Fatal borealpox in an immunosuppressed patient treated with antivirals and vaccinia immunoglobulin - Alaska, 2023.

BACKGROUND: Borealpox virus (BRPV, formerly known as Alaskapox virus) is a zoonotic member of the Orthopoxvirus genus first identified in a person in 2015. In the six patients with infection previously observed BRPV involved mild, self-limiting illness. We report the first fatal BRPV infection in an immunosuppressed patient. METHODS: A man aged 69 years from Alaska's Kenai Peninsula was receiving anti-CD20 therapy for chronic lymphocytic leukemia. He presented to care for a tender, red papule in his right axilla with increasing induration and pain. The patient failed to respond to multiple prescribed antibiotic regimens and was hospitalized 65 days postsymptom onset for progression of presumed infectious cellulitis. BRPV was eventually detected through orthopoxvirus real-time polymerase chain reaction testing of mucosal swabs. He received combination antiviral therapy, including 21 days of intravenous tecovirimat, intravenous vaccinia immunoglobulin, and oral brincidofovir. Serial serology was conducted on specimens obtained posttreatment initiation. FINDINGS: The patient's condition initially improved with plaque recession, reduced erythema, and epithelization around the axillary lesion beginning one-week post-therapy. He later exhibited delayed wound healing, malnutrition, acute renal failure, and respiratory failure. He died 138 days postsymptom onset. Serologic testing revealed no evidence the patient generated a humoral immune response. No secondary cases were detected. CONCLUSION: This report demonstrates that BRPV can cause overwhelming disseminated infection in certain immunocompromised patients. Based on the patient's initial response, early BRPV identification and antiviral therapies might have been beneficial. These therapies, in combination with optimized immune function, should be considered for patients at risk for manifestations of BRPV.

Effect of semaglutide 2.4 mg on physical functioning and weight- and health-related quality of life in adults with overweight or obesity: Patient-reported outcomes from the STEP 1-4 trials.

AIMS: To summarize the effects of semaglutide 2.4 mg on weight-related quality of life (WRQOL) and health-related quality of life (HRQOL), focusing on the confirmatory secondary endpoint of physical functioning. MATERIALS AND METHODS: The STEP 1-4 Phase 3a, 68-week, double-blind, randomized controlled trials assessed the efficacy and safety of semaglutide 2.4 mg versus placebo in individuals with overweight/obesity. WRQOL and HRQOL were assessed by change from baseline to Week 68 in two different but complementary measures, the Impact of Weight on Quality of Life-Lite Clinical Trials Version (IWQOL-Lite-CT; STEP 1 and 2) and the SF-36v2 Health Survey Acute (SF-36v2; STEP 1-4). RESULTS: Superiority for semaglutide 2.4 mg over placebo based on IWQOL-Lite-CT and SF-36v2 physical functioning scores was confirmed in STEP 1 and 2 and in STEP 1, 2 and 4, respectively. At Week 68, a greater proportion of participants treated with semaglutide 2.4 mg than with placebo reached meaningful within-person change (MWPC) thresholds for IWQOL-Lite-CT Physical Function scores in STEP 1 (51.8% vs. 28.3%; p < 0.0001) and STEP 2 (39.6% vs. 29.5%; p = 0.0083) and the MWPC threshold for SF-36v2 Physical Functioning in STEP 1 (39.8% vs. 24.1%; p < 0.0001), STEP 2 (41.0% vs. 27.3%; p = 0.0001) and STEP 4 (18.0% vs. 6.6%; p < 0.0001). All other IWQOL-Lite-CT and SF-36v2 scale scores in STEP 1-4 were numerically improved with semaglutide 2.4 mg versus placebo, except for SF-36v2 Role Emotional in STEP 2. CONCLUSIONS: Semaglutide 2.4 mg significantly improved physical functioning, with greater proportions of participants achieving MWPC compared with placebo, and showed beneficial effects on WRQOL and HRQOL beyond physical functioning.

A Systematic Review of the Effectiveness of Health Education Programs for Cervical Cancer Prevention in Rural Communities: Implications for Promoting Health Equity.

Rural women face an increased risk of cervical cancer diagnosis in comparison to women living in metropolitan areas. This review synthesized and critically evaluated cervical cancer screening interventions that target women living in rural communities in the USA. EBSCO, JSTOR, Medline, PsychINFO, Psychology and Behavioral Sciences Collection, PubMed, and Cochrane Library were searched using keywords related to cervical cancer screening, rural communities, and prevention interventions. Study eligibility included randomized controlled trials or quasi-experimental designs, a psychosocial or educational intervention targeting cervical cancer prevention, and implementation in a rural setting. Eleven articles met criteria for the systematic review and 6 of those included information sufficient for meta-analysis. Cochrane guidelines, CONSORT-Equity 2017, and PROGRESS-Plus were used to assess included studies. The systematic review encompassed 9720 participants who were involved in a variety of intervention types: social media campaigns, faith-based, and patient navigation with lay health advisors. None of the studies met all criteria for the health equity assessment. The meta-analysis found that women in the intervention groups were more likely to participate in cervical cancer screening than women in control groups (OR: 2.43, 95% CI: 1.49 to 3.97). The type of intervention mattered in increasing cervical cancer screening participation for women living in rural communities. Educational interventions in combination with patient navigation saw the most success in promoting cervical cancer screening. Further, health inequities focus is lacking robust consideration. Our results highlight a continued need to develop multicomponent interventions with a health equity focus to address barriers to screening and prevention.

Allogeneic haemopoietic cell transplant services in Australia and New Zealand in the first year of the COVID-19 pandemic: a report from Australia and New Zealand transplant and cellular therapies.

BACKGROUND: The COVID-19 pandemic has caused major disruption to health systems, with allogeneic haemopoietic cell transplant (alloHCT) services a particularly vulnerable area. Ongoing provision of alloHCT has required dynamic responses at national and local levels. In Australia and New Zealand (ANZ), a high reliance on unrelated donors from overseas registries has posed an additional challenge. AIMS: To describe the impact of COVID-19 on alloHCT services in ANZ in the first year of the pandemic. METHODS: Data from the national alloHCT patient and unrelated donor registries were extracted for a 2-year time frame. Comparisons were made between a pre-pandemic period of 1 March 2019 to 29 February 2020 and the corresponding dates during the pandemic, 1 March 2020 to 28 February 2021. RESULTS: There was a 13% decrease in the number of allogeneic transplants, a reversal of steady increases in previous years, with the largest decrease in unrelated donor transplants. Local donors supplied a greater proportion of unrelated stem cell products. With a switch to universal cryopreservation, the time from request of a product to infusion increased by a median of 25.5 days for overseas products and 14 days for local products. There was a significant increase in the number of products collected but not used. CONCLUSIONS: A strong public health response and coordinated transplant community activities allowed for safe provision of alloHCT in ANZ; however, our data suggest that the timely delivery of allogeneic transplants was affected by the COVID-19 pandemic. Continued dedicated efforts are required to minimise further impacts.

Factors associated with delaying medical care: cross-sectional study of Nebraska adults.

BACKGROUND: Delayed medical care may result in adverse health outcomes and increased cost. Our purpose was to identify factors associated with delayed medical care in a primarily rural state. METHODS: Using a stratified random sample of 5,300 Nebraska households, we conducted a cross-sectional mailed survey with online response option (27 October 2020 to 8 March 2021) in English and Spanish. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals. RESULTS: The overall response rate was 20.8% (n = 1,101). Approximately 37.8% of Nebraskans ever delayed healthcare (cost-related 29.7%, transportation-related 3.7%), with 22.7% delaying care in the past year (10.1% cost-related). Cost-related ever delay was associated with younger age [< 45 years aOR 6.17 (3.24-11.76); 45-64 years aOR 2.36 (1.29-4.32)], low- and middle-income [< $50,000 aOR 2.85 (1.32-6.11); $50,000-$74,999 aOR 3.06 (1.50-6.23)], and no health insurance [aOR 3.56 (1.21-10.49)]. Transportation delays were associated with being non-White [aOR 8.07 (1.54-42.20)], no bachelor's degree [≤ high school aOR 3.06 (1.02-9.18); some college aOR 4.16 (1.32-13.12)], and income < $50,000 [aOR 8.44 (2.18-32.63)]. Those who did not have a primary care provider were 80% less likely to have transportation delays [aOR 0.20 (0.05-0.80)]. CONCLUSIONS: Delayed care affects more than one-third of Nebraskans, primarily due to financial concerns, and impacting low- and middle-income families. Transportation-related delays are associated with more indicators of low socio-economic status. Policies targeting minorities and those with low- and middle-income, such as Medicaid expansion, would contribute to addressing disparities resulting from delayed care.

Assessing the effects of sunlight and water on asphalt binder and pavement leachability related to the environment.

Extensive global research conducted over 30 years explores asphalt leachability and stormwater runoff. Asphalt's widespread usage in construction materials underscores the importance of understanding its environmental consequences. This study aims to assess the influence of sunlight exposure on water quality, particularly regarding the release of hazardous organic compounds such as polycyclic aromatic compounds. We investigated the effect of concurrent versus sequential exposure to water and sunlight, and dark versus light trials utilizing thin films of asphalt binder as well as old and freshly prepared pavement cores for analysis. Initial laboratory experiments reveal significant water-soluble species when thin asphalt films are exposed to solar simulation while underwater. However, simulating environmental conditions found in roadways by exposing the asphalt binder to solar simulation followed by water immersion leads to a substantial decrease in compound formation. Leachate water from 17-year-old asphalt and 15-year-old concrete pavements exhibits complex compound compositions associated with atmospheric and/or vehicular deposition, posing challenges in deconvoluting their origins. Light and dark trials conducted on freshly prepared asphalt pavement under environmental conditions of sunlight and rain demonstrate minimal runoff variation, with semi-volatile organic compound levels resembling the background. Future investigations will focus on applying insights gained from this study to analyze larger sample sets, with an emphasis on inherent hazardous compound variations.

Using Grand Rounds to Train and Prepare a Local Public Health Workforce To Manage COVID-19 Outbreaks During the 2020-2021 Pandemic Winter Upsurge.

In response to the coronavirus disease 2019 (COVID-19) pandemic, the Los Angeles County Department of Public Health (DPH) expanded its workforce by >250 staff during Fall 2020 to manage the expected volume of outbreaks, which ultimately peaked. The workforce included reorganized groups of physicians, nurses, outbreak investigators from several DPH programs, and a 100+ member data science team tasked with designing and operating a data system and information flow process that became the backbone infrastructure of support for field investigation and outbreak management in real-time. The accelerated workforce expansion was completed in 3 months. To prepare new and reassigned permanent staff for fieldwork, DPH and several faculty from the Emory University Rollins School of Public Health adopted a flexible, skills-based series of medical Grand Rounds. These 16 sessions were grounded in practice- and problem-based learning principles using case studies, interactive scenarios, and didactic presentations based on scientific and public health practice information to teach knowledge and skills that were needed to manage COVID-19 outbreaks in different sectors. The evaluation suggests positive experience with the training series as well as impact on job performance.

Protecting First Responders While Maintaining Personal Privacy During the COVID-19 Pandemic: One County's Approach.

In this case study, the authors discuss a special situation infectious disease alert process for first responders. Issues explored include the development of this infectious disease alert process and legal issues that the DuPage County Health Department addressed to share protected health information between public health and public safety. The authors illustrate the important relationship between a local health department and its legal counsel as they balanced the needs of different stakeholder groups and identified a solution that satisfied both without infringing on individual privacy. The case study closes with a discussion regarding the value of multisector collaborations and opportunities to improve information sharing between sectors.

Methods for a composite ecological suitability measure to inform cumulative restoration assessments in Gulf of Mexico estuaries.

Ecosystem management requires a systematic, holistic approach that considers ecological and social outcomes. Effective restoration practices promote a balance of ecological and social goals by addressing ecological integrity, efficiently maximizing benefits while minimizing investment, and encompassing collaborative stakeholder engagement. Socio-ecological assessments can inform adaptive management and be utilized to prioritize restoration activities and monitor restoration effectiveness. In estuarine systems, socio-ecological assessments should evaluate the ability of habitats to support both ecologically and locally important species. The composite measure presented utilizes a combination of ecological and social measures to characterize ecological suitability for individual and multiple Gulf of Mexico estuarine species. The ecological suitability value (ES) for a given spatial unit is based on a suite of biophysical measures of the quality and extent of suitable habitat for each species, the species' trophic importance in a food web context, and the importance of each species in relation to stakeholder values and benefits. ES values for individual spatial units can be aggregated to estimate the distribution of ecological suitability at the estuarine scale. The ES values are calculated using examples for each step in the process. The information provided by ecological suitability characterizations can support restoration prioritization decisions for Gulf of Mexico estuaries and can provide a baseline measure to gauge restoration effectiveness over time to inform cumulative restoration assessments.

Attention and Memory in Depersonalization-Spectrum Dissociative Disorders: Impact of Selective-Divided Attentional Condition, Stimulus Emotionality, and Stress.

We investigated cognition in depersonalization-spectrum dissociative disorders without comorbid posttraumatic stress disorder to explore evidence for emotionally avoidant information processing. Forty-eight participants with DSM-IV dissociative disorder (DD) (Depersonalization Disorder - 37, Dissociative Disorder NOS -11), 36 participants with Posttraumatic Stress Disorder (PTSD), and 56 healthy controls (HC) were administered the Weschler Adult Intelligence Scale-III (WAIS); the Weschler Memory Scale-III (WMS); and three Stroop tasks: the Standard Stroop, a selective-attention Emotional Stroop using neutral, dissociation, and trauma-related word categories, and a divided-attention Emotional Stroop using comparable words. Participants were also administered a paired-associates explicit and implicit memory test using emotionally neutral and negative words, before and after the Trier Social Stress Test. The DD and HC groups had comparable general intelligence and memory scores, though dissociation severity was inversely related to verbal comprehension and working memory. In the selective-attention condition, DD participants showed greater incidental recall across word categories with comparable interference. However in the divided-attention condition, DD participants significantly favored lesser attentional interference at the expense of remembering words. Across attentional conditions, DD participants had better recall for disorder-related than neutral words. Pre-stress, the DD group demonstrated better explicit memory for neutral versus negative words with reversal after stress, whereas the HC group demonstrated the opposite pattern; implicit memory did not differ. Cognition in the PTSD control group was generally dissimilar to the DD group. The findings in toto provide substantial evidence for emotionally avoidant information processing in DD, vulnerable to the impact of stress, at the level of both attention and memory.

A. thaliana Hybrids Develop Growth Abnormalities through Integration of Stress, Hormone and Growth Signaling.

Hybrids between Arabidopsis thaliana accessions are important in revealing the consequences of epistatic interactions in plants. F1 hybrids between the A. thaliana accessions displaying either defense or developmental phenotypes have been revealing the roles of the underlying epistatic genes. The interaction of two naturally occurring alleles of the OUTGROWTH-ASSOCIATED KINASE (OAK) gene in Sha and Lag2-2, previously shown to cause a similar phenotype in a different allelic combination in A. thaliana, was required for the hybrid phenotype. Outgrowth formation in the hybrids was associated with reduced levels of salicylic acid, jasmonic acid and abscisic acid in petioles and the application of these hormones mitigated the formation of the outgrowths. Moreover, different abiotic stresses were found to mitigate the outgrowth phenotype. The involvement of stress and hormone signaling in outgrowth formation was supported by a global transcriptome analysis, which additionally revealed that TCP1, a transcription factor known to regulate leaf growth and symmetry, was downregulated in the outgrowth tissue. These results demonstrate that a combination of natural alleles of OAK regulates growth and development through the integration of hormone and stress signals and highlight the importance of natural variation as a resource to discover the function of gene variants that are not present in the most studied accessions of A. thaliana.

Multiplexed Simian Immunodeficiency Virus-Specific Paired RNA-Guided Cas9 Nickases Inactivate Proviral DNA.

Human and simian immunodeficiency virus (HIV and SIV) infections establish lifelong reservoirs of cells harboring an integrated proviral genome. Genome editing CRISPR-associated Cas9 nucleases, combined with SIV-specific guiding RNA (gRNA) molecules, inactivate integrated provirus DNA in vitro and in animal models. We generated RNA-guided Cas9 nucleases (RGNu) and nickases (RGNi) targeting conserved SIV regions with no homology in the human or rhesus macaque genome. Assays in cells cotransfected with SIV provirus and plasmids coding for RGNus identified SIV long terminal repeat (LTR), trans-activation response (TAR) element, and ribosome slip site (RSS) regions as the most effective at virus suppression; RGNi targeting these regions inhibited virus production significantly. Multiplex plasmids that coexpressed these three RGNu (Nu3), or six (three pairs) RGNi (Ni6), were more efficient at virus suppression than any combination of individual RGNu and RGNi plasmids. Both Nu3 and Ni6 plasmids were tested in lymphoid cells chronically infected with SIVmac239, and whole-genome sequencing was used to determine on- and off-target mutations. Treatment with these all-in-one plasmids resulted in similar levels of mutations of viral sequences from the cellular genome; Nu3 induced indels at the 3 SIV-specific sites, whereas for Ni6 indels were present at the LTR and TAR sites. Levels of off-target effects detected by two different algorithms were indistinguishable from background mutations. In summary, we demonstrate that Cas9 nickase in association with gRNA pairs can specifically eliminate parts of the integrated provirus DNA; also, we show that careful design of an all-in-one plasmid coding for 3 gRNAs and Cas9 nuclease inhibits SIV production with undetectable off-target mutations, making these tools a desirable prospect for moving into animal studies. IMPORTANCE Our approach to HIV cure, utilizing the translatable SIV/rhesus macaque model system, aims at provirus inactivation and its removal with the least possible off-target side effects. We developed single molecules that delivered either three truncated SIV-specific gRNAs along with Cas9 nuclease or three pairs of SIV-specific gRNAs (six individual gRNAs) along with Cas9 nickase to enhance efficacy of on-target mutagenesis. Whole-genome sequencing demonstrated effective SIV sequence mutation and inactivation and the absence of demonstrable off-target mutations. These results open the possibility to employ Cas9 variants that introduce single-strand DNA breaks to eliminate integrated proviral DNA.

CrRLK1L receptor-like kinases HERK1 and ANJEA are female determinants of pollen tube reception.

Communication between the gametophytes is vital for angiosperm fertilisation. Multiple CrRLK1L-type receptor kinases prevent premature pollen tube burst, while another CrRLK1L protein, FERONIA (FER), is required for pollen tube reception in the female gametophyte. We report here the identification of two additional CrRLK1L homologues, HERCULES RECEPTOR KINASE 1 (HERK1) and ANJEA (ANJ), which act redundantly to promote pollen tube growth arrest at the synergid cells. HERK1 and ANJ localise to the filiform apparatus of the synergid cells in unfertilised ovules, and in herk1 anj mutants, a majority of ovules remain unfertilised due to pollen tube overgrowth, together indicating that HERK1 and ANJ act as female determinants for fertilisation. As in fer mutants, the synergid cell-specific, endomembrane protein NORTIA (NTA) is not relocalised after pollen tube reception; however, unlike fer mutants, reactive oxygen species levels are unaffected in herk1 anj double mutants. Both ANJ and HERK1 associate with FER and its proposed co-receptor LORELEI (LRE) in planta. Together, our data indicate that HERK1 and ANJ act with FER to mediate female-male gametophyte interactions during plant fertilisation.

Should clinical automated perimetry be considered for routine functional assessment of early/intermediate age-related macular degeneration (AMD)? A systematic review of current literature.

PURPOSE: There is growing interest in functional testing for early/intermediate age-related macular degeneration (iAMD). However, systematic evaluation of existing clinical functional tests is lacking. This systematic review examines evidence for using clinical automated perimetry in routine assessment of early/iAMD. RECENT FINDINGS: PubMed, Web of Science Core Collection, and Embase were searched from inception to October 2020 to answer, is there evidence of visual field defects in early/iAMD, and if so, are early/iAMD visual field defects linked to real-world patient outcomes? Articles using clinical automated perimetry (commercially accessible and non-modified devices/protocols) were included. Microperimetry was excluded as this has yet to be incorporated into clinical guidelines. The primary outcome was global visual field indices including mean deviation (MD), pattern standard deviation (PSD), mean sensitivity (MS) and frequency of defects. The secondary outcome was any real-world patient outcome including quality of life and/or activities of daily living indices. Twenty-six studies were eligible for inclusion and all studies were observational. There was consistent evidence of worsened MD, PSD, MS and frequency of defects for early/iAMD compared to normal eyes under photopic, low-photopic and scotopic conditions. Meta-analysis of studies using standard automated perimetry (SAP) under photopic conditions revealed worsened MD (-1.52dB [-2.27, -0.78 dB]) and MS (-1.47dB [-2, -0.94 dB]) in early/iAMD compared to normal eyes, representing large statistical effect sizes but non-clinically meaningful reductions. There was insufficient data for meta-analyses regarding other clinical automated perimetry protocols. Only one study assessed a real-world patient outcome (on-road driving performance), with no significant link to visual field outcomes in early/iAMD. SUMMARY: Significant reduction of global visual field indices is present in early/iAMD, but not clinically meaningful using SAP under photopic conditions. Translational relevance of visual field outcomes to patient outcomes in early/iAMD remains unclear. Thus, SAP under photopic conditions is unlikely to be useful for routine assessment of early/iAMD.

A conceptual approach to characterizing ecological suitability: Informing socio-ecological measures for restoration effectiveness.

A combination of ecological and socio-economic outcome indicators is essential for understanding and assessing the effectiveness of the remediation and restoration of degraded ecosystems and revitalizing communities that could benefit from these ecosystem management activities. In this paper, we propose and develop a conceptual approach to characterize ecological suitability that incorporates ecological attributes that support ecosystem structural diversity and functionality, stakeholder values and perceptions, and the benefits derived from ecosystem goods and services. A structured literature review was used to identify existing restoration frameworks and indicators to inform the conceptual foundation for characterizing ecological suitability. The structure of the conceptual approach primarily builds from ecological and social attributes in the International Principles and Standards for the Practice of Ecological Restoration (Gann et al., 2019). We provide a conceptual example of the ecological suitability approach in estuaries. This example is based on habitat suitability and food web characterizations in combination with the provisioning of ecosystem services and desired social benefits to prioritize and evaluate restoration effectiveness. This foundational work sets the stage for developing a composite measure of ecological suitability. The holistic conceptual approach presented complements existing information regarding restoration effectiveness evaluations. Characterizing ecological suitability is a novel way to incorporate ecological and social information and communicate potential restoration outcomes to ecosystem managers and stakeholders.

Pilot study of tai chi and qigong on body composition, sleep, and emotional eating in midlife/older women.

Weight gain and related adverse changes in body composition are prevalent among midlife and older women and contribute to chronic disease (e.g., type 2 diabetes, hypertension, depression). Tai Chi (TC) and Qigong (QG), forms of Meditative Movement, demonstrate improved physical/psychological symptoms and body composition. Using a standardized TC/QG protocol, we explored pre/post intervention differences in percent body fat and factors related to body composition in midlife/older women. In the context of a single-group pilot study, females ages 45-75 (N = 51) enrolled in an 8-week TC/QG intervention. Primary outcome measures of body composition, sleep quality, emotional eating and select secondary outcome psycho-emotional factors (perceived stress, mood state, mindfulness, self-compassion, body awareness) were collected. Change in percent body fat did not reach statistical significance (p = .30, M =  0.35, 95% CI [- 0.32, 1.0]). Sleep quality improved significantly, p = .04, M = - 0.88, 95% CI [-1.71, - 0.04]. Emotional eating changed in the expected direction, but not significantly, p = .08, M =  -0.16, 95% CI [-0.34, 0.02]. Significant differences were found in body awareness, p = .01, M =  0.36, 95% CI [0.08, 0.63] and perceived stress, p = .05, M =  -2.36, 95% CI [-4.76, 0.04]. Preliminary results are promising as results showed improvements in factors related to healthy body composition. Refined research is needed to understand if/how TC/QG may improve body composition among midlife and older women.

A multicenter, prospective randomized trial of negative pressure wound therapy for infrainguinal revascularization with a groin incision.

BACKGROUND: Wound complications after open infrainguinal revascularization are a frequent cause of patient morbidity, resulting in increased healthcare costs. The purpose of the present study was to assess the effects of closed incision negative pressure therapy (ciNPT) on groin wound complications after infrainguinal bypass and femoral endarterectomy. METHODS: A total of 242 patients who had undergone infrainguinal bypass (n = 124) or femoral endarterectomy (n = 118) at five academic medical centers in New England from April 2015 to August 2019 were randomized to ciNPT (PREVENA; 3M KCI, St Paul, Minn; n = 118) or standard gauze (n = 124). The primary outcome measure was a composite endpoint of groin wound complications, including surgical site infections (SSIs), major noninfectious wound complications, or graft infections within 30 days after surgery. The secondary outcome measures included 30-day SSIs, 30-day noninfectious wound complications, readmission for wound complications, significant adverse events, and health-related quality of life using the EuroQoL 5D-3L survey. RESULTS: The ciNPT and control groups had similar demographics (age, 67 vs 67 years, P = .98; male gender, 71% vs 70%, P = .86; white race, 93% vs 93%, P = .97), comorbidities (previous or current smoking, 93% vs 94%, P = .46; diabetes, 41% vs 48%, P = .20; renal insufficiency, 4% vs 7%, P = .31), and operative characteristics, including procedure type, autogenous conduit, and operative time. No differences were found in the primary composite outcome at 30 days between the two groups (ciNPT vs control: 31% vs 28%; P = .55). The incidence of SSI at 30 days was similar between the two groups (ciNPT vs control: 11% vs 12%; P = .58). Infectious (13.9% vs 12.6%; P = .77) and noninfectious (20.9% vs 17.6%; P = .53) wound complications at 30 days were also similar for the ciNPT and control groups. Wound complications requiring readmission also similar between the two groups (ciNPT vs control: 9% vs 7%; P = .54). The significant adverse event rates were not different between the two groups (ciNPT vs control: 13% vs 16%; P = .53). The mean length of the initial hospitalization was the same for the ciNPT and control groups (5.2 vs 5.7 days; P = .63). The overall health-related quality of life was similar at baseline and at 14 and 30 days postoperatively for the two groups. Although not powered for stratification, we found no differences among the subgroups in gender, obesity, diabetes, smoking, claudication, chronic limb threatening ischemia, bypass, or endarterectomy. On multivariable analysis, no differences were found in wound complications at 30 days for the ciNPT vs gauze groups (odds ratio, 1.4; 95% confidence interval, 0.8-2.6; P = .234). CONCLUSIONS: In contrast to other randomized studies, our multicenter trial of infrainguinal revascularization found no differences in the 30-day groin wound complications for patients treated with ciNPT vs standard gauze dressings. However, the SSI rate was lower in the control group than reported in other studies, suggesting other practice patterns and processes of care might have reduced the rate of groin infections. Further study might identify the subsets of high-risk patients that could benefit from ciNPT.

Varying levels of depressive symptoms and lifestyle health behaviors in a low income, urban population.

This study examined the relationships between varying levels of depressive symptoms and key dietary indicators of chronic disease risk, sugar-sweetened beverage (SSB) and fruit and vegetable (F + V) consumption, among a racially/ethnically diverse urban population in Los Angeles County (LAC). Analyses were carried out using data from a 2012 cross-sectional health survey of 1401 low-income public health center clients. Participants with a high level of depressive symptoms consumed 30% more SSBs (IRR = 1.30, 95% CI = 1.08, 1.55) than participants with a lower level of these symptoms. Other predictors of higher SSB consumption included being African American/Black (IRR = 1.65, 95% CI = 1.32, 2.05), male (IRR = 1.20, 95% CI = 1.06, 1.35), U.S. born (IRR = 1.32, 95% CI = 1.11, 1.57), and using tobacco (IRR = 1.26, 95% CI = 1.11, 1.43). Similar associations with F + V consumption were not found. Findings suggest that depressive symptoms may influence certain health behaviors in certain groups under certain situations. Policy and practice implications are discussed within this context.

Living with the financial consequences of cancer: A life course perspective.

PURPOSE: Financial hardship can be a major cause of distress among persons with cancer, resulting in chronic stress and impacting physical and emotional health. This paper provides an analysis of the lived experience of cancer patients' financial hardship from diagnosis to post-treatment. METHODS: In-depth interviews were conducted with 26 cancer survivors who reported financial hardship during and/or after treatment. The interviews were analyzed using DedooseTM as an organizational tool, the life course perspective as an organizing theoretical framework, and a thematic analysis tool 1 to answer our research questions. Our analysis identified that timing and sequencing of life transitions and stress proliferation furthered the process of financial stress over time. FINDINGS: Cancer survivors do not experience financial toxicity as a singular process; the experience can be quite different depending on age and life transitions. PRACTICE/POLICY IMPLICATIONS: These findings provide psychosocial oncology providers with a framework for identifying patients at risk for financial distress and addressing the critical needs related to their life stage.

Health Educator Perspectives on Seeking Medicaid Reimbursement in Indiana.

Health education is a growing field. However, there is confusion about the role delineation of health education specialists (HES) and other health education (HE) providers. Additionally, recent reimbursement opportunities allow employers to bill for HE services but offer confusing language regarding eligible service-providing professionals. This study surveyed health educators in Indiana to assess knowledge, attitudes, and perceived abilities to bill Medicaid and other insurers for HE services. Using a cross-sectional research design, an original 22-item Web-based questionnaire was developed and distributed to all Certified Health Education Specialist/Master Certified Health Education Specialist (CHES/MCHES) practitioners residing in Indiana. Additional respondents were recruited using a snowball technique, as original respondents asked to share the survey with colleagues. A final data set of 61 respondents was analyzed. All respondents' organizations provided HE services, with the majority indicating they do not charge and do not bill for HE services. Additionally, 60% of the respondents agreed that HES should be reimbursed for services, and the vast majority believed reimbursement to be important for the field. With recent reimbursement opportunities for HE and preventative health services, it is important that HES advocate for the profession and for potential reimbursement opportunities, such as Medicaid, to enhance the field and support HES jobs.