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Item Open Access Commentary: Suicide risk is high, but often overlooked, in autistic spectrum disorder populations(2022-08-11) Curtis, LukeSelf-Harm Significantly Higher in Populations with ADHD, Anxiety, ASD, Depression, and Eating Disorders. I appreciated your recent paper on the large and well-matched studies on nonfatal self-harm and suicide among adolescents in the UK Clinical Practice Research Datalink (Cybulski et al. 2021). This large study involved 56,008 self-harm cases and 1,399,356 controls aged 10–19 years and reported that many diagnoses were associated with significantly higher rates of self-harm. Compared to controls, the risk of self-harm was significantly higher in attention-deficit/hyperactivity disorder (ADHD) (OR 3.3, 95% CI 3.1–3.4), anxiety disorder (OR 3.8, 95% CI 3.7–3.9), autism spectrum disorder (ASD) (OR 2.4, 95% CI 2.3–2.6), depression (OR 7.9, 95% CI 7.8–8.2), and eating disorders (OR 3.1, 95% CI 3.0–3.2) (Cybulski et al. 2021).Item Open Access Partisan media exposure, polarization, and candidate evaluations in the 2016 general election(2022-10-13) Morris, David S.; Morris, Jonathan S.Objective This study aims to examine the influence of Republican and Democratic partisan television news on attitudes toward candidates for president immediately following the 2016 general election. Method Using two waves of the 2016 American National Election Study, we examine feelings toward Donald Trump and Hillary Clinton before and after the election. Results Exposure to Republican partisan media did have a significant negative effect on feelings toward Hillary Clinton, even when controlling for party identification, ideology, and feelings toward Clinton before the election. Consumption of Democratic partisan television, however, had no influence on feelings toward Donald Trump. Conclusion Further fragmentation and the expansion of partisan media has—and will continue to—benefit Republicans over Democrats.Item Open Access A Novel Phenotype-Based Drug-Induced Liver Injury Causality Assessment Tool (DILI-CAT) Allows for Signal Confirmation in Early Drug Development(2022) Tillmann, Hans L.; Hermann, Richard P.; Rockey, Don C.; Suzuki, Ayako; Merz, MichaelItem Open Access Racial and Gender Diversity Among Students and Faculty in EHAC-Accredited Environmental Health Sciences Programs: Trend Analysis from 2009 to 2021(2022-07-22) Balanay, Jo Anne; Mitchell, Leslie D; Richards, Stephanie LDiversity in the environmental health sciences (EHS) workforce is crucial in providing culturally sensitive services to diverse communities. This may be influenced by academic faculty training a diverse student body in the field of environmental health. This study aimed to characterize the diversity of students and faculty in EHS programs accredited by the National Environmental Health Science and Protection Accreditation Council (EHAC). A retrospective analysis was conducted on secondary data obtained from annual surveys administered to program directors in EHAC-accredited academic programs that included both undergraduate and graduate EHS degrees. The database covered surveys on gender and race that were conducted by EHAC for 12 academic years spanning 2009-2010 to 2020-2021. Results show most students (undergraduate and graduate) were female (54.4% and 52.1%, respectively) and white (61.0% and 50.7%, respectively). Increasing trends were observed over the last 12 years (2009-2021) in female undergraduate (from 53.7% to 59.8%) and graduate (from 47.1% to 60.3%) students and in non-white undergraduate students (from 40.0% to 48.2%). Most faculty (teaching in undergraduate and graduate programs) were male (64.4% and 64.3%, respectively) and white (77.9% and 92.1%, respectively). Increasing trends were observed from 2009 to 2021 in female faculty teaching undergraduate (from 27.7% to 42.2%) and graduate (from 31.3% to 42.1%) students. Native American, Alaska Native, Native Hawaiian, and Pacific Islander are consistently the most underrepresented racial groups in both undergraduate and graduate students and faculty. This study provides baseline data on the diversity of students and faculty in EHAC-accredited programs, which is important in informing future research and efforts to increase such diversity. Gender and racial disparity in EHS students and faculty needs to be addressed to provide necessary support to women and non-White constituents by institutional change in culture through active recruitment and by stronger collaboration between professional organizations and minority groups.Item Open Access Insights into Diversity in the Environmental Health Science Workforce(2022-02-07) Balanay, Jo Anne; Richards, Stephanie LEnvironmental Health Science (EHS) professionals protect the public from environmental threats by conducting risk assessments and recommending preventative measures based on scientific findings. The EHS field itself is diverse in scientific areas (eg, air quality, water quality, food safety, healthy homes, preparedness, climate change, vectors/pests, tracking/informatics, occupational health, industrial hygiene) studied and evaluated by researchers and practitioners (https://www.neha.org/eh-topics). Scientific findings discovered in the EHS field help health leaders analyze and develop policies to protect health based on practical knowledge.1 Diversity is currently a wide-ranging societal topic, and this issue impacts the EH field. Many aspects related to diversity in EH involve the communities affected by environmental exposures and the EHS workforce serving these communities.Item Open Access Utilization of EHR to Improve Support Person Engagement in Health Care for Patients With Chronic Conditions(2022-02-09) Hodgson, Jennifer; Welch, Melissa; Tucker, Emily; Forbes, Thompson; Pye, JosephInnovations in electronic health record (EHR) systems invite new patient and family engagement methods and create opportunities to reduce healthcare disparities. However, many patients and their identified support persons (ie, proxies) are unsure how to interface with the technology. This phenomenological qualitative study served as a pilot study to investigate the patient, proxy, and provider lived experiences utilizing patient-facing EHR portals. Individual interviews and focus groups were utilized to collect qualitative data from 21 patient, proxy, and healthcare provider participants across 3 time points. Colaizzi's phenomenological data analysis method was utilized to interpret the data. Four themes emerged highlighting critical benefits and obstacles for patients and support persons interfacing with a patient portal: (a) agency, (b) connection, (c) support, and (d) technology literacy. Results help highlight strategies and dispel myths essential to advancing patient and family engagement using EHR patient portal systems. The study's outcomes reflect recommendations for onboarding proxies and improving patient/family engagement and family-centered care models.Item Open Access Community Lost? Changes and Stratification in Perceived Neighborhood Social Cohesion among Families with Children(2022-02-16) Campbell, Colin; Pearlman, Jessica; Verdery, Ashton M.; England, KiraNeighborhood social cohesion is strongly associated with health and well-being, especially among families with children. However, there is a widespread perception in the media, policy circles, and prominent research traditions that neighborhood social cohesion has decreased in recent decades for the United States as a whole and among certain subpopulations. Unfortunately, the empirical evidence for such trends is thin. In this study, we use data on families with children from two studies, the Survey of Income and Program Participation and the Fragile Families and Child Wellbeing Study, to explore trends in neighborhood social cohesion and how individual- and neighborhood-level characteristics pattern disparities in the experience of neighborhood social cohesion. Counter to popular perceptions, our results show increases in neighborhood social cohesion over recent decades, at least for families with children. However, our results reveal persistent disparities in the experience of neighborhood social cohesion by individual and neighborhood characteristics.Item Open Access Understanding COVID-19 Situation in Nepal and Implications for SARS-CoV-2 Transmission and Management(2022-06-07) Dawadi, Prabin; Syangtan, Gopiram; Lama, Bhupendra; Kanel, Sushil R.; Joshi, Dev Raj; Pokhrel, Lok R.; Adhikari, Rameshwar; Joshi, Hem R.; Pavel, IoanaEmerging infectious diseases (EIDs) present one of the greatest challenges to public health in the 21st century. An emerging virus, depending on its potential to spread among humans, may cause individual or sporadic cases, culminating in a localized outbreak requiring public health intervention, or, in the worst-case scenario, a widespread epidemic, or worldwide pandemic.1 The novel Coronavirus Disease 2019 (COVID-19) is a new respiratory disease caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that is causing worldwide public health and economic challenges and has been recognized as a pandemic by the World Health Organization.2 The virus was first reported in Wuhan, Hubei Province, China, in December 2019.2,3 SARS-CoV-2 is an enveloped and positive single-stranded RNA virus belonging to the ß-coronavirus genus.2-4 SARS-CoV-2 holds high homology with SARS-CoV and targets angiotensin-converting enzyme receptor-2 (ACE2) for the viral attachment.4 A schematic depicting SARS-CoV-2 structure and pathogenesis is presented in Figure 1.5 There are very few studies on the transmission of SARS-CoV-2 through treated or untreated wastewater from advanced countries; however, COVID-19 surveillance of wastewater in developing countries has not been reported adequately.6 There is thus a need to study the presence of SARS-CoV-2 in wastewater in the developing countries like Nepal.Item Open Access Differences in receipt of multimodality therapy by race,insurance status, and socioeconomic disadvantage in patientswith resected pancreatic cancer(2022-03-10) Hao, Scarlett; Mitsakos, Anastasios; Irish, William; Tuttle‐Newhall, Janet Elizabeth; Parikh, Alexander A.; Rebecca A., SnyderBackground and Methods:Racial and socioeconomic disparities in receipt ofadjuvant chemotherapy affect patients with pancreatic cancer. However, differencesin receipt of neoadjuvant chemotherapy among patients undergoing resection arenot well‐understood. A retrospective cross‐sectional cohort of patients withresected AJCC Stage I/II pancreatic ductal adenocarcinoma was identified fromthe National Cancer Database (2014–2017). Outcomes included receipt ofneoadjuvant versus adjuvant chemotherapy, or receipt of either, defined asmultimodality therapy and were assessed by univariate and multivariate analysis.Results:Of 19 588 patients, 5098 (26%) received neoadjuvant chemotherapy, 9624(49.1%) received adjuvant chemotherapy only, and 4757 (24.3%) received nochemotherapy. On multivariable analysis, Black patients had lower odds ofneoadjuvant chemotherapy compared to White patients (OR: 0.80, 95% CI:0.67–0.97) but no differences in receipt of multimodality therapy (OR: 0.89, 95%CI: 0.77–1.03). Patients with Medicaid or no insurance, low educational attainment,or low median income had significantly lower odds of receiving neoadjuvantchemotherapy or multimodality therapy.Conclusions:Racial and socioeconomic disparities persist in receipt of neoadjuvantand multimodality therapy in patients with resected pancreatic adenocarcinoma.Discussion:Policy and interventional implementations are needed to bridge thecontinued socioeconomic and racial disparity gap in pancreatic cancer care.Item Open Access Risk aversion in the use of complex kidneys in paired exchange programs: Opportunities for even more transplants?(2022-02-18) Roll, Garrett R.; Cooper, Matthew; Verbesey, Jennifer; Veale, Jeffrey L.; Ronin, Matthew; Irish, William; Waterman, Amy D.; Flechner, Stuart M.; Leeser, David B.This retrospective review of the largest United States kidney exchange reports characteristics, utilization, and recipient outcomes of kidneys with simple compared to complex anatomy and extrapolates reluctance to accept these kidneys. Of 3105 transplants performed, only 12.8% were right kidneys and 23.1% had multiple renal arteries. 59.3% of centers used fewer right kidneys than expected and 12.1% transplanted zero right kidneys or kidneys with more than 1 artery. Five centers transplanted a third of these kidneys (35.8% of right kidneys and 36.7% of kidneys with multiple renal arteries). 22.5% and 25.5% of centers currently will not entertain a match offer for a left or right kidney with more than one artery, respectively. There were no significant differences in all-cause graft failure or death-censored graft loss for kidneys with multiple arteries, and a very small increased risk of graft failure for right kidneys versus left of limited clinical relevance for most recipients. Kidneys with complex anatomy can be used with excellent outcomes at many centers. Variation in use (lack of demand) for these kidneys reduces the number of transplants, so systems to facilitate use could increase demand. We cannot know how many donors are turned away because perceived demand is limited.Item Open Access Differentiation of Human Induced Pluripotent Stem Cells into Keratinocytes(2022-04-05) Koch, Peter J.; Webb, Saiphone; Gugger, Jessica A.; Salois, Maddison N.; Koster, Maranke I.Investigating basic biological mechanisms underlying human diseases relies on the availability of sufficient quantities of patient cells. As most primary somatic cells have a limited lifespan, obtaining sufficient material for biological studies has been a challenge. The development of induced pluripotent stem cell (iPSC) technology has been a game changer, especially in the field of rare genetic disorders. iPSC are essentially immortal, can be stored indefinitely, and can thus be used to generate defined somatic cells in unlimited quantities. Further, the availability of genome editing technologies, such as CRISPR/CAS, has provided us with the opportunity to create “designer” iPSC lines with defined genetic characteristics. A major advancement in biological research stems from the development of methods to direct iPSC differentiation into defined cell types. In this article, we provide the basic protocol for the generation of human iPSC-derived keratinocytes (iPSC-K). These cells have the characteristics of basal epidermal keratinocytes and represent a tool for the investigation of normal epidermal biology, as well as genetic and acquired skin disorders. © 2022 The Authors. Current Protocols published by Wiley Periodicals LLC.Item Open Access Dynamic modeling of public and private decision-making for hurricane risk management including insurance, acquisition, and mitigation policy(2022-06-08) Guo, Cen; Nozick, Linda; Kruse, Jamie; Millea, Meghan; Davidson, Rachel; Trainor, JosephWe develop a computational framework for the stochastic and dynamic modeling of regional natural catastrophe losses with an insurance industry to support government decision-making for hurricane risk management. The analysis captures the temporal changes in the building inventory due to the acquisition (buyouts) of high-risk properties and the vulnerability of the building stock due to retrofit mitigation decisions. The system is comprised of a set of interacting models to (1) simulate hazard events; (2) estimate regional hurricane-induced losses from each hazard event based on an evolving building inventory; (3) capture acquisition offer acceptance, retrofit implementation, and insurance purchase behaviors of homeowners; and (4) represent an insurance market sensitive to demand with strategically interrelated primary insurers. This framework is linked to a simulation-optimization model to optimize decision-making by a government entity whose objective is to minimize region-wide hurricane losses. We examine the effect of different policies on homeowner mitigation, insurance take-up rate, insurer profit, and solvency in a case study using data for eastern North Carolina. Our findings indicate that an approach that coordinates insurance, retrofits, and acquisition of high-risk properties effectively reduces total (uninsured and insured) losses.Item Open Access Conversations with leaders: Sharing perspectives on the impact of and response to COVID-19 and other crises(2022-06-02) Schmidt, Steven W.; English, Leona M.; Carr-Chellman, AliLessons learned during the COVID-19 pandemic, through trial and error and sharing stories of successes and failures, have resulted in progress in the quest to resume what we refer to as normal or regular college life for students, faculty, and staff. However, it is doubtful that we will ever get back to the exact same situation that we were in prior to March of 2020, and that may not even be an appropriate goal for which to strive. We can learn from this pandemic and continuously improve what we do based on lessons learned rather than simply focusing on getting back to some sort of prepandemic “normal” state. This article and this entire edition of New Directions for Adult and Continuing Education are part of those efforts to document our experiences so we all can learn from them and move forward with that knowledge in mind.Item Open Access Social Connectivity During the COVID-19 Pandemic: Disparities among Medicare Beneficiaries(2021-07-07) Jacobs, Molly; Ellis, CharlesPurpose: Social connections are essential for health and well-being at all ages and may be especially important for promoting health in later life. Maintaining social connections, however, became increasingly difficult during the COVID-19 pandemic when stay-at-home orders were enacted, and social distancing became necessary. This study examines the social connectivity among Medicare beneficiaries during the COVID-19 pandemic highlighting the importance technological availability, income, and race. Methods: Data from the 2020 Medicare Beneficiaries Survey COVID supplement was used to evaluate social connectedness during the spring and fall of 2020. Binomial logistic regression evaluated the relationship between feelings of social connectedness and race/ethnicity, urban status of residence, income, availability of household technologies, internet access, and chronic conditions. Results: Lower social connectivity is significantly correlated with race and income. Blacks had a nearly 30% higher likelihood of feeling socially disconnected than other racial groups. Individuals with chronic conditions, particularly cancer, were significantly more likely to feel socially disconnected. Internet access and the availability of technological devices decreased the odds of feeling socially disconnected by 20% and 15% respectively. Conclusion: The COVID-19 pandemic decreased the social connectedness of many vulnerable groups specifically Blacks, those living with chronic conditions, and individuals with limited access to technology. While it is outside the scope of the current study, additional research is needed to determine how to address the social and psychological impacts of the COVID-19 pandemic among elderly Americans.Item Open Access Morbihan disease: A diagnostic dilemma: two cases with successful resolution(2021-06-11) Donthi, Deepak; Nenow, Joseph; Samia, Arthur; Phillips, Charles; Papalas, John; Prenshaw, KarynMorbihan syndrome is a rare entity characterized by persistent erythema and solid edema of upper two-thirds of the face. Although its etiology is poorly understood, it is known to have a wide differential diagnosis and is frequently under-recognized.1–3 We report two such cases of Morbihan syndrome in patients that responded well to treatment with a combination of 2.5% hydrocortisone cream, brimonidine 0.33% topical gel, metronidazole gel and 100 mg doxycycline twice daily. This report emphasizes the necessity of biopsy for clinical correlation in cases of chronic facial edema. It also serves to highlight a potential association of Morbihan syndrome to diabetes mellitus through recently discovered pathophysiology of diabetes on the lymphatic system. It underscores the effectiveness of our therapeutic regimen in the context of other treatment regimen effectiveness. Finally, it highlights novel advances into the diagnosis and treatment of the disease.Item Open Access Four Kinds of Hard: An Understanding of Cancer and Death among Latino Community Leaders(2021-03-23) Larson, Kim L.; Mathews, Holly F.; Moye, Janet P.; Congema, Marianne R.; Hoffman, Sarah J.; Murrieta, Karla M.; Johnson, Lee AnnEarly integration of palliative care after a diagnosis of cancer improves outcomes, yet such care for Latino populations is lacking in rural regions of the United States. We used a participatory action research design with Latino community leaders from emerging immigrant communities in North Carolina to explore sociocultural perspectives on cancer and death. Thematic analysis was conceptualized as Four Kinds of Hard represented by four themes: Receiving an Eviction Notice, Getting in the Good Book, Talking is (Sometimes) Taboo, and Seeing Their Pain Makes us Suffer. These themes captured fears of deportation, coping with cancer through faithfulness, ambivalence about advance care planning, and a desire to spare families from suffering. Findings suggest strategies to improve conversations about end-of-life wishes when facing advanced illness and death. This study demonstrates the importance of training Latino community leaders to improve palliative care and bridge service gaps for Latino families living in emerging rural communities.