National Institutes of Health Stroke Scale Reporting in Medicare Claims Data: Reporting in the First 3 Years.

BACKGROUND: Since 2016, hospitals have been able to document International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for the National Institutes of Health Stroke Scale (NIHSS). As of 2023, the Centers for Medicare & Medicaid Services uses NIHSS as a risk adjustment variable. We assessed associations between patient- and hospital-level variables and contemporary NIHSS reporting. METHODS: We performed a retrospective cross-sectional analysis of 2019 acute ischemic stroke admissions using deidentified, national 100% inpatient Medicare Fee-For-Service data sets. We identified index acute ischemic stroke admissions using the ICD-10-CM code I63.x and abstracted demographic information, medical comorbidities, hospital characteristics, and NIHSS. We linked Medicare and Mount Sinai Health System (New York, NY) registry data from 2016 to 2019. We calculated NIHSS documentation at the patient and hospital levels, predictors of documentation, change over time, and concordance with local data. RESULTS: There were 231 383 index acute ischemic stroke admissions in 2019. NIHSS was documented in 44.4% of admissions and by 66.5% of hospitals. Hospitals that documented ≥1 NIHSS were more commonly teaching hospitals (39.0% versus 5.5%; standardized mean difference score, 0.88), stroke certified (37.2% versus 8.0%; standardized mean difference score, 0.75), higher volume (mean, 80.8 [SD, 92.6] versus 6.33 [SD, 14.1]; standardized mean difference score, 1.12), and had intensive care unit availability (84.9% versus 23.2%; standardized mean difference score, 1.57). Adjusted odds of documentation were lower for patients with inpatient mortality (odds ratio, 0.64 [95% CI, 0.61-0.68]; P<0.0001), in nonmetropolitan areas (odds ratio, 0.49 [95% CI, 0.40-0.61]; P<0.0001), and male sex (odds ratio, 0.95 [95% CI, 0.93-0.97]; P<0.0001). NIHSS was documented for 52.9% of Medicare cases versus 93.1% of registry cases, and 74.7% of Medicare NIHSS scores equaled registry admission NIHSS. CONCLUSIONS: Missing ICD-10-CM NIHSS data remain widespread 3 years after the introduction of the ICD-10-CM NIHSS code, and there are systematic differences in reporting at the patient and hospital levels. These findings support continued assessment of NIHSS reporting and caution in its application to risk adjustment models.

Limited Impact of Delta Variant's Mutations on the Effectiveness of Neutralization Conferred by Natural Infection or COVID-19 Vaccines in a Latino Population.

The SARS-CoV-2 pandemic has impacted public health systems all over the world. The Delta variant seems to possess enhanced transmissibility, but no clear evidence suggests it has increased virulence. Our data show that pre-exposed individuals had similar neutralizing activity against the authentic COVID-19 strain and the Delta and Epsilon variants. After only one vaccine dose, the neutralization capacity expanded to all tested variants in pre-exposed individuals. Healthy vaccinated individuals showed a limited breadth of neutralization. One vaccine dose did induce similar neutralizing antibodies against the Delta as against the authentic strain. However, even after two doses, this capacity only expanded to the Epsilon variant.

Limited impact of Delta variant’s mutations in the effectiveness of neutralization conferred by natural infection or COVID-19 vaccines in a Latino population.

The SARS-CoV-2 pandemic has impacted public health systems all over the world. The Delta variant seems to possess enhanced transmissibility, but no clear evidence suggests it has increased virulence. Our data shows that pre-exposed individuals had similar neutralizing activity against the authentic COVID-19 strain and the Delta and Epsilon variants. After one vaccine dose, the neutralization capacity expands to all tested variants. Healthy vaccinated individuals showed a limited breadth of neutralization. One vaccine dose induced similar neutralizing antibodies against the Delta compared to the authentic strain. However, even after two doses, this capacity only expanded to the Epsilon variant.

A Rainwater Harvesting and Treatment System for Domestic Use and Human Consumption in Native Communities in Amazonas (NW Peru): Technical and Economic Validation.

The inhabitants of Tunants and Yahuahua face water supply problems in terms of quantity and quality, leading to socio-environmental and health impacts in the areas. The objective of this research, therefore, is to determine the technical and economic feasibility of a proposal for a rainwater harvesting and treatment system for human consumption in the native communities. For the technical feasibility, monthly water demand per family was compared with the amount of water collected in the rainy and dry seasons. In addition, 16 physical, chemical, and microbiological parameters were evaluated at the inlet and outlet of the water system. The economic feasibility was determined by the initial investment and maintenance of the systems; with the benefits, we obtained the net present social value (NPSV), social internal rate of return (SIRR), and cost-effectiveness (CE). Technically, oxygenation and chlorination in the storage tanks allowed for water quality in physical, chemical, and microbiological aspects, according to the D.S. N° 031-2010-SA standard, in all cases. Finally, with an initial investment of S/2,600 and S/70.00 for annual maintenance of the system, it is possible to supply up to six people per family with an average daily consumption of 32.5 L per person. It is suggested that the system be used at scale in the context of native communities in north-eastern Peru.

Experimental Approaches for Improving the Assessment of Partner Violence.

Intimate partner violence (IPV) is a serious and widespread problem. Unfortunately, like many other private behaviors, self-report is one of the few practical means of assessing IPV. Despite its known limitations, few studies have examined methods for improving the assessment of IPV through self-report, particularly in research contexts. The current study examined implicit goal priming (IGP) and restricted response latencies (RRL), which have previously been used successfully to improve reporting of other types of sensitive information. Participants in the IGP condition engaged in a word-matching task intended to subliminally prime an honesty goal immediately before completing the IPV self-report measure. In the RRL condition, the amount of time participants were allotted to answer each question was restricted to 3 s. Using a pilot sample of 71 cohabiting/married couples, we currently provide experimental support for the utility of the IGP task for increasing the frequency of reported IPV, as well as agreement between self-reports and partner reports, particularly when used in conjunction with the RRL method. We found the strongest and most consistent effects for women's reports of severe IPV perpetration and victimization, which is important given the extreme nature of these forms of IPV and because they are frequently underreported by women. We also found evidence to support the use of these methods to enhance reporting of other forms of IPV and provide additional directions for future research.

Situational and Dispositional Determinants of College Men's Perception of Women's Sexual Desire and Consent to Sex: A Factorial Vignette Analysis.

Sexual victimization of women by men on college campuses is a growing societal concern, with research identifying a host of situational and characterological factors that may predict men's likelihood to engage in sexual misconduct. In the present study, we examined the relative contribution and potential interplay of these various determinants on college men's perceptions of women's sexual desire and consent in hypothetical dating scenarios depicting a sexual interaction. We found that the men (N = 145) in this sample (a) conflated sexual desire with consent, (b) varied their appraisals of consent and desire depending on whether and how the woman in the vignette communicated consent or refusal, (c) perceived higher levels of consent if the man in the vignette had intercourse with the woman previously and as a function of escalating sexual intimacy in the ongoing interaction, (d) endorsed higher levels of perceived desire and consent across situations if they more strongly held rape-supportive attitudes, and (e) moderated their association between situational factors and perceptions of a woman's sexual intentions based on their endorsement of rape myths and a hypermasculine ideology. We conclude that efforts to prevent sexual violence among college students may benefit from being modeled on our findings that some men are likelier to infer consent regardless of the situation, that specific situational factors can foster misperceptions of consent across men in general, and that certain individuals in particular situations may pose the greatest risk for sexual misconduct.

Person- and Incident-Level Predictors of Blame, Disclosure, and Reporting to Authorities in Rape Scenarios.

Rapes perpetrated during college are both common and underreported. Research highlights that several person- and incident-level factors relating to gender and sexuality may diminish reporting, by themselves and as they pertain to attributions of blame for the assault. In this study, male and female college students (N = 916) read vignettes describing a rape perpetrated by a man against a woman, a man against a man, or a woman against a man. Participants rated the blameworthiness of both perpetrator and victim and rated the likelihood that they would disclose the rape to social ties or health services or report it to authorities if they were in the victim's position. We found that male gender and heterosexual orientation predicted higher victim blame, lower perpetrator blame, and lower likelihood of disclosure, although relative endorsement of masculine gender ideology seemed to be driving these associations, as well as predicted lower likelihood of reporting to authorities. Controlling for other factors, vignettes portraying a woman raping a man led to a lower likelihood of disclosing or reporting the assault, compared with a male-on-female rape. We also found that the effects of female-on-male rape and traditional masculine ideologies tied to rape disclosure partially by decreasing blame to the perpetrator, which itself carried a unique influence on decisions to report. Our findings overall indicate that factors related to gender, sexuality, and blame have myriad influences and may contribute to low rates of disclosing rape to important outlets.

An Examination of Emotion Regulation and Alcohol Use as Risk Factors for Female-Perpetrated Dating Violence.

Dating violence is a serious problem among college students. Research indicates that females perpetrate as much, if not more, psychological and physical aggression against their dating partners relative to their male counterparts. Unfortunately, there is considerably less research on risk factors for female-perpetrated dating violence, hindering efforts aimed at preventing violence in their relationships. This study examined 2 risk factors for female-perpetrated dating violence, namely alcohol use and emotion regulation, within a sample of undergraduate female college students (N = 379). Using structural equation modeling, results demonstrated that emotion regulation was associated with psychological aggression perpetration, and this was partially mediated by alcohol use. Moreover, a 2-chain mediation was present, such that emotion regulation deficits predicted alcohol use, which in turn predicted psychological aggression, which finally predicted physical aggression. These findings are consistent with theoretical models of dating violence and indicate that intervention programs should focus their efforts on increasing adaptive emotion regulation, decreasing alcohol use, and reducing psychological aggression.