Cultural humility development in adults serving as mentors for youth: A qualitative evidence synthesis.

This qualitative review synthesizes evidence regarding how cultural humility (i.e., critical self-reflection, challenging inequity) may be influenced by the experience of serving as a mentor in a youth program. A systematic search identified 35 qualitative studies with findings that address this question. Thematic synthesis of extracted data identified the following six themes, all but one of which pertains to ways in which serving as a mentor appeared to have enhanced the cultural humility of the adults involved: (1) humanizing others: awareness of experiential differences, (2) reflecting inward on one's own identity, biases, and opportunities, (3) connecting with others, (4) recognizing environmental influences on human development, (5) envisioning contributions to community change, and (6) counterevidence: deficit-oriented attributions. Findings indicate that mentor cultural humility development primarily entailed individual and interpersonal awareness with relatively less evidence of increased awareness of and action to change inequality. The identified themes provide promising directions for future research as well as potentially useful avenues for incorporating consideration of cultural humility more intentionally in the development and evaluation of mentoring programs for youth.

Distribution and diversity of type VI secretion system clusters in Enterobacter bugandensis and Enterobacter cloacae.

Gram-negative bacteria use type VI secretion systems (T6SSs) to antagonize neighbouring cells. Although primarily involved in bacterial competition, the T6SS is also implicated in pathogenesis, biofilm formation and ion scavenging. Enterobacter species belong to the ESKAPE pathogens, and while their antibiotic resistance has been well studied, less is known about their pathogenesis. Here, we investigated the distribution and diversity of T6SS components in isolates of two clinically relevant Enterobacter species, E. cloacae and E. bugandensis. T6SS clusters are grouped into four types (T6SSi-T6SSiv), of which type i can be further divided into six subtypes (i1, i2, i3, i4a, i4b, i5). Analysis of a curated dataset of 31 strains demonstrated that most of them encode T6SS clusters belonging to the T6SSi type. All T6SS-positive strains possessed a conserved i3 cluster, and many harboured one or two additional i2 clusters. These clusters were less conserved, and some strains displayed evidence of deletion. We focused on a pathogenic E. bugandensis clinical isolate for comprehensive in silico effector prediction, with comparative analyses across the 31 isolates. Several new effector candidates were identified, including an evolved VgrG with a metallopeptidase domain and a Tse6-like protein. Additional effectors included an anti-eukaryotic catalase (KatN), M23 peptidase, PAAR and VgrG proteins. Our findings highlight the diversity of Enterobacter T6SSs and reveal new putative effectors that may be important for the interaction of these species with neighbouring cells and their environment.

Striving for safety, impact, and equity: A critical consideration of AJCP publications on formal youth mentoring programs.

In this virtual special issue (VSI) we curate and reflect upon 22 articles on formal youth mentoring previously published in the American Journal of Community Psychology (AJCP). First, we provide historical context and highlight AJCP's 2002 special issue on mentoring, which played an important role in establishing youth mentoring as a vibrant area of research. Next, we review and discuss findings from subsequent AJCP studies in three interrelated lines of inquiry: (1) the importance of facilitating high-quality mentoring relationships; (2) associations among youth's presenting needs, relationship quality, and outcomes; and (3) program practices leading to stronger, more impactful relationships. Throughout, we highlight and expand upon critical commentary from AJCP contributors, calling on the field to move away from paternalistic models that overly localize risk with youth and families without interrogating structural oppression. Our recommendations include: (1) centering critical consciousness, racial equity, and social justice in program curricula and mentor trainings; (2) respectfully engaging grassroots programs developed for and by communities of color that are underrepresented in research; (3) making meaningful efforts to recruit mentors from marginalized communities and removing barriers to their participation; and (4) examining youth's racial, ethnic, and other areas of identity development processes during mentoring.

Identifying predictors of psychological well-being among volunteer mentors in Big Brothers Big Sisters.

Big Brothers Big Sisters (BBBS) facilitates mentoring relationships between youth and volunteer mentors. Although research has examined outcomes for youth in BBBS, relatively less investigation has been undertaken for volunteer outcomes. This study explored factors associated with changes in psychological well-being among BBBS volunteer mentors. Participants included 593 mentors (Mage = 31) surveyed at study baseline and 15-month follow-up. A classification and regression decision tree approach was used to predict residualized change in psychological well-being from study baseline with match length included as the first split variable, and demographic, individual, and relationship variables included as candidate predictors. Analyses indicated that mentors with longer relationships (>4.5 months) reported more positive change in psychological well-being compared with mentors with shorter relationships. Perceived quality of program supervision was a further predictor within both groups of volunteers. Findings suggest that longer relationships and greater program support may contribute to mentor well-being.

Risk of relapse and readmission among hospitalized adults with carbapenem non-susceptible gram-negative infections.

BACKGROUND: Infections caused by carbapenem-nonsusceptible gram-negative (C-NS) pathogens are associated with increased mortality and high treatment costs. Identification of potentially modifiable factors that may improve patient outcomes is important for better management of C-NS GN infections. METHODS: This was a retrospective study of hospitalized adults with electronic health record evidence of complicated urinary tract infection (cUTI), bacterial pneumonia (BP), complicated intra-abdominal infection (cIAI), or bacteremia (BAC) due to C-NS GN organisms from January 2013 to March 2018. Treatment patterns and clinical characteristics during the index hospitalization were analyzed descriptively and stratified by infection site(s). The effect of patient characteristics on index infection relapse during the postdischarge period and on readmission with 30 days was modeled using logistic regression. RESULTS: The study included 2,862 hospitalized patients with C-NS GN infections. Index infection sites were 38.4% cUTI ± BAC, 21.5% BP ± BAC, 18.7% cUTI + BP ± BAC, 14.7% any cIAI, and 6.7% BAC only. The majority of patients (83.6%) received an antibiotic during their index hospitalization; among these, the most common classes given were penicillins (52.9%), fluoroquinolones (50.7%), and carbapenems (38.9%). During the postdischarge period, 21.7% of patients had a relapse of the index infection and 63.9% of patients were readmitted to the hospital. Factors associated with increased adjusted odds ratio (OR) for relapse or readmission included Charlson comorbidity score of ≥3 relative to 0 (relapse: OR [95% CI] = 1.34 [1.01-1.76], p = .040; readmission: OR [95% CI] 1.92 [1.50-2.46], p < .001), preindex immunocompromised status (relapse: OR [95% CI] 1.37 [1.05-1.79], p = .019; readmission: OR [95% CI] = 1.60 [1.27-2.02], p < .001), and preindex carbapenem use (relapse: OR [95% CI] = 1.35 [1.07-1.72], p = .013; readmission: OR [95% CI] = 1.25 [1.00-1.57], p = .048). CONCLUSIONS: Adverse postdischarge outcomes were common among hospitalized patients with C-NS GN infections and were significantly associated with previous carbapenem use and patient clinical characteristics such as higher comorbidity burden and immunocompromised status. Adoption of antimicrobial stewardship and consideration of individual patient risk factors in making treatment decisions may help improve clinical outcomes.

Risk of chemotherapy-induced febrile neutropenia in intermediate-risk regimens: Clinical and economic outcomes of granulocyte colony-stimulating factor prophylaxis.

BACKGROUND: Chemotherapy-induced neutropenia increases the risk of febrile neutropenia (FN) and infection with resultant hospitalizations, with substantial health care resource utilization (HCRU) and costs. Granulocyte-colony stimulating factor (GCSF) is recommended as primary prophylaxis for chemotherapy regimens having more than a 20% risk of FN. Yet, for intermediate-risk (10%-20%) regimens, it should be considered only for patients with 1 or more clinical risk factors (RFs) for FN. It is unclear whether FN prophylaxis for intermediate-risk patients is being optimally implemented. OBJECTIVE: To examine RFs, prophylaxis use, HCRU, and costs associated with incident FN during chemotherapy. METHODS: This retrospective study used administrative claims data for commercial and Medicare Advantage enrollees with nonmyeloid cancer treated with intermediate-risk chemotherapy regimens during January 1, 2009, to March 31, 2020. Clinical RFs, GCSF prophylaxis, incident FN, HCRU, and costs were analyzed descriptively by receipt of primary GCSF, secondary GCSF, or no GCSF prophylaxis. Multivariable Cox regression analysis was used to examine the association between number of RFs and cumulative FN risk. RESULTS: The sample comprised 13,937 patients (mean age 67 years, 55% female). Patients had a mean of 2.3 RFs, the most common being recent surgery, were aged 65 years or greater, and had baseline liver or renal dysfunction; 98% had 1 or more RFs. However, only 35% of patients received primary prophylaxis; 12% received secondary prophylaxis. The hazard ratio of incident FN was higher with increasing number of RFs during the first line of therapy, yet more than 54% of patients received no prophylaxis, regardless of RFs. Use of GCSF prophylaxis varied more by chemotherapeutic regimen than by number of RFs. Among patients treated with rituximab, cyclophosphamide, hydroxydaunorubicin hydrochloride (doxorubicin hydrochloride), vincristine, and prednisone, 76% received primary prophylaxis, whereas only 22% of patients treated with carboplatin/paclitaxel received primary prophylaxis. Among patients with a first line of therapy FN event, 78% had an inpatient stay and 42% had an emergency visit. During cycle 1, mean FN-related coordination of benefits-adjusted medical costs per patient per month ($13,886 for patients with primary prophylaxis and $18,233 for those with none) were driven by inpatient hospitalizations, at 91% and 97%, respectively. CONCLUSIONS: Incident FN occurred more often with increasing numbers of RFs, but GCSF prophylaxis use did not rise correspondingly. Variation in prophylaxis use was greater based on regimen than RF number. Lower health care costs were observed among patients with primary prophylaxis use. Improved individual risk identification for intermediate-risk regimens and appropriate prophylaxis may decrease FN events toward the goal of better clinical and health care cost outcomes. DISCLOSURES: This work was funded by Sandoz Inc., which participated in the design of the study, interpretation of the data, writing and revision of the manuscript, and the decision to submit the manuscript for publication. The study was performed by Optum under contract with Sandoz Inc. The author(s) meet criteria for authorship as recommended by the International Committee of Medical Journal Editors. The authors received no direct compensation related to the development of the manuscript. Dr Li is an employee of Sandoz Inc. Drs Bell and Lal and Mr Peterson-Brandt were employees of Optum at the time of the study. Ms Anderson and Dr Aslam are employees of Optum. Dr Lyman has been primary investigator on a research grant from Amgen to their institution and has consulted for Sandoz, G1 Therapeutics, Partners Healthcare, BeyondSpring, ER Squibb, Merck, Jazz Pharm, Kallyope, Teva; Fresenius Kabi, Seattle Genetics, and Samsung.

Are adults influenced by the experience of mentoring youth? A scoping review.

AIMS: A relatively large body of research exists on the effectiveness of mentoring programs directed at youth and numerous syntheses of this literature have proven useful for advancing both research and practice. Less studied, but also important is the potential for adults serving in the role of mentor to young persons to be influenced by this experience. A scoping review was conducted with the aim of identifying and critically assessing major trends in the methods and findings in this literature. METHODS: Included sources were empirical studies reporting findings that address potential influences on adults (18+) serving as mentors to youth (<18) in formal programs designed for this purpose. The initial search resulted in 3155 records and 96 were included in the review. RESULTS: Approximately half of the studies (58%) focused on younger adults (ages 18-22 years old, e.g., college students) serving as mentors; only a small minority of studies focused on adults over 35 years old (10%). Most studies were qualitative (n = 54). Studies with a quantitative component (n = 18 quantitative only; n = 24 mixed methods) exhibited a significant risk of bias for inferring effects on mentors due to limitations in study design (e.g., lack of comparison group). Studies most often addressed potential outcomes for mentors in academic/career (55%) and social (45%) domains, when findings suggested possible effects on mentors, they were nearly universally in a positive direction. CONCLUSION: Existing research, although consistent with the potential for adults to benefit from the experience of mentoring youth, has insufficient rigor and representativeness to adequately address this question. Future research should utilize more rigorous quantitative designs and samples with greater representativeness of the different stages of adult development.

Burden of illness in progressive fibrosing interstitial lung disease.

BACKGROUND: Progressive fibrosing interstitial lung disease (ILD) is a relatively new clinical concept describing a variety of ILDs characterized by progressive pulmonary fibrosis with associated lung function decline and worsening chest imaging. Little is known about health care resource utilization (HCRU) and costs associated with progressive fibrosing ILDs other than idiopathic pulmonary fibrosis (IPF). This study analyzed the adjusted HCRU and cost burden among patients with incident non-IPF progressive fibrosing ILD vs matched patients with incident fibrosing ILD that had not yet progressed. METHODS: This was a retrospective study of insured US adults newly diagnosed with non-IPF fibrosing ILD from October 2016 to June 2019, conducted using administrative claims data from the Optum Research Database. Progressive disease was identified using claims-based proxies comprising health care utilization associated with management of progressive fibrosing ILD. Patients in the progressive population were 1:1 propensity score matched to not-yet-progressed patients on the basis of baseline demographic and clinical characteristics. All-cause HCRU and health care costs were presented as weighted per-patient-per-month (PPPM) measures to account for variable follow-up. Differences in study outcomes between matched cohorts were evaluated using Z-tests for continuous measures and Rao-Scott tests for binary measures. RESULTS: The postmatch cohorts comprised 11,025 patients with evidence of progression matched to 11,025 patients with not-yet-progressed fibrosing ILD. Mean (SD) weighted PPPM counts of follow-up health care encounters were significantly higher for the progressive vs not-yet-progressed cohort: ambulatory visits, 4.2 (3.6) vs 3.1 (3.3); emergency department visits, 0.3 (0.5) vs 0.1 (0.3); and inpatient (IP) stays, 0.1 (0.2) vs 0.0 (0.1) (P < 0.001 for all). Among patients with an IP stay, those with progressive disease had more inpatient days than those with not-yet-progressed disease (mean [SD] 1.6 [2.4] days vs 1.0 [1.3] days, P < 0.001). Mean weighted PPPM (SD) all-cause health care costs were also significantly higher for progressive vs not-yet-progressed patients, including total costs ($4,382 [$9,597] vs $2,243 [$4,162], P < 0.001), medical costs ($3,662 [$9,150] vs $1,627 [$3,524], P < 0.001), and pharmacy costs ($720 [$2,097] vs $616 [$2,070], P = 0.002). The difference in medical costs between cohorts was driven primarily by higher inpatient costs for progressive vs not-yet-progressed patients ($1,729 [$7,557] vs $523 [$2,118], P < 0.001). CONCLUSIONS: Progressive fibrosing ILD carries a substantial economic and health care burden. Among patients with incident non-IPF fibrosing ILD, all-cause HCRU and costs were significantly higher for those with a progressive phenotype than for matched patients whose disease had not yet progressed. The cost differential was driven primarily by hospitalizations, which were longer and more frequent for the progressive cohort. Disclosures: This work was funded by Boehringer Ingelheim Pharmaceuticals, Inc. Drs Conoscenti and Shetty are employees of Boehringer Ingelheim (BI). Dr Singer was an employee of BI at the time the study was conducted. Dr Brown was a paid consultant for BI for this study. Dr Bengtson, Ms Anderson, and Dr Brekke are employees of Optum, which was contracted by BI to conduct the study. Medical writing assistance was provided by Yvette Edmonds, PhD (Optum), and was contracted and funded by Boehringer Ingelheim Pharmaceuticals, Inc.

Impact of timing of nintedanib initiation among patients newly diagnosed with idiopathic pulmonary fibrosis.

AIMS: While nintedanib treatment has been shown to slow the progression of idiopathic pulmonary fibrosis (IPF) in patients across varying levels of lung function, the effect of treatment timing on outcomes has not been examined. We assessed hospitalization risk and medical costs among patients with IPF based on the timing of nintedanib initiation after IPF diagnosis. MATERIALS AND METHODS: This retrospective administrative claims study included data from 04/01/2014-09/30/2019 for patients aged ≥40 years who initiated nintedanib within 1 year of IPF diagnosis. Patients were assigned to study cohorts based on the time from IPF diagnosis to nintedanib initiation. All-cause hospitalization and all-cause medical costs were modeled using marginal structural models including inverse probability weights to adjust for both baseline and time-varying characteristics. RESULTS: Of 11,195 patients diagnosed with IPF during the identification period, 449 met the study selection criteria (mean age 72.3 years, 68% male, mean follow-up time 13.3 months). Adjusted hospitalization risk and medical costs both varied significantly by the timing of nintedanib initiation (p < .001 and p = .020, respectively). Adjusted weighted hospitalization risk was higher among untreated vs. treated patients in months 2-3, months 4-6, and months 7-12 after diagnosis (hazard ratio [95% CI] 1.97 [1.09-3.56], p = .026; 2.62 [1.22-5.63], p = .014; and 5.57 [2.31-13.45], p < .001, respectively). Medical costs were 69% higher for patients initiating treatment in months 2-3 vs. month 1 (cost ratio [95% CI] 1.69 [1.20-2.38], p = .003). LIMITATIONS: Disease severity could not be assessed because clinical data were unavailable; however, proxies such as oxygen use were included to adjust for between-cohort differences in disease severity. CONCLUSIONS: Patients who initiate nintedanib promptly after IPF diagnosis may have reduced hospitalization risk and medical costs compared with those who start treatment later. Additional studies are warranted to improve understanding of the impact of prompt antifibrotic therapy on patient outcomes.

Claims-based Prevalence of Disease Progression among Patients with Fibrosing Interstitial Lung Disease Other than Idiopathic Pulmonary Fibrosis in the United States.

Rationale: Chronic fibrosing interstitial lung disease (ILD) with a progressive phenotype is a clinical concept describing the broad group of ILDs characterized by progressive pulmonary fibrosis. The prevalence of progressive fibrotic ILDs other than idiopathic pulmonary fibrosis (IPF) is not well understood. Objectives: We used a novel algorithm to estimate the prevalence range of disease progression among patients with non-IPF fibrotic ILD in a U.S. claims database. Methods: This was a retrospective study including adults with commercial or Medicare Advantage with Part D (MAPD) insurance using administrative claims data from October 2015 to September 2019. Patients likely to have non-IPF fibrosing ILD with a progressive phenotype were identified via an algorithm that incorporated ILD-related diagnosis codes (excluding IPF) and claims-based proxies for fibrotic ILD progression, including pulmonary function tests, chest imaging, oral corticosteroid (OCS) medications, immunosuppressive medications, lung transplant, oxygen therapy, palliative care, and respiratory hospitalization. The prevalence range of non-IPF fibrotic ILD with progressive disease behavior was calculated using strict and lenient case definitions to account for potential imprecision in the progression proxies. Results: Of nearly 9 million study-eligible patients, 17,136 were identified with non-IPF fibrosing ILD. The prevalence of disease progression per 10,000 (95% confidence interval) ranged from 12.14 (11.74-12.54) to 29.05 (28.43-29.67) over a mean observation time of 1.44 years for MAPD enrollees (n = 14,686), and from 0.89 (0.81-0.97) to 2.36 (2.24-2.48) over a mean observation time of 1.29 years for commercial enrollees (n = 2,450). Prevalence estimates increased with age for both insurance types. Among patients with progression, 4,097 met at least two progression proxies not considering OCS (strict case definition) and 9,946 met at least one progression proxy (lenient case definition). The mean (standard deviation) number of proxies met was 2.1 (1.3), and the most common individual proxies met (alone or in combination with other proxies) were OCS use (48.9%), respiratory hospitalization (44.2%), and oxygen therapy (44.1%). Conclusions: This is among the first claims-based estimates of the prevalence of non-IPF chronic fibrosing ILD with a progressive phenotype. Our analysis indicates that this phenotype is rare in the overall population but increases substantially with increasing age.

A Pilot Evaluation of a Social Justice and Race Equity Training for Volunteer Mentors.

Mentor training on cultural humility is an area of needed support in formal youth mentoring relationships. This pilot study used an experimental design to examine the role of a social justice and race equity training on volunteer mentors' cognitive and affective outcomes related to cultural humility in mentoring. The sample included 99 volunteer mentors paired with adolescent mentees in an established formal mentoring program. Mentors predominantly identified as White (89%), and the majority (72%) were paired with youth of color. Participants were randomly assigned to either the training or control condition. Findings from intention-to-treat analyses indicated that training group participants (n = 49) exhibited greater increases in self-efficacy to provide racial/ethnic support over time than participants in the control group (n = 50). As-treated analyses indicated that training attendees (n = 23) exhibited greater increases in self-efficacy to provide racial/ethnic support over time than participants who did not attend the training (n = 76). Results indicated no significant changes over time in participants' training content knowledge, awareness of racial privilege, ethnocultural empathy, or social justice interest and behavioral intentions. Analyses also indicated an attendance bias within the training condition, such that mentors who attended the training reported significantly more awareness of racial privilege, social justice interest, and social justice behavioral intentions compared to training condition mentors who were invited but did not attend the training. Implications for training volunteer mentors within formal mentoring programs are discussed.

Act, Talk, Reflect, Then Act: The Role of Natural Mentors in The Critical Consciousness of Ethnically/Racially Diverse College Students.

The current mixed-method study examined the role of natural mentors in the cyclical process of college students' sociopolitical development, particularly their critical consciousness. College students (N = 145) completed surveys at two time points over a one-year period. Path analyses indicated that critical action and perceived inequalities were significantly associated with more social justice conversations with mentors and that having more social justice conversations with mentors was significantly associated with more critical action and perceived inequality. Further, mentoring conversations and sociopolitical efficacy helped to explain the positive role of perceived inequality and action on later attitudes around perceived inequalities and critical action. Qualitative one-on-one interviews of a subset of participants (n = 30) expanded findings from the quantitative data and revealed detailed information about how mentors supported youth critical consciousness. Specifically, mentors engaged in 1) dialogue and reflection, 2) information and resource sharing, 3) nonjudgmental, comfortable conversations, and 4) role modeling. Findings inform the iterative nature of critical consciousness and on how older adolescents leverage support from natural mentors in this process.

Emerging Adults' Social Justice Engagement: Motivations, Barriers, and Social Identity.

This study examines emerging adults' perceived motivations and barriers to social justice engagement, and how their social identities shape involvement. We conducted in-depth interviews with service-learning students (n = 30). Thematic analysis of interview data revealed that participants perceived several motivations and barriers to engagement, including the following: (a) the current political climate, (b) self-efficacy to make small-scale changes, (c) social support in action, (d) proximity to the social issue, (e) knowledge of resources, and (f) limited personal resources. Participants also described how their identities shaped engagement such that participants reflected upon their multiple privileged and marginalized identities and how their identities influenced their approach to engaging with a particular social issue. Findings have implications for recruiting and sustaining emerging adults' involvement in activities aimed at changing social issues.

Differences in Real-World Health and Economic Outcomes Among Patients with COPD Treated with Combination Tiotropium/Olodaterol Versus Triple Therapy.

BACKGROUND: The 2018 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends combination long-acting muscarinic antagonists/long-acting beta2-agonists (LAMA + LABA) as preferred maintenance therapy for patients with symptomatic chronic obstructive lung disease (COPD) after monotherapy and stepping up to triple therapy (TT; LAMA + LABA + inhaled corticosteroids [ICS]) in case of further exacerbations. Restrictions on TT recommendations have primarily been driven by higher pneumonia risk associated with regular ICS use. Evidence suggests that TT is overprescribed, which may affect economic and clinical outcomes. OBJECTIVE: To compare health plan-paid costs, COPD exacerbations, and pneumonia diagnoses among patients newly treated with a LAMA + LABA regimen composed of tiotropium (TIO) + olodaterol (OLO) in a fixed-dose combination inhaler (TIO + OLO) or TT in a U.S. Medicare Advantage Part D insured population. METHODS: This retrospective study identified COPD patients aged ≥ 40 years who were initiating TIO + OLO or TT (index regimen) between January 1, 2014, and March 31, 2018, from a national administrative claims database. Continuous insurance coverage for 12 months pretreatment (baseline) and ≥ 30 days posttreatment (follow-up) was required. Patients were followed until the earliest of study end (May 31, 2018), discontinuation of index regimen (≥ 60-day gap in index regimen coverage), switch to a different regimen, or health plan disenrollment. Before analysis of outcomes, TIO + OLO and TT patients were 1:1 propensity score-matched on baseline demographics, comorbidities, COPD medication use, medical resource use, and costs. Cohort differences in post-match outcomes were assessed by Wald Z-test (annualized costs) and Kaplan-Meier method (time to first COPD exacerbation and pneumonia diagnosis). RESULTS: After matching, each cohort had 1,454 patients who were well balanced on baseline characteristics. Compared with TT, the TIO + OLO cohort incurred $7,041 (41.1%) lower mean COPD-related total costs ($10,094 vs. $17,135; P < 0.001); cohort differences in the medical component ($3,666 lower for TIO + OLO) were driven by lower mean acute inpatient costs ($3,053 lower for TIO + OLO). Combined mean COPD plus pneumonia-related medical costs were $5,212 (39.0%) lower for TIO + OLO versus TT ($8,209 vs. $13,421; P = 0.006), and total mean all-cause costs were $9,221 (30.4%) lower for TIO + OLO versus TT ($21,062 vs. $30,283; P < 0.001). Kaplan-Meier analysis found longer time to first severe COPD exacerbation (P = 0.020) and first pneumonia diagnosis (P = 0.002) for TIO + OLO versus TT and a lower percentage of TIO + OLO patients experiencing these events (severe COPD exacerbation: 9.0% vs. 16.1%; pneumonia: 14.5% vs. 19.3%). A secondary analysis, which expanded the TIO + OLO cohort to include any LAMA + LABA regimen, had similar findings for all outcomes. CONCLUSIONS: COPD patients initiating TIO + OLO incurred lower costs to health plans and experienced fewer COPD exacerbation and pneumonia events relative to TT. These findings provide important real-world economic and clinical insight into the GOLD recommendations for TIO + OLO and LAMA + LABA therapy. The study findings also indicate the continued inconsistency between the recommendations and real-world clinical practices pertaining to TT. DISCLOSURES: This study was sponsored by Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI). Palli and Franchino-Elder are employees of BIPI. Frazer, DuCharme, Buikema, and Anderson are employees of Optum, which was contracted by BIPI to conduct this study. The authors received no direct compensation related to the development of the manuscript. BIPI was given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations.

A Qualitative Systematic Review of Youth Participatory Action Research Implementation in U.S. High Schools.

This qualitative systematic review examined the context-specific factors that influence the implementation of youth participatory action research (YPAR) projects in high schools within the United States. Thematic synthesis was conducted to identify and analyze the YPAR implementation factors that were present in 38 peer-reviewed studies. Results indicate the following two analytic themes concerning YPAR implementation in high schools: (a) pedagogical strategies and (b) stakeholder dynamics and needs. The themes provide support for existing ecological frameworks of implementation factors and demonstrate that adult researchers' project-specific decisions are nested within educational power structures. This paper will discuss the implications of these YPAR implementation themes in executing YPAR projects in high schools.

Helping me helps us: The role of natural mentors in the ethnic identity and academic outcomes of Latinx adolescents.

This research investigated the potential contributions of natural mentoring relationships and ethnic identity to the academic attitudes and performance of Latinx high school students. In a sample of 347 urban Latinx students in grades 9 and 10, analyses examined the presence and quality of mentoring relationships as well as ethnic identity exploration and affirmation as predictors of changes in grade point average and the perceived economic value of education. Analyses included tests for a hypothesized role of ethnic identity in mediating associations of mentoring measures with the academic outcomes. The presence of a mentoring relationship was not significantly related to ethnic identity or change in academic outcomes over time. However, mentoring relationship quality was associated with a more positive ethnic identity, and support was found for the hypothesis that ethnic identity mediates the association between the quality of mentoring relationships and change over time in the economic values toward education among Latinx adolescents. Study findings suggest the importance of supportive adults in the ethnic identity and academic outcomes of Latinx adolescents. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Social inequality within the IEP meeting: Three factors that disempower students.

How do stakeholder power dynamics promote social inequalities and impede empowerment of students with disabilities in the individualized education program (IEP) process? This conceptual case study explores the role of critical discourse in reducing social inequality in the IEP process for students with disabilities in two special education day schools within a metropolitan school district. The lead author's observations and field notes describe three influential stakeholder tensions over an 11-month period in two schools for children with disabilities. Sociopolitical history, or the historical context of the public school system within the metropolitan district, provides the overarching temporal ecology for all examples of stakeholder tensions. Individual stakeholder perceptions of private vs. public schools and the role of separate schools are the second and third tensions that influence student participation in the setting. Implications for increasing critical discourse in order to adequately empower students with disabilities in the IEP process are considered.

Natural Mentoring, Academic Motivation, and Values Toward Education Among Latinx Adolescents.

We examined the roles of relational and instrumental relationship quality with natural mentors and academic intrinsic motivation on Latinx adolescents' perceived economic values of education. Participants were 256 Latinx youth (M = 15.07 years old; 116 boys, 140 girls) who completed surveys in 9th and 10th grades. Path analyses indicated significant cross-sectional effects in 9th grade such that instrumental quality was associated with more perceived benefits of education, and relational quality was associated with fewer perceived limitations of education. Neither instrumental nor relational quality in 9th grade was associated with either benefits or limitations of education in 10th grade. Instrumental relationship quality in 9th grade, however, did have an indirect effect on perceived benefits of education in 10th grade through intrinsic motivation. Implications for research on natural mentoring with Latinx adolescents are discussed.

Compliance with clinical guidelines and adherence to antiretroviral therapy among patients living with HIV.

Objective: Evaluation of provider compliance with antiretroviral (ARV) treatment guidelines and patient adherence to ARVs is important for HIV care quality assessment; however, there are few current real-world data for guideline compliance and ARV adherence in the US. This study evaluated provider compliance with US Department of Health and Human Services (DHHS) guidelines and patient adherence to ARVs in a US population of patients with HIV.Methods: This was a retrospective claims study of adults with HIV-1 receiving ARV treatment between January 2010-December 2014. Follow-up began at first ARV treatment and ended at health plan disenrollment or study end. ARV regimens for treatment-naïve patients were categorized as "preferred/recommended", "alternative", or "non-preferred/recommended/alternative" according to DHHS guidelines. ARV adherence was evaluated using proportion of days covered (PDC) and medication possession ratio (MPR).Results: The analysis included 25,320 patients (84.4% male, mean age 45.3 years) and 39,071 regimens. Preferred/recommended regimens were most common during each study year, but the proportion of non-preferred/recommended/alternative regimens was substantial (15.9-20.6%). Only 53.6% of patients had optimal adherence by PDC ≥0.95, and 57.9% by MPR ≥0.95. Guideline non-compliance and sub-optimal adherence were more prevalent among female vs male patients (22.6% vs 14.8% [in 2014] and 65.9% vs 53.7%, respectively).Conclusions: Provider non-compliance with DHHS guidelines and sub-optimal ARV adherence among patients with HIV remain common in real-world practice, particularly for female patients. Healthcare providers should follow the latest clinical guidelines to ensure that patients receive recommended therapy, and address non-adherence when selecting ARV regimens.

Supporting adults to support youth: An evaluation of two social justice trainings.

The current research examined pre- and post survey data in two social justice trainings for adults who support youth, including staff and volunteers (Study 1, N = 44) at youth-serving organizations and adults who mentor young Black men and boys (Study 2, N = 72). We investigate whether training participants' self-report scores of cultural competences (studies 1 and 2), self-efficacy for race equity (Study 1) and racial self-efficacy to support mentee (Study 2) changed between the beginning of the training and after the training. Furthermore, we examine whether the changes depend upon whether training participants share cultural background with the youth with whom they work. In Study 1, findings indicated that training participants reported significantly increased scores of cultural sensitivity and self-efficacy for race equity. Individuals who were not first-generation college students saw higher increases in sociopolitical awareness. In Study 2, participants reported significantly higher scores of cultural sensitivity and racial self-efficacy to support their mentees. Furthermore, non-Black and women participants showed greater increases in self-efficacy than Black and male participants. These results fill a gap in the literature on the potential role of social justice trainings to increase cultural competencies among adults who work with diverse youth.