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Resident training programs in the US use the Orthopaedic In-Training Examination (OITE) developed by the American Academy of Orthopaedic Surgeons (AAOS) to assess the current knowledge of their residents and to identify the residents at risk of failing the Amerian Board of Orthopaedic Surgery (ABOS) examination. Optimal strategies for OITE preparation are constantly being explored. There may be a role for Large Language Models (LLMs) in orthopaedic resident education. ChatGPT, an LLM launched in late 2022 has demonstrated the ability to produce accurate, detailed answers, potentially enabling it to aid in medical education and clinical decision-making. The purpose of this study is to evaluate the performance of ChatGPT on Orthopaedic In-Training Examinations using Self-Assessment Exams from the AAOS database and approved literature as a proxy for the Orthopaedic Board Examination. 301 SAE questions from the AAOS database and associated AAOS literature were input into ChatGPT's interface in a question and multiple-choice format and the answers were then analyzed to determine which answer choice was selected. A new chat was used for every question. All answers were recorded, categorized, and compared to the answer given by the OITE and SAE exams, noting whether the answer was right or wrong. Of the 301 questions asked, ChatGPT was able to correctly answer 183 (60.8%) of them. The subjects with the highest percentage of correct questions were basic science (81%), oncology (72.7%, shoulder and elbow (71.9%), and sports (71.4%). The questions were further subdivided into 3 groups: those about management, diagnosis, or knowledge recall. There were 86 management questions and 47 were correct (54.7%), 45 diagnosis questions with 32 correct (71.7%), and 168 knowledge recall questions with 102 correct (60.7%). ChatGPT has the potential to provide orthopedic educators and trainees with accurate clinical conclusions for the majority of board-style questions, although its reasoning should be carefully analyzed for accuracy and clinical validity. As such, its usefulness in a clinical educational context is currently limited but rapidly evolving. ChatGPT can access a multitude of medical data and may help provide accurate answers to clinical questions. [ABSTRACT FROM AUTHOR]

Aim: To assess the relationship between dietary antioxidant intake and periodontal health in US adults and the potential role of mitochondrial function. Materials and Methods: We performed a cross‐sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014. Dietary antioxidant intake was evaluated using three diet‐related indices: dietary oxidative balance score (DOBS), dietary total antioxidant capacity (DTAC) of antioxidant vitamins and composite dietary antioxidant index (CDAI). Periodontal parameters included attachment loss (AL) and probing pocket depth (PPD). Mitochondrial dysfunction was assessed using the methylmalonic acid (MMA) level. Weighted multivariable linear regression analyses were employed to investigate the association between dietary antioxidant intake and periodontal status. Additionally, exploratory mediation analyses were conducted to determine the mediating effect of MMA on the association. Results: Totally, 5520 participants were included in our study. Participants with higher DOBS and DTAC scores had lower mean AL/PPD and MMA values. CDAI was negatively associated with mean AL and PPD. Furthermore, MMA mediated 9.4% and 4.9% of the associations between DOBS and mean AL and mean PPD, respectively. MMA also accounted for 7.2% and 3.3% of the association between DTAC and mean AL and PPD, respectively. Conclusions: The findings support that dietary antioxidant intake helps in improving periodontal health, possibly and partially by enhancing mitochondrial function. [ABSTRACT FROM AUTHOR]

Growth mindset has been shown to predict academic achievement in a variety of student populations, though the strength of the relationship can vary depending on the characteristics of the students examined. Using a large-scale sample of middle school students from a diverse district in the United States, we examine how multiple facets of students' experiences and background characteristics may interact to impact the relation between mindset and academic achievement. We consider whether the risk factors of socioeconomic status (including a student's daily experience of that status) and recent school transition interacted with mindset in predicting academic achievement. We show that mindset is most predictive of academic achievement in students with two academic risk factors. These results highlight the importance of context when considering how mindset might be used to improve academic achievement for students at the greatest academic risk. [ABSTRACT FROM AUTHOR]

In a nationwide sample of cisgender Black women in the US, we assessed the associations between social and structural factors and interest in using HIV preexposure prophylaxis (PrEP). Among 315 respondents, 62.2% were interested in PrEP if it were provided for free. Positive social norms surrounding PrEP, including injunctive norms (perceived social acceptability of PrEP use) and descriptive norms (perceived commonality of PrEP use), were positively associated with interest in using PrEP. Concerns about HIV infection, recently visiting a health care provider, and comfort discussing PrEP with a provider were also positively associated with interest in using PrEP. Anticipating PrEP disapproval from others was negatively associated with interest in PrEP. Although PrEP can promote autonomy and personal discretion, Black women's PrEP-related decisions occur in a complex social environment. Black women may benefit from interventions to promote positive norms and attitudes surrounding PrEP at the community level and empower them in discussions with their providers about PrEP. [ABSTRACT FROM AUTHOR]

Approximately one-quarter of people with HIV (PWH) in the U.S. receive coverage through the Medicare program; however, no prior real-world study has examined antiretroviral therapy (ART) gaps and adherence and associated factors in this population. This retrospective cohort analysis used 2013–2018 national Medicare fee-for-service claims data to identify all PWH initiated on a new ART regimen including protease inhibitors [PI], non-nucleoside reverse transcriptase inhibitors [NNRTIs], or integrase strand transfer inhibitors [INSTIs] between 1/1/2014 and 12/31/2017. Study outcomes included ART adherence (based on proportion of days covered [PDC]), continuous treatment gaps ranging from 1 to 6 days to ≥ 180 days, and discontinuation (continuous gap ≥ 90 days) in the 12-month follow-up period. Multivariable regressions were used to assess factors associated with ART adherence and discontinuation. The final sample included 48,627 PWH (mean age: 54.5 years, 74.4% male, 47.5% White, 89.8% disabled). Approximately 53.0% of PWH had a PDC ≥ 0.95, 30.2% had a PDC between 0.70 and < 0.95, and 16.8% had PDC < 0.70. Treatment gaps of at least ≥ 7-days (55.2%) and ≥ 30-days (26.2%) were common and 10.1% PWH discontinued treatment. Younger age, female sex, Black race, higher comorbidity score, mental health conditions, and substance use disorder were associated with higher odds of lower adherence and discontinuation (all p-values < 0.05). In conclusion, suboptimal adherence and treatment gaps in ART use were commonly observed among PWH in Medicare. Interventions and policies to mitigate barriers to adherence are urgently needed in this population to both improve their survival and increase the potential for ending the HIV epidemic in the US. [ABSTRACT FROM AUTHOR]

Gun ranges in the United States are underinvestigated regarding indoor air quality (IAQ) and energy efficiency. Navy Environmental Health Center (NEHC), National Guard Bureau (NGB), and Air Force Civil Engineer Support Agency (AFCESA) recommend using 100% outdoor air, but this measure will cause prohibitive energy costs since indoor gun ranges must maintain a low air velocity ranging from 0.25 to 0.36 m/s and a supply temperature close to the range target temperature. Hence, typical commercial firing ranges use a fixed outdoor air ratio (OAR) ranging from 25% to 30% together with high-efficiency particulate air filtration to save energy. This OAR is arbitrary and not supported by any standards or guidelines. To obtain reliable control of contaminant levels and better energy efficiency, we propose a model-based demand control ventilation feedback control strategy in which carbon monoxide is monitored and controlled as a proper IAQ indicator around the clock. Our 52-day field study demonstrates that our demand control ventilation control strategy can ensure proper IAQ, reduce the OAR from 30% to as low as 2.5%, and cut up to 85% cooling load and 70% heating load introduced by ventilation. Indoor gun ranges in the United States often struggle with keeping the air clean and energy costs down. Existing recommendations suggest using a lot of outdoor air for ventilation, but this can be expensive because gun ranges need to maintain specific air conditions. Most gun ranges use a fixed amount of outdoor air and special filters to save energy, even though there are no clear guidelines for this. To tackle these issues, we have come up with a smart ventilation system. It constantly checks the air for carbon monoxide, a sign of bad air quality. Our 52-day study showed that this system works considerably well. It keeps the air clean, reduces the need for outdoor air substantially, and cuts down on heating and cooling costs. This means that indoor gun ranges can have clean air and save energy at the same time. It is a practical and efficient solution for making indoor shooting ranges safer and more cost-effective. [ABSTRACT FROM AUTHOR]

Background: The prognostic value of triglyceride-glucose (TyG) index in general type 2 diabetes mellitus (T2DM) patients is still unclear. Therefore, we aimed to determine the associations between TyG and all-cause/cause-specific death in a T2DM cohort and explore whether such associations would be modified by age. Methods: A total of 3,376 patients with T2DM from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 were selected and divided into the younger group (< 65 yrs) and the older group (≥ 65 yrs). Baseline TyG was calculated and cause-specific mortality status [cardiovascular (CV), cancer, and non-CV] was determined by the NHANES Public-Use Linked Mortality Files through 31 December 2019. Multivariate Cox and restricted cubic spline (RCS) regression models were used to evaluate the association between TyG and all-cause/cause-specific mortality. Interaction between TyG and age to mortality was also evaluated. Sensitivity analyses were performed in patients without cardiovascular disease, chronic kidney disease, or insulin treatment. Results: During a median follow-up of 107 months, 805 all-cause deaths occurred, of which 250 and 144 were attributed to CV and cancer deaths. There was a significant age interaction to the association between TyG and all-cause/non-CV mortality. After fully adjusting for potential confounding factors, higher TyG was associated with an increased risk of all-cause [TyG per unit increase Hazard Ratio (HR) 1.33, 95% Confidence Interval (CI) 1.06–1.66, p = 0.014] and non-CV mortality (TyG per unit increase HR 1.54, 95% CI 1.18–2.01, p = 0.002) only in the younger group, but not in the older group. There was no significant association between TyG and CV/cancer death in the total cohort and two age subgroups. Similar results were found in RCS and sensitivity analyses. Conclusion: In a national sample of patients with T2DM in the United States, we found that the association between TyG and all-cause/non-CV death was modified by age. Higher TyG was only associated with an increased risk of all-cause/non-CV only in T2DM patients younger than 65 years old, but not in older patients. [ABSTRACT FROM AUTHOR]

The present study utilized the National Health and Nutrition Examination Survey (NHANES) database to examine the relationship between serum levels of heavy metals and Diabetic retinopathy (DR) in individuals aged over 30 years with type 2 diabetes mellitus (T2DM) in the United States. A cross-sectional analysis was conducted on 1583 individuals with T2DM from the NHANES 2011–2020, including 331 individuals in the DR group and 1252 individuals in the non-DR group. We collected data on serum levels of heavy metals, DR, and serum albumin for descriptive statistics, linear regression, and logistical regression analysis. After adjusting for age, gender, race and other factors, there was no statistically significant association between blood cadmium, selenium, mercury, or lead and DR. However, serum manganese (Mn) and DR had a significant negative association (β = − 0.2045, 95% CI = − 0.3484, − 0.0606). Serum albumin partially modulated the indirect influence of serum Mn on the incidence of DR, accounting for 12.80% of the association between serum Mn and DR. There was a negative association between serum Mn levels and the prevalence of DR in people with T2DM. Mn intake at least in this study has a little influence on the onset and development of DR. [ABSTRACT FROM AUTHOR]

Summary: This cross-sectional study investigated the relationship between composite dietary antioxidant index (CDAI) and individual dietary antioxidant intakes, including vitamins A, C, and E, zinc, selenium, and carotenoids, and bone mineral density (BMD) in the US population aged 20 years older. We found a positive correlation between CDAI and femoral BMD. Moreover, higher intakes of vitamin C, vitamin E, selenium, zinc, and carotenoids were associated with higher femoral BMD. Introduction: While individual dietary antioxidants have shown beneficial effects on bone metabolism, the diverse and potentially interacting nature of dietary components may limit the accuracy of evaluating their impact on bone health. Thus, this study aims to investigate the association between CDAI and BMD. Additionally, we explore the relationship between the intake of individual components of the CDAI and BMD. Methods: The CDAI is a novel index evaluating total dietary antioxidant intake, considering vitamins A, C, and E, zinc, selenium, and carotenoids. A cross-sectional analysis was conducted using data from participants aged ≥ 20 in the National Health and Nutrition Examination Survey (2005–2010, 2013–2014, and 2017–2018). We utilized multivariate linear regression models to examine the relationship between CDAI, individual dietary antioxidants, including vitamins A, C, and E, zinc, selenium, carotenoids, and femoral BMD. Results: The final analysis included 10,584 participants with a mean age of 50.73 ± 16.65 years. After multivariate adjustment, the second to fourth quartiles of CDAI (− 2.00–0.04, 0.04–2.54, and 2.54–70.78) exhibited higher femoral BMD compared to the first quartile of CADI (− 7.34 to − 2.00). Multiple regression analysis revealed that higher intakes of vitamin C, vitamin E, selenium, zinc, and carotenoids were associated with higher femoral BMD. Conclusions: CDAI serves as a comprehensive tool for evaluating the overall antioxidant capacity of antioxidants in diets. Additionally, our study shows a positive correlation between CDAI and BMD, which indicates that the combined intake of dietary antioxidants may help reduce the risk of osteoporosis in adults. [ABSTRACT FROM AUTHOR]

Background: The screening, brief intervention, and referral to treatment (SBIRT) model is recommended by the U.S. Preventive Services Task Force to improve recognition of and intervention for unhealthy alcohol use. How SBIRT implementation differs by demographic characteristics is poorly understood. Methods: We analyzed data from the 2015–2019 National Survey on Drug Use and Health from respondents ≥18 years old who used an outpatient clinic and had at least one alcoholic drink within the past year. Respondents were grouped into one of three mutually exclusive groups: "no binge drinking or alcohol use disorder (AUD)," "binge drinking without AUD," or "AUD." Outcome variables were likelihood of screening, brief intervention (BI), referral to treatment (RT), and AUD treatment. The demographic predictors on which outcomes were regressed included gender, age, race and ethnicity, sexual orientation, insurance status, and history of military involvement. Consistent with SBIRT guidelines, the entire sample was included in the screening model; screened persons with either binge drinking without AUD or with AUD were included in the BI model; screened persons with AUD were included in the RT model, and persons referred to treatment with AUD were included in the AUD treatment model. Results: Analyses included 120,804 respondents. Women were more likely than men to be screened, but less likely to receive BI or RT. When referred to treatment, women were more likely than men to receive it. Persons aged ≥50 were least likely to be screened about alcohol, but most likely to receive BI, while persons aged 18–25 were least likely to receive BI or AUD treatment. Racial and ethnic minorities were less likely than White persons to be screened; Asians were less likely to receive RT, and Black persons were less likely to receive treatment than White persons. Persons identifying as gay, lesbian, or bisexual were equally as likely or more likely to receive SBIRT or AUD treatment as those identifying as heterosexual. Persons without insurance were less likely to be screened than those with insurance. Persons with a history of military involvement were more likely to be screened and receive BI and RT than persons who had not served in the military. Conclusions: Demographic disparities in SBIRT implementation exist. Addressing the sources of these disparities and minimizing attrition from care could improve outcomes for persons with unhealthy alcohol use. [ABSTRACT FROM AUTHOR]

(1) Background: With increasing international travel and mass population displacement due to war, famine, climate change, and immigration, pathogens, such as Staphylococcus aureus (S. aureus), can also spread across borders. Methicillin-resistant S. aureus (MRSA) most commonly causes skin and soft tissue infections (SSTIs), as well as more invasive infections. One clonal strain, S. aureus USA300, originating in the United States, has spread worldwide. We hypothesized that S. aureus USA300 would still be the leading clonal strain among US-born compared to non-US-born residents, even though risk factors for SSTIs may be similar in these two populations (2) Methods: In this study, 421 participants presenting with SSTIs were enrolled from six community health centers (CHCs) in New York City. The prevalence, risk factors, and molecular characteristics for MRSA and specifically clonal strain USA300 were examined in relation to the patients' self-identified country of birth. (3) Results: Patients born in the US were more likely to have S. aureus SSTIs identified as MRSA USA300. While being male and sharing hygiene products with others were also significant risks for MRSA SSTI, we found exposure to animals, such as owning a pet or working at an animal facility, was specifically associated with risk for SSTIs caused by MRSA USA300. Latin American USA300 variant (LV USA300) was most common in participants born in Latin America. Spatial analysis showed that MRSA USA300 SSTI cases were more clustered together compared to other clonal types either from MRSA or methicillin-sensitive S. aureus (MSSA) SSTI cases. (4) Conclusions: Immigrants with S. aureus infections have unique risk factors and S. aureus molecular characteristics that may differ from US-born patients. Hence, it is important to identify birthplace in MRSA surveillance and monitoring. Spatial analysis may also capture additional information for surveillance that other methods do not. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus (S. aureus) is known to cause human infections and since the late 1990s, community-onset antibiotic resistant infections (methicillin resistant S. aureus (MRSA)) continue to cause significant infections in the United States. Skin and soft tissue infections (SSTIs) still account for the majority of these in the outpatient setting. Machine learning can predict the location-based risks for community-level S. aureus infections. Multi-year (2002–2016) electronic health records of children <19 years old with S. aureus infections were queried for patient level data for demographic, clinical, and laboratory information. Area level data (Block group) was abstracted from U.S. Census data. A machine learning ecological niche model, maximum entropy (MaxEnt), was applied to assess model performance of specific place-based factors (determined a priori) associated with S. aureus infections; analyses were structured to compare methicillin resistant (MRSA) against methicillin sensitive S. aureus (MSSA) infections. Differences in rates of MRSA and MSSA infections were determined by comparing those which occurred in the early phase (2002–2005) and those in the later phase (2006–2016). Multi-level modeling was applied to identify risks factors for S. aureus infections. Among 16,124 unique patients with community-onset MRSA and MSSA, majority occurred in the most densely populated neighborhoods of Atlanta's metropolitan area. MaxEnt model performance showed the training AUC ranged from 0.771 to 0.824, while the testing AUC ranged from 0.769 to 0.839. Population density was the area variable which contributed the most in predicting S. aureus disease (stratified by CO-MRSA and CO-MSSA) across early and late periods. Race contributed more to CO-MRSA prediction models during the early and late periods than for CO-MSSA. Machine learning accurately predicts which densely populated areas are at highest and lowest risk for community-onset S. aureus infections over a 14-year time span. [ABSTRACT FROM AUTHOR]

The collection of electronic course templates suggested in this article results from collaborative investigation between instructional support staff and academic staff users of the virtual learning environment (VLE) at two institutions, one in the United Kingdom and the other in the United States. The particular VLE in use at both institutions was Sakai, although the experience described here can be applied to the design process and workflow using any VLE that allows the selection and some configuration of standard tools. We applied the lattice model of Hill, Fresen and Geng (2012) to design and build a set of six course site templates, which are used as the basis on which site owners can easily build new sites in the VLE. As the ultimate goal of template provision is to underpin pedagogy, academics are free to use a template or build a site from scratch, based on their own teaching context, and they may adapt any template according to the pedagogical purpose and nature of the course. The underlying assumptions are that academic staff retain full control over the content, tools and permissions in their new site. The templates are not mutually exclusive--that is, aspects from any template may be incorporated, where applicable, into another one. We conclude that it is helpful for the VLE support team to take the lead in proposing a set of templates according to the predominant teaching and learning models in use at a particular institution, which may contribute to consistency across course sites and ultimately result in an improved student learning experience.

Compared to the training of higher education management professionals in the US, the training of their counterparts in China is relatively modest, with few programs offered at the graduate level. Further, few concrete solutions have been proposed for tackling the challenge of preparing managerial professionals for the sound development of higher educational institutions in China. Based on existing theories and practices associated with professionalization and findings from the literature and data collected from universities both in China and the US, this paper examines the training of higher education professionals from a comparative perspective in the two countries. With the intention of identifying the characteristics of "best practices" for the training and education of institutional executives, in an effort to provide possible suggestions for the future development of higher management training in China, the paper will discuss the topic from two perspectives: short-term in-service training programs and formal PhD and EdD programs.

Background Racial inequities exist in retention in human immunodeficiency virus (HIV) care and multilevel analyses are needed to contextualize and address these differences. Leveraging data from a multisite clinical cohort of people with HIV (PWH), we assessed the relationships between patient race and residential characteristics with missed HIV care visits. Methods Medical record and patient-reported outcome (PRO; including mental health and substance-use measures) data were drawn from 7 participating Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites including N = 20 807 PWH from January 2010 through December 2015. Generalized estimating equations were used to account for nesting within individuals and within census tracts in multivariable models assessing the relationship between race and missed HIV care visits, controlling for individual demographic and health characteristics and census tract characteristics. Results Black PWH resided in more disadvantaged census tracts, on average. Black PWH residing in census tracts with higher proportion of Black residents were more likely to miss an HIV care visit. Non-Black PWH were less likely to miss a visit regardless of where they lived. These relationships were attenuated when PRO data were included. Conclusions Residential racial segregation and disadvantage may create inequities between Black PWH and non-Black PWH in retention in HIV care. Multilevel approaches are needed to retain PWH in HIV care, accounting for community, healthcare setting, and individual needs and resources. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objectives of this study are (1) to assess practice patterns among urogynecology/female pelvic medicine and reconstructive surgery (FPMRS) providers regarding the use of bladder diaries (BD) and (2) to review the literature regarding BD. Methods: For the first objective, a survey was emailed to United States-based urogynecology providers in 2019 querying frequency of use of bladder diaries (FBD), indications, problems, patient education methods, and perception of utility. Chi-square tests and multiple logistic regression were performed. For the second objective, we reviewed literature published in English by searching the terms "voiding," "bladder," or "incontinence," in combination with "diary," "log," or "questionnaire." Results: A total of 371 of 851 (43.5%) contacted providers responded. Nearly 80% were attending physicians, 75.5% of whom completed the FPMRS fellowship; 20.8% of all respondents and nearly 25% of fellowship-trained attendings reported FBD <20% in the last year. FPMRS providers were more likely to report FBD >80%. A total of 97.5% of respondents cited difficulty in using BD. Most (71.6%) taught patients to use BD themselves or shared responsibility with a nonphysician staff member (53.4%). BD is a validated and valuable instrument; however, there are obstacles to its use. Despite recent innovations including electronic and automated BD, there is a paucity of data regarding the provider-viewed challenges in implementing BD. Conclusions: The literature supports the use of BD; however, many survey respondents, including fellowship-trained attendings, never or rarely use BD. Most respondents reported difficulty in using BD. More research is needed to improve the ease, accuracy, and widespread adaptation of BD use in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To examine the associations of healthy dietary patterns with cardiometabolic biomarkers and all-cause mortality among individuals with prediabetes. Methods: This cohort study included 8363 adults with prediabetes from the National Health and Nutrition Examination Survey 1999–2014. Healthy dietary patterns including Alternate Healthy Eating Index-2010 (AHEI-2010), Alternate Mediterranean Diet score (AMED), Dietary Approaches to Stop Hypertension score (DASH), and Healthy Eating Index-2015 (HEI-2015) were calculated based on 24-h dietary recall data. Mortality status was obtained by linkage to National Death Index records. Cardiometabolic biomarkers, including blood glucose, insulin, HbA1c, C-reactive protein (CRP), and lipids, were measured at recruitment. Results: During 61,991 person-years of follow-up, 991 deaths occurred. Comparing the extreme quartiles, the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality were 0.65 (0.49, 0.85) for AHEI-2010 (P-trend = 0.002), 0.68 (0.50, 0.92) for AMED (P-trend = 0.004), 0.72 (0.53, 0.98) for DASH (P-trend = 0.03), and 0.78 (0.58, 1.05) for HEI-2015 (P-trend = 0.08). Besides, the HRs (95% CIs) for all-cause mortality per 20-percentile increment in scores were 0.78 (0.67, 0.90) for AHEI-2010 (P = 0.001), 0.73 (0.62, 0.86) for AMED (P < 0.001), 0.84 (0.69, 1.02) for DASH (P = 0.08), and 0.86 (0.74, 1.00) for HEI-2015 (P = 0.04). In addition, higher dietary scores were associated with favorable blood glucose, insulin, HOMA-IR, blood lipids, and CRP (all P-trend < 0.05). The high-density lipoprotein cholesterol and CRP explained 1.53–9.21% of the associations between dietary patterns and all-cause mortality (P < 0.05). Conclusions: Diets with higher AHEI-2010, AMED, DASH, and HEI-2015 were associated with improved cardiometabolic factors and lower all-cause mortality among individuals with prediabetes. These findings suggest that multiple healthy dietary patterns instead of a one-size-fits-all diet plan might be beneficial and acceptable for individuals with prediabetes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Unhealthy lifestyle factors are risk factors for stroke, and they play a key role in stroke secondary prevention. A better understanding of these factors may aid with improvements in public health policy. OBJECTIVE: Our objective was to comprehensively understand the trends in unhealthy lifestyle factors in people who have previously had a stroke in the US. METHODS: Utilizing data from the biannual United States National Health and Nutrition Examination Surveys (NHANESs) between 1999 and 2018, we collated data on unhealthy lifestyle factors (smoking, alcohol drinking, depression, unhealthy diet, high BMI, physical inactivity, and sedentary behavior) in adults with a history of stroke. The Joinpoint Regression model was used to calculate the annual percentage change (APC) and average annual percentage change (AAPC) to identify trends. Logistic regression modeling was used to identify the influence of sociodemographic factors (age, sex, race/ethnicity, marital status, employment status, family income, and highest education level). RESULTS: The analysis included 2017 respondents with a history of stroke. Current alcohol drinking (39.3% (95% confidence interval: 29.8, 48.7) to 57.4% (45.7, 69.0) p = 0.008) and obesity (39.2% (28.3, 50.2) to 49.4% (38.9, 59.8) p = 0.029) increased significantly from 1999 to 2018. The prevalence of smoking and depression remained generally stable. The proportion of respondents with an unhealthy diet decreased from 1999 (44.5% (32.4, 56.5)) to 2011 (29.0% (17.5, 40.4) p = 0.019), but then returned to its original prevalence in 2018 (42.0% (31.4, 52.7)). From 2007 to 2018, the proportion of respondents who were physically inactive decreased significantly, from 70.4% (64.4, 76.3) to 55.1% (46.1, 64.2; p = 0.017). After a gradual increase in sedentary activity from 2007 to 2012, this declined from 2013 to 2018, with no statistical significance. We found stroke survivors who were widowed, divorced, separated, or unemployed were at a higher risk of having unhealthy lifestyles than those who were employed or had other marital statuses. CONCLUSIONS: A modest reduction in the prevalence of physical inactivity was observed in Americans with a history of stroke between 1999 and 2018. The prevalences of smoking, drinking, depression, poor diet, obesity, and sedentary behavior were stable or increasing. [ABSTRACT FROM AUTHOR]

The country's public hospitals, guided by the principles established by the first such hospital in 1736 and codified through the policies of the Surgeon General in 1936, have played an outsized role as safety net institutions for disadvantaged populations. Public hospitals are predominantly located in urban, under-resourced neighborhoods and treat a larger percentage of low-income individuals who are uninsured or enrolled in Medicaid. In assessing the status of public hospitals and urban communities in the twenty-first century, the impact of the COVID-19 pandemic was evaluated at two high-performing public hospitals, Grady Memorial Hospital and Rush University Medical Center, and a network of safety hospitals affiliated with the Missouri Hospital Association. COVID-19 infections and death rates stratified by race and ethnicity were examined. The results suggest a trend toward lower mortality in African American patients in the first year of the pandemic and possible adverse outcomes in a subset of rural hospitals in Missouri. This study highlights the need to expand funding and support for the nation's essential hospitals. [ABSTRACT FROM AUTHOR]

Context: Managing COVID-19 outbreaks at U.S. nursing homes highlight the structural weaknesses of pre-pandemic long-term care emergency preparedness protocols. Objective: To understand how nursing home administrators managed staffing and facility operations during an active COVID-19 outbreak. Methods: This descriptive qualitative study conducted semi-structured interviews with administrators at 40 U.S. nursing homes from July 2020-December 2021. Interview questions focused on the impact of COVID-19 on nursing home operations and staffing, among other topics. Interview transcripts were qualitatively analysed to identify overarching themes using modified grounded theory and thematic analysis. Findings: Four major themes emerged from analysis. (1) Administrators described the rapidity of viral infection of staff and residents as overwhelming and long-lasting; (2) a COVID-19 outbreak had an immediate impact on staffing levels; (3) administrators implemented short-term compensatory strategies to manage staffing shortages during COVID-19 outbreaks; and (4) administrator and staff roles and responsibilities expanded in order to maintain facility operations during, and post-COVID-19 outbreak. Limitations: Findings may not be generalizable to all U.S. nursing homes and may not reflect current COVID-19 mitigation protocols and perspectives as interviews concluded in December 2021. Implications: U.S. nursing home administrators used crisis-management strategies to sustain facility operations during active COVID-19 outbreaks. This approach highlights on-going weaknesses in the long-term care infrastructure at U.S. nursing homes. Learning from administrator experiences during the COVID-19 pandemic is critical for the development of robust emergency preparedness plans and the improvement of state and federal resource coordination efforts to support U.S. nursing homes during future public health emergencies. [ABSTRACT FROM AUTHOR]

Background: The many studies revealing a connection between serum uric acid (SUA) and dementia have reported conflicting results. This study sought to investigate the relations between SUA and cognitive function in older adults. Materials and methods: The sample was 2,767 American adults aged ≥60 years from the National Health and Nutrition Examination Survey 2011–2014. Cognitive performance was evaluated by the Consortium to Establish a Registry for Alzheimer’s Disease test, animal fluency test, digit symbol substitution test, and composite z-score. Multivariate linear regression analyses were conducted to estimate the association between SUA and cognitive function. Results: SUA level and cognitive function were significantly, positively correlated. Age significantly correlated with the association between SUA and cognitive function. Conclusion: These findings support a connection between SUA and cognition, showing a positive link between SUA and cognitive scores among older American adults. We contend that a slight rise in uric acid within the normal range is advantageous for enhanced cognition. To confirm the precise dosetime- response relation, more tests will be needed. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between different body fat distribution and different sites of BMD in male and female populations. Methods: Use the National Health and Nutrition Examination Survey (NHANES) datasets to select participants. The weighted linear regression model investigated the difference in body fat and Bone Mineral Density (BMD) in different gender. Multivariate adjusted smoothing curve-fitting and multiple linear regression models were used to explore whether an association existed between body fat distribution and BMD. Last, a subgroup analysis was performed according to age and gender group. Results: Overall, 2881 participants were included in this study. Compared to males, female participants had lower BMD (P < 0.05) and higher Gynoid fat mass (P < 0.00001), while there was no difference between Android fat mass (P = 0.91). Android fat mass was positively associated with Total femur BMD (Males, β = 0.044, 95% CI = 0.037, 0.051, P < 0.00001; Females, β = 0.044, 95% CI = 0.039, 0.049, P < 0.00001), Femoral neck BMD (Males, β = 0.034, 95% CI = 0.027, 0.041, P < 0.00001; Females, β = 0.032, 95% CI = 0.027, 0.037, P < 0.00001), and Total spine BMD (Males, β = 0.036, 95% CI = 0.029, 0.044, P < 0.00001; Females, β = 0.025, 95% CI = 0.019, 0.031, P < 0.00001). The Gynoid fat mass, subgroup analysis of age and ethnicity reached similar results. Conclusion: Body fat in different regions was positively associated with BMD in different sites, and this association persisted in subgroup analyses across age and race in different gender. [ABSTRACT FROM AUTHOR]

In a nationwide sample of Black women in the U.S., we assessed preferences for HIV preexposure prophylaxis (PrEP) products, including long-acting injectable (LAI) PrEP and once-daily oral PrEP. Among 315 respondents, 32.1% were aware of PrEP and 40.6% were interested in using it; interest increased to 62.2% if PrEP were provided for free. Oral PrEP was the preferred option (51.1%), followed by LAI PrEP (25.7%), vaginal gel (16.5%), and vaginal ring (6.7%). When examining oral and LAI PrEP alone, most (62.7%) preferred oral PrEP. LAI PrEP was more likely to be preferred among respondents with concerns about healthcare costs or PrEP-related stigma, and among those who reported inconsistent condom use and multiple sexual partners. Although most Black women preferred oral PrEP, LAI PrEP may be appealing to a subset with social and structural barriers to PrEP use, such as cost and stigma, and those at increased risk of HIV infection. [ABSTRACT FROM AUTHOR]

This paper investigates whether local religious beliefs have a significant impact on the practice of earnings management. We extend the existing literature on the role of firm characteristics in mitigating earnings management by showing that local religious beliefs significantly impact the practice of earnings management. Specifically, exploring firms located in the U.S. counties that vary from 2000 through 2010, we document the negative relationship between religiosity and earnings management using multivariate regression analysis. Our results show that firms in counties with strong religious social norms are less likely to engage in earnings management. Furthermore, we attempt to mitigate endogeneity concerns by employing a modified Difference-Differences model and Propensity score matching methods. We find that the negative effects of religion on earnings management still hold. Overall, these findings emphasize the empirical relevance of the association between the local social norms and earnings manipulations. [ABSTRACT FROM AUTHOR]

Background Despite the availability of safe and efficacious coronavirus disease 2019 vaccines, a significant proportion of the American public remains unvaccinated and does not appear to be immediately interested in receiving the vaccine. Methods In this study, we analyzed data from the US Census Bureau's Household Pulse Survey, a biweekly cross-sectional survey of US households. We estimated the prevalence of vaccine hesitancy across states and nationally and assessed the predictors of vaccine hesitancy and vaccine rejection. In addition, we examined the underlying reasons for vaccine hesitancy, grouped into thematic categories. Results A total of 459 235 participants were surveyed from 6 January to 29 March 2021. While vaccine uptake increased from 7.7% to 47%, vaccine hesitancy rates remained relatively fixed: overall, 10.2% reported that they would probably not get a vaccine and 8.2% that they would definitely not get a vaccine. Income, education, and state political leaning strongly predicted vaccine hesitancy. However, while both female sex and black race were factors predicting hesitancy, among those who were hesitant, these same characteristics predicted vaccine reluctance rather than rejection. Those who expressed reluctance invoked mostly "deliberative" reasons, while those who rejected the vaccine were also likely to invoke reasons of "dissent" or "distrust." Conclusions Vaccine hesitancy comprises a sizable proportion of the population and is large enough to threaten achieving herd immunity. Distinct subgroups of hesitancy have distinctive sociodemographic associations as well as cognitive and affective predilections. Segmented public health solutions are needed to target interventions and optimize vaccine uptake. [ABSTRACT FROM AUTHOR]

The paper industry is a high-carbon emission and energy-intensive industry. From the perspective of low-carbon trade and carbon neutrality, its energy conservation and emission reduction are worthy of attention. This study used the input-output model to calculate the embodied carbon emissions of China’s paper industry’s export trade to the United States from 2006 to 2020 and used the logarithmic mean division index (LMDI) method to analyze influencing factors of the change of embodied carbon emissions. The study found that the embodied carbon emissions of China’s paper industry’s export trade to the United States generally shows a stable downward trend after reaching the peak with the increase of export trade scale; scale effect is the main factor that causes the embodied carbon emissions, while technological progress, policy support, and environmental regulations are important driving forces to promote carbon emission reduction. The research results of this paper not only can test and guide China’s paper industry trade policies and industrial policies, but they can also provide decision-making reference for China and the United States to promote the carbon emission reduction of the paper industry. [ABSTRACT FROM AUTHOR]

With the planned construction of vast offshore wind farms along the US East Coast, identifying and understanding key coastal processes, such as sea breezes, has become a critical need for the sustainability and development of US offshore wind energy. In this study, a new two-step identification method is proposed to detect and characterize three types of sea breezes (pure, corkscrew and backdoor) over the US northeastern coast from a year-long WRF (Weather Research and Forecasting) simulation. The results suggest that the proposed detection method can identify the three different types of sea breezes in the model simulation. Key sea breeze features, such as the calm zone associated with pure sea breezes and coastal jets associated with corkscrew sea breezes, are evident in the sea breeze composite imagery. In addition, the simulated sea breeze events indicate a seasonal transition from pure to corkscrew sea breeze between March and August as the land-sea thermal contrast increases. Furthermore, the location and extension of the sea breeze front are different for each type of sea breeze, suggesting that the coastal impact of sea breeze varies with sea breeze type. From the wind energy perspective, the power production associated with a 10MW offshore wind turbine would be approximately 3 to 4 times larger during a corkscrew sea breeze event than the other two types of sea breezes. This highlights the importance of identifying the correct type of sea breeze in numerical weather/wind energy forecasting. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study is to predict the possible trajectory of coronavirus disease 2019 (COVID-19) spread in the United States. Prediction and severity ratings of COVID-19 are essential for pandemic control and economic reopening in the United States. Method: In this study, we apply the logistic and Gompertz model to evaluate possible turning points of the COVID-19 pandemic in different regions. By combining uncertainty and severity factors, this study constructed an indicator to assess the severity of the coronavirus outbreak in various states. Results: Based on the index of severity ratings, different regions of the United States are classified into 4 categories. The result shows that it is possible to identify the first turning point in Montana and Hawaii. It is unclear when the rest of the states will reach the first peak. However, it can be inferred that 75% of regions will not reach the first peak of coronavirus before August 2, 2020. Conclusion: It is still essential for the majority of states to take proactive steps to fight against COVID-19 before August 2, 2020. [ABSTRACT FROM AUTHOR]

The author reflects on the surge in college-based mutual aid networks across the U.S. in response to the COVID-19 pandemic. Topics discussed include the inequalities between students on campus revealed by the pandemic, ways in which mutual aid groups approach their activities as students return to campuses after months of online education, the establishment of Carleton Mutual Aid in May 2021, a slowdown in donations being received by mutual aid groups as the pandemic continues, and tips for student mutual aid groups in conducting its activities.

Background: Although effective treatments exist, alcohol use disorder (AUD) is undertreated. We used a cascade of care framework to understand gaps in care for persons with AUD. Methods: Using 2015–2019 National Survey on Drug Use and Health data, we evaluated the following steps in the cascade of care: (1) adult prevalence of AUD; (2) proportion of adults with AUD who utilized health care in the past 12 months; (3) proportion with AUD screened about their alcohol use; (4) proportion with AUD who received a brief intervention about their alcohol misuse; (5) proportion with AUD who received information about treatment for alcohol misuse; and (6) proportion with AUD who received treatment. Analyses were stratified by AUD severity. Results: Of the 214,505 persons included in the sample, the weighted prevalence of AUD was 7.8% (95% CI 7.6–8.0%). Cascades of care showed the majority of individuals with AUD utilized health care in the past 12 months [81.4% (95% CI 80.7–82.1%)] and were screened about alcohol use [69.9% (95% CI 68.9–70.8%)]. However, only a minority of individuals received subsequent steps of care, including 11.6% (95% CI 11.0–12.2%) who reported receiving a brief intervention, 5.1% (95% CI 4.6–5.6%) who were referred to treatment, and 5.8% (95% CI 5.4–6.3%) who received treatment. Similar patterns were observed when cascades of care were stratified by AUD severity. Conclusions: Persons with AUD commonly utilize health care and are often screened about alcohol use, but few receive treatment. Healthcare settings—particularly primary care settings—represent a prime opportunity to implement AUD treatment to improve outcomes in this high‐risk population. [ABSTRACT FROM AUTHOR]

The tempo-spatial patterns of Covid-19 infections are a result of nested personal, societal, and political decisions that involve complicated epidemiological dynamics across overlapping spatial scales. High infection "hotspots" interspersed within regions where infections remained sporadic were ubiquitous early in the outbreak, but the spatial signature of the infection evolved to affect most regions equally, albeit with distinct temporal patterns. The sparseness of Covid-19 infections in the United States was analyzed at scales spanning from 10 to 2,600 km (county to continental scale). Spatial evolution of Covid-19 cases in the United States followed multifractal scaling. A rapid increase in the spatial correlation was identified early in the outbreak (March to April). Then, the increase continued at a slower rate and approached the spatial correlation of human population. Instead of adopting agent-based models that require tracking of individuals, a kernel-modulated approach is developed to characterize the dynamic spreading of disease in a multifractal distributed susceptible population. Multiphase Covid-19 epidemics were reasonably reproduced by the proposed kernel-modulated susceptible-infectious-recovered (SIR) model. The work explained the fact that while the reproduction number was reduced due to nonpharmaceutical interventions (e.g., masks, social distancing, etc.), subsequent multiple epidemic waves still occurred; this was due to an increase in susceptible population flow following a relaxation of travel restrictions and corollary stay-at-home orders. This study provides an original interpretation of Covid-19 spread together with a pragmatic approach that can be imminently used to capture the spatial intermittency at all epidemiologically relevant scales while preserving the "disordered" spatial pattern of infectious cases. [ABSTRACT FROM AUTHOR]

We examined HIV viral load non-suppression (≥ 200 copies/mL) subsequent to person-periods (3–18 months) bookended by two self-reports of alcohol use on a standardized patient reported outcome assessment among adults in routine HIV care. We examined the relative risk (RR) of non-suppression associated with increases and decreases in alcohol use (relative to stable use), stratified by use at the start of the person-period. Increases in drinking from abstinence were associated with higher risk of viral non-suppression (low-risk without binge: RR 1.16, 95% CI 1.03, 1.32; low-risk with binge: RR 1.35, 95% CI 1.11, 1.63; high-risk: RR 1.89, 95% CI 1.16, 3.08). Decreases in drinking from high-risk drinking were weakly, and not statistically significantly associated with lower risk of viral non-suppression. Other changes in alcohol use were not associated with viral load non-suppression. Most changes in alcohol consumption among people using alcohol at baseline were not strongly associated with viral non-suppression. [ABSTRACT FROM AUTHOR]

There are limited data on longitudinal outcomes for coronavirus disease 2019 (COVID-19) hospitalizations that account for transitions between clinical states over time. Using electronic health record data from a hospital network in the St. Louis, Missouri, region, we performed multistate analyses to examine longitudinal transitions and outcomes among hospitalized adults with laboratory-confirmed COVID-19 with respect to 15 mutually exclusive clinical states. Between March 15 and July 25, 2020, a total of 1,577 patients in the network were hospitalized with COVID-19 (49.9% male; median age, 63 years (interquartile range, 50–75); 58.8% Black). Overall, 34.1% (95% confidence interval (CI): 26.4, 41.8) had an intensive care unit admission and 12.3% (95% CI: 8.5, 16.1) received invasive mechanical ventilation (IMV). The risk of decompensation peaked immediately after admission; discharges peaked around days 3–5, and deaths plateaued between days 7 and 16. At 28 days, 12.6% (95% CI: 9.6, 15.6) of patients had died (4.2% (95% CI: 3.2, 5.2) had received IMV) and 80.8% (95% CI: 75.4, 86.1) had been discharged. Among those receiving IMV, 35.1% (95% CI: 28.2, 42.0) remained intubated after 14 days; after 28 days, 37.6% (95% CI: 30.4, 44.7) had died and only 37.7% (95% CI: 30.6, 44.7) had been discharged. Multistate methods offer granular characterizations of the clinical course of COVID-19 and provide essential information for guiding both clinical decision-making and public health planning. [ABSTRACT FROM AUTHOR]

Background: The causes and cures for Autism Spectrum Disorders (ASDs), apraxia, and other conditions involving motor and speech delays remain speculative. To offset symptoms, many individuals will try integrative approaches, including making dietary changes and adding vitamins, minerals, and fish oil supplements.Primary Study Objective: The purpose of this study was to glean opinions about the effectiveness of specific food blends and nutrients on speech and motor impairments within a sample population of adults and children (N = 77) who self-report having communication delays and/or motor dysfunction symptoms, and who are among a population currently taking IQed (N = 632) nutritional composition.Methods/design: A 28-point survey instrument was designed across key areas relating to symptoms of speech and motor abilities. Additional subquestions were included for descriptive summary and description statistical interpretation of the data. The Web-based survey was conducted on a sample population of adults and children (N = 77) who self-reported having communication delays and motor function symptoms, and who are among a population currently taking IQed (N = 632) nutritional composition, a whole food complete vitamin and meal replacement product.Setting: The survey was conducted via the Internet using SurveyMonkey (San Mateo, CA, USA).Participants: Consumers (or their caregiver) completed an online survey and answered questions about nutritional supplementation use and their opinion about product effectiveness on symptoms. A total of 88 individuals responded to the survey and 11 were excluded for incompletion of the survey. Included participants comprise 55 males and 22 females (N = 77) with a median age of 10.5 y and an age range from 2 to 70 y. Participants' geographic location represent as 85.7% from the United States and 9 other countries (14.3%).Primary Outcome Measures: Effectiveness was measured based on participant ratings using a numeric rating scale to report on changes in symptoms for a defined period of use of the supplement.Results: Ninety-two percent of the survey respondents reported positive behavioral or physical changes when IQed formula was added to the diet, with most (64%) reporting positive changes within the first 2 wk. Difficulty with speech and communication was the highest reported area of difficulty for this population, afflicting 83.8% of respondents. After supplementation, expressive speech improved for 85.7% of the participants with the increased vocalizations (sounds, words) factor showing the highest observed improvement (88.1%) among all speech/communication factors combined. In all other categories, more than 67% of the survey takers reported improvements in all factors: speech (77.6%), oral motor skills (63.2%), receptive ability (69.6%), focus (65.1%), motor planning (77.6%), mood (62.3%), social skills (59.3%), and physical/behavioral health (47.3%), with any adverse effects reported in less than 1%.Conclusion: Consumers reported improvements in symptoms by use of a blended vitamin and mineral product (IQed Smart Nutrition composition). The implication for this study is to further research on alternative modalities of treatments for ASD and ASD-type conditions using natural food products, vitamin and mineral supplements, and Ayurvedic and botanical ingredients. [ABSTRACT FROM AUTHOR]

Background Retention in care (RIC) leads to reduced HIV transmission and mortality. Few studies have investigated clinic services and RIC among people living with HIV (PLWH) in the United States. We conducted a multisite retrospective cohort study to identify clinic services associated with RIC from 2010–2016 in the United States. Methods PLWH with ≥1 HIV primary care visit from 2010–2016 at 7 sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) were included. Clinic-level factors evaluated via site survey included patients per provider/trainee, navigation, RIC posters/brochures, laboratory test timing, flexible scheduling, appointment reminder methods, and stigma support services. RIC was defined as ≥2 encounters per year, ≥90 days apart, observed until death, administrative censoring (31 December 2016), or loss to follow-up (censoring at first 12-month interval without a visit with no future visits). Poisson regression with robust error variance, clustered by site adjusting for calendar year, age, sex, race/ethnicity, and HIV transmission risk factor, estimated risk ratios (RRs) and 95% confidence intervals (CIs) for RIC. Results Among 21 046 PLWH contributing 103 348 person-years, 67% of person-years were retained. Availability of text appointment reminders (RR, 1.13; 95% CI, 1.03–1.24) and stigma support services (RR, 1.11; 95% CI, 1.04–1.19) were associated with better RIC. Disparities persisted for age, sex, and race. Conclusions Availability of text appointment reminders and stigma support services was associated with higher rates of RIC, indicating that these may be feasible and effective approaches for improving RIC. [ABSTRACT FROM AUTHOR]

Background Rates of early syphilis in US women are steadily increasing, but predictors of infection in this group are not clearly defined. Methods This retrospective analysis focused on women enrolled in the US CFAR Network of Integrated Clinical Systems cohort between January 2005 and December 2016 with syphilis testing performed. The primary outcome of incident syphilis infection was defined serologically as a newly positive test with positive confirmatory testing after a negative test or a 2-dilution increase in rapid plasma regain titer. Infection rates were calculated for each woman-year in care with testing. Predictors of syphilis were sought among sociodemographics, clinical information, and self-reported behaviors. Multivariable logistic regression models were created; a subgroup analysis assessed predictors in women of reproductive age. Results The annual rate of incident syphilis among 4416 women engaged in human immunodeficiency virus (HIV) care and tested during the 12-year study period was 760/100 000 person-years. Independent predictors of infection were injection drug use as a risk factor for HIV acquisition (aOR, 2.2; 95% CI, 1.3–3.9), hepatitis C infection (aOR, 1.9; 95% CI, 1.1–3.4), black race (aOR, 2.2; 95% CI, 1.3–3.7 compared with white race), and more recent entry to care (since 2005 compared with 1994–2004). Predictors were similar in women aged 18–49. Conclusions Syphilis infection is common among US women in HIV care. Syphilis screening and prevention efforts should focus on women reporting drug use and with hepatitis C coinfection. Future studies should identify specific behaviors that mediate syphilis acquisition risk in women who use drugs. [ABSTRACT FROM AUTHOR]

Background: Recently, there has been an increase in prescription drug abuse and related fatalities. Although opioid analgesics are commonly implicated, there have been significant increases in the prevalence of benzodiazepine exposures and overdoses. Objective: To describe national trends in pediatric benzodiazepine exposures from 2000 to 2015. Methods: A retrospective database analysis was conducted. Data regarding benzodiazepine exposures in children ages 0 to <18 years reported to participating United States poison centers from January 2000 through December 2015 were obtained from the National Poison Data System. Population data were obtained from the US Census Bureau to determine annual population estimates. Data were analyzed using chi-square tests. Results: A total of 296,838 pediatric benzodiazepine exposures were identified during the study period. The rate of pediatric benzodiazepine exposure increased 54% between 2000 and 2015. The severity of medical outcomes also increased, as did the prevalence of co-ingestion of multiple drugs, especially in children ages 12 to <18 years. Nearly half of all reported exposures in 2015 were documented as intentional abuse, misuse, or attempted suicide, reflecting a change from prior years. The most commonly identified pediatric benzodiazepines of exposures were alprazolam, clonazepam, and lorazepam. Conclusions: The rate and severity of reported pediatric benzodiazepine exposure is increasing over time. Adolescent exposures are of specific concern, as co-ingestion and intentional abuse were found to be more common in this group. Medical providers and caretakers should be cognizant of this growing epidemic to avoid preventable harm to adolescents, young children, and infants. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) infection is common among people living with human immunodeficiency virus (PLWH). Extrahepatic manifestations of HCV, including myocardial infarction (MI), are a topic of active research. MI is classified into types, predominantly atheroembolic type 1 MI (T1MI) and supply-demand mismatch type 2 MI (T2MI). We examined the association between HCV and MI among patients in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems, a US multicenter clinical cohort of PLWH. MIs were centrally adjudicated and categorized by type using the Third Universal Definition of Myocardial Infarction. We estimated the association between chronic HCV (RNA+) and time to MI while adjusting for demographic characteristics, cardiovascular risk factors, clinical characteristics, and history of injecting drug use. Among 23,407 PLWH aged ≥18 years, there were 336 T1MIs and 330 T2MIs during a median of 4.7 years of follow-up between 1998 and 2016. HCV was associated with a 46% greater risk of T2MI (adjusted hazard ratio (aHR) = 1.46, 95% confidence interval (CI): 1.09, 1.97) but not T1MI (aHR = 0.87, 95% CI: 0.58, 1.29). In an exploratory cause-specific analysis of T2MI, HCV was associated with a 2-fold greater risk of T2MI attributed to sepsis (aHR = 2.01, 95% CI: 1.25, 3.24). Extrahepatic manifestations of HCV in this high-risk population are an important area for continued research. [ABSTRACT FROM AUTHOR]

Banks today have been increasingly reducing their physical presence and redirecting customers to digital channels, and yet, the consequences of this strategy are not well studied. This research investigates the effects of banks' branch network changes (i.e., branch openings and branch closures) on customer omnichannel banking behavior. Using a proprietary data set from a large commercial bank in the United States, this paper shows the asymmetric effects of branch openings and branch closures on customer omnichannel banking behavior. In particular, it finds that branch openings increase customers' branch transactions. However, the first branch opening leads to a migration of complex transactions to the branches, which might result in a net decrease in online banking in the short term. As consumers interact more with the physical channel, there is a gradual synergistic increase in customers' transactions via online banking as well as alternative channels due to a learning spillover effect. This learning spillover effect goes from easy online inquiries to more complex online transactions as additional branches open. On the contrary, branch closures result in a favorable migration pattern from the branch channel to online banking. This pattern, however, could be reversed once the last branch closes within the customer's residential neighborhood. Banks today have been increasingly reducing their physical presence and redirecting customers to digital channels, and yet, the consequences of this strategy are not well studied. This paper investigates the effects of banks' branch network changes (i.e., branch openings and branch closures) on customer omnichannel banking behavior. Using approximately 0.85 million (33 months') anonymized individual-level banking transactions from a large commercial bank in the United States, this paper shows the asymmetric effects of branch openings and branch closures on customer omnichannel banking behavior. In particular, we find that branch openings increase customers' branch transactions; however, the first branch opening leads to a migration of complex transactions to the branches, which might result in a net decrease in online banking in the short term. As consumers interact more with the physical channel, there is a gradual synergistic increase in customers' transactions via online banking as well as alternative channels due to a learning spillover effect. The learning spillover effect goes from easy online inquiries to more complex online transactions as additional branches open. On the contrary, branch closures result in a favorable migration pattern from the branch channel to online banking. This pattern, however, could be reversed once the last branch closes within the customer's residential neighborhood. Our study teases out the underlying mechanisms that drive customer omnichannel banking behavior in the context of branch openings and branch closures, and discusses the managerial implications for branch network restructuring and banking channel management. [ABSTRACT FROM AUTHOR]

Background: Whether weight gain after smoking cessation attenuates the health benefits of quitting is unclear.Methods: In three cohort studies involving men and women in the United States, we identified those who had reported quitting smoking and we prospectively assessed changes in smoking status and body weight. We estimated risks of type 2 diabetes, death from cardiovascular disease, and death from any cause among those who had reported quitting smoking, according to weight changes after smoking cessation.Results: The risk of type 2 diabetes was higher among recent quitters (2 to 6 years since smoking cessation) than among current smokers (hazard ratio, 1.22; 95% confidence interval [CI], 1.12 to 1.32). The risk peaked 5 to 7 years after quitting and then gradually decreased. The temporary increase in the risk of type 2 diabetes was directly proportional to weight gain, and the risk was not increased among quitters without weight gain (P<0.001 for interaction). In contrast, quitters did not have a temporary increase in mortality, regardless of weight change after quitting. As compared with current smokers, the hazard ratios for death from cardiovascular disease were 0.69 (95% CI, 0.54 to 0.88) among recent quitters without weight gain, 0.47 (95% CI, 0.35 to 0.63) among those with weight gain of 0.1 to 5.0 kg, 0.25 (95% CI, 0.15 to 0.42) among those with weight gain of 5.1 to 10.0 kg, 0.33 (95% CI, 0.18 to 0.60) among those with weight gain of more than 10.0 kg, and 0.50 (95% CI, 0.46 to 0.55) among longer-term quitters (>6 years since smoking cessation). Similar associations were observed for death from any cause.Conclusions: Smoking cessation that was accompanied by substantial weight gain was associated with an increased short-term risk of type 2 diabetes but did not mitigate the benefits of quitting smoking on reducing cardiovascular and all-cause mortality. (Funded by the National Institutes of Health.). [ABSTRACT FROM AUTHOR]

Background: It is known that perchlorate, nitrate and thiocyanate have the property of inhibiting sodium iodide symporter. Animal studies have suggested that these compounds, especially perchlorate, might also interfere with insulin secretion. However, the association between their exposure and diabetes risk is largely unknown in humans.Methods: Among 11 443 participants (mean age 42.3 years) from the National Health and Nutritional Examination Survey 2001-14, urinary perchlorate, nitrate and thiocyanate were measured by using ion chromatography coupled with electrospray tandem mass spectrometry. Diabetes was defined as self-reported doctor diagnosis, use of oral hypoglycaemic medication or insulin, fasting plasma glucose ≥ 126 mg/dl or glycated haemoglobin A1c (HbA1c) ≥ 6.5%.Results: The median (interquartile range) levels of urinary perchlorate, nitrate and thiocyanate were 3.32 (1.84, 5.70) μg/l, 46.4 (27.9, 72.0) mg/l and 1.23 (0.59, 2.78) mg/l, respectively. Higher levels of urinary perchlorate were associated with elevated levels of fasting glucose, HbA1c, insulin and homeostatic model assessment of insulin resistance (all Ptrend < 0.001). After multivariate adjustment including urinary creatinine, smoking status and body mass index (BMI), higher urinary perchlorate, but not nitrate or thiocyanate, was associated with an increased prevalence of diabetes mellitus. Comparing extreme quintiles, the odds ratio (95% confidence interval) of diabetes was 1.53 (1.21, 1.93; Ptrend < 0.001) for perchlorate, 1.01 (0.77, 1.32; Ptrend = 0.44) for nitrate and 0.98 (0.73, 1.31; Ptrend = 0.64) for thiocyanate. When urinary perchlorate, nitrate and thiocyanate were further mutually adjusted, the results did not materially change. Similar results were observed when analyses were stratified by smoking status, as well as by age, gender, kidney function and BMI.Conclusions: Higher urinary perchlorate levels are associated with an increased prevalence of diabetes mellitus, independent of traditional risk factors. Future prospective studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: This study examined different cooking methods for red meats in relation to type 2 diabetes (T2D) risk among U.S. women who consumed red meats regularly (≥2 servings/week).Research Design and Methods: We monitored 59,033 women (1986-2012) aged 30-55 years and free of diabetes, cardiovascular disease, and cancer at baseline when information on frequency of different cooking methods for red meats, including broiling, barbequing, roasting, pan-frying, and stewing/boiling, was collected.Results: During 1.24 million person-years of follow-up, we documented 6,206 incident cases of T2D. After multivariate adjustment including red meat cooking methods, total red meat and processed red meat intake were both associated with a monotonically increased T2D risk (both P trend <0.05). After multivariate adjustment including total red meat intake, a higher frequency of broiling, barbequing, and roasting red meats was each independently associated with a higher T2D risk. When comparing ≥2 times/week with <1 time/month, the hazard ratios (HRs) and 95% CI of T2D were 1.29 (1.19, 1.40; P trend <0.001) for broiling, 1.23 (1.11, 1.38; P trend <0.001) for barbequing, and 1.11 (1.01, 1.23; P trend = 0.14) for roasting. In contrast, the frequency of stewing/boiling red meats was not associated with T2D risk, and an inverse association was observed for pan-frying frequency and T2D risk. The results remained similar after cooking methods were further mutually adjusted.Conclusions: Independent of total red meat consumption, high-temperature and/or open-flame cooking methods for red meats, especially broiling and barbequing, may further increase diabetes risk among regular meat eaters. [ABSTRACT FROM AUTHOR]

Background: Falls are the leading cause of hip fracture in older women, with important public health implications. Fall risk increases with age and other clinical factors, and varies by race/ethnicity. International studies suggest that fall risk is lower in Asians, although data are limited in U.S.Populations: This study examines racial/ethnic differences in fall prevalence among older U.S. women within a large integrated healthcare delivery system.Methods: This cross-sectional study used data from 6277 women ages 65-90 who responded to the 2008 or 2011 Kaiser Permanente Northern California Member Health Survey (KPNC-MHS). The KPNC-MHS is a mailed questionnaire sent to a random sample of adult members stratified by age, gender, and geographic location, representing a population estimate of >200,000 women age ≥65 years. Age, race/ethnicity, self-reported health status, presence of diabetes, arthritis or prior stroke, mobility limitations and number of falls in the past year were obtained from the KPNC-MHS. The independent association of race/ethnicity and recent falls was examined, adjusting for known risk factors.Results: The weighted sample was 76.7% non-Hispanic white, 6.2% Hispanic, 6.8% black and 10.3% Asian. Over 20% reported having fallen during the past year (28.5% non-Hispanic white, 27.8% Hispanic, 23.4% black and 20.1% Asian). Older age was associated with greater fall risk, as was having diabetes (OR 1.24, CI 1.03-1.48), prior stroke (OR 1.51, CI 1.09-2.07), arthritis (OR 1.61, CI 1.39-1.85) and mobility limitations (OR 2.82, CI 2.34-3.39), adjusted for age. Compared to whites, Asian (OR 0.64, CI 0.50-0.81) and black (OR 0.73, CI 0.55-0.95) women were much less likely to have ≥1 fall in the past year, adjusting for age, comorbidities, mobility limitation and poor health status. Asians were also less likely to have ≥2 falls (OR 0.62, CI 0.43-0.88).Conclusions: Among older women, the risk of having a recent fall was substantially lower for black and Asian women when compared to white women. This may contribute to their lower rates of hip fracture. Future studies should examine cultural and behavioral factors that contribute to these observed racial/ethnic differences in fall risk among U.S. women. [ABSTRACT FROM AUTHOR]

Findings Jiom cusp catastrophe modeling of binge drinking among college students in the United States (U.S.) and high school students in other countries (i.e., Japan) have advanced our understanding of alcohol abuse. No reported stitdy has used the same method to investigate binge drinking among U.S. high school students, a high-risk populationfbr alcohol abuse. In this study, we analyzed data for 12'h graders (n - 1122) from the 2015 Monitoring the Future (MFT) Study with cusp catastrophe models. Guided by Kahneman's dual-system theory that integrates the theories of reasoned action and planned behavior. perceived alcohol harm (0-3, larger indicating less harm) was modeled as asymmetry variable (knowledge and beliefs). and drinking in social settings (contextual ftictors, 0 = no and 4 = always) as bifurcation variable to predict binge drinking in the past two weeks (0,1,2,3 or more times). Analytical results indicated that a cusp model, depending on the method for parameter estimation could explain 36-88% of the variance in binge drinking while a linear model only explained up 1014%. Results from the indirect cusp modeling methods indicated that perceived alcohol harm and drinking in social settings both significantly predicted binge drinking. However, the estimated cusp point varied depending on the method fcr parameter estimation. In conclusion, the dynamics of binge drinking among U.S. high school students are nonlinear and discrete. Knowledgebased interventions to prevent binge drinking need to emphasize social and contextual factors that may trigger sudden behavior change to achieve greater intervention effect. To advance cusp catastrophe modeling, further research is needed to improve the method for parameter estimation. [ABSTRACT FROM AUTHOR]

Mailed outreach promoting colorectal cancer (CRC) screening with a stool blood test kit may increase participation, but magnitude and consistency of benefit of this intervention strategy is uncertain. Our aim was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing mailed outreach offering stool tests to usual care, clinic-based screening offers on CRC screening uptake in the USA. We performed a systematic literature search of five databases for RCTs of mailed outreach from January 1980 through June 2017. Primary outcome was screening completion, summarized using random-effects meta-analysis as pooled differences in proportion completing the screening and relative risk of achieving screening compared to control. Subgroup analyses by test type offered-fecal immunochemical test (FIT) or guaiac fecal occult blood test (gFOBT), the presence of telephone reminders, and the presence of predominant underserved/minority population within study were performed. Quality of evidence was evaluated using the GRADE framework. Seven RCTs which enrolled 12,501 subjects were included (n = 5703 assigned mailed outreach and n = 6798 usual care). Mailed outreach resulted in a 28% absolute (95% CI 25-30%; I2 = 47%) and a 2.8-fold relative (RR 2.65, 95% CI 2.03-3.45; I2 = 92%) increase in screening completion compared to usual care, with a number needed to invite estimated to be 3.6. Similar outcomes were observed across subgroups. Overall body of evidence was at moderate quality. Mailed outreach offering a gFOBT or FIT is associated with a large and consistent increase in CRC screening completion and should be considered for more widespread implementation for improving screening rates nationwide. [ABSTRACT FROM AUTHOR]

Natural gas hydrates have been hailed as a new and promising unconventional alternative energy, especially as fossil fuels approach depletion, energy consumption soars, and fossil fuel prices rise, owing to their extensive distribution, abundance, and high fuel efficiency. Gas hydrate reservoirs are similar to a storage cupboard in the global carbon cycle, containing most of the world's methane and accounting for a third of Earth's mobile organic carbon. We investigated gas hydrate stability zone burial depths from the viewpoint of conditions associated with stable existence of gas hydrates, such as temperature, pressure, and heat flow, based on related data collected by the global drilling programs. Hydrate‐related areas are estimated using various biological, geochemical and geophysical tools. Based on a series of previous investigations, we cover the history and status of gas hydrate exploration in the USA, Japan, South Korea, India, Germany, the polar areas, and China. Then, we review the current techniques for hydrate exploration in a global scale. Additionally, we briefly review existing techniques for recovering methane from gas hydrates, including thermal stimulation, depressurization, chemical injection, and CH4–CO2 exchange, as well as corresponding global field trials in Russia, Japan, United States, Canada and China. In particular, unlike diagenetic gas hydrates in coarse sandy sediments in Japan and gravel sediments in the United States and Canada, most gas hydrates in the northern South China Sea are non‐diagenetic and exist in fine‐grained sediments with a vein‐like morphology. Therefore, especially in terms of the offshore production test in gas hydrate reservoirs in the Shenhu area in the north slope of the South China Sea, Chinese scientists have proposed two unprecedented techniques that have been verified during the field trials: solid fluidization and formation fluid extraction. Herein, we introduce the two production techniques, as well as the so‐called "four‐in‐one" environmental monitoring system employed during the Shenhu production test. Methane is not currently commercially produced from gas hydrates anywhere in the world; therefore, the objective of field trials is to prove whether existing techniques could be applied as feasible and economic production methods for gas hydrates in deep‐water sediments and permafrost zones. Before achieving commercial methane recovery from gas hydrates, it should be necessary to measure the geologic properties of gas hydrate reservoirs to optimize and improve existing production techniques. Herein, we propose horizontal wells, multilateral wells, and cluster wells improved by the vertical and individual wells applied during existing field trials. It is noteworthy that relatively pure gas hydrates occur in seafloor mounds, within near‐surface sediments, and in gas migration conduits. Their extensive distribution, high saturation, and easy access mean that these types of gas hydrate may attract considerable attention from academia and industry in the future. Herein, we also review the occurrence and development of concentrated shallow hydrate accumulations and briefly introduce exploration and production techniques. In the closing section, we discuss future research needs, key issues, and major challenges related to gas hydrate exploration and production. We believe this review article provides insight on past, present, and future gas hydrate exploration and production to provide guidelines and stimulate new work into the field of gas hydrates. [ABSTRACT FROM AUTHOR]

This study used Hofstede's cultural dimensions theory to examine Generation Z investors' socially responsible investment perceptions, utilizing data collected from Taiwan and the United States. Generation Z is the most global and socially empowered generation in history, and whether social responsibility appeals to Generation Z warrants investigation. Of 412 questionnaires collected in the United States, 380 were usable, and of 475 collected in Taiwan, 439 were usable. This study exained four variables, namely nationality, gender, work experience, and share ownership; these variables affected how the participants in this study understood and accepted the concept of socially responsible investment. These results provide interesting insight into Generation Z's pro-social attitudes, Perceived consumer effectiveness and trust. This paper suggests implications for cross-cultural study theory and practice, as well as future research directions. [ABSTRACT FROM AUTHOR]

In DC systems, DC resistive type superconducting fault current limiters (R-SFCLs) can respond within a few hundred milliseconds and limit the fault current to a very low level to protect the power equipment in DC systems. The main part of R-SFCLs are superconducting tapes. When short-circuit faults occur in the system, the superconducting tapes will quench and become a large quenched resistor to limit the fault current. The surrounding magnetic fields and the magnetic fields caused by the superconducting tapes itself influence the quench characteristics of the superconducting tapes of R-SFCLs. Thus, the current limiting characteristics of R-SFCLs will also be affected. Until present, very few studies have investigated the effects of magnetic fields on quench characteristics of superconducting tapes for DC R-SFCL. The objective of this paper is to obtain the effects of magnetic fields on quench characteristics of superconducting tapes for DC R-SFCL. Two different kinds of YBa2Cu3O7-δ (YBCO) tapes are studied under a permanent magnetic field of 0, 42.4, 75.9, 122.9 mT, respectively. One is from Shanghai Superconductor Technology Co., Ltd., Shanghai, China, type ST-12-L (named SC_SH) and the other is from American Superconductor Inc. Boston, MA, USA, type 8602 (named SC_8602). The research results show that the magnetic fields influence both the amplitude and the rising rate of the quenched resistance of an SC_SH tape. Under the same magnetic field, both the speed of quenching and the quenching resistance of SC_SH tape are larger than them of SC_8602 when the prospective current exceeds 800 A. Thus SC_SH tape can limit the fault current faster and to a lower level. [ABSTRACT FROM AUTHOR]

Missed HIV medical visits predict poor clinical outcomes. We sought to identify patients at high risk of missing visits. We analyzed 2002-2014 data from six large US HIV clinics. At each visit, we predicted the likelihood of missing the next scheduled visit using demographic, clinical, and patient-reported psychosocial variables. Overall, 10,374 participants contributed 105,628 HIV visits. For 17% of visits, the next scheduled appointment was missed. The strongest predictor of a future missed visit was past-year missed visits. A model with only this predictor had area under the receiver operator curve = 0.65; defining "high risk" as those with any past-year missed visits had 73% sensitivity and 51% specificity in correctly identifying a future missed visit. Inclusion of other clinical and psychosocial predictors only slightly improved performance. Past visit attendance can identify those at increased risk for future missed visits, allowing for proactive allocation of resources to those at greatest risk. [ABSTRACT FROM AUTHOR]