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Fine particulate matter ( PM 2.5 ), tiny particles in the air, is air contamination that negatively impacts the environment and human health when levels in the air are high. The elevated level of PM 2.5 also reduces visibility and causes the air to appear hazy. Due to its impact on environment and health, almost every country around the world keeps track of PM 2.5 air quality level and records the data repeatedly over time in many sites. As the data are collected repeatedly, there is likely to be a natural dependency among the repeated measures of PM 2.5 level in a specific site. Modeling and analyzing these repeated data will help policymakers recommend new policies and/or update existing policies. Thus adequate modeling of such data is of enormous interest among the researchers and policymakers. It is noteworthy that as the data are collected repeatedly in immense volume, big data modeling techniques are required for modeling such data. This paper proposed a new modeling framework to analyze and trajectory risk prediction of categorical responses from big data collected repeatedly. We developed a divide and recombine approach to analyzing big data gathered continually. We used the Markov model for data division, and the Markov chain is used to recombine the marginal and conditional probabilities and estimated joint probabilities for trajectory. We illustrated the proposed model using PM 2.5 outdoor air pollution data from the United States between the years 2000 to 2020. The performance of the proposed methodology is also checked through bootstrap simulation studies. The proposed methodology will be useful to analyze and trajectory risk prediction of repeatedly measured responses from big data from various fields. [ABSTRACT FROM AUTHOR]

Due to the decrease in the total petroleum reserves worldwide, and the growing increase in the price of petroleum, fuel consumption has become the dominant factor in the selection of the proper vehicle. However, in some countries such as Malaysia, people tend to use fuel-efficient vehicles such as motorcycles. Statistics shows that in Malaysia, the number of motorcycles is almost half of the total registered vehicles. Therefore, motorcycles as widely used vehicles have an impact on overall energy consumptions in the country. Minimum fuel economy standard can be one of the effective policies to reduce the fuel consumption in transport sector. While the main problem to set the minimum fuel economy standard is to identify the annual fuel economy improvement of the vehicle, this study aims to find a method to calculate the annual fuel economy improvement and to calculate the potential reduction in fuel consumption by implementing a fuel economy standard for motorcycles in Malaysia. The calculation is based on four scenarios of sensitivity analysis which are 5, 10, 15, and 20 % from the baseline fuel economy. While this study only covers the fuel economy standard of motorcycles, the method can be applied to the other types of motor vehicles without major modifications. [ABSTRACT FROM AUTHOR]

Background-The obesity-hypertension link over the life course has not been well characterized, although the prevalence of obesity and hypertension is increasing in the United States. Methods and Results-We studied the association of body mass index (BMI) in young adulthood, into middle age, and through late life with risk of developing hypertension in 1132 white men of The Johns Hopkins Precursors Study, a prospective cohort study. Over a median follow-up period of 46 years, 508 men developed hypertension. Obesity (BMI ⩾30 kg/m2) in young adulthood was strongly associated with incident hypertension (hazard ratio, 4.17; 95% confidence interval, 2.34-7.42). Overweight (BMI 25 to <30 kg/m2) also signaled increased risk (hazard ratio, 1.58; 95% confidence interval, 1.28-1.96). Men of normal weight at age 25 years who became overweight or obese at age 45 years were at increased risk compared with men of normal weight at both times (hazard ratio, 1.57; 95% confidence interval, 1.20-2.07), but not men who were overweight or obese at age 25 years who returned to normal weight at age 45 years (hazard ratio, 0.91; 95% confidence interval, 0.43-1.92). After adjustment for time-dependent number of cigarettes smoked, cups of coffee taken, alcohol intake, physical activity, parental premature hypertension, and baseline BMI, the rate of change in BMI over the life course increased the risk of incident hypertension in a dose-response fashion, with the highest risk among men with the greatest increase in BMI (hazard ratio, 2.52; 95% confidence interval, 1.82-3.49). Conclusions-Our findings underscore the importance of higher weight and weight gain in increasing the risk of hypertension from young adulthood through middle age and into late life. [ABSTRACT FROM AUTHOR]

The article focuses on the evaluation of the low-cost EasyCD4 assay to enumerate CD4 lymphocytes in resource-limited settings in a cross-sectional study conducted in the U.S. and Uganda. The researchers have compated cell counts on replicate samples from HIV-infected patients by the EasyCD4 assay, a microcapillary flow-based system, and by standard flow cytometry or FACSCount with linear regression and the Bland-Altman method. Finally, the results suggest that EasyCD4 may be applied with high positive and negative predictive value in resource-limited settings.

We demonstrate theoretically, using multiple-time-scale perturbation theory, the existence of nonseparable superpositions of elastic waves in an externally driven elastic system composed of three one-dimensional elastic wave guides coupled via nonlinear forces. The nonseparable states span a Hilbert space with exponential complexity. The amplitudes appearing in the nonseparable superposition of elastic states are complex quantities dependent on the frequency of the external driver. By tuning these complex amplitudes, we can navigate the state's Hilbert space. This nonlinear elastic system is analogous to a two-partite two-level quantum system. [ABSTRACT FROM AUTHOR]

Background: Population-based studies showing the advantage of computer-assisted total knee arthroplasty (CATKA) over conventional total knee arthroplasty (TKA) are outdated. More recent institution-based studies with relatively small sample sizes may hinder wider adoption. This cohort-based study aimed to compare postoperative CATKA and TKA in-hospital complications and 90-day all-cause readmissions using 2017-2018 data., Methods: Patients who underwent a primary unilateral CATKA or TKA were identified in the New York Statewide Planning and Research Cooperative System database. In-hospital complications were defined based on the 2020 Centers for Medicare & Medicaid Services total hip arthroplasty and TKA complications measure. Ninety-day readmissions were identified using unique patient identifiers. Logistic regression with a generalized estimating equation was used to assess associations of computer assistance with in-hospital complications and 90-day all-cause readmissions., Results: A total of 80,468 TKAs were identified during the study period, of which 7,395 (9.2%) were CATKAs. Significantly fewer complications occurred among patients who had CATKAs compared with conventional TKAs (0.4% of total CATKAs vs 2.6% of total conventional TKAs, P < 0.001); patients who had CATKAs had fewer 90-day all-cause readmissions compared with those who underwent TKAs (363 vs 4,169 revisits, P < 0.01). Computer assistance was associated with significantly lower odds of in-hospital complications (odds ratio, 0.15, 95% confidence interval, 0.09 to 0.24; P < 0.05) but not 90-day all-cause readmissions., Conclusion: Patients undergoing CATKAs had markedly lower odds of in-hospital complications, compared with patients having TKAs, which has implications for both patient outcomes and hospital reimbursement. These more recent cohort-based findings encourage wider CATKA adoption., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

The scientific community has been releasing whole genomic sequences of SARS-CoV-2 to facilitate the investigation of molecular features and evolutionary history. We retrieved 36 genomes of 18 prevalent countries of Asia, Europe and America for genomic diversity and mutational analysis. Besides, we studied mutations in the RBD regions of Spike (S) proteins to analyze the drug efficiency against these mutations. In this research, phylogenenetic analysis, evolutionary modeling, substitution pattern analysis, molecular docking, dynamics simulation, etc. were performed. The genomic sequences showed >99% similarity with the reference sequence of China.TN93 + G was predicted as a best nucleotide substitution model. It was revealed that effective transition from the co-existing SARS genome to the SARS-CoV-2 and a noticeable positive selection in the SARS-CoV-2 genomes occurred. Moreover, three mutations in RBD domain, Val/ Phe367, Val/ Leu 382 and Ala/ Val522, were discovered in the genomes from Netherland, Bangladesh and the USA, respectively. Molecular docking and dynamics study showed RBD with mutation Val/Leu382 had the lowest binding affinity with remdesivir. In conclusion, the SARS-CoV-2 genomes are similar, but multiple degrees of transitions and transversions occurred. The mutations cause a significant conformational change, which are needed to be investigated during drug and vaccine development., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Context: The Caribbean diaspora in the United States is a diverse community that is afflicted with high morbidity and mortality due to preventable chronic diseases., Objective: Our goal is to determine which culturally sensitive health and nutrition educational modalities have the highest efficacy for improving general health in the Caribbean diaspora., Methods: A scoping literature review was performed on the MEDLINE, CINAHL, and Web of Science databases using terms related to health and nutrition in the Caribbean population. Original, peer-reviewed research published from 2010 to 2020, which took place in the U.S. and Caribbean countries, were included in our review., Results: We identified a total of nine articles that met our inclusion criteria. Rate differences for individual education program features were calculated to assess the likelihood of a positive impact on diet, physical activity, and diabetes., Conclusion: Our review helps to identify key educational modalities targeting diabetes, diet, and physical activity levels that can be used to meet the health and nutritional needs of the Caribbean diaspora population.

To investigate the relationship between intestinal microbiota and SARS-CoV-2-mediated pathogenicity in a United States, majority African American cohort. We prospectively collected fecal samples from 50 SARS-CoV-2 infected patients, 9 SARS-CoV-2 recovered patients, and 34 uninfected subjects seen by the hospital with unrelated respiratory medical conditions (controls). 16S rRNA sequencing and qPCR analysis was performed on fecal DNA/RNA. The fecal microbial composition was found to be significantly different between SARS-CoV-2 patients and controls (PERMANOVA FDR- P  = .004), independent of antibiotic exposure. Peptoniphilus, Corynebacterium and Campylobacter were identified as the three most significantly enriched genera in COVID-19 patients compared to controls. Actively infected patients were also found to have a different gut microbiota than recovered patients (PERMANOVA FDR- P  = .003), and the most enriched genus in infected patients was Campylobacter , with Agathobacter and Faecalibacterium being enriched in the recovered patients. No difference in microbial community structure between recovered patients and uninfected controls was observed, nor a difference in alpha diversity between the three groups. 24 of the 50 COVID-19 patients (48%) tested positive via RT-qPCR for fecal SARS-CoV-2 RNA. A significant difference in gut microbial composition between SARS-CoV-2 positive and negative samples was observed, with Klebsiella and Agathobacter being enriched in the positive cohort. No significant associations between microbiome composition and disease severity was found. The intestinal microbiota is sensitive to the presence of SARS-CoV-2, with increased relative abundance of genera ( Campylobacter, Klebsiella ) associated with gastrointestinal (GI) disease. Further studies are needed to investigate the functional impact of SARS-CoV-2 on GI health.

Physician-pharmacist collaborative care (PPCC) is effective in improving blood pressure (BP) control, but primary care provider (PCP) engagement in such models has not been well-studied. The authors analyzed data from PPCC referrals to 108 PCPs, for patients with uncontrolled hypertension, assessing the proportion of referral requests approved, disapproved, and not responded to, and reasons for disapproval. Of 2232 persons with uncontrolled hypertension, PPCC referral requests were sent for 1516 (67.9%): 950 (62.7%) were approved, 406 (26.8%) were disapproved, and 160 (10.6%) received no response. Approval rates differed widely by PCP with a median approval rate of 75% (interquartile range, 41%-100%). The most common reasons for disapproval were: PCP prefers to manage hypertension (19%), and BP controlled per PCP (18%); 8% of cases were considered too complex for PPCC. Provider acceptance of a PPCC hypertension clinic was generally high and sustained but varied widely among PCPs. No single reason for disapproval predominated., (©2015 Wiley Periodicals, Inc.)

Background: The guidelines for initial empiric antimicrobial therapy for ventilator-associated pneumonia (VAP) are highly dependent on the type of causative pathogen and the time of diagnosis. The objective of this study was to examine the microbial causes of VAP and describe any variability by the timing of VAP onset and over time., Methods: A prospective surveillance study was conducted in the adult general intensive care unit of a tertiary care hospital in Riyadh, Saudi Arabia. Microbial isolates obtained from blood and different respiratory specimens of patients diagnosed with VAP (using the US Centers for Disease Control and Prevention definition) between August 2003 and June 2009 were included., Results: A total of 457 pathogens were identified during the study; 380 (83.2%) were associated with primary VAP and 77 (16.8%) were associated with recurrent VAP. Of primary VAP pathogens, 159 (41.8%) were associated with early-onset (<5 days) and 221 (58.2%) were associated with late-onset (≥5 days) VAP. The most common pathogen identified was Acinetobacter spp (26.5%), followed by Pseudomonas aeruginosa (21.7%), Staphylococcus aureus including methicillin-resistant S. aureus (MRSA) (15.3%), Klebsiella spp (6.8%), Haemophilus spp (6.1%), and Enterobacter spp (5.0%). Acinetobacter spp and MRSA were significantly associated with late-onset VAP while Haemophilus spp and Streptococcus pneumoniae were significantly associated with early-onset VAP. Acinetobacter spp was the only pathogen associated with recurrent VAP and its incidence showed a significant increasing trend during the study period. Acinetobacter spp was significantly associated with prolonged ventilation, sedation, and nasogastric intubation., Conclusions: Acinetobacter baumannii is the most common and increasingly important pathogen associated with VAP in our patients, especially late-onset and recurrent VAP., (Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: This retrospective study evaluated the impact of disease progression and of specific sites of metastasis on patient reported outcomes (PROs) that assess symptom burden and health related quality of life (HRQoL) in women with metastatic breast cancer (mBC)., Methods: HER-2 negative mBC patients (n = 102) were enrolled from 7 U.S. community oncology practices. Demographic, disease and treatment characteristics were abstracted from electronic medical records and linked to archived Patient Care Monitor (PCM) assessments. The PCM is a self-report measure of symptom burden and HRQoL administered as part of routine care in participating practices. Linear mixed models were used to examine change in PCM scores over time., Results: Mean age was 57 years, with 72% of patients Caucasian, and 25% African American. Median time from mBC diagnosis to first disease progression was 8.8 months. Metastasis to bone (60%), lung (28%) and liver (26%) predominated at initial metastatic diagnosis. Results showed that PCM items assessing fatigue, physical pain and trouble sleeping were sensitive to either general effects of disease progression or to effects associated with specific sites of metastasis. Progression of disease was also associated with modest but significant worsening of General Physical Symptoms, Treatment Side Effects, Acute Distress and Impaired Performance index scores. In addition, there were marked detrimental effects of liver metastasis on Treatment Side Effects, and of brain metastasis on Acute Distress., Conclusions: Disease progression has a detrimental impact on cancer-related symptoms. Delaying disease progression may have a positive impact on patients' HRQoL.

With increased longevity and increased prevalence of diabetes, hypertension, heart disease, and obesity, dementia is likely to raise three to fourfold. The diagnosis of the Alzheimer's type dementia is being challenged as the majority of the dementias appear to be of the mixed type. Biological and genetic factors combined with life style choices play a role in the development of the dementias. The drugs in current use to modify the symptoms have had little impact. Today's research challenges the long held amyloid theory of Alzheimer 's disease. Research has been inconsistent and more support is needed to help us identify preventable and modifiable factors of the disease.

The economic stimulus law of 2009 included incentive payments to encourage providers and hospitals to adopt and "meaningfully use" electronic health records. One resource was excluded from these regulations: patient data from the patient's health insurer, although health insurance companies tie together multiple sectors of the healthcare industry in a single patient-centered data form known as the claims history. They also have considerable experience with information technology (IT). As a result, they are uniquely positioned to move adoption of health IT systems forward. Health plan technologies should be included in the meaningful-use requirements. The result will be additional functionality, which in the end will improve quality, lower costs, and improve individual health.

This paper outlines a practical and pragmatic approach to containing mental health costs, especially when caring for Medicaid recipients. The role of psychiatrists as primary care gatekeepers in the managed care system is also discussed. We conclude that a single-payor system seems to be the best alternative for timely and quality mental health care, and that early detection via education and screening for families predisposed to substance abuse/mental illness is also beneficial in controlling costs.