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Approximately one in four Australian children aged 5-17 years are overweight or obese. Most of the health effects of overweight and obesity in childhood do not eventuate until into adulthood; therefore, motivation for children to have a healthy diet may be low. This scoping review examined the literature for associations between diet quality in 5-18 year olds and 'school-valued' outcomes including student attendance, academic performance, behaviour at school and mental health. A literature search for studies that assessed dietary intake and at least one 'school-valued' outcome in schoolchildren, in highly developed countries was conducted. After applying selection criteria, 35 studies were included examining academic performance (46%), behaviour (11%), mental health (31%) and 11% examining two of these outcomes each. No relevant studies addressed attendance. In general, dietary factors including consumption of fruit and vegetables, discretionary foods and/or beverages, or overall diet quality, were suggested to be correlates of the 'school-valued' outcomes. However, the evidence is not comprehensive. This review elucidates the extent and nature of available literature, and provides a basis for future research where the potential benefits of diet on 'school-valued' outcomes can be thoroughly explored. [ABSTRACT FROM AUTHOR]

This article is an empirical analysis of the relationship between patent ownership and variety innovation for US agricultural biotechnology firms in the years 1976–1999. Counts of new varieties include corn, soybean, or wheat varieties protected by either patents or plant variety protection certificates, while patent portfolio size is defined as the count of a firm's gene and method patents. Negative binomial regression results indicate that firms with larger patent portfolios did not exhibit scale economies in variety creation nor did firms with wider technological diversity in their patent portfolios create significantly greater numbers of new varieties. However, firms experienced positive spillover effects from rival firms’ patent ownership, and patent ownership increases this effect. Sample firms that have merged in the past do not produce significantly greater numbers of new varieties after considering an increase in portfolio size and did not experience greater economies of scale in creating new varieties compared with firms that experienced no past mergers. [ABSTRACT FROM AUTHOR]

This paper examines international patent application decisions of nine agricultural biotechnology firms from 1990–2000 in Australia, Brazil, Canada, China, the European Patent Office, Japan and South Africa. The data reveal a low frequency of international applications despite an initial United States' application, indicating very low values for patents abroad. The results indicate that invention quality plays an important role in firms' decisions to patent abroad and that a single international application is a good predictor of multiple international applications. Further, significant country fixed effects suggest wide differences in business climates and patent enforcement among countries. [ABSTRACT FROM AUTHOR]

Discusses the financial concerns and business strategies during inflation/recession of business owners and managers in the U.S. General business areas which are perceived to be affected by the inflation/recession of the economy; Impact of the recession on sales; Strategies being practiced to cope with economic uncertainty.

Objective: To estimate racial and ethnic disparities in type 2 diabetes mellitus after gestational diabetes mellitus (GDM) and to investigate baseline pregnancy clinical and social or structural characteristics as mediators., Methods: We conducted a retrospective cohort of individuals with GDM using linked 2009-2011 New York City birth and hospital data and 2009-2017 New York City A1c Registry data. We ascertained GDM and pregnancy characteristics from birth and hospital records. We classified type 2 diabetes as two hemoglobin A 1c test results of 6.5% or higher. We grouped pregnancy characteristics into clinical (body mass index [BMI], chronic hypertension, gestational hypertension, preeclampsia, preterm delivery, caesarean, breastfeeding, macrosomia, shoulder dystocia) and social or structural (education, Medicaid insurance, prenatal care, and WIC [Special Supplemental Nutrition Program for Women, Infants, and Children] participation). We used Cox proportional hazards models to estimate associations between race and ethnicity and 8-year type 2 diabetes incidence, and we tested mediation of pregnancy characteristics, additionally adjusting for age and nativity (U.S.-born vs foreign-born)., Results: The analytic data set included 22,338 patients with GDM. The 8-year type 2 diabetes incidence was 11.7% overall and 18.5% in Black, 16.8% in South and Southeast Asian, 14.6% in Hispanic, 5.5% in East and Central Asian, and 5.4% in White individuals with adjusted hazard ratios of 4.0 (95% CI 2.4-3.9), 2.9 (95% CI 2.4-3.3), 3.3 (95% CI 2.7-4.2), and 1.0 (95% CI 0.9-1.4) for each group compared with White individuals. Clinical and social or structural pregnancy characteristics explained 9.3% and 23.8% of Black, 31.2% and 24.7% of Hispanic, and 7.6% and 16.3% of South and Southeast Asian compared with White disparities. Associations between education, Medicaid insurance, WIC participation, and BMI and type 2 diabetes incidence were more pronounced among White than Black, Hispanic, and South and Southeast Asian individuals., Conclusion: Population-based racial and ethnic inequities are substantial in type 2 diabetes after GDM. Characteristics at the time of delivery partially explain disparities, creating an opportunity to intervene on life-course cardiometabolic inequities, whereas weak associations of common social or structural measures and BMI in Black, Hispanic and South and Southeast Asian individuals demonstrate the need for greater understanding of how structural racism influences postpartum cardiometabolic risk in these groups., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: Current National Comprehensive Cancer Network guidelines for gastroenteropancreatic neuroendocrine tumors (GEPNETs) recommend complete (R0) surgical resection of the primary tumor and metastases, if feasible. However, large multicenter studies of recurrence patterns of GEPNETs after resection have not been performed., Methods: Patients 18 years or older who presented to 7 participating National Comprehensive Cancer Network institutions between 2004 and 2008 with a new diagnosis of a small bowel, pancreas, or colon/rectum neuroendocrine tumor (NET) and underwent R0 resection of the primary tumor, and synchronous metastases, if present, were included in this analysis. Descriptive statistics and Kaplan-Meier estimates were used to calculate recurrence rates and time-associated end points, respectively., Results: Of 294 patients with GEPNETs, 50% were male, 88% were White, and 99% had Eastern Cooperative Oncology Group performance status 0 to 1. The median age was 55 years (range, 20-90). The median follow-up time from R0 resection was 62.1 months. Recurrence rates were 18% in small bowel NETs (n = 110), 26% in pancreatic NETs (n = 141), and 10% in colon/rectum NETs (n = 50). The frequency of surveillance imaging was highly variable., Conclusions: R0 resection was associated with variable risk of recurrence across subtypes. Further research to inform refinement of guidelines for the appropriate duration of surveillance after R0 resection is needed., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Prior studies have identified diabetes and disease severity (defined using hemoglobin A1c [HbA1c]) as potential risk factors for complications after shoulder arthroplasty. Evaluations of diabetes status and risk of adverse outcomes beyond the 30-day window either are limited or have not accounted for disease severity. Further, measures of diabetes severity other than HbA1c have yet to be investigated in a shoulder arthroplasty population., Questions/purposes: (1) Are diabetes status and glycemic control associated with adverse events, including deep infection, all-cause revision, and 90-day readmission after shoulder arthroplasty? (2) Is postoperative HbA1c associated with revision risk? (3) Is there a threshold of preoperative HbA1c that best identifies patients with diabetes who are at higher risk of 3-year deep infection, 1-year all-cause revision, or 90-day readmission? (4) Can the Adapted Diabetes Complications Severity index (aDCSI) be used as an alternative measure of diabetes severity in evaluating the risk of deep infection, all-cause revision, and 90-day readmission and identification of patients with diabetes at higher risk for these events? (5) Is there a difference between elective and traumatic shoulder arthroplasty patients?, Methods: We conducted a retrospective registry-based cohort study using Kaiser Permanente's Shoulder Arthroplasty Registry (2005-2015). Primary shoulder arthroplasties were classified as patients with and without diabetes. Patients with diabetes were further evaluated using two disease severity measures (1) HbA1c, with good glycemic control classified as preoperative HbA1c < 7.0% and poor control defined as HbA1c ≥ 7.0%; and (2) aDCSI, classified as mild (score of 0-2) or severe (score ≥ 3) diabetes. Cox regression was used to evaluate the risk of deep infection and revision according to diabetes status and disease severity; conditional logistic regression was used for 90-day readmission. Time-dependent 1-year postoperative HbA1c was used to evaluate revision risk in Cox regression. All models were adjusted for covariates and stratified by elective versus trauma shoulder arthroplasty. Receiver operating characteristic curves were generated for HbA1c and aDCSI to determine whether a threshold exists to identify patients at higher risk of deep infection, all-cause revision, or 90-day readmission. The study sample consisted of 8819 patients; 7353 underwent elective shoulder arthroplasty and 1466 underwent shoulder arthroplasty due to trauma. For elective shoulder arthroplasty, 1430 patients (19%) had diabetes, and among the patients who underwent arthroplasty due to trauma, 444 (30%) had diabetes., Results: Patients with diabetes who underwent elective shoulder arthroplasty and had poor glycemic control had a higher likelihood of 90-day readmission compared with patients without diabetes (OR, 1.5; 95% CI, 1.0-2.1; p = 0.032). No association was found for patients with diabetes who underwent shoulder arthroplasty due to trauma. No association was found between postoperative HbA1c and revision risk. Receiver operating characteristic curve analysis suggested preoperative HbA1c performed poorly at differentiating adverse events. When using aDCSI, patients with severe diabetes who underwent both elective and traumatic shoulder arthroplasty had a higher likelihood of 90-day readmission compared with patients without diabetes (OR, 1.6; 95% CI, 1.2-2.2; p = 0.001 and OR, 1.8; 95% CI, 1.2-2.7; p = 0.005, respectively). Similar to HbA1c, the aDCSI was a poor classifier in differentiating adverse events., Conclusions: Of the longer-term outcomes evaluated, more-severe diabetes was only found to be associated with an increase in 90-day readmissions after shoulder arthroplasty; a stronger association was found when using the aDCSI in identifying diabetes severity. Arbitrary cutoffs in HbA1c may not be the best method for determining risk of postoperative outcomes. Future work investigating perioperative diabetes management should work to identify and validate measures, such as the aDCSI, that better identify patients at higher risk for postoperative outcomes and, more importantly, whether outcomes can be improved by modifying these measures with targeted interventions., Level of Evidence: Level III, therapeutic study.

Since 2018 and currently in 2019, the United States and Canada experienced a rapidly spreading measles virus outbreak. The developing outbreak may be due to a lack of vaccination, an inadequate dosage of measles (MMR) vaccine, clusters of intentionally under-vaccinated children, imported measles from global travel, and from those who are immunocompromised or have other life-threatening diseases. The infection originated mainly from travelers who acquired measles abroad and has thus led to a major outbreak and health concern not only in the United States and Canada but also in other parts of the world. According to World Health Organization, from January 2019 through September 2019, 1234 cases of measles have been reported in the United States and 91 reported cases in Canada, while in 2018, 372 and 28 cases were reported in the United States and Canada, respectively. A potential driving factor to the increased cases maybe because fewer children have been vaccinated over the last number of years in both countries. This article is a narrative review of cases discussing the measles outbreak among partially vaccinated and unvaccinated children and adults in the United States and Canada in 2018 and 2019.

Introduction: Most countries have laws against driving while impaired by drugs. However, in many countries, including Canada and the United States, police must have individualized suspicion that the driver has recently used an impairing substance before they can gather the evidence required for laying a criminal charge. This report studies police documentation of drug involvement among drivers who had a motor-vehicle crash after using an impairing substance., Methods: We obtained blood samples and police reports on injured drivers treated in participating British Columbia trauma centres following a crash. Blood was analyzed for alcohol, cannabinoids, other recreational drugs, and impairing medications. Corresponding police reports were examined to determine whether police recorded that the driver's ability was impaired by alcohol, drug or medication, or that one of these substances was a possible contributory factor in the crash., Results: We obtained blood samples and corresponding police reports on 1816 injured drivers. Mean driver age was 44 years, 63.2% were male, and 25.8% were admitted to hospital. Alcohol was detected in 272 drivers (15.0%), THC (tetrahydrocannabinol - the principal psychoactive ingredient in cannabis) in 136 (7.5%), other recreational drugs in 166 (9.1%), and potentially impairing medications in 363 (20.0%). Police reported that the driver's ability was impaired by alcohol or that alcohol was a possible contributory factor in 64.1% of the crashes involving alcohol-positive drivers. Drug impairment or drugs as a possible contributory factor was reported in 5.9% of the crashes involving THC-positive drivers, and in 16.9% of the crashes involving drivers who tested positive for other recreational drugs. Medication impairment was reported in only 2.2% of the crashes involving medication-positive drivers., Conclusion: Police seldom document drug involvement in drivers who were in a crash after using cannabis, other recreational drugs or potentially impairing medications. This finding raises serious concerns about the ability of the police to effectively enforce current drug-impaired driving laws and public health officials' continued reliance on police crash reports to monitor the prevalence of drug-impaired driving., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: The Biologics Price Competition and Innovation Act, introduced as part of the Affordable Care Act, directed the FDA to create an approval pathway for biologic products shown to be biosimilar or interchangeable with an FDA-approved innovator drug. These biosimilars will not be chemically identical to the reference agent. Investigational studies conducted with biosimilar agents will likely provide limited real-world evidence of their effectiveness and safety. How do we best monitor effectiveness and safety of biosimilar products once approved by the FDA and used more extensively by patients?, Objective: To determine the feasibility of developing a distributed research network that will use health insurance plan and health delivery system data to detect biosimilar safety and effectiveness signals early and be able to answer important managed care pharmacy questions from both the government and managed care organizations., Methods: Twenty-one members of the AMCP Task Force on Biosimilar Collective Intelligence Systems met November 12, 2013, to discuss issues involved in designing this consortium and to explore next steps., Results: The task force concluded that a managed care biosimilars research consortium would be of significant value. Task force members agreed that it is best to use a distributed research network structurally similar to existing DARTNet, HMO Research Network, and Mini-Sentinel consortia. However, for some surveillance projects that it undertakes, the task force recognizes it may need supplemental data from managed care and other sources (i.e., a "hybrid" structure model)., Conclusions: The task force believes that AMCP is well positioned to lead the biosimilar-monitoring effort and that the next step to developing a biosimilar-innovator collective intelligence system is to convene an advisory council to address organizational governance.

Objectives: To evaluate the clinical impact of a troponin assay switch in suspected acute coronary syndromes (ACS)., Methods: Retrospective analysis of ACS cases in the 3 months before and after changing to a contemporary, higher sensitivity troponin assay. Admitting diagnosis, proportion with a positive result, initial treatment and testing, coronary artery intervention, inhospital events, and final discharge diagnosis were compared by assay group., Results: Seven hundred seventy patients were included: 319 (41.4%) preassay and 451 (58.6%) postassay. Preassay change, non-ST segment elevation myocardial infarction at admission (43.0% vs. 70.5%; diff [95% confidence interval (CI)] = -27.5 [-34.2, -20.6]) was diagnosed less often, and a positive troponin was less common (33.2% vs. 72.3%; diff [95% CI] = -39.1 [-45.4, -32.2]). However, anticoagulation (53.3% vs. 42.4%; diff [95% CI] = 10.9 [3.8, 18.0]) and cardiac catheterization use were more frequent (53.9% vs. 41.9%; diff [95% CI] = 12.0 [19.0, 48.5]). There was no difference in coronary intervention (41.9% vs. 40.7%; diff [95% CI] = 1.2 [-9.0, 11.2]) by assay period. Inhospital event were rare (unstable ventricular arrhythmia = 1.2%, cardiac arrest = 3.4%, death = 4.4%) with no difference between groups. A non-ACS diagnosis at discharge was more common in the postassay group (31.6% vs. 46.5%; diff [95% CI] = 14.9 [7.9, 21.6])., Conclusions: Although non-ST segment elevation myocardial infarction diagnosis at admission and a positive troponin were more frequent postassay change, rates of anticoagulation and cardiac catheterization were lower and a non-ACS diagnosis at discharge was more common. These data suggest an evolving understanding and clinical impact of contemporary troponin assays when used in real-world settings.

Background: Major depressive disorder (MDD) is commonly chronic and/or recurrent. We aimed to determine whether a chronic and/or recurrent course of MDD is associated with acute and longer-term MDD treatment outcomes., Method: This cohort study recruited out-patients aged 18-75 years with non-psychotic MDD from 18 primary and 23 psychiatric care clinics across the USA. Participants were grouped as: chronic (index episode >2 years) and recurrent (n = 398); chronic non-recurrent (n=257); non-chronic recurrent (n=1614); and non-chronic non-recurrent (n = 387). Acute treatment was up to 14 weeks of citalopram (≤ 60 mg/day) with up to 12 months of follow-up treatment. The primary outcomes for this report were remission [16-item Quick Inventory of Depressive Symptomatology - Self-Rated (QIDS-SR(16)) ≤ 5] or response (≥ 50% reduction from baseline in QIDS-SR(16)) and time to first relapse [first QIDS-SR16 by Interactive Voice Response (IVR) ≥ 11]., Results: Most participants (85%) had a chronic and/or recurrent course; 15% had both. Chronic index episode was associated with greater sociodemographic disadvantage. Recurrent course was associated with earlier age of onset and greater family histories of depression and substance abuse. Remission rates were lowest and slowest for those with chronic index episodes. For participants in remission entering follow-up, relapse was most likely for the chronic and recurrent group, and least likely for the non-chronic, non-recurrent group. For participants not in remission when entering follow-up, prior course was unrelated to relapse., Conclusions: Recurrent MDD is the norm for out-patients, of whom 15% also have a chronic index episode. Chronic and recurrent course of MDD may be useful in predicting acute and long-term MDD treatment outcomes.

In this review we give an overview of current knowledge of (68)Ga-labeled pharmaceuticals, with focus on imaging receptor-mediated processes. A major advantage of a (68)Ge/(68)Ga generator is its continuous source of (68)Ga, independently from an on-site cyclotron. The increase in knowledge of purification and concentration of the eluate and the complex ligand chemistry has led to (68)Ga-labeled pharmaceuticals with major clinical impact. (68)Ga-labeled pharmaceuticals have the potential to cover all today's clinical options with (99m)Tc, with the concordant higher resolution of positron emission tomography (PET) in comparison with single photon emission computed tomography. (68)Ga-labeled analogs of octreotide, such as DOTATOC, DOTANOC, and DOTA-TATE, are in clinical application in nuclear medicine, and these analogs are now the most frequently applied of all (68)Ga-labeled pharmaceuticals. All the above-mentioned items in favor of successful application of (68)Ga-labeled radiopharmaceuticals for imaging in patients are strong arguments for the development of a (68)Ge/(68)Ga generator with Marketing Authorization and thus to provide pharmaceutical grade eluate. Moreover, now not one United States Food and Drug Administration-approved or European Medicines Agency-approved (68)Ga-radiopharmaceutical is available. As soon as these are achieved, a whole new radiopharmacy providing PET radiopharmaceuticals might develop., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: Studies worldwide in emergency departments (ED) find that a substantial proportion of patients seek care for non-urgent conditions. Managed care programs may help address this overuse of ED facilities, but non-urgent ED care is not easily identified outside of ED settings. This article employed an algorithm using insurance data to identify and characterize patients having low urgency ED visits. Non-urgentis the term used in the ED literature for ED visits that might have been managed outside an ED setting such as in a physician office. Low urgency ED visits could include visits that require an ED setting but for less severe conditions than high urgency ED visits., Design: Analysis of ED visits by members of the largest health insurer in Hawaii., Methodology: Visits were defined as low urgency if classified by the ED as low severity and if, in addition, the patients required no procedures beyond physician and nursing care. A simple example would be a physician order for a laboratory test. Even if the test was routine, the fact the doctor ordered the test during the ED visit suggests the result might be needed right away to make a management decision. Another example of a procedure would be a radiograph., Principal Finding: Medicaid participants, children age 1 to 5, and people living on less populated Hawaiian Islands most frequently had low urgency visits. The visits were also more common on weekends than weekdays, and more common among males compared to females. Of all low urgency visits by Medicaid participants, 32% were by repeat users of the ED. The percentage for members of non-Medicaid plans was 16%. People with one low urgency visit in the past year were more than twice as likely as others to have a similar visit in the next year. People with two or more low urgency visits in the past year were five times as likely to have a low urgency ED visit in the next year., Conclusion: The results identify several areas such as youth, island of residence, and past history of low urgency ED visits that might become the focus of managed care programs.

Grandparent behaviors in the United States and the Republic of China are examined to identify curriculum themes for helping them adjust to their changing role. The 3,286 non-consanguineous subjects included Chinese (n = 751), African Americans (n = 777), Caucasian Americans (n = 1,086), and Mexican Americans (n = 672). Analyses were performed using 1) Generation with three levels (grandparent, parent, and grandchild) and 2) Culture with four levels (Chinese, African American, Caucasian American, and Mexican American). The results revealed significant differences in perceptions about grandparents across cultures as well as between generations within cultures. All three generations reported grandparent strengths and needs. Specific guidelines and curriculum topics are recommended for education to support grandparent development.

This article describes the contractual relations that are emerging between health maintenance organizations (HMOs) and hospitals. Six HMOs in four large metropolitan areas provided information on 102 hospital contracts. The authors found that the HMOs are becoming more aggressive in placing hospitals in competition with each other for HMO patients. Staff and network HMOs are able to obtain a higher concentration of patients and substantially larger discounts for inpatient services than are individual practice association (IPA) plans in this study.

From 1967-1986, 21 children were treated for pineal germinoma, including 16 biopsy-proven, 2 biopsy non-diagnostic, and 3 metastatic unbiopsied (marker negative) patients. Ten of 18 (56%) biopsied patients underwent partial or sub-total tumor resection. Twenty patients were irradiated, 19 of whom are alive. No irradiated patient died of progressive germinoma, but two patients relapsed in the spinal cord and required treatment intensification for salvage. Long-term survivors have significant morbidity. Determination of the minimum effective treatment remains the chief therapeutic challenge.

To evaluate the usefulness of the case report literature concerning toxic epidermal necrolysis, we surveyed English-language reports published from January 1966 to April 1987, using epidermal necrolysis as a key word in the MEDLINE database. Of the 345 articles identified, 80 definitely or possibly contained individual case reports of at least 100 words; 59 of these 82 (72%) were available and reviewed. These 59 reports included a total of 73 separate cases of toxic epidermal necrolysis possibly related to drugs, which represents less than 5% of the case of toxic epidermal necrolysis that occurred in this period. In 62% of these 73 cases the apparent purpose of the report was to show an association between a given drug and the development of toxic epidermal necrolysis. The drugs most frequently associated with toxic epidermal necrolysis are allopurinol, the nonsteroidal anti-inflammatory agents, phenytoin, and the sulfonamide antibiotics. Given that only a small proportion of cases of toxic epidermal necrolysis appear in the case report literature, except to present association with drugs not previously reported, the contribution of case reports in providing an estimate of the relative risk of drug-associated toxic epidermal necrolysis is limited. Furthermore, our analysis suggests that the adoption of specific diagnostic criteria for and more uniform reporting of signs, symptoms, and therapy could greatly increase the usefulness of the case report literature. We propose a minimum set of informational and specific diagnostic criteria.