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During the COVID-19 pandemic, forecasting COVID-19 trends to support planning and response was a priority for scientists and decision makers alike. In the United States, COVID-19 forecasting was coordinated by a large group of universities, companies, and government entities led by the Centers for Disease Control and Prevention and the US COVID-19 Forecast Hub ( https://covid19forecasthub.org ). We evaluated approximately 9.7 million forecasts of weekly state-level COVID-19 cases for predictions 1–4 weeks into the future submitted by 24 teams from August 2020 to December 2021. We assessed coverage of central prediction intervals and weighted interval scores (WIS), adjusting for missing forecasts relative to a baseline forecast, and used a Gaussian generalized estimating equation (GEE) model to evaluate differences in skill across epidemic phases that were defined by the effective reproduction number. Overall, we found high variation in skill across individual models, with ensemble-based forecasts outperforming other approaches. Forecast skill relative to the baseline was generally higher for larger jurisdictions (e.g., states compared to counties). Over time, forecasts generally performed worst in periods of rapid changes in reported cases (either in increasing or decreasing epidemic phases) with 95% prediction interval coverage dropping below 50% during the growth phases of the winter 2020, Delta, and Omicron waves. Ideally, case forecasts could serve as a leading indicator of changes in transmission dynamics. However, while most COVID-19 case forecasts outperformed a naïve baseline model, even the most accurate case forecasts were unreliable in key phases. Further research could improve forecasts of leading indicators, like COVID-19 cases, by leveraging additional real-time data, addressing performance across phases, improving the characterization of forecast confidence, and ensuring that forecasts were coherent across spatial scales. In the meantime, it is critical for forecast users to appreciate current limitations and use a broad set of indicators to inform pandemic-related decision making.

During the COVID-19 pandemic, forecasting COVID-19 trends to support planning and response was a priority for scientists and decision makers alike. In the United States, COVID-19 forecasting was coordinated by a large group of universities, companies, and government entities led by the Centers for Disease Control and Prevention and the US COVID-19 Forecast Hub (https://covid19forecasthub.org). We evaluated approximately 9.7 million forecasts of weekly state-level COVID-19 cases for predictions 1–4 weeks into the future submitted by 24 teams from August 2020 to December 2021. We assessed coverage of central prediction intervals and weighted interval scores (WIS), adjusting for missing forecasts relative to a baseline forecast, and used a Gaussian generalized estimating equation (GEE) model to evaluate differences in skill across epidemic phases that were defined by the effective reproduction number. Overall, we found high variation in skill across individual models, with ensemble-based forecasts outperforming other approaches. Forecast skill relative to the baseline was generally higher for larger jurisdictions (e.g., states compared to counties). Over time, forecasts generally performed worst in periods of rapid changes in reported cases (either in increasing or decreasing epidemic phases) with 95% prediction interval coverage dropping below 50% during the growth phases of the winter 2020, Delta, and Omicron waves. Ideally, case forecasts could serve as a leading indicator of changes in transmission dynamics. However, while most COVID-19 case forecasts outperformed a naïve baseline model, even the most accurate case forecasts were unreliable in key phases. Further research could improve forecasts of leading indicators, like COVID-19 cases, by leveraging additional real-time data, addressing performance across phases, improving the characterization of forecast confidence, and ensuring that forecasts were coherent across spatial scales. In the meantime, it is critical for forecast users to appreciate current limitations and use a broad set of indicators to inform pandemic-related decision making.

Several subgroups of the International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/APNN) have periodically analyzed APN (nurse practitioner and clinical nurse specialist) development around the world. The primary objective of this study was to describe the global status of APN practice regarding scope of practice, education, regulation, and practice climate. An additional objective was to look for gaps in these same areas of role development in order to recommend future initiatives. An online survey was developed by the research team, and included questions on APN practice roles, education, regulation/credentialing, and practice climate. The study was launched in August 2018 at the 10 Annual ICN NP/APNN Conference in Rotterdam, Netherlands. Links to the survey were provided there and via multiple platforms over the next year. Survey results from 325 respondents, representing 26 countries, were analyzed through descriptive techniques. Although progress was reported, particularly in education, results indicated the APN profession around the world continues to struggle over titling, title protection, regulation development, credentialing, and barriers to practice. APNs have the potential to help the world reach the Sustainable Development Goal of universal health coverage. Several recommendations are provided to help ensure APNs achieve these goals.

Background This project aimed to optimize communication strategies to support family communication about familial hypercholesterolemia (FH) and improve cascade testing uptake among at-risk relatives. Individuals and families with FH provided feedback on multiple strategies including: a family letter, digital tools, and direct contact. Methods Feedback from participants was collected via dyadic interviews ( n  = 11) and surveys ( n  = 98) on communication strategies and their proposed implementation to improve cascade testing uptake. We conducted a thematic analysis to identify how to optimize each strategy. We categorized optimizations and their implementation within the project’s healthcare system using a Traffic Light approach. Results Thematic analysis resulted in four distinct suggested optimizations for each communication strategy and seven suggested optimizations that were suitable across all strategies. Four suggestions for developing a comprehensive cascade testing program, which would offer all optimized communication strategies also emerged. All optimized suggestions coded green ( n  = 21) were incorporated. Suggestions coded yellow ( n  = 12) were partially incorporated. Only two suggestions were coded red and could not be incorporated. Conclusions This project demonstrates how to collect and analyze stakeholder feedback for program design. We identified feasible suggested optimizations, resulting in communication strategies that are patient-informed and patient-centered. Optimized strategies were implemented in a comprehensive cascade testing program.

Background Orthopaedic surgery lags behind other surgical specialties in terms of gender diversity. The percentage of women entering orthopaedic residency persistently remains at 14% despite near equal ratios of women to men in medical school classes. This trend has been attributed to negative perceptions among women medical students of workplace culture and lifestyle in orthopaedics as well as lack of exposure, particularly during medical school when most women decide to enter the field. Since 2012, The Perry Initiative, a nonprofit organization that is focused on recruiting and retaining women in orthopaedics, had conducted extracurricular outreach programs for first- and second-year female medical students to provide exposure and mentoring opportunities specific to orthopaedics. This program, called the Medical Student Outreach Program (MSOP), is ongoing at medical centers nationwide and has reached over 300 medical students in its first 3 program years (2012–2014). Questions/purposes (1) What percentage of MSOP participants eventually match into orthopaedic surgery residency? (2) Does MSOP impact participants’ perceptions of the orthopaedics profession as well as intellectual interest in the field? Methods The percentage of program alumnae who matched into orthopaedics was determined by annual followup for our first two cohorts who graduated from medical school. All program participants completed a survey immediately before and after the program that assessed the impact of MSOP on the student’s intention to pursue orthopaedics as well as perceptions of the field and intellectual interest in the discipline. Results The orthopaedic surgery match rate for program participants was 31% in our first graduating class (five of 16 participants in 2015) and 28% in our second class (20 of 72 participants in 2016). Pre/post program comparisons showed that the MSOP influenced students’ perceptions of the orthopaedics profession as well as overall intellectual interest in the field. Conclusions The results of our study suggest that The Perry Initiative’s MSOP positively influences women to choose orthopaedic surgery as a profession. The match rate for program alumnae is twice the percentage of females in current orthopaedic residency classes. Given these positive results, MSOP can serve as a model, both in its curricular content and logistic framework, for other diversity initiatives in the field.

The beginning of the U.S. COVID-19 pandemic interrupted integral services and supports for those in recovery from substance use disorders. The current study used qualitative and quantitative data to identify 1) pandemic-related barriers/stressors, 2) coping strategies employed, and 3) how the stressors and strategies predicted subsequent substance use frequency. Participants were 48 adults (40.5% female; 90.2% White) between 26 and 60 years old (M = 42.66, SD = 8.44) who were part of a larger, multi-year longitudinal study of individuals in recovery from substance use disorders. Individuals completed two interviews, one during the six weeks of initial stay-at-home orders in the state in which data were collected and the second within six to twelve months of their initial interview. Common barriers to recovery included cancelled support meetings, changes in job format (i.e., being fired or furloughed), and lack of social support. Common coping strategies included self-care, leisure activities/hobbies, taking caution against exposure, and strengthening personal relationships. The relationship between cravings at baseline and substance use at follow up was stronger for those who experienced worsening of their mental health (B = 21.80, p < .01) than for those who did not (B = 5.45, p = 0.09), and for those who were taking caution against exposure (B = 24.57, p < .01) than for those who were not (B = 1.87, p = 0.53). Those who engaged in self-care (B = 0.00, p>.99) had lower rates of substance use at follow-up than those who did not employ self-care as a coping mechanism (B = 16.10, p < .01). These findings inform research priorities regarding prospective effects of the pandemic on treatment endeavors, particularly emphasizing treating mental health and encouraging self-care strategies.

Background Systemic sclerosis (SSc) is a rare connective tissue disorder with heterogeneous manifestations. Two predominant subtypes, limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc), are distinguished based on skin involvement distribution. A comprehensive conceptual SSc model is needed to support measurement strategies for outcome studies. This qualitative study aimed to explore key SSc disease concepts and develop a conceptual disease model capturing the heterogeneous lived experiences of patients with SSc. Methods Patient- and clinician-reported concepts specific to dcSSc (more severe and faster-progressing than lcSSc) were identified via a targeted literature review and used to develop a preliminary dcSSc symptom model and a semi-structured qualitative interview guide. The guide was used in concept elicitation interviews with adults with lcSSc and dcSSc. A final conceptual SSc symptoms model was refined based on interview results. Results Disease concepts were retrieved from 35 peer-reviewed articles and 17 clinical trials focusing on patients with dcSSc. The preliminary dcSSc symptom model included skin, hand, gastrointestinal, pain, joint, muscle, mouth, sexual, lung, cardiovascular, cognitive, ocular, and other symptoms. During concept elicitation interviews, participants (n = 44) reported 112 unique symptoms (within 13 domains). Twenty-six symptoms had not previously been identified in pertinent literature. Hand and skin symptoms were reported by all participants. Over 95% of participants reported at least one gastrointestinal and pain symptom, around 80% reported joint and mouth symptoms, 70% reported muscle symptoms, and over 50% reported ocular symptoms. Cognitive, lung, sexual, and cardiac symptoms were reported by fewer than half of participants. Participants with dcSSc reported a broader variety of symptoms than those with lcSSc. However, concepts relevant to patients with dcSSc and lcSSc strongly overlapped, suggesting that a single conceptual model is appropriate to map symptoms for both subtypes. The overlap was further reflected in the most bothersome symptoms, which included skin fibrosis and hand symptoms for both populations. Conclusions The final conceptual model captures the heterogeneous symptoms of SSc and reflects the lived experience of patients with SSc. It covers both clinical SSc subtypes and can support the choice and/or development of instruments to measure patient experiences in clinical trials.

Women represent only 15.3% of all residents and fellows in the field of orthopedic surgery. The rate of increase of women in the field of orthopedics continues to lag behind all other surgical specialties. The purpose of this study was 2-fold: (1) to evaluate male/female representation in orthopedic specialty societies and (2) to examine the involvement of male/female orthopedic surgeons on committees, in leadership roles, at annual meetings, and in receipt of monetary awards. A 12-question, anonymous survey was distributed to the executive directors of all 23 orthopedic specialty societies. The survey included questions about the breakdown of male/female membership as well as male/female orthopedic surgeon participation in various functions of the society. Fourteen (60.9%) of 23 executive directors from orthopedic specialty societies responded to the survey. Seven (50.0%) of 14 survey respondents reported society membership of more than 1000. Six (42.9%) of 14 survey respondents reported male membership of more than 1000, while only the Ruth Jackson Orthopaedic Society reported female membership of more than 1000. Eleven (78.6%) of 14 survey respondents (eg, American Association of Hip and Knee Surgeons, American Orthopaedic Foot and Ankle Society, American Orthopaedic Society for Sports Medicine) reported having more than 10 men in leadership positions, whereas 13 (92.9%) of 14 respondents reported 10 or fewer women in leadership positions. Most orthopedic specialty societies have lower female than male membership, fewer women in leadership positions, and fewer monetary awards granted to women compared with men. This disparity was more evident in anatomic societies (eg, American Association of Hip & Knee Surgeons, American Orthopaedic Foot and Ankle Society) compared with general orthopedic societies (eg, Ruth Jackson Orthopaedic Society, Orthopaedic Research Society). Female orthopedic surgeons remain underrepresented in orthopedic specialty societies. [Orthopedics. 2021;44(5):289–292.]

Background The total burden of migraine includes not only the episodes with headache pain but extends throughout the interictal periods. Interictal symptoms and associated psychological responses may profoundly impact well-being and drive treatment-seeking behavior. Methods A cross-sectional online survey was conducted with participants aged ≥ 18 years, 250 with episodic migraine (EM) and 250 with chronic migraine (CM), having ≥ 4 monthly migraine headache days. All were naïve to galcanezumab or began ≤ 6 months before survey completion. The study evaluated factors associated with the Migraine Interictal Burden Scale (MIBS-4), including social determinants of health and well-being. Multiple linear regression, logistic regression, and random forests (RF) were used to explore predictors of MIBS-4. Results The majority of participants (90%) were female with a mean (standard deviation) age of 40.6 (± 12.0) years and 18.1 (± 12.7) years since the first migraine episode. Sociodemographically, the EM and CM groups were similar. Common comorbidities were anxiety disorder (45%) and depression (44%). Migraine family history was reported in 59% of participants. MIBS-4 was correlated with a number of diverse variables, including well-being, anxiety sensitivity, income, aura symptoms, and the worst migraine pain in the year before starting galcanezumab. Linear and logistic regression identified years since the first symptom, worst migraine attack pain, premonitory symptoms, and income as significant predictors. RF explained more of the variance than multiple linear regression and introduced additional concepts to the prediction of MIBS, identifying well-being (WHO-5 total score), the WHO-5 item “cheerful and in good spirits,” worry about exercise, and fear of missing social obligations as significant predictors. Socioeconomic status and income were also critical explanatory variables for interictal burden (IIB) based on regression modeling and RF. Still, income was the only variable significantly associated with IIB across regression and RF methods. Conclusions Interictal burden should be considered in the medical care of people with migraine. This additional burden is holistic, with psychosocial and socioeconomic elements in addition to residual symptoms. It is essential to consider this when assessing the impact of IIB.