Outpatient visits and antibiotic use due to higher valency pneumococcal vaccine serotypes.

BACKGROUND: In 2022-2023, 15- and 20-valent pneumococcal conjugate vaccines (PCV15/PCV20) were recommended for infants. We aimed to estimate the incidence of outpatient visits and antibiotic prescriptions in U.S. children (≤17 years) from 2016-2019 for acute otitis media, pneumonia, and sinusitis associated with PCV15- and PCV20-additional (non-PCV13) serotypes to quantify PCV15/20 potential impacts. METHODS: We estimated the incidence of PCV15/20-additional serotype-attributable visits and antibiotic prescriptions as the product of all-cause incidence rates, derived from national healthcare surveys and MarketScan databases, and PCV15/20-additional serotype-attributable fractions. We estimated serotype-specific attributable fractions using modified vaccine-probe approaches incorporating incidence changes post-PCV13 and ratios of PCV13 versus PCV15/20 serotype frequencies, estimated through meta-analyses. RESULTS: Per 1000 children annually, PCV15-additional serotypes accounted for an estimated 2.7 (95% confidence interval 1.8-3.9) visits and 2.4 (1.6-3.4) antibiotic prescriptions. PCV20-additional serotypes resulted in 15.0 (11.2-20.4) visits and 13.2 (9.9-18.0) antibiotic prescriptions annually per 1,000 children. PCV15/20-additional serotypes account for 0.4% (0.2-0.6%) and 2.1% (1.5-3.0%) of pediatric outpatient antibiotic use. CONCLUSIONS: Compared with PCV15-additional serotypes, PCV20-additional serotypes account for >5 times the burden of visits and antibiotic prescriptions. Higher-valency PCVs, especially PCV20, may contribute to preventing pediatric pneumococcal respiratory infections and antibiotic use.

Insights From a Community-Based Strategy to Assess Tobacco and Vape Shop Retailers' Implementation of Tobacco 21 Law in El Paso, Texas.

In 2019, the United States Congress passed Tobacco 21 (T21) legislation that raised the minimum legal sales age for tobacco products from 18 to 21. However, although the federal legislation superseded weaker state laws that were already in place in some states, including Texas, local guidance for retailers was inconsistent. Given that retailers are ultimately responsible for policy implementation, the American Heart Association (AHA) initiated a process of assessing retailers knowledge and perceptions of the law through a survey targeting all tobacco retailers and accompanying ethnography of a subset of vape shops in El Paso, Texas. The process yielded lessons learned for assessment of community-based policy implementation including key considerations for personnel and process that are applicable to other community-based assessment processes. While AHA considered an in-person approach ideal, having an alternate online response option was necessary. In addition, a focused approach and in-depth understanding of the purpose was key to responsiveness of the retailers.

Purpose maintained: Adverse childhood experiences and meaning in life.

OBJECTIVE: Three studies examined the relationship between adverse childhood experiences and meaning in life, focusing on the facets of meaning-coherence, significance, and purpose. METHOD: In Study 1 (N = 1804), college students rated adverse childhood experiences, global meaning in life, and its facets. In Study 2 (N = 822), noncollege adults rated childhood trauma, meaning in life facets, attachment style, mood, and neuroticism. In Study 3 (N = 380) college students wrote about a positive and negative childhood memory, rating the facets of meaning immediately after each writing task. RESULTS: In Studies 1-2, at the level of zero-order correlations, adverse childhood experiences related negatively to coherence, significance, and purpose. Controlling for the other facets, adverse childhood experiences remained negatively related to coherence and significance but were unrelated to purpose. Negative relationships between adverse childhood experiences and coherence and significance maintained controlling for covariates (Study 2). In Study 3, the predicted 3-way interaction showed that after recalling a negative childhood memory, adverse childhood experiences predicted lower significance and coherence but higher purpose. CONCLUSIONS: Adverse childhood experiences consistently predict lower feelings of coherence and significance but, accounting for these associations, are unrelated to purpose. Purpose may represent a motivational strength emerging out of childhood adversity.

Systems-Level Evaluation of Safe Routes to School Policies in El Paso, Texas: A Modeling Study on Health and Economic Outcomes.

Safe Routes to School (SRTS) policies are linked to physical health benefits for school-age children; however, few studies have assessed long-term impacts on cardiovascular disease (CVD). This study used systems science methods to predict long-term health and economic impact of SRTS among school-age children in El Paso County, Texas. We developed an agent-based model containing 2 modules: the pedestrian injury module and the CVD module. We simulated 10 000 school-age children under 2 scenarios-SRTS policies implemented and no SRTS policies implemented-and then calculated pedestrian injuries, pedestrian injury-related deaths, coronary heart disease (CHD) and stroke events, and health care costs. When SRTS policies were implemented, the model estimated 157 fewer CHD cases and 217 fewer stroke cases per 10 000 people and reduced CVD-related health care costs ($13 788 per person). The model also predicted 129 fewer pedestrian injuries and 1.3 injury-related deaths per 10 000 people and $2417 savings in injury-related health care costs. SRTS could save an estimated $16 205 per person in health care costs. This simulation shows SRTS in El Paso County could prevent pedestrian injuries among school-age children and protect cardiovascular health in the long term. Our findings provide evidence for practitioners and policy makers to advocate for SRTS policies at the local level.

Smoke-Free Policy Adoption in Horizon City and El Paso Community College: A Strategic Campaign Approach That Turns a "No" Into a "Yes".

Coalitions in Horizon City in El Paso County, Texas and the El Paso Community College (EPCC) had previously attempted to pass smoke-free policies in 2008 and 2016, respectively; however, both policies failed to pass at those times. The coalitions refocused their activities and were successful in passing policies in EPCC in 2020 and in Horizon City in 2021. We employed a participatory case study method to understand what factors changed between the first and second attempts at smoke-free policy adoption in Horizon City and EPCC. Using the Advocacy Coalition Framework as a basis for analysis, we identified the role of coalitions, their beliefs, use of power resources, role of policy brokers, and external events. We identify best practices and make recommendations for coalitions seeking to adopt smoke-free policies in other locations.

We Have a Voice: An Examination of Intimate Partner Violence in a Native American Community.

Indigenous people experience a higher rate of intimate partner violence (IPV) than other racial/ethnic groups; however, limited research examines IPV among this population. In collaboration with a tribe in the western United States, this study surveyed a sample of indigenous people (N = 27) to learn about their experiences with victimization. Results show that respondents experienced high amounts of recent relationship and lifetime victimization, mostly consistent with previous literature. Additional issues and challenges emerged from the data, such as low reporting rates and service accessibility. These findings are contextualized within prior IPV literature, and we offer recommendations for future research.

Quantifying evidence toward pathogenicity for rare phenotypes: The case of succinate dehydrogenase genes, SDHB and SDHD.

PURPOSE: The weight of the evidence to attach to observation of a novel rare missense variant in SDHB or SDHD in individuals with the rare neuroendocrine tumors, pheochromocytomas and paragangliomas (PCC/PGL), is uncertain. METHODS: We compared the frequency of SDHB and SDHD very rare missense variants (VRMVs) in 6328 and 5847 cases of PCC/PGL, respectively, with that of population controls to generate a pan-gene VRMV likelihood ratio (LR). Via windowing analysis, we measured regional enrichments of VRMVs to calculate the domain-specific VRMV-LR (DS-VRMV-LR). We also calculated subphenotypic LRs for variant pathogenicity for various clinical, histologic, and molecular features. RESULTS: We estimated the pan-gene VRMV-LR to be 76.2 (54.8-105.9) for SDHB and 14.8 (8.7-25.0) for SDHD. Clustering analysis revealed an SDHB enriched region (ɑɑ 177-260, P = .001) for which the DS-VRMV-LR was 127.2 (64.9-249.4) and an SDHD enriched region (ɑɑ 70-114, P = .000003) for which the DS-VRMV-LR was 33.9 (14.8-77.8). Subphenotypic LRs exceeded 6 for invasive disease (SDHB), head-and-neck disease (SDHD), multiple tumors (SDHD), family history of PCC/PGL, loss of SDHB staining on immunohistochemistry, and succinate-to-fumarate ratio >97 (SDHB, SDHD). CONCLUSION: Using methodology generalizable to other gene-phenotype dyads, the LRs relating to rarity and phenotypic specificity for a single observation in PCC/PGL of a SDHB/SDHD VRMV can afford substantial evidence toward pathogenicity.

The Science of Meaning in Life.

Meaning in life has long been a mystery of human existence. In this review, we seek to demystify this construct. Focusing on the subjective experience of meaning in life, we review how it has been measured and briefly describe its correlates. Then we review evidence that meaning in life, for all its mystery, is a rather commonplace experience. We then define the construct and review its constituent facets: comprehension/coherence, purpose, and existential mattering/significance. We review the many experiences that have been shown to enhance meaning in life and close by considering important remaining research questions about this fascinating topic.

Religious fundamentalism, right-wing authoritarianism, and meaning in life.

OBJECTIVE: Two studies examined the relationship between right-wing authoritarianism (RWA) and religious fundamentalism (RF), and tested their unique contributions to meaning in life (MIL). METHOD: We recruited Amazon Mechanical Turk Participants located in the United States. Studies 1 (N = 827) included measures of RWA, RF, and global MIL. Study 2 (N = 809) additionally included measures of the facets of global MIL (existential significance, purpose, and coherence), and intrinsic religiosity. RESULTS: In both studies, RWA, RF, and MIL were positively correlated. Partial correlations and structural equation modeling showed that, when modeled together, RF significantly contributes to MIL and RWA facets were either unrelated or negatively related. Study 2 extended these results to show that RF primarily contributed positively to global MIL through existential significance, rather than purpose or coherence. When modeled jointly with intrinsic religiosity, religious fundamentalism no longer contributed to MIL. CONCLUSIONS: These studies demonstrate that RF positively contributes to the experience of MIL, and that the link between RWA and MIL arises from their mutual overlap with RF. The link between RF and MIL is about religiosity, rather than fundamentalism. Implications are discussed.

Duration of Outpatient Antibiotic Therapy for Common Outpatient Infections, 2017.

Our objective was to describe the duration of antibiotic therapy for the management of common outpatient conditions. The median duration of antibiotic courses for most common conditions, except for acute cystitis, was 10 days, in many cases exceeding guideline-recommended durations.

Unnecessary Antibiotic Prescribing in US Ambulatory Care Settings, 2010-2015.

The proportion of antibiotic prescriptions prescribed in US physician offices and emergency departments that were unnecessary decreased slightly, from 30% in 2010-2011 to 28% in 2014-2015. However, a greater decrease occurred in children: 32% in 2010-2011 to 19% in 2014-2015. Unnecessary prescribing in adults did not change during this period.

Incidence of Pharyngitis, Sinusitis, Acute Otitis Media, and Outpatient Antibiotic Prescribing Preventable by Vaccination Against Group A Streptococcus in the United States.

BACKGROUND: Group A Streptococcus (GAS) is a leading cause of acute respiratory conditions that frequently result in antibiotic prescribing. Vaccines against GAS are currently in development. METHODS: We estimated the incidence rates of healthcare visits and antibiotic prescribing for pharyngitis, sinusitis, and acute otitis media (AOM) in the United States using nationally representative surveys of outpatient care provision, supplemented by insurance claims data. We estimated the proportion of these episodes attributable to GAS and to GAS emm types included in a proposed 30-valent vaccine. We used these outputs to estimate the incidence rates of outpatient visits and antibiotic prescribing preventable by GAS vaccines with various efficacy profiles under infant and school-age dosing schedules. RESULTS: GAS pharyngitis causes 19.1 (95% confidence interval [CI], 17.3-21.1) outpatient visits and 10.2 (95% CI, 9.0-11.5) antibiotic prescriptions per 1000 US persons aged 0-64 years, annually. GAS pharyngitis causes 93.2 (95% CI, 82.3-105.3) visits and 53.2 (95% CI, 45.2-62.5) antibiotic prescriptions per 1000 children ages 3-9 years, annually, representing 5.9% (95% CI, 5.1-7.0%) of all outpatient antibiotic prescribing in this age group. Collectively, GAS-attributable pharyngitis, sinusitis, and AOM cause 26.9 (95% CI, 23.9-30.8) outpatient visits and 16.1 (95% CI, 14.0-18.7) antibiotic prescriptions per 1000 population, annually. A 30-valent GAS vaccine meeting the World Health Organization's 80% efficacy target could prevent 5.4% (95% CI, 4.6-6.4%) of outpatient antibiotic prescriptions among children aged 3-9 years. If vaccine prevention of GAS pharyngitis made the routine antibiotic treatment of pharyngitis unnecessary, up to 17.1% (95% CI, 15.0-19.6%) of outpatient antibiotic prescriptions among children aged 3-9 years could be prevented. CONCLUSIONS: An efficacious GAS vaccine could prevent substantial incidences of pharyngitis infections and associated antibiotic prescribing in the United States.

Trends in US Outpatient Antibiotic Prescriptions During the Coronavirus Disease 2019 Pandemic.

BACKGROUND: The objective of our study was to describe trends in US outpatient antibiotic prescriptions from January through May 2020 and compare with trends in previous years (2017-2019). METHODS: We used data from the IQVIA Total Patient Tracker to estimate the monthly number of patients dispensed antibiotic prescriptions from retail pharmacies from January 2017 through May 2020. We averaged estimates from 2017 through 2019 and defined expected seasonal change as the average percent change from January to May 2017-2019. We calculated percentage point and volume changes in the number of patients dispensed antibiotics from January to May 2020 exceeding expected seasonal changes. We also calculated average percent change in number of patients dispensed antibiotics per month in 2017-2019 versus 2020. Data were analyzed overall and by agent, class, patient age, state, and prescriber specialty. RESULTS: From January to May 2020, the number of patients dispensed antibiotic prescriptions decreased from 20.3 to 9.9 million, exceeding seasonally expected decreases by 33 percentage points and 6.6 million patients. The largest changes in 2017-2019 versus 2020 were observed in April (-39%) and May (-42%). The number of patients dispensed azithromycin increased from February to March 2020 then decreased. Overall, beyond-expected decreases were greatest among children (≤19 years) and agents used for respiratory infections, dentistry, and surgical prophylaxis. CONCLUSIONS: From January 2020 to May 2020, the number of outpatients with antibiotic prescriptions decreased substantially more than would be expected because of seasonal trends alone, possibly related to the coronavirus disease 2019 pandemic and associated mitigation measures.

Changes in US Outpatient Antibiotic Prescriptions From 2011-2016.

BACKGROUND: While antibiotics are life-saving drugs, their use is not without risk, including adverse events and antibiotic resistance. The majority of US antibiotic prescriptions are prescribed in outpatient settings, making outpatient antibiotic prescribing an important antibiotic stewardship target. The primary objective of this study was to describe trends in US outpatient oral antibiotic prescriptions from 2011-2016. METHODS: We estimated annual oral antibiotic prescription rates using national prescription dispensing count data from IQVIA Xponent, divided by census estimates for 2011-2016. We calculated the ratio of broad- to narrow-spectrum prescriptions by dividing broad-spectrum prescription rates by narrow-spectrum prescription rates. We used Poisson models to estimate prevalence rate ratios, comparing 2011 and 2016 antibiotic prescription rates, and linear models to evaluate temporal trends throughout the study period. RESULTS: Oral antibiotic prescription rates decreased 5%, from 877 prescriptions per 1000 persons in 2011 to 836 per 1000 persons in 2016. During this period, rates of prescriptions dispensed to children decreased 13%, while adult rates increased 2%. The ratio of broad- to narrow-spectrum antibiotics decreased from 1.62 in 2011 to 1.49 in 2016, driven by decreases in macrolides and fluoroquinolones. The proportion of prescriptions written by nurse practitioners and physician assistants increased during the study period; in 2016, these providers prescribed over one-quarter of all antibiotic prescriptions. CONCLUSIONS: Outpatient antibiotic prescription rates, especially of broad-spectrum agents, have decreased in recent years. Clinicians who prescribe to adults, including nurse practitioners and physician assistants, are important targets for antibiotic stewardship.

Meaning making, self-determination theory, and the question of wisdom in personality.

Self-determination theory (SDT) has advanced the most comprehensive model of motives for human flourishing in the field of personality psychology and beyond. In this article, we evaluate SDT relative to the process of meaning making, particularly from a narrative perspective, showing what SDT can and cannot explain about the construction of self-identity and its relation to human flourishing. On the one hand, SDT explains how subjective assessments of need fulfillment drive the process of self-determined living. The internal motives that follow such fulfillment serve as important themes in people's life stories that predict several markers of hedonic and eudaimonic well-being. On the other hand, SDT's focus on subjective fulfillment limits what SDT can explain about how wisdom, which is a canonical good of both eudaimonia and meaning making, helps people make sense of life's more difficult or unfulfilling events. SDT may facilitate a facet of wisdom that is more subjective and experiential but not the critical facet of wisdom defined by objectively more complex structures of interpretation.

The existential function of right-wing authoritarianism.

OBJECTIVE: Four studies tested the existential and existential buffering functions of right-wing authoritarianism (RWA). We tested whether the facets of meaning mediated these functions. METHOD: All studies measured RWA and meaning in life (MIL). Study 1, N = 2,319, also measured covariates, including Protestant Work Ethic and religiosity. Study 2, N = 505, examined RWA and meaning facets (purpose, coherence, and significance), and measured religiosity. Study 3, N = 971, measured psychological distress to test the existential buffering function of RWA. Study 4, N = 833, tested this hypothesis using meaning facets and tested for moderated mediation. RESULTS: In all studies, RWA and MIL were positively correlated. In Study 1, Protestant Work Ethic and religiosity weakened this association. In Study 2, significance mediated the association between RWA and global MIL. Religiosity wiped out the relationship between RWA and meaning variables, except significance. Study 3 supported the existential buffering hypothesis: distress and global MIL were less strongly related among those high on RWA. Study 4 replicated this finding for MIL facets. Significance mediated the existential buffering function of RWA. CONCLUSIONS: Findings extend scientific knowledge by demonstrating that RWA contributes to MIL, particularly existential mattering, and especially for those experiencing distress. We discuss implications for our understanding of RWA and MIL.

Burden and correlates of readmissions related to pulmonary edema in US hemodialysis patients: a cohort study.

Background: Pulmonary edema is prevalent and may be a common cause of hospital readmissions in hemodialysis patients. We aimed to estimate the national burden of, and identify correlates of, readmissions related to pulmonary edema among hemodialysis patients. Methods: In this retrospective cohort study using national registry data, we identified prevalent US hemodialysis patients (n = 215 251) with index admissions while under Medicare primary coverage in 2011-13. We defined readmissions as admissions occurring within 30 days of the index discharge and pulmonary edema-related readmissions as readmissions with discharge diagnoses of fluid overload, heart failure or pulmonary edema. Multivariable logistic regression models were used to determine odds ratios (ORs) for pulmonary edema-related readmissions by patient and index admission characteristics. Results: About one-quarter (23%) of index hospital admissions were followed by a readmission, with nearly half (44%) of the readmissions being associated with pulmonary edema. The strongest independent correlate of pulmonary edema-related readmission was a pulmonary edema-related index admission [OR = 2.32; 95% confidence interval (CI) 2.22-2.41]. With the exception of dialysis vintage <1 year (OR = 1.18; 95% CI 1.14-1.22), chronic obstructive pulmonary disease (OR = 1.34; 95% CI 1.29-1.38), dialysis non-compliance (OR = 1.53; 95% CI 1.41-1.64) and congestive heart failure (OR = 1.85; 95% CI 1.77-1.93), patient characteristics were not generally associated with higher risk of pulmonary edema-related readmission. Conclusions: Readmissions related to pulmonary edema are common in hemodialysis patients. Interventions aimed at preventing such readmissions could have a substantial impact on readmissions overall, particularly targeted at incident hemodialysis patients with a prior history of heart failure and patients initially admitted for pulmonary edema.

The Ties That Bind: Materiality, Identity, and the Life Course in the "Things" Families Keep.

Using an interdisciplinary research methodology across three archaeological and historical case studies, this article explores "family archives." Four themes illustrate how objects held in family archives, curation practices, and intergenerational narratives reinforce a family's sense of itself: people-object interactions, gender, socialization and identity formation, and the "life course." These themes provide a framework for professional archivists to assist communities and individuals working with their own family archives. We argue that the family archive, broadly defined, encourages a more egalitarian approach to history. We suggest a multiperiod analysis draws attention to historical forms of knowledge and meaning-making practices over time.

Early hospital readmission among hemodialysis patients in the United States is associated with subsequent mortality.

Dialysis providers in the United States may soon be held accountable for their patients' 30-day hospital readmissions. However, few studies have evaluated the timing of readmissions, which determines the window in which dialysis providers could act to prevent readmission. We therefore examined the timing of readmissions of hemodialysis patients in the United States and its association with mortality among 285,795 prevalent adult Medicare-primary hemodialysis patients from a national registry. Patients had at least one hospitalization in 2010-2013 (first index) and survived for 30 days or more. Readmission timing was defined as 0-7, 8-14, or 15-30 days after the index discharge. Multivariable Cox proportional hazards models were used to estimate the association between readmission timing (referent no readmission) and mortality, censored at one year. Overall, 23.1% of patients had readmissions within 30 days of the index discharge, of which over one-third (35.9%) were within the first week. Regardless of timing, patients with readmissions had a higher risk of death within one year, compared to those with no readmissions, with hazard ratios of 2.04 (95% confidence interval 2.00-2.09) for being readmitted within 15-30 days; 1.98 (1.93-2.04) for being readmitted within 8-14 days; and 1.76 (1.71-1.80) for being readmitted within 0-7 days. Thus, opportunities for dialysis providers to intervene and prevent early readmission may be limited. Regardless of the timing, readmission appears independently associated with a substantially increased risk of mortality in this population.

Phytogeographic patterns and cryptic diversity in an aposematic toad from NW Argentina.

The Yungas Redbelly Toad, Melanophryniscus rubriventris, is patchily distributed in Argentina, confined to the upland portion (1000-2000m above sea level) of the montane forests of northern and central regions of Salta, and in central-eastern and south-eastern Jujuy. This species is known for its striking aposematic color variation across its geographic distribution, and was once treated as a complex of three subspecies based on distinctive color patterns. Here we assess the geographical genetic variation within M. rubriventris and quantify divergence in color and pattern among individuals sampled from Northwestern Argentina. We compare multi-gene phylogeography of M. rubriventris to patterns of dorsal and ventral coloration to test whether evolutionary affinities predict variation in warning color. Our results reveal two well-supported species lineages: one confined to the extreme northern portion of our sampling area, and the other extending over most of the Argentine portion of the species' range, within which there are two populations. However, these well-supported evolutionary relationships do not mirror the marked variation in warning coloration. This discordance between DNA genealogy and warning color variation may reflect selection brought about by differences in local predation pressures, potentially coupled with effects of sexual selection and thermoregulation.