Exposure Rate Research Articles

Feasibility and Acceptability of a Family-Based Telehealth Intervention for Families Impacted by the Child Welfare System: Formative Mixed Methods Evaluation.

Despite elevated rates of trauma exposure, substance misuse, mental health problems, and suicide, systems-impacted teens and their caregivers have limited access to empirically supported behavioral health services. Family-based interventions are the most effective for improving mental health, education, substance use, and delinquency outcomes, yet the familial and placement disruption that occurs during child welfare involvement can interfere with the delivery of family-based interventions. To address this gap in access to services, we adapted an in-person, empirically supported, family-based affect management intervention using a trauma-informed lens to be delivered via telehealth to families impacted by the child welfare system (Family Telehealth Project). We describe the intervention adaptation process and an open trial to evaluate its feasibility, acceptability, and impact. Adaptations to the in-person, family-based affect management intervention were conducted iteratively with input from youth, caregivers, and systems partners. Through focus groups and collaborative meetings with systems partners, a caregiver-only version of the intervention was also developed. An open trial of the intervention was conducted to assess family perspectives of its acceptability and feasibility and inform further refinements prior to a larger-scale evaluation. Participants included English-speaking families involved in the child welfare system in the past 12 months with teens (aged 12-18 years). Caregivers were eligible to participate either individually (caregivers of origin, kinship caregivers, or foster parents; n=7) or with their teen (caregiver of origin only; n=6 dyads). Participants completed session feedback forms and surveys at pretreatment, posttreatment, and 3-month posttreatment time points. Qualitative exit interviews were conducted with a subset of participants (12/19, 63%) to further understand their experiences with the intervention. Session attendance was high, and both caregivers and teens reported high acceptability of clinicians and sessions on feedback forms. Families were comfortable with video technology, with very few (<5%) sessions having reported technology problems. Thematic analysis of exit interview transcripts indicated that families used effective communication and affect management skills taught during the intervention. Regarding challenges and barriers, some caregiver-only participants expressed a desire to have their teen also participate in the intervention. All interview participants reported that they would recommend the intervention to others and perceptions of the intervention were overwhelmingly positive. Quantitative surveys revealed differential responses to the intervention regarding affect management and communication. An open trial of the Family Telehealth Project, a skills-based telehealth intervention for families impacted by the child welfare system, suggests high levels of intervention feasibility and acceptability. Participants noted improvements in areas often hindered by the impacts of trauma and family separation: communication and affect management. Perceptions of the intervention were positive overall for both teens and caregivers. The Family Telehealth Project shows promise in addressing the gaps in behavioral health access for systems-impacted families. ClinicalTrials.gov NCT04488523; https://clinicaltrials.gov/study/NCT04488523.

Because kids don't come with manuals

Parents often struggle with discipline as well as how best to support their children's social and emotional growth. Unfortunately, many pediatricians, nurses, teachers, and other professionals involved in the lives of young children and their families lack the formal training and/or time to address parenting questions and concerns. And, although evidence‐based parenting programs do exist, their impact is limited by low rates of uptake. Logistical barriers to implementation and workforce shortages limit their availability, and even when available, families often face numerous obstacles to enrolling in and completing programs. From a public health perspective, lack of accessibility and low exposure rates severely limit their potential for reducing the prevalence of behavioral and emotional problems and for promoting psychological wellbeing.

Zinc boro-aluminosilicate glass for infrared and gamma sensing applications: Physical properties and gamma ray attenuation aspects

The demand for more materials for efficient shielding of radiation has been on the rise day by day due to some witnessed progress in applications of radiations in science and technology. In this research, we investigated the gamma ray shielding capacity of zinc boro-aluminosilicate (ZBASi) glass by varying concentrations of B2O3. Fundamentally, experimental and theoretical means were both adopted to evaluate photon shielding characteristics of the studied glasses. Additionally, amorphous nature and crystalline sizes of the glass sample were determined using XRD technique and Debye Scherrer equation respectively. The results show that as the B2O3 content increased from 55 to 70 wt %, the optical bandgap, and packing density decreased. However, the density, and molar volume were found to increase accordingly. Using Phy-x/PSD and genat4, the maximum values of mass attenuation coefficient (MAC) for ZBASi-4, ZBASi-3, ZBASi-2, and ZBASi-1 were found to be 20.2, 17.5, 16.3, and 9.6 cm2/g at 20 KeV, respectively. With respect to exposure rate, the exposure buildup factor (EBF) is low in the region where density is high, meaning that photon attenuation power is high in the region of low EFB (high density). The production of aluminosilicate glass poses fewer environmental risks than that of traditional lead-based shielding materials. It is therefore a more environmentally friendly option since harmful heavy metals are not involved.

A Pilot Study Exploring the Feasibility of Virtual Written Exposure Therapy with Underserved Black Perinatal Women.

In the USA, Black pregnant women are at the highest risk for maternal morbidity. They also experience the highest rates of trauma exposure and posttraumatic stress disorder (PTSD). PTSD takes a toll on Black women's mental and physical health, placing them at risk for maternal morbidity. It increases several mental health symptoms such as suicidality, anxiety, re-living the trauma, and numbness. These mental health conditions adversely affect health behaviors, including those essential for maternal health, such as attending prenatal and postpartum appointments. Furthermore, untreated PTSD is associated with higher blood pressure, increasing Black mothers' risk of pre-eclampsia. For a variety of reasons including cultural mistrust, stigma, transportation, time constraints, and access to care, PTSD is frequently underassessed and undertreated among Black perinatal women. Written exposure therapy (WET) is a state-of-the-art brief treatment for PTSD. In this study, we explored the initial feasibility of the virtual delivery of WET to reduce PTSD symptoms among Black perinatal women. Results found the virtual delivery of WET to be feasible. Symptom reduction for PTSD in participants was 50-100% during follow-up, suggesting potential effectiveness of the intervention. Implications for virtual delivery of WET in reducing risk for Black maternal morbidity are discussed.

Non-additivity of the functional properties of individual P450 species and its manifestation in the effects of alcohol consumption on the metabolism of ketamine and amitriptyline

To explore functional interconnections between multiple P450 enzymes and their manifestation in alcohol-induced changes in drug metabolism, we implemented a high-throughput study of correlations between the composition of the P450 pool and the substrate saturation profiles (SSP) of amitriptyline and ketamine demethylation in a series of 23 individual human liver microsomes preparations from donors with a known history of alcohol consumption. The SSPs were approximated with linear combinations of three Michaelis-Menten equations with globally optimized KM (substrate affinity) values. This analysis revealed a strong correlation between the rate of ketamine metabolism and alcohol exposure. For both substrates, alcohol consumption caused a significant increase in the role of the low-affinity enzymes. The amplitudes of the kinetic components and the total rate were further analyzed for correlations with the abundance of 11 major P450 enzymes assessed by global proteomics. The maximal rate of metabolism of both substrates correlated with the abundance of CYP3A4, their predicted principal metabolizer. However, except for CYP2D6 and CYP2E1, responsible for the low-affinity metabolism of ketamine and amitriptyline, respectively, none of the other potent metabolizers of the drugs revealed a positive correlation. Instead, in the case of ketamine, we observed negative correlations with the abundances of CYP1A2, CYP2C9, and CYP3A5. For amitriptyline, the data suggest inhibitory effects of CYP1A2 and CYP2A6. Our results demonstrate the importance of functional interactions between multiple P450 species and their decisive role in the effects of alcohol exposure on drug metabolism.

Identifying and quantifying exposures involving counterfeit opioid analgesic products

Introduction The increasing presence of counterfeit opioid drugs in the United States can contaminate data collection systems and confound estimates derived from surveillance of the opioid epidemic. Data sources and analyses that can quantify the contribution of counterfeit opioid products are needed to provide accurate and timely data to inform public health responses. We describe a novel approach to identify and quantify intentional abuse and misuse exposures involving suspected counterfeit opioid products in United States poison center data. Methods An ecological study was performed using data, including narrative case notes, reported to participating United States Poison Centers of the Researched Abuse, Diversion and Addiction Related Surveillance System between 2009-Quarter 1 and 2021-Quarter 4. A machine learning natural language processing approach was used to develop a predictive model. Results Sensitivity for detecting suspected non-counterfeit-involved exposures by the predictive model was 92%, specificity was 73%, and the area under the receiver operating characteristic curve was 92%. Overall, only 2.1% of intentional abuse and misuse exposure calls were predicted to be suspected counterfeit-involved during 2009–2021; however, we observed an exponential increase in suspected counterfeit exposures over this time period. There was a 7-fold increase in the estimated number of suspected counterfeit exposures from 2009 to 2021, and 23.7% of all opioid analgesic intentional abuse and misuse exposures were suspected counterfeit-involved in 2021. Discussion We demonstrate the feasibility and reliability of using machine learning natural language processing to identify exposures involving suspected counterfeit opioid products in United States poison center data. Results suggest that suspected counterfeits have had a meaningful influence on rates of intentional abuse exposures to opioid analgesics in more recent years. Conclusions The increasing presence of counterfeit opioid drugs can contaminate data collection systems and compromise the reliability of the data.

Association between greenness exposure and depression rate among Bangkok residents: An ecological longitudinal study

This ecological study aimed to examine the relationship between greenness exposure and depression among Bangkok residents, using the district as a unit of analysis. This study utilized data on depression (ICD-10 F32, F33), environmental parameters, and demographic and health infrastructure variables in 50 districts in Bangkok recorded from 2018 to 2020. The Excellence Center for Depressive Disorder provided information on the number of new depression cases, including only those who had registered permanent residence in Bangkok. Greenness was measured using the normalized difference vegetation index (NDVI), which was extracted from a Terra-MODIS sensor. Then, the association between greenness exposure and depression was evaluated using descriptive statistics, bivariate analysis, and generalized additive mixed models with adjustment for covariates. From 2018 to 2020, a mean of 4.57 ± 6.45 cases was recorded per 100,000 population annually, and the mean NDVI was 0.33 ± 0.09. Adjusted for all covariates, as well as considering the smooth terms basis, an increase in one unit of NDVI value would contribute to depression rate reduction by up to 77.7 % (risk ratio = 0.223, 95 % CI = 0.200 – 0.248). PM2.5 exhibited an insignificant positive association with depression incidence rate. Additionally, temperature and humidity were associated with depression rate in the final model (p < 0.05). Living in greener areas would contribute to a lower depression incidence rate in Bangkok. However, the study is subject to limitations, including the impact of the COVID-19 pandemic, which may have influenced both depression rates and access to green spaces during the study period. Policies that can increase environmental greenness should be promoted to enhance social interactions and physical activities.

A new method to evaluate fluoroscopic system collimator performance.

Fluoroscopy uses collimators to limit the radiation field size. Collimators are often evaluated annually during equipment performance evaluations to maintain compliance with regulatory and/or accreditation bodies. A method to evaluate and quantify fluoroscopy collimator performance was developed. A radiation field and displayed image measurement device consisting of radiopaque rulers and radiochromic film strips was placed on the x-ray source assembly exit window to evaluate fluoroscopy collimator performance. This method was used to evaluate collimator performance on 79 fluoroscopic imaging systems including fixed C-arms, mobile C-arms, mini C-arms, and radiographic fluoroscopic systems. The excess length (EL), excess width (EW), and sum EL + EW of the radiation field relative to the displayed image were measured and compared to the limits specified in 21CFR1020.32. Four systems exceeded these limits. Placing the radiation measurement device at the x-ray source assembly exit window relative to the image receptor cover increased the film exposure rate by a factor up to 14.6. The time required to set up and complete the fluoroscopy collimator performance measurements using this method ranged from 5 to 10 min. This method provides an easily implemented quantitative measure of fluoroscopy system collimator performance that satisfies regulatory and accreditation body requirements.

Association between lifetime criminal legal involvement and acute healthcare utilization in middle-aged and older US adults, 2015-2019.

Five decades into the era of mass incarceration, a growing number of older adults have experienced criminal legal involvement (CLI) in their lifetime. Studies have shown that prior incarceration is associated with substantial disease burden, but little is known about the distinct needs and utilization patterns of middle-aged and older adults with lifetime CLI compared to those without. Using a nationally representative data set, we tested the association between lifetime CLI exposure and use of acute care services among middle-aged and older adults. Our sample included 44,007 US adults (25,074 middle-aged-50-64 years; 18,709 older- ≥65 years) who participated in the National Survey of Drug Use and Health (2015-2019). The data is publicly available. Our independent variable was lifetime CLI. Using separate negative binomial regression models for middle-aged and older adults, we tested the association between lifetime CLI and acute healthcare utilization (ED visits and nights spent inpatient) controlling for relevant sociodemographic covariates. For middle-aged respondents, 19.1% reported lifetime CLI; for older adults, the rate of exposure was 9.6%. In multivariate models, CLI was associated with increased ED visits in middle-aged adults (IRR 1.18, 95% CI 1.06-1.31) but not older adults (IRR 0.99, 95% CI 0.85-1.16). CLI was associated with increased nights hospitalized in both groups (middle-aged: IRR 1.33, 95% CI 1.08-1.62; older adults: IRR 1.26, 95% CI 1.01, 1.57). Middle-aged and older adults with lifetime CLI experience higher rates of acute care utilization than their peers with no lifetime CLI, even after adjustment for confounders. As the cohort of adults from the era of mass incarceration ages, understanding the mechanisms by which lifetime CLI impacts health outcomes is crucial in designing interventions to improve outcomes and reduce unnecessary acute healthcare utilization.

3D-Printable Biopolymers for Socket Preservation Technique: Soft Tissues Response: A Pilot Randomised Clinical Study.

The aim of the present parallel clinical study is to evaluate the efficacy of 3D-printed biopolymers compounded with osteoconductive material (beta-tricalcium phosphate and hydroxyapatite) for soft tissue closure after tooth extraction. this study followed the CONSORT reporting guidelines; 39 patients were treated with socket preservation using 3D-printed biopolymers and randomly divided into 3 groups (Test 1, Test 2, and Control). All cases were treated without flap elevation, careful cleaning and debridement of the sites, and then randomly sealed as follows: In T1, with a 3D-printed disk of poli-D-lactic acid with 10% of hydroxyapatite; in T2, using a 3D-printed disk of poli-ε caprolactone with 20% of β-tricalcium phosphate; and in T3, the socket was left open to heal. At baseline (extraction time) and 6 weeks after extraction, the rate of exposure was evaluated and stratified according to the site (anterior, posterior). No dropouts were observed during the 6 weeks follow-up. All sites underwent uneventful healing with no complications. For posterior teeth, Test 1 and Test 2 showed full healing of the soft tissues with a reduction of the exposed area from 46.5 ± 8.25 mm2 to 0.6 ± 0.84 mm2 and from 47.1 ± 8.67 mm2 to 0.6 ± 0.7 mm2, respectively. The Control group exhibited a reduction from 45.6 ± 7.25 mm2 to 1.2 ± 0.9 mm2. Both Tests 1 and 2, when compared to the Control group, showed statistically significant better healing (p < 0.05). Anterior teeth showed a complete closure of the socket 4 weeks after the extraction with no noticeable differences between Test and Control. Both materials used in this study showed evidence to achieve the purpose. Ethical Guidelines: written informed consent was obtained from the participants of the study, as requested by the Ethics Committee for Health Research Faculty of Dentistry, Universitas Trisakti, with the following number: 641/S3/KEPK/FKG/5/2023.

Sub‐Nanometer‐Scale Cu9S5 Enables Efficiently Electrochemical Nitrate Reduction to Ammonia

AbstractThe sub‐nanometer is a key feature size in materials science. Unlike single‐atom and nanomaterials, size effects and inter‐component cooperative actions in sub‐nanomaterials will effective on its performance is more significant. Here, 0.95 nm ordered arrangement Cu9S5 sub‐nanowires (Cu9S5 SNWs) are synthesized through the co‐assembly effect of inorganic nuclei (Cu9S5) and clusters (phosphotungstic acid‐PTA), achieving a significant increase in the specific surface area of the sample and ≈100% atomic exposure rate, which is the key to its high catalytic activity. PTA clusters not only act as a “charge transfer station” to accelerate the inter‐component electron transfer process, but also facilitate the dissociation of water and provide more hydrogen protons, thus dramatically facilitating the electrocatalytic process. The experimental results show that the Cu9S5 SNWs exhibited excellent nitrate reduction reaction (NO3−RR) properties. The Faraday efficiency (FE) of NO3−RR is 90.4% at the optimum potential −0.3 VRHE (reversible hydrogen electrode) and the ammonia production is as high as 0.37 mmol h−1 cm−2, which is superior to most reported electrocatalysts. In addition, the Zn‐NO3− liquid‐flow battery devices assembled using Cu9S5 SNWs as electrode materials show excellent application results. This work provides a reference for the design of highly efficient sub‐nanoscale NO3−RR electrocatalysts.

8096 Optimization of Radiation Safety Release Instructions After Iodine-131 Treatment for Differentiated Thyroid Cancers

Abstract Disclosure: A.H. Smith: None. T. Greist: None. Introduction: Iodine-131 (I-131) is a common therapy for treatment of differentiated thyroid cancers (DTC); however its radioactivity poses a risk to public health. There is wide inter-facility variation in release instructions to minimize incident exposure to other individuals. Isolation measures to reduce gamma exposure may pose harm to an individual's mental or physical health, especially in new parents or patients who require caregivers. Most studies estimating incident exposure utilize cumulative dosimetry to estimate duration of safety release instructions, but this relies on expert assumptions of the clearance of I-131, which is altered in patients who have had their thyroid removed. Measuring real-time longitudinal gamma exposure would optimize recommendations to balance the radiation safety risks with the risks associated with isolation. Objective: Quantify real-time longitudinal incident gamma radiation exposure to others from patients with DTC status post thyroidectomy treated with I-131. Methods: Patients were asked to measure exposure rates at a distance of one meter three times a day for fourteen days, using a portable ion chamber at their homes. Exposure rates over time were used to form an exponential decay model and to estimate the time after which cumulative exposure is below a reasonably low threshold. Results: 32 patients were included in the study. The average effective half-life was 15.8 hours. Exposure readings over time were best fit with an exponential decay model using one decay rate, rather than a model that uses separate extrathyroidal and thyroidal decay rates. Among patients administered less than 114 mCi, cumulative gamma exposure is less than 100 mR after 24 hours of isolation. Between 114 and 163 mCi, cumulative gamma exposure is less than 100 mR after 48 hours of isolation. Conclusion: Cumulative gamma radiation exposure at one meter was found to be low enough to consider re-evaluating isolation protocols and safety release instructions for long-term distancing in patients status post thyroidectomy treated with I-131. Presentation: 6/1/2024

8675 Dosing of Radioactive Iodine for Papillary Thyroid Cancer in Advanced Chronic Kidney Disease

Abstract Disclosure: C. Cheatham: None. D. Beckman: None. INTRO Radioactive Iodine (RAI) ablation is an important treatment for patients diagnosed with papillary thyroid carcinoma. Most studies completed on RAI in renal dysfunction were focused on End Stage Renal Disease (ESRD) patients on dialysis to establish protocols on timing of dialysis to allow desired clinical response to RAI without increased risks and minimizing exposure of dialysis staff to radiation dose. The ideal RAI dosing and monitoring of patients with advanced chronic kidney disease (CKD) stage 4 or 5 not requiring dialysis has not been systematically reviewed. CASE 26 year-old female with CKD stage 4/5 secondary to chronic hydronephrosis from vesicoureteral reflux with baseline eGFR 15-20 mL/min/1.73 m2 was diagnosed with papillary thyroid cancer. She underwent total thyroidectomy with central and left lateral neck dissection, resulting in pathologic stage I, pT2 N1b M0 disease, high risk for recurrence according to the 2015 American Thyroid Association guidelines due to 17 positive lymph nodes from left level II-IV and VI, multiple with extranodal extension, as well as 1 vessel angioinvasion. She was referred for adjuvant RAI ablation after withdrawal from thyroid hormone. Decision was made to proceed with a 50% dose reduction and close monitoring of radioactivity clearance as an inpatient given decrease of eGFR to 10-12 mL/min/1.73 m2. She was cleared for discharge 4 days after RAI dose of 74.8mCi when activity level dropped to &amp;lt;2mR/hr. Post-ablation whole body scan showed activity in the thyroid bed and parasternal notch without evidence of metastatic disease. Post-treatment non-stimulated thyroglobulin 6 weeks later was 0.4 ng/mL down from 269.7 ng/mL. DISCUSSION Given RAI is predominately renally cleared, decreased renal function affects clearance rates and associated exposure to radiation. Risks with decreased RAI clearance include bone marrow toxicity and prolonged isolation requirements. In a 2017 retrospective review, patients with eGFR &amp;lt;30 mL/min/1.73 m2 had delayed clearance leading to a mean proportional reduction of exposure rate at 48 hours of -67.2% compared to -94.3% in healthy controls. While protocols exist for patients on hemodialysis, no such protocols have been established for patients with advanced CKD not requiring dialysis. For this patient, after multidisciplinary discussion with nuclear medicine, health physics, and nephrology in setting of further eGFR reduction during hormone withdrawal, decision was made to reduce the intended dose by 50% with inpatient monitoring and backup to dialyze if no significant decrease in radiation activity level was seen or if she were to progress to anuric or oliguric renal failure. This case highlights the need for established protocols and long-term studies to evaluate risk and treatment response in relation to dosing of RAI in this population, but a 50% dose reduction appears to be effective without adverse event. Presentation: 6/2/2024

Conventional Intraoral Imaging Exposure Rates among Dental Students

Conventional Intraoral Imaging Exposure Rates among Dental Students

Sweetened Areca Nut, A Risk in Dental Caries among Adolescents in Pune, Maharashtra? A Case-Control Study

Abstract Introduction: Smokeless tobacco (SLT) causes dental caries and so does chewing of areca nut (sweetened supari) due to the presence of sugar. Since conflicting views exist about whether areca nut causes dental caries or not, and since studies are undertaken in adults and data on adolescents are not available, this study was carried out. Since those were cross-sectional or longitudinal studies, this case-control study was undertaken to understand if flavored/sweetened areca nut is a risk factor for dental caries. Material and Method: This unmatched case-control study was conducted among the male students of 8th to 10th standard in the age group of 12–16 of four Madhyamik Vidyalaya’s (MVs) in Pimpri–Chinchwad (urban area), Pune. A directed acyclic graph (DAG) was drawn to determine the independent variables to be selected for the study and minimal variables to be adjusted during data analysis. Selection of cases was based on diagnostic and eligibility criteria. The data on the use of sweetened areca nuts and the presence of caries were collected through oral examination and a semistructured questionnaire administered by the principal investigator on a one-to-one basis between August 2022 and October 2022. Data were analyzed using epiinfoTM 7.2.5.0. Results: This study of 146 males in the age group of 13 to 16 years had 61 students as cases and 85 as controls. No significant difference was observed between the group with (cases) and without (controls) dental caries for areca nut use (pack years) whether consumed daily or less frequently for 1 year or more. While the exposure rate to areca nut among cases was 44.26%, for the control group it was 36.47%. The odds ratio of sweetened areca nut as being the risk factor for dental caries was 1.38 at 95% CI (0.70–2.71) with P = 0.44. Conclusion: This study revealed that the adolescent users of sweetened areca nuts studying in government schools had a higher exposure odds ratio for dental caries. However, it was not significant statistically. Information bias including recall may have influenced the outcome.

Devastation of the cerrado of mato grosso do sul and the advance of arenization in the pardo river watershed

Despite the significant biodiversity in the Cerrado, the process of occupation, subsequent economic cycles, and intensification of agriculture in a predatory manner have caused profound alterations in this biome. This study analyzed changes in land use and land cover in the Cerrado of Mato Grosso do Sul between 1985 and 2022 by mapping and also investigating the formation and dynamics of sand dunes in the Bauru sedimentary basin, focusing on the Pardo River watershed. MapBiomas Network data, collection 8, were used for land use and land cover analysis. Arenization foci cartography was conducted using brightness index 2 based on Sentinel-2 satellite images in Sentinel Application Platform software. The historical analysis of land use and cover in the Cerrado of Mato Grosso do Sul revealed a rapid transformation of the landscape, with a drastic reduction of native vegetation and an intensification of large-scale monocultures. Between 1985 and 2022, the Cerrado of Mato Grosso Sul lost 4.6 million hectares of native vegetation (forest formations, savannahs, grasslands, and wetlands), representing 24.54% of this territory. Recent changes in land use include pasture-soybean and pasture-eucalyptus. In the Pardo River watershed, arenization foci cover an area of 17,834.34 hectares, with varying dimensions ranging from less than 1 hectare to 376.41 hectares. The arenization process occurs in different slope compartments, such as the base, slope, and interfluves. The physical and chemical characteristics of Quartzipsamments, such as low organic carbon content in soil, are associated with high rates of surface exposure and weakened load-dependent structures, leading to degradation. Arenization occurs where natural vegetation has been suppressed and soil has been depleted by poorly managed production processes.

Health care transition rates and associated factors for adolescents with asthma

BackgroundAdolescents and young adults (AYAs) with asthma, face increased risks during healthcare transition (HCT) from pediatric to adult care. Despite guidelines advocating for more HCT preparedness, this does not consistently occur in clinical practice. The rates of transition preparation exposure in adolescents with asthma are unknown. Objective(s)Our goal was to understand the rates of HCT exposure among adolescents with asthma in the United States along with predictive characteristics associated with receiving HCT exposure using data from a nationally representative survey. MethodsWe studied adolescents aged 12-17 years old with asthma in the 2020-2021 National Survey of Children’s Health (NSCH) dataset. Associations were explored between sociodemographic, health-related and provider practice-related variables and HCT exposure through univariate analysis and multivariable logistic regression. ResultsOnly 19% of adolescents with asthma from this cohort met criteria indicating they received HCT exposure. In our multivariable analysis, older age, female gender, having a provider actively work with the child to make positive choices about health, a written care plan addressing transition, routine preventive care visits, and a caregiver had someone discuss about health insurance into adulthood were associated with higher odds of HCT exposure. Hispanic ethnicity, lack of insurance, and living in a metropolitan area were associated with lower odds of receiving transitional care preparation but were not significant in the multivariable model. ConclusionsOur findings underscore the need to improve transitional care preparation for adolescents with asthma, with attention needed to address disparities based on sociodemographic factors, including healthcare access.

Associations between gun violence exposure and suicide mortality rates in US counties.

Gun violence traumatizes communities and places a heavy burden on the mental health of those exposed. This ecological study examines the association between gun violence exposure and suicide mortality rates in US counties for the period 1999-2020 at various urbanicity levels. A Bayesian hierarchical Gamma-Poisson model with state random effects was employed to model the age-adjusted suicide mortality rates which adjusted for sex ratio, urbanicity, social vulnerability, gun ownership, culture of honor, and exposure spillovers from neighbouring counties. Results indicate a small significant positive association between gun violence and suicide mortality rates. Urbanicity levels do not appear to modify this association, although the association may be slightly smaller for large urban metros. Gun violence exposure may be positively associated with suicide mortality in US counties.

Contrast and quantum noise in single-exposure dual-energy thoracic imaging with photon-counting x-ray detectors

Objective.Photon-counting x-ray detectors (PCDs) can produce dual-energy (DE) x-ray images of lung cancer in a single x-ray exposure. It is important to understand the factors that affect contrast, noise and the contrast-to-noise ratio (CNR). This study quantifies the dependence of CNR on tube voltage, energy threshold and patient thickness in single exposure, DE, bone-suppressed thoracic imaging with PCDs, and elucidates how the fundamental processes inherent in x-ray detection by PCDs contribute to CNR degradation.Approach.We modeled the DE CNR for five theoretical PCDs, ranging from an ideal PCD that detects every primary photon in the correct energy bin while rejecting all scattered radiation to a non-ideal PCD that suffers from charge-sharing and electronic noise, and detects scatter. CNR was computed as a function of tube voltage and high energy threshold for average and larger-than-average patients. Model predictions were compared with experimental data extracted from images acquired using a cadmium telluride (CdTe) PCD with two energy bins and analog charge summing for charge-sharing suppression. The imaging phantom simulated attenuation, scatter and contrast in lung nodule imaging. We quantified CNR improvements achievable with anti-correlated noise reduction (ACNR) and measured the range of exposure rates over which pulse pile-up is negligible.Main Results.The realistic model predicted overall trends observed in the experimental data. CNR improvements with ACNR were approximately five-fold, and modeled CNR-enhancements were on average within 10% of experiment. CNR increased modestly (i.e.<20%) when increasing the tube voltage from 90 kV to 130 kV. Optimal energy thresholds ranged from 50 keV to 70 keV across all tube voltages and patient thicknesses with and without ACNR. Quantum efficiency, electronic noise, charge sharing and scatter degraded CNR by ~50%. Charge sharing and scatter had the largest effect on CNR, degrading it by ~30% and ~15% respectively. Dead-time losses were less than 5% for patient exposure rates within the range of clinical exposure rates.Significance.In this study, we (1) employed analytical and computational models to assess the impact of different factors on CNR in single-exposure DE imaging with PCDs, (2) evaluated the accuracy of these models in predicting experimental trends, (3) quantified improvements in CNR achievable through ACNR and (4) determined the range of patient exposure rates at which pulse pile-up can be considered negligible. To the best of our knowledge, this study represents the first systematic investigation of single-exposure DE imaging of lung nodules with PCDs.

The Role of Firearm and Police Violence Exposure in Youth Firearm Beliefs and Access

Rates of youth firearm exposure and carriage are well-established, but less work has examined how exposure to police violence and firearm violence, as victim or witness, may be associated with beliefs in gun ownership for society or access to guns. This study used survey data from a multiracial sample of 276 youth living in New Orleans, Louisiana ( M age = 17.76) to examine these associations. Results from binary logistic regressions confirmed a significant association between higher belief in gun ownership for safety and all violence exposures, directly and indirectly. We did not find support for an association between gun access and any violence exposures. The findings shed light on pathways to firearm violence risk and provide critical information on youth firearm attitudes.