Delays in completion of metabolic and bariatric surgery (MBS) remain common and may adversely affect postoperative cardiometabolic recovery. This study examined whether delayed MBS completion was associated with differences in postoperative cardiometabolic outcomes over 24 months. This prospective longitudinal cohort study included 413 adults referred to MBS from academic and community-based programs in Texas. Of these, 172 participants completed MBS within the study period and comprised the analytic sample for the present analysis. Repeated measures of weight and cardiometabolic biomarkers were collected before MBS and 6, 12- and 24-months post-MBS. Generalized estimating equations were used to evaluate associations between cardiometabolic biomarkers (anthropometrics, HbA1c, lipids), timing of MBS completion (early completion: ≤3 months after referral; delayed completion: >3 to 15 months after referral), adjusting for covariates. Among 172 adults who completed MBS, 66 completed surgery within 3 months of referral, and 106 completed surgery > 3 to 15 months post-referral. Among early completers, the median time from referral to surgery was 2.0 months (IQR 0.7–4.3), compared with 5.6 months (IQR 3.2–9.6) among delayed completers. Participants identified as 39.2

Objectives:This study aims to evaluate the association between hormone replacement therapy (HRT) use and clinical outcomes in women with rotator cuff tears (RCTs) over a five-year follow-up period. Patients and methods:Between February 2011 and June 2015, a total of 77 women aged ≥ 45 years with symptomatic RCTs in a multi-center cohort were retrospectively analyzed. The HRT status was self-reported. Patient-reported outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Shoulder Pain and Disability Index (SPADI), and Mental Health Inventory (MHI), assessed at multiple time points over 60 months. Magnetic resonance imaging data were used to evaluate tear size, muscle atrophy, and fatty infiltration. Results:Of a total of 77 women included in the analysis, the HRT group consisted of 13 patients and the non-HRT group consisted of 64 patients. The mean age of women receiving HRT was 58.7 ± 7.0 years, compared to 63.5 ± 8.6 years in those not on HRT (p = 0.061). No statistically significant differences in baseline characteristics or clinical outcomes were observed between HRT and non-HRT groups (p > 0.05). Patients on HRT showed distinct recovery trends, particularly among those managed non-operatively, with early improvements in ASES and SPADI scores that fluctuated over time. Imaging analysis revealed significantly greater odds of moderate-to-severe muscle atrophy in the HRT group (p = 0.0187), although fatty infiltration and tear size did not significantly differ. Conclusion:Hormone replacement therapy use demonstrated distinct functional recovery trends in women with rotator cuff tears, particularly among non-operatively managed patients, though no statistically significant differences in overall clinical outcomes were observed. These findings suggest that hormonal status may selectively influence musculoskeletal recovery and warrant further investigation to better inform sex-specific management for rotator cuff tears during and following the menopause transition.

Background: The surgical count is an important part of the surgical procedure and helps to prevent retained surgical items. This retrospective chart review examines risk factors for count discrepancies. Methods: We reviewed count documentation of surgical procedures (n=92,571) for 5 years between January 2019 and December 2023 at an academic medical center. Results: There was a notable higher percentage of cases with incorrect counts when the American Society of Anesthesiologists (ASA) classification is 4 or 5, more than one primary surgeon, 2 or more assisting surgeons, 4 or 5 circulating nurses, 3 or more scrub persons, longer OR time, and cases classified as add-on/urgent/emergent. Conclusions: Findings may assist leaders in developing strategies to mitigate risk factors for a count discrepancy.

Severe obesity among adolescents in the United States is a major public health concern. While metabolic and bariatric surgery (MBS) is safe and effective for adolescents with severe obesity, no standardized lifestyle interventions are available to support MBS outcomes. TeenLyft, a 6-month behavioral support intervention adapted from the Diabetes prevention program, was provided to teens for peri-operative MBS care beginning four weeks before surgery. This study evaluated TeenLyft's efficacy on improving weight-related behaviors using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. Adolescents aged 13-18 years were recruited from a single tertiary care center MBS program. Participants enrolled in TeenLyft received online educational videos. The five RE-AIM dimensions were assessed independently using a mixed-methods approach. Data sources included baseline (pre-surgery), 3- and 6-month post-MBS follow-up data on anthropometric measures and cardiometabolic biomarkers, interviews, and electronic health records. Quantitative data provided descriptive statistics, and paired t-tests assessed within-subject changes over time to evaluate effectiveness. Qualitative data were thematically analyzed. For Reach, 76 adolescents enrolled in TeenLyft, 47 of whom did not complete MBS, and 29 (38.1%) completed MBS, with participants indicating the program structure and suitability were reasons for enrollment. In terms of effectiveness (N = 29), older age was significantly associated with greater excess weight loss (EWL > 50%: 16.8 ± 0.7 vs. 15.3 ± 1.1 years, p = 0.0083), as was female sex (p = 0.0062). As expected, weight and body mass index significantly decreased from pre-surgery to six months post-MBS (136.1 kg to 95.7 kg, p = 0.0001; BMI 48.3 to 33.3 kg/m2, p = 0.0001). Adolescents reported that the program supported their physical and emotional health and wanted more mental health-related content. Adoption was influenced by clinical staff involvement in recruitment, content development, and content alignment with adolescent needs. Implementation followed the outlined protocols with some additional adaptations to boost engagement via additional social media platforms. Maintenance showed most adolescents attended follow-up clinic visits at 6- and 12-month (83% and 67% respectively). Adolescents emphasized that the program provided education and skills to support post-operative weight management. The RE-AIM framework suggested that TeenLyft was a successful approach for providing behavioral support pre-and post-MBS. Additional benefits could be bolstered with support for mental health management.Trial Registration: NCT05393570.

Weight bias internalization (WBI) negatively effects health outcomes in people with obesity. Little is known about how these experiences relate to quality of life and vary in racially/ethnically diverse adolescents with severe obesity. Associations between WBI and health-related quality of life (HRQOL) by race/ethnicity among a sample of adolescents seeking metabolic and bariatric surgery (MBS) were examined in this analysis. In this single-site cross-sectional study of adolescents seeking MBS (NCT05393570, March 2022 to October 2024), WBI was measured using the 11-item weight bias internalization scale and HRQOL by the standardized HRQOL scale. Race/ethnic group differences were evaluated by univariate/multivariable linear regression analysis. Multivariable regression models were adjusted for age, sex, body mass index, and race/ethnicity. The final sample consisted of 76 adolescents (mean age 15.7 [SD 1.4] years, mean BMI 44.7 kg/m2, 69.7

Objective Glenohumeral (GH) osteoarthritis (OA) is the third most common large joint disease, after hip and knee OA. This study aimed to identify risk factors for GH OA.Methods We used data from the Dallas Shoulder cohort, including individuals aged 40–85. Those with confirmed GH OA based on X-ray were cases, and those without were controls. Univariate, least absolute shrinkage and selection operator and multivariate analyses identified risk factors, including age, body mass index (BMI), sex, work-related shoulder problems, shoulder disability, dislocation, previous trauma, surgery, smoking, hypertension, diabetes, depression, heart disease, OA, night pain and overall sleep quality.Results A total of 1827 cases and 1556 controls were identified for GH OA. In univariate analysis, significant associations with GH OA were found for increasing age (>40 to ≤50: OR 3.29, 95% CI 2.44 to 4.45; >50 to ≤60: OR 5.90, 95% CI 4.49 to 7.77; >60 to ≤70: OR 12.18, 95% CI 9.22 to 16.08 and >70: OR 16.54, 95% CI 12.47 to 21.94), higher BMI (≤19: OR 1.44, 95% CI 1.01 to 2.04; >25 to ≤30: OR 1.57, 95% CI 1.32 to 1.86; >30 to ≤35: OR 1.85, 95% CI 1.54 to 2.22 and >35: OR 1.77, 95% CI 1.28 to 2.45), prior shoulder injury (OR 1.30; 95% CI 1.12 to 1.50), shoulder surgery history (OR 0.71; 95% CI 0.57 to 0.87), shoulder pain at night (OR 1.35; 95% CI 1.07 to 1.70) and hypertension (OR 0.70; 95% CI 0.60 to 0.81). In multivariate analysis, significant associations remained for age (>40 to ≤50: OR 2.99, 95% CI 2.21 to 4.06; >50 to ≤60: OR 5.48, 95% CI 4.14 to 7.23; >60 to ≤70: OR 11.22, 95% CI 8.44 to 14.88 and >70: OR 16.65, 95% CI 12.45 to 22.17), BMI (≤19: OR 1.49, 95% CI 1.01 to 2.20; >25 to ≤30: OR 1.45, 95% CI 1.20 to 1.77; >30 to ≤35: OR 1.70, 95% CI 1.39 to 2.09 and >35: OR 1.78, 95% CI 1.25 to 2.55) and previous shoulder trauma (OR 0.80; 95% CI 0.68 to 0.94).Conclusion We identified increasing age and higher BMI as factors associated with GH OA. Due to the large sample size, many risk factors were assessed. Since the shoulder is not a weight-bearing joint, the BMI-GH OA link is likely molecular and systemic, warranting further investigation.Level of evidence Prognostic level III.

This cross-sectional study analyzed adolescent metabolic and bariatric surgery (MBS) utilization before and after glucagon like receptor agonist (GLP-1RA) medication approval, comparing trends across race and ethnic groups. Although both MBS and GLP-1RA are effective weight management strategies, adolescent MBS utilization increased, while adult rates declined from 2021 through 2023.

Background Due to the widespread use of social media and the internet in today’s connected world, obesity and depression rates are increasing concurrently on a global scale. This study investigated the complex dynamics involving social media recruitment for scientific research, race, ethnicity, and depression among metabolic and bariatric surgery (MBS) candidates. Objective This study aimed to determine (1) the association between social media recruitment and depression among MBS candidates and (2) racial and ethnic differences in social media recruitment engagement. Methods The analysis included data from 380 adult MBS candidates enrolled in a prospective cohort study from July 2019 to December 2022. Race and ethnicity, recruitment method (social media: yes or no), and depression status were evaluated using χ2 tests and logistic regression models. Age, sex, and ethnicity were adjusted in multivariable logistic regression models. Results The mean age of the candidates was 47.35 (SD 11.6) years, ranging from 18 to 78 years. Participants recruited through social media (n=41, 38.32%) were more likely to report past or current episodes of depression compared to nonsocial media–recruited participants (n=74, 27.11%; P=.03), with a 67% increased likelihood of depression (odds ratio [OR] 1.67, 95% CI 1.04‐2.68, P=.03). Further analysis showed that participants with a history of depression who were below the mean sample age were 2.26 times more likely to be recruited via social media (adjusted OR [aOR] 2.26, 95% CI 1.03‐4.95; P=.04) compared to those above the mean age. Hispanic (n=26, 38.81%) and non-Hispanic White (n=53, 35.10%) participants were significantly more likely to be recruited via social media than non-Hispanic Black (n=27, 18.37%) participants (P<.001). After adjusting for covariates, non-Hispanic Black participants were 60% less likely than non-Hispanic White participants to be recruited via social media (aOR 0.40, 95% CI 0.22‐0.71; P=.002). Conclusions We found that individuals recruited through social media channels, especially younger participants, were more likely to report past or current episodes of depression compared to those recruited through nonsocial media. The study also showed that non-Hispanic Black individuals are less likely to engage in social media recruitment for scientific research versus other racial and ethnic groups. Future mental health–related studies should consider strategies to mitigate potential biases introduced by recruitment methods to ensure the validity and generalizability of research findings.

OBJECTIVE:Prenatal substance exposure (PSE) is a known risk factor for negative birth outcomes and long-term health outcomes like neurodevelopmental problems. Children in foster care have increased exposure to PSE and higher proportions of developmental delay compared with the general population. It is unclear whether differences still exist among developmental delay screening among children in foster care with and without PSE. METHODS:Data were extracted from patient medical records of a primary care clinic for children in foster care between January 1, 2018, and December 31, 2021. Cox proportional hazards regression generated hazard of positive developmental delay screening using the Ages and Stages Questionnaire-3 among those who with and without PSE controlling for sex, race, ethnicity, prematurity, caregiver type, as well as interaction between PSE and prematurity and PSE and race. RESULTS:The sample included 975 patients. 60.4% had PSE, and 62.6% had a positive developmental delay screening at least once. 52.9% were male, and 45.5% were White. Those who had PSE but were nonpremature had 1.14 (95% confidence interval, 1.01-1.29) times the hazard of positive developmental delay screening compared with those without PSE and prematurity. However, those with PSE and prematurity had 2.01 times the hazard of positive developmental delay screening than those without either condition. CONCLUSION:Children in foster care with PSE are at risk for positive developmental delay screening compared with those without; however, those with both PSE and prematurity are at extra risk. This interaction should be considered when making inferences regarding developmental delay screening in this population.

Background: Challenges to treat excess weight in primary care settings include time constraints during encounters and barriers to multiple visits for patient families, especially those from vulnerable backgrounds. Dynamo Kids! (DK), a bilingual (English/Spanish) e-health intervention, was created to address these system-level challenges. This pilot study assessed the effect of DK use on parent-reported healthy habits and child BMI. Methods: In this 3-month, quasi-experimental cohort design, DK was offered to parents with children aged 6-12 years with BMI ≥85th percentile in three public primary care sites in Dallas, Texas. DK included three educational modules, one tracking tool, recipes, and links to internet resources. Parents completed an online survey before and after 3 months. Pre-post changes in family nutrition and physical activity (FNPA) scores, clinic-measured child %BMIp95, and self-reported parent BMI were assessed using mixed-effects linear regression modeling. Results: A total of 73 families (mean child age = 9.3 years; 87% Hispanic, 12% non-Hispanic Black, and 77% Spanish-speaking families) completed the baseline survey (participants) and 46 (63%) used the DK site (users). Among users, pre-post changes (mean [standard deviation]) showed an increase in FNPA scores (3.0 [6.3], p = 0.01); decrease in child %BMIp95 (-1.03% [5.79], p = 0.22); and decrease in parent BMI (-0.69 [1.76], p = 0.04). Adjusted models showed -0.02% [95% confidence interval: -0.03 to -0.01] change in child %BMIp95 for each minute spent on the DK website. Conclusions: DK demonstrated a significant increase in parent FNPA scores and decrease in self-reported parent BMI. e-Health interventions may overcome barriers and require a lower dosage than in-person interventions.

IntroductionTo examine if perceptions of harmfulness and addictiveness of hookah and cigarettes impact the age of initiation of hookah and cigarettes, respectively, among US youth. Youth (12-17 years old) users and never users of hookah and cigarettes during their first wave of PATH participation were analyzed by each tobacco product (TP) independently. The effect of perceptions of (i) harmfulness and (ii) addictiveness at the first wave of PATH participation on the age of initiation of ever use of hookah was estimated using interval-censoring Cox proportional hazards models.MethodsUsers and never users of hookah at their first wave of PATH participation were balanced by multiplying the sampling weight and the 100 balance repeated replicate weights with the inverse probability weight (IPW). The IPW was based on the probability of being a user in their first wave of PATH participation. A Fay’s factor of 0.3 was included for variance estimation. Crude hazard ratios (HR) and 95% confidence intervals (CIs) are reported. A similar process was repeated for cigarettes.ResultsCompared to youth who perceived each TP as “a lot of harm”, youth who reported perceived “some harm” had younger ages of initiation of these tobacco products, HR: 2.53 (95% CI: 2.87-4.34) for hookah and HR: 2.35 (95% CI: 2.10-2.62) for cigarettes. Similarly, youth who perceived each TP as “no/little harm” had an earlier age of initiation of these TPs compared to those who perceived them as “a lot of harm”, with an HR: 2.23 (95% CI: 1.82, 2.71) for hookah and an HR: 1.85 (95% CI: 1.72, 1.98) for cigarettes. Compared to youth who reported each TP as “somewhat/very likely” as their perception of addictiveness, youth who reported “neither likely nor unlikely” and “very/somewhat unlikely” as their perception of addictiveness of hookah had an older age of initiation, with an HR: 0.75 (95% CI: 0.67-0.83) and an HR: 0.55 (95% CI: 0.47, 0.63) respectively.DiscussionPerceptions of the harmfulness and addictiveness of these tobacco products (TPs) should be addressed in education campaigns for youth to prevent early ages of initiation of cigarettes and hookah.

Obesity is a pandemic that disproportionately affects children from vulnerable populations in the USA. Current treatment approaches in primary care settings in the USA have been reported to be insufficient at managing pediatric obesity, primarily due to implementation challenges for healthcare systems and barriers for families. While the literature has examined the efficacy of pediatric obesity interventions focused on internal validity, it lacks sufficient reporting and analysis of external validity necessary for successful translation to primary care settings. We conducted a systematic review of the primary-care-setting literature from January 2007 to March 2020 on family-based pediatric weight management interventions in both English and/or Spanish for children ages 6-12 years in the USA using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. A literature search, using PRISMA guidelines, was conducted in January 2022 using the following electronic databases: Medline Ovid, Embase, and Cochrane Library. 22 270 records were screened, and 376 articles were reviewed in full. 184 studies were included. The most commonly reported dimensions of the RE-AIM framework were Reach (65%), Efficacy/Effectiveness (64%), and Adoption (64%), while Implementation (47%) and Maintenance (42%) were less often reported. The prevalence of reporting RE-AIM construct indicators ranged greatly, from 1% to 100%. This systematic review underscores the need for more focus on external validity to guide the development, implementation, and dissemination of future pediatric obesity interventions based in primary care settings. It also suggests conducting additional research on sustainable financing for pediatric obesity interventions. This systematic review underscores the need for more focus on external validity to guide the development, implementation, and dissemination of future pediatric obesity interventions based in primary care settings. Pediatric weight management research focused on primary care centers for children ages 6-12 in the USA has typically focused on assessing the effectiveness of the intervention rather than how to translate and disseminate such interventions into different settings for diverse populations, or external validity. Using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, we conducted a systematic review to report how existing research reports external validity.

Abstract Background: Young women, ages 18–39 years, with breast cancer are disproportionately impacted by pronounced socioeconomic disparities, a burden that is exacerbated among mothers as they face competing demands in managing cancer and caregiving responsibilities. Although previous analyses identified 64% of young women with breast cancer as mothers at diagnosis and qualitative studies have reported conflicting views on chemotherapy receipt among mothers, their treatment patterns are not well-defined. Additionally, whether having multiple or young children influences treatment patterns due to increased demands is also unknown. We aimed to determine the association between motherhood or offspring characteristics and chemotherapy receipt by age, stage, race and ethnicity. Methods: We retrospectively linked the Texas Cancer Registry to live birth certificates from 1995 to 2016. Analyses comprised a multicultural, population-based sample of 1,783 mothers who had delivered at least one live birth at diagnosis and 946 young women without children diagnosed with microscopically confirmed invasive breast cancer, between January 1, 2013, and December 31, 2016, at ages 18–39 years. Chemotherapy receipt was based on first course of treatment. Multivariable logistic regression estimated odds ratios (OR) with 95% confidence intervals (CI): model 1 (motherhood), model 2 (number of children), and model 3 (number of young [ages <13 years] children). Model 1 was adjusted for age, stage, insurance, Yost index, receipt of radiation therapy, and surgery type. Models 2 and 3 were adjusted for these covariates plus age of children, number of young children (model 2) and number of children (model 3). Heterogeneity was assessed using single- referent ORs and relative excess risk due to interaction (RERI), and multiplicative models with stratified ORs and likelihood ratio tests (pLRT). Results: Of the 2,729 women, 1,565 (73%) received chemotherapy. There was no association between motherhood (OR=1.00, 95% CI [0.82,1.21]), number of children (OR=0.94, 95% CI [0.72,1.22]), or number of young children (OR =1.07, 95% CI [0.72,1.54]) and chemotherapy receipt. Decreased odds for chemotherapy receipt were observed by race: Non-Hispanic (NH) Black women without children had an ORstratified of 0.57 (95% CI [0.37,0.89]) and NH White mothers had an ORsingle-referent of 0.71 (95% CI [0.51,0.93] and ORstratified of 0.69 (95% CI [0.53,0.95]) compared to NH White women without children (RERI=-0.63, 95% CI [-1.86,-0.09]; pLRT=0.05). Among mothers, those ages >35 years with 2+ young children had an OR of 0.45 (95% CI 0.21,0.98; pLRT=0.39) compared to those with children ages ≥13 years. Conclusion: We found no differences in overall chemotherapy receipt, but observed decreased receipt by race and age, independent of stage, possibly due to unmeasured systemic and clinical factors. Future studies examining detailed tumor characteristics and treatment information could inform targeted interventions to support young women with breast cancer throughout their cancer trajectories. Citation Format: Quiera S Booker, Caitlin C Murphy, Sarah E Messiah, Folefac D. Atem, Bijal S Balasubramanian. Motherhood and chemotherapy receipt: a population-based study of young women with breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A012.

Objectives The purpose of this pilot study was to obtain baseline quantitative pupillometry (QP) measurements before and after catheter-directed cerebral angiography (DCA) to explore the hypothesis that cerebral angiography is an independent predictor of change in pupillary light reflex (PLR) metrics.Design This was a prospective, observational pilot study of PLR assessments obtained using QP 30 min before and after DCA. All patients had QP measurements performed with the NPi-300 (Neuroptics) pupillometer.Setting Recruitment was done at a single-centre, tertiary-care academic hospital and comprehensive stroke centre in Dallas, Texas.Participants Fifty participants were recruited undergoing elective or emergent angiography. Inclusion criteria were a physician-ordered interventional neuroradiological procedure, at least 18 years of age, no contraindications to PLR assessment with QP, and nursing transport to and from DCA. Patients with a history of eye surgery were excluded.Main outcome measures Difference in PLR metric obtained from QP 30 min before and after DCA.Results Statistically significant difference was noted in the pre and post left eye readings for the minimum pupil size (a.k.a., pupil diameter on maximum constriction). The mean maximum constriction diameter prior to angiogram of 3.2 (1.1) mm was statistically larger than after angiogram (2.9 (1.0) mm; p<0.05); however, this was not considered clinically significant. Comparisons for all other PLR metrics pre and post angiogram demonstrated no significant difference. Using change in NPi pre and post angiogram (Δpre=0.05 (0.77) vs Δpost=0.08 (0.67); p=0.62), we calculated the effect size as 0.042. Hence, detecting a statistically significant difference in NPi, if a difference exists, would require a sample size of ~6000 patients.Conclusions Our study provides supportive data that in an uncomplicated angiogram, even with intervention, there is no effect on the PLR.

Previous studies indicate that obesity is a risk factor of suicide behaviors among adolescents. Whether this association has remained consistent during the ongoing obesity epidemic remains unknown. The time trends of the obesity–suicide association were examined using the 1999–2019 biannual Youth Risk Behavior Survey data (n = 161,606). Prevalence odds ratio of suicide behaviors among adolescents with obesity (vs. adolescents with no obesity) for each survey year and time trends using National Cancer Institute Joinpoint regression analysis was calculated. For each year post-baseline, there was a significant increase of prevalence odds ratio of 1.4 (1.2–1.6)–1.6 (1.3–2.0) for suicide ideation, 1.3 (1.1–1.7) –1.7 (1.4–2.0) for plan, and 1.3 (1.0–1.7) –1.9 (1.5–2.4) for an attempt, except for the 2013 survey for attempt (1.19 [0.9–1.6]). Significant positive trends were found from1999 to 2019 for ideation and plan, with biannual %-changes of + 0.92 and + 1.22%, respectively. Adolescents with obesity have consistently higher odds of engaging in suicide behaviors than their peers without obesity since the beginning of the United States obesity epidemic, and this association grew stronger as the obesity epidemic continued.

PURPOSE:Evaluate the effectiveness of the clinical decision support tools (CDSTs), POC Advisor (POCA), and Modified Early Warning System (MEWS) in identifying sepsis risk and influencing time to treatment for inpatients, comparing their respective alert mechanisms. METHODS:This study was conducted at two academic university medical center hospitals. Data from adult inpatients in medical-surgical and telemetry units were analyzed from January 1, 2020, to December 31, 2020. Criteria included sepsis-related ICD-10 codes, antibiotic administration, and ordered sepsis labs. Subsequent statistical analyses utilized Fisher's exact test and Wilcoxon Rank Sum test, focusing on mortality differences by age, sex, and race/ethnicity. RESULTS:Among 744 patients, 143 sepsis events were identified, with 83% already receiving treatment upon CDST alert. Group 1 (POCA alert) showed reduced response time compared with MEWS, while Group 3 (MEWS) experienced longer time to treatment. Group 4 included sepsis events missed by both systems. Mortality differences were not significant among the groups. CONCLUSION:While CDSTs play a role, nursing assessment and clinical judgment are crucial. This study recognized the potential for alarm fatigue due to a high number of CDST-driven alerts, while emphasizing the importance of a collaborative approach for prompt sepsis treatment and potential reduction in sepsis-related mortality.

Emergency department (ED) utilization for preventable reasons by patients with foster care history is unexplored. Medical records of ED encounters from primary care patients were pulled from a southwestern children’s hospital system. Necessity of ED encounter was categorized using the New York University- ED Algorithm into emergent, intermediate, or non-emergent. Associations were explored at the encounter- and patient-level. Partial proportional logistic models generated odds of preventable (i.e., intermediate or nonemergent) ED utilization among encounters, and Poisson models determined incidence of preventable ED use at the patient level. Findings suggested that when a patient with history in foster care used the ED, the odds that it was preventable were lower than if the child did not have such experience. Further, patients with foster care history were less likely to use the ED for concerns that did not need immediate attention but were more likely to use the ED for intermediate reasons.

OBJECTIVE:This study aimed to apply classification and regression tree analysis to determine factors associated with glenohumeral osteoarthritis and establish specific cutoff points for risk factors based on this methodology. DESIGN:The cross-sectional study included 3383 participants with shoulder pain. Cases were selected for glenohumeral osteoarthritis. Patients with other shoulder pathologies were included as controls. Thirty-three potential risk factors were assessed. The classification and regression tree analysis was used to determine the highest-ranked risk factors associated with glenohumeral osteoarthritis. Multivariable logistic regression analysis was then performed using the cutoff points obtained from the classification and regression tree analysis. RESULTS:The classification and regression tree analysis showed that age and body mass index were the two most significant risk factors for glenohumeral osteoarthritis. Multivariable logistic regression revealed that age categories ≥31 to < 58 yrs (odds ratio = 8.92), ≥58 to < 64 yrs (odds ratio = 20.20), and ≥64 yrs (odds ratio = 42.20), and body mass index categories ≥25-30 kg/m 2 (odds ratio = 1.47) and ≥30 kg/m 2 (odds ratio = 1.71) had higher odds of developing glenohumeral osteoarthritis compared with age <31 yrs and body mass index <25 kg/m 2 . CONCLUSIONS:This was the first study to use classification and regression tree analysis to evaluate significant risk factors for glenohumeral osteoarthritis and establish cutoff points for increased risk. The findings present age categories that are distinct from the arbitrary age groups used in previous studies.

Context: The childcare center (CCC) setting has the potential to be a strong foundation that supports the introduction of sustainable healthy lifestyle behaviors to prevent childhood obesity. It is important to assess barriers and facilitators to healthy weight development initiatives via program evaluation, including measuring CCC staff readiness to change. Objective: The overall goal of this study was to assess the readiness level over 1 school year among CCC staff who participated in “Healthy Caregivers-Healthy Children” (HC2), a cluster randomized controlled trial that evaluated the effectiveness of a childhood obesity prevention program from 2015 to 2018 in 24 low-income, racially/ethnically diverse centers. A secondary outcome was to assess how a CCC's stage of readiness to change was associated with CCC nutrition and physical activity environment, measured via the Environment and Policy Assessment and Observation (EPAO) tool. Design: Mixed-models analysis with the CCC as the random effect assessed the impact of readiness to change over time on EPAO outcomes. Participants: Eighty-eight CCC teachers and support staff completed the HC2 readiness to change survey in August 2015 and 68 in August 2016. Only teachers and staff randomized to the treatment arm of the trial were included. Main Outcome: Readiness to change and the EPAO. Results: Results showed the majority of CCC staff in advanced stages of readiness to change at both time points. For every increase in readiness to change stage over 1 year (eg, precontemplation to contemplation), there was a 0.28 increase in EPAO nutrition scores (95% confidence interval [CI], 0.04-0.53; P = .02) and a 0.52 increase in PA score (95% CI, 0.09-0.95; P = .02). Conclusions: This analysis highlights the importance between CCC staff readiness to change and the CCC environment to support healthy weight development. Future similar efforts can include consistent support for CCC staff who may not be ready for change to support successful outcomes.