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Many studies have examined behavioral and social drivers of COVID-19 vaccination initiation, but few have examined these drivers longitudinally. We sought to identify the drivers of COVID-19 vaccination initiation using the Behavioral and Social Drivers of Vaccination (BeSD) Framework. Participants were a nationally-representative sample of 1,563 US adults who had not received a COVID-19 vaccine by baseline. Participants took surveys online at baseline (spring 2021) and follow-up (fall 2021). The surveys assessed variables from BeSD Framework domains (i.e., thinking and feeling, social processes, and practical issues), COVID-19 vaccination initiation, and demographics at baseline and follow-up. Between baseline and follow-up, 65% of respondents reported initiating COVID-19 vaccination. Vaccination intent increased from baseline to follow-up (p < .01). Higher vaccine confidence, more positive social norms towards vaccination, and receiving vaccine recommendations at baseline predicted subsequent COVID-19 vaccine initiation (all p < .01). Among factors assessed at follow-up, social responsibility and vaccine requirements had the greatest associations with vaccine initiation (all p < .01). Baseline vaccine confidence, social norms, and vaccination recommendations were associated with subsequent vaccine initiation, all of which could be useful targets for behavioral interventions. Furthermore, interventions that highlight social responsibility to vaccinate or promote vaccination requirements could also be beneficial., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

This paper examines how paid and unpaid work affects leisure differently for older women and men in China and India. We use data from the World Health Organization's Study on Global Aging and Health. We find that urban China, with higher levels of public welfare and gender equality, represents the best scenario for older adults' leisure life in developing countries. Although urban Chinese women are disadvantaged relative to urban Chinese men, they still enjoy longer hours of leisure and relaxing leisure than both men and women in rural China, urban India and rural India. Furthermore, the Blinder-Oaxaca decomposition results show gender disparities in unpaid housework to be the primary driver of gender inequalities in leisure in all societies, albeit to varying degrees. These findings highlight the role of public welfare, gender equality, and the gendered consequences of the family support model in shaping older adults' leisure life., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Little is known about parental awareness of multisystem inflammatory syndrome in children (MIS-C), a rare but severe sequela of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection., Methods: Via a nationally representative, cross-sectional survey of US parents conducted via Ipsos KnowledgePanel from October to November 2021, we used bivariate and multivariable analyses to describe and identify demographic variables associated with parental knowledge of and attitudes toward MIS-C and to examine associations with perceived coronavirus disease 2019 (COVID-19) severity and susceptibility., Results: Response rate was 64.2% (3230/5034). Thirty-two percent of respondents had heard of MIS-C. After adjustment, higher educational level (compared to high school degree; some college: odds ratio [OR], 2.00 [95% confidence interval {CI}, 1.44-2.77]; bachelor's degree or higher: OR, 3.14 [95% CI, 2.26-4.35]), being a healthcare worker (OR, 1.82 [95% CI, 1.37-2.42]), having a child with a chronic medical condition (OR, 1.62 [95% CI, 1.22-2.14]), and experience with more severe COVID-19 (OR, 1.46 [95% CI, 1.14-1.86]) were associated with MIS-C awareness. Respondents with a child aged 12-17 years were less likely to be aware of MIS-C compared to those without (OR, 0.78 [95% CI, .63-.96]), as were male respondents (OR, 0.56 [95% CI, .46-.69]) and respondents aged 18-34 years (OR, 0.72 [95% CI, .54-.94]) compared to those aged 35-44 years. Awareness of MIS-C was associated with higher perceived COVID-19 severity and susceptibility (regression coefficients, 0.18 [95% CI, .10-.25], P < .001; 0.19 [95% CI, .11-.28], P < .001, respectively)., Conclusions: This survey highlights the need to increase parental awareness of MIS-C. Future studies should explore how education regarding MIS-C as a complication of SARS-CoV-2 infection could improve understanding of pediatric disease severity and susceptibility., Competing Interests: Potential conflicts of interest. E. A. H. and J. D. C. are investigators on clinical trials of COVID-19 vaccines sponsored by Moderna and Novavax. All other authors report no potential conflicts., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: Palliative hypofractionated radiotherapy (RT) is an effective mode of treating painful bone metastasis. While 8 Gy single fraction radiation is often effective for the same, for complicated bone metastases a protracted fractionated regimen is preferred, of which 30 Gy/10#/2weeks or 20 Gy/5#/1 week are the most common worldwide. However such schedules add to the burden of already overburdened radiation treatment facilities in a busy center, wherein alternative logistic favourable schedules with treatment on weekends are preferred. Here we compare the efficacy of a twice weekly schedule to that of standard continuous 20 Gy/5 #/1 week schedule in terms of pain relief, response and quality of life., Materials and Methods: A prospective non randomized study was undertaken from Jan 2018 to May 2019, wherein eligible patients of complicated bone metastases received palliative radiotherapy of 20 Gy/5#, either continuously for 5 fractions from Monday to Saturday or twice weekly, Saturday and Wednesday, starting on a Saturday over about 2 weeks. Pain relief was assessed by the Visual Analogue Scale (VAS) and FACES pain scale recorded prior to starting palliative RT and at 4 weeks, 3 months and 6 months., Results: Thirteen patients received continuous Hypofractionated RT while 16 received it in a twice weekly schedule. Spine was the most common site receiving palliative Radiation (27/29), while breast cancer was the most common primary (16/29). The demographic and the baseline characteristics were comparable. The mean pain score decline at 4 weeks was 2.56 ± 1.1 and 2.71 ± 0.52 in the 5-day and the two-week schedule, respectively (p = 0.67)., Conclusion: A twice weekly schedule over about two weeks was found to be equivalent in pain control and response to the standard fractionated palliative radiation and, thus, can be safely employed in resource constrained, busy radiotherapy centers., Competing Interests: Conflict of interest None declared., (© 2023 Greater Poland Cancer Centre.)

Background: Carcinoma of buccal mucosa forms a sizeable percentage of the diagnosed oral cavity cancers in India. There is limited data on elective treatment of the contralateral neck for well-lateralized carcinoma with no involved nodes in the contralateral neck. We conducted this study to compare locoregional control in patients treated with unilateral vs . bilateral neck irradiation., Materials and Methods: 48 patients with carcinoma of buccal mucosa were selected. Patients were divided into unilateral and bilateral arms based on radiation treatment of the ipsilateral or bilateral neck. All patients received adjuvant radiation with Cobalt 60 unit. Patient-specific and follow-up data were collected from records and dosimetric data from treatment planning system (TPS). Chi-square and unpaired t-test was used to compare data between arms and Kaplan Meier plot; Cox regression was used for survival analysis., Results: After a median follow-up of 23 months, 15 (31.3%) patients had developed disease recurrence, 8 and 7 in the unilateral and bilateral arms, respectively (p = 0.591). There was no contralateral neck failure during the follow-up period. The 2-year disease-free survival was 68.2% and 72.2% in the unilateral and bilateral arms, respectively. Among risk factors for disease recurrence, depth of invasion (DOI), delay in starting radiation and planning target volume (PTV) coverage were significant contributing factors. Cox multivariate regression suggested DOI and delay in starting radiation to be significant prognostic factors for disease-free survival (DFS)., Conclusion: Bilateral neck radiation does not provide any advantage over ipsilateral neck radiation for properly selected well lateralized buccal mucosal squamous cell carcinoma. Ipsilateral neck radiation facilitates better sparing of organs at risk., Competing Interests: Conflict of interest No conflict of interest., (© 2022 Greater Poland Cancer Centre.)

Background: Little was known about US parental attitudes, beliefs, and intentions surrounding coronavirus disease 2019 (COVID-19) vaccines for children before their introduction., Methods: An online cross-sectional nationally representative survey of US parents/guardians of children < 18 years old via Ipsos KnowledgePanel, fielded from October 26, 2021 to November 30, 2021., Results: Response rate was 64.2% (3230/5034). For children ages 0-4 years, 51.5% of parents were likely to have their children vaccinated, and for ages 5-11 and 12-17, 54.0% and 69.7% of parents, respectively, reported they were likely to vaccinate or had already vaccinated their children. Among respondents with unvaccinated children, 25.2% (ages 0-4) and 22.0% (ages 5-11) reported they would seek COVID-19 vaccination for their children as soon as authorization occurred. Factors associated with willingness to have children receive a COVID-19 vaccine were: belief in benefits of COVID-19 vaccination (odds ratio [OR] = 6.44, 5.68, 4.57 in ages 0-4, 5-11, and 12-17 respectively), acceptance of routine childhood vaccines (OR = 6.42, 5.48, 1.76), parental COVID-19 vaccination (OR = 1.85, 3.70, 6.16), perceptions that pediatric COVID-19 is severe (OR = 1.89, 1.72, 1.35), Hispanic ethnicity (OR = 2.07, 2.29, 2.60), influenza vaccine acceptance (OR = 1.07, 0.88, 1.62), presence of children of another age group in the household (OR = 0.71, 0.71, 0.65), and attitudinal barriers to COVID-19 vaccination (OR = 0.30, 0.26, 0.49)., Conclusions: Belief in the benefits of COVID-19 vaccination and acceptance of routine childhood vaccines are the strongest predictors of intention to vaccinate children. Further research is needed to track how parental attitudes change as more data about pediatric COVID-19 vaccines become available and how intentions translate into pediatric vaccine uptake., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Polymer nanoparticles and microparticles have been used primarily for drug delivery. There is now growing interest in further developing polymer-based solid cavitation agents to also enhance ultrasound imaging. We previously reported on a facile method to produce hollow poly(lactic-co-glycolic acid) (PLGA) microparticles with different diameters and degrees of porosity. Here, we investigate the cavitation response from these PLGA microparticles with both therapeutic and diagnostic ultrasound transducers. Interestingly, all formulations exhibited stable cavitation; larger porous and multicavity particles also provided inertial cavitation at elevated acoustic pressure amplitudes. These larger particles also achieved contrast enhancement comparable to that of commercially available ultrasound contrast agents, with a maximum recorded contrast-to-tissue ratio of 28 dB. Therefore, we found that multicavity PLGA microparticles respond to both therapeutic and diagnostic ultrasound and may be applied as a theranostic agent., Competing Interests: Conflict of interest disclosure The authors have no relevant financial interests in the article and no other potential conflicts of interest to disclose., (Copyright © 2021 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

For site-specific diseases such as atherosclerosis, it is desirable to noninvasively and locally deliver therapeutics for extended periods of time. High-intensity focused ultrasound (HIFU) provides targeted drug delivery, yet remains unable to sustain delivery beyond the HIFU treatment time. Furthermore, methods to validate HIFU-enhanced drug delivery remain limited. In this study, we report on HIFU-targeted implantation of degradable drug-loaded sound-sensitive multicavity PLGA microparticles (mcPLGA MPs) as a theranostic agent for the treatment of arterial lesions. Once implanted into the targeted tissue, mcPLGA MPs eluted dexamethasone for several days, thereby reducing inflammatory markers linked to oxidized lipid uptake in a foam cell spheroid model. Furthermore, implanted mcPLGA MPs created hyperechoic regions on diagnostic ultrasound images, and thus noninvasively verified that the target region was treated with the theranostic agents. This novel and innovative multifunctional theranostic platform may serve as a promising candidate for noninvasive imaging and treatment for site-specific diseases such as atherosclerosis.

Background: Brachytherapy for carcinoma cervix has moved from Point A based planning to optimization of dose based on HR-CTV. Guidelines have been published by GEC ESTRO on HR-CTV delineation based on clinical gynecological examination and MR sequences. These have given significant clinical results in terms of local control. However, many centers around the country and worldwide still use CT based planning, which restricts HR-CTV delineation, as disease and cervix can rarely be differentiated on a planning CT. Various studies have been done to develop CT based contouring guidelines from the available data, but enough evidence is not available on the clinical outcome when treatment is optimized to HR-CTV contoured on CT images. The purpose of this study is to find out the relation between local control and dosimetry of HR-CTV as delineated on CT images., Materials and Methods: Patients of locally advanced carcinoma cervix treated radically with EBRT of 50 Gy in 25# and at least 4 cycles of concurrent weekly Cisplatin having a complete or partial response to EBRT were taken for study. All patients had completed CT based Intracavitary brachytherapy to 21 Gy in 3# of 7 Gy per # with dose prescription at point A and optimizing dose to reduce bladder and rectal toxicity. Follow up data on locoregional recurrence was obtained. HR-CTV delineation was done retrospectively on the treatment plan following guidelines by Viswanathan et al. EQD2 doses for EBRT+BT were calculated for point A and HR-CTV D90. The dosimetric data to HR-CTV and to Point A were then compared with patients with locoregional control and with local recurrence., Results: 48 patients were taken, all had squamous cell carcinoma. The median age was 48 years. 33.33% were stage IIA, the rest were stage IIB. Median follow-up was 30 months with 25% developing recurrence of the disease. HR-CTV D90 EQD2 dose was significantly higher in patients with locoregionally controlled disease than in patients with local recurrence (83.97 Gy 10 vs. 77.96 Gy 10 , p = 0.002). Patients with HR-CTV D90 EQD2 dose greater than or equal to 79.75 Gy 10 had better locoregional control than patients receiving dose less than 79.75 Gy 10 (p = 0.015). Kaplan Meier plot for PFS showed significantly improved PFS for patients receiving HR-CTV D90 dose of at least 79.75 Gy 10 (log-rank p-value = 0.007). Three year progression free survival was 87.1% in patients receiving HR-CTV D90 dose of at least 79.75 Gy 10 ., Conclusion: CT based HR-CTV volume delineation with the help of pre brachytherapy clinical diagrams and MRI imaging may be feasible in a select subgroup of patients with complete or near-complete response to external beam radiation., Competing Interests: Conflict of interest None declared., (© 2021 Greater Poland Cancer Centre.)

Deep vein thrombosis (DVT) is a disorder when a blood clot (thrombus) is formed in one of the deep veins. These clots detach from the original sites and circulate in the blood stream at high velocities. Diagnosing these blood clots at an early stage is necessary to decide the treatment strategy. For label-free, in vivo, and real-time detection, high framerate photoacoustic imaging can be used. In this work, a dual modal clinical ultrasound and photoacoustic (PA) system is used for the high framerate PA imaging of circulating blood clots in blood at linear velocities up to 107 cm/sec. Blood clot had 1.4 times higher signal-to-noise ratio (SNR) in the static mode and 1.3 times higher SNR compared to blood PA signal in the flow experiments. This work demonstrates that fast-moving circulating blood clots are easy to recognize against the background PA signal and may aid in early diagnosis., (© 2020 Wiley-VCH GmbH.)

Photoacoustic imaging-a hybrid biomedical imaging modality finding its way to clinical practices. Although the photoacoustic phenomenon was known more than a century back, only in the last two decades it has been widely researched and used for biomedical imaging applications. In this review we focus on the development and progress of the technology in the last decade (2011-2020). From becoming more and more user friendly, cheaper in cost, portable in size, photoacoustic imaging promises a wide range of applications, if translated to clinic. The growth of photoacoustic community is steady, and with several new directions researchers are exploring, it is inevitable that photoacoustic imaging will one day establish itself as a regular imaging system in the clinical practices., (© 2021 Institute of Physics and Engineering in Medicine.)

Tissue local temperature information is necessary for guiding energy-based medical treatments. In cancer treatments such as thermal therapy, heating is applied to local tissue to kill the tumor cells. These techniques require a temperature monitoring device with high sensitivity. In this Letter, we demonstrate a pulsed-laser-diode-(PLD)-based photoacoustic temperature sensing (PATS) system for monitoring tissue temperature in real time. The system takes advantage of a high repetition rate (7000 Hz), a near-infrared wavelength (803 nm), and a relatively high energy 1.42 mJ/pulse laser. The system is capable of providing local temperature information at high temporal resolution of 1 ms and high sensitivity of 0.31°C. The temperature data measured with a PLD-PATS system are compared with the data provided by the commercial fiber Bragg grating sensor. The proposed system will find applications in radio-frequency ablation, photothermal therapy, and focused ultrasound, etc., used for cancer treatments.

Electroporation is a powerful tool for inactivating cells and transfecting biological cells and has applications in biology, genetic engineering, medicine, environment, and many others. We report a new continuous flow device embedded with insulating micropillars to achieve better performance of cell inactivation. The use of micropillars creates multiple electroporation zones with enhanced local electric field strengths. Using a model solution of Saccharomyces cerevisiae, we examined the inactivation performance of the device under various applied electric voltages and flow rates. Results from the numerical simulations and experiments showed that even with an induced transmembrane potential of 0.58 V, close to 63% of cell inactivation was achieved at a flow rate of 2.5 mL/h. This was higher than the 24% cell inactivation observed for a reference device without micropillars that was subjected to the same conditions., (© 2019 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Blockage of healthy blood vessels by blood clots can lead to serious or even life-threatening complications. The use of a combined ultrasound (US) and photoacoustic (PA) imaging was explored for blood clot monitoring during microbubble-assisted sonothrombolysis. PA imaging is an emerging hybrid imaging modality that has garnered the attention of the biomedical imaging community in recent years. It enables the study of the composition of a blood clot due to its sensitivity toward optical absorption. Here, in vitro imaging of the side of a blood clot facing the microbubbles was done over time. The US and PA signal-to-noise (SNR) ratio value changes during microbubble-assisted sonothrombolysis were studied for two different local environments: blood clot in deionized water and blood clot in blood. In the first case, US and PA SNR values increased by 4.6% and reduced by 20.8%, respectively after 30 min of sonothrombolysis treatment. After 10 min of sonothrombolysis treatment of the blood clot in blood, the US and PA SNR values increased by 7.7% and 38.3%, respectively. The US and PA SNR value changes were recorded in response to its local environment. This technique can be used to determine the final composition of the blood clot which may, in turn, help in the administration of clot-dissolving drugs.

Individuals in developing countries often engage in paid and unpaid work till late in life due to low household savings and limited welfare provisions. Yet, physical disabilities associated with aging can limit their ability to work. While work can be beneficial for economic and psychological well-being, this paper investigates whether engagement in paid and unpaid work mediates the impact of physical disabilities on quality of life for older adults. We exploit the different levels of health services and social security in rural and urban China and India to examine the effect of public provisions in the process. We use nationally representative data of individuals aged 50 and above from the World Health Organization Study on Global Ageing and Adult Health Wave 1, conducted in 2008-10 in China and in 2007-08 in India. Using a causal mediation analysis framework, we find that paid work plays a minor role in mediating the effect of physical disabilities on quality of life in all societies, and the mediated effect is smaller in urban China than in other societies. Unpaid work is beneficial only in urban China, and it does not mediate the impact of physical disabilities on quality of life elsewhere. The findings indicate that promoting productive engagement alone, without improving basic public provisions, will have limited impact on improving quality of life of the aging population in developing countries., (Copyright © 2018. Published by Elsevier Ltd.)

Background: Frontal assessment battery (FAB) was devised as a specific study design to assess frontal lobe dysfunction. Since Parkinson's disease (PD) is often associated with cognitive and other higher mental function complications, FAB test has been carried out by a number of workers to assess the integrity of the frontal lobe. On the other hand, the other frequently conducted test, performed in order to evaluate the mental status, is the Mini Mental State examination of Folstein (MMSE), but its reliability has been questioned in PD, since it does not assess the functions of the frontal lobe alone., Material and Methods: The present study was undertaken in order to assess the suitability of application of the FAB test in Indian patients and to perform its comparative analysis with the MMSE scale., Results and Conclusions: It was observed that the FAB test correlated with the age and the level of education of the patient. The results also correlated with that of the MMSE study, in spite of the fact that the latter is not considered to be a test which can assess exclusively the status of the frontal lobe. To the best of our knowledge, this is first study undertaken in India in this regard., Competing Interests: None

Dual-modal photoacoustic (PA) and ultrasound (US) contrast agents are becoming increasingly popular in recent years. Here, a flow-focusing junction based microfluidic device is used for the generation of nitrogen microbubbles (<7 μm) in two photoacoustic contrast agents: methylene blue (MB) and black ink (BI). The microbubble diameter and production rate could be precisely controlled in both MB and BI solutions. Microbubbles were collected from the outlet of the microfluidic device and optical microscope was used to study the size distributions in both solutions. Next, the microbubbles in both solutions were injected into tubes for phantom imaging experiments. Signal to noise ratio (SNR) of both US, PA imaging experiments were calculated to be 51 dB, 58 dB in MB + microbubbles and 56 dB, 61 dB in BI + microbubbles, respectively. Finally, the microbubbles were injected into the urinary bladder of rats for in vivo animal imaging. The SNR in US imaging with MB + microbubbles and BI + microbubbles were 41 dB and 48 dB, respectively. Similarly, the SNR in PA imaging with the same solutions were 32 dB and 36 dB, respectively. The effect of size and concentration of microbubbles in both MB and BI solutions, on the US and PA signals, has been examined.

An important reason for public intervention in health in developing countries is to address the issue of accessibility. However, numerous studies have found inconclusive evidence of the effect of public expenditure on health outcomes. Here, I revisit the debate by examining the effect of public expenditure on the use of health services, which is an important link between expenditure and outcomes. I use data from two recent waves of the National Family Health Survey of India to study the role of public expenditure on the use of healthcare services during pregnancy and childbirth. India has high state-level variations in the use of prenatal care and delivery by skilled personnel as well as levels of public expenditure. I exploit the variation in public expenditure to identify its effect on the use of healthcare services, controlling for other confounding factors. The results show a significant effect of public expenditure at the state level on the use of both prenatal and delivery care at the individual level. Also, there is no evidence of public expenditure crowding out private expenditure. Further, there is strong evidence that public expenditure reaches the desired targets. The results highlight the positive implications of raising public expenditure for healthcare use of pregnancy and childbirth services in the Indian context.

A novel continuous flow microfluidic platform specifically designed for environmental monitoring of O/W emulsions during an aftermath of oil spills is reported herein. Ionized polycyclic aromatic hydrocarbons which are toxic are readily released from crude oil to the surrounding water phase through the smaller oil droplets with enhanced surface area. Hence, a multi-module microfluidic device is fabricated to form ion enrichment zones in the water phase of O/W emulsions for the ease of detection and to separate micron-sized oil droplets from the O/W emulsions. Fluorescein ions in the water phase are used to simulate the presence of these toxic ions in the O/W emulsion. A DC-biased AC electric field is employed in both modules. In the first module, a nanoporous Nafion membrane is used for activating the concentration polarization effect on the fluorescein ions, resulting in the formation of stable ion enrichment zones in the water phase of the emulsion. A 35.6% amplification of the fluorescent signal is achieved in the ion enrichment zone; corresponding to 100% enrichment of the fluorescent dye concentration. In this module, the main inlet is split into two channels by using a Y-junction so that there are two outlets for the oil droplets. The second module located downstream of the first module consists of two oil droplet entrapment zones at two outlets. By switching on the appropriate electrodes, either one of the two oil droplet entrapment zones can be activated and the droplets can be blocked in the corresponding outlet., (© 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Photo-thermal behavior of binary liquid mixtures has been studied by high repetition rate (HRR) Z-scan technique with femtosecond laser pulses. Changes in the peak-valley difference in transmittance (ΔT P-V ) for closed aperture Z-scan experiments are indicative of thermal effects induced by HRR femtosecond laser pulses. We show such indicative results can have a far-reaching impact on molecular properties and intermolecular interactions in binary liquid mixtures. Spectroscopic parameters derived from this experimental technique show that the combined effect of physical and molecular properties of the constituent binary liquids can be related to the components of the binary liquid., (© The Author(s) 2016.)

Background: Cognitive symptoms are common in advanced Parkinson's disease (PD). However, assessment of cognitive impairment is difficult in PD because of accompanying motor symptoms and the coexistence of nonmotor symptoms. Specific subdomains affected in the disease are not reflected in the conventional scales used for assessing cognition., Objectives: This study was aimed at looking at the spectrum of cognitive impairment in the various phenotypes and stages of PD and the correlation of cognitive impairment with motor and nonmotor symptoms of PD., Patients and Methods: Fifty PD patients fulfilling the UK PD Society Brain Bank's criteria were selected after obtaining explicit consent. Patients were assessed clinically and by using various scales like Scales for Outcomes in PD-Cognition (SCOPA-COG), mini-mental state examination, and Beck's Depression Inventory and Scoring., Results: The mean age was 58 years, 82% of the patients were male, and the mean modified Hoehn and Yahr staging was 2. The most commonly affected domains were memory and executive functioning. Cognitive impairment was more in those with late-onset disease, more advanced stage of disease, and in the postural instability and gait disorder (PIGD) subgroup. The cognitive function deteriorated with increasing age and duration of the illness. Significant correlation with cognitive impairment was obtained for the manifestations of increased motor disability, presence of coexistent psychotic symptoms and depression., Conclusions: Cognitive impairment was common among PD patients, and it was more prevalent with increasing duration of the disease, in older patients, in late-onset disease, and in the PIGD subgroup. Increasing motor disability and associated psychotic symptoms as well as depression significantly increased the cognitive impairment.

Operating at biologically benign conditions, multi-photon fluorescence imaging microscopy has benefitted immensely from recent developments in microscopic resolution enhancement. Fluorescence microscopy continues to be the best choice for experiments on live specimens, however, multi-photon fluorescence imaging often suffers from overlapping fluorescence of typical dyes used in microscopy, limiting its scope. This limitation has been the focus of our research where we show that by making simple modifications to the laser pulse structure, it is possible to resolve these overlapping fluorescence complications. Specifically, by using pairs of femtosecond pulses with variable delay in place of single pulse excitation, we show controlled fluorescence excitation or suppression of one of the fluorophores over the other through wave-packet interferometry. Such an effect prevails even after the fluorophore coherence timescale, which effectively results in a higher spatial resolution. Here we extend the effect of our pulse-pair technique to microscopic axial resolution experiments and show that such pairs of pulses can also 'enhance' axial resolution.

This article examines the implications of revenue changes on the financial condition of nonprofit hos pitals. I examine these implications empirically by studying the effect of changes in Medicare payments in the Balanced Budget Act of 1997. Using data from the Healthcare Cost Report Information System maintained by the Centers for Medicare & Medicaid Services between 1996 and 2004, I show that even though revenue fell significantly, resulting in a decline in profitability, hospitals did not significantly change their capital structure and use of capital. An important implication of this is a higher cost of borrowing for these hospitals, which can affect future capital accumulation and viability. Nonprofit hospitals are a very important part of the healthcare delivery system in the United States. Medicare patients constitute the single largest segment of their revenue sources. Understanding the consequences of the changes in Medicare reimbursement on hospital finances is useful in framing future revisions of Medicare payments.

Transcription coupled nucleotide excision repair (TCR) is a major pathway responsible for removal of helix distorting DNA lesions from transcriptionally active regions of the genome. Rad26, a key factor of the TCR pathway, is known to play a role during early steps of TCR. Here, we show that Rad26-mediated TCR is not absolutely dependent on active transcription elongation in budding yeast. As per our results, RAD26-deleted cells show enhanced UV sensitivity compared to wild type cells under conditions where transcription elongation is inhibited. The increased UV sensitivity observed in RAD26-deleted cells, however, is not due to reduced expression of the major NER-responsive genes. Interestingly, transcription of the constitutively expressed RPB2 gene is adversely affected in RAD26-deleted cells during UV-induced DNA damage repair. In consonance, chromatin immunoprecipitation analysis showed that unlike in wild type, in RAD26-deleted cells no significant reduction in RNA polymerase II occupancy occurs during nucleotide excision repair in the transcriptionally active loci like, RPB2, PYK1 and RPL2B. These results collectively indicate that removal of RNAPII during DNA damage repair following UV irradiation is dependent on Rad26.

Exploiting changes in welfare policy across states and over time and comparing relevant population subgroups within an econometric difference-in-differences framework, we estimate the effects of welfare reform on adult women's illicit drug use from 1992 to 2002, the period during which welfare reform unfolded in the U.S. The analyses are based on all available and appropriate national datasets, each offering unique strengths and measuring a different drug-related outcome. We investigate self-reported illicit drug use (from the National Household Surveys on Drug Abuse and National Surveys on Drug Use and Health), drug-related prison admissions (from the National Corrections Reporting Program), drug-related arrests (from Federal Bureau of Investigation Uniform Crime Reports), and drug-related emergency department episodes (from the Drug Abuse Warning Network). We find robust evidence that welfare reform led to a 10-21% decline in illicit drug use among women at risk of relying on welfare, as well as associated declines in drug-related arrests (6-7%), drug-related hospital emergency department episodes (7-11%), and possibly drug-related prison admissions (11-19%). The findings indicate that an appropriately designed system with sufficient job opportunities for those are able to work can result in both increases in employment and decreases in drug use.

Context: Prenatal care generally includes contraceptive and health education that may help women to control their subsequent fertility. However, research has not examined whether receipt of prenatal care is associated with subsequent birthspacing., Methods: Longitudinally linked birth records from 113,662 New Jersey women who had had a first birth in 1996-2000 were used to examine associations between the timing and adequacy of prenatal care prior to a woman's first birth and the timing of her second birth. Multinomial logistic regression analyses adjusted for social and demographic characteristics, hospital and year of birth., Results: Most women (85%) had initiated prenatal care during the first trimester. Women who had not obtained prenatal care until the second or third trimester, or at all, were more likely than those who had had first-trimester care to have a second child within 18 months, rather than in 18-59 months (odds ratios, 1.2-1.6). Similarly, women whose care had been inadequate were more likely than those who had had adequate care to have a short subsequent birth interval (1.2). The associations were robust to alternative measures of prenatal care and birth intervals, and were strongest for mothers with less than 16 years of education., Conclusions: Providers should capitalize on their limited encounters with mothers who initiate prenatal care late or use it sporadically to ensure that these women receive information about family planning., (Copyright © 2012 by the Guttmacher Institute.)

For vulnerable and frail older adults, management of daily financial obligations can become an overwhelming burden spiraling into at-risk situations. Social service agencies have developed community-based Daily Money Management programs to assist these adults in protecting their financial security. Through this study the authors present the first economic estimates of the costs of Daily Money Management programs which, along with case management programs, save $60,000 per individual when compared with the cost of nursing home placement, making them highly cost effective. Most importantly, individuals are able to remain in their homes. The authors address the current gap between cost-effective community-based practice and public policy support.

Exploiting variation in welfare reform across states and over time and using relevant comparison groups, this study estimates the effects of welfare reform on an important source of human capital acquisition among women at risk for relying on welfare: vocational education and training. The results suggest that welfare reform reduced enrollment in full-time vocational education and had no significant effects on part-time vocational education or participation in other types of work-related courses, though there appears to be considerable heterogeneity across states with respect to the strictness of educational policy and the strength of work incentives under welfare reform. In addition, we find evidence of heterogeneous effects by prior educational attainment. We find no evidence that the previously-observed negative effects of welfare reform on formal education (including college enrollment), which we replicated in this study, have been offset by increases in vocational education and training.

Objective: This paper presents the reliability and validity of a "competing food choice" construct designed to assess whether factors related to consumption of less-healthful food were perceived to be barriers to fruit and vegetable consumption in college freshmen., Design: Cross-sectional, self-administered survey., Setting: An urban public college with a large, diverse student population., Participants: A convenience sample of 408 college freshmen., Variables Measured: A "competing food choice" construct and fruit and vegetable intake., Analyses: Factor analysis, Cronbach α, and correlation coefficients were used to determine the reliability and validity of the construct., Results: Three factors were produced from the factor analysis of the 11-item competing food choice construct: "competitive food" barriers (Cronbach alpha = 0.73), fruit and vegetable-related "time" barriers (Cronbach alpha = 0.67), and "quality" barriers (Cronbach alpha = 0.64). Construct validity assessments revealed significant inverse correlations between fruit and vegetable consumption and competitive food barriers (r = -0.15, P < .01 current and r = -0.25, P < .01 prior) and time barriers (r = -0.12, P < .05 current and r = -0.10, P < .05 prior)., Conclusions and Implications: This "competing food choice" construct demonstrated satisfactory reliability and construct validity among college freshmen., (Copyright 2010 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.)

Objective: To understand the important dimensions of the financial and operational performance of non-profit hospitals., Data Source: Secondary data for non-profit US hospitals between 1996 and 2004., Study Design: I use iterative principal factor analysis of hospitals' financial and operational ratios for each year of the study. For factor interpretation, I use oblique rotation., Data Collection/extraction Methods: Financial ratios were created using cost report data from HCRIS 2552-96 available from the Centers for Medicaid & Medicare Services (CMS)., Principal Finding: I identify five factors--capital structure, profitability, activity, liquidity, and an operational factor--that explain most of the variation in the performance of non-profit hospitals. I also find that capital structure is more important than profitability in determining the performance of these hospitals., Conclusion: The importance of capital structure highlights a significant shift in the organization of the non-profit hospitals' finances.

Objective: To estimate the effectiveness of a tailored multicomponent community-based smoking cessation intervention among Chinese immigrants living in New York City, implemented within the context of state and city-wide tobacco control policy initiatives for the general population., Methods: A pre-post-test quasi-experimental design with representative samples from Chinese populations living in two communities in New York City: Flushing, Queens, the intervention community and Sunset Park, Brooklyn, the comparison community. From November 2002 to August 2003 baseline interviews were conducted with 2537 adults aged 18-74. In early 2006, 1384 participants from the original cohort completed the follow-up interview. During the intervention period (October 2003 to September 2005), both communities were exposed to tobacco control public policy changes. However, only Flushing received additional linguistically and culturally-specific community-level tobacco control interventions., Results: From 2002 to 2006 overall smoking prevalence among Chinese immigrants declined from 17.7% to 13.6%, a relative 23% decrease. After controlling for socio-demographic characteristics, there was an absolute 3.3% decrease in smoking prevalence attributed to policy changes with an additional absolute decline in prevalence of 2.8% in the intervention community relative to the control community., Conclusion: City-wide tobacco control policies are effective among high-risk urban communities, such as Chinese immigrants. In addition, community-based tailored tobacco control interventions may increase the reduction in smoking prevalence rates beyond that achieved from public policies.

Households and workplaces are the predominant location for exposure to secondhand smoke. The purpose of this study is to examine the association between health status and smoking restrictions at home and work and to compare the relative effect of household and workplace smoking restrictions on health status. This study uses data from a cross sectional representative probability sample of 2,537 Chinese American adults aged 18-74 living in New York City. The analysis was limited to 1,472 respondents who work indoors for wages. Forty-three percent of respondents reported a total smoking ban at home and the workplace, 20% at work only, 22% home only, and 15% reported no smoking restriction at home or work. Nonsmokers [corrected] who live under a total household smoking ban only or both a total household and total workplace ban were respectively 1.90 and 2.61 times more likely to report better health status compared with those who reported no smoking ban at work or home. Before the NYC Clean Indoor Air Act second-hand smoke (SHS) exposure among this immigrant Chinese population at home and work was high. This study finds that household smoking restrictions are more strongly associated with better health status than workplace smoking restrictions. However, better health status was most strongly associated with both a ban at work and home. Public health efforts should include a focus on promoting total household smoking bans to reduce the well-documented health risks of SHS exposure.

Cross-national comparisons that assess dimensions of health system performance indicate that the US provides higher rates of revascularization procedures than France and other developed nations, but we believe these findings are misleading. In this paper, we compare the use of these procedures in the US, France and their two world cities, Manhattan and Paris. In doing so, we address a number of limitations associated with existing cross-national comparisons of heart disease treatment. After adjusting for the prevalence of disease in these nations and cities, we found that residents of France aged 45-64 years receive more revascularization procedures than residents of the US and that Parisians receive more revascularizations than residents of Manhattan. Older residents 65 years and over (65+) in the US receive more of these procedures than their French counterparts, but the differences are not nearly as great as previous studies suggest. Moreover, our data on Manhattan and Paris where the population and level of health resources are more comparable, indicate that older Parisians obtain more revascularization procedures than older Manhattanites. Finally, we found that the use of revascularization procedures is significantly lower in Manhattan among persons without private health insurance and among racial and ethnic minorities.