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Civil infrastructure underpins urban receipts of food, energy, and water (FEW) produced in distant watersheds. In this study, we map flows of FEW goods from watersheds of the contiguous United States to major population centers and highlight the critical infrastructure that supports FEW flows. To do this, we draw upon detailed records of agriculture, electricity, and public water supply production and couple them with commodity flow and infrastructure information. We also compare the flows of virtual water embedded in food and energy commodity flows with physical water flows in inter‐basin water transfer projects around the country. We found that the virtual blue water transfers through crops and electricity to major US cities was 53 billion and 8 billion m3 in 2017, respectively, while physical interbasin water transfers for crops, electricity, and public supply water averaged 20.8 billion m3. Highways are the primary infrastructure used to import virtual water associated with food and fuel into cities, although waterways and railways are most utilized for long‐distance transport. All of the 204 watersheds in the contiguous US support the food, energy, and/or water supplies of major US cities, with dependencies stretching far beyond each city's borders. Still, most cities source the majority of their FEW and embedded water resources from nearby watersheds. Infrastructure such as water supply dams and inland ports serve as important buffers for both local and supply‐chain sourced water stress. These findings can inform efforts to reduce water resources and infrastructure risks in domestic supply chains. Key Points: Civil infrastructure enables US cities to access FEW resources from distant watershedsMost cities depend on nearby watersheds for FEW and embedded waterVirtual water transfers through food and energy exceed physical water transfers [ABSTRACT FROM AUTHOR]

Summary: Objective: This study sought to systematically compare the efficacy and mechanism of cyclodextrins as drug interventions in lipid metabolism diseases, potentially providing ideas for subsequent research directions and clinical applications. Methods: We used the bibliometric method for feature mining, applied VOSviewer software for clustering analysis, and applied content analysis for objective descriptions and accurate analysis. Results: (1) We collected more than 50 studies, which is the basic database of this study. (2) The academic bubble map showed that this research area was popular in the United States. (3) Cluster analysis showed that the intensively studied diseases in this field were Niemann–Pick type C (NPC), atherosclerosis (AS), and obesity. The hot‐spot cyclodextrin types were HP‐β‐CD. (4) Literature measurement revealed the involvement of 15 types of lipid metabolism diseases. Among them, NPC, diabetes, and obesity were studied in clinical trials. Dyslipidemia and AS have been reported relatively more frequently in animal experiments. The studies of cellular experiments provide insight into the molecular mechanisms that intervene in lipid metabolism diseases from multiple perspectives. The exploration of the molecular mechanisms by which cyclodextrins exert their pharmacological effects mainly revolves around lipid metabolism. Conclusion: It is worthwhile to investigate the role and mechanism of cyclodextrins in other lipid metabolism diseases. The potential efficacy evaluation of cyclodextrins as pharmaceutical drugs for oral or injectable formulations is less studied and may become a new focus in the future. [ABSTRACT FROM AUTHOR]

Barriers to accessing offline healthcare may discourage patients from undergoing mammography screening. Online patient–provider communication (OPPC) offers a supplementary health resource that can complement traditional medical encounters and facilitate mammography screening. This study examines how offline healthcare barriers influence mammography screening, taking into account OPPC as an independent variable and cancer fatalism and patient activation as two mediators. Data from the 2017, 2018, and 2020 iterations of the Health Information National Trends Survey were used for this study. Results showed that OPPC was positively linked to mammography screening. Offline healthcare barriers had a negative association with patient activation and subsequent mammography behaviors. Moreover, offline healthcare barriers and OPPC were associated with mammography screening through serial mediation of cancer fatalism and patient activation. This study has important implications for encouraging mammography screening. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia (BPD) is a prevalent lung disease in neonates that is associated with numerous complications and high mortality. The promising approach to treat BPD is the use of mesenchymal stem cells (MSCs), However, the current treatment of MSCs presents safety concerns, including occlusion of blood vessels and tumorigenicity. In this study, relevant publications from the Web of Science Core Collection were downloaded in January 2023. The acquired data were analyzed and predicted for trends and hotspots in this field using CiteSpace software. Results revealed that in recent years, the focus of co-cited references has been primarily on the clinical studies of MSCs and the application of MSCs derivatives for treating BPD models. The keywords that have gained attention are extracellular vesicles and exosomes. The United States has emerged as the most influential co-authoring country in this field. Among the co-cited journals, the American Journal of Respiratory and Critical Care Medicine holds the highest influence. Thus, this study provides trends in publications, collaboration, research interests, and hotspots, and provides clues for novel ideas and strategies in to further MSCs treatments for BPD. [ABSTRACT FROM AUTHOR]

Background Tetanus, a life-threatening infection, has become rare in the United States since introduction of tetanus toxoid-containing vaccines (TTCVs), recommended as a childhood series followed by decennial boosters beginning at age 11–12 years; vaccination uptake is high in children but suboptimal in adults. The objective of this study was to estimate the prevalence of sero-immunity to tetanus among persons aged ≥6 years in the United States and to identify factors associated with tetanus sero-immunity. Understanding population protection against tetanus informs current and future vaccine recommendations. Methods Anti-tetanus toxoid antibody concentrations were measured for participants of the 2015–2016 National Health and Nutrition Examination Survey (NHANES) aged ≥6 years for whom surplus serum samples were available using a microsphere-based multiplex antibody capture assay. Prevalence of sero-immunity, defined as ≥0.10 IU/mL, was estimated overall and by demographic characteristics. Factors associated with tetanus sero-immunity were examined using multivariable regression. Results Overall, 93.8% of the US population aged ≥6 years had sero-protection against tetanus. Prevalence of sero-immunity was above 90% across racial/ethnic categories, sex, and poverty levels. By age, ≥ 90% had protective sero-immunity through age 69 years, but prevalence of sero-immunity declined thereafter, with 75.8% of those aged ≥80 years having protective sero-immunity. Older age (adjusted prevalence ratio [aPR]: 0.89, 95% confidence interval [CI]:.85–.92) and being born outside the United States (aPR: 0.96, 95% CI:.93–.98) were significantly associated with lower prevalence of sero-immunity. Conclusions The majority of the US population has vaccine-induced sero-immunity to tetanus, demonstrating the success of the vaccination program. [ABSTRACT FROM AUTHOR]

Background: The prevalence of caregiving in the United States has increased from 16.6% to 19.2% during the period between 2015 and 2020. Caregivers play a critical public health role post-pandemic and as the population ages. However, caregiving can be detrimental to the health of caregivers. Many studies have shown that communication and connectedness are effective forms of health intervention for caregivers, but how this can be achieved requires further investigation. Objective: This study aimed to investigate the indirect effect of caregiving on problems of alcohol drinking through psychological distress. Moreover, this study aimed to provide initial evidence of the distinct effects of online and offline communication and connectedness on caregivers' well-being. Methods: The predictions were evaluated by examining responses to the Health Information National Trends Survey 2020 (n = 3,865). A mediation analysis was conducted to test the mediating effect of psychological distress on the association between caregiving and alcohol drinking. A second-level moderation analysis was performed. The online communication and connectedness, social media use for health, and the offline type, marital or romantic partnership, were tested as moderators to lessen the psychological distress of caregiving. Results: A competitive mediation was identified. We found a positive indirect effect from caregiving to alcohol drinking mediated by psychological distress (bp =.0017, p <.05) but a negative direct effect from caregiving to alcohol drinking (bp = -.0340, p <.05). Furthermore, the study reported a strongly positive effect of moderated moderation on the linkage from caregiving to psychological distress. The negative impact of caregiving on mental distress was greater among those who used social media less, particularly those without a romantic or marital partner. Conclusions: The findings indicate that caregivers experience more mental distress, which leads to risky behavior. This study highlights the crucial role of both online and offline connectedness in mitigating the adverse consequences of caregiving. [ABSTRACT FROM AUTHOR]

Urinary incontinence afflicts up to 40% of adult women in the United States. Stress urinary incontinence (SUI) accounts for approximately one-third of these cases, precipitating ~200,000 surgical procedures annually. Continence is maintained through the interplay of sub-urethral support and urethral sphincter coaptation, particularly during activities that increase intra-abdominal pressure. Currently, surgical correction of SUI focuses on the re-establishment of sub-urethral support. However, mesh-based repairs are associated with foreign body reactions and poor localized tissue healing, which leads to mesh exposure, prompting the pursuit of technologies that restore external urethral sphincter function and limit surgical risk. The present work utilizes a human platelet-derived CD41a and CD9 expressing extracellular vesicle product (PEP) enriched for NF-κB and PD-L1 and derived to ensure the preservation of lipid bilayer for enhanced stability and compatibility with hydrogel-based sustained delivery approaches. In vitro, the application of PEP to skeletal muscle satellite cells in vitro drove proliferation and differentiation in an NF-κB-dependent fashion, with full inhibition of impact on exposure to resveratrol. PEP biopotentiation of collagen-1 and fibrin glue hydrogel achieved sustained exosome release at 37 °C, creating an ultrastructural "bead on a string" pattern on scanning electron microscopy. Initial testing in a rodent model of latissimus dorsi injury documented activation of skeletal muscle proliferation of healing. In a porcine model of stress urinary incontinence, delivery of PEP-biopotentiated collagen-1 induced functional restoration of the external urethral sphincter. The histological evaluation found that sustained PEP release was associated with new skeletal muscle formation and polarization of local macrophages towards the regenerative M2 phenotype. The results provided herein serve as the first description of PEP-based biopotentiation of hydrogels implemented to restore skeletal muscle function and may serve as a promising approach for the nonsurgical management of SUI. [ABSTRACT FROM AUTHOR]

Upon request from tribal nations, and as part of the Centers for Disease Control and Prevention's (CDC's) emergency response, CDC staff provided both remote and on-site assistance to tribes to plan, prepare, and respond to the COVID-19 pandemic. From April 2, 2020, through June 11, 2021, CDC deployed a total of 275 staff to assist 29 tribal nations. CDC staff typically collaborated in multiple work areas including epidemiology and surveillance (86%), contact tracing (76%), infection prevention control (72%), community mitigation (72%), health communication (66%), incident command structure (55%), emergency preparedness (38%), and worker safety (31%). We describe the activities of CDC staff in collaboration with 4 tribal nations, Northern Cheyenne, Hoopa Valley, Shoshone-Bannock, and Oglala Sioux Tribe, to combat COVID-19 and lessons learned from the engagement. [ABSTRACT FROM AUTHOR]

In this study, a full-scale test on the bending performance of concrete sandwich laminated floor slabs with integrated thermal and sound insulation was carried out, and the effects of different reinforcement ratios on the bending performance of concrete sandwich laminated floor slabs were investigated as well as the variation law of the failure modes, characteristic loads, load-mid span deflection, load-rebar strain curves, and anti-slip performance. The results indicate that the concrete sandwich laminated floor slabs present typical bending failure characteristics. According to bending failure characteristics, the damage process can be divided into three stages, i.e., elasticity, cracking, and failure. The bearing capacity significantly increases with the increase in reinforcement ratio. The normal service, yield, and ultimate loads of bearing capacity of the floor slabs with a larger reinforcement ratio increase by 54.55%, 52.94%, and 46.46%, respectively. Moreover, the mid-span deflection decreases significantly with the increase in reinforcement ratio, and the cracking expansion is also delayed. Before cracking, the prefabricated layer and laminated layer can realize load bearing together, and the floor slab is in a state of complete interaction. When the floor slabs reach the ultimate state, the superimposed surface produces a sliding effect, and the floor slab is in a state of partial interaction. The finite element analysis software ABAQUS (with the version number of ABAQUS 2020, the chief creator of David Hibbitt, and the sourced location of the United States) was used to perform nonlinear numerical simulation. The test results accord well with the simulation results, which verifies the correctness of the finite element model. Based on finite element simulation, the influence of post-cast concrete strength on the ultimate load can be ignored. [ABSTRACT FROM AUTHOR]

As part of a national survey on social workers' attitudes toward immigrants and immigration (N=4,499), we collected information on respondents' perceptions of immigrants as threats and respondents' views on structural inequality as it pertains to immigrants' opportunities for success. Contrary to the Council on Social Work Education's Educational Policy and Accreditation Standards stating the need for social workers to understand the existence and functioning of structural forces of inequality, nearly a third of our respondents denied that immigrants are disadvantaged compared to U.S.-born citizens, and more than a third denied that disadvantage is related to race, ethnicity, or national origin. Those who denied disadvantage were more likely than those who did not to see immigrants as threats. We provide interpretations for these findings and offer some recommendations for social work research and education geared toward deepening practitioners' knowledge of the structural barriers faced by immigrants. [ABSTRACT FROM AUTHOR]

In today's highly competitive world market, businesses can hardly maintain their competitiveness without strong innovation abilities. In the past, many Chinese enterprises have enjoyed success through imitation. But to continue to succeed in a global marketplace, they must develop ambidextrous innovation abilities. The resource‐based theory eloquently posits that competitive advantage is associated with different and heterogeneous resources. To obtain such resources, firms must establish an external network to acquire necessary knowledge and skills. In this paper, we develop a theoretical model linking network orientation, organisational improvisation, ambidexterity and competitive tension. We postulate that organisational improvisation has a mediating effect and competitive tension is a moderator. Empirical results (N = 340) show that (1) network orientation leads to both exploratory and exploitative innovations, (2) the above effect is mediated by organisational improvisation and (3) competitive tension positively moderates the effect between network orientation and organisational improvisation. [ABSTRACT FROM AUTHOR]

In the past decade, clinical and laboratory studies have led to important new insights into the biology of leukemia and its treatment. This review describes the progress of leukemia research in the United States in recent years. Whereas the traditional method of treatment is chemotherapy, it is nonselective and could induce systemic toxicities. Thus, in parallel with research on new chemotherapies, great emphasis has been placed on developing immunotherapies. Here, we will review the current immunotherapies available in research and development that overcome current challenges, specifically looking in the field of chimeric antigen receptor T‐cell (CAR‐T) therapies, checkpoint inhibitors, and antibody‐drug conjugates. With about 100 clinical trials for CAR‐T therapies and 30 in checkpoint inhibitors for leukemia treatment, scientists are trying to make these technologies cheaper, faster, and more feasible. Further describing the delivery of these therapeutics, we look at the current progress, clinical, and preclinical status of nano‐based medicines such as liposomes, polymeric micelles, and metal nanoparticles. Taking advantage of their physicochemical and biologic properties, nanoparticles have been shown to increase the efficacy of commonly administered chemotherapies with reduced adverse effects. [ABSTRACT FROM AUTHOR]

Evidence of the benefits of culinary nutrition education is growing in the literature. Culinary nutrition education programs are naturally experiential, social, skills-based, and effective in improving nutrition-related beliefs, knowledge, and behaviors. In this article, we explore a set of motivational experiences in culinary nutrition education that have been identified as "drivers" of behavior change. These drivers emerged from 20 years of implementation and evaluation of hands-on cooking programs across the life span in more than 30 states within the United States. From these drivers, we developed a framework to guide both new and existing programs that can be best designed to motivate behavior change. These frameworks add value to the work of culinary nutrition educators and will inform and support future culinary nutrition education programs. In future research, health educators implementing skills-based health promotion programs in diverse settings can test the application of this framework to determine its relevance in broader areas. [ABSTRACT FROM AUTHOR]

Toxoplasma gondii is a global protozoan parasite capable of infecting most warm-blooded animals. Although healthy adult humans generally have no symptoms, severe illness does occur in certain groups, including congenitally infected fetuses and newborns, immunocompromised individuals including transplant patients. Epidemiological studies have demonstrated that consumption of raw or undercooked meat products is one of the major sources of infection with T. gondii. The goal of this study was to develop a framework to qualitatively estimate the exposure risk to T. gondii from various meat products consumed in the United States. Risk estimates of various meats were analyzed by a farm-to-retail qualitative assessment that included evaluation of farm, abattoir, storage and transportation, meat processing, packaging, and retail modules. It was found that exposure risks associated with meats from free-range chickens, nonconfinement-raised pigs, goats, and lamb are higher than those from confinement-raised pigs, cattle, and caged chickens. For fresh meat products, risk at the retail level was similar to that at the farm level unless meats had been frozen or moisture enhanced. Our results showed that meat processing, such as salting, freezing, commercial hot air drying, long fermentation times, hot smoking, and cooking, are able to reduce T. gondii levels in meat products, whereas nitrite and/or nitrate, spice, low pH, and cold storage have no effect on the viability of T. gondii tissue cysts. Raw-fermented sausage, cured raw meat, meat that is not hot-air dried, and fresh processed meat were associated with higher exposure risks compared with cooked meat and frozen meat. This study provides a reference for meat management control programs to determine critical control points and serves as the foundation for future quantitative risk assessments. [ABSTRACT FROM AUTHOR]

Refugees are at risk for psychiatric morbidity, yet little is known about their mental health conditions. We identified factors associated with depression symptoms among Bhutanese refugees in the US. We randomly selected adult Bhutanese refugees (N = 386) to complete a cross-sectional survey concerning demographics, mental health symptoms, and associated risk factors. The case definition for depression symptoms was ≥1.75 mean depression score on the Hopkins Symptom Checklist-25. More women (26 %) than men (16 %) reported depression symptoms ( p = 0.0097). Higher odds of depression symptoms were associated with being a family provider, self-reported poor health, and inability to read and write Nepali (OR 4.6, 39.7 and 4.3, respectively) among men; and self-reported poor health and inability to read and write Nepali (OR 7.6, and 2.6 respectively) among women. US-settled Bhutanese refugees are at risk for depression. Providers should be aware of these concerns. Culturally appropriate mental health services should be made more accessible at a local level. [ABSTRACT FROM AUTHOR]

In this study, the development of a convective boundary layer (CBL) in the Badanjilin region was investigated by comparing the observation data of two cases. A deep neutral layer capped a CBL that occurred on 30 August 2009. This case was divided into five sublayers from the surface to higher atmospheric elevations: surface layer, mixed layer, inversion layer, neutral layer, and sub-inversion layer. The development process of the CBL was divided into three stages: S1, S2, and S3. This case was quite different from the development of the three-layer CBL observed on 31 August 2009 because the mixed layer of the five-layer CBL (CBL5) eroded the neutral layer during S2. The specific initial structure of the CBL5 was correlated to the synoptic background of atmosphere during nighttime. The three-stage development process of the CBL5 was confirmed by six simulations using National Center for Atmospheric Research (USA) large-eddy simulation (NCAR-LES), and some of its characteristics are presented in detail. [ABSTRACT FROM AUTHOR]

The article explores the connection between isolation from job opportunities and the persistence of gender and racial inequalities in U.S. society. The authors utilize survey data to suggest that a significant white male advantage over white women and Hispanics in number of job leads. The role of social networks and social capital in sustaining this advantage is discussed. Inequality in the receipt of job information is tied to high levels of supervisory authority. Other topics include minorities in the labor market, civil rights, and equal opportunity.

Relatively recently, neural network is introduced into the tourist forecasting field [1, 2, 3]. The forecasting in this field is important for the corporation in the industry to improve its financial earnings. Results show that the hybrid forecasting system is more robust and able to select variables automatically and makes more accurate prediction than the stand-alone neural network. Applying Vector Autoregression (VAR) and genetic algorithm (GA) in hybrid systems with neural network can improve the NN's prediction capability. Case studies have been carried out to demonstrate how to build our VAR-NN-GA system and its advantages. Another case study is the Asian Pacific stock markets, which is more complicated. There exist strong time-dependent correlations between the US market and the Asian markets. While it is difficult to model the markets' interactions with a static model, VAR and GA are adopted for the dynamic model-selection process. The results for the stock market case study show that the hybrid system is about 30% better than the best individual NN for this case study. We can see that, as the domain of prediction become more complicated, the advantage of our system is clearer. [ABSTRACT FROM AUTHOR]

Slope length and slope steepness are the two topographic factors (L and S) used in the Universal Soil Loss Equation (USLE) for soil erosion prediction. These factors are usually extracted from the digital elevation models (DEM). We hypothesized that different DEM resolutions and sources influence extracted topographic factors and therefore soil loss estimation. The objective of this study was to quantify the effect of different DEM resolutions on the topographic factor calculation and consequently soil loss prediction on different geomorphological types in China and United States. We selected three typical landforms of plains, hills and mountains in both countries. We used 1) open source DEMs of 3-, 10-, 30-, and 90-m in the United States, and 2) DEMs generated with 1:10,000 and 1:50,000 topographic maps in China to extract topographic factors using a LS software tool. The Chinese Soil Loss Equation (CSLE) was used to calculate average annual soil loss. The results showed that different DEM resolutions had different effects on the extracted L and S factors. Slope length and the L factor were overestimated as DEM resolutions coarsened, and the trend of the overestimation in different landforms was the same. Slope steepness and the S factor were underestimated as DEM resolution decreased in all landforms. However, the LS factor as a product of L and S factors, which reflects relative soil loss if the other factors are held constant, are less sensitive to DEM resolutions than either L or S factor alone due to partial error cancelation. Thus, the LS factor is not as greatly affected by DEM resolutions as either L or S factor alone. The relative soil loss errors are similar for all DEMs, and "good results for wrong reasons" are obtained with coarser DEMs. Overall results indicate that except for the 90 m DEM for certain occasion, all DEMs may be used to estimate soil loss for all types of terrains for practical application, as far as the relative soil loss errors are concerned. However, in the range of 3–90 m resolutions, for the sake of good practice and solid scientific support, higher resolution DEMs if available ought to be used to minimize estimation errors of L and S factors and consequently to increase confidence of soil loss prediction. • A topographic LS software and the Chinse Soil Loss Equation were evaluated. • Slope length and its L factor were overestimated as DEM resolutions coarsened. • Slope steepness and its S factor were underestimated as DEM resolutions decreased. • The LS factor is not as greatly affected by DEM resolutions as either L or S alone. • All DEMs may be used to estimate soil loss for practical and economical concerns [ABSTRACT FROM AUTHOR]

To date, China has the world's largest wind power generation capacity, followed by the United States. Yet, China's utilization of this installed capacity trails that of the United States by a huge gap. This paper seeks to explain this gap by focusing on the role of institutions. First, it analyzes the institutions that either facilitate or impede wind integration in the two countries. Next, it synthesizes these institutions into coherent institutional logics for China and the United States. Then, it corroborates the institutional analysis with empirical evidence from China and the United States. Finally, it compares the two countries and summarizes what China can learn from the United States to reduce wind curtailment. Overall, this paper finds that China's dominant institutional logic of wind integration is state centrism and it is complemented by partial decentralization and liberalization – a system that is more conducive to capacity addition than capacity utilization. By contrast, the United States' dominant institutional logic of wind integration is market competition but a competing logic also exists which is regulatory interventionism – a system that aligns capacity addition and utilization better but engenders greater policy uncertainty. Because the two countries have distinct institutional logics that generate different root causes for wind curtailment, this paper argues that simply transplanting solutions from the United States to China will not work. What China can learn from the United States is to make incremental improvements to address the frictions between its dominant and complementary institutional logics. • China's dominant institutional logic of wind integration is state centrism. • The U.S.'s dominant institutional logic of wind integration is market competition. • Different institutional logics underpin different solutions to wind curtailment. • China shall make incremental improvements along its dominant institutional logic. [ABSTRACT FROM AUTHOR]

Anemia is common in patients with rheumatoid arthritis (RA), and it is unknown whether the dietary inflammatory index (DII) is linked to anemia. This study aimed to clarify the prevalence of anemia in RA patients and its association with the DII. The data utilized in this study were collected from the National Health and Nutrition Examination Survey database from 1999 to 2018. The prevalence of anemia in RA patients was estimated by ethnicity, sex, and age. Weighted multivariate logistic regression was utilized to explore the correlation between anemia risk and DII. The most crucial dietary factors related to the risk of anemia in RA patients were screened by stepwise regression. A nomogram model was established according to key dietary factors. A total of 10.25% (confidence interval, 8.58-11.92%) of RA patients will develop anemia, with the lowest prevalence around the age of 60. In addition, higher DII levels were discovered in anemic patients than in nonanemic patients. In multivariate regression models, an important positive association was revealed between anemia and growing quartiles of DII (Q4 vs Q1: odds ratio = 1.98; confidence interval, 1.25-3.15). In the subgroup analysis, the adjusted relation of DII with anemia in females, Mexicans, smokers, nondrinkers, and age groups ≥ 60 years was statistically significant. The same association was observed in the sensitivity analysis. A nomogram model based on stepwise regression screening of key dietary factors showed good discriminatory power to identify anemic risk in RA patients (area under the curve: 0.707). In patients with RA, high DII levels were associated with the risk of anemia. More attention should be given to controlling dietary inflammation to better prevent and treat anemia., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Takotsubo syndrome has been reported in patients with COVID-19, although minimal data are available. This investigation assessed the incidence and impact of takotsubo syndrome on patients hospitalized with COVID-19., Methods: A retrospective cohort study was conducted using International Statistical Classification of Diseases, Tenth Revision, codes to identify patients with a primary diagnosis of COVID-19 with or without takotsubo syndrome in the National Inpatient Sample 2020 database. Outcomes between groups were compared after propensity score matching for patient and hospital demographics and comorbidities., Results: A total of 211,448 patients with a primary diagnosis of COVID-19 were identified. Of these, 171 (0.08%) had a secondary diagnosis of takotsubo syndrome. Before matching, patients with COVID-19 and takotsubo syndrome, compared with patients without takotsubo syndrome, were older (68.95 vs 64.26 years; P < .001); more likely to be female (64.3% vs 47.2%; P < .001); and more likely to have anxiety (24.6% vs 12.8%; P < .001), depression (17.5% vs 11.4%; P = .02), and chronic obstructive pulmonary disease (24.6% vs 14.7%; P < .001). The takotsubo syndrome group had worse outcomes than the non-takotsubo syndrome group for death (30.4% vs 11.1%), cardiac arrest (7.6% vs 2.1%), cardiogenic shock (12.9% vs 0.4%), length of hospital stay (10.7 vs 7.5 days), and total charges ($152,685 vs $78,468) (all P < .001). After matching and compared with the non-takotsubo syndrome group (n = 508), the takotsubo syndrome group (n = 170) had a higher incidence of inpatient mortality (30% vs 14%; P < .001), cardiac arrest (7.6% vs 2.8%; P = .009), and cardiogenic shock (12.4% vs 0.4%; P < .001); a longer hospital stay (10.7 vs 7.6 days; P < .001); and higher total charges ($152,943 vs $79,523; P < .001)., Conclusion: Takotsubo syndrome is a rare but severe in-hospital complication in patients with COVID-19., (© 2024 The Authors. Published by The Texas Heart Institute®.)

Background: People with chronic hepatitis B (CHB) commonly experience social and self-stigma. This study sought to understand the impacts of CHB-related stigma and a functional cure on stigma., Methods: Adults with CHB with a wide range of age and education were recruited from 5 countries and participated in 90-minute qualitative, semi-structured interviews to explore concepts related to CHB-associated stigma and its impact. Participants answered open-ended concept-elicitation questions regarding their experience of social and self-stigma, and the potential impact of reduced CHB-related stigma., Results: Sixty-three participants aged 25 to 71 years (15 from the United States and 12 each from China, Germany, Italy, and Japan) reported emotional, lifestyle, and social impacts of living with CHB, including prejudice, marginalization, and negative relationship and work experiences. Self-stigma led to low self-esteem, concealment of CHB status, and social withdrawal. Most participants stated a functional cure for hepatitis B would reduce self-stigma., Conclusions: CHB-related social and self-stigma are widely prevalent and affect many aspects of life. A functional cure for hepatitis B may reduce social and self-stigma and substantially improve the health-related quality of life of people with CHB. Incorporating stigma into guidelines along with infectivity considerations may broaden the patient groups who should receive treatment., (© 2024. The Author(s).)

Background: Online information on mpox (monkeypox) is not well studied. We have analysed the video content, information quality, and audience engagement of mpox-related videos on TikTok., Methods: Using a hashtag-based searching strategy, we identified 2462 mpox-related videos on TikTok from 1 January to 11 August 2022; 85 were included after exclusion criteria screening. Videos were evaluated for content on features and treatment of mpox. Video and information quality was assessed using the DISCERN instrument and the Journal of the American Medical Association (JAMA) criteria. We recorded video source, evaluation scores, and viewer engagement metrics. The Kruskal-Wallis test was used for statistical analysis and multiple linear regression for factor-association studies., Results: Of the 85 videos, two assessed all content topics and highlighted 33% of all content items in clinical guidelines. The overall average score for the videos was 39.56 of 80 on the DISCERN instrument and 1.93 of 4 on the JAMA criteria. No video met all JAMA criteria. Subgroup analysis based on author identity suggested the variance in video scores by source (p<0.05 for all). Overall scores were higher for videos produced by doctors and science communicators than for those made by institutional users, nurses, and the general public. Multiple linear regression analysis showed that having people in the video (69.20, p=0.0001) and including information on treatment choices (1.15, p=0.045) were significant, independent determinants of audience engagement., Conclusion: Public-directed TikTok videos on mpox frequently provide incomplete, inaccurate information, highlighting the potential risks of using TikTok as a health information source., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Identifying the onset age of cancer is essential for its early intervention. The aim of this study was to characterize the features and investigate the variation tendency of first primary colorectal cancer (CRC) onset age in the USA., Methods: For this retrospective population-based cohort analysis, data on patients diagnosed with first primary CRC (n = 330,977) between 1992 and 2017 were obtained from the Surveillance, Epidemiology, and End Results dataset. Annual percent changes (APC) and average APCs were calculated to examine the changes in average age at CRC diagnosis using the Joinpoint Regression Program., Results: From 1992 to 2017, the average age at CRC diagnosis decreased from 67.0 to 61.2 years, declining by 0.22% and 0.45% annually before and after 2000. The age at diagnosis was lower in the distal than in the proximal CRC cases and the age has the downward trends in all subgroups of sex, race, and stage. Over one-fifth of CRC patients were initially diagnosed with distantly metastatic CRC, with the age lower than that in localized CRC cases (63.5 vs 64.8 years)., Conclusions: The first primary CRC onset age has decreased significantly in the USA over the last 25 years and the modern lifestyle may be responsible for the decline. Specifically, the age of proximal CRC is invariably higher than that of distal CRC. Moreover, the age of advanced stage is lower than that of the early stage. Clinicians should adopt earlier screening age and more effective screening techniques for CRC., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

China has shut down and abandoned a substantial number of coal mines since 1999, which have been releasing methane (CH 4 ) for many years. However, the characteristics of China's abandoned mine methane (AMM) emissions are still unclear; this is a concerning knowledge gap because coal mines are the largest contributor to China's anthropogenic CH 4 emissions. This study used two methods to estimate China's historical AMM emissions over the past 40 years (1980-2020) and to project its AMM emissions to 2060 which is the target year for China's carbon neutrality goal. The results show that China's AMM emissions increased substantially from 0.11 ± 0.03 million tons per year (Mt/yr) (3.1 ± 0.84 Mt/yr CO 2 -eq) in 1980 to 4.7 ± 0.94 Mt/yr (131 ± 26 Mt/yr CO 2 -eq) in 2020. An accelerated growth rate was found during 1998-2005, with AMM emissions rapidly increasing by approximately three times, which was consistent with the high number of mine shutdowns. In 2019, we found that AMM emissions had become the fourth largest anthropogenic source in China, higher than the national anthropogenic CH 4 emissions of individual United Nations Framework Convention on Climate Change Annex I countries excluding the United States of America and the Russian Federation. If unabated, China's AMM emissions are projected to peak at 8.7 ± 2.6 Mt/yr in 2040 and reach approximately one-third of China's anthropogenic carbon dioxide emissions in 2060. This study reveals that understanding AMM emissions can help more accurately quantify China's total CH 4 emissions and guide their future mitigation., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Azithromycin (Zithromax) is an azalide antibiotic that binds to the 50S ribosomal subunit of the susceptible organism and thereby interferes with its protein synthesis. An open-label, randomized, single-dose, 3-way crossover bioequivalence study was conducted to compare the rate and extent of absorption of the azithromycin 250-mg tablet manufactured at Pfizer Dalian (China) and that at Pfizer Barceloneta (United States) under fasted and fed conditions in healthy Chinese subjects. This study aimed to support a generic consistency evaluation program, initiated by the National Medical Products Administration, for evaluating the quality and efficacy of the products manufactured in China. In the study, the within-subject standard deviation for area under the serum concentration-time profile from time 0 to 72 hours after dosing in the fasted condition was <0.294, and the 90%CI for the ratio was within 80% to 125%; the within-subject SDs for serum peak concentration in the fasted condition, area under the serum concentration-time profile from time 0 to 72 hours after dosing in the fed condition, and serum peak concentration in the fed condition, were all >0.294, with the upper confidence bounds being <0.00, and the point estimates of the ratios being within 80% to 125%. The results support the bioequivalence between azithromycin tablets manufactured in China and the United States in fasted and fed conditions, with both tablets showing an acceptable safety/tolerability profile in the studied population., (© 2022 Pfizer (China) Research and Development Co. Ltd. Clinical Pharmacology in Drug Development published by Wiley Periodicals LLC on behalf of American College of Clinical Pharmacology.)

Atherosclerosis is a pathological vascular state caused by the interaction of environmental and hereditary factors. Epigenetic modifications may be the bridge connecting environmental factors and genetic factors. A search for publications on the Web of Science database in the field of atherosclerosis related to epigenetics was conducted from the earliest mention to 31 December 2020. Data on total and annual publications, citations, impact factors, Hirsch (H)-index, citation times, most prolific authors, and frequently published journals were collected for quantitative and qualitative comparison. A total of 1848 publications related to epigenetics and atherosclerosis were found. The major contributing countries were the China (522, 28.23%), United States (485, 26.23%), and Germany (119, 6.44%). The greatest number of retrieved publications were published in the journal, "Arteriosclerosis, Thrombosis, and Vascular Biology" (62, 3.66%). The publication "Oxidative Stress and Diabetic Complications" was cited 2370 times. The most frequent keywords were "DNA methylation" and "LncRNA". Publications on epigenetic research in the atherosclerosis field have increased significantly every year, indicating that the study of epigenetic modifications plays an increasingly important role in understanding the pathology of atherosclerosis.

Objectives: An environment-wide association study (EWAS) may be useful to comprehensively test and validate associations between environmental factors and cardiovascular disease (CVD) in an unbiased manner., Approach and Results: Data from National Health and Nutrition Examination Survey (1999-2014) were randomly 50:50 spilt into training set and testing set. CVD was ascertained by a self-reported diagnosis of myocardial infarction, coronary heart disease or stroke. We performed multiple linear regression analyses associating 203 environmental factors and 132 clinical phenotypes with CVD in training set (false discovery rate < 5%) and significant factors were validated in the testing set (P < 0.05). Random forest (RF) model was used for multicollinearity elimination and variable importance ranking. Discriminative power of factors for CVD was calculated by area under the receiver operating characteristic (AUROC). Overall, 43,568 participants with 4084 (9.4%) CVD were included. After adjusting for age, sex, race, body mass index, blood pressure and socio-economic level, we identified 5 environmental variables and 19 clinical phenotypes associated with CVD in training and testing dataset. Top five factors in RF importance ranking were: waist, glucose, uric acid, and red cell distribution width and glycated hemoglobin. AUROC of the RF model was 0.816 (top 5 factors) and 0.819 (full model). Sensitivity analyses reveal no specific moderators of the associations., Conclusion: Our systematic evaluation provides new knowledge on the complex array of environmental correlates of CVD. These identified correlates may serve as a complementary approach to CVD risk assessment. Our findings need to be probed in further observational and interventional studies., (Copyright © 2018. Published by Elsevier Ltd.)

Background and Aims: An environment-wide association study (EWAS) may be useful to comprehensively test and validate associations between environmental factors and peripheral arterial disease (PAD) in an unbiased manner., Methods: Data from cross-sectional cohorts from the US National Health and Nutrition Examination Survey (1999-2004) were randomly 50:50 split into training set and testing set. A value of ankle-brachial index (ABI) <1.0 or >1.4 defined PAD. We performed multiple linear regression analyses associating each of the 417 environmental and self-reported factors with PAD in the training set (false discovery rate <5%). Significant findings were validated in the testing set (p < 0.05) and entered into a logistic regression model with penalized likelihood based on the Akaike Information Criterion (AIC)., Results: Overall, 6819 participants >40 years old were included. The validated factors comprised positive associations with smoking-associated factors (cigarette smoker, family smoker and smoked >100 cigarettes, urinary cotinine), cadmium, urinary albumin, C-reactive protein, blood o-xylene and thyroxine 4, and inverse associations with α-carotene and trans-/cis-β-carotene for PAD. Finally, only 4 of these factors were nominally significant in the AIC-selected model: cadmium (OR 1.27, 95% CI 1.12-1.45), cis-β-carotene (OR 0.81, 95% CI 0.72-0.91), CRP (OR 1.19, 95% CI 1.03-1.38) and urinary albumin (OR 1.20, 95% CI 1.04-1.38)., Conclusions: Our systematic evaluation provides new knowledge on the complex array of environmental correlates of PAD. These identified correlates need to be probed in further observational and interventional studies., (Copyright © 2018 Elsevier B.V. All rights reserved.)