse for rural Māori students. Medical programme admission pathways need to undergo a fundamental shift–from workforce pathways to workforce and equity pathways in order to address rural workforce issues.

Immunosuppression-Free Life after Pediatric Liver Transplant: A Case-Control Study from the Society of Pediatric Liver Transplant (SPLIT) Registry

To compare long-term outcomes of pediatric liver transplant (LT) recipients off immunosuppression (IS) with matched controls on IS using data from the Society of Pediatric Liver Transplant (SPLIT) registry. This was a retrospective case-control study. SPLIT participants <18years of age, ≥4years after isolated LT, and off IS for ≥1year (cases) were age- and sex-matched 1:2 to patients with the same primary diagnosis and post-LT follow-up duration (controls). Primary outcomes included retransplantation, allograft rejection, IS comorbidities, and prevalence of SPLIT-derived composite ideal outcome (c-IO) achieved at the end of the follow-up period. Differences were compared using multiple linear regression for continuous outcomes and logistic regression for dichotomous data. The study cohort was composed of 33 cases (42.4% male, 60.6% biliary atresia, median age at LT of 0.7 [P25, P75, 0.5, 1.6] years, median IS withdrawal time of 9 [P25, P75, 6, 12] years after LT) and 66 age- and sex-matched controls. No cases required retransplantation. Cases and controls had similar growth parameters, laboratory values, calculated glomerular filtration rates, rates of post-transplant lymphoproliferative disease, graft rejection, and attainment of c-IO. No differences in allograft rejection rates, IS complications, or c-IO prevalence were seen between SPLIT patients off IS and age- and sex-matched controls remaining on IS. Discontinuation of IS most commonly occurred in the context of rigorously designed IS withdrawal trials. The available sample size was small, affecting generalizability to the broader pediatric LT population.

Rooftop solar, electric vehicle, and heat pump adoption in rural areas in the United States

The deployment of residential rooftop solar, electric vehicles (EVs), and heat pumps is critical to meet climate goals. We evaluate historical community- and household-level technology adoption patterns in rural areas, and explore associations with housing, socioeconomic, demographic, political, spatial, and energy equity characteristics. We reveal several emergent patterns and disparities in rural technology adoption. We find that higher educational attainment and democratic voting rates are significant predictors of adoption across all residential technologies. Specifically, EV adoption shows the highest association with democratic voting rates. We also find that rooftop solar adoption is most significantly inversely associated with energy burden, while there is a high degree of spatial dependence in heat pump adoption. Rooftop solar and EV adoption are particularly correlated at household, community, and state levels. Findings suggest that designing policies and programs that promote information diffusion, target low-income renters, and are tailored to the geographic and political context may together increase technology adoption rates and ensure more equitable diffusion. By identifying the factors that influence technology adoption in rural areas, we aim to inform the development of policies and programs that can facilitate the widespread deployment of clean energy technologies and contribute to the achievement of climate goals.

Vancomycin and daptomycin dosing recommendations in patients receiving home hemodialysis using Monte Carlo simulation

BackgroundFew drug dosing recommendations for patients receiving home hemodialysis (HHD) have been published which has hindered the adoption of HHD. HHD regimens vary widely and differ considerably from conventional, thrice weekly, in-center hemodialysis in terms of treatment frequency, duration and blood and dialysate flow rates. Consequently, vancomycin and daptomycin clearances in HHD are also likely to be different, consequently HHD dosing regimens must be developed to ensure efficacy and minimize toxicity when these antibiotics are used. Many HHD regimens are used clinically, this study modeled ten common HHD regimens and determined optimal vancomycin and daptomycin dosing for each HHD regimen.MethodsMonte Carlo simulations using pharmacokinetic data derived from the literature and demographic data from a large HHD program treating patients with end stage kidney disease were incorporated into a one-compartment pharmacokinetic model. Virtual vancomycin and daptomycin doses were administered post-HHD and drug exposures were determined in 5,000 virtual patients receiving ten different HHD regimens. Serum concentration monitoring with subsequent dose changes was incorporated into the vancomycin models. Pharmacodynamic target attainment rates were determined for each studied dose. The lowest possible doses that met predefined targets in virtual patients were chosen as optimal doses.ResultsHHD frequency, total dialysate volumes and HHD durations influenced drug exposure and led to different dosing regimens to meet targets. Antibiotic dosing regimens were identified that could meet targets for 3- and 7-h HHD regimens occurring every other day or 4–5 days/week. HHD regimens with 3-day interdialytic periods required higher doses prior to the 3-day period. The addition of vancomycin serum concentration monitoring allowed for calculation of necessary dosing changes which increased the number of virtual subjects meeting pharmacodynamic targets.ConclusionsDoses of vancomycin and daptomycin that will meet desired pharmacodynamic targets in HHD are dependent on patient and HHD-specific factors. Doses used in conventional thrice weekly hemodialysis are unlikely to meet treatment goals. The antibiotic regimens paired with the HHD parameters studied in this analysis are likely to meet goals but require clinical validation.

An interpretive phenomenological analysis of nursing student perceptions of summative assessment feedback using LEGO® Serious Play®

PurposeThe aim of the study is to explore perceptions of the impact of assessment feedback by international undergraduate nursing students. Research to date indicates that summative assessment feedback may impact significantly on student achievement but if it is undertaken sub optimally or does not provide students with the opportunity to engage with the process and reflexively respond, it can also be exceptionally damaging to the learning experience.Design/methodology/approachA scoping exercise of overall student feedback experience was initially collated via the adoption of an Interpretive Phenomenological Approach (IPA). Participants were recruited via purposive sampling and the LEGO® Serious Play® method was used to collect data. Analysis with Quirkos software was used to examine the salience as well as commonality of findings as an integral part of a recognised five-step thematic analytical approach.FindingsFeedback was perceived, by students, as significantly impacting factor in relation to their overall progression, attainment and retention rates. Themes generated from the findings evidenced student perceptions that summative feedback is a positive driver and source of motivation for academic success and progression. It was perceived that levels of attainment were related to the clarity, quality and individualised nature of feedback that students received and that this was perceived to be evident in their final grades. These were accompanied by perceptions that feedback clarity also determined the potential of breaking down perceived student barriers to learning, their perceived capacity for effective assignment planning and preparation and the likelihood of them having any positive collective or individual interpersonal relationships with their tutors. Summarised, students perceived that feedback ought to lead to student empowerment in managing their studies and as such it ought to be clear, straightforward and non-ambiguous.Research limitations/implicationsThe methodological design of the study means that generalisability from its findings was never intended or possible. However, there may be the potential transferability of findings to similar institutions and contexts of nurse education with students who have similar demographic profiling. The study was also a means of providing an insight into the lived experience of students which could be used in the prospective adaptation of feedback mechanisms for staff at a local level within Higher Education.Practical implicationsThe study reveals the perceived impact of gamification as a mechanism of summative assessment as conveyed by a designated group of students. Whilst specific recommendations for change can only be made within the context specificity of the research, there may be aspects of the findings which are potentially transferable to other similar contexts of Higher Education delivery whose pedagogical approaches mirror those in operation at the institution where the research was undertaken. It became apparent that the standardisation of feedback approaches offered many opportunities to improve existing systems. The issue of monitoring workloads is also of significance in terms of the level and degree of summative assessment and feedback that academic staff can undertake.Originality/valueThe study revealed the perceived magnitude of assessment feedback on progression, attainment and retention rates, alongside the perceived need for a universal feedback template and the opportunity to provide audio-video feedback. This study adds to existing knowledge in the field of pedagogic practice about both the execution of LEGO® Serious Play® as a research methodology and why the perceptions of feedback as articulated and illuminated by a group of contemporary nursing students ought to matter in the context of Higher Education.

Two Interventions on Pathologic Nodal Staging in a Population-Based Lung Cancer Resection Cohort

BackgroundDespite its prognostic importance, poor pathologic nodal staging of lung cancer prevails. We evaluated the impact of 2 interventions to improve pathologic nodal staging. MethodsWe implemented a lymph node specimen collection kit to improve intraoperative lymph node collection (surgical intervention) and a novel gross dissection method for intrapulmonary node retrieval (pathology intervention) in nonrandomized stepped-wedge fashion, involving 12 hospitals and 7 pathology groups. We used standard statistical methods to compare surgical quality and survival of patients who had neither intervention (group 1), pathology intervention only (group 2), surgical intervention only (group 3), and both interventions (group 4). ResultsOf 4019 patients from 2009 to 2021, 50%, 5%, 21%, and 24%, respectively, were in groups 1 to 4. Rates of nonexamination of lymph nodes were 11%, 9%, 0%, and 0% and rates of nonexamination of mediastinal lymph nodes were 29%, 35%, 2%, and 2%, respectively, in groups 1 to 4 (P < .0001). Rates of attainment of American College of Surgeons Operative Standard 5.8 were 22%, 29%, 72%, and 85%; and rates of International Association for the Study of Lung Cancer complete resection were 14%, 21%, 53%, and 61% (P < .0001).Compared with group 1, adjusted hazard ratios for death were as follows: group 2, 0.93 (95% CI, 0.76-1.15); group 3, 0.91 (0.78-1.03); and group 4, 0.75 (0.64-0.87). Compared with group 2, group 4 adjusted hazard ratio was 0.72 (0.57-0.91); compared with group 3, it was 0.83 (0.69-0.99). These relationships remained after exclusion of wedge resections. ConclusionsCombining a lymph node collection kit with a novel gross dissection method significantly improved pathologic nodal evaluation and survival.

Effect of lipid-lowering treatment on lipid and glycemic profile of patients with elevated lipoprotein(a) levels

Aim: The evaluation of the effect of lipid-lowering treatment in patients with elevated levels of lipoprotein(a) [Lp(a)]. Material and methods: A prospective study including 70 patients with dyslipidemia and elevated Lp(a) levels (&gt;30 mg/dL) attending a Lipid Clinic in Greece. Subjects were allocated to the following therapies according to the national guidelines for cholesterol management: high-intensity statin monotherapy (S; n=28), ezetimibe added to high-intensity statin (SE; n=31), and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor added to high-intensity statin plus ezetimibe (SEP; n=11). Follow-up duration was 3 months. We investigated the effect of these lipid-lowering interventions on participants’ lipidemic and glycemic profile. Comparisons between groups were adjusted for the baseline levels of the studied parameters. Results: Mean age was 51 ± 15 years, 40% were male, 39% were diagnosed with familial hypercholesterolaemia (FH), 16% with atherosclerotic cardiovascular disease (ASCVD), while 36%, 33% and 15% were at very high, high, and moderate cardiovascular risk, respectively. All interventions significantly reduced apolipoprotein B (apoB), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), but only PCSK9 inhibitors significantly reduced Lp(a) levels (SEP: -28% vs SE: +11% vs S: +17%, p&lt;0.05). Patients in the SE group achieved the highest rates of LDL-C target attainment (SEP: 36.4% vs SE: 12.9% vs S: 3.6% for LDL-C &lt;55 mg/dL; SEP: 36.4% vs SE: 16.1% vs S: 7.1% for LDL-C &lt;70 mg/dL, p&lt;0.05 for the comparison among groups). No significant effect on glycemic profile across treatment groups was noted. Conclusions: Add-on PCSK9 inhibitors were associated with the highest rates of LDL-C target achievement compared with high-intensity statin ± ezetimibe in high-risk patients with elevated Lp(a) and were the only class to significantly lower Lp(a) levels.

Retrospective Study of IDegLira, a New Fixed-Ratio Combination, in Japanese Patients With Type 2 Diabetes Mellitus: Analysis of Background Factors Affecting Effectiveness After 6 Months of Treatment.

The aim of the study was to provide real-world data on the effectiveness and safety of a new fixed-ratio combination, insulin degludec/liraglutide (IDegLira) injection in Japanese patients with type 2 diabetes mellitus (T2DM). The primary endpoint was the change in glycated hemoglobin (HbA1c) level 6 months after the introduction of IDegLira. We also examined the rate of achievement of target HbA1c 7% and the individualized HbA1c targets set for each patient. Baseline characteristics associated with the change in HbA1c were also assessed. Seventy-five patients with T2DM were included in the analysis. After the initiation of IDegLira, HbA1c decreased significantly from baseline with a change of -1.81% (baseline 9.61% and at 6 months 7.80%; P < 0.001). At baseline, the achievement rate of 7% HbA1c was 2.67% (n = 2), which increased to 36.0% (n = 27) after 6 months of IDegLira introduction (P < 0.05). The attainment rate of individualized HbA1c targets, which were set considering each patient's characteristics, improved from 2.67% (n = 2) to 49.3% (n = 37) (P < 0.001). Regardless of sex, body mass index, estimated glomerular filtration rate, duration of diabetes, or history of glucagon-like peptide-1 receptor agonist use, IDegLira significantly reduced HbA1c, but a higher C-peptide index was associated with a greater reduction in HbA1c. In this study, initiation of IDegLira in a real-world clinical setting was beneficial in lowering HbA1c in Japanese T2DM patients with inadequate glycemic control with existing therapy.

Congestion Detection and Mitigation Technique for Multi-Hop Communication in WSN

The primary function of a network system is to gather information from the observation region and transmit it to the base station. The network life span and congestion are the two major concerns in wireless networks. To enhance the lifespan of the sensor system; multi-hopping has been proved as best in class. Congestion is an important factor to be taken, where multiple nodes forward data to one another in the process of communication. Hence to overcome the issue of congestion in WSN, we proposed a congestion detection and mitigation method along with the multi-hop concept. In this technique, we have considered different routes among communication units that were classified on distance, relative attainment rate (RAR) and node storage occupancy. A utility function (U) has been proposed and calculated using the above illustrated factors for every node that acts as a neighbour to the transmitting node. Neighbour node with highest U-valued will be considered as the packet forwarding node's next hop. In this manner congestion free nodes are selected for data transmission.

Application of a warfarin dosing calculator to guide individualized dosing versus empirical adjustment after fixed dosing: a pilot study.

Background: Warfarin has a narrow therapeutic window and individual variation, and patients require regular follow-up and monitoring of the International Normalized Ratio (INR) for dose adjustment. The calculation method of Warfarin Dosing Calculator (WDC) software is based on the European and American populations, and its accuracy in the Chinese population is yet to be verified. Objective: This study was to evaluate the feasibility of applying Warfarin Dosing Calculator software intervention in a real-world clinical research setting in China. Methods: The pilot study divided the included patients after valve replacement into an experimental group and a control group, with 38 cases in each group. In the control group, the initial dose was fixed at 2.5mg/d and the dose was adjusted empirically during the study period; in the experimental group, the Warfarin Dosing Calculator software was applied to guide the dosing, and patients in both groups were followed up for 3months. Analysis of the incidence anticoagulation outcomes and excessive anticoagulation events in both groups. Kaplan-Meier survival curves were used to analyze the correlation between different dosing regimens and first International Normalized Ratio attainment, and Logrank tests were performed. Results: The mean time required for first International Normalized Ratio compliance in the experimental group was 4.38days less than in the control group, and the mean number of tests was 1.43 less (p < 05). Time in therapeutic range (TTR) was significantly higher in the experimental group than in the control group (p < 05). Kaplan-Meier survival curve analysis showed that the first International Normalized Ratio attainment rate was significantly higher in the experimental group than in the control group (p = 01). No major bleeding events occurred in either group, but other excessive anticoagulation events (INR>3.5 and minor bleeding) were significantly reduced in the experimental group compared with the control group (p < 05). Conclusion: Application of Warfarin Dosing Calculator software to guide individualized warfarin dosing may be better than a fixed dose of 2.5mg/d. It may be shorten the time to first International Normalized Ratio attainment, and the attainment rate in the same time, and can better improve the mean Time in therapeutic range level value and reduce excessive anticoagulation events, which improves the safety of warfarin anticoagulation therapy in clinical practice. Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=52793, ChiCTR2000032393.

Bile duct injury after cholecystectomy: timing of surgical repair should be based on clinical presentation. The experience of a tertiary referral center with Hepp-Couinaud hepatico-jejunostomy

Impact of timing of repair on outcomes of patients repaired with Hepp-Couinaud hepatico-jejunostomy (HC-HJ) after bile duct injury (BDI) during cholecystectomy remains debated. This is an observational retrospective study at a tertiary referral hepato-biliary center. HC-HJ was always performed in patients without sepsis or bile leak and with dilated bile ducts. Timing of repair was classified as: early (≤ 2 weeks), intermediate (> 2 weeks, ≤ 6 weeks), and delayed (> 6 weeks). 114 patients underwent HC-HJ between 1994 and 2022: 42.1% underwent previous attempts of repair at referring institutions (Group A) and 57.9% were referred without any attempt of repair before referral (Group B). Overall, a delayed HC-HJ was performed in 78% of patients; intermediate and early repair were performed in 17% and 6%, respectively. In Group B, 10.6% of patients underwent an early, 27.3% an intermediate, and 62.1% a delayed repair. Postoperative mortality was nil. Median follow-up was 106.7 months. Overall primary patency (PP) attainment rate was 94.7%, with a 5- and 10-year actuarial primary patency (APP) of 84.6% and 84%, respectively. Post-repair bile leak was associated with PP loss in the entire population (odds ratio [OR] 9.75, 95% confidence interval [CI] 1.64–57.87, p = 0.012); no correlation of PP loss with timing of repair was noted. Treatment of anastomotic stricture (occurred in 15.3% of patients) was performed with percutaneous treatment, achieving absence of biliary symptoms in 93% and 91% of cases at 5 and 10 years, respectively. BDI can be successfully repaired by HC-HJ regardless of timing when surgery is performed in stable patients with dilated bile ducts and without bile leak.

Breaking Cyclic Intergenerational Literacy Deficits: Describing Linguistic Interactions Between Adolescent Mothers and Their Young Children

Adolescent mothers (AMs) often experience limited academic and financial attainment and higher rates of mental health disorders, which may affect their relationships with their children. Although children of AMs are at higher risk for developmental delays, there is no clear evidence of the relationships between mother characteristics and child outcomes. This descriptive study explored AMs’ and their children’s sociodemographic characteristics and language skills, home literacy environment, and the quality of mother–child interactions. Eight AM–child dyads were recruited from local school districts. Data were collected through questionnaires, standardized measures of language, and mother–child interactions. Most AMs demonstrated below-average language skills and most children had language scores that fell within the average range. AMs demonstrated strong affectionate behaviors, and emerging responsive, encouraging, and teaching behaviors when interacting with their children. This study provides unique data on AMs’ language characteristics that have not been clearly published in the literature.

Relieving the Burden of Self-Reliance: Centering the Experiences of Black Women Graduate Students in Predominantly White Institutions

Research to explore the experiences of Black women graduate students in colleges and universities is limited despite the increased focus and prioritization of diversity, equity, and inclusion efforts, particularly at Predominantly White Institutions. This is problematic as Black women have the highest increases of graduate school attainment rates in the United States of all gender and racial/gender groups; yet, these settings are not equipped to support them. Grounded in Intersectionality and Womanist perspectives, this study explores the educational experiences of 19 Black women who recently obtained graduate degrees from Predominantly White Institutions. Findings from the study reveal that in these environments, no spaces were created to nurture them in their interlocking identities, students engaged in distancing dilemmas, diversity efforts appeared delusional, collective efforts by the students generated achievement, and positive mentoring lessened inequality gaps. Concrete and practical strategies are provided to systematically support Black women graduate students and relieve them of the burden of self-reliance.

Impact of model-informed precision dosing on achievement of vancomycin exposure targets in pediatric patients with cystic fibrosis.

Vancomycin is commonly used to treat acute pulmonary exacerbations in pediatric patients with cystic fibrosis (CF) and a history of methicillin-resistant Staphylococcus aureus. Optimizing vancomycin exposure during therapy is essential and area under-the-curve (AUC)-guided dosing is now recommended. Model-informed precision dosing (MIPD) utilizing Bayesian forecasting is a powerful approach that can support AUC-guided dose individualization. The objective of the current study was to examine the impact of implementing an AUC-guided dose individualization approach supported via a MIPD clinical decision support (CDS) tool on vancomycin exposure, target attainment rate, and safety in pediatric patients with CF treated with vancomycin during clinical care. A retrospective chart review was performed in patients with CF at a single children's hospital comparing pre- and post-implementation of a MIPD approach for vancomycin supported by a cloud-based, CDS tool integrated into the electronic health record (EHR). In the pre-MIPD period, vancomycin starting doses of 60 mg/kg/day (<13 years) or 45 mg/kg/day (≥13 years) were used. Dose adjustment was guided by therapeutic drug monitoring (TDM) with a target trough 10-20 mg/L. In the post-MIPD period, starting dose and dose adjustment were based on the MIPD CDS tool predictions with a target 24 h AUC (AUC24 ) 400-600 mg*h/L. Exposure and target achievement rates were retrospectively calculated and compared. Rates of acute kidney injury (AKI) were also compared. Overall, 23 patient courses were included in the pre-MIPD period and 21 patient courses in the post-MIPD period. In the post-MIPD period, an individualized MIPD starting dose resulted in 71% of patients achieving target AUC24 compared to 39% in the pre-MIPD period (p < 0.05). After the first TDM and dose adjustment, target AUC24 achievement was also higher post-MIPD versus pre-MIPD (86% vs. 57%; p < 0.05). AKI rates were low and similar between periods (pre-MIPD 8.7% vs. post-MIPD 9.5%; p = 0.9). An MIPD approach implemented within a cloud-based, EHR-integrated CDS tool safely supported vancomycin AUC-guided dosing and resulted in high rates of target achievement.

A national multiple baseline cohort study of mental health conditions in early adolescence and subsequent educational outcomes in New Zealand

Young people experiencing mental health conditions are vulnerable to poorer educational outcomes for many reasons, including: social exclusion, stigma, and limited in-school support. Using a near-complete New Zealand population administrative database, this prospective cohort study aimed to quantify differences in educational attainment (at ages 15–16 years) and school suspensions (over ages 13–16 years), between those with and without a prior mental health condition. The data included five student cohorts, each starting secondary school from 2013 to 2017 respectively (N = 272,901). Both internalising and externalising mental health conditions were examined. Overall, 6.8% had a mental health condition. Using adjusted modified Poisson regression analyses, those with prior mental health conditions exhibited lower rates of attainment (IRR 0.87, 95% CI 0.86–0.88) and higher rates of school suspensions (IRR 1.63, 95% CI 1.57–1.70) by age 15–16 years. Associations were stronger among those exhibiting behavioural conditions, compared to emotional conditions, in line with previous literature. These findings highlight the importance of support for young people experiencing mental health conditions at this crucial juncture in their educational pathway. While mental health conditions increase the likelihood of poorer educational outcomes, deleterious outcomes were not a necessary sequalae. In this study, most participants with mental health conditions had successful educational outcomes.

The Impact of Pediatric CKD on Educational and Employment Outcomes.

Pediatric patients with chronic kidney disease (CKD) are at risk for neurocognitive deficits and academic underachievement. This population may be at risk for lower educational attainment and higher rates of unemployment; however, published data has focused on patients with advanced CKD and exist in isolation from assessment of neurocognition and kidney function. Data from the Chronic Kidney Disease in Children (CKiD) cohort study were used to characterize educational attainment and employment status in young adults with CKD. We utilized ratings of executive function as a predictor of future educational attainment and employment status. Linear regression models predicted the highest grade level completed. Logistic regression models predicted unemployment. 296 CKiD participants aged 18 years or older had available educational data. 220/296 had employment data. By age 22, 97% had completed high school and 48% completed 2+ years of college. Among those reporting employment status, 58% were part- or full-time employed, 22% were non-working students, and 20% were unemployed and/or receiving disability. In adjusted models, lower kidney function (p=0.02), worse executive function (p=0.02), and poor performance on achievement testing (p=0.004) predicted lower grade level completed relative to expectation for age. CKiD study patients appear to have a better high school graduation rates (97%) than the adjusted national high school graduation rate (86%). Conversely, roughly 20% of participants were unemployed or receiving disability at study follow-up. Tailored interventions may benefit CKD patients with lower kidneyfunction and/or executive function deficits to optimize educational/employment outcomes in adulthood.