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Makerspaces have the potential to improve the learning outcomes of students in both middle and high schools. They support science, technology, engineering, arts, and mathematics (STEAM) style initiatives, as well as promote natural creativity among students who tend to struggle in expressing it. This study aims to gain significant insight from professionals who are involved in the Makerspaces movement within STEAM secondary education. The findings of the study highlight the critical strategies, effects, and issues behind the implementation of Makerspaces in support of STEAM education at secondary schools. These findings suggest that, for instance, Makerspaces provide students who struggle with school with a means to demonstrate their true knowledge in a way that appeals to them. In addition, in order to utilize Makerspaces properly and effectively, secondary school teachers need professional development experiences that are specific to their needs.

Introduction: The Electronic Nicotine Delivery Systems (ENDS) industry recently introduced non-tobacco nicotine (NTN), which is not tobacco-derived and is often marketed as "tobacco-free nicotine." Given its novelty, it is important to understand where young adults learn about NTN ENDS. This study examined sources of exposure to NTN ENDS and relationships with NTN ENDS use and susceptibility. Methods: We analyzed online survey data collected in Fall 2021 from 642 young adults (18–25 years) who had heard of NTN ENDS. We assessed 9 sources of NTN ENDS exposure (e.g., retail stores, social media) and examined associations between sources of exposure and NTN current (past-month) use, lifetime (non-current) use, and susceptibility to use, adjusting for demographics and other tobacco product use. Results: Participants reported current NTN ENDS use (37.4%), lifetime use (12.0%), susceptibility (18.5%), or no susceptibility to use (32.1%). The most common sources of NTN ENDS exposure were retail stores (87.7%) and social media (81.0%). Exposure to NTN ENDS via social media was associated with greater odds of current NTN ENDS use (vs. no susceptibility) (aOR = 1.83, 95%CI: 1.02–3.28). Exposure via online streaming platforms was associated with greater odds of current (aOR = 1.75, 95%CI: 1.08–2.82) and lifetime NTN ENDS use (aOR = 2.42, 95%CI: 1.25–4.68). Conclusions: Young adults were exposed to and learned about NTN ENDS from diverse sources, primarily retail shops and social media. Further, exposure via social media and streaming platforms were associated with NTN ENDS use. Future studies should explore the content of NTN information from various sources to inform prevention efforts. [ABSTRACT FROM AUTHOR]

Background: Current e-cigarette use has increased among young adults in the USA despite a consistent decrease in perceiving e-cigarettes as less harmful than cigarettes over time. This study examined time-varying predictors associated with the changes in e-cigarette relative harm perception over time among US young adults. Methods: Data were from the 2013–2018 Population Assessment of Tobacco and Health (PATH) Study for young adults (18–24 years). A time-varying effect model (TVEM) was applied to examine the association between the relative harm perception change and the associated time-varying predictors. Results: Of the 8427 young adults, the prevalence of those who perceived e-cigarettes as less harmful than cigarettes decreased from 50.3% in Wave 1 (2013–2014) to 27.7% in Wave 4 (2016–2018). Young adults who were male were more likely to perceive e-cigarettes as less harmful than cigarettes over time (OR = 1.58; 95%CI, 1.53–1.64). In addition, the changes in e-cigarette relative harm perception were less noticeable among those with advanced degrees, who had non-combustible smoke-free home rules, who held negative tobacco-related attitudes, and those who were current e-cigarette users or ever used alcohol (all p values < 0.05). Conclusions: A decline was observed in US young adults who perceived e-cigarettes as less harmful than cigarettes from the PATH Study across four waves (2013–2018). The study findings underscore the importance of risk communication that focuses on harm perception profiles and the need for appropriate interventions to balance the considerations of e-cigarette use among young adults. [ABSTRACT FROM AUTHOR]

Most critics focus on the pain and suffering of the first-generation Vietnamese immigrants depicted in Lan Cao's Monkey Bridge. This paper explores how Cao strategically uses the philosophy of karma in Vietnamese Buddhism to provide a method for alleviating their suffering in this novel. It argues that she employs karma to investigate the origins of the adversity and trauma experienced by the first-generation Vietnamese immigrants, including the pro-American attitude of the early Vietnamese authorities during the Vietnam War, the imperialistic actions of the United States, and the resulting karmic consequences. In addition, they demonstrate, through actions like forming "hui", a way to change their fate and heal their trauma for later generations of Vietnamese immigrants, emphasizing positive transformation of karma. This paper suggests that the Buddhist philosophy of karma provides an effective strategy for Vietnamese American immigrants to reflect on the Vietnam War, overcome adversity, and heal their own trauma. [ABSTRACT FROM AUTHOR]

Drought events have been linked with the enhancements of organic aerosols (OA), but the mechanisms have not been comprehensively understood. This study investigates the relationships between the monthly standardized precipitation–evapotranspiration index (SPEI) and surface OA in the contiguous United States (CONUS) during the summertime from 1998 to 2019. OA under severe drought conditions shows a significant increase in mass concentrations across most of the CONUS relative to non-drought periods with the Pacific Northwest (PNW) and Southeastern United States (SEUS) experiencing the highest average enhancement of 1.79 µg m−3 (112 %) and 0.92 µg m−3 (33 %), respectively. In the SEUS, a linear regression approach between OA and sulfate was used to estimate the isoprene epoxydiols derived secondary organic aerosol (IEPOX SOA), which is the primary driver of the OA enhancements under droughts due to the simultaneous increase of isoprene and sulfate. The rise of sulfate is mainly caused by the reduced wet deposition because of the up to 62 % lower precipitation amount. In the PNW, OA enhancements are closely linked to intensified wildfire emissions, which raise OA mass concentrations to be four to eight times higher relative to non-fire conditions. All ten Earth system models participating in the sixth phase of the Coupled Model Intercomparison Project (CMIP6) can capture the negative slopes between SPEI and OA in the PNW with CESM2-WACCM and GFDL-ESM4 performing the best and worst in predicting the OA enhancement under severe droughts. However, all models significantly underestimate the OA increase in the SEUS with Nor-ESM2-LM and MIRCO6 showing relatively better performance. This study reveals the key drivers of the elevated OA levels under droughts in the CONUS and underscores the deficiencies of current climate models in their predictive capacity for assessing the impact of future droughts on air quality. [ABSTRACT FROM AUTHOR]

The impact of autonomous vehicles on the spatial size of cities remains ambiguous, as the future is highly uncertain. This paper uses counterfactual analysis techniques to examine the effects of autonomous vehicles on urban expansion for metropolitan areas in the United States if autonomous vehicles had been introduced before. We argue that distance cost and congestion cost, which are the two components of transportation cost with different effects on urban expansion, should be addressed in autonomous vehicle research. By coupling historical data with hypothetical scenarios of introducing autonomous vehicles to cities, we find that urban expansion, rather than urban densification, would have been the dominant effect if autonomous vehicles had been introduced into cities. The finding indicates that if autonomous vehicles are widely adopted in the future, they are likely to have similar, or even larger, effects on future urban expansion than in the counterfactual past. [ABSTRACT FROM AUTHOR]

Introduction: An estimated 38 million people are living with human immunodeficiency virus (HIV) worldwide. Pharmacists are well positioned to provide care to patients with HIV, but gaps in HIV education among pharmacists exist. Recognizing the need to educate and prepare future pharmacists, a 2-credit advanced HIV elective course was created for Doctor of Pharmacy students at Washington State University College of Pharmacy and Pharmaceutical Sciences in the United States, and Masters of Clinical Pharmacy students from University of Western Cape School of Pharmacy in South Africa. Methods: Course topics included diagnosis and treatment of HIV in children and adults, management of common comorbidities, pre-exposure prophylaxis, pharmacogenetic applications, and antiretroviral drug-drug interactions. Course effectiveness was evaluated using student examination results. Student perceptions were evaluated using pre- and post-course self-assessments involving abilities, confidence, and attitudes toward caring for people living with HIV. Results: Student pharmacists demonstrated competency in HIV knowledge, demonstrated skills in application to clinical-based scenarios, and reported significantly improved confidence and abilities as well as positive changes in attitudes toward people with HIV. Conclusion: This course contributed to student learning across different student cohorts in an institutional program in the United States including successful execution of distance learning and clinical application for students at a program in South Africa. [ABSTRACT FROM AUTHOR]

Objectives: Despite significant declines in cigarette smoking during the past decade, other tobacco products gained popularity among middle and high school students. This study examined temporal trends in exclusive and concurrent use of tobacco products among middle and high school students in the United States from 2011 through 2020. Methods: We used multiple annual datasets from the National Youth Tobacco Survey from 2011 through 2020 (N = 193 350) to examine trends of current (past 30 days) exclusive, dual, and poly use of tobacco products (ie, cigarettes, electronic cigarettes [e-cigarettes], cigars, hookahs, and smokeless tobacco). We used joinpoint regression models to calculate log-linear trends in annual percentage change (APC). Results: During 2011-2020, exclusive use of any tobacco product decreased significantly, except for e-cigarettes, which increased significantly at an APC of 226.8% during 2011-2014 and 14.6% during 2014-2020. This increase was more pronounced among high school students (APC = 336.6% [2011-2014] and 15.7% [2014-2020]) than among middle school students (APC = 10.4% [2014-2020]) and among male students (APC = 252.8% [2011-2014] and 14.8% [2014-2020]) than among female students (APC = 13.6% [2014-2020]). During 2011-2020, we also found upward trends in dual use of e-cigarettes and cigarettes (APC = 17.3%). Poly use of e-cigarettes, cigarettes, and any other tobacco products increased significantly at an APC of 57.1% during 2011-2014. Conclusions: The emergence of new tobacco products such as e-cigarettes in the US market has shifted the landscape of tobacco use among adolescents in the last decade toward poly product use, in which e-cigarettes are a prominent component. Our findings underscore the increasing complexity of tobacco use among adolescents in the United States and the need for strong policies and regulations adapted to evolving trends in cigarette and noncigarette tobacco products. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the trend and factors associated with smoking marijuana from a hookah device among US adults. Methods: Data were drawn from the Population Assessment of Tobacco and Health (PATH) Study, an ongoing nationally representative, longitudinal cohort study of the US population. Adult respondents who self-reported ever smoking marijuana from a hookah at Wave 5 (2018–19, N = 34,279 US adults) were included in the multivariable analysis. Trend analysis also was conducted using National Cancer Institute JoinPoint software from 2015 to 2019. Results: In 2018–19, an estimated 23.6 million (9.7%) US adults reported ever smoking marijuana from a hookah. Trend analysis showed the increasing prevalence of using marijuana from a hookah device from Wave 3 (8.9%) to Wave 5 (9.7%; time trend p =.007). Adults aged 25–44 years old (vs. 18–24; 13%, vs. 9%), whites (vs. Black; 11% vs. 9%), and lesbian, gay, or bisexual (LGB vs. straight; 17% vs. 9%) were more likely to report ever smoking marijuana from a hookah (ps <.05). Former and current users (vs. never users) of e-cigarettes (19% and 25% vs. 5%), cigarettes (11% and 21% vs. 2%), cigars (17% and 27% vs. 3%), and pipes (21% and 33% vs. 7%) and past 30-day blunt users (vs. non-users; 39% vs. 9%) were more likely to ever smoke marijuana from a hookah (ps <.05). Pregnant women (vs. non-pregnant; 12.8% vs. 8.6%; p = 0.03) were more likely to smoke marijuana from a hookah. Conclusions: Smoking marijuana from a hookah device is prevalent among young adults in the US, especially among vulnerable populations, and has increased significantly from 2015–2019. [ABSTRACT FROM AUTHOR]

Background and Purpose: An active lifestyle is important for health maintenance and disease prevention. This study was to examine what factors predict an active lifestyle in HIV+ and HIV- adults from the United States Deep South. Methods: The sample included 279 participants (174 HIV+ and 105 HIV-) who completed a comprehensive assessment. An active lifestyle composite was created using variables of employment status, level of social support, level of physical activity, and diet. Correlations and regression analyses were conducted between the active lifestyle composite and possible predictors for all (HIV+ and HIV-), HIV+, and HIV- participants, respectively. Results: Lower levels of depression, higher socioeconomic status (SES), and younger age were significant predictors of a more active lifestyle for the full sample, HIV+, and HIV- participants, respectively. Conclusion: SES and depression represent important factors influencing engagement in an active lifestyle in PLWH. Such factors should be considered when developing and implementing lifestyle interventions. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we demonstrated that overall 51.2% of patients with hepatocellular carcinoma (HCC) had elevated alpha-fetoprotein (AFP) levels. The proportion of patients with elevated AFP levels was stationary in the period from 2011 to 2020. The proportion of patients with Barcelona Clinic Liver Cancer classification (BCLC) stages 0–A HCC decreased from 2011 to 2020, whereas the proportion of patients with non-HBV- and non-HCV (NBNC)-HCC increased in the same period. Furthermore, the proportion of patients with early-stage HCC (i.e., BCLC stages 0–A) was lower for NBNC-HCC than for HBV- or HCV-related HCC. Advanced tumor stage, severe underlying liver disease, viral etiology, and female gender are associated with elevated AFP levels in HCC patients. A recent study from the US showed a decreasing trend in the elevated serum alpha-fetoprotein (AFP) level (i.e., ≥20 ng/mL) in hepatocellular carcinoma (HCC) patients at the time of diagnosis. Furthermore, advanced tumor stage and severe underlying liver disease were associated with elevated AFP levels. We aimed to evaluate this issue in an area endemic for hepatitis B virus (HBV). Between 2011 and 2020, 4031 patients were newly diagnosed with HCC at our institution. After excluding 54 patients with unknown AFP data, the remaining 3977 patients were enrolled in this study. Elevated AFP level was defined as ≥20 ng/mL. Overall, 51.2% of HCC patients had elevated AFP levels; this proportion remained stationary between 2011 and 2020 (51.8% vs. 51.1%). Multivariate analysis showed that female gender (odds ratio (OR) = 1.462; p < 0.001), tumor size per 10 mm increase (OR = 1.155; p < 0.001), multiple tumors (OR = 1.406; p < 0.001), Barcelona Clinic Liver Cancer stages B–D (OR = 1.247; p = 0.019), cirrhosis (OR = 1.288; p = 0.02), total bilirubin > 1.4 mg/dL (OR = 1.218; p = 0.030), and HBV- or hepatitis C virus (HCV)-positive status (OR = 1.720; p < 0.001) were associated with elevated AFP levels. In conclusion, a stationary trend in elevated serum AFP level in HCC patients has been noted in the past 10 years. Advanced tumor stage, severe underlying liver disease, viral etiology, and female gender are associated with elevated AFP levels in HCC patients. [ABSTRACT FROM AUTHOR]

Background: Pictorial health warning label (PHWL) is an effective risk communication measure among cigarette smokers. However, there is a lack of knowledge regarding the effect of PHWL on low- and high-frequency waterpipe (WP) smokers. This study examined the effects of PHWL on puffing behavior, subjective experiences, and toxicant exposures among low- and high-frequency WP smokers in the United States (US). Methods: Sixty current (past-month) WP smokers (low-frequency; n = 30 and high-frequency; n = 30) completed two 45-min ad libitum WP smoking sessions in a cross-over design study (WP with no-PHWL vs. WP with PHWL). We compared the mean differences of puff topography, expired carbon monoxide (eCO), plasma nicotine concentration, and subjective experiences between the two smoking groups. Results: Mean age of low-frequency smokers was 21.5 years and high-frequency smokers was 21.3 years. Compared to high-frequency, low-frequency smokers had significant reduction in average total smoking time [mean difference (SD) = −7.6 (10.2) min vs. −2.6 (6.7) min, p = 0.03] and number of puffs [mean difference (SD) = −33.37 (70.7) vs. −0.70 (29.2), p = 0.02] following exposure to PHWL compared to no-PHWL condition. Post-session subjective experiences were lower among high-frequency smokers compared to low-frequency smokers following smoking WP with PHWL compared to the no-PHWL session (puff liking −1.2 vs. −0.5; puff satisfaction −1.0 vs. −0.3; craving reduction −0.5 vs. 1.2) (p < 0.05 for all). Conclusion: Our findings indicate that placing PHWL on the WP device may be a promising strategy with differential effectiveness among WP smokers: low-frequency (reduce puffing behaviors) and high-frequency (reduce smoking experience). [ABSTRACT FROM AUTHOR]

Agency mortgage‐backed securities (MBSs) with diverse characteristics are traded in parallel through individualized specified pool (SP) contracts and standardized to‐be‐announced (TBA) contracts with delivery flexibility. This parallel trading environment generates distinctive effects on MBS pricing and trading: (i) Although cheapest‐to‐deliver (CTD) issues are present in TBA trading and absent from SP trading by design, MBS heterogeneity associated with CTD discounts affects SP yields positively, with the effect stronger for lower‐value SPs; (ii) high selling pressure amplifies the effects of MBS heterogeneity on SP yields; and (iii) greater MBS heterogeneity dampens SP and TBA trading activities but increases their ratio. [ABSTRACT FROM AUTHOR]

The publications on elbow pain (EP) in overhead sports are increasing. The results of previous studies mostly focus on the influence of EP in the ball game and throwing sports. Thus, a bibliometric analysis of these publications may show the direction of hot topics and future research trends. The purpose of this study is to identify the research trends on EP in overhead sports. For the methods, the first step is to use the main keywords of 'Elbow pain' and 'Overhead sport' merging auxiliary vocabulary to reach the relevant global publications between 1970 and 2022 in the Web of Science (WoS) database. The literature data set is imported into EndNote literature manager software to remove duplication. Secondly, the duplication-reduced articles are imported to an Excel sheet according to the inclusion and exclusion criteria of this study. In the third step, VOSviewer software is applied as the main analysis tool in extracting data for analysis from the articles. Then, the main research results for three aspects are obtained by VOSviewer software which extracted and analyzed the parameters of author name, article title, publication journal, keywords, organization, publication country/region, and the sum of times cited from 455 qualified papers. The study found that the United States of America made the most outstanding contribution to this theme study. The research on EP in overhead sports in China requires more attention from scholars. EP in swimming is a new research direction worthy of attention. In conclusion, the research results prove the growth trend of EP in overhead sports. The EP problem not only exists in the ball game and throwing sports but also swimming. Sport commercialization and the involvement of related professional sports organizations determine the degree of EP's attention in a specific sport and the development of solutions. The development of a region or country also affects the depth and scope of EP study. Clinical research development and in-depth exploration are one of the bases to solve EP problems. Non-clinical action is beneficial to EP patients, but it still needs to be explored and studied. [ABSTRACT FROM AUTHOR]

While substantial progress has been made to improve our understanding of biogenic isoprene emissions under unstressed conditions, large uncertainties remain with respect to isoprene emissions under stressed conditions. Here, we use the US Drought Monitor (USDM) as a weekly drought severity index and tropospheric columns of formaldehyde (HCHO), the key product of isoprene oxidation, retrieved from the Ozone Monitoring Instrument (OMI) to derive top-down constraints on the response of summertime isoprene emissions to drought stress in the southeastern United States (SE US), a region of high isoprene emissions that is also prone to drought. OMI HCHO column density is found to be 6.7 % (mild drought) to 23.3 % (severe drought) higher than that under non-drought conditions. A global chemical transport model, GEOS-Chem, with version 2.1 of the Model of Emissions of Gases and Aerosols from Nature (MEGAN2.1) emission algorithm can simulate this direction of change, but the simulated increases at the corresponding drought levels are 1.1–1.5 times that of OMI HCHO, suggesting the need for a drought-stress algorithm in the model. By minimizing the model–OMI differences in HCHO to temperature sensitivity under different drought levels, we derived a top-down drought stress factor (γd_OMI) in GEOS-Chem that parameterizes using water stress and temperature. The algorithm led to an 8.6 % (mild drought) to 20.7 % (severe drought) reduction in isoprene emissions in the SE US relative to the simulation without it. With γd_OMI the model predicts a nonlinear increasing trend in isoprene emissions with drought severity that is consistent with OMI HCHO and a single site's isoprene flux measurements. Compared with a previous drought stress algorithm derived from the latter, the satellite-based drought stress factor performs better with respect to capturing the regional-scale drought–isoprene responses, as indicated by the near-zero mean bias between OMI and simulated HCHO columns under different drought conditions. The drought stress algorithm also reduces the model's high bias in organic aerosol (OA) simulations by 6.60 % (mild drought) to 11.71 % (severe drought) over the SE US compared to the no-stress simulation. The simulated ozone response to the drought stress factor displays a spatial disparity due to the isoprene-suppressing effect on oxidants, with an <1 ppb increase in O 3 in high-isoprene regions and a 1–3 ppbv decrease in O 3 in low-isoprene regions. This study demonstrates the unique value of exploiting long-term satellite observations to develop empirical stress algorithms on biogenic emissions where in situ flux measurements are limited. [ABSTRACT FROM AUTHOR]

Background: Electronic cigarette (e-cigarette) and cannabis (marijuana) use is rapidly increasing. Objectives: To report percentage prevalence and changes over time in current (past 30 days) e-cigarette, cannabis, and dual (concurrent) use in the population of reproductive age women (18–44 years old) in the United States. Methods: Our cross-sectional analysis involved data of 11, 004 women from Waves 1 to 3 of the Population Assessment of Tobacco and Health (PATH) Study (2013–2016). We estimated weighted percentage prevalence and 95% confidence intervals (CIs) and changes between 2013 and 2016 in current e-cigarette, cannabis, and dual use at each wave overall and across race/ethnicity, age, education, cigarette smoking status, alcohol use, and perceived mental health. Changes were reported as p for trend. Results: Between 2013 and 2016, e-cigarette use increased 13.6% (p for trend <.001) [15.2% (95% CI:14.2, 16.2) in 2013–2014; 22.2% (95% CI: 20.2, 24.3) in 2014–2015; and 28.8% (95% CI: 26.3, 31.3) in 2015–2016]; cannabis use increased 6.2% (p for trend <.001) [23.6% (95% CI: 22.1, 25.1) in 2013–2014; 28.5% (95% CI: 26.0, 31.0) in 2014–2015; and 29.8% (95% CI: 27.9, 31.1) in 2015–2016]; and dual use declined 0.3% (p for trend <.001) [5.8% (95% CI: 5.2, 6.3) in 2013–2014; 4.8% (95% CI: 3.7, 5.8) in 2014–2015; and 5.5% (95% CI: 4.2, 6.7) in 2015–2016]. Increases and declines in prevalence varied across sociodemographic characteristics, cigarette smoking status, alcohol use, and perceived mental health. Conclusions: Continued monitoring can capture further changes in prevalence and patterns to inform targeted public health intervention programs. [ABSTRACT FROM AUTHOR]

E-cigarette flavors can create sensations of sweetness and coolness while masking the aversiveness of nicotine. Recently, non-tobacco nicotine (NTN) products were introduced to the market, but little is known about flavors in NTN e-cigarette use. We examined associations between flavors (i.e., sweet, mint/menthol) and susceptibility to and use of NTN e-cigarettes. 1239 US young adults (18–25 years) completed an anonymous, online survey in Fall 2021. The analytic sample included 520 participants who had used e-cigarettes and heard of NTN. Multinomial logistic regression models analyzed associations of flavored e-cigarette use (sweet and mint/menthol) with NTN e-cigarette use status (i.e., current [past-month] use, past [ever but not current] use, susceptible to use, and non-susceptible to use [reference]). Overall, 46.2% of participants reported current NTN use, 14.8% reported past use, 16.7% were susceptible to use, and 22.3% reported no susceptibility. Participants reported dual-use of sweet and mint/menthol NTN e-cigarette flavors (56.5%), sweet flavors use (24.8%), and mint/menthol flavor use (1.7%). Ever dual use of sweet and mint/menthol flavors was associated with current (OR = 9.64, 95%CI: 3.21–28.98) and past NTN e-cigarette use (8.30, [2.10–32.80]). Ever sweet flavor use was associated with current NTN use (3.80, 95%CI: 1.44–10.03) and susceptibility to future use (4.25, [1.53–11.81]). Similar findings were observed for mint/menthol flavors (current: 5.03, [1.41–17.99]; susceptible: 5.65, [1.64–19.51]). The use of sweet and mint/menthol flavors was significantly associated with NTN e-cigarette use among US young adults, highlighting the need for ongoing surveillance of flavored NTN e-cigarettes and appropriate regulations to discourage use. • Sweet flavor use was related to current use and susceptibility to NTN e-cigarettes. • Mint/menthol flavor use was related to current use and susceptibility to NTN e-cigarettes. • Dual sweet and mint/menthol flavor use was related to current and past NTN e-cigarette use. • Regulating sweet and mint/menthol flavors may help to reduce NTN product use. [ABSTRACT FROM AUTHOR]

Background: The effects of drastic curricular changes necessitated by the COVID-19 pandemic on medical students' education and wellbeing have remained largely unstudied. Out study aimed to characterize how medical students were affected by the pandemic, specifically how limitations introduced by the pandemic may have affected the quality, delivery, and experience of medical education. Methods: Three hundred students from 5 U.S. allopathic medical schools were surveyed to determine students' perceptions about their quality of medical education, professional development, and mental health during the COVID-19 pandemic (October 2020-December 2020). Results: A large majority of students report that while lecture-based learning has not been significantly affected by the pandemic, small-group and clinical learning have greatly declined in quality. Students also reported higher levels of depression, anxiety, and uncertainty with regards to their futures as physicians. Conclusions: The COVID-19 pandemic has greatly affected the medical student education and wellbeing. Although medical schools have implemented measures to continue to train medical students as effectively as they can, further strategies must be devised to ensure the well-being of students in the present and for future national emergencies. [ABSTRACT FROM AUTHOR]

Drought is an extreme weather and climate event that has been shown to cause the worsening of ozone (O3) air pollution. Using 15‐year (2005–2019) surface O3 observations and weekly US Drought Monitor (USDM) indices, this study estimated that summertime US‐mean surface O3 increased by 1.47 ppb per USDM level. It is revealed that O3 responses to drought display a spatial east‐west variation: higher O3 enhancement in the Southeast (2.24 ppb/USDM), and no significant change or even a decrease in the west (e.g., −0.06 ppb/USDM in California). The diurnal changes of O3 with drought also show an opposite pattern between the Southeast and California. Formaldehyde (HCHO) and nitrogen dioxide (NO2) column, two satellite‐based O3 precursors proxies, show an increasing rate of 0.41 × 1015 molec/cm2/USDM and 0.03 × 1015 molec/cm2/USDM in the Southeast, respectively, while these rates are not statistically significant in California. We explained this spatial discrepancy from the perspective of O3 chemistry by applying a zero‐dimensional model at the sites with long‐term observations in California and Georgia. Isoprene concentrations decreased by ∼37% under exceptional drought in California causing a reduction of O3 production (PO3) by ∼23.7% during daytime. On the contrary, isoprene increased by ∼41% in Georgia inducing a consequent increase of PO3 by ∼33.4% which accounts for more than half of the O3 enhancement. This study reveals the key role of biogenic isoprene on ozone chemistry under drought conditions. Key Points: O3 responses to drought display an east‐west discrepancy in the contiguous US: higher enhancement in the southeast yet decrease in the westThe decrease of O3 in California is due to the up to 24% reduction of the O3 production rate (PO3) caused by the decrease of isopreneThe increase of isoprene in the southeast causes an increase of PO3 by up to 33%, accounting for more than half of the O3 enhancement [ABSTRACT FROM AUTHOR]

Objective. The rise of zoonotic diseases has become a global health issue around the world. The present study is aimed at assessing the global status and the trends in scrub typhus (ST) research. Methods. Publications related to ST studies from 1945 to 21st July 2020 were retrieved from the Scopus database. The search for the ST literature was conducted using the entry terms of the MeSH (Medical Subject Headings) database. Full research articles and reviews were included in the analysis, and no limitation to the language was specified. Key bibliometric indicator analysis was performed using Microsoft Excel, Bibliometrix (an R package), GraphPad Prism 5, and VOSviewer (version 1.6.6). Results. A total of 1567 publications were retrieved. The results revealed a significant increase in the number of ST publications over time. The documents received an average of 11.22 citations per document. Mahidol University in Thailand (258, 16.46%) was the most productive institution, while the American Journal of Tropical Medicine and Hygiene published the most ST articles (88, 5.62%). Korea (195, 12.44%) was the most productive country, followed by India (178, 11.36%) and China (106, 6.76%). Richards AL was the most productive author with 36 articles. Conclusions. The study findings provide useful insights into the global efforts and works related to the progress of ST research, which can be used to identify future research areas, such as vaccine development. [ABSTRACT FROM AUTHOR]

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (Ptrend =.020) and 1.00, 0.64, 047, and 0.64 for high body fat (Ptrend =.012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries. [ABSTRACT FROM AUTHOR]

Drug abuse poses great physical and psychological harm to humans, thereby attracting scholarly attention. It often requires experience and time for a researcher, just entering this field, to find an appropriate method to study drug abuse issue. It is crucial for researchers to rapidly understand the existing research on a particular topic and be able to propose an effective new research method. Text mining analysis has been widely applied in recent years, and this study integrated the text mining method into a review of drug abuse research. Through searches for keywords related to the drug abuse, all related publications were identified and downloaded from PubMed. After removing the duplicate and incomplete literature, the retained data were imported for analysis through text mining. A total of 19,843 papers were analyzed, and the text mining technique was used to search for keyword and questionnaire types. The results showed the associations between these questionnaires, with the top five being the Addiction Severity Index (16.44%), the Quality of Life survey (5.01%), the Beck Depression Inventory (3.24%), the Addiction Research Center Inventory (2.81%), and the Profile of Mood States (1.10%). Specifically, the Addiction Severity Index was most commonly used in combination with Quality of Life scales. In conclusion, association analysis is useful to extract core knowledge. Researchers can learn and visualize the latest research trend. [ABSTRACT FROM AUTHOR]

Cancer is a major health problem in the United States with extremely high mortality. The detection and isolation of cancer cells are becoming increasingly important for cancer diagnosis. We describe a microfluidic device modified with silica nanoparticles to enhance the isolation of cancer cells using affinity separation. The isolation of seven different cancer cell lines spiked into liquid biopsies was demonstrated and compared with unmodified separation devices. Cancer cells were isolated using CD71 which has already been demonstrated to be a widespread "net" for capturing cancer cells of any phenotype as the affinity target. The capture efficiency of our nanoparticle (NP)-modified HB chip showed significant differences compared with the normal HB chip, exhibiting an average increase of 16%. The cell enrichment increased by a factor of 2 over unmodified chips. Patient-derived ALL cells, COG-LL-332, were spiked into blood with concentrations ranging from 1% to 20% of total leukocytes, and isolated with the purity of 41%–65%. The results of this study demonstrated that the increase of cell–chip interactions after nanoparticle modification improved capture efficiency and capture purity, and can be applied to a wide range of cell separations. [ABSTRACT FROM AUTHOR]

Background: Meningioma incidence was reported to have risen substantially in the United States during the first decade of the 21st century. There are few reports about subsequent incidence trends. This study provides updated data to investigate trends in meningioma incidence by demographic and tumor characteristics at diagnosis in the United states from 2004 to 2015. Methods: Trends in meningioma incidence were analyzed using data from the Surveillance, Epidemiology, and End Results‐18 (SEER‐18) registry database of the National Cancer Institute. The joinpoint program was used to calculate annual percent change (APC) in incidence rates. Results: The overall incidence of meningioma increased by 4.6% (95% CI, 3.4‐5.9) annually in 2004‐2009, but remained stable from 2009 to 2015 (APC, 0; 95% CI, −0.8 to 0.8). Females (10.66 per 100 000 person‐years) and blacks (9.52 per 100 000 person‐years) had significant predominance in meningioma incidence. Incidence in many subgroups increased significantly up to 2009 and then remained stable until 2015. However, meningioma incidence in young and middle‐aged people increased significantly throughout the entire time period from 2004 to 2015 (APC: 3.6% for <20‐year‐olds; 2.5% for 20‐39‐year‐olds; 1.8% for 40‐59‐year‐olds). The incidence of WHO II meningioma increased during 2011‐2015 (APC = 5.4%), while the incidence of WHO III meningioma decreased during 2004‐2015 (APC = −5.6%). Conclusion: In this study, the incidence of meningioma was found to be stable in recent years. Possible reasons for this finding include changes in population characteristics, the widespread use of diagnostic techniques, and changes in tumor classification and risk factors in the US population. [ABSTRACT FROM AUTHOR]

Background: Robotic-assisted surgery (RAS) with its advantages continues to gain popularity among surgeons. This study analyzed the increased costs of RAS in common surgical procedures using the National Inpatient Sample.Methods: Retrospective analysis of the 2012-2014 Healthcare Cost and Utilization Project-NIS was performed for the following laparoscopic/robotic procedures: cholecystectomy, ventral hernia repair, right and left hemicolectomy, sigmoidectomy, abdominoperineal resection, and total abdominal hysterectomy (TAH). Patients with additional concurrent procedures were excluded. Costs were compared between the laparoscopic procedures and their RAS counterparts. Total costs and charges for cholecystectomy (the most common procedure in the dataset) were compared based on the payer and characteristics of hospital (region, rural/urban, bed size, and ownership).Results: A total of 91,630 surgeries (87,965 laparoscopic, 3665 robotic) were analyzed. The average cost for the laparoscopic group was $10,227 ± $4986 versus $12,340 ± $5880 for the robotic cases (p < 0.001). The overall and percentage increases for laparoscopic versus robotic for each procedure were as follows: cholecystectomy $9618 versus $10,944 (14%), ventral hernia repair $10,739 versus $13,441 (25%), right colectomy $12,516 versus $15,027 (20%), left colectomy $14,157 versus $17,493 (24%), sigmoidectomy $13,504 versus $16,652 (23%), abdominoperineal resection $17,708 versus $19,605 (11%), and TAH $9368 versus $9923 (6%). Hysterectomy was the only procedure performed primarily using RAS and it was found to have the lowest increase in costs. Increased costs were associated with even higher increases in charges, especially in investor-owned private hospitals.Conclusion: RAS is more costly when compared to conventional laparoscopic surgery. Additional costs may be lower in centers that perform a higher volume of RAS. Further analysis of long-term outcomes (including reoperations and readmissions) is needed to better compare the life-long treatment costs for both surgical approaches. [ABSTRACT FROM AUTHOR]

This article is based on the analysis of a pair of cross‐national parallel surveys on Chinese students, respectively inside the People's Republic of China and in the US. Specifically, it makes comparisons between two cross‐sectional groups: 1) Chinese students in a PRC university who intend to study abroad (with a subset that stated that the United States is their top destination), versus 2) Chinese students already at a US university. Building on a "motility" concept while using an "Intellectual Migration" conceptual framework and chi‐square and logistic regression analyses, it demonstrates that Chinese students' possibly returning to the PRC are significantly influenced by their gender, college GPA, family finance, assessment of China's current and future development. The results on outmigration or return migration intentions are presented, and it concludes with some policy implications and future research directions. [ABSTRACT FROM AUTHOR]

Using publicly available data, this article aims to understand how immigration policies in Canada and the United States have affected the flow and utilization of highly‐skilled migrants from China and India. Reviewing existing literature on the policies about, and utilization of, human capital among highly‐skilled migrants, and describing the policy contexts in both receiving countries, we present detailed empirical evidence to show that in spite of their higher education attainment than the general population and the total foreign‐born population, China‐ and India‐born migrants are not immune from the brain waste phenomenon. This is especially so among the India‐born. We end the article with policy implications for both countries. [ABSTRACT FROM AUTHOR]

The genus Fuscoporia of the Hymenochaetaceae is characterized by resupinate to pileate basidiocarps, a dimitic hyphal system with fine crystal aggregates and encrusted generative hyphae in dissepiment edge and tube trama, the presence of hymenial setae, and hyaline, thin-walled, smooth basidiospores. Members of the F. contigua group are easy to distinguish from other species of Fuscoporia because of the moderately large pores, presence of mycelial setae, and large hymenial setae. Here, we explore phylogenetic relationships among 20 species of Fuscoporia based on examination of some 90 collections sampled worldwide. Seven new species are recognized in the F. contigua group--F. americana, F. centroamericana, F. costaricana, F. latispora, F. monticola, F. septiseta, and F. sinica--described from China, Costa Rica, Mexico, and the United States. Phylogenetic analyses inferred from DNA sequences of the nuc rDNA internal transcribed spacer (ITS1-5.8S-ITS2 = ITS), D1-D2 domains of nuc 28S rDNA (28S), and translation elongation factor EF-1 alpha (tef1) support the F. contigua group as one of two major clades within Fuscoporia comprising nine species worldwide. [ABSTRACT FROM AUTHOR]

Introduction: Pedestrian road safety remains a public health priority. The objective of this study is to describe trends in fatalities and injuries after pedestrian-motor vehicle collisions in the U.S. and identify associated risk factors for pedestrian fatalities.Methods: This is a cross-sectional study of U.S. pedestrian-motor vehicle collisions from 2006 to 2015 (performed in 2017). Pedestrian fatality and injury data were obtained from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System and National Automotive Sampling System General Estimates System. Frequencies of fatalities, injuries, and associated characteristics were calculated. Multivariable logistic regression was performed for risk of fatality, controlling for demographic and crash-related factors.Results: There were 47,789 pedestrian fatalities and 674,414 injuries during the 10-year study period. Fatality rates were highest among the elderly aged 85 years and older (2.95/100,000 population), whereas injury rates were highest for those aged 15-19 years (35.23/100,000 population). Predictors associated with increased risk for death include the following: male sex (AOR=1.36, 95% CI=1.15, 1.62), age ≥65 years (AOR=3.44, 95% CI=2.62, 4.50), alcohol involvement (AOR=2.63, 95% CI=1.88, 3.67), collisions after midnight (AOR=5.21, 95% CI=3.20, 8.49), at non-intersections (AOR=2.76, 95% CI=2.21, 3.45), and involving trucks (AOR=2.15, 95% CI=1.16, 3.97) and buses (AOR=5.82, 95% CI=3.67, 9.21).Conclusions: Potentially modifiable factors are associated with increased risk of death after pedestrian-motor vehicle collisions. Interventions including elder-friendly intersections and increasing visibility of pedestrians may aid in decreasing pedestrian injuries and deaths. [ABSTRACT FROM AUTHOR]

This study examines the impact of green space health on local flooding based on the analysis of eighty-two watersheds in four Texas metropolitan statistical areas: Dallas, Houston, San Antonio, and Austin. The runoff records in October 2007 and October 2012 were selected for the assessment. The study met the methodological challenge posed by comparison by using the Normalized Difference Vegetation Index (NDVI) datasets produced based on the Moderate Resolution Imaging Spectroradiometer (MODIS) imagery of the 250-m resolution as a proxy to represent the health of green space. Two linear regression models were employed to explain the variation in mean daily runoff depth in 2007 and 2012, while controlling multiple contextual variables.Results indicate that watersheds containing healthier green spaces were likely to generate lower amounts of runoff in both periods. Standardized coefficients of green space health also show that the NDVI is a powerful and significant predictor to explain variation in runoff. These findings illustrate the important role of urban green spaces in attenuating local flooding and may provide planners and decision-makers with a method to consider, using this kind of objective greenery index in further developing local and regional green infrastructure and land-use plans. [ABSTRACT FROM AUTHOR]

The impacts of the foreclosure crisis have been widespread, catalyzing the worst economic downturn since the Great Depression and leading to dramatic declines in housing equity and wealth. However, Black and Hispanic households and communities have been disproportionately affected by the crisis, contributing to a tightening of credit standards and a retrenchment of lending in these communities. This study uses a unique, national data set of purchase mortgages originated between 2004 and 2007 to examine the racial and ethnic dimensions of subprime lending practices that were prevalent during the boom and explores the role that these lending practices had on subsequent rates of default. This study thus contributes to the debate on the causes of the housing crisis and its implications for racial inequality in America. [ABSTRACT FROM AUTHOR]

Introduction: The study aimed to explore the gap of prevalence of healthy lifestyle behaviors including smoking cessation, quitting drinking, physical activity and healthy eating between Chinese adults with and without cardiovascular diseases (CVDs). Methods: This study is a cross-sectional component of Prospective Urban Rural Epidemiology (PURE)-China study, which recruited ~46,000 participants from 70 rural and 45 urban communities between 2005 and 2009. Participants were divided into disease (with CVDs) and control (without any diseases) groups. The adjusted rates were estimated for different strata by the generalized, linear mixed-effects model, including community as a random effect with additional adjustment for age, sex, education and income. Results: Among 40,490 participants, <10% had all four healthy lifestyle behaviors (disease group versus control group: urban areas: 7.8% versus 8.1%; rural areas: 3.4% versus 3.2%). The rates of smoking cessation and quitting drinking were significantly higher in disease group for both urban and rural residents (P<0.001). In urban areas, higher rates were observed in all other three healthy lifestyle behaviors except physical activity in low-income regions (P<0.05). Similarly, the higher trends were observed for stopping smoking and drinking while opposite trends for healthy eating among rural residents from low-income regions (P<0.05). Conclusions: Our study showed that the prevalence of adopting all four behaviors was low among Chinese adults. Individuals with CVDs were more likely to follow healthy lifestyle behaviors, but it still indicated a large gap between the actual and ideal adoption of healthy lifestyle behaviors, which called for the promotion of population-wide strategies to modify lifestyle behaviors in addition to individual health-care intervention strategies. [ABSTRACT FROM AUTHOR]

This study investigated interim assessments effects on the achievement gap. The data were collected from a field experiment conducted in 2010–2011 in K-8 public schools in Indiana in the U.S. Two-level models were utilized to determine whether interim assessments interacted with student SES, race, level of prior achievement, gender, school composition and urbanicity. The results are overall mixed. The majority of the interaction effects are close to zero and statistically non-significant. However, the treatment may have helped reduce the gender and race gaps in reading and mathematics in grades 3–8. The treatment may also have helped reduce the achievement gap between middle- and high-achievers in grades 3–8. The interactions between interim assessments and school composition and urbanicity were overall non-significant. [ABSTRACT FROM AUTHOR]

We evaluate the robustness of momentum returns in the US stock market over the period 1965-2012. We find that momentum profits have become insignificant since the late 1990s. Investigations of momentum profits in high and low volatility months address the concerns about unprecedented levels of market volatility in this period rendering momentum strategy unprofitable. Momentum profits remain insignificant in tests designed to control for seasonality, up or down market conditions, firm size and liquidity. Past returns, can no longer explain the cross-sectional variation in stock returns, even following up markets. Investigation of post holding period returns of momentum portfolios and risk adjusted buy and hold returns of stocks in momentum suggests that investors possibly recognize that momentum strategy is profitable and trade in ways that arbitrage away such profits. These findings are partially consistent with Schwert (Handbook of the economics of finance. Elsevier, Amsterdam, 2003) that documents two primary reasons for the disappearance of an anomaly in the behavior of asset prices, first, sample selection bias, and second, uncovering of anomaly by investors who trade in the assets to arbitrage it away. In further analyses we find evidence that suggest two other possible explanations for the declining momentum profits, besides uncovering of the anomaly by investors, that involve decline in the risk premium on a macroeconomic factor, growth rate in industrial production in particular and relative improvement in market efficiency. [ABSTRACT FROM AUTHOR]

Evidence of the association between global cognitive function and mortality is much, but whether specific cognitive function is related to mortality is unclear. To address the paucity of knowledge on younger populations in the US, we analyzed the association between specific cognitive function and mortality in young and middle-aged adults. We analyzed data from 5,144 men and women between 20 and 59 years of age in the Third National Health and Nutrition Examination Survey (1988–94) with mortality follow-up evaluation through 2006. Cognitive function tests, including assessments of executive function/processing speed (symbol digit substitution) and learning recall/short-term memory (serial digit learning), were performed. All-cause mortality was the outcome of interest. After adjusting for multiple variables, total mortality was significantly higher in males with poorer executive function/processing speed (hazard ratio (HR) 2.02; 95% confidence interval 1.36 to 2.99) and poorer recall/short-term memory (HR 1.47; 95% confidence interval 1.02 to 2.12). After adjusting for multiple variables, the mortality risk did not significantly increase among the females in these two cognitive tests groups. In this sample of the US population, poorer executive function/processing speed and poorer learning recall/short-term memory were significantly associated with increased mortality rates, especially in males. This study highlights the notion that poorer specific cognitive function predicts all-cause mortality in young and middle-aged males. [ABSTRACT FROM AUTHOR]

Although the link between impaired lung function and cardiovascular events and type 2 diabetes mellitus has been recognized, the association between impaired lung function and metabolic syndrome has not been comprehensively assessed in the United States (U.S.) population. The aim of our study was to explore the association between impaired lung function and metabolic syndrome in a nationally representative sample of men and women. This cross-sectional population-based study included 8602 participants aged 20–65 years in the Third National Health and Nutrition Examination Survey (NHANES III). We examined the relationship between the different features of metabolic syndrome and lung function, including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). After adjusting for potential confounders such as age, body mass index, inflammatory factors, medical condition, and smoking status, participants with more components of metabolic syndrome had lower predicted values of FVC and FEV1 (p for trend <0.001 for both). Impaired pulmonary function was also associated with individual components of metabolic syndrome, such as abdominal obesity, high blood pressure, high triglycerides, and low high density lipoprotein (HDL) cholesterol (p<0.05 for all parameters). These results from a nationally representative sample of US adults suggest that a greater number of features of metabolic syndrome is strongly associated with poorer FVC and FEV1. In clinical practice, more comprehensive management strategies to address subjects with metabolic syndrome and impaired lung function need to be developed and investigated. [ABSTRACT FROM AUTHOR]

Osimertinib is a third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) that is clinically effective in patients with EGFR-mutated non-small-cell lung cancer (NSCLC). However, the use of this treatment is limited by its high cost. A cost-effectiveness analysis of different sequences of osimertinib administration in China and the United States was conducted in the present study. Markov models were established based on data from the FLAURA and AURA3 trials. First-line osimertinib was compared with both first-generation EGFR-TKIs and second-line osimertinib after the failure of first-generation EGFR-TKIs. The analysis also considered different payment modalities available in China. Additionally, one-way and probability sensitivity analyses, with a willingness-to-pay threshold (WTP) of three times the per capita gross domestic product [$27,783/quality-adjusted life year (QALY) for China and $100,000/QALY for the United States], were performed. The first-line osimertinib group displayed higher QALYs and costs than those of the first-generation EGFR-TKI group. The first generation EGFR-TKI group displayed an incremental cost-effectiveness ratio (ICER) of $212,252/QALY in China and $151,922/QALY in the United States. In addition, the ICERs were negative in the second-line osimertinib group, with higher QALYs and lower costs compared with those in the first-line osimertinib group. Furthermore, osimertinib company donation was of benefit in China, with an average cost-effectiveness of $836/QALY. The one-way sensitivity analysis highlighted the influence of utilities in different states. First-line osimertinib could be cost-effective either with higher WTP or a price reduction of 68% in China and 9% in the United States. Although first-line osimertinib therapy could have health benefits, it was not cost-effective compared with first-line first-generation EGFR-TKIs and second-line osimertinib therapy. However, paying via company donation may be a good choice in China. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is the most common joint disorder in the United States, and the gut microbiome has recently emerged as a potential etiologic factor in OA development. Recent studies have shown that a microbiome is present at joint synovia. Therefore, we aimed to characterize the intra-articular microbiome within osteoarthritic synovia and to illustrate its role in OA disease progression. RNA-sequencing data from OA patient synovial tissue was aligned to a library of microbial reference genomes to identify microbial reads indicative of microbial abundance. Microbial abundance data of OA and normal samples was compared to identify differentially abundant microbes. We computationally explored the correlation of differentially abundant microbes to immunological gene signatures, immune signaling pathways, and immune cell infiltration. We found that microbes correlated to OA are related to dysregulation of two main functional pathways: increased inflammation-induced extracellular matrix remodeling and decreased cell signaling pathways crucial for joint and immune function. We also confirmed that the differentially abundant and biologically relevant microbes we had identified were not contaminants. Collectively, our findings contribute to the understanding of the human microbiome, well-known OA risk factors, and the role microbes play in OA pathogenesis. In conclusion, we present previously undiscovered microbes implicated in the OA disease progression that may be useful for future treatment purposes. [ABSTRACT FROM AUTHOR]

Plants with crassulacean acid metabolism (CAM) are increasing in distribution and abundance in drylands worldwide, but the underlying drivers remain unknown. We investigate the impacts of extreme drought and CO2 enrichment on the competitive relationships between seedlings of Cylindropuntia imbricata (CAM species) and Bouteloua eriopoda (C4 grass), which coexist in semiarid ecosystems across the Southwestern United States. Our experiments under altered water and CO2 water conditions show that C. imbricata positively responded to CO2 enrichment under extreme drought conditions, while B. eriopoda declined from drought stress and did not recover after the drought ended. Conversely, in well‐watered conditions B. eriopoda had a strong competitive advantage on C. imbricata such that the photosynthetic rate and biomass (per individual) of C. imbricata grown with B. eriopoda were lower relative to when growing alone. A meta‐analysis examining multiple plant families across global drylands shows a positive response of CAM photosynthesis and productivity to CO2 enrichment. Collectively, our results suggest that under drought and elevated CO2 concentrations, projected with climate change, the competitive advantage of plant functional groups may shift and the dominance of CAM plants may increase in semiarid ecosystems. [ABSTRACT FROM AUTHOR]

The number of transgender and gender-diverse patients seeking medical care in the United States is increasing. For many of these patients, pharmacotherapy is a part of their gender-affirming transition. Effective instructional methods and resources for teaching pharmacy students about this patient population's social considerations and medical treatments is lacking. Three hours of educational material on caring for transgender patients was added to a third-year course in a four-year Doctorate of Pharmacy program in the United States. The content included cultural, empathy, and medical considerations. Students in the course were given a survey to assess their perception of each instructional method's effectiveness and self-assess their confidence in providing competent gender-affirming care to transgender people before and after the learning session. The survey response rate was 36% (54/152). Students' self-assessed confidence to provide competent care to people who are transgender increased significantly. Before the learning session, the median confidence level was 4/10 (Interquartile range (IQR) 3–6), after the class session, the median confidence increased to 7/10 (IQR 6–8, p < 0.01). Students rated the pre-class video, jeopardy game, and patient panel as most helpful to improving their skills. The addition of transgender-related patient care material into the Doctorate of Pharmacy curriculum significantly increased the students' confidence to provide competent care to people who are transgender. [ABSTRACT FROM AUTHOR]

The effects of urban expansion and population change on vacant land patterns are not fully understood. While the majority of previous research documents that depopulation can result in increased vacant urban areas, there are conflicting findings in regards to the effects of urban expansion. What remains unclear is whether higher urban elasticity (expansion in size) contributes to increases in urban vacancies, or the inverse. While elastic cities extend their boundaries and develop outwardly, inelastic cities contract or stay the same in size and utilize infill development. This research sought to determine if urban elasticity plays a significant role in contributing to urban vacancy increases through an exploratory, quasi-experimental longitudinal analysis of vacant address data from 40 U.S. cities of over 100,000 persons from 2000 to 2010. We compared the top 20 elastic (boundaries expanded the most) and inelastic (boundaries contracted the most) cities. A fixed effects panel model was developed to observe changes over time and differences in total, residential, and business land uses. Results indicate that aggressive urban expansion can contribute to increased urban vacancies, specifically in reference to residential land uses. This finding clarifies what had heretofore been a murky aspect of the urban studies literature. [ABSTRACT FROM AUTHOR]

Background: Red blood cell (RBC) folate is an indicator of long-term folate nutrition. Whether there is an association between RBC folate and periodontitis is unclear. This study aimed to use the NHANES database to determine whether RBC folate is associated with moderate/severe periodontitis., Methods: A cross-sectional analysis of 10,151 participants in the NHANES database from 2009 to 2014 was performed. Multivariate logistic regression was used to analyze the independent relationship between RBC folate and moderate/severe periodontitis. The generalized additive model (GAM), restricted cubic splines (RCS), smooth curve fitting, and threshold effect analysis were used to explore the dose-response relationship and the potential nonlinear relationship between RBC folate and periodontitis. Finally, subgroup analysis and interaction tests were performed to determine the effect of covariates on the relationship between RBC folate and moderate/severe periodontitis., Results: After adjusting for all confounders, there was a negative association between RBC folate concentration and moderate/severe periodontitis. The lowest fraction Q1 (< 360 ng/mL) of RBC folate concentration was used as the reference group, multivariable-adjusted ORs and 95% CIs of the second (360-463 ng/mL), third (464-569 ng/mL), fourth (570-732 ng/mL), and the highest quintile (> 733 ng/mL) categories were 0.88 (0.77, 1.01), 0.83 (0.72, 0.96), 0.77 (0.67, 0.90), 0.65 (0.56, 0.77) respectively. Additionally, a threshold nonlinear association was found between RBC folate (ng/mL) log2 transformation and moderate/severe periodontitis., Conclusion: This cross-sectional study revealed a negative relationship between RBC folate and moderate/severe periodontitis within a certain threshold range. Dentists and policymakers should pay closer attention to oral hygiene and health care for people with low or high RBC folate levels. Further causal and longitudinal research mechanisms are needed to validate our findings., (© 2024. The Author(s).)

Volatile organic compounds (VOCs) represent a significant component of air pollution. However, studies evaluating the impact of VOC exposure on chronic obstructive pulmonary disease (COPD) have predominantly focused on single pollutant models. This study aims to comprehensively assess the relationship between multiple VOC exposures and COPD. A large cross-sectional study was conducted on 4983 participants from the National Health and Nutrition Examination Survey. Four models, including weighted logistic regression, restricted cubic splines (RCS), weighted quantile sum regression (WQS), and the dual-pollution model, were used to explore the association between blood VOC levels and the prevalence of COPD in the U.S. general population. Additionally, six machine learning algorithms were employed to develop a predictive model for COPD risk, with the model's predictive capacity assessed using the area under the curve (AUC) indices. Elevated blood concentrations of benzene, toluene, ortho-xylene, and para-xylene were significantly associated with the incidence of COPD. RCS analysis further revealed a non-linear and non-monotonic relationship between blood levels of toluene and m-p-xylene with COPD prevalence. WQS regression indicated that different VOCs had varying effects on COPD, with benzene and ortho-xylene having the greatest weights. Among the six models, the Extreme Gradient Boosting (XGBoost) model demonstrated the strongest predictive power, with an AUC value of 0.781. Increased blood concentrations of benzene and toluene are significantly correlated with a higher prevalence of COPD in the U.S. population, demonstrating a non-linear relationship. Exposure to environmental VOCs may represent a new risk factor in the etiology of COPD., (© 2024. The Author(s).)

Background: The American Heart Association recently introduced a new model for cardiovascular health (CVH) known as Life's Essential 8 (LE8). The impact of LE8 on hypertensive individuals is currently unclear. In our study, we investigated the correlation between comprehensive and individual CVH indicators as defined by LE8, and the mortality rates in hypertension patients., Methods: We analyzed a total of 8,448 hypertensive individuals aged ≥ 20 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2016. These participants were nonpregnant and noninstitutionalized. We identified their mortality by linking their data to the National Death Index until December 31, 2019. The overall cardiovascular health (CVH) was assessed using the LE8 score, which ranged from 0 to 100. Additionally, we evaluated the scores for each component of diet, physical activity, tobacco/nicotine exposure, sleep duration, body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure. The CVH were categorized into low (0-49), moderate (50-79), and high (80-100) CVH., Results: Over an average follow-up period of 7.41 years, 1,482 (17.54%) of the participants died, among which 472 deaths were attributed to CVD. When compared to adults with lower total CVH scores, those with elevated total CVH scores displayed a 37% reduced risk of mortality from all causes (adjusted hazard ratio [aHR] = 0.63, 95% confidence interval [CI] = 0.45-0.88). In relation to CVD-specific mortality, the corresponding aHRs for moderate and high total CVH scores were 0.76 (0.60-0.97) and 0.54 (0.31-0.94), respectively. Furthermore, after adjusting for potential confounders, it was observed that higher scores on the LE8 index were associated with a reduced risk of both all-cause mortality (aHR for every 10-score increase, 0.91; 95% CI = 0.86-0.96) and CVD-specific mortality (aHR for every 10-score increase, 0.82; 95% CI = 0.75-0.90). Notably, a linear dose-response relationship was observed in this association. Similar patterns were identified in the relationship between health behavior and both all-cause and CVD-specific mortality., Conclusions: Achieving a higher CVH score, as per the new LE8 guidelines, has been found to be associated with a reduced risk of mortality from all causes and specifically from CVD in patients with hypertension. Therefore, public health and healthcare initiatives that focus on promoting higher CVH scores could potentially yield significant benefits in terms of reducing mortality rates among individuals with hypertension., (© 2024. The Author(s).)

Debates surrounding the efficacy of influenza vaccination for survival benefits persist, and there is a lack of data regarding its duration of protection. A self-controlled case series (SCCS) and a 1:4 matched case-control study were conducted using the National Health Interview Survey (NHIS) and public-use mortality data from 2005 to 2018 in the United States. The SCCS study identified participants who received influenza vaccination within 12 months before the survey and subsequently died within 1 year of postvaccination. The matched case-control study paired participants who died during the influenza season at the time of survey with four survivors. Among 1167 participants in the SCCS study, there was a 46% reduction in all-cause mortality and a 43% reduction in cardiovascular mortality within 29-196 days of postvaccination. The greatest protection was observed during days 29-56 (all-cause mortality: RI: 0.19; 95% CI: 0.12-0.29; cardiovascular mortality: RI: 0.28; 95% CI: 0.14-0.56). Among 626 cases and 2504 controls included in the matched case-control study, influenza vaccination was associated with a reduction in all-cause mortality (OR: 0.74, 95% CI: 0.60-0.92) and cardiovascular mortality (OR: 0.64, 95% CI: 0.44-0.93) during the influenza season. This study highlights the importance of influenza vaccination in reducing the risks of all-cause and cardiovascular mortality, with effects lasting for approximately 6 months., (© 2024 The Author(s). Journal of Medical Virology published by Wiley Periodicals LLC.)

Background: Our recent pilot study suggests intra-arterial tenecteplase (TNK) during the first pass of endovascular treatment (EVT) seems safe, may increase first-pass reperfusion and good outcome in acute ischaemic stroke (AIS) patients with large-vessel occlusion (LVO)., Aims: To determine the efficacy and safety of intra-arterial TNK administration during EVT in AIS-LVO patients presenting up to 24 hours from symptom onset., Sample Size Estimates: A maximum of 380 patients are required to test the superiority hypothesis with 80% power according to a two-side 0.05 level of significance, stratified by age, gender, baseline systolic blood pressure, prestroke modified Rankin Scale (mRS), baseline National Institute of Health stroke scale, baseline ASPECTS, time from onset to groin puncture, intravenous thrombolysis before EVT, stroke territory and stroke aetiology., Design: Intra-arterial TNK during thrombectomy for acute stroke (BRETIS-TNK II) study is a prospective, randomised, adaptive enrichment, open-label, blinded end point, multicentre study. Eligible AIS-LVO patients are randomly assigned into the experimental group and control group with a ratio of 1:1. The experimental group will be treated with intra-arterial infusion of TNK during EVT. The control group will be treated with standard EVT., Outcome: The primary end point is a favourable outcome, defined as an mRS score of 0-2 at 90 days. The primary safety end point is symptomatic intracranial haemorrhage within 48 hours, which is defined as an increase in the National Institutes of Health Stroke Scale score of ≥4 points as a result of the intracranial haemorrhage., Conclusions: The results of BRETIS-TNK II will provide evidence for the efficacy and safety of intra-arterial TNK administration during EVT in AIS patients with LVO., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The underrepresentation of scholarly works from low- and middle-income countries (LMICs) in academic literature is a documented concern, attributed partly to editorial biases. This trend, prevalent across various disciplines, has been less explored in the context of medical ethics journals. This study aimed to examine the composition of editorial board members (EBM) in high-impact medical ethics journals and to evaluate the extent of international diversity within these editorial teams., Methods: This study incorporated an analysis of 16 high-impact medical ethics journals. Information regarding the EBM of these journals was systematically gathered and categorized based on the World Bank's country income classifications. An in-depth examination of the editorial board compositions was then conducted., Results: The study identified 669 EBM across the selected journals. A predominant 89.84% (601) of these members were from high-income countries (HICs), with upper-middle-income countries contributing 7.47% (50) and lower-middle-income countries 2.69% (18). No EBM were associated with low-income countries. A regional breakdown indicated that North America was the most represented area, accounting for 48.88% (327), followed by Europe & Central Asia (27.50%, 184), East Asia & Pacific (13.45%, 90), Latin America & Caribbean (4.63%, 31), Sub-Saharan Africa (4.19%, 28), Middle East & North Africa (0.75%, 5), and South Asia (0.60%, 4). In total, these EBMs hailed from 46 different countries, with the United States representing the largest proportion (43.80%, 293), followed by the United Kingdom (13.15%, 88), Australia (7.92%, 53), Germany (6.73%, 45), and Canada (5.08%, 34)., Conclusions: There is a significant lack of international representation within the EBM of high-impact medical ethics journals. The majority of editors in this field are affiliated with HICs, leading to a severe underrepresentation of LMICs within the editorial boards., (© 2024. The Author(s).)

Objective: Adverse childhood experiences (ACEs), which refer to childhood traumatic events, have been identified as risk factors for tobacco use in adulthood. However, studies are limited on the effect of sex on the association of ACEs with e-cigarettes and dual use of e-cigarettes and cigarettes. This study explored sex differences in the association of ACEs with e-cigarettes, cigarettes, and dual use of e-cigarettes and cigarettes among adults in the United States., Methods: This was a cross-sectional analysis of data from adults aged ≥18 years in the 2020 Behavioral Risk Factor Surveillance System ( N = 62,768). ACEs, the independent variable, was a composite score assessed from 11 questions (with responses yes-1 or no/never-0) related to childhood emotional abuse, physical abuse, sexual abuse, and household dysfunction and categorized as 0 (reference), 1, 2, 3, or ≥4. The dependent variable, tobacco use patterns, included nonuse (reference), e-cigarette only, cigarette only, and dual use of e-cigarettes and cigarettes. Multinomial logistic regression was performed to test the interaction between sex and ACEs while controlling for potential confounders., Results: Although we found no statistically significant interaction by sex, a greater number of ACEs were associated with higher odds of the different tobacco use patterns among females and males, with varying strengths of associations. Specifically, females who reported ≥4 ACEs compared with none had higher odds of e-cigarette (aOR [95% CI]: 3.58 [1.49-8.63]), cigarette (2.57 [1.72-3.83]) and dual use (3.25 [1.79-5.91]) relative to nonuse. Males with ≥4 ACEs had higher odds of cigarette (1.75 [1.15-2.65]) and dual use (7.64 [3.95-14.79])., Conclusion: Our findings underscore the importance of developing appropriate, tailored trauma-informed intervention strategies for females and males. It is also important to consider ACEs in designing tobacco-specific preventive programs to curb initiation and promote cessation among U.S. adults., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.