Responses to Wildfire and Prescribed Fire Smoke: A Survey of a Medically Vulnerable Adult Population in the Wildland-Urban Interface, Mariposa County, California.

California plans to substantially increase the use of prescribed fire to reduce risk of catastrophic wildfires. Although for a beneficial purpose, prescribed fire smoke may still pose a health concern, especially among sensitive populations. We sought to understand community health experience, adaptive capacity, and attitudes regarding wildland and prescribed fire smoke to inform public health guidance. We conducted a cross-sectional survey of medically vulnerable persons in a rural, high fire risk county (N = 106, 76% > 65 years) regarding wildfire and prescribed smoke health effects; health protective actions; information needs; and support for fire management policies. Qualitative comments were reviewed for context and emerging themes. More than half (58%) of participants reported health impacts from wildfire smoke; 26% experienced impacts from prescribed fire smoke. Participants expressed strong support for prescribed fire, although also concerns about safety and smoke. Respondents reported taking actions to reduce smoke exposure (average 5 actions taken per person), but many (47%) lacked confidence that they could successfully protect their health. Persons who were satisfied with the information received tended to be more confident in their ability to protect their health compared to those who were not satisfied (61% vs. 35%). More information was desired on many topics, including notifications about prescribed fire, health protection and exposure reduction. As California expands use of prescribed fire, the need for effective health protective communication regarding smoke is increasingly vital. We recommend seeking solutions that strengthen community resilience and address equity for vulnerable populations.

Health-Related Quality of Life After Single Ventricle Palliation or Tetralogy of Fallot Repair.

Single ventricle (SV) cardiac lesions and tetralogy of Fallot (TOF) are both common forms of cyanotic congenital heart disease. With advances in perioperative care and longitudinal follow-up, survival of these patients has dramatically improved and the majority survive to adulthood. This study compares health-related quality of life (HRQoL) of adult SV and TOF patients to each other and the general population. HRQoL of all surviving, non-transplanted SV and TOF patients 21 years of age and older at our institution was assessed with the SF-36 questionnaire via phone. Additional data including demographic parameters and information related to comorbidities and healthcare utilization were also analyzed. Among 81 eligible SV patients and 207 TOF patients, 33 (41%) and 75 (36%) completed the SF-36 phone survey, respectively. The mean age of SV patients was 32 vs. 38 years in the TOF group (p=0.01). SV patients reported more hepatic, pulmonary, and renal comorbidities. TOF patients were more likely to complete advanced degrees and more likely to have children (p=0.03). SV physical functioning scores were worse compared to TOF. In other domains of the SF-36 questionnaire, SV and TOF scores were similar. Compared to the general population, both groups reported worse bodily pain and mental health, but other aspects of psychosocial and general health were comparable. Overall HRQoL is good for both SV and TOF patients through early and mid-adulthood. Some QoL metrics were modestly worse in the SV patients. While these patients may have some physical limitations, psychosocial wellbeing appears preserved.

Publication Quality Following Short Summer Cancer Research Internships.

Publications of research conducted during short-term research education training programs serve as an outcome measure for students' successes and a program's value. We compared the impact of cancer publications from research conducted during a short-term cancer research education training program, to publications by program participants in the years following completion of the training program and earning an academic or professional degree. Bibliometrics and altmetrics from NIH, ResearchGate, Google Scholar and Scopus® that measure publication impact were collected on cancer publications by student interns in the CaRES (Cancer Research Experiences for Students) R25 program from 1999 to 2017; and on cancer publications in subsequent years by program alumni (students who completed CaRES). Publication characteristics and impact measures were described and compared. Of 558 publications, 206 (37%) were related to CaRES internship projects and 352 (63%) related to any cancer research in which program alumni engaged following their internships. CaRES project publications were cited more frequently and held a higher research interest score than later cancer publications by CaRES alumni but appeared in journals having lower impact factors (p < 0.05). A higher proportion of alumni were first authors of their publications as compared to first authorship by interns (p = 0.02). Research conducted during short-term cancer research programs can be scientifically meaningful and of comparable quality to publications by program alumni who engage in cancer research careers.

Outcomes in Pediatric Post-Cardiotomy ECMO Support With Modification of Systematic Support Strategy.

BACKGROUND: Utilization of extracorporeal membrane oxygenation (ECMO) support in the post-cardiotomy setting is vital to successful perioperative outcomes following pediatric cardiac surgery. Specific analysis of protocolized management strategies and staff preparedness is imperative to optimizing institutional ECMO outcomes. METHODS: All patients requiring post-cardiotomy ECMO support at a single institution from 2013 to 2019 were retrospectively reviewed. In 2015, several modifications were made to the ECMO support paradigm that addressed deficiencies in equipment, critical care protocols, and staff preparedness. Cases were stratified according to era of ECMO support; patients supported prior to paradigm change from 2013 to 2015 (Group EARLY, n = 20), and patients supported following the implementation of systematic modifications from 2016 to 2019 (Group LATE, n = 26). The primary outcomes of interest were survival to decannulation and hospital discharge. RESULTS: Median age at cannulation was 24.5 days (IQR 7-96) and median duration of support was 4 days (IQR 2-8). Overall survival to decannulation was 78.3% (65% EARLY vs. 88.5% LATE, P = .08) and overall survival to hospital discharge was 58.7% (35% EARLY vs. 76.9% LATE, P = .004). CONCLUSION: Systematic modifications to ECMO support strategy and staff preparation are associated with a significant increase in perioperative survival for pediatric patients requiring post-cardiotomy ECMO support.

Examining racial and socioeconomic disparity in the pediatric heart transplant evaluation.

Racial disparities have been reported among pediatric patients waitlisted for and undergoing heart transplantation but have not been studied further upstream in the transplant candidate evaluation process. We retrospectively studied our single-center experience in order to investigate any potential biases in the evaluation process. Results of the heart transplant evaluation in children ≤18 years old at our institution were analyzed. Primary outcome was final disposition to waitlist or not. Race was defined by family self-identification. Descriptive and comparative statistical analyses were performed. From 2013 to 2019, 133 unique patients were referred for listing consideration. While Black patients comprised 44% of the referral population and had more markers of socioeconomic disadvantage, they comprised 43% of the patients who were listed for transplantation with no significant difference between these proportions (p = .96). Black and White patients made up a similar proportion of patients deemed too well or too ill for listing. Black patients had lower annual household income estimates and rates of household marriage. Despite identifying significant social challenges in 27 patients (18 of them Black), only five patients (3 Black and 2 White) were turned down for listing due to social barriers. While limited by the small number of patients turned down for social barriers, our transplant evaluation process does not appear to result in racial disparities in access to listing. Further studies are needed using national cohorts to explore possible racial disparities upstream from waitlisting and transplantation, such as during the referral and evaluation.

Therapeutic orientation preferences in trainee clinical psychologists: personality or training?

This study investigated the relative influence of person and training factors on preference for three common therapeutic orientations--cognitive-behavioural therapy (CBT), psychodynamic therapy, and systemic therapy--in 142 U.K. trainee clinical psychologists. Consistent with previous research, preferences for therapeutic orientation were related to personality, philosophical worldview, the theoretical emphasis of training courses, and the orientation of supervisors. Preference for psychodynamic therapy was influenced more by training factors and preference for CBT more by person factors, with the influence of both sets of factors being approximately equal for systemic therapy. Supervision was more influential than the theoretical emphasis of training courses in predicting preferences for psychodynamic and systemic therapies, with the converse pattern found for CBT.