Outcomes After Liver Transplantation With Incidental Cholangiocarcinoma.

Cholangiocarcinoma (CCA) is currently a contraindication to liver transplantation (LT) in the United Kingdom (UK). Incidental CCA occurs rarely in some patients undergoing LT. We report on retrospective outcomes of patients with incidental CCA from six UK LT centres. Cases were identified from pathology records. Data regarding tumour characteristics and post-transplant survival were collected. CCA was classified by TNM staging and anatomical location. 95 patients who underwent LT between 1988-2020 were identified. Median follow-up after LT was 2.1 years (14 days-18.6 years). Most patients were male (68.4%), median age at LT was 53 (IQR 46-62), and the majority had underlying PSC (61%). Overall median survival after LT was 4.4 years. Survival differed by tumour site: 1-, 3-, and 5-year estimated survival was 82.1%, 68.7%, and 57.1%, respectively, in intrahepatic CCA (n = 40) and 58.5%, 42.6%, and 30.2% in perihilar CCA (n = 42; p = 0.06). 1-, 3-, and 5-year estimated survival was 95.8%, 86.5%, and 80.6%, respectively, in pT1 tumours (28.2% of cohort), and 65.8%, 44.7%, and 31.1%, respectively, in pT2-4 (p = 0.018). Survival after LT for recipients with incidental CCA is inferior compared to usual outcomes for LT in the United Kingdom. LT for earlier stage CCA has similar survival to LT for hepatocellular cancer, and intrahepatic CCAs have better survival compared to perihilar CCAs. These observations may support LT for CCA in selected cases.

Public perception of climatological tornado risk in Tennessee, USA.

The southeastern United States experiences some of the greatest tornado fatality rates in the world, with a peak in the western portion of the state of Tennessee. Understanding the physical and social characteristics of the area that may lead to increased fatalities is a critical research need. Residents of 12 Tennessee counties from three regions of the state (N = 1804) were asked questions about their perception of climatological tornado risk in their county. Approximately half of participants underestimated their local tornado risk calculated from 50 years of historical tornado data. The percentage of participants underestimating their climatological risk increased to 81% when using model estimates of tornado frequencies that account for likely missed tornadoes. A mixed effects, ordinal logistic regression model suggested that participants with prior experience with tornadoes are more likely to correctly estimate or overestimate (rather than underestimate) their risk compared to those lacking experience (ß = 0.52, p < 0.01). Demographic characteristics did not have a large influence on the accuracy of climatological tornado risk perception. Areas where more tornadoes go unreported may be at a disadvantage for understanding risk because residents' prior experience is based on limited observations. This work adds to the literature highlighting the importance of personal experiences in determining hazard risk perception and emphasizes the uniqueness of tornadoes, as they may occur in rural areas without knowledge, potentially prohibiting an accumulation of experiences.

Impact of the Development of a Regional Collaborative to Reduce 30-Day Heart Failure Readmissions.

Thirty-day heart failure readmissions can be reduced if multiple interventions, such as 7-day postdischarge follow-up, are implemented, but this task is challenging for health systems. Ten hospitals participated in a multisystem collaborative implementing evidence-based strategies. The overall 30-day readmission rate was reduced more in the collaborating hospitals than in the noncollaborating hospitals (from 29.32% to 27.66% vs from 27.66% to 26.03%, P = .008). Regional collaboration between health care systems within a quality improvement project was associated with reduced 30-day readmission.

Accuracy of MMPI-2-RF validity scales for identifying feigned PTSD symptoms, random responding, and genuine PTSD.

The Minnesota Multiphasic Personality Inventory-2-RF (MMPI-2-RF) validity scales were evaluated to determine accuracy when differentiating honest responding, random responding, genuine posttraumatic stress disorder (PTSD), and feigned PTSD. Undergraduate students (n = 109), screened for PTSD, were randomly assigned to 1 of 4 instructional groups: honest, feign PTSD, half random, and full random. Archival data provided clinical MMPI-2-RF profiles consisting of 31 veterans diagnosed with PTSD. Veterans were diagnosed with PTSD using a structured interview and had passed a structured interview for malingering. Validity scales working as a group had correct classification rates of honest (96.6%), full random (88.9%), genuine PTSD (80.7%), fake PTSD (73.1%), and half random (44.4%). Results were fairly supportive of the scales' ability to discriminate feigning and full random responding from honest responding of normal students as well as veterans with PTSD. However, the RF validity scales do not appear to be as effective in detecting partially random responding.

Wildfires and Older Adults: A Scoping Review of Impacts, Risks, and Interventions.

Climate change is leading to worsening disasters that disproportionately impact older adults. While research has begun to measure disparities, there is a gap in examining wildfire-specific disasters. To address this gap, this scoping review analyzed literature to explore the nexus of wildfires and older adults. We searched peer-reviewed literature using the following inclusion criteria: (1) published in a peer-reviewed journal; (2) available in English; (3) examines at least one topic related to wildfires; and (4) examines how criterion three relates to older adults in at least one way. Authors screened 261 titles and abstracts and 138 were reviewed in full, with 75 articles meeting inclusion criteria. Findings heavily focused on health impacts of wildfires on older adults, particularly of smoke exposure and air quality. While many articles mentioned a need for community-engaged responses that incorporate the needs of older adults, few addressed firsthand experiences of older adults. Other common topics included problems with evacuation, general health impacts, and Indigenous elders' fire knowledge. Further research is needed at the nexus of wildfires and older adults to highlight both vulnerabilities and needs as well as the unique experience and knowledge of older adults to inform wildfire response strategies and tactics.

Keeping Each Other Safe: Who Checks on Their Neighbors During Weather Extremes in Summer and Winter?

OBJECTIVE: Weather extremes are increasing with climate change and associated with higher morbidity and mortality. Promotion of social connections is an emerging area of research and practice for risk reduction during weather extremes. This study examines the practice of checking on neighbors during extreme summer heat and extreme winter weather. Objectives are to (1) describe the extent of neighbor checking during these extremes, and (2) examine factors associated with neighbor checking. METHODS: We analyze survey data (n = 442) from a primarily low- and moderate- income study sample in a Southeastern U.S. city, using descriptive statistics and logistic regression. RESULTS: About 17.6% of participants checked on neighbors during extreme summer heat, and 25.2% did so during extreme winter weather. Being middle or older aged and having more adverse physical health impacts were positively associated with neighbor checking, for both extremes. For winter only, having less education was positively associated with neighbor checking. CONCLUSIONS: Community-based partnerships for reducing risk during weather extremes may consider people who are older or have experienced their own adverse health impacts as initial target groups for promoting neighbor checking. Future research should also examine the motivations for, details about, and impacts of neighbor checking in greater depth.

Adapting to Climate Change in the Upper Mississippi River Basin: Exploring Stakeholder Perspectives on River System Management and Flood Risk Reduction.

In the Midwestern United States (US), river flooding is a climate change-related hazard that poses a significant threat to health, well-being and economic stability. The 2019 Midwest floods led to major flooding at every monitoring site along the Mississippi River, set record water levels at 42 sites, and resulted in an estimated $6.2 billion in infrastructure damage and recovery costs. Although the risks associated with increasing flooding in the Midwestern US have been well recognized, less is known about the adaptation challenges and opportunities in the region, particularly in the Upper Mississippi River Basin. This exploratory study examined stakeholder perspectives on river system management, flood risk reduction, and adaptation planning in the Upper Mississippi River Basin. We conducted in-depth interviews with flood management stakeholders between August and October 2019. Interview data were analyzed using thematic analysis. Five themes emerged from the interviews: (1) River flooding in the Midwestern US is a different experience than US coastal flooding; (2) River flooding in the Midwestern US is a regional experience that requires a regional response; (3) Local actors face constrained resources for flood risk protection and recovery; (4) Differentiated responsibility across levels of governments makes recovery and response difficult to navigate; and (5) Competing stakeholder goals challenge cooperative flood hazard management. Overall, these results suggest that locally focused adaptation efforts, while perhaps appropriate for coastal communities or more urban contexts, are suboptimal strategies for communities in the flood-prone river basins of the Midwestern US. Instead, structures and support for regional collaboration should be considered and pursued.

Mental Health and Weather Extremes in a Southeastern U.S. City: Exploring Group Differences by Race.

The connection between mental health and weather extremes is a public health concern, but less studied to date than physical health. This exploratory study examines the mental health impacts of two kinds of weather extremes increasingly linked to climate change-summer heat waves and extreme winter weather-in a low- to middle-income population in the Southeastern U.S. The distribution of mental health impacts, and potential pathways to them, are examined with a focus on race. Data are from a random-sample survey of 426 participants and are analyzed with bivariate statistics and path analysis. Self-reported mental health impacts, in both seasons, were common in our study, with White participants tending to report worse impacts than participants who identified with other racial groups. Physical health had direct effects on mental health across several models, overall and by racial group. For summer heat waves, concern about climate change and social cohesion had direct and indirect effects, respectively, on mental health in White participants only. For extreme winter weather, preparedness had a direct negative effect on mental health in White, but not Black, participants. Results suggest that there may be racial differences in the influence of human and social capital factors on mental health related to weather extremes, warranting further study of this critical topic and with larger racial subgroup samples.

Two Decades of Speaker Recognition Evaluation at the National Institute of Standards and Technology.

The National Institute of Standards and Technology has been conducting Speaker Recognition Evaluations (SREs) for over 20 years. This article provides an overview of the practice of evaluating speaker recognition technology as it has evolved during this time. Focus is given to the current state of speaker recognition evaluation. Highlights from past SREs and future plans are also discussed.

Public understanding of local tornado characteristics and perceived protection from land-surface features in Tennessee, USA.

Misunderstandings about the influence of land-surface features on tornado frequency and other tornado-related misconceptions may affect how people prepare for and behave during hazardous weather events. This research uses a phone survey (n = 1804) to assess how participants in three regions of Tennessee perceive their local tornado characteristics (i.e., direction of travel, seasonality, and diurnal timing) and their belief in protection from land-surface features (i.e., hills, water bodies, and buildings). Region of residence influences most beliefs in local tornado characteristics, and demographic characteristics, specifically age and gender, also have some influence. Residents in hilly East Tennessee are more likely to believe they are protected by hills and underestimate the proportion of nocturnal tornadoes, while residents in West Tennessee are more likely to believe they are protected by water bodies, perhaps because of proximity to the Mississippi River. Outside of the typical severe-weather season, participants were uncertain of when tornadoes were likely to occur; specifically, they did not recognize their local wintertime tornado activity. Because public perceptions are related to local features, local organizations and personnel, for example National Weather Service offices and broadcast meteorologists, may be most helpful in dispelling these misconceptions.

Health Impacts of Extreme Weather Events: Exploring Protective Factors with a Capitals Framework.

PURPOSE: Extreme weather events are increasing with climate change. The physical and mental health of people served by social workers may be especially at risk from these hazards. This exploratory study examines if specific types of human, financial, physical, and social capital are associated with health impacts from excessive summer heat and extreme winter weather. METHOD: Data from resident surveys (N = 424) in low- and moderate-income areas of a Southeastern US city are analyzed with descriptive statistics and logistic regression. RESULTS: Key findings are that health status and social cohesion are negatively associated with health impacts of summer heat and winter extremes. CONCLUSION: Further study is needed of how specific types of capital may help people cope with a changing climate. Social capital may be a particularly relevant area for social work to address within the pressing issue of climate, weather, and the health of vulnerable groups.

Heat and Humidity in the City: Neighborhood Heat Index Variability in a Mid-Sized City in the Southeastern United States.

Daily weather conditions for an entire city are usually represented by a single weather station, often located at a nearby airport. This resolution of atmospheric data fails to recognize the microscale climatic variability associated with land use decisions across and within urban neighborhoods. This study uses heat index, a measure of the combined effects of temperature and humidity, to assess the variability of heat exposure from ten weather stations across four urban neighborhoods and two control locations (downtown and in a nearby nature center) in Knoxville, Tennessee, USA. Results suggest that trees may negate a portion of excess urban heat, but are also associated with greater humidity. As a result, the heat index of locations with more trees is significantly higher than downtown and areas with fewer trees. Trees may also reduce heat stress by shading individuals from incoming radiation, though this is not considered in this study. Greater amounts of impervious surfaces correspond with reduced evapotranspiration and greater runoff, in terms of overall mass balance, leading to a higher temperature, but lower relative humidity. Heat index and relative humidity were found to significantly vary between locations with different tree cover and neighborhood characteristics for the full study time period as well as for the top 10% of heat index days. This work demonstrates the need for high-resolution climate data and the use of additional measures beyond temperature to understand urban neighborhood exposure to extreme heat, and expresses the importance of considering vulnerability differences among residents when analyzing neighborhood-scale impacts.

Validity of infant race/ethnicity from birth certificates in the context of U.S. demographic change.

OBJECTIVE: To compare infant race/ethnicity based on birth certificates with parent report of infant race/ethnicity in a survey. DATA SOURCES: The 2007 Oklahoma birth certificates and SEED for Oklahoma Kids baseline survey. STUDY DESIGN: Using sensitivity scores and positive predictive values, we examined consistency of infant race/ethnicity across two data sources (N = 2,663). DATA COLLECTION/EXTRACTION METHODS: We compared conventional measures of infant race/ethnicity from birth certificate and survey data. We also tested alternative measures that allow biracial classification, determined from parental information on the infant's birth certificate or parental survey report. PRINCIPAL FINDINGS: Sensitivity of conventional measures is highest for whites and African Americans and lowest for Hispanics; positive predictive value is highest for Hispanics and African Americans and lowest for American Indians. Alternative measures improve values among whites but yield mostly low values among minority and biracial groups. CONCLUSIONS: Health disparities research should consider the source and validity of infant race/ethnicity data when creating sampling frames or designing studies that target infants by race/ethnicity. The common practice of assigning the maternal race/ethnicity as infant race/ethnicity should continue to be challenged.

Pb neurotoxicity: neuropsychological effects of lead toxicity.

Neurotoxicity is a term used to describe neurophysiological changes caused by exposure to toxic agents. Such exposure can result in neurocognitive symptoms and/or psychiatric disturbances. Common toxic agents include heavy metals, drugs, organophosphates, bacterial, and animal neurotoxins. Among heavy metal exposures, lead exposure is one of the most common exposures that can lead to significant neuropsychological and functional decline in humans. In this review, neurotoxic lead exposure's pathophysiology, etiology, and epidemiology are explored. In addition, commonly associated neuropsychological difficulties in intelligence, memory, executive functioning, attention, processing speed, language, visuospatial skills, motor skills, and affect/mood are explored.

Discriminating among ADHD alone, ADHD with a comorbid psychological disorder, and feigned ADHD in a college sample.

Since the early 2000s concern has increased that college students might feign ADHD in pursuit of academic accommodations and stimulant medication. In response, several studies have validated tests for use in differentiating feigned from genuine ADHD. Although results have generally been positive, relatively few publications have addressed the possible impact of the presence of psychological disorders comorbid with ADHD. Because ADHD is thought to have accompanying conditions at rates of 50% and higher, it is important to determine if the additional psychological disorders might compromise the accuracy of feigning detection measures. The present study extended the findings of Jasinski et al. (2011) to examine the efficacy of various measures in the context of feigned versus genuine ADHD with comorbid psychological disorders in undergraduate students. Two clinical groups (ADHD only and ADHD + comorbid psychological disorder) were contrasted with two non-clinical groups (normal controls answering honestly and normal participants feigning ADHD). Extending previous research to individuals with ADHD and either an anxiety or learning disorder, performance validity tests such as the Test of Memory Malingering (TOMM), the Letter Memory Test (LMT), and the Nonverbal Medical Symptom Validity Test (NV-MSVT) were effective in differentiating both ADHD groups from normal participants feigning ADHD. However, the Digit Memory Test (DMT) underperformed in this study, as did embedded validity indices from the Wechsler Adult Intelligence Scale-IV (WAIS-IV) and Woodcock Johnson Tests of Achievement-III (WJ-III).

Neuropsychiatric symptom assessments in toxic exposure.

The goal of this review is to provide guidelines for evaluating psychiatric and mood changes that result from neurotoxicity. Mood changes that are often seen to varying degrees in neurotoxicity include increased anxiety, depression, irritability, impulsiveness, and psychosis. Some common agents that induce neurotoxicity include drugs, heavy metals, and organophosphates with presentations varying somewhat depending upon the mechanism of toxicity. The authors discuss in detail psychiatric assessment for patients with suspected of having neurotoxicologic syndrome.

Using symptom validity tests to detect malingered ADHD in college students.

Recently there has been growing concern that college students may feign symptoms of ADHD in order to obtain academic accommodations and stimulant medication. Unfortunately research has only begun to validate detection tools for malingered ADHD. The present study cross-validated the results of Sollman, Ranseen, and Berry (2010) on the efficacy of several symptom validity tests for detection of simulated ADHD among college students. Undergraduates with a history of diagnosed ADHD were randomly assigned either to respond honestly or exaggerate symptoms, and were compared to undergraduates with no history of ADHD or other psychiatric disorders who were also randomly assigned to respond honestly or feign symptoms of ADHD. Similar to Sollman et al. (2010) and other recent research on feigned ADHD, several symptom validity tests, including the Test of Memory Malingering (TOMM), Letter Memory Test (LMT), Digit Memory Test (DMT), Nonverbal Medical Symptom Validity Test (NV-MSVT), and the b Test were reasonably successful at discriminating feigned and genuine ADHD. When considered as a group, the criterion of failure of 2 or more of these SVTs had a sensitivity of. 475 and a specificity of 1.00.