The Association Between State-Level Prenatal Substance Use Policies and Rates of Maternal Mortality in the United States: A Legal Epidemiology Study.

Little research has explored relationships between prenatal substance use policies and rates of maternal mortality across all 50 states, despite evidence that prenatal substance use elevates risk of maternal death. This study, utilizing publicly available data, revealed that state-level mandated testing laws predicted maternal mortality after controlling for population characteristics.

"It's just us sitting there for 23 hours like we done something wrong": Isolation, incarceration, and the COVID-19 pandemic.

For the millions of people incarcerated in United States' prisons and jails during the COVID-19 pandemic, isolation took many forms, including medical isolation for those sick with COVID-19, quarantine for those potentially exposed, and prolonged facility-wide lockdowns. Incarcerated people's lived experience of isolation during the pandemic has largely gone undocumented. Through interviews with 48 incarcerated people and 27 staff at two jails and one prison in geographically diverse locations in the United States, we document the implementation of COVID-19 isolation policies from the perspective of those that live and work in carceral settings. Incarcerated people were isolated from social contact, educational programs, employment, and recreation, and lacked clear communication about COVID-19-related protocols. Being isolated, no matter the reason, felt like punishment and was compared to solitary confinement-with resultant long-term, negative impacts on health. Participants detailed isolation policies as disruptive, detrimental to mental health, and dehumanizing for incarcerated people. Findings point to several recommendations for isolation policy in carceral settings. These include integrating healthcare delivery into isolation protocols, preserving social relationships during isolation, promoting bidirectional communication about protocols and their effect between facility leadership and incarcerated people. Most importantly, there is an urgent need to re-evaluate the current approach to the use of isolation in carceral settings and to establish external oversight procedures for its use during pandemics.

Stakeholder-driven development and implementation of CRICIT: an app to support high-quality data capture and protocol monitoring for outpatient clinical trials with vulnerable populations.

Introduction: Choosing an appropriate electronic data capture system (EDC) is a critical decision for all randomized controlled trials (RCT). In this paper, we document our process for developing and implementing an EDC for a multisite RCT evaluating the efficacy and implementation of an enhanced primary care model for individuals with opioid use disorder who are returning to the community from incarceration. Methods: Informed by the Knowledge-to-Action conceptual framework and user-centered design principles, we used Claris Filemaker software to design and implement CRICIT, a novel EDC that could meet the varied needs of the many stakeholders involved in our study. Results: CRICIT was deployed in May 2021 and has been continuously iterated and adapted since. CRICIT's features include extensive participant tracking capabilities, site-specific adaptability, integrated randomization protocols, and the ability to generate both site-specific and study-wide summary reports. Conclusions: CRICIT is highly customizable, adaptable, and secure. Its implementation has enhanced the quality of the study's data, increased fidelity to a complicated research protocol, and reduced research staff's administrative burden. CRICIT and similar systems have the potential to streamline research activities and contribute to the efficient collection and utilization of clinical research data.

Response to substance use during hospitalization: A survey study of current and ideal policies and practices.

People may use nonprescribed substances during an acute hospitalization. Hospital policies and responses can be stigmatizing, involve law enforcement, and lead to worse patient outcomes, including patient-directed discharge. In the United States, there is currently little data on hospital policies that address the use of substances during hospitalization. In this cross-sectional study, we surveyed clinicians at US hospitals with Accreditation Council of Graduate Medical Education (ACGME)-accredited addiction medicine fellowships about their current practices and policies and what they would include in an ideal policy. We had 77 responses from 55 out of 86 ACGME-addiction medicine fellowships (63.9%). Respondents identified policies at 21.8% of the institutions surveyed. Current responses to inpatient substance use vary, though most do not match what clinicians identify as an ideal response. Our results suggest that the use of nonprescribed substances during a hospitalization may be common, but a majority of hospitals likely do not have patient-centered policies to address this.

The psychological impact of wrongful convictions: Exploring retrospective trajectories of distress in exonerees.

OBJECTIVE: Although an emerging body of research has examined the legal causes of wrongful convictions, there is little research that examines the psychological impact of wrongful convictions. This study aims to understand the psychological experiences of exonerees, with a focus on the role of meaning-making in individuals' reactions to trauma. The study also aims to examine exonerees' self-reported trajectories of distress throughout their experience of being wrongfully convicted and subsequently exonerated. METHOD: A total of 46 exonerees completed an online survey. Measures included: Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, PTSD Checklist for DSM-5, Posttraumatic Growth Inventory, World Assumptions Questionnaire, Meaning in Life Questionnaire, Satisfaction with Life Scale, and a self-reported retrospective trajectory measure. RESULTS: Cluster analysis suggested a four-factor solution: Chronic Distress, Relief and Readjustment, Recovery, and Intense Distress with Minimal Recovery. The Recovery cluster (n = 17; 37.0%) had significantly lower levels of PTSD and anxiety symptoms than the other three groups. The Recovery cluster had higher levels of positive world assumptions and lower levels of searching for meaning than the other three clusters, but there were no differences among clusters in level of meaning made, presence of meaning, depression symptoms, and satisfaction with life. CONCLUSIONS: The results revealed that exonerees with more positive world beliefs (conceptualized as an outcome of meaning-making) have lower rates of PTSD and anxiety. Consistent with the literature, results also suggest that the search for meaning may be indicative of increased distress and less recovery. Clinical and policy implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Phylogenetic risk assessment is robust for forecasting the impact of European insects on North American conifers.

Some introduced species cause severe damage, although the majority have little impact. Robust predictions of which species are most likely to cause substantial impacts could focus efforts to mitigate those impacts or prevent certain invasions entirely. Introduced herbivorous insects can reduce crop yield, fundamentally alter natural and managed forest ecosystems, and are unique among invasive species in that they require certain host plants to succeed. Recent studies have demonstrated that understanding the evolutionary history of introduced herbivores and their host plants can provide robust predictions of impact. Specifically, divergence times between hosts in the native and introduced ranges of a nonnative insect can be used to predict the potential impact of the insect should it establish in a novel ecosystem. However, divergence time estimates vary among published phylogenetic datasets, making it crucial to understand if and how the choice of phylogeny affects prediction of impact. Here, we tested the robustness of impact prediction to variation in host phylogeny by using insects that feed on conifers and predicting the likelihood of high impact using four different published phylogenies. Our analyses ranked 62 insects that are not established in North America and 47 North American conifer species according to overall risk and vulnerability, respectively. We found that results were robust to the choice of phylogeny. Although published vascular plant phylogenies continue to be refined, our analysis indicates that those differences are not substantial enough to alter the predictions of invader impact. Our results can assist in focusing biosecurity programs for conifer pests and can be more generally applied to nonnative insects and their potential hosts by prioritizing surveillance for those insects most likely to be damaging invaders.

Postdeployment Treatment Gap: Symptoms and Treatment Utilization Among Returning National Guard Soldiers.

This study evaluated rates of psychiatric symptoms and mental health treatment utilization among National Guard service members during the post-deployment period. National Guard service members (n=311) completed surveys assessing demographics, beliefs about mental health treatment, emotion regulation strategies, and psychiatric symptoms. Mental health treatment utilization was assessed at 6-month follow-up. Post-deployment, 41.2% of the sample had psychiatric symptoms above the clinical cut-off for at least one symptom measure. This proportion increased at follow-up (53.5%). Alcohol use disorder (AUD) symptoms showed the largest increase (d=0.66), although symptoms of depression and posttraumatic stress disorder (PTSD) also showed small magnitude increases. Among those with elevated symptoms post-deployment (n=128), only 27.8% received mental health treatment at follow-up. Severity of depression, anxiety, and PTSD were higher among those who utilized treatment. The post-deployment period is a vulnerable one. Continued efforts to understand and address barriers to treatment for this population are warranted.

Evolutionary history predicts high-impact invasions by herbivorous insects.

A long-standing goal of invasion biology is to identify factors driving highly variable impacts of non-native species. Although hypotheses exist that emphasize the role of evolutionary history (e.g., enemy release hypothesis & defense-free space hypothesis), predicting the impact of non-native herbivorous insects has eluded scientists for over a century.Using a census of all 58 non-native conifer-specialist insects in North America, we quantified the contribution of over 25 factors that could affect the impact they have on their novel hosts, including insect traits (fecundity, voltinism, native range, etc.), host traits (shade tolerance, growth rate, wood density, etc.), and evolutionary relationships (between native and novel hosts and insects).We discovered that divergence times between native and novel hosts, the shade and drought tolerance of the novel host, and the presence of a coevolved congener on a shared host, were more predictive of impact than the traits of the invading insect. These factors built upon each other to strengthen our ability to predict the risk of a non-native insect becoming invasive. This research is the first to empirically support historically assumed hypotheses about the importance of evolutionary history as a major driver of impact of non-native herbivorous insects.Our novel, integrated model predicts whether a non-native insect not yet present in North America will have a one in 6.5 to a one in 2,858 chance of causing widespread mortality of a conifer species if established (R 2 = 0.91) Synthesis and applications. With this advancement, the risk to other conifer host species and regions can be assessed, and regulatory and pest management efforts can be more efficiently prioritized.

Firearm Ownership and Capability for Suicide in Post-Deployment National Guard Service Members.

OBJECTIVE: National Guard service members demonstrate increased suicide risk relative to the civilian population. One potential mechanism for this increased risk may be familiarity with and access to firearms following deployment. This study examined the association between firearm ownership, reasons for ownership, and firearm familiarity with a widely studied suicide risk factor-capability for suicide-among National Guard service members. METHOD: Data were drawn from a cross-sectional survey of National Guard service members conducted immediately post-deployment in 2010. Service members (n = 2,292) completed measures of firearm ownership, firearm familiarity, and capability for suicide. RESULTS: Firearm ownership and increased firearm familiarity were associated with capability for suicide (d = 0.47 and r = .25, for firearm ownership and familiarity, respectively). When examined separately based on reason for ownership, owning a firearm for self-protection (d = 0.33) or owning a military weapon (d = 0.27) remained significantly associated with capability for suicide. In contrast, owning a firearm for hobby purposes did not (d = -0.07). CONCLUSION: Our findings support theories emphasizing practical aspects of suicide (e.g., three-step theory) and suggest that owning firearms, in particular for self-protection, along with familiarity using firearms may be associated with greater capability for suicide.

Evaluating the Impact of Treatment Care Planning on Quality Measures.

PURPOSE: The Center for Medicare & Medicaid Innovation Oncology Care Model (OCM) requires documentation of a 13-point Institute of Medicine care management plan for Medicare patients. In addition, OCM includes evaluation of quality using key performance measures that align with the ASCO Quality Oncology Practice Initiative (QOPI). Both efforts are designed to improve patient-centered care and foster patients' engagement in their care plan. METHODS: A multicenter quality improvement project was conducted to develop a strategy to meet the OCM treatment planning (TP) requirement (Plan), pilot clinician education coupled with use of electronic TP in early-stage breast cancer (Do), evaluate the impact of TP on QOPI measures (Study), and develop recommendations for future implementation (Act). RESULTS: Thirty-three clinical providers and 171 women with breast cancer were included. Improved performance on several QOPI measures was observed for the intervention group compared with the historical control group. CONCLUSION: Meeting the OCM TP requirement through incorporating a technology solution provided an opportunity for quality improvement and preparation for full-scale TP within the OCM. TP delivery was associated with improved performance on select ASCO QOPI measures, which is likely to correspond with improved performance on quality measures within OCM.

Incidence and Risk Factors of Intracranial Hemorrhage in Liver Transplant Recipients.

BACKGROUND: Intracranial hemorrhage after liver transplantation is an infrequently reported complication but one which can have devastating consequences. METHODS: We performed a retrospective cross-sectional analysis of all liver transplants performed between January 2010 and June 2015 at a single high-volume institution using a prospectively maintained electronic database and query of the electronic medical record. Cases of intracranial hemorrhage were adjudicated as either spontaneous intraparenchymal hemorrhage(IPH) or extra-axial hemorrhage (EAH). Patients with confirmed intracranial hemorrhage were compared with all other liver transplant recipients. Risk factors were identified by univariate analysis and logistic regression models for IPH and EAH. RESULTS: Thirty-one (5.2%) of 595 liver transplant recipients developed an intracranial hemorrhage within 12 months of transplantation, 15 IPH and 16 EAH. The majority of intracranial hemorrhages were diagnosed within 1 month of transplantation. Eight (26%) intracranial hemorrhage patients died during hospitalization. Fourteen (45%) intracranial hemorrhage patients died within 1 year of transplantation and 1-year mortality was greater than in patients without intracranial hemorrhage (11.2%, P < 0.01). Female sex (adjusted odds ratio [OR], 3.291; 95% confidence interval [CI], 1.092-9.924; P = 0.034), higher pretransplant bilirubin (adjusted OR, 1.037; 95% CI, 1.006-1.070; P = 0.020), and greater increase in pretransplant to posttransplant systolic blood pressure (adjusted OR, 1.029; 95% CI, 1.006-1.052; P = 0.012) were associated with posttransplant IPH. Lower pretransplant serum fibrinogen level (adjusted OR, 0.988; 95% CI, 0.979-0.998; P = 0.017) was associated with posttransplant EAH. CONCLUSIONS: Postoperative blood pressure control and pretransplant fibrinogen levels may be modifiable risk factors for preventing posttransplant intracranial hemorrhage.

Standardized phenology monitoring methods to track plant and animal activity for science and resource management applications.

Phenology offers critical insights into the responses of species to climate change; shifts in species' phenologies can result in disruptions to the ecosystem processes and services upon which human livelihood depends. To better detect such shifts, scientists need long-term phenological records covering many taxa and across a broad geographic distribution. To date, phenological observation efforts across the USA have been geographically limited and have used different methods, making comparisons across sites and species difficult. To facilitate coordinated cross-site, cross-species, and geographically extensive phenological monitoring across the nation, the USA National Phenology Network has developed in situ monitoring protocols standardized across taxonomic groups and ecosystem types for terrestrial, freshwater, and marine plant and animal taxa. The protocols include elements that allow enhanced detection and description of phenological responses, including assessment of phenological "status", or the ability to track presence-absence of a particular phenophase, as well as standards for documenting the degree to which phenological activity is expressed in terms of intensity or abundance. Data collected by this method can be integrated with historical phenology data sets, enabling the development of databases for spatial and temporal assessment of changes in status and trends of disparate organisms. To build a common, spatially, and temporally extensive multi-taxa phenological data set available for a variety of research and science applications, we encourage scientists, resources managers, and others conducting ecological monitoring or research to consider utilization of these standardized protocols for tracking the seasonal activity of plants and animals.

An Annual Plant Growth Proxy in the Mojave Desert Using MODIS-EVI Data.

In the arid Mojave Desert, the phenological response of vegetation is largely dependent upon the timing and amount of rainfall, and maps of annual plant cover at any one point in time can vary widely. Our study developed relative annual plant growth models as proxies for annual plant cover using metrics that captured phenological variability in Moderate-Resolution Imaging Spectroradiometer (MODIS) Enhanced Vegetation Index (EVI) satellite images. We used landscape phenologies revealed in MODIS data together with ecological knowledge of annual plant seasonality to develop a suite of metrics to describe annual growth on a yearly basis. Each of these metrics was applied to temporally-composited MODIS-EVI images to develop a relative model of annual growth. Each model was evaluated by testing how well it predicted field estimates of annual cover collected during 2003 and 2005 at the Mojave National Preserve. The best performing metric was the spring difference metric, which compared the average of three spring MODIS-EVI composites of a given year to that of 2002, a year of record drought. The spring difference metric showed correlations with annual plant cover of R² = 0.61 for 2005 and R² = 0.47 for 2003. Although the correlation is moderate, we consider it supportive given the characteristics of the field data, which were collected for a different study in a localized area and are not ideal for calibration to MODIS pixels. A proxy for annual growth potential was developed from the spring difference metric of 2005 for use as an environmental data layer in desert tortoise habitat modeling. The application of the spring difference metric to other imagery years presents potential for other applications such as fuels, invasive species, and dust-emission monitoring in the Mojave Desert.