Machine Learning-based Analysis of Publications Funded by the National Institutes of Health's Initial COVID-19 Pandemic Response.

Background: The National Institutes of Health (NIH) mobilized more than $4 billion in extramural funding for the COVID-19 pandemic. Assessing the research output from this effort is crucial to understanding how the scientific community leveraged federal funding and responded to this public health crisis. Methods: NIH-funded COVID-19 grants awarded between January 2020 and December 2021 were identified from NIH Research Portfolio Online Reporting Tools Expenditures and Results using the "COVID-19 Response" filter. PubMed identifications of publications under these grants were collected and the NIH iCite tool was used to determine citation counts and focus (eg, clinical, animal). iCite and the NIH's LitCOVID database were used to identify publications directly related to COVID-19. Publication titles and Medical Subject Heading terms were used as inputs to a machine learning-based model built to identify common topics/themes within the publications. Results and Conclusions: We evaluated 2401 grants that resulted in 14 654 publications. The majority of these papers were published in peer-reviewed journals, though 483 were published to preprint servers. In total, 2764 (19%) papers were directly related to COVID-19 and generated 252 029 citations. These papers were mostly clinically focused (62%), followed by cell/molecular (32%), and animal focused (6%). Roughly 60% of preprint publications were cell/molecular-focused, compared with 26% of nonpreprint publications. The machine learning-based model identified the top 3 research topics to be clinical trials and outcomes research (8.5% of papers), coronavirus-related heart and lung damage (7.3%), and COVID-19 transmission/epidemiology (7.2%). This study provides key insights regarding how researchers leveraged federal funding to study the COVID-19 pandemic during its initial phase.

Analysis of National Institutes of Health Funding for the COVID-19 Pandemic.

Background: Evaluating the National Institute's Health's (NIH's) response to the coronavirus disease 2019 (COVID-19) pandemic via grants and clinical trials is crucial to determining the impact they had on aiding US citizens. We determined how the NIH's funding for COVID-19 research was disbursed and used by various institutions across the United States. Methods: We queried NIH RePORTER and isolated COVID-19-related grants from January 2020 to December 2021. We analyzed grant type, geographical location, and awardee institution. Manuscripts published from these grants were quantitatively analyzed. COVID-19 clinical trials were mapped and distances from counties to clinical trial sites were calculated using ArcGis. Results: A total of 2401 COVID-19 NIH grants resulted in 14 654 manuscripts from $4.2 billion and generated more than 150 000 citations. R01s make up 32% of grants (763/2401) and 8% of funding ($329 million). UM1 grants account for the majority of funding (30.8%; $1.3 Billion). Five states received 50.6% of funding: North Carolina, Washington, New York, California, and Massachusetts. Finally, of the 1806 clinical trials across 1266 sites in the United States, the majority were in metropolitan areas in close proximity to areas of high COVID-19 disease burden. Conclusions and Relevance: Evaluating the outcome of the NIH's response to the COVID-19 pandemic is of interest to the general public. The present study finds that the NIH disbursed more than $4 billion in funding to large consortiums and clinical trials to develop diagnostics, therapeutics, and vaccines. Approximately 8% of funding was used for R01 grants. Clinical trial sites were generally located in areas of high COVID-19 burden.

A qualitative focus group analysis: Increasing fieldwork capacity in genetic counseling training programs.

Genetic counselors are an integral part of the healthcare system; however, the number of genetic counselors in many parts of the United States is limited, impacting access to comprehensive healthcare for all patients. One solution to addressing this deficit includes modifying genetic counseling training programs to increase student enrollment. Fieldwork capacity, driven by a limited number of rotation sites and supervisors, produces a significant bottleneck to entering the profession. Other professions have reported on techniques to increase fieldwork capacity; however, the practicality of these techniques for genetic counseling training has yet to be explored. This study seeks to investigate the perspectives of key stakeholders in genetic counseling training programs on the practicality of techniques already posited in the literature from other allied health professions. Semi-structured focus group interviews with 25 participants were conducted at the 2019 National Society of Genetic Counselors conference. Participants included program directors and supervisors from clinical, industry, and laboratory backgrounds. The focus group responses were analyzed using directed content analysis and a split coding technique, after which several themes emerged within the larger domains of rotation structures, systems infrastructure, skill-building methods, and other novel techniques to increase fieldwork capacity. Emerging themes included the importance of finding quality student placements rather than maximizing the quantity of participatory cases; a need for transparency about the transferability of skills learned from novel experiences; scaffolding student entrustment to expand supervisor capacity; and recognizing nuances in implementation for individual programs. Overall, the results emphasize the importance of openness in communication to manage expectations for students and supervisors, who may be more hesitant to try novel rotation placements and skill-building techniques. Genetic counseling programs may use these results to address the bottleneck of fieldwork capacity, increasing student enrollment.

Beyond multiple choice: Clinical simulation as a rigorous and inclusive method for assessing genetic counseling competencies.

Educational use of clinical simulation is a way for students to immerse themselves within a realistic yet safe and structured environment as they practice clinical skills. It is widely used in healthcare training and evaluation, and there are best practices for design, implementation, debriefing, and assessment. An increasing number of genetic counseling graduate programs use simulation in various ways, ranging from role-plays to working with professional simulated/standardized patient (SP) actors. At this time, there is very little consistency across programs, research on the approaches, and standards by which simulation is incorporated into training. Simulation is an understudied but promising approach for genetic counselor (GC) education and assessment. After graduation, GCs demonstrate their competence as entry-level providers through American Board of Genetic Counseling (ABGC) multiple-choice examination (MCE), along with their participatory clinical encounters from graduate training. Data from genetic counseling and other professions highlight the limitations and biases of MCEs, suggesting they not only fail to accurately capture competency, but also that they disadvantage underrepresented individuals from entering the field. In addition, MCEs are limited as a tool for assessing nuanced counseling and communication skills, as compared to more quantitative scientific knowledge. We propose that innovative, evidence-based approaches such as simulation have the potential to not only enhance learning, but also to allow GCs to better demonstrate competency during training and in relation to the board examination. Collaborative approaches, research, and funding are needed to further explore the viability of routinely incorporating simulation into GC training and assessment.

Coffee and conversation: A genuine dialogue on authentic professional learning between genetic counselor educators.

Lifelong learning is a term frequently referred to in the training and continuing professional development of genetic counselors. It implies the ability to continuously engage in self-motivated reflection to identify knowledge gaps and develop a learning plan to address identified needs or interests. In contrast to this definition, the path to continuing professional development for most genetic counselors involves attendance at conferences; yet much data suggest that other forms of learning are more effective at leading to practice change and improved patient or quality outcomes. These conflicting ideas beg the question: what is professional learning? A dialogue between two genetic counselor educators, both with advanced training in health professional education, shares personal beliefs regarding lifelong learning in the genetic counseling profession. This discourse represents an authentic conversation that was audio-recorded and transcribed with minimal editing to improve clarity and readability. The views presented in this dialogue are highly personal, yet grounded in educational theory. References are provided to those that desire further reading on the topics discussed. Several authentic learning strategies are described, including communities of practice, peer supervision, and personal learning projects. The authors consider ways to increase knowledge acquisition from conference attendance and discuss how learning on the job becomes embedded in practice. As a result of this discourse, the authors hope to inspire genetic counselors to reflect over their continuing professional development and consider their job as a learning environment that presents rich, ongoing, and unique opportunities for growth. The authors invite and challenge readers to identify learning needs and set goals for themselves to address those needs. For those with interest in education, it is hoped that the conversation sparks new or invigorated interest that will lead to novel or more effective learning opportunities with improved outcomes for patients, students, and colleagues alike.

Trauma-focused therapy in early psychosis: results of a feasibility randomized controlled trial of EMDR for psychosis (EMDRp) in early intervention settings.

BACKGROUND: Trauma is prevalent amongst early psychosis patients and associated with adverse outcomes. Past trials of trauma-focused therapy have focused on chronic patients with psychosis/schizophrenia and comorbid Post-Traumatic Stress Disorder (PTSD). We aimed to determine the feasibility of a large-scale randomized controlled trial (RCT) of an Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) intervention for early psychosis service users. METHODS: A single-blind RCT comparing 16 sessions of EMDRp + TAU v. TAU only was conducted. Participants completed baseline, 6-month and 12-month post-randomization assessments. EMDRp and trial assessments were delivered both in-person and remotely due to COVID-19 restrictions. Feasibility outcomes were recruitment and retention, therapy attendance/engagement, adherence to EMDRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes. RESULTS: Sixty participants (100% of the recruitment target) received TAU or EMDR + TAU. 83% completed at least one follow-up assessment, with 74% at 6-month and 70% at 12-month. 74% of EMDRp + TAU participants received at least eight therapy sessions and 97% rated therapy sessions demonstrated good treatment fidelity. At 6-month, there were signals of promise of efficacy of EMDRp + TAU v. TAU for total psychotic symptoms (PANSS), subjective recovery from psychosis, PTSD symptoms, depression, anxiety, and general health status. Signals of efficacy at 12-month were less pronounced but remained robust for PTSD symptoms and general health status. CONCLUSIONS: The trial feasibility criteria were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable clinical outcomes. A larger-scale, multi-center trial of EMDRp is feasible and warranted.

The Intensive Care Unit Bundle Board: A Novel Real-Time Data Visualization Tool to Improve Maintenance Care for Invasive Catheters.

BACKGROUND: Critically ill patients are at greater risk of healthcare-associated infections (HAIs). The use of maintenance bundles helps to reduce this risk but also generates a rapid accumulation of complex data that is difficult to aggregate and subsequently act upon. OBJECTIVES: We hypothesized that a digital display summarizing nursing documentation of invasive catheters (including central venous access devices, arterial catheters, and urinary catheters) would improve invasive device maintenance care and documentation. Our secondary objectives were to see if this summary would reduce the duration of problematic conditions, that is, characteristics associated with increased risk of infection. METHODS: We developed and implemented a data visualization tool called the "Bundle Board" to display nursing observations on invasive devices. The intervention was studied in a 28-bed medical intensive care unit (MICU). The Bundle Board was piloted for 6 weeks in June 2022 and followed by a comparison phase, where one MICU had Bundle Board access and another MICU at the same center did not. We retrospectively applied tile color coding logic to prior nursing documentation from 2021 until the pilot phase to facilitate comparison pre- and post-Bundle Board release. RESULTS: After adjusting for time, other quality improvement efforts, and nursing shift, multiple linear regression demonstrated a statistically significant improvement in the completion of catheter care and documentation during the pilot phase (p < 0.0001) and comparison phase (p = 0.002). The median duration of documented problematic conditions was significantly reduced during the pilot phase (p < 0.0001) and in the MICU with the Bundle Board (comparison phase, p = 0.027). CONCLUSION: We successfully developed a data visualization tool that changed ICU provider behavior, resulting in increased completion and documentation of maintenance care and reduced duration of problematic conditions for invasive catheters in MICU patients.

Script concordance testing in genetic counseling training: A pilot study.

Clinical reasoning is a complex skill that represents a trainee's ability to use their professional knowledge and skills to assess and solve the problems that arise in clinical practice. As an integral tenet of the genetic counseling process, clinical reasoning skills underlie many of the Practice-Based Competencies (2019) across a variety of domains. Despite the long-lasting recognition of the importance of this complex skill in the training of genetic counselors, clinical reasoning has traditionally been difficult to assess in a standardized way in healthcare education. Script concordance testing is a standardized method of assessing clinical reasoning skills in ambiguous clinical situations. The tool has been used to successfully measure the clinical reasoning skills of trainees in various healthcare training programs and has never been used in a genetic counseling training program. We conducted a pilot study to assess the utility of script concordance testing in the field of genetic counseling as an objective measure of clinical reasoning in trainees. The script concordance test was constructed for the field of genetic counseling and administered to 22 second year genetic counseling students in the Joan H. Marks Graduate Program in Human Genetics at Sarah Lawrence College. Twelve genetic counselors served on a panel to provide expert clinical reasoning responses and a scoring grid was developed using the aggregate scores method. The utility of the tool was measured using Cronbach's alpha coefficient, and scores of students and the panel were compared using Hedge's g. Results revealed statistically significant differences between the scores of panelists and students and good reliability. This study shows that script concordance testing can be used to measure clinical reasoning skills in genetic counseling trainees in a way that is reliable, standardized, and easy to use, thereby allowing programs to better assess the clinical reasoning skills of trainees prior to graduation.

Commonalities and contrasts: North American program directors' perspectives on genetic counseling education.

There is currently a gap in the literature regarding education by and for genetic counseling (GC) students and genetic counselors. Since little is written about current strategies used in GC graduate programs, we conducted a qualitative semi-structured interview study of North American GC program directors to learn about their educational goals and practices. We recruited 25 program directors from the United States and Canada through the Association of Genetic Counseling Program Directors for interviews using a video conferencing platform. Interviews were recorded and transcribed, followed by content analysis to analyze education frameworks; processes of program planning and development; approaches and strategies for teaching and assessing GC core knowledge and skills; and systemic factors that influence GC education. We emphasized areas that are challenging to teach, particularly ethical, legal, and social issues (ELSI); disability issues; genomics; counseling skills; diversity, equity, inclusion, justice (DEIJ) issues; professional identity; research skills; and teaching skills. We found commonalities supported by standards and practice-based competencies and also a rich diversity of program cultures, approaches, and techniques for teaching and assessing genetic counseling skills. There was a consistent theme of integration across the program for all areas examined. A multilayered, comprehensive approach to DEIJ issues was advocated. Planned change was a logical outcome of program assessment, while unplanned change called for flexibility and creativity. The description of GC educational practices provides documentation of current approaches and strategies, guidance for new GC programs, and inspiration for continued evolution of existing GC graduate programs.

Sustaining small-scale fisheries through a nation-wide Territorial Use Rights in Fisheries system.

Territorial Use rights in Fisheries (TURFs) are used around the world to manage small-scale fisheries and they've shown varying levels of success. Our understanding of what leads to different performance levels is limited due to several reasons. Firstly, these systems are often present in areas with low monitoring capacity where data is scarce. Secondly, past research has centered on the analysis of successful cases, with little attention paid to entire systems. Thirdly, research has been ahistorical, disconnected from the development process of TURF systems. Fourthly, TURFs are often viewed as homogenous ignoring the socio-ecological conditions under which they develop. To address these gaps, the study focuses on Mexico as a case study and context. The research first presents a historical overview of the development of TURF systems in Mexico, including the institutional and legal frameworks that have shaped their evolution. The paper then presents a TURF database that maps all TURF systems in Mexico, including their geographical locations and characteristics. In addition, the study presents case studies based on identified archetypes that showcase the diversity of TURF systems in Mexico, highlighting the different types of systems and the challenges they face. By presenting a comprehensive map of all TURF systems in Mexico, this research paper aims to make an important addition to the case studies in the global literature on TURF systems and provide a valuable resource for marine resource management policymakers, researchers, and practitioners.

Early Empiric Antibiotic Use in Patients Hospitalized With COVID-19: A Retrospective Cohort Study.

OBJECTIVE: To investigate temporal trends and outcomes associated with early antibiotic prescribing in patients hospitalized with COVID-19. DESIGN: Retrospective propensity-matched cohort study using the National COVID Cohort Collaborative (N3C) database. SETTING: Sixty-six health systems throughout the United States that were contributing to the N3C database. Centers that had fewer than 500 admissions in their dataset were excluded. PATIENTS: Patients hospitalized with COVID-19 were included. Patients were defined to have early antibiotic use if they received at least 3 calendar days of intravenous antibiotics within the first 5 days of admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 322,867 qualifying first hospitalizations, 43,089 patients received early empiric antibiotics. Antibiotic use declined across all centers in the data collection period, from March 2020 (23%) to June 2022 (9.6%). Average rates of early empiric antibiotic use (EEAU) also varied significantly between centers (deviance explained 7.33% vs 20.0%, p < 0.001). Antibiotic use decreased slightly by day 2 of hospitalization and was significantly reduced by day 5. Mechanical ventilation before day 2 (odds ratio [OR] 3.57; 95% CI, 3.42-3.72), extracorporeal membrane oxygenation before day 2 (OR 2.14; 95% CI, 1.75-2.61), and early vasopressor use (OR 1.85; 95% CI, 1.78-1.93) but not region of residence was associated with EEAU. After propensity matching, EEAU was associated with an increased risk for in-hospital mortality (OR 1.27; 95% CI, 1.23-1.33), prolonged mechanical ventilation (OR 1.65; 95% CI, 1.50-1.82), late broad-spectrum antibiotic exposure (OR 3.24; 95% CI, 2.99-3.52), and late Clostridium difficile infection (OR 1.60; 95% CI, 1.37-1.87). CONCLUSIONS: Although treatment of COVID-19 patients with empiric antibiotics has declined during the pandemic, the frequency of use remains high. There is significant inter-center variation in antibiotic prescribing practices and evidence of potential harm. Our findings are hypothesis-generating and future work should prospectively compare outcomes and adverse events.

Strengthening Equity and Inclusion in Urban Greenspace: Interrogating the Moral Management & Policing of 2SLGBTQ+ Communities in Toronto Parks.

There is growing recognition that greenspace provides invaluable benefits to health and wellbeing, and is essential infrastructure for promoting both social and environmental sustainability in urban settings. This paper contributes towards efforts to build 'just' and equitable urban sustainability, and more specifically greenspace management, by drawing attention to hostility and exclusion experienced by two-spirit, lesbian, gay, bisexual, transgender, queer, genderqueer, pansexual, transsexual, intersex and gender-variant (2SLGBTQ+) park occupants. There is evidence that access to greenspace is inequitable-despite ongoing media accounts of targeted violence and discriminatory police patrolling of 2SLGBTQ+ communities in urban parks, this population has not received adequate research attention. This paper examines systemic barriers that impede urban greenspace access among 2SLGBTQ+ communities, including how the threat of violence in greenspace limits opportunities for accessing benefits associated with naturalized settings. These themes are explored within the context of the City of Toronto, Canada. Our mixed-method approach draws upon key informant interviews, key document content analysis, and ground-truthing. Our findings reveal how queer corporeality, kinship and love subvert deeply entrenched heteronormative social values and understandings of sexuality, partnership, gender, and use of public space, challenging institutional understandings of morality and daily life. The paper concludes by reflecting on the state of 2SLGBTQ+ communities' relationships to greenspace, and potential ways forward in building greater inclusivity into the social fabric of park design and management.

Fatigue Performance of Type I and Type II Fibre Bragg Gratings Fabricated by Femtosecond Laser Inscription through the Coating.

Strain sensing technology using fibre Bragg grating (FBG) sensors is an attractive capability for aerospace structural health monitoring (SHM) and assessment because they offer resistance to harsh environments, low maintenance, and potential for high density and high strain sensing. The development of FBG inscription techniques through the fibre polymer coating using infrared (IR) lasers has overcome the mechanical weaknesses introduced by removal of the fibre coating, which is typically required for conventional UV laser inscription of FBGs. Type I and Type II femtosecond gratings are fabricated using through-coating inscription techniques, but the higher laser energy used for Type II gratings damages the glass fibre core, impacting mechanical performance. This paper investigates the fatigue performance of Type I and Type II through-coating FBG sensors with different fibre geometries and photosensitisation approaches to evaluate their overall reliability and durability, with a view to assess their performance for potential use in civil and defence SHM applications. The fatigue performance of FBG sensors was assessed under high-strain and high-frequency mechanical loading conditions by using a custom-designed electro-dynamically actuated loading assembly. In addition, pre- and post-fatigue microscopic analyses and high-resolution reflection spectrum characterisation were conducted to investigate the failure regions of the fibres and the effect of fatigue loading on reflection spectrum features. As expected, Type I gratings had a significantly higher fatigue life compared to Type II gratings. However, Type II gratings performed significantly better than conventional UV laser-inscribed FBGs and electrical foil strain gauges. Type II gratings withstand higher temperatures, and are therefore more suitable for application in harsh environments.

Genetic counseling students' and recent graduates' attitudes toward psychiatric illness.

Due to the high prevalence of mental illness in the general population, genetic counselors are likely to encounter patients with mental illness in practice, regardless of specialty. However, previous studies have shown that recent graduates of genetic counseling programs do not feel comfortable discussing mental illness in clinical encounters. One possible explanation for this discomfort is stigma toward mental illness, a well-documented phenomenon both in society and in the healthcare field. Previous studies of this phenomenon in genetic counselors and trainees have relied on self-report measures and are vulnerable to social desirability bias. We sought to gain a holistic understanding of attitudes toward mental illness held by genetic counseling trainees by measuring implicit and explicit biases. This study assessed 141 responses from genetic counseling students and recent graduates from master's graduate programs across North America. They were asked to complete a survey, which included a demographic questionnaire, a scale that has been validated for use for a variety of healthcare professionals (Nordt et al. 2006, Schizophrenia Bulletin, 32, 709), measuring explicit attitudes toward those with depression and schizophrenia (i.e., social distance and stereotype endorsement), and an implicit association test. Mean scores on the social distance and stereotype endorsement scales were higher for schizophrenia than depression, indicating higher levels of explicit bias toward the former than the latter. Participants held slightly significant implicit bias toward individuals with either physical or mental illness. These data suggest that unconscious or implicit bias may not contribute to unpreparedness to address psychiatric disorders in clinical practice that has been previously reported by new graduates. Therefore, genetic counseling trainees may be receptive to clinically relevant education pertaining to mental illness. These results could inform the curriculum of genetic counseling programs and facilitate provision of services to this population.

Human trafficking and violence: Findings from the largest global dataset of trafficking survivors.

BACKGROUND: Human trafficking is a recognized human rights violation, and a public health and global development issue. Violence is often a hallmark of human trafficking. This study aims to describe documented cases of violence amongst persons identified as victims of trafficking, examine associated factors throughout the trafficking cycle and explore prevalence of abuse in different labour sectors. METHODS AND FINDINGS: The IOM Victim of Trafficking Database (VoTD) is the largest database on human trafficking worldwide. This database is actively used across all IOM regional and country missions as a standardized anti-trafficking case-management tool. This analysis utilized the cases of 10,369 trafficked victims in the VoTD who had information on violence. RESULTS: The prevalence of reported violence during human trafficking included: 54% physical and/or sexual violence; 50% physical violence; and 15% sexual violence, with 25% of women reporting sexual violence. Experiences of physical and sexual violence amongst trafficked victims were significantly higher amongst women and girls (AOR 2.48 (CI: 2.01,3.06)), individuals in sexual exploitation (AOR 2.08 (CI: 1.22,3.54)) and those experiencing other forms of abuse and deprivation, such as threats (AOR 2.89 (CI: 2.10,3.98)) and forced use of alcohol and drugs (AOR 2.37 (CI: 1.08,5.21)). Abuse was significantly lower amongst individuals trafficked internationally (AOR 0.36 (CI: 0.19,0.68)) and those using forged documents (AOR 0.64 (CI: 0.44,0.93)). Violence was frequently associated with trafficking into manufacturing, agriculture and begging (> 55%). CONCLUSIONS: An analysis of the world's largest data set on trafficking victims indicates that violence is indeed prevalent and gendered. While these results show that trafficking-related violence is common, findings suggest there are patterns of violence, which highlights that post-trafficking services must address the specific support needs of different survivors.

The Case for Onlay Biologic Mesh in Abdominal Wall Reconstruction Using Progressive Tension Suture Fixation.

BACKGROUND: After many years of debate, underlay and sublay placement of mesh slowly emerged as the standard of care in abdominal wall reconstruction because of lower hernia recurrence rates. However, onlay has the advantages of being faster, less invasive, and technically easier compared with underlay and sublay. Therefore, if a similar recurrence could be achieved, then onlay should be a consideration. In this study, we present a new onlay method using multipoint progressive tension suture fixation. METHODS: This was a retrospective chart review of patients who underwent abdominal wall reconstruction from 2012 to 2019. Inclusion criteria included onlay mesh placement and at least 1 year of follow-up. The core principles of the surgical technique are establishing myofascial continuity by component separation and reinforcing the repair with onlay mesh that is fixated with multipoint progressive tension sutures. RESULTS: The number of patients after exclusions was 59, and the average body mass index was 32.52 ± 6.44 kg/m2. More than half (62.7%) of patients had a history of hypertension, 95% had at least 1 prior abdominal/pelvic surgery, and 61% had at least 1 prior hernia repair. Postoperative complications included 20.3% of patients requiring drainage of a fluid collection in the clinic setting, and 29.3% of patients requiring return to the operating room for any reason (including superficial wound debridement). The average defect size was 231.88 ± 195.86 cm2, the mean follow-up was 3.11 ± 1.83 years, and the recurrence rate was 5.1%. CONCLUSIONS: We report a hernia recurrence rate of 5.1% in a high-risk population with complex defects at a mean of 3.1 years of follow-up using onlay mesh fixated with multipoint progressive tension sutures. This recurrence rate is similar to that reported for both underlay and sublay techniques. However, the onlay approach is technically easier, faster, and less invasive compared with underlay and sublay techniques, which may translate into wider reproducibility, lower costs, and improved patient safety.

A focused ethnographic study on the role of health and sustainability in food choice decisions.

In the United States, typical dietary patterns are not necessarily healthy and sustainable. In order to shift diets, we need to provide support to individuals in a way that reflects what matters most to them. In this study, we aimed to identify the considerations that are most important to individuals regarding food-related decisions, and to determine how those considerations relate to specific foods, with a focus on health and environmental sustainability. In a sequential mixed-methods design, we first conducted 27 semi-structured interviews with participants in California and Nebraska. These interviews included a free-listing activity, where we used a technical construct of salience, Smith's S Index, to identify the considerations that were most important to our participants. We followed up with 20 of those participants to complete a pile-sorting survey, where participants sorted and rated 42 food items for price, taste, health, convenience, familiarity, and environmental impact. Our findings showed that the most salient considerations cited by our participants were price, health, taste, and time. There was consensus for how participants rated the foods for price, taste, convenience, and familiarity. However, there was only weak consensus for how participants rated the foods for health impact, and no consensus for how participants rated the foods for environmental impact. There was also disagreement on how to sort new plant-based products intended to replace or substitute meat and other animal-based foods. These findings have implications for how to communicate about healthy and sustainable diets. They highlight conflicting considerations, disagreement in classification of new products, and limited consensus for perceived health and environmental impact of foods, which present challenges to the achievement of diets that are healthy and environmentally sustainable in the United States.

Effects of semantic reinforcement, semantic discrimination, and affix frequency on new word learning in skilled and less skilled readers in Grades 6 to 12.

Two approaches to word learning were investigated in 1214 6th- to 12th-grade students. Definitions were provided, followed either by two sentences that were semantically correct exemplars, called semantic reinforcement learning, or by one correct sentence and a contrasting incorrect sentence (i.e., example followed by a structurally aligned non-example), called semantic discrimination learning. Type of learning was blocked, and examples and non-examples were explained. Effects of affix frequency were also assessed. Students were taught words, followed by assessments of abilities to recall the meanings of the words immediately after learning them, to choose the correct words among distractors to match given definitions after all words had been instructed, and to judge the semantic veracity of new sentences containing taught words 1-3 days later. Explanatory item response models were used to predict word learning using student and item characteristics along with their interactions. Few grade-related differences emerged. Higher-frequency affixes were generally beneficial for learning and retention across comprehension skill levels and measures. Immediate recall of word meanings was facilitated by semantic reinforcement learning. In contrast, performance after all the words had been instructed was facilitated by semantic discrimination learning, but only for more highly skilled comprehenders. The ability to learn the meanings of new words accounted for unique variance on one measure of reading comprehension, controlling for decoding, previously acquired vocabulary knowledge, and working memory. Results are discussed with reference to models of vocabulary learning and implications for vocabulary instruction for adolescents.

Ranking United States Plastic Surgery Residency Programs Based on Academic Achievement of Faculty Members.

INTRODUCTION: The Doximity Residency Navigator is currently the only resource that ranks plastic surgery residency programs. Given the paucity of objective program rankings, in this study, we devised a new algorithm to rank plastic surgery programs based on academic achievement of faculty members. METHODS: The Fellowship and Residency Electronic Interactive Database was used to obtain the following information on plastic surgery programs: the amount of 2017 National Institute of Health and Veterans Administration funding, lifetime and 5-year faculty h-indices, and the number of faculty on editorial boards of journals. Based on all of this information, an overall ranking of the top 25 plastic surgery programs was created. RESULTS: The top program for annual National Institutes of Health and Veteran Affairs funding was the University of Southern California (integrated and independent). The top programs for faculty lifetime h-index were the University of Michigan (integrated) and New York University (independent). The top program for faculty 5-year h-index was the University of Pennsylvania (integrated and independent). The top program for the number of faculty members who are on the editorial boards of major journals was Harvard University (integrated and independent). The top program overall was Harvard University (integrated and independent). CONCLUSION: We ranked plastic surgery residency programs based on objective data related to faculty academic achievement. Academic achievement rankings are just one of numerous other factors that medical students should synthesize when making informed decisions when applying to residency.