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Objective: To assess both individual and interactive effects of prenatal medical conditions depression and diabetes, and health behaviors including smoking during pregnancy on infant birth defects. Methods: The data for this research study were collected by the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2018. Birth certificate records were used in each participating jurisdiction to select a sample representative of all women who delivered a live-born infant. Complex sampling weights were used to analyze the data with a weighted sample size of 4,536,867. Descriptive statistics were performed to explore frequencies of the independent and dependent variables. Bivariate and multivariable analyses were conducted to examine associations among the independent and dependent variables. Results: The results indicate significant interaction between the variables smoking and depression and depression and diabetes (OR = 3.17; p-value < 0.001 and OR = 3.13; p-value < 0.001, respectively). Depression during pregnancy was found to be strongly associated with delivering an infant with a birth defect (OR = 1.31, p-value < 0.001). Conclusion: Depression during pregnancy and its interaction with smoking and diabetes are vital in determining birth defects in infants. The results indicate that birth defects in the United States can be reduced by lowering depression in pregnant women. [ABSTRACT FROM AUTHOR]

Mergers and acquisitions (M&A) have become a common strategy for companies looking to grow and expand their operations. However, the potential benefits of M&A can also attract unwanted attention from potential acquirers, which can lead to hostile takeover attempts. To protect themselves from hostile takeovers, companies often implement anti-takeover defense strategies. Anti-takeover defense strategies refer to a range of defensive tactics that target companies can employ to deter or prevent hostile takeovers. These strategies can take various forms, including structural defenses, governance defenses, and financial defenses. This research paper examines antitakeover defense strategies in mergers and acquisitions (M&A) using secondary data sources. The paper provides an overview of the various types of anti-takeover defense strategies that are commonly used by companies, including structural, governance, and financial defenses. The paper also analyzes the various anti-takeover defense strategies adopted in protecting shareholder value and limiting competition. The regulatory frameworks governing anti-takeover defense strategies in different jurisdictions are also explored, including the United States, United Kingdom, European Union, and Japan. The findings of this study indicate that the use of anti-takeover defense strategies can be effective in protecting shareholder value, but may also limit competition and potentially result in lower acquisition premiums. The paper concludes by discussing the implications of these findings for companies involved in M&A transactions, and the need to balance the protection of shareholder interests with the potential benefits of being an attractive target for acquisition. Overall, this research provides a comprehensive analysis of the complex landscape of antitakeover defense strategies in M&A transactions, based on secondary data sources. The findings of this study contribute to the understanding of the role of anti-takeover defense strategies in M&A transactions and the considerations that must be taken into account by companies when implementing these strategies. [ABSTRACT FROM AUTHOR]

This study aims to provide comparative data on clinical features and in-hospital outcomes among U.S. adults admitted to the hospital with COVID-19 and influenza infection using a nationwide inpatient sample (N.I.S.) data 2020. Data were collected on patient characteristics and in-hospital outcomes, including patient's age, race, sex, insurance status, median income, length of stay, mortality, hospitalization cost, comorbidities, mechanical ventilation, and vasopressor support. Additional analysis was performed using propensity matching. In propensity-matched cohort analysis, influenza-positive (and COVID-positive) patients had higher mean hospitalization cost (USD 129,742 vs. USD 68,878, p = 0.04) and total length of stay (9.9 days vs. 8.2 days, p = 0.01), higher odds of needing mechanical ventilation (OR 2.01, 95% CI 1.19–3.39), and higher in-hospital mortality (OR 2.09, 95% CI 1.03–4.24) relative to the COVID-positive and influenza-negative cohort. In conclusion, COVID-positive and influenza-negative patients had lower hospital charges, shorter hospital stays, and overall lower mortality, thereby supporting the use of the influenza vaccine in COVID-positive patients. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore associations between allegations of malpractice and the severity of the alleged malpractice injury. The public-use data file of the National Practitioner Data Bank was used to identify 34,042 dentist malpractice reports from January 1, 2010, through December 31, 2020. Univariate descriptive analysis was conducted to identify frequencies of malpractice allegations when classified by the severity of the alleged malpractice injury, practitioner graduation year, and year of original report processing. Ordinal logistic regression analyses were conducted to explore associations between the malpractice allegation type and the severity of the alleged malpractice injury. A total of 15,183 valid reports were used in the analysis. Compared with treatment-related allegations, a surgery-related allegation proved 5.3 times more likely to result in minor permanent injury; a diagnosis-related allegation was 6.5 times more likely to result in significant permanent injury and 10.4 times more likely to result in major permanent injury; and an anesthesia-related allegation was 6.2 times more likely to result in major permanent injury. The confounding variable of graduation year proved significant with respect to major temporary and minor permanent injury. As the allegation group advanced from diagnosis-related to anesthesia-, treatment-, and surgery-related allegations, the odds of a higher severity of injury did not increase. Establishing a proper diagnosis and developing a treatment plan to manage the anticipated complications of the procedure to be performed are critical to a successful outcome. [ABSTRACT FROM AUTHOR]

Problem definition: We consider the quality competition between two hospitals under the plan of one insurer. The insurer aims to maximize the overall achievable quality in the system by selecting either the fee-for-service (FFS) or the bundled payment (BP) scheme to compensate each hospital. The demand, the costs, and the probability of successfully treating patients depend on a hospital's chosen quality. Under such a setting, we use game theoretic models to study the choice of insurer and the impact of payment schemes on the equilibrium qualities of hospitals. Our models seek answers to the following questions. Is BP (FFS) payment scheme always associated with high (low) equilibrium quality? What factors affect the equilibrium qualities of competing hospitals and the choice of the insurer and how? Academic/practical relevance: Competing hospitals under same or different payment models from an insurer is rather common for healthcare delivery in the United States. However, there is a lack of understanding about the impact of payment schemes on quality outcomes from both the hospital's and the insurer's perspective. To the best of our knowledge, ours is the first paper to incorporate competition and the insurer's perspective to study the impact of different payment models on quality. Methodology: Game theory, equilibrium analysis. Results: We show that BP (FFS) is not always associated with high (low) equilibrium quality and that the equilibrium qualities of the two hospitals are strategic complements. We characterize when the insurer might assign the BP to both hospitals, the FFS to both hospitals, or the BP to one and the FFS to the other hospital. Managerial implications: Our findings provide prescriptive guidelines to an insurer choosing payment models. We also show that a specific quality outcome is achievable not by choosing any payment model but by a careful design of its parameters. Our numerical studies show that hospital readmission reduction initiatives are most effective when run in conjunction with cost reduction initiatives. [ABSTRACT FROM AUTHOR]

Multiple myeloma, the second-most common hematopoietic malignancy in the United States, still remains an incurable disease with dose-limiting toxicities and resistance to primary drugs like proteasome inhibitors (PIs) and Immunomodulatory drugs (IMiDs). We have created a computational pipeline that uses pharmacogenomics data-driven optimization-regularization/greedy algorithm to predict novel drugs ("secDrugs") against drug-resistant myeloma. Next, we used single-cell RNA sequencing (scRNAseq) as a screening tool to predict top combination candidates based on the enrichment of target genes. For in vitro validation of secDrugs, we used a panel of human myeloma cell lines representing drug-sensitive, innate/refractory, and acquired/relapsed PI- and IMiD resistance. Next, we performed single-cell proteomics (CyTOF or Cytometry time of flight) in patient-derived bone marrow cells (ex vivo), genome-wide transcriptome analysis (bulk RNA sequencing), and functional assays like CRISPR-based gene editing to explore molecular pathways underlying secDrug efficacy and drug synergy. Finally, we developed a universally applicable R-software package for predicting novel secondary therapies in chemotherapy-resistant cancers that outputs a list of the top drug combination candidates with rank and confidence scores. Thus, using 17AAG (HSP90 inhibitor) + FK866 (NAMPT inhibitor) as proof of principle secDrugs, we established a novel pipeline to introduce several new therapeutic options for the management of PI and IMiD-resistant myeloma. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the multifaceted impact of the COVID-19 pandemic on dental practices and their readiness to resume dental practice during arduous circumstances. The authors distributed an observational survey study approved by The University of Texas Health Science Center at San Antonio Institutional Review Board to dental care practitioners and their office staff members using Qualtrics XM software. The survey was completed anonymously. The authors analyzed the data using R statistical computing software, χ2 test, and Wilcoxon rank sum test. Nearly all participants (98%) felt prepared to resume dental practice and were confident of the safety precautions (96%). Only 21% of dentists felt the COVID-19 pandemic changed their dental treatment protocols, with at least two-thirds agreeing that precautions would influence their efficiency adversely. Although most participants were satisfied with the resources their dental practice provided for support during the pandemic (95%), most were concerned about the impact on their general health and safety (77%) and to their dental practice (90%), found working during the pandemic difficult (≈ 60%), and agreed there are challenges and long-term impacts on the dental profession (> 75%). Dental care professionals, although affected by the COVID-19 pandemic and at high risk of developing COVID-19, were prepared to resume dental practice during most challenging circumstances. The pandemic has affected dental care practitioners substantially; thus, there is need to formulate psychological interventions and safety precautions to mitigate its impact. Further research should evaluate the long-term effects on dentistry and oral health and interceptive measures for better communication and programming around future challenges. [ABSTRACT FROM AUTHOR]

• Personality traits alone should not be considered as antecedents of the propensity to engage in DDB but researchers should also consider that driver's cognitive failure plays a key role in distracting young drivers. • Four of the five Big Five personality traits (i.e., extraversion, neuroticism, conscientiousness, and agreeableness) along with cognitive failure play a major role in the propensity to engage in distracted driving behavior. • The results from this research can be used to develop custom initiatives to decrease the amount of distraction among young adults. Distracted driving is a major safety concern. This paper explores the role personality traits and self-reported cognitive failures play in the propensity towards distracted driving behavior (DDB) among young adults in the United States. Two independent time-separated studies (study 1 with 522 participants; study 2 with 314 participants) confirm the role of cognitive failures as a mediator between specific personality traits and DDB propensity among young adult drivers. The results of this study suggest drivers' personality traits such as extraversion, conscientiousness, and neuroticism have a direct impact on DDB propensity. In addition, there is evidence that cognitive failure mediates the relationship between these three personality traits and DDB propensity. Lastly, based on the results, agreeableness moderates the relationship between cognitive failure and DDB propensity. Together, these findings suggest that personality traits should be considered in conjunction with driver's cognitive failure in explaining DDB propensity. Future research using a combination of self-reported, naturalistic and simulation studies may provide additional insight into the relationships between personality traits, cognitive failures, and the propensity towards DDB. [ABSTRACT FROM AUTHOR]

Background: "Clean" dietary labels are often viewed by consumers as referencing products that are minimally processed, without additives, preservatives, artificial colors, or ingredients, but may also be interpreted as vegan, gluten‐free, dairy‐free, "real," or "natural." Although the "clean" diet trend continues to grow in popularity, there is a lack of consensus regarding the definition and use of this terminology with a corresponding lack of regulation for such labels in the United States. Method: This multidisciplinary scoping review examines the public health implications of the "clean" label trend and the legal and policy landscape for regulation. We report on findings from case law and legal research generated through the Westlaw database and from the U.S. Food and Drug Administration (FDA) enforcement actions and website documents to discuss options for federal‐ and state‐level intervention to mitigate harm. Results: One feasible avenue for change is for the FDA to provide industry guidance, disseminate public statements to debunk myths, and enforce labeling statutes to police deceptive "clean" labeling claims. We also suggest consumer‐protection litigation and state‐level litigation via attorneys general as alternative actions to combat the abundant misinformation associated with "clean" diets and labels. Discussion: Although the FDA has taken some enforcement actions, these efforts are insufficient given the proliferation of "clean" label products in the marketplace and the potential for adverse impacts on public health including increased risk for disordered eating. The current unregulated, undefined landscape for "clean" dietary labels thus requires urgent action by federal authorities and state attorneys general. [ABSTRACT FROM AUTHOR]

Mobility is a critical element of one's quality of life regardless of one's age. Although the challenges for women are more significant than those for men as they age, far less is known about the gender differences in mobility patterns of older adults, especially in the United States (US) context. This paper reports on a study that examined potential gender gaps in mobility patterns of older adults (aged 65 years and over) in the US by analyzing data from the 2017 National Household Travel Survey. Elderly respondents were first classified into one of six clusters based on socio-demographic variables. A Structural Equation Model (SEM) was then estimated and showed that gender gaps existed in the mobility patterns of the elderly, and the differences were diverse across the different clusters. The most substantial gender gap was found in the Senior Elder with Medical Condition(s) cluster, followed by the High-income Workers cluster and the Middle-income Urban Residents cluster. In contrast, females in the Low-Income Single Elder cluster enjoyed statistically significant positive mobility differences with their male counterparts. Our results also found that female elderly in the Senior Elder with Medical Condition(s) and the Low-income Family Elder clusters suffered most after the cessation of driving, with the largest mobility gender gap in the Middle-income Urban Resident cluster. This study will help transportation planners and policymakers understand gender and other socio-demographic differences in elderly mobility. Thus, it will facilitate the development of measures to improve elderly mobility and reduce gender gaps by recognizing and addressing specific target groups' mobility characteristics and needs rather than treating the elderly as a single potential user group. [ABSTRACT FROM AUTHOR]

This study explores the role of social identities in consumer‐brand relationship through the case study of the first hijab‐wearing Barbie doll in the United States. Through a qualitative analysis of people's response to the announcement of the new Barbie doll on Twitter, the study reveals how ethnic‐identity based products influence consumers relationship with an iconic brand. Ethnic‐based products help in social identification and facilitate some consumers desire to buy the product however, they also elicit negative emotions, racism, and animosity in other group of consumers resulting in weakening of their ties with a once favored brand. Theoretical and managerial implications for multicultural marketing are discussed. [ABSTRACT FROM AUTHOR]

The literature posits that some CEO overconfidence benefits shareholders, though high levels may not. We argue that adequate controls and independent viewpoints provided by an independent board mitigates the costs of CEO overconfidence. We use the concurrent passage of the Sarbanes-Oxley Act and changes to the NYSE/NASDAQ listing rules (collectively, SOX) as natural experiments, to examine whether board independence improves decision making by overconfident CEOs. The results are strongly supportive: after SOX, overconfident CEOs reduce investment and risk exposure, increase dividends, improve postacquisition performance, and have better operating performance and market value. Importantly, these changes are absent for overconfident-CEO firms that were compliant prior to SOX. [ABSTRACT FROM AUTHOR]

Unhealthy alcohol use, smoking, and depressive symptoms are risk factors for cardiovascular disease (CVD). Little is known about their co-occurrence – termed a syndemic, defined as the synergistic effect of two or more conditions—on CVD risk in people with HIV (PWH). We used data from 5621 CVD-free participants (51% PWH) in the Veteran's Aging Cohort Study-8, a prospective, observational study of veterans followed from 2002 to 2014 to assess the association between this syndemic and incident CVD by HIV status. Diagnostic codes identified cases of CVD (acute myocardial infarction, stroke, heart failure, peripheral artery disease, and coronary revascularization). Validated measures of alcohol use, smoking, and depressive symptoms were used. Baseline number of syndemic conditions was categorized (0, 1, ≥ 2 conditions). Multivariable Cox Proportional Hazards regressions estimated risk of the syndemic (≥ 2 conditions) on incident CVD by HIV-status. There were 1149 cases of incident CVD (52% PWH) during the follow-up (median 10.1 years). Of the total sample, 64% met our syndemic definition. The syndemic was associated with greater risk for incident CVD among PWH (Hazard Ratio [HR] 1.87 [1.47–2.38], p < 0.001) and HIV-negative veterans (HR 1.70 [1.35–2.13], p < 0.001), compared to HIV-negative with zero conditions. Among those with the syndemic, CVD risk was not statistically significantly higher among PWH vs. HIV-negative (HR 1.10 [0.89, 1.37], p =.38). Given the high prevalence of this syndemic combined with excess risk of CVD, these findings support linked-screening and treatment efforts. [ABSTRACT FROM AUTHOR]

A vital element in development by the main technological problems is structural change and an improved substantiality of good leadership. "Many of what we do at the beginning of infrastructure, technology and data is almost unknown, and a great deal of it is related to transition and the acceptance of the company. While the study results are continually reinforced, it remains a crucial challenge for others to consider that necessary enhancement in analysis guidelines, policies and skills will result in a generational change in the process. A substantial range of reports has interpreted the influential effect of large data on their activities for companies in the United States. The primary goal is to ensure that the banks' productivity fluctuates when the Bank's artificial intelligence programs cannot integrate effectively and reliably, with a longer-term effect on bank profitability. The survey conducted quantitative and qualitative methodologies by conducting comprehensive interviews and surveys with a determined number of data collection respondents. It then examined the data collected with the use of the SPSS methodological tool to verify the hypotheses. The results show that artificial intelligence programs in the banks had a greater financial performance. Therefore, the researchers should be able to choose many variables to create a modern questionnaire to assess the significance and effect of artificial intelligence on the success of the Bank and the management of big data. [ABSTRACT FROM AUTHOR]

While foreign adversaries continue to launch cyberattacks aimed at disrupting elections in the United States, Congress has been reluctant to take action. After Russia interfered in the 2016 election, cybersecurity experts articulated clear measures that must be taken to secure U.S. election systems against foreign interference. Yet the federal government has failed to act. Congress's reticence is based on a misguided notion that greater federal involvement in the conduct of elections unconstitutionally infringes on states' rights. Both state election officials and certain congressional leaders operate under the assumption that federalism principles grant states primacy in conducting federal elections. This Comment dispels the myth that Congress must defer to states to regulate federal elections. The text of the Elections Clause in Article I, Section 4 of the U.S. Constitution confers to Congress final authority in determining the "Times, Places and Manner" of federal elections. Therefore, the system of administering federal elections is based on decentralization rather than federalism. The risk of foreign interference in U.S. elections was a precise reason the founders bestowed on Congress ultimate control over federal elections. States and municipalities lack the capacity to effectively combat foreign cyber invasion. This Comment makes the case that Congress has a responsibility to exercise its power under the Elections Clause to create a federal plan to secure voter registration databases and voting mechanisms against cyberattacks in order to protect the integrity of American democracy. [ABSTRACT FROM AUTHOR]

Background: Targeted therapies and checkpoint blockade therapy (CBT) have shown efficacy for patients with Hodgkin lymphoma (HL) in the relapsed and refractory (R/R) setting, but once discontinued owing to progression or side effects, it is unclear how successful further therapies will be. Moreover, there are no data on optimal sequencing of these treatments with standard therapies and other novel agents. In a multicenter, retrospective analysis, we investigated whether exposure to CBT could sensitize HL to subsequent therapy. Materials and Methods: Seventeen centers across the U.S. and Canada retrospectively queried medical records for eligible patients. The primary aim was to evaluate the overall response rate (ORR) to post‐CBT treatment using the Lugano criteria. Secondary aims included progression‐free survival (PFS), duration of response, and overall survival (OS). Results: Eighty‐one patients were included. Seventy‐two percent had stage III–IV disease, and the population was heavily pretreated with a median of four therapies before CBT. Most patients (65%) discontinued CBT owing to progression. The ORR to post‐CBT therapy was 62%, with a median PFS of 6.3 months and median OS of 21 months. Post‐CBT treatment regimens consisted of chemotherapy (44%), targeted agents (19%), immunotherapy (15%), transplant conditioning (14%), chemotherapy/targeted combination (7%), and clinical trials (1%). No significant difference in OS was found when stratified by post‐CBT regimen. Conclusion: In a heavily pretreated R/R HL population, CBT may sensitize patients to subsequent treatment, even after progression on CBT. Post‐CBT regimen category did not impact OS. This may be a novel treatment strategy, which warrants further investigation in prospective clinical trials. Implications for Practice: Novel, life‐prolonging treatment strategies in relapsed and refractory (R/R) Hodgkin lymphoma (HL) are greatly desired. The results of this multicenter analysis concur with a smaller, earlier report that checkpoint blockade therapy (CBT) use in R/R HL may sensitize patients to their subsequent treatment. This approach may potentially enhance therapeutic options or to bridge patients to transplant. Prospective data are warranted prior to practice implementation. As more work is done in this area, we may also be able to optimize sequencing of CBT and novel agents in the treatment paradigm to minimize treatment‐related toxicity and thus improve patient quality of life. This study investigated the outcome of checkpoint blockade therapy on subsequent treatment for patients with relapsed and refractory Hodgkin lymphoma in a large, multicenter, retrospective analysis. [ABSTRACT FROM AUTHOR]

The contribution of this research lies in the use of real-world data to test several hypotheses about the role of two signals--sequels and advertising expenditures--in the motion picture industry. The authors analyze the data with a dynamic simultaneous-equations model of the drivers and the interrelationships of the behaviors of movie audiences, studios, and exhibitors. Specifically, the authors test for the attenuating role of third-party information sources, such as critics' review consensus and cumulative word of mouth, on the strength of the two aforementioned signals. The authors find evidence of such an effect both at the release phase across movies and over the postrelease phase for any movie. Notably, they hypothesize and show that sequels and advertising expenditures have a positive interaction effect on box office revenues. This is an important finding because though most firms use multiple signals for their products, empirical work on the interaction of two or more signals is rare. This study offers several new and interesting empirical insights into the market dynamics of the motion picture industry. [ABSTRACT FROM AUTHOR]

This study tested a lagged correlation between Japanese public diplomacy expenditure in the United States and U.S. news sentiment about Japan from 1996 to 2018. We conducted a sentiment analysis to measure news sentiment of The New York Times, The Washington Post, and The Wall Street Journal for 45,822 news articles with 30,197 unique bigram tokens. Using a time-series analysis, this study found that Japanese public diplomacy expenditure was positively related to U.S. news sentiment after controlling for Japanese exports to the U.S. and Japanese real GDP. In our test for the opposite direction, U.S. news sentiment was also positively associated with public diplomacy expenditure, after controlling for Japanese exports to the U.S. and Japanese real GDP. [ABSTRACT FROM AUTHOR]

Through the potency monitoring program at the University of Mississippi supported by National Institute on Drug Abuse (NIDA), a total of 18108 samples of cannabis preparations have been analyzed over the last decade, using a validated GC/FID method. The samples are classified as sinsemilla, marijuana, ditchweed, hashish, and hash oil (now referred to as cannabis concentrate). The number of samples received over the last 5 years has decreased dramatically due to the legalization of marijuana either for medical or for recreational purposes in many US states. The results showed that the mean Δ9-THC concentration has increased dramatically over the last 10 years, from 8.9% in 2008 to 17.1% in 2017. The mean Δ9-THC:CBD ratio also rose substantially from 23 in 2008 to 104 in 2017. There was also marked increase in the proportion of hash oil samples (concentrates) seized (0.5-4.7%) and their mean Δ9-THC concentration (6.7-55.7%) from 2008 to 2017. Other potency monitoring programs are also present in several European countries such as The Netherlands, United Kingdom, France, and Italy. These programs have also documented increases in Δ9-THC concentrations and Δ9-THC:CBD ratios in cannabis. These trends in the last decade suggest that cannabis is becoming an increasingly harmful product in the USA and Europe. [ABSTRACT FROM AUTHOR]

As part of Sustainable Development Goals, the United Nations have set targets of upgrading slums and reducing poverty in all its dimensions by 2030. Policies towards improving the living conditions of slum-dwellers require proper assessment of their standard of living as well as understanding the associated characteristics. In this paper, using slum-level primary household survey data from three largest Indian cities, we, first, assess the standard of living of slum dwellers using both monetary and non-monetary approaches and then explore how various household and spatial characteristics are consistently or differently associated with both forms of assessments. We use standard monetary indicators, but to assess non-monetary standard of living, use a counting approach framework and justify the selection of specific indicators in the context of slums. Our analysis yields some interesting observations as some characteristics are differently associated with monetary and non-monetary living standards, which should affect policy designs in slums. [ABSTRACT FROM AUTHOR]

Chikungunya virus (CHIKV) has been detected sporadically since the 1950s and includes three distinct co-circulating genotypes. In late 2013, the Asian genotype of CHIKV was responsible for the Caribbean outbreak (CO) that rapidly became an epidemic throughout the Americas. There is a limited understanding of the molecular evolution of CHIKV in the Americas during this epidemic. We sequenced 185 complete CHIKV genomes collected mainly from Nicaragua in Central America and Florida in the United States during the 2014–2015 Caribbean/Americas epidemic. Our comprehensive phylogenetic analyses estimated the epidemic history of the Asian genotype and the recent Caribbean outbreak (CO) clade, revealed considerable genetic diversity within the CO clade, and described different epidemiological dynamics of CHIKV in the Americas. Specifically, we identified multiple introductions in both Nicaragua and Florida, with rapid local spread of viruses in Nicaragua but limited autochthonous transmission in Florida in the US. Our phylogenetic analysis also showed phylogeographic clustering of the CO clade. In addition, we identified the significant amino acid substitutions that were observed across the entire Asian genotype during its evolution and examined amino acid changes that were specific to the CO clade. Deep sequencing analysis identified specific minor variants present in clinical specimens below-consensus levels. Finally, we investigated the association between viral phylogeny and geographic/clinical metadata in Nicaragua. To date, this study represents the largest single collection of CHIKV complete genomes during the Caribbean/Americas epidemic and significantly expands our understanding of the emergence and evolution of CHIKV CO clade in the Americas. [ABSTRACT FROM AUTHOR]

Objectives. To investigate the prospective association of diet pill and laxative use for weight control with subsequent first eating disorder diagnosis in young women. Methods. We used longitudinal data from 10 058 US women spanning 2001 through 2016. We used multivariable logistic regression models, adjusting for age, race/ethnicity, and overweight status to estimate the association between weight-control behaviors and subsequent eating disorder diagnosis. Results. Among those who had not previously received an eating disorder diagnosis, women who reported diet pill (adjusted odds ratio [AOR] = 5.6; 95% confidence interval [CI] = 3.0, 10.5) or laxative (AOR = 6.0; 95% CI = 4.2, 8.7) use for weight control had higher odds of receiving a subsequent first eating disorder diagnosis within 1 to 3 years than those who did not report using these products. Conclusions. Use of diet pills or laxatives for weight loss can be dangerous and may be a warning sign that warrants counseling and evaluation for the presence of or risk of developing an eating disorder. Public Health Implications. Policymakers and public health professionals should develop and evaluate policy initiatives to reduce or prohibit access to diet pills and laxatives abused for weight control. [ABSTRACT FROM AUTHOR]

As the overall survival rate for burn injury has improved, increased emphasis is placed on postburn morbidity and the optimization of functional and cosmetic outcomes. One major cause of morbidity and functional deficits is that of joint contractures. The true incidence of postburn contractures and their associated risk factors remains unknown. This study examines the incidence and severity of contractures in a large, multicenter, burn population. The associated risk factors for the development of contractures are determined. Data from the National Institute on Disability and Rehabilitation Research Burn Model System database, for adult burn survivors from 1994 to 2003, were analyzed. Demographic and medical data were collected on each subject. The primary outcome measures included the presence of contractures, number of contractures per patient, and severity of contractures at each of nine locations (shoulder, elbow, hip, knee, ankle, wrist, neck, lumbar spine, and thoracic spine) at time of hospital discharge. Regression analysis was performed to determine predictors of the presence, severity, and numbers of contractures, with P < .05 used for statistical significance. Of the 1865 study patients, 620 (33%) developed at least 1 contracture at hospital discharge. Among those with at least one contracture, the mean is three (3.38) contractures per person. The shoulder was the most frequently contracted joint (23.0%), followed by the elbow (19.9%), wrist (17.3%), ankle (13.6%), and knee (13.4%). Most contractures were mild (47.2%) or moderate (32.9%) in severity. Statistically significant predictors of contracture development were male sex, black race, Hispanic ethnicity, medical problems, neuropathy, TBSA grafted, and TBSA burned. Predictors of the severity of contracture included male sex, black race, medical problems, neuropathy, TBSA grafted, and TBSA burned. Predictors of the number of contractures included male sex, medical problems, flash burn, neuropathy, TBSA burned, and TBSA grafted. Similar to a previous single-center study on postburn contractures, approximately one third of the patients with an eligible burn injury requiring autografting developed a contracture at hospital discharge. It is likely that these contractures develop despite early therapeutic interventions such as positioning and splinting; therefore, the challenge to the burn community remains, to identify new and better prevention strategies. [ABSTRACT FROM AUTHOR]

Joint contractures are a major cause of morbidity and functional deficit. The incidence of postburn contractures and their associated risk factors in the pediatric population has not yet been reported. This study examines the incidence and severity of contractures in a large, multicenter, pediatric burn population. Associated risk factors for the development of contractures are determined. Data from the National Institute on Disability and Rehabilitation Research Burn Model System database, for pediatric (younger than 18 years) burn survivors from 1994 to 2003, were analyzed. Demographic and medical data were collected on each subject. The primary outcome measures included the presence of contractures, number of contractures per patient, and severity of contractures at each of nine locations (shoulder, elbow, hip, knee, ankle, wrist, neck, lumbar, and thoracic) at time of hospital discharge. Regression analysis was performed to determine predictors of the presence, severity, and numbers of contractures, with P < .05 used for statistical significance. Of the 1031 study patients, 237 (23%) developed at least 1 contracture at hospital discharge. Among those with at least one contracture, the mean was three (3.3) contractures per person. The shoulder was the most frequently contracted joint (27.9%), followed by the elbow (17.6%), wrist (14.2%), knee (13.3%), and ankle (11.9%). Most contractures were mild (38.5%) or moderate (36.3%) in severity. The statistically significant predictors of contracture development were age and intensive care unit (ICU) length of stay. The statistically significant predictors of severity of contracture were age, ICU length of stay, presence of amputation, and black race. Predictors of the number of contractures included total age, length of stay, length of ICU stay, presence of amputation, TBSA burned, and TBSA grafted. This is the first study to report the epidemiology of postburn contractures in the pediatric population. Approximately one quarter of children with a major burn injury developed a contracture at hospital discharge, and this could potentially increase as the child grows. Contractures develop despite early therapeutic interventions such as positioning and splinting; therefore, it is essential that we identify novel and more effective prevention strategies. [ABSTRACT FROM AUTHOR]

Objective: Helicobacter pylori infection is the major cause of dyspepsia, peptic ulcer disease, and gastric cancer. This paper will make specific recommendations for a diagnostic and treatment strategy tailored to the international student population. Participants/Methods: This paper is a case report and narrative review based on recent international epidemiologic studies and consensus conference recommendations identified in MEDLINE. Results: In the nations (mostly Asian) that send the largest number of students to the United States, the prevalence of H. pylori is generally 60% to 80%, whereas the prevalence in the United States is about 25%. The patterns of antibiotic resistance in those countries are also different than that in the general US population. Conclusions: Health care providers should have a higher index of suspicion for Helicobacter infection among international students with dyspepsia and need to use a different treatment regimen than is standard for the general US population. [ABSTRACT FROM AUTHOR]

* Context.--End-stage kidney disease (ESKD) is defined as renal impairment requiring renal replacement therapy to sustain life. With a 1-year mortality of ???20% to 30%, many die of complications related to this disease. Objective.--To determine the percentage of autopsy cases of decedents with ESKD in which the contribution of ESKD to death is accurately reflected in the final report. Design.--Autopsy case records were retrospectively reviewed at 4 institutions (Yale New Haven Hospital, University of Chicago Medical Center, University of Illinois at Chicago Hospital, University of Iowa Hospital). Clinical, macroscopic, and microscopic autopsy findings were reviewed, with attention to renal disease findings. Results.--One hundred sixty decedents with documented ESKD and premortem dialysis who underwent autopsy assessment were identified. ESKD was implicated as a cause of death (CoD) or significant contributing factor in 44 cases (28%), but not in the remaining 116 cases (72%). Cardiovascular disease was the most common CoD in ESKD. There was significant interpathologist variation in the inclusion of ESKD as a CoD across institutions. These rates ranged from 85% correlation (23 of 27 cases), to 13% (4 of 31 and 8 of 62 cases at 2 institutions), and 22.5% (9 of 40 cases) across the 4 participating institutions. Conclusions.--The recognition at autopsy of ESKD as a CoD or contributing CoD at autopsy in patients undergoing dialysis remains low (28%). The detrimental impact of ESKD is not reflected in hospital autopsy reports, which carries implications for collection of vital statistics and allocation of research funding for kidney diseases. [ABSTRACT FROM AUTHOR]

The role of exhibition swine in influenza A virus transmission was recently demonstrated by >300 infections with influenza A(H3N2) variant viruses among individuals who attended agricultural fairs. Through active influenza A virus surveillance in US exhibition swine and whole-genome sequencing of 380 isolates, we demonstrate that exhibition swine are actively involved in the evolution of influenza A viruses, including zoonotic strains. First, frequent introduction of influenza A viruses from commercial swine populations provides new genetic diversity in exhibition pigs each year locally. Second, genomic reassortment between viruses cocirculating in exhibition swine increases viral diversity. Third, viral migration between exhibition swine in neighboring states demonstrates that movements of exhibition pigs contributes to the spread of genetic diversity. The unexpected frequency of viral exchange between commercial and exhibition swine raises questions about the understudied interface between these populations. Overall, the complexity of viral evolution in exhibition swine indicates that novel viruses are likely to continually reemerge, presenting threats to humans. [ABSTRACT FROM AUTHOR]

Although studies suggest that anti-fat attitudes and fear of fatness exist among Indian women, few researchers have examined the cross-cultural applicability of their measures prior to assessing Indian samples. In the present study, we evaluated the measurement equivalence of two related measures, the Anti-Fat Attitudes Questionnaire (AFA) and the Goldfarb Fear of Fat Scale (GFFS), and tested for differences in means among college women in India (n= 226) and European American college women in the USA (n= 211). For both measures, there was good evidence for measurement equivalence across samples. Mean comparisons suggested that the Indian and European American participants differed significantly in some but not other dimensions of attitudes toward fatness. Whereas Indian women reported greater dislike of overweight others, European American women reported greater fear of gaining weight and beliefs that they may gain weight. However, overall differences in GFFS fear of fatness were not statistically significant. Although these results are interpreted cautiously, they offer preliminary evidence regarding the attitudes toward fatness among Indian and European American college women. Further examination of these constructs would serve to facilitate a better understanding of the potential mechanisms underlying body image concerns and eating psychopathology across diverse cultural groups. [ABSTRACT FROM PUBLISHER]

The major venous societies in the United States share a common mission to improve the standards of medical practitioners, the educational goals for teaching and training programs in venous disease, and the quality of patient care related to the treatment of venous disorders. With these important goals in mind, a task force made up of experts from the specialties of dermatology, interventional radiology, phlebology, vascular medicine, and vascular surgery was formed to develop a consensus document describing the Core Content for venous and lymphatic medicine and to develop a core educational content outline for training. This outline describes the areas of knowledge considered essential for practice in the field, which encompasses the study, diagnosis, and treatment of patients with acute and chronic venous and lymphatic disorders. The American Venous Forum and the American College of Phlebology have endorsed the Core Content. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To examine psychological insulin resistance (PIR), the unwillingness to accept insulin therapy, within a unique U.S. population of patients with diabetes. Methods: A cross-sectional survey of PIR among low-income, U.S. Latino and African-American (AA) patients with type 2 diabetes recruited from a diabetes specialty clinic. Results: Data from 136 insulin-naïve respondents (57% female, 69% Latino, mean age 51.1±10.3 years; $200–$1000 median monthly household income; grade 8–12 median education) revealed a 48% prevalence of complete unwillingness to begin insulin. In comparing Latinos to AA, Latino respondents were younger, lived fewer years in the U.S., had less education, were more likely unwilling to use insulin (53% vs. 30%, p =0.03), and reported a more negative attitude to 8 of 9 PIR domains (p ≤0.01 for each). Fewer years in the U.S. predicted greater unwillingness and a more negative attitude on 8 of 9 PIR domains (p ≤0.03 for each); and less education predicted greater feelings of unfairness (p =0.01). Conclusions: PIR is highly prevalent among low income, U.S. Latino patients with type 2 diabetes. Our data may help to better guide culturally appropriate counseling regarding insulin use. [Copyright &y& Elsevier]

Abstract: Background: Most bariatric surgery programs in the United States require preoperative psychological evaluations for candidates for surgery. Among those who perform these evaluations is concern that many patients engage in “impression management” or minimizing the symptoms of distress to receive a recommendation to proceed with surgery from the mental health professional. We sought to assess the prevalence of socially desirable responding and its associations with measures of psychological functioning among bariatric surgery candidates at 2 academic medical centers in the United States. Methods: The participants were male (n = 66) and female (n = 293) bariatric surgery candidates who presented for psychological evaluation. The participants completed 2 measures of socially desirable response styles (Marlowe-Crowne Social Desirability Scale and Personality Assessment Inventory Positive Impression Management scale) and standardized measures of anxiety, depression, and alcohol-related problems. Results: The participants exhibited elevated scores on the social desirability indicators, with 33.3–39.8% scoring above the recommended cut-score on the Personality Assessment Inventory Positive Impression Management scale and 62.3–67% scoring 1 standard deviation above the standardization mean on the Marlowe-Crowne Social Desirability Scale. Scores on the Marlowe-Crowne Social Desirability Scale and Personality Assessment Inventory Positive Impression Management scale correlated inversely with the clinical measures of anxiety and depression, and the high/low scorers on the social desirability indices exhibited significant differences in anxiety and depression. Thus, elevated scores on the social desirability indices were associated with underreporting of certain clinical symptoms. Conclusion: A substantial proportion of bariatric surgery candidates appear to present themselves in an overly favorable light during the psychological evaluation. This response style is associated with less reporting of psychological problems and might interfere with the accurate assessment of patient functioning. [Copyright &y& Elsevier]

This paper studies the innovation response of upstream technology suppliers when their downstream buyers transition from regulation to competition. By modeling the impact of the 1990s U.S. electricity deregulation on patenting, we find that after deregulation, the net competition effect (comprising the pure competition and the escape competition effect) decreased innovation by 18.3% and the appropriation effect increased innovation by 19.6%. Other deregulation factors have led to a 20.6%decline. In aggregate, after deregulation, innovation by the upstream technology suppliers has declined by 19.3%, and upstream innovation quality and generality have declined as well. [ABSTRACT FROM AUTHOR]

This article reviews the barriers to diversity in biomedical research and describes the evolution of efforts to address climate issues to enhance the ability to attract, retain, and develop underrepresented minorities, whose underrepresentation is found both in science and medicine, in the graduate-school biomedical research doctoral programs (PhD and MD/PhD) at Mount Sinai School of Medicine. We also describe the potential beneficial impact of having a climate that supports diversity and inclusion in the biomedical research workforce. The Mount Sinai School of Medicine diversity-climate efforts are discussed as part of a comprehensive plan to increase diversity in all institutional programs: PhD, MD/PhD, and MD, and at the residency, postdoctoral fellow, and faculty levels. Lessons learned from 4 decades of targeted programs and activities at the Mount Sinai School of Medicine may be of value to other institutions interested in improving diversity in the biomedical science and academic medicine workforce. Mt Sinai J Med 79:498-511, 2012 © 2012 Mount Sinai School of Medicine [ABSTRACT FROM AUTHOR]

Background: In 2009, the promulgation of US Food and Drug Administration (FDA) tobacco regulation focused attention on cigarette flavor additives. The tobacco industry had prepared for this eventuality by initiating a research program focusing on additive toxicity. The objective of this study was to analyze Philip Morris' Project MIX as a case study of tobacco industry scientific research being positioned strategically to prevent anticipated tobacco control regulations. Methods and Findings: We analyzed previously secret tobacco industry documents to identify internal strategies for research on cigarette additives and reanalyzed tobacco industry peer-reviewed published results of this research. We focused on the key group of studies conducted by Phillip Morris in a coordinated effort known as ''Project MIX.'' Documents showed that Project MIX subsumed the study of various combinations of 333 cigarette additives. In addition to multiple internal reports, this work also led to four peer-reviewed publications (published in 2001). These papers concluded that there was no evidence of substantial toxicity attributable to the cigarette additives studied. Internal documents revealed post hoc changes in analytical protocols after initial statistical findings indicated an additive-associated increase in cigarette toxicity as well as increased total particulate matter (TPM) concentrations in additive-modified cigarette smoke. By expressing the data adjusted by TPM concentration, the published papers obscured this underlying toxicity and particulate increase. The animal toxicology results were based on a small number of rats in each experiment, raising the possibility that the failure to detect statistically significant changes in the end points was due to underpowering the experiments rather than lack of a real effect. Conclusion: The case study of Project MIX shows tobacco industry scientific research on the use of cigarette additives cannot be taken at face value. The results demonstrate that toxins in cigarette smoke increase substantially when additives are put in cigarettes, including the level of TPM. In particular, regulatory authorities, including the FDA and similar agencies elsewhere, could use the Project MIX data to eliminate the use of these 333 additives (including menthol) from cigarettes. [ABSTRACT FROM AUTHOR]

The University of Mississippi has a contract with the National Institute on Drug Abuse (NIDA) to carry out a variety of research activities dealing with cannabis, including the Potency Monitoring (PM) program, which provides analytical potency data on cannabis preparations confiscated in the United States. This report provides data on 46,211 samples seized and analyzed by gas chromatography-flame ionization detection (GC-FID) during 1993–2008. The data showed an upward trend in the mean Δ9-tetrahydrocannabinol (Δ9-THC) content of all confiscated cannabis preparations, which increased from 3.4% in 1993 to 8.8% in 2008. Hashish potencies did not increase consistently during this period; however, the mean yearly potency varied from 2.5–9.2% (1993–2003) to 12.0–29.3% (2004–2008). Hash oil potencies also varied considerably during this period (16.8 ± 16.3%). The increase in cannabis preparation potency is mainly due to the increase in the potency of nondomestic versus domestic samples. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study is to examine the relationship between economic outcome and international public relations investment by other countries in the U.S. Based on country-level data analysis, this study found that the number of international public relations contracts by other countries in the U.S. was positively related to (1) U.S. imports from those countries, (2) U.S. direct investment to those countries, and (3) the number of U.S. tourists visiting those countries, after controlling for economic size. [Copyright &y& Elsevier]

Depigmented patches covering approximately 15% of newborn's body, surrounded by areas of thickened skin. Mild scaling and hyperpigmentation. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated the association between the polymorphic cytochrome P450 2D6 (CYP2D6) enzyme and the clinical outcomes in women receiving adjuvant tamoxifen for early stage breast cancer. German and U.S. cohorts of 1,325 patients who had diagnoses between 1986 and 2005 of stage I through III breast cancer were analyzed. The researchers found an association between CYP2D6 variation and clinical outcomes among women with hormone receptor-positive breast cancer treated with tamoxifen. A comment on the study is presented.

Previous research suggests that Latinos tend to score higher than Anglos on psychometric indicators of socially desirable responding. The purpose of the current study was to test several methodological and cultural explanations for these group differences. Hypothesized explanations included varying levels of problems in living, measurement bias, differential structure of socially desirable responding measures, reliabilities of response style indicators, or cultural factors. Results supported previous findings that self-identified Latino (N=143) respondents score significantly higher than Anglos (N=93) on some socially desirable responding indicators. Groups did not differ in levels of psychopathology and socially desirable responding indicators demonstrated structural similarity, equivalent relations to external criteria, and equivalent reliabilities across groups. Thus, data suggest normative differences between these groups in social presentation that should be considered in culturally sensitive clinical practice. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1–12, 2009. [ABSTRACT FROM AUTHOR]

Congenital heart defects (CHDs) are the most prevalent and serious of all birth defects in the United States. However, little is known about the impact of CHD-affected pregnancies on subsequent maternal health. Thus, there is a need to characterize the metabolic alterations associated with CHD-affected pregnancies. Fifty-six plasma samples were identified from post-partum women who participated in the National Birth Defects Prevention Study between 1997 and 2011 and had (1) unaffected control offspring (n = 18), (2) offspring with tetralogy of Fallot (ToF, n = 22), or (3) hypoplastic left heart syndrome (HLHS, n = 16) in this pilot study. Absolute concentrations of 408 metabolites using the AbsoluteIDQ® p400 HR Kit (Biocrates) were evaluated among case and control mothers. Twenty-six samples were randomly selected from above as technical repeats. Analysis of covariance (ANCOVA) and logistic regression models were used to identify significant metabolites after controlling for the maternal age at delivery and body mass index. The receiver operating characteristic (ROC) curve and area-under-the-curve (AUC) are reported to evaluate the performance of significant metabolites. Overall, there were nine significant metabolites (p < 0.05) identified in HLHS case mothers and 30 significant metabolites in ToF case mothers. Statistically significant metabolites were further evaluated using ROC curve analyses with PC (34:1), two sphingolipids SM (31:1), SM (42:2), and PC-O (40:4) elevated in HLHS cases; while LPC (18:2), two triglycerides: TG (44:1), TG (46:2), and LPC (20:3) decreased in ToF; and cholesterol esters CE (22:6) were elevated among ToF case mothers. The metabolites identified in the study may have profound structural and functional implications involved in cellular signaling and suggest the need for postpartum dietary supplementation among women who gave birth to CHD offspring. [ABSTRACT FROM AUTHOR]

Artificial blood is a product made to act as a substitute for red blood cells. While true blood serves many different functions, artificial blood is designed for the sole purpose of transporting oxygen and carbon dioxide throughout the body. Depending on the type of artificial blood, it can be produced in different ways using synthetic production, chemical isolation, or recombinant biochemical technology. Development of the first blood substitutes dates back to the early 1600s, and the search for the ideal blood substitute continues. Various manufacturers have products in clinical trials; however, no truly safe and effective artificial blood product is currently marketed. It is anticipated that when an artificial blood product is available, it will have annual sales of over $7.6 billion in the United States alone. [ABSTRACT FROM AUTHOR]

The Internet is transforming the way in which consumers approach their health care needs. Sex and age are influential aspects of one's health as well as disease risk and are thus integral components of the emerging picture of health information seekers. Using data from Surveying the Digital Future, Year 4, a nationally representative, longitudinal telephone survey of Americans 12 years of age and older (n = 2010), we examine the reasons for, assessments of and actions taken as a result of health information found online among men and women and older and younger people. Although we tend to think of the Internet as a young person's technology, the percent of adults 60 years of age and older is similar to that of adolescents using the Internet as a health care information resource, thus suggesting an untapped opportunity with online interventions for older adults. Nonetheless, as age increases so too does the report of frustration with the experience. Men are more likely to report a positive seeking experience than women. Differences in Internet use fail to explain these observed sex and age differences in the seeking experience. Across the spectrum of age, sex and Internet skill, Internet health information seeking appears to enhance the patient-provider relationship. [ABSTRACT FROM AUTHOR]

The article reflects on various concerns over the potential effects of trap fishing on coral reefs and associated habitats. The paper constructed a socioeconomic study to characterize the U.S. Caribbean fish trap fishery in predicting appropriate management actions. Researchers conducted interviews on fishermen, as to reveal the presence of a diverse fishery, fishing practices, and capital investment. The study suggested that targeted policies should be implemented to improve the socioeconomic performance of the fishery and the political acceptability of management actions.

Abstract: This study aims to test the public relations efforts of other countries as a predictor of their newsworthiness in the US news media, after controlling for national traits and social significance. Based on a content analysis of US newspaper and television news coverage (New York Times, Washington Post, ABC, NBC, CBS, and CNN) of 97 countries, this study found that the public relations of other countries’ governments is a significant predictor of these countries’ prominence in the US news coverage. [Copyright &y& Elsevier]

Background: Several subtypes of HIV-1 circulate in infected people worldwide, including subtype B in the United States and subtype C in Africa and India. To understand the biological properties of HIV-1 subtype C, including cellular tropism, virus entry, replication efficiency and cytopathic effects, we reciprocally inserted our previously characterized envelope V3-V5 regions derived from 9 subtype C infected patients from India into a subtype B molecular clone, pNL4-3. Equal amounts of the chimeric viruses were used to infect T-lymphocyte cell lines (A3.01 and MT-2), coreceptor cell lines (U373-MAGI-CCR5/CXCR4), primary blood T-lymphocytes (PBL) and monocyte-derived macrophages (MDM). Results: We found that subtype C envelope V3-V5 region chimeras failed to replicate in T-lymphocyte cell lines but replicated in PBL and MDM. In addition, these chimeras were able to infect U373MAGI-CD4+-CCR5+ but not U373MAGI-CD4+-CXCR4+ cell line, suggesting CCR5 coreceptor utilization and R5 phenotypes. These subtype C chimeras were unable to induce syncytia in MT-2 cells, indicative of non-syncytium inducing (NSI) phenotypes. More importantly, the subtype C envelope chimeras replicated at higher levels in PBL and MDM compared with subtype B chimeras and isolates. Furthermore, the higher levels subtype C chimeras replication in PBL and MDM correlated with increased virus entry in U373MAGI-CD4+-CCR5+. Conclusion: Taken together, these results suggest that the envelope V3 to V5 regions of subtype C contributed to higher levels of HIV-1 replication compared with subtype B chimeras, which may contribute to higher viral loads and faster disease progression in subtype C infected individuals than other subtypes as well as rapid HIV-1 subtype C spread in India. [ABSTRACT FROM AUTHOR]