United States Research Articles

Diagrammatic devices in early to mid-twentieth-century American art pedagogy

ABSTRACT Diagrams demonstrating principles of formal arrangement (what is commonly called composition or design) were pervasive in the production and interpretation of pictorial art in the United States throughout the first half of the twentieth century. This essay surveys three of the most influential: a Japan-inspired design manual written by art educator Arthur Dow and first published in 1899; a WWI-era proportional scheme devised by illustrator and amateur classical archeologist Jay Hambidge, and a series of essays from 1926 on the ‘mechanics of form organization’ by painter (and, at the time, Art Students League of New York instructor), Thomas Hart Benton. These and similar devices were an integral part of the relentless standardization and self-conscious modernization of artists’ methods modeled on industrial processes of mass production and pursued between the Civil War and the Great Depression by educators and policy-makers interested in establishing the teaching of art in the United States on a more practical basis than that provided by the European academic tradition. Despite their once near-ubiquity and pivotal role in the development of several generations of American modernists, including Georgia O’Keeffe, George Bellows and Jackson Pollock, as described here, these hugely popular devices are almost entirely forgotten today.

Outcomes following use of hepatitis B surface antigen positive liver allografts in hepatitis B surface antigen negative recipients

The use of positive hepatitis B surface antigen (HBsAg+) liver allografts has been increasing globally and is gaining wider acceptance within the United States. However, most of the data supporting the use of HBsAg+ organs has been in the setting of recipients with chronic hepatitis B. We aim to describe our institutional experience using HBsAg+ liver donors in HBsAg-negative recipients via case series. Between 2019 and 2021, 10 HBsAg-negative recipients received a HBsAg+ liver transplant. Kaplan-Meier survival analysis showed no difference in survival when compared to all other liver transplants performed at the institution during the same period (p=0.5, HR=1.6, CI=0.4-6.5). Based on these findings, the use of HBsAg+ liver donors appears to be safe; however, continued follow-up is required to understand further risks associated with the use of HBsAg+ liver allografts.

Market-level tenant default risk on residential REIT operational efficiency

ABSTRACT Selecting which geographical markets a REIT serves is an important managerial decision that is expected to significantly impact firm performance. This paper investigates whether holding properties in areas with greater incidence of evictions impacts REIT operational efficiency. Using a comprehensive database of eviction lawsuits in the United States in combination with a time-series of residential REIT portfolio holdings, we construct REIT-year eviction exposure scores to analyse whether more exposure to areas with high aggregate eviction rates is a risk factor affecting REIT efficiency. We posit that market-level tenant default risk captures a locational risk dimension that should be considered in REIT portfolio management. Our results show that REITs with more exposure to markets with high tenant default risk observe higher operational inefficiencies after controlling for relevant firm characteristics and local market factors. These results are robust to multiple model specifications that control for potential endogeneity and omitted variable biases. Our findings have significant implications for REIT managers and investors, suggesting that the choice of property locations should consider aggregate tenant default risk as a determinant factor in residential REIT performance.

Anthropogenic warming has ushered in an era of temperature-dominated droughts in the western United States.

Historically, meteorological drought in the western United States (WUS) has been driven primarily by precipitation deficits. However, our observational analysis shows that, since around 2000, rising surface temperature and the resulting high evaporative demand have contributed more to drought severity (62%) and coverage (66%) over the WUS than precipitation deficit. This increase in evaporative demand during droughts, mostly attributable to anthropogenic warming according to analyses of both observations and climate model simulations, is the main cause of the increased drought severity and coverage. The unprecedented 2020-2022 WUS drought exemplifies this shift in drought drivers, with high evaporative demand accounting for 61% of its severity, compared to 39% from precipitation deficit. Climate model simulations corroborate this shift and project that, under the fossil-fueled development scenario (SSP5-8.5), droughts like the 2020-2022 event will transition from a one-in-more-than-a-thousand-year event in the pre-2022 period to a 1-in-60-year event by the mid-21st century and to a 1-in-6-year event by the late-21st century.

Assessing the Safety, User Acceptability, Dissemination, and Reach of a Comprehensive Web-Based Resource on Medications for Opioid Use Disorder (MOUD Hub): Protocol for a Development and Usability Study

Background Medications for opioid use disorder (MOUD), such as methadone and buprenorphine, are the gold standard for opioid use disorder (OUD) treatment. Owing to various barriers, MOUD access and retention are low in the United States. The internet presents a digital solution to mitigate barriers, but a comprehensive and reliable resource is lacking. We present a user-friendly, web-based resource, the MOUD Hub, that provides reliable information on MOUD. Objective This study aims to assess the safety, acceptability, feasibility of dissemination, and reach of the MOUD Hub using focus groups and advertising on 1 key search engine and 1 social media platform. Methods This protocol describes the development of the MOUD Hub and the descriptive observational feasibility study that will be undertaken. The MOUD Hub uses motivational interviewing principles to guide users through the stages of change. The website provides evidence-based information from national health and substance use agencies, harm reduction organizations, and peer-reviewed literature. First, pilot focus groups with 10 graduate students who have lived experience with OUD will be conducted to provide feedback on safety concerns. Then, focus groups with 20-30 potential MOUD Hub users (eg, people with OUD with and without MOUD experience, friends and family, and health care providers) will be conducted to assess safety, acceptability, reach, and usability. Data will be analyzed using inductive thematic analysis. The website will be advertised on Google and MOUD-specific Reddit forums to assess dissemination, reach, and user acceptability based on the total user volume, sociodemographic characteristics, pop-up survey responses, and 1-year engagement patterns. This information will be collected through Google Analytics. Potential differences between users from Google and Reddit will be assessed. Results The MOUD Hub will be launched in January 2025. Data collected from 5 focus groups (approximately 30-40 participants) will be used to improve the website before launching it. There is no target sample size for the second stage of the study as it aims to assess dissemination feasibility and reach. Data will be collected for a year, analyzed every 3 months, and used to improve the website. Conclusions The MOUD Hub offers an innovative theory-based approach, tailored to people with OUD and their family and friends, to increase access to and retention in MOUD treatment in the United States and provides broader harm reduction resources for those not currently in a position to receive treatment or those at risk of resuming illicit opioid use. Findings from this feasibility phase will serve to better tailor the MOUD Hub. After modifying the website based on our findings, we will use a randomized controlled trial to assess its efficacy in increasing MOUD access and retention, contributing to growing research on web-based interventions for OUD. International Registered Report Identifier (IRRID) PRR1-10.2196/57065

Trends in Short Interpregnancy Interval Births in the United States, 2016–2022

OBJECTIVE: To measure contemporary trends in the prevalence of short interpregnancy interval (IPI) births in the United States. METHODS: We conducted a repeated cross-sectional analysis using 2016–2022 natality data from the National Vital Statistics System. We included all singleton live births to individuals with at least one prior live birth. We examined trends over time in short IPIs less than 18 months, as well as for specific durations within this time frame (less than 6 months, 6–11 months, and 12–17 months), using linear probability models that estimated changes in the prevalence of each IPI duration over time. We then estimated the prevalence of each short IPI duration by maternal race and ethnicity, socioeconomic characteristics (age, education, insurance payer at delivery), and geography (U.S. census region, state of residence). RESULTS: The study sample included 14,770,411 singleton live births to individuals with at least one prior live birth in 2016–2022. Roughly a third (29.8%) of births had an overall IPI of less than 18 months (5.0% less than 6 months, 11.0% 6–11 months, and 13.8% 12–17 months). For IPIs less than 6 months, a slight statistical decline in prevalence was identified over the study period in unadjusted and adjusted models (adjusted annual percentage point change −0.02, 95% CI, −0.03 to −0.02). Slight statistical increases in the prevalence of IPIs of 6–11 and 12–17 months were identified in unadjusted models but were no longer significant and reversed direction in adjusted models, respectively. Long-standing inequities in the distribution of the shortest IPIs (less than 6 months) were stable compared with prior work across the indicators examined in this study. CONCLUSION: Overall, it appears the prevalence of short IPIs has remained stable between 2016 and 2022.

Pre-Exposure Prophylaxis for the Prevention of HIV-1: An Assessment of Oral Pre-Exposure Prophylaxis Usage Patterns, First Evidence of HIV-1, and HIV-1 Risk Factors in the United States.

In clinical trials, once-daily oral tenofovir-based pre-exposure prophylaxis (PrEP) significantly reduced HIV-1 acquisition risk; however, this was highly dependent on medication adherence and persistence. We report clinical characteristics, PrEP usage patterns, first evidence of HIV-1, and associated risk factors among adults with commercial insurance using oral PrEP in the United States using health plan claims from the IQVIA PharMetrics® Plus database between January 1, 2015, and March 31, 2020, from individuals who newly initiated emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) or FTC/tenofovir alafenamide (TAF) for daily PrEP. Overall, 25,419 individuals were included (FTC/TDF, n = 24,232; FTC/TAF, n = 1187), with generally similar characteristics reported during the 6-month baseline period across cohorts. Mean follow-up length was 504 and 77 days for FTC/TDF and FTC/TAF, respectively, corresponding with the 2019 approval of FTC/TAF for PrEP. Similarly, mean PrEP use duration was 354 and 68 days for FTC/TDF and FTC/TAF, respectively. PrEP breaks (>90-day gap) were observed in 11.1% of individuals using FTC/TDF, with a mean break duration of 249 days; 20.0% of individuals using FTC/TDF and 7.3% using FTC/TAF had ≥1 sexually transmitted infection diagnosis during follow-up. From 6 to 12 months of follow-up, mean FTC/TDF proportion of days covered (PDC; 0.74 vs. 0.67) and persistence (70.2% vs. 57.4%) decreased; real-world PDC and persistence were lower than reported in globally conducted clinical trials. First evidence of HIV-1 was infrequent among individuals using FTC/TDF (0.6%), though 60.3% had PrEP on hand when HIV-1 definition was met; high-risk sexual behavior, syphilis, and gonorrhea were the most important risk factors.

JAHA at Scientific Sessions 2023: Moving Toward Social Justice in Cardiovascular Health in the United States.

Attention to social justice is essential to improving cardiovascular health outcomes. In the absence of social justice, equitable cardiovascular health is impossible. This viewpoint provides a brief synopsis of the 2023 Journal of the American Heart Association (JAHA)-sponsored session titled "Moving Towards Social Justice in Cardiovascular Health." We define social justice and summarize the burden of cardiovascular disease inequity in the United States. We also highlight strategies for achieving social justice, including addressing workforce diversity, integrating social determinants into cardiovascular research, designing cardiovascular interventions to close the equity gap, and improving inclusivity in cardiovascular disease trials.

Private equity involvement in primary care: the case of Ireland.

Private equity (PE) firms play an increasingly important role in healthcare. Yet, existing research remains uneven, mostly focused on the United States and on certain sectors such as nursing homes. Some geographical areas and health specialties remain under-explored. This brief paper outlines a research agenda focusing on three key issues: (1) PE's significance and (2) business strategies in healthcare, and (3) PE's impacts on health and healthcare. The paper uses primary care in Ireland as an example. The proposed research agenda should improve our understanding of the nature of PE in healthcare and serve as a basis for policy-makers to explore appropriate and effective regulation of PE to reduce its negative impacts if and when they exist.

Delivery-Related Maternal Morbidity and Mortality Among Patients With Cardiac Disease

OBJECTIVE: To assess the risk of severe maternal morbidity (SMM) and mortality among pregnant patients with cardiovascular disease (CVD). METHODS: This was a retrospective cohort study of U.S. delivery hospitalizations from 2010 to 2020 using weighted population estimates from the National Inpatient Sample database. The primary objective was to evaluate the risk of SMM and maternal mortality among patients with CVD at delivery hospitalization. International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations, CVD, and SMM events. Multivariable logistic regression analyses were performed to compare SMM and mortality risk among patients with CVD and those without CVD. Given the substantial racial and ethnic disparities in SMM, mortality, and CVD burden, secondary objectives included evaluating SMM and mortality across racial and ethnic groups and assessing the population attributable fraction within each group. Lastly, subgroup analyses of SMM by underlying CVD diagnoses (eg, congenital heart disease, chronic heart failure) were performed. Variables used in the regression models included socioeconomic and demographic maternal characteristics, maternal comorbidities, and pregnancy-specific complications. RESULTS: Among 38,374,326 individuals with delivery hospitalizations, 203,448 (0.5%) had CVD. Patients with CVD had an increased risk of SMM (11.6 vs 0.7%, adjusted odds ratio [aOR] 12.5, 95% CI, 12.0–13.1) and maternal death (538 vs 5 per 100,000 delivery hospitalizations, aOR 44.1, 95% CI, 35.4–55.0) compared with those without CVD. Patients with chronic heart failure had the highest SMM risk (aOR 354.4, 95% CI, 301.0–417.3) among CVD categories. Black patients with CVD had a higher risk of SMM (aOR 15.9, 95% CI, 14.7–17.1) than those without CVD with an adjusted population attributable fraction of 10.5% (95% CI, 10.0–11.0%). CONCLUSION: CVD in pregnancy is associated with increased risk of SMM and mortality, with the highest risk of SMM among patients with chronic heart failure. Although CVD affects less than 1% of the pregnant population, it contributes to nearly 1 in 10 SMM events in the United States.

Dandy walker syndrome: A bibliometric analysis of the most 100 cited articles

Introduction: Dandy-Walker Syndrome (DWS), a complex neurodevelopmental disorder, has intrigued clinicians and researchers since its description by physicians Walter Dandy and Arthur Walker. Despite its recognition for nearly a century, understanding its etiology, pathogenesis, and clinical manifestations remains elusive. This bibliometric analysis aims to elucidate influential academic works on DWS. Methods: In January 2024, we conducted a Scopus search for articles on DWS and identified the top 100 referenced publications. The Harzing Publish or Perish search engine was utilized with relevant terms, including “Dandy-Walker,” “Dandy-Walker Syndrome,” and “Dandy-Walker Malformation.” Data from Scopus, including publication details and citation counts, were compiled and organized using Microsoft Excel. Statistical analysis and data visualization were performed using Python, with Pandas, Matplotlib, Seaborn, and NetworkX libraries employed for this purpose. Results: The bibliometric analysis of DWS research revealed key insights. Significant research output was noted in the 2000-2009 and 1990-1999 decades. The cumulative citations totaled 6,059, with an average of 2.60 citations per year per article. Leading authors included W B Dobyns, Kathleen J Millen, and G Pilu. Institutions such as the University of California and Harvard Medical School were prominent, with the United States being the predominant contributor. Major journals like the American Journal of Medical Genetics played significant roles. Conclusion: This bibliometric study summarizes the most-cited articles on DWS, providing light on the field and its seminal works that have shaped both present-day clinical treatment and the trajectory of future research.

Community-Based Mental Health Improvement Initiatives: A Narrative Review and Indiana Case Study.

There is a global mental health crisis: mental illness is underrecognized, underdiagnosed, and undertreated with adverse effects on mental, physical, and social health. In the United States, there is an insufficient number of traditional psychiatric and psychological resources to provide the mental health care needed to solve this crisis. Community-based interventions could be an important adjunct to traditional mental health care. An evaluation of peer-reviewed articles was performed describing community-based interventions and identified 3 approaches with some evidence of effectiveness: (1) interventions that enhance community mental health literacy to improve recognition of early signs of mental illness for early engagement and provide community, family, and peer support; (2) community clinics providing social, medical, and mental health care and support to transition-age youth (15-25 years); and (3) social networking activities to enhance interactions among elders suffering from social isolation and loneliness. Multisector, multidisciplinary, and multicomponent interventions involving health care providers and community-based organizations had the best evidence of effectiveness and should target transition-age youth and elders.

Association Between Noninvasive Liver Fibrosis Scores and Heart Failure in a General Population.

The association between nonalcoholic fatty liver disease and cardiovascular disease is firmly established, yet the association between noninvasive liver fibrosis scores and cardiovascular events remains a topic of uncertainty. Our study aimed to explore the association between liver fibrosis and heart failure. The data set was from the National Health and Nutrition Examination Survey 2011 to 2018. Advanced hepatic fibrosis risk was assessed through 3 noninvasive liver fibrosis scores: Fibrosis-4 score (FIB-4), the nonalcoholic fatty liver disease fibrosis score (NFS), and the aspartate aminotransferase to platelet ratio index (APRI). We included 19 695 eligible participants. The national prevalence of advanced liver fibrosis risk in the United States was 4.20%, 8.06%, and 0.35% as determined by FIB-4, NFS, and APRI scores, respectively. Weighted logistic regression analysis revealed significant associations between advanced liver fibrosis risk and the prevalence of heart failure (continuous variables, FIB-4: odds ratio [OR], 1.15 [95% CI, 1.07-1.23]; NFS: OR, 1.42 [95% CI, 1.23-1.64]; APRI: OR, 1.44 [95% CI, 1.15-1.81]). When the scores were assessed as categorical variables, the results were still significant (FIB-4 ≥2.67 versus FIB-4 <1.3: OR, 2.18 [95% CI, 1.47-3.24]; NFS ≥0.675 versus NFS <-1.455: OR, 2.53 [95% CI, 1.37-4.68]). Subgroup analysis found that the association between APRI and heart failure was stronger in female patients. In the general US population, the prevalence of advanced liver fibrosis risk varied between 0.35% and 8.06% as indicated by noninvasive liver fibrosis scores. FIB-4, NFS, and APRI scores were linked to an elevated prevalence of heart failure.

Challenges to School Success Among Children in U.S. Military Families

ABSTRACT Introduction More than 90% of children in military families attend civilian schools that may lack understanding of the unique experiences and stressors of military life. School success in children of military families has important implications on future academic achievement, health outcomes, and military groups; yet there has not been an examination of challenges of school success among children of military families in the United States using nationally representative data. Materials and Methods Data captured in the 2021-2022 National Survey of Children’s Health, limited to children aged 6 to 17 years, were used to examine the association between child’s caregiver military status and challenges of school success: lack of school engagement measured through caring about school and completing schoolwork, school absenteeism, and grade repetition (n = 60,599). Weighted to be nationally representative, bivariate analyses used chi-squared tests to examine estimates between selected variables and caregiver military status. Multivariable regression analyses were used to examine the association between caregiver military status and challenges of school success measures. Results In both unadjusted and adjusted analyses, we found that children of military families were more likely to not be engaged in school (adjusted odds ratios 1.35; 95% CI 1.19–1.53) and more likely to repeat a grade (adjusted odds ratios 1.33; 95% CI 1.09–1.64) than their civilian counterparts. There were no statistically significant differences in school absenteeism between children of military families and of civilian families. Conclusions This study extends beyond previous research findings that have focused primarily on academic achievement by including school engagement, attendance, and grade repetition for a more holistic and complete understanding of school success of children in military families. Our findings can be informational for school systems and policymakers to create educational and connective interventions for children in military families to improve school success.

Are veterans willing to assist with firearm safety for suicide prevention?

ABSTRACT Veterans in the United States are affected by suicide at higher rates than the general population. This may be due to a higher probability for veterans to use more lethal methods of suicides such as firearms. While veterans often decline to disclose suicidal tendencies to healthcare providers, they show higher connectedness and willingness to heed the advice of peers. Considering this information, it is important to analyze how veteran peers could assist in a suicidal crisis. Veteran responses (n = 1,247) to the Gatekeeper Behavior Scale (GBS) and Firearm Safety Scale (FSS) were analyzed to determine predictive traits of willingness to assist a peer securely store or disable firearms during a suicidal crisis. Results show that veterans are willing to assist in securing firearms to prevent suicide death but are more willing to do so by locking, removing or disabling the firearms than storing them with law enforcement. Older veterans were also more likely to report a willingness to intervene than their younger peers. Of the GBS predictors, only the Likeliness to Help subscale predicted a willingness to intervene with firearm safety. Recommendations for training and interventions that further encourage helping behavior during suicidal episodes are discussed.

Development and validation of a measurement tool to assess student perceptions of using real patients in physical therapy education at the Rocky Mountain University, the United States: a methodological study.

This study aimed to develop and validate the Student Perceptions of Real Patient Use in Physical Therapy Education (SPRP-PTE) survey to assess physical therapy student (SPT) perceptions regarding real patient use in didactic education. This cross-sectional observational study developed a 48-item survey and tested the survey on 130 SPTs. Face and content validity were determined by an expert review and Content Validity Index (CVI). Construct validity and internal consistency reliability were determined via exploratory factor analysis (EFA) and Cronbach's Alpha. Three main constructs were identified (Value, Satisfaction, and Confidence), each having 4 subconstruct components (Overall, Cognitive, Psychomotor, and Affective Learning). Expert review demonstrated adequate face and content validity (CVI = 96%). The initial EFA of the 48-item survey revealed items with inconsistent loadings and low correlations, leading to the removal of 18 items. An EFA of the 30-item survey demonstrated 1-factor loadings of all survey constructs except Satisfaction and the entire survey. All constructs had adequate internal consistency (Cronbach's Alpha > 0.85). The SPRP-PTE survey provides a reliable and valid way to assess student perceptions of real patient use. Future studies are encouraged to validate the SPRP-PTE survey further.

Empiric antibiotic prescribing practices for gram-positive coverage of late-onset sepsis in neonatal intensive care units in North America.

Late-onset sepsis (LOS) in the neonatal intensive care unit (NICU) causes significant morbidity and mortality, yet guidance on empiric management is limited. We surveyed NICUs across Canada and the United States regarding their empiric antimicrobial regimens for LOS, thereby identifying large practice variations and high rates of empiric vancomycin use.

Power Plays in the Eastern Mediterranean And the Decline of US‐Turkey Relations

AbstractIn the summer of 2020, Turkey and Greece deployed naval vessels in the contested eastern Mediterranean waters, which led first to a standoff and eventually a collision. Soon after, a US warship arrived at Crete. While this move should have been intended to calm tensions between the two historical rivals, some observers saw this as a show of support for Greece, marking a significant shift from the traditional American role of mediator. This article examines the US responses to gas exploration and other disputes in the eastern Mediterranean, including the Greek‐Turkish divide over Cyprus. It argues that Washington's tilt toward Athens has been pushing Ankara to deepen its economic, diplomatic, and even military relations with Moscow. The United States could rebalance with Turkey and drive a wedge between it and Russia, for instance through incorporating its NATO ally into strategies for reducing Europe's reliance on President Vladimir Putin for energy resources. But if the current zero‐sum approach persists, Turkey is likely to continue to look east—which is not in the American interest.

Power and racial differences in the communication experiences of Black and White patients living with advanced cancer and their care partners: An application of co-cultural theory

ABSTRACT We investigated power imbalances in racially discordant medical interactions in the context of advanced cancer care within the United States. We applied co-cultural theory to the transcripts of 43 interviews conducted with Black and White cancer patients and their care partners. We found Black patients and care partners perceived providers as dismissing their concerns. In response, they engaged in extensive preparation, rationalization, and utilizing liaisons. White patients and care partners recognized and took advantage of their privilege and utilized liaisons. Some patients acquiesced and conferred with others in response to power enacted by oncologists. We concluded co-cultural theory is useful in explaining what occurs in racially discordant patient-provider interactions. Our findings highlight the need for provider communication and de-biasing training. Trial registration: ClinicalTrials.gov identifier: NCT03780816..

Postpartum Acute Care Utilization in a Health Care System in the Southeastern United States.

Introduction: Postpartum acute care utilization (PACU), including visits to an emergency department, obstetric triage, or urgent care ("outpatient"), and hospital readmissions, may indicate medical complications and signal unmet health needs. Methods: We estimated the incidence of PACU and examined patterns by sociodemographic factors, pregnancy and birth characteristics, time since discharge from the birth hospitalization, and medical indications. We constructed a retrospective cohort of people aged ≥18 years who delivered ≥1 liveborn infant >20 weeks of gestation from July 1, 2021, to December 31, 2022, using electronic health record data from a quaternary maternity hospital in the Southeastern United States PACU data throughout the health care system were collected through March 31, 2023. We excluded people with a hospital stay >6 days (n = 29). Results: In this cohort of 6,041 birthing people, 11.3% had ≥1 outpatient encounters(range 0-6) and 3.2% had ≥1 hospital readmissions (range 0-4) within 12 weeks of discharge from the birth hospitalization. Median time to first outpatient PACU was 10 days post-discharge and 6 days for first hospital readmission. Among encounters for the top five medical indications, time to first postpartum acute care encounter varied by medical indication (log-rank test of equality over strata Chi-square = 69.93, degrees of freedom = 4, p < 0.0001). Complications specified during the puerperium (n = 234) and hypertension and hypertensive-related conditions complicating the puerperium (n = 87) were the two most frequent indications. Conclusion: These findings can inform efforts to direct health resources to improve postpartum health care and health outcomes.