Exclusive Categories Research Articles

Assessing socioeconomic disparities and the likelihood of multimodal treatment utilization in patients with pancreatic cancer using SEER Medicare data.

677 Background: Optimal treatment for pancreatic cancer necessitates multimodal therapies combining surgery, chemotherapy, and radiation. Socioeconomic determinants of health may influence access to these treatments, leading to disparities in outcomes. This study examines the association between socioeconomic status (SES) and the likelihood of receiving multimodal treatment among pancreatic cancer patients using SEER Medicare data. Methods: Our study population consists of elderly persons diagnosed with pancreatic cancer from the 2008–2017 SEER-Medicare dataset. A multinomial logistic regression controlling for sociodemographic characteristics, cancer stage, comorbidities, geographic region, and ecological measures of urbanicity and SES was used to assess the likelihood of receiving one of three mutually exclusive treatment categories: no treatment, one modality (surgery, chemotherapy, or radiotherapy), or multiple modalities (different combinations of surgery, chemotherapy, and radiotherapy), with multiple modalities as the reference group. Survival analysis was conducted using Kaplan-Meier curves (KMC) and Cox proportional hazards (CPH) models. Results: Adjusted analyses showed that among stages 0–3 patients, living in areas with a high percentage of individuals without a high school education (non-HS) was associated with increased odds of receiving no treatment (OR = 1.26, p < 0.01) and one modality (OR = 1.20, p < 0.01) versus multiple modalities. Low median household income was linked to higher odds of no treatment (OR = 1.30, p < 0.01) and one modality (OR = 1.16, p < 0.05). This pattern persisted in stage 4 patients, where high non-HS percentage increased odds of no treatment (OR = 1.38, p < 0.01), and low median income was associated with higher odds of no treatment (OR = 1.25, p < 0.05). Non-Hispanic Black patients had higher odds of receiving no treatment in both stages 0–3 (OR = 1.26, p < 0.05) and stage 4 (OR = 1.91, p < 0.01) compared to Non-Hispanic Whites. Being married was associated with reduced odds of receiving no treatment for stages 0–3 (OR = 0.53, p < 0.01) and stage 4 (OR = 0.55, p < 0.01). Lower SES and being Non-Hispanic Black are associated with decreased likelihood of receiving multimodal treatment across all stages. Patients receiving multimodal therapies demonstrated improved survival on our KMC analysis, and CPH models indicated lower mortality for those receiving multiple modalities. Conclusions: Socioeconomic disparities significantly influence multimodal treatment utilization in pancreatic cancer. Lower SES indicators—high non-HS percentages, low median income—and being Non-Hispanic Black are associated with decreased use of multimodal therapies and poorer survival. Addressing these disparities is essential to ensure equitable access to optimal treatments and improve survival rates.

Studying gender in the experiences of patients with heart failure: A scoping review of qualitative studies and methodological recommendations.

Considering how gendered experiences play a role in the lives of patients with heart failure (HF) is critical in order to understand their experiences, optimise clinical care and reduce health inequalities. The aim of our study was to review how gender is being studied in qualitative research in HF, specifically to (1) analyse how gender is conceptualised and applied in qualitative HF research; and (2) identify methodological opportunities to better understand the gendered experiences of patients with HF. We conducted a systematic search of literature, including qualitive or mixed-methods articles focussing on patients' perspectives in HF and using gender as a primary analytical factor, excluding articles published before 2000. Our search returned 3121 records, which were independently screened by two authors, resolving disagreements through a consensus procedure. Two reviewers extracted the characteristics of the included studies and methodological quality. We applied the Integrating Sex and Gender Checklist and gender theory as an analytical tool to synthesise results relating to the conceptualisation and application of gender in the included studies. We included 11 qualitative articles that used interviews (n = 10) or focus groups (n = 1) to investigate the role of gender in experiences of patients with HF. None of the included studies defined their conceptual approach to gender, or used gender-related theoretical frameworks. This led to results and conclusions which were drawn along binary lines - representing gender as two separate, oppositional and mutually exclusive categories, and paying little attention to the dynamic, relational and context-dependent aspects of gender. Although researchers have investigated the role of gender in the experiences of patient with HF, methodological improvements are needed to prevent the current retelling of gender as a binary variable with two opposed and mutually exclusive categories. To better understand gendered experiences in HF, researchers need to avoid a reductionist and essentialist approach to gender. To this end, researchers should clearly state their conceptual approach to gender and analyse their findings using state-of-the-art gender theoretical frameworks and intersectional approaches. Ultimately, this will allow the development of tailored and effective clinical care.

Creative Writing in Foreign Language Learning: Systemic Literature Review

Creative competence as one of the transformative competencies in the future education framework 2030 must begin to be realized in foreign language learning, including writing skills. This study aims to map the position of creative writing in existing studies. The method used for tracing is NVivo as a coding tool. The 78 articles found are then selected by inclusion and exclusion categories to produce 25 articles for further coding. The results of the coding are then read and studied with four perspectives, namely the language that is the object of study, the problems for achieving creative competence, the solutions offered and the benefits that can be obtained to overcome emerging foreign language learning problems. The findings from this SLR indicate that the language which is the most dominant object of study is English. Linguistic problems in the context of discourse and demotivating non-linguistics are the dominant problems, while the solutions offered are mostly focused on creative writing strategies. The benefits obtained are the improvement of writing skills, language skills, motivation, and self-quality of foreign language learners. The research gap that can be mapped from the findings above is that attention to foreign languages other than English in creative writing research and discourse-based learning must be increased.

Electronic Flashcards in Health Professions Education: A Scoping Review.

Electronic flashcards (EFs) are a widely used learning resource in medical education. This scoping review provides a comprehensive overview of the existing empirical research on EFs and a direction for future research on EF interventions. The authors organized the reviewed articles into 4 nonmutually exclusive categories: development, delivery, utilization, and associated outcomes. In this scoping review, search queries were composed for 6 databases (PubMed, Embase, Education Resource Information Center, Web of Science, PsychInfo, and the Cumulative Index to Nursing and Allied Health Literature). The database search was conducted on April 12, 2024, for articles published before this date using the following keywords (as well as other keywords): anki, quizlet, firecracker, osmosis, flashcard, spaced repetition, spaced interval training, spaced interval learning, spaced test, and parallel curriculum. Two reviewers screened the studies for eligibility and performed data extraction between August 12, 2024, and September 26, 2024. Sixty-four studies were included in the review. Most articles were published in the last 6 years (2019-2024) (49 [77%]), in the United States (45 [7%]), and in the context of undergraduate medical education (42 [66%]). The studies predominantly focused on the utilization (51 [78%]) and associated outcomes (38 [59%]) of EFs. In contrast, EF development (12 [19%]) and delivery methods (16 [25%]) were less frequently examined. This review of the rapidly increasing body of research on EFs suggests broad use and satisfaction among health professions learners; however, much work remains to be done to systematically understand EF development and delivery. Future research directions may consider more systematic investigations of how decisions made during the development and delivery of EFs affect downstream use and learning outcomes. Addressing these gaps will deepen the understanding of how EFs affect medical education pedagogy and facilitate the informed integration and refinement of these tools within curricula.

Six Questions for Every Content Analysis: Revisiting the Stemler’s Overview

Content analysis (CA) is a technique widely used in various fields to systematically and objectively interpret textual, visual, or multimedia data. It facilitates the categorisation of phenomena or events for enhanced analysis and interpretation. In other words, CA is a technique for investigating social reality, which involves inferring attributes of a non-manifest context from attributes of a manifest text. This paper revisited Stemler’s work, “an overview of content analysis” with specific emphasis on salient questions every content analysis effort ought to address. Following the review of the Stemler’s, it is found that addressing the indispensable questions divulges that not all documents are amenable to CA under three conditions; substantial portions missing, improper recording and uncodability of document(s) owing to ambiguity of content or missing passages. This study also revealed some fatal flaws that inhibit the efficacy of CA: over- reliance on word-counts to attribute relevance, faulty definitions of categories and non-mutually exclusive and exhaustive categories. Thus, it is recommended that every CA should be tailored-made to answer the six indispensable questions so as to increase its credence and utility, which in turn addresses theoretical underpinnings, methodological rigor, ethical considerations, and the dynamic interplay between content, context, and interpretation.

“What Made Me Change”: Transformative Experiences in the Jihadist Radicalization Process

ABSTRACT Disentangling the roots of radicalization leading to violence is a worldwide challenge. Unfortunately, empirical data are scarce. Through fieldwork conducting interviews with Muslim persons deprived of liberty (PDL) in Spanish prisons, this research examines transformative experiences that may have influenced radicalization leading to violence from the 3N model and the life-course perspective lenses. PDL because of jihadist terrorism (n = 30), common criminals who carry out proselytizing work (n = 22), and non-radicals (control group, n = 64) were asked about the turning point in their lives. Their responses were coded into exclusive thematic categories following an inductive-deductive mixed approach. Jihadists and proselytizers identified experiences linking their personal identity to religion—ideological ties—as a transformative point that provided them purpose and sparked the desire for leaving their criminal lifestyle behind. Also, proselytizers referred to family-related experiences—familial ties—as a turning point which also prompted them to criminal desistance, whereas this was not mentioned by jihadists. All groups had in common the experience of incarceration as a major turning point and a moderate level of self-reported religiosity. Overall, these findings contribute to the understanding and prevention of jihadist radicalization.

Solution Processable Se-annulated Swallow Tail Perylene Bisimide Exhibiting Room Temperature Columnar Phase and Efficient Ambipolar Charge Carrier Mobility.

This study presents a selenium-annulated perylene bisimide (PBI-SeST) stabilizing room temperature columnar hexagonal phase with exceptionally low clearing temperature. The synthesis of this Se-annulated PBI (PBI-SeST) was accomplished using the reductive Cadogan cyclization method, with the introduction of swallow tails to reduce the clearing temperature and improve solubility. In addition, the charge carrier mobility of the Se-bay annulated PBI is assessed by space charge limited current (SCLC) technique and juxtaposed with PBI as well as nitrogen and sulphur-bay-annulated PBIs. It is noteworthy that all these PBIs exhibited ambipolar charge carrier mobility, a characteristic that diverges from the prevailing literature where predominantly electron transport behavior was observed for PBIs. This distinguishes them as an exclusive category of solution-processable, self-assembling organic semiconductors.

Heterogeneity in Prescription Opioid Misuse Motives by Age in Adolescents and Young Adults in the United States.

Adolescent (12-17 years) and young adult (18-25 years) prescription opioid misuse (POM) is linked to poor health outcomes. We investigated how POM motives vary across these ages and the potential links between motives and other substance use, mental health, and sociodemographic characteristics to help guide screening and prevention. Pooled 2015-2019 US National Survey on Drug Use and Health data were used, with 137,858 participants. Cross-tabulations estimated prevalence of individual motives and motive category by age. Mutually exclusive motive categories were no past-year POM, pain relief only, pain/sleep/relax (ie, some combination of only these motives), and any non-self-treatment motives (eg, get high, experiment). Logistic regression models evaluated links between motive category and sociodemographic, mental health, and substance use (eg, alcohol, cannabis, nicotine, other prescription misuse) outcomes by age group, versus reference groups of no past-year POM or pain relief only. Pain relief was the most common POM motive (estimated at >50% at all ages), but POM for non-self-treatment motives was the most common category after 14 years. POM for non-self-treatment motives had the highest adjusted odds ratios (aORs) of all substance use and mental health characteristics (eg, past-year substance use disorder aORs of 6.11 in adolescents [95% confidence interval (CI), 4.23-8.85] and 4.81 [95% CI, 4.01-5.77] in young adults, versus the pain relief only reference). POM for any non-self-treatment motives is linked to the highest prevalence of other substance use and mental health concerns, whereas POM for pain relief also signals a need for substance use and mental health screening.

Musculoskeletal Injuries in Female U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021.

Musculoskeletal injuries (MSKIs) are highly prevalent and costly conditions among active duty service members (ADSMs), and female service members sustain these injuries at a higher rate than men. However, lack of women-specific research regarding MSKIs in the U.S. military has limited Department of Defense (DoD) leadership from assessing and addressing the burden of these conditions. The purposes of this study were to report the incidence, prevalence, and types of MSKIs sustained by female ADSMs across the four services in direct care (DC) and private sector care (PC) settings from fiscal years (FYs) 2016 through 2021 and to quantify and describe the health care utilization and private sector costs associated with MSKIs in women over the same period. This retrospective, longitudinal population study included ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Head/Neck, Upper Extremity (UE), Spine, and Lower Extremity (LE) MSKIs in female ADSMs, associated health care utilization, and private sector costs were derived by querying electronic health records from military treatment facilities, PC claims, and theater medical data from the Military Health System Data Repository from October 1, 2015 to September 30, 2021 (FY16-21). Health care utilization associated with MSKIs among female ADSMs for each body region in DC and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC MSKI-associated costs in service women were captured for each year and categorized by service, body region, and setting. In FY21, 10.8% (n = 27,976) of female ADSMs sustained Head/Neck MSKI, 16.3% (n = 42,294) UE MSKI, 23.6% (n = 61,048) Spine MSKI, and 33.3% (n = 86,235) LE MSKI. Across the study period, female ADSMs had a 25%-29% higher risk of any MSKI (risk ratio (RR) 1.25-1.29) relative to men. Female soldiers had the highest annual prevalence of MSKIs (62.1%-66.4%), while female Marines had the highest risk of MSKI relative to men (RR 1.40-1.47) for all four major body regions. From FY16 to FY21, the body region with the highest risk of MSKI relative to men was Head/Neck (RR 1.61-1.63), while the region with the lowest relative risk was UE (RR 1.05-1.10). LE MSKIs represented the most common and costly type of injury in female ADSMs, with 406,997 outpatient DC and 87,374 PC encounters in FY21. Total PC costs of LE MSKI for female ADSMs were $30,643,535 in FY21 alone. This is the first population-level assessment of MSKI prevalence, incidence rates, health care utilization, and PC costs over a 6-year period for service women in the military health system (MHS). Female ADSMs sustain MSKIs at a higher rate than their male counterparts. Given the critical role of service women in the military, MHS leaders, researchers, and public health officials should continue to explore the underlying causes of these disparities in MSKI rates between the sexes, by expanding research efforts to all services and military settings.

Musculoskeletal Head and Neck Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021.

Active duty service members (ADSMs) of the U.S. Armed Forces are uniquely at risk for musculoskeletal injuries (MSKIs) of the Head/Neck region, including the eye and face, from training with head gear, donning Kevlar, operating aircraft, and maintaining sitting or standing postures for prolonged durations. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Head/Neck MSKIs across the Services from fiscal years (FYs) 2016 to 2021. This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Head/Neck MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities, private sector care (PC) claims, and theater medical data from October 1, 2015 to September 30, 2021 (FYs 16-21), using the Military Health System Data Repository. Utilization associated with Head/Neck MSKIs in both the direct care and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to Head/Neck MSKIs were captured for each year. In FY21, 109,683 ADSMs sought care for Head/Neck MSKIs, representing 7.3% of the U.S. Armed Forces. The prevalence of Head/Neck MSKIs ranged from 6.9 to 7.8% during FY16-21, with the highest annual prevalence among the Air Force (8.0-9.4%) and Army (7.9-8.8%). Within direct care across the services, Soldiers presented for the highest proportion (45.9-47.9%) of outpatient encounters for Head/Neck MSKI annually. The Air Force relied most heavily on PC for outpatient Head/Neck MSKI care, which accounted for $9,134,741 in PC costs and comprised 37.2% of all PC encounters in FY21. This retrospective, descriptive study established prevalence/incidence, health care utilization, and PC costs for Head/Neck MSKIs across the services from FY16-21, emphasizing the burden of Head/Neck MSKIs among the U.S. Armed Forces, with PC costs amounting to $42,912,940 in FY21 alone.

Lower Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021.

Lower Extremity musculoskeletal injuries (LE MSKIs) represent a significant portion of overuse injuries in active duty service members (ADSMs). However, variations in study methods and research gaps related to LE MSKIs have prevented Department of Defense (DoD) leaders from assessing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of LE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs. This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for LE MSKIs, associated health care utilization, and costs were obtained by querying electronic health records (EHR) from military treatment facilities (MTFs), private sector care (PC) claims, and theater medical data from the Military Health System Data Repository (MDR) from October 1, 2015 to September 30, 2021 (FY16-21). Utilization associated with LE MSKIs in both the direct care (DC) and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to LE MSKIs were captured for each year. In FY21, LE MSKIs occurred in 25.3% of ADSMs (n = 378,615). A higher proportion of females sustained an LE MSKI (33.3%), compared to males (23.7%). From FY16-21, the Army had the highest annual prevalence of LE MSKIs (30.9-35.5%), followed by the Air Force (23.8-31.0%), Marine Corps (23.4-27.0%), and Navy (17.2-19.8%). Incidence rate patterns were similar, with the Army sustaining LE MSKIs at 320 to 377 injuries per 1,000 person-years, followed by the Air Force (241-318), Marines (255-288), and Navy (173-203). Overuse/non-specific MSKIs of the knee were the most common injury type and body region affected, respectively. There were 10,675,543 DC and 1,875,307 PC outpatient encounters from FY16-21 with a primary or secondary diagnosis of LE MSKI. The Air Force was most reliant on PC, with 21.5 to 36.8% of LE MSKI-related encounters occurring outside MTFs during FY16-21. Over $99 million was paid by TRICARE on LE MSKI in FY21 alone with Same Day Surgeries accounting for almost half ($48 million) of this total. Among U.S. ADSMs, LE MSKIs remain highly prevalent and costly. We observed disparities across the Services in the prevalence and incidence of LE MSKIs, and their respective reliance on the private sector for management of these conditions. Findings from this work may support military leaders and MSKI researchers who seek to reduce the impact of LE MSKIs on the readiness and overall health of the U.S. Military.

Capturing and Categorizing the Burden of Musculoskeletal Injuries in U.S. Active Duty Service Members: A Comprehensive Methodology.

Musculoskeletal injuries (MSKIs) represent the most common, costly, and impactful medical conditions affecting active duty service members (ADSMs) of the United States Armed Forces. Inconsistent, variable MSKI surveillance methods and often incompletely described criteria for cohort selection, injuries, incidence, and prevalence have limited efforts to observe longitudinal trends, identify gaps in care, or highlight specific military branches or sites that could benefit from enhanced MSKI intervention protocols. The purpose of this manuscript is to present a comprehensive, well-documented, and reproducible framework for capturing and categorizing MSKI burden, healthcare utilization, and private sector costs for ADSMs across a 12-year period spanning the International Classification of Diseases, 10th Revision, Clinical Modification transition. This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Upper Extremity, Lower Extremity, Spine, and Head/Neck MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities, private sector care (PC) claims, and theater medical data from October 1, 2010 to September 30, 2021 (Fiscal Years 10-21), using the Military Health System Data Repository. Utilization associated with MSKIs per body region in the direct care and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC MSKI-associated costs were captured per year and categorized by service, body region, and setting. MSKI surveillance research in ADSMs has been impacted by variable, often incompletely described methods. While our approach is not without limitations, our aim was to present a well-documented, reproducible methodology for MSKI investigation in military personnel. By presenting a comprehensive blueprint for capturing and categorizing MSKI care in U.S. service members, our goal is for this methodology to enhance the efforts of researchers, public health officials, and Military Health System leaders to combat MSKIs, the primary medical threat to military readiness.

Burden of Musculoskeletal Injuries in U.S. Active Duty Service Members: A 12-Year Study Spanning Fiscal Years 2010-2021.

Musculoskeletal injuries (MSKIs) represent the most substantial and enduring threat to U.S. military readiness. Previous studies have focused on narrow surveillance periods, single branches of service, and used variable approaches for MSKI identification and classification. Therefore, the goals of this retrospective population study were to report the incidence, prevalence, and types of MSKIs sustained by active duty service members (ADSMs) across four Services in direct care (DC) and private sector care (PC) settings over fiscal years (FYs) 2010-2021, and to quantify and describe associated health care utilization and PC costs over the same period. This study included ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Head/Neck, Upper Extremity (UE), Spine (upper back, middle back, lower back, pelvic), and Lower Extremity (LE) MSKIs in ADSMs, associated health care utilization, and PC costs were derived by querying electronic health records from DC, PC claims, and theater medical data from the Military Health System Data Repository. Patient episodes of care and associated PC costs related to MSKIs in DC and PC settings were classified into mutually exclusive outpatient encounter categories and acute inpatient stays, body regions, and Services. Over FY10-21, the most prevalent MSKIs were LE (24-29%) followed by Spine (17-20%), UE (14-16%), and Head/Neck (6-8%). Across FY10-21, soldiers were more likely to sustain LE MSKI than Airmen (risk ratio 1.12-1.30) and Marines demonstrated an increasing risk of LE MSKI prevalence and incidence (relative to Airmen) over the study period. The rise in prevalence of LE, Spine, UE, and Head/Neck MSKIs over FY10-21 was accompanied by increased health care utilization and reliance on PC care, especially same-day surgeries (SDS). PC reliance for SDS increased across body regions from FY10 to its peak in FY20 (Head/Neck: 22.7% to 49.7%, Spine: 37.1% to 57.0%, LE: 38.6% to 51.5%, UE: 40.4% to 53.5%). In FY21, the MHS incurred the highest PC costs for LE MSKIs ($132,242,289), followed by Spine ($98,738,863), UE ($92,118,071), and Head/Neck ($42,718,754). To our knowledge, this is the first population study of MSKIs in ADSMs spanning the ICD-10 CM transition (FY15-16) that includes the four Services. Across Services, MSKIs in the U.S. military remain a prevalent and persistent problem. Consistent with prior research, the LE was the most common and costly body region affected by MSKIs. Service members with MSKIs demonstrated an increasing reliance on PC for MSKI care, particularly SDS, over the study period. Expanding future research efforts to include all Services to assess risk factors and patient outcomes for treatments across DC and PC settings is vital to mitigate the threat posed by MSKIs to the readiness of the U.S. Armed Forces.

Musculoskeletal Spine Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Healthcare Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021.

Low back pain and musculoskeletal injuries (MSKIs) of the Spine are the most common reason for U.S. active duty service members (ADSMs) to seek medical care. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Spine (thoracic, lumbar, sacral, and pelvic) MSKIs across the four major branches of service from Fiscal Years (FY) 2016 to 2021. This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Spine MSKIs, associated health care utilization, and costs were obtained by querying electronic health records (EHRs) from military treatment facilities, private sector care (PC) claims, and theater medical data from the Military Health System Data Repository from October 1, 2015 to September 30, 2021 (FY16-21). Utilization associated with Spine MSKIs in both the direct care (DC) and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to Spine MSKIs were captured per year. In FY21, 269,301 ADSMs sought care for Spine MSKI, representing 18.0% of the U.S. Armed Forces. The prevalence of Spine MSKIs ranged from 17.4 to 19.5% during FY16-21, with the highest annual prevalence among the Army (20.7-22.9%) and Air Force (19.0-22.6%). Across the study period, Soldiers had the highest share (47.8-50.4%) of DC outpatient encounters for Spine MSKI (primary or secondary diagnosis). The Air Force relied most heavily on PC for outpatient Spine MSKI care across the study period, where in FY21 Airmen accounted for 36.5% of the outpatient PC Spine MSKI encounters totaling $21,140,935 in PC costs. In FY21, total PC costs for Spine MSKI totaled $99,317,832. This retrospective, descriptive study establishes prevalence/incidence, health care utilization, and PC costs for Spine MSKIs across the Services from FY16-21 and highlights the burden of Spine MSKIs among the U.S. Armed Forces, with costs amounting to over $99 million in PC reliance in FY21 alone.

Upper Extremity Musculoskeletal Injuries in United States Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016-2021.

Upper Extremity musculoskeletal injuries (UE MSKIs) represent a major threat to the overall health and readiness of U.S. active duty service members (U.S. ADSMs). However, a lack of prior research and inconsistent study and surveillance methodology has limited Department of Defense (DoD) leaders from assessing and addressing the burden of these conditions. The purpose of this study was to report the incidence, prevalence, and types of UE MSKIs sustained by ADSMs across four branches of service and describe associated health care utilization and private sector costs. This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for UE MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities (MTF), private sector care (PC) claims, and theater medical data from the Military Health System Data Repository from October 1, 2015 to September 30, 2021 (Fiscal Years [FYs] 16-21). Utilization associated with UE MSKIs in both the direct care (DC) and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to UE MSKIs were captured for each year. In FY21, UE MSKIs occurred in 15.0% of ADSMs (n = 224,842). From FY16-21, the Army had the highest annual prevalence of UE MSKIs (16.7-18.8%), followed by the Air Force (15.2-17.6%), Marine Corps (13.2-14.7%), and Navy (11.1-12.6%). Incidence rate patterns were similar, with the Army sustaining UE MSKIs at 172 to 199 injuries per 1,000 person-years, followed by the Air Force (150-181), Marines (140-157), and Navy (113-130). Overuse/non-specific MSKIs of the shoulder were the most common UE injury type and body region affected, respectively. There were 5,641,191 DC and 1,290,153 PC outpatient encounters from FY16-21 with a primary or secondary diagnosis of UE MSKI. The Air Force was most reliant on PC, with 31.5% of their UE MSKI-related encounters occurring outside MTFs during FY16-21. Among U.S. ADSMs, UE MSKIs are both highly prevalent and financially burdensome. We observed variation across the Services in the prevalence and incidence of UE MSKIs, and their respective reliance on the private sector for management of these conditions. Findings from this work may support military leaders and MSKI researchers who seek to reduce the impact of UE MSKIs on the readiness and overall health of the U.S. Military.

Utilizing Invasive Coronary Functional Testing in a Coronary Microvascular and Vasomotor Dysfunction Program: Methods and Considerations.

Coronary microvascular and vasomotor dysfunction (CMVD) is associated with a threefold increased risk of major adverse cardiovascular events (MACE) and is the primary mechanism responsible for angina/ischemia in patients with nonobstructive coronary artery disease (ANOCA/INOCA). Proper assessment for CMVD is vital to provide targeted treatment and improve patient outcomes. Invasive coronary functional testing (ICFT) is the "gold standard," for CMVD assessment and can be used to diagnose all endotypes. However, there is a lack of standardization for ICFT protocols and use in the treatment of CMVD. To provide a comprehensive overview of ICFT protocols utilized at the Christ Hospital Womens Heart Center (TCH-WHC). Here, we outline our standard operating procedures for ICFT utilized at TCH-WHC, including the procedures two main methods: Doppler and Thermodilution. We describe our structured approach for ICFT referral and postdiagnostic clinical management utilized at The Christ Hospital Women's Heart Center (TCH-WHC) CMVD program. We then quantified how ICFT has contributed to growth of the TCH-WHC. From October of 2020 until July of 2024, a total of 422 patients have undergone ICFT at TCH-WCH, 64% were performed via the Doppler protocol and 36% were performed via the Thermodilution protocol. Based on exclusive endotype categories, 19% had an endothelial-independent CMD alone, 19% had endothelial-dependent CMD or microvascular VSA alone, 3% had epicardial VSA alone, 42% had mixed disease (any combination of the above categories), and 17% had a normal ICFT. ICFT provides opportunity to provide diagnostic clarity and optimize medical treatment for CMVD. TCH-WHC's structured approach for ICFT referral and protocol for conducting comprehensive ICFT which has been vital for the growth of our specialized CMVD program.

A translanguaging perspective on multilingual identity construction of a native English teacher on a Chinese social media platform

ABSTRACT Native English-Speaking Teachers (NESTs) have long been assumed as monolingual, and the translanguaging practices and multilingual identity construction of NESTs have been under-explored. This study investigates how NESTs construct multilingual identity in online English teaching videos through translanguaging. Focusing on one NEST on a popular Chinese social media platform, a combination of multimodal video analysis and qualitative content analysis was conducted. The findings reveal that the NEST breaks linguistic barriers, incorporating gestures, body movements, signs, languages, and different speaking styles to share her experiences, evaluations, and emotions about language and language learning and teaching. These translanguaging practices empowered her to traverse the boundaries of distinctive L1 and L2 identities and develop multiple multilingual identities: an experienced English teacher with Chinese as an additional language, a foreigner valuing English language learning in China, and a passionate English speaker proud of learning Chinese. Findings reveal that translanguaging affords the NEST to construct trans-lingual, trans-cultural, and trans-national identities, while such multilingual identity construction is interwoven with her NEST identity. These findings call for a need to shift from viewing NESTs as monolingual models to multilinguals with translanguaging competences and reflect that nativeness and nonnativeness are not exclusive categories but mutually constitutive subjectivities.

Mental health, risk behaviors, and social life factors in relation to adolescents' suicide ideation, plans and attempt.

This study investigated differences in mental health and well-being, risk behaviors, and social life factors among adolescents who experienced different forms of suicidality. We examined 18-years-olds in the Danish National Birth Cohort (N = 47,852). Suicidality was defined with mutually exclusive categories ranging from no suicidality, self-reported suicide ideation, plans, and attempt as well as hospital-recorded suicide attempt. The proportion of adolescents with self-reported poor mental health and well-being, risk behaviors, and social life factors were compared across forms of suicidality. Sample weights were applied. Depressive symptoms were reported by 14% (95% CI 13%;14%) of girls with no suicidality, 44% (95% CI 43%;45%) of girls with suicide ideation, and 68% (95% CI 65%;72%) 66% (95% CI 60%;72%) of girls with self-reported suicide attempt or hospital-recorded suicide attempt respectively. Among boys, depressive symptoms were reported by 5% (95% CI 4%;5%) of those with no suicidality, 27% (95% CI 26%;28%) of those with suicide ideation, and 51% (95% CI 45%;57%) and 40% (95% CI 22%;58%) of those with self-reported suicide attempt or hospital-recorded suicide attempt respectively. Likewise, other aspects of poor mental health and well-being gradually increased relative with more severe forms of suicidality, while no notable differences were identified between adolescents with self-reported and hospital-recorded suicide attempt. Similar tendencies were observed for risk behaviors and social life factors. These findings suggest that adolescents with suicidality, including the large proportion with suicide ideation only, faces challenges across several parameters of mental health and well-being, risk behavior, and social life factors. This emphasizes the need for community-based interventions to identify and support the large group of adolescents experiencing both more and less severe forms of suicidality. Clinicians should prioritize comprehensive psychiatric intervention to address the complex needs of suicidal adolescents effectively.

Consistency in Self-Reported Race-and-Ethnicity Over Time: Implications for Improving the Accuracy of Imputations and Making the Best Use of Self-Report.

Medicare Bayesian Improved Surname and Geocoding (MBISG), which augments an imperfect race-and-ethnicity administrative variable to estimate probabilities that people would self-identify as being in each of 6 mutually exclusive racial-and-ethnic groups, performs very well for Asian American and Native Hawaiian/Pacific Islander (AA&NHPI), Black, Hispanic, and White race-and-ethnicity, somewhat less well for American Indian/Alaska Native (AI/AN), and much less well for Multiracial race-and-ethnicity. To assess whether temporal inconsistency of self-reported race-and-ethnicity might limit improvements in approaches like MBISG. Using the Medicare Health Outcomes Survey (HOS) baseline (2013-2018) and 2-year follow-up data (2015-2020), we evaluate the consistency of self-reported race-and-ethnicity coded 2 ways: the 6 mutually exclusive MBISG categories and individual endorsements of each racial-and-ethnic group. We compare the consistency of self-reported race-and-ethnicity (HOS) to the accuracy of MBISG (using 2021 Medicare Consumer Assessment of Healthcare Providers and Systems data). Concordance (C-statistic) of HOS baseline and follow-up self-reported race-and-ethnicity was 0.95-0.97 for AA&NHPI, Black, Hispanic, and White, 0.83 for AI/AN, and 0.72 for Multiracial using mutually exclusive categories (weighted concordance=0.956). Concordance of MBISG with self-report followed a similar pattern and had similar values, with somewhat lower AI/AN and Multiracial values. The concordance of individual endorsements over time was somewhat higher than for classification (weighted concordance=0.975). The concordance of MBISG with self-reported race-and-ethnicity appears to be limited by the consistency of self-report for some racial-and-ethnic groups when employing the 6-mutually-exclusive category approach. The use of individual endorsements can improve the consistency of self-reported data. Reconfiguring algorithms such as MBISG in this form could improve its overall performance.

Amiri Baraka's Humanist Theater: A Reading of A Black Mass

Abstract This essay articulates Amiri Baraka's relationship to humanist universalism through his work as a theatermaker, in particular through his play A Black Mass. Baraka's Black nationalist writings are infused with humanist assumptions despite the apparent contradiction between humanist universalism and nationalist separatism. The essay nominates as poietic the form of humanism that Baraka values, meaning that, for Baraka, humans imagine new worlds into existence from materials taken by the world as it is. This poietic humanism values contingency, invention, and impermanence and refuses essentialisms. The essay begins by drawing from Baraka's essays on theater the claim that the work, or action, of revolutionary art is to set into motion a doubling, to produce oppositions that remain unsettled. Next is an extended reading of Baraka's play A Black Mass, first staged in New Jersey in 1966, which he uses to settle philosophical scores with the Nation of Islam. Although the play borrows its plot from the Nation of Islam's myth of Yakub, which casts the white race as fundamentally monstrous, A Black Mass resists a vision of history as racial destiny. It does so, first, by staging the production of the human as a category of exclusion and so critiquing the process of racialization, and second, by rooting its tragic plot structure in a break between the expressive self and the poietic community. The essay's conclusion briefly contextualizes Baraka's poietic humanism within late 1960s debates among nationalist and Negritude thinkers, suggesting Frantz Fanon as an important influence and reasserting a dynamic approach to racial difference in Baraka's vision of Black art.