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Background: Understanding the impacts of Medicare coverage among immigrants is of high policy importance, but there is currently limited evidence. In this study, we examined the effects of near universal access to Medicare coverage at age 65 years between immigrants and US‐born residents. Methods: Using the 2007–2019 Medical Expenditure Panel Survey, we employed a regression discontinuity design, which exploits the eligibility for Medicare at age 65 years. Our outcomes were health insurance coverage, healthcare spending, access to and use of health care, and self‐reported health status. Results: Medicare eligibility at age 65 led to significant increases in Medicare coverage among immigrants and US‐born residents (74.6 [95% CI: 71.6–77.5] and 81.6 [95% CI: 80.5–82.7] percentage points). Medicare enrollment at age 65 decreased total healthcare spending and out‐of‐pocket spending by $1579 (95% CI: −2092 to 1065) and $423 (95% CI: −544 to 303) for immigrants and $1186 (95% CI: −2359 to 13) and $450 (95% CI: −774 to 127) for US‐born residents. After Medicare enrollment at age 65, immigrants reported only limited improvements in overall access to and use of health care, but they reported significant increases in the use of high‐value care (11.5 [95% CI: 6.8–16.2], 8.3 [95% CI: 6.0–10.6], 8.4 [95% CI: 1.0–15.8], and 2.3 [95% CI: 0.9–3.7] percentage points increase for colorectal cancer screening, eye examination for diabetes, influenza vaccine, and cholesterol measurement) and improvements in self‐reported health (5.9 [95% CI: 0.9–10.8] and 4.8 [95% CI: 0.5–9.0] percentage points increase for good perceived physical and mental health). Medicare enrollment also increased prescription drug spending by $705 (95% CI: 292–1117), despite the unchanged use of prescription drugs. For US‐born residents, use of high‐value care, self‐reported health, and prescription drug use and spending did not change substantially after Medicare enrollment. Conclusion: Medicare has the potential to improve care among older adult immigrants. [ABSTRACT FROM AUTHOR]

Forest resources and the flow of ecosystem services they provide play a key role in supporting national and regional economies, improving people's lives, protecting biodiversity, and mitigating the impacts of climate change. Based on the ISI (Institute of Scientific Information) Web of Science (WoS) database, we used a bibliometric approach to analyze the research status, evolution process, and hotspots of forest ecosystem services (FES) from a compilation of 8797 documents published between 1997 and 2019. The results indicated that: (1) research on forest ecosystem services has developed rapidly over the past 23 years. Institutions in the United States and other developed countries have significantly contributed to undertake research on the topic of ecosystem services. (2) The 11 hotpot key focus areas of completed research were payments for ecosystem services, biodiversity conservation, forest governance, ecosystem approaches, climate change, nitrogen, ecosystem management, pollination, cities, ecological restoration, and policy. (3) The trade-off relationships among ecosystem services, ecosystem resilience and stability have become the research frontier in this field. (4) Future research on FES will likely focus on the formation and evolution mechanism of ecosystem services; the interaction, feedback and intrinsic connections of ecosystem services at different scales; analysis of the trade-offs and synergies; unified evaluation standards, evaluation systems, model construction and scenario analyses; in-depth studies of the internal correlation mechanism between forest ecosystem services and human wellbeing; and realization of cross-disciplinary and multi-method integration in sustainable forest management and decision-making. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify and analyze the 100 top-cited articles in the field of osteoarthritis (OA) from 1990 to 2020. We used the Web of Science to retrieve the articles related to OA. Then we selected 100 target articles and manually collected their general information, including article title, author, year of publication, journal, type of article, and the number of citations. The 100 top-cited articles were published in the period from 1990 to 2015. These articles have been cited 66,494 times in total, with the highest being 2382 times, the lowest being 433 times, the median number being 613, and a mean of 664.94 times. The 100 top-cited articles appeared in a total of 35 influential journals. The greatest number of articles in the top of 100 was published in Arthritis and Rheumatism. The authors of these articles came from 18 countries, led by the United States (n = 48), followed by the United Kingdom (n = 15). Among all the institutions, Boston University led the list with 10 articles. The most prevalent type of the study was review (n = 38) and clinical study (n = 38), followed by guideline (n = 12), basic science (n = 10) and other types. This study provided some insights on the literature development and citation of OA in the recent 30 years. Articles published in high-impact journals are more likely to be cited in the field of OA. As recent studies did not have enough time to accumulate the number of citations, the latest articles may not be included in the top 100 cited articles. [ABSTRACT FROM AUTHOR]

Background: According to recent evidence, psychobiotics exert beneficial effects on central nervous system-related diseases, such as mental disorders. Lactobacillus plantarum PS128 (PS128), a novel psychobiotic strain, improves motor function, depression, and anxiety behaviors. However, the psychobiotic effects and mechanisms of PS128 in Alzheimer's disease (AD) remain to be explored. Objectives: The goal of the current study was to evaluate the beneficial effects of PS128 and to further elucidate its mechanism in AD mice. Methods: PS128 (1010 colony-forming unit (CFU)/ml) was administered via oral gavage (o.g.) to 6-month-old male wild-type B6 and 3 × Tg-AD mice (harboring the PS1M146V, APPswe and TauP30IL transgenes) that received an intracerebroventricular injection of streptozotocin (icv-STZ, 3 mg/kg) or vehicle (saline) for 33 days. After serial behavioral tests, fecal short-chain fatty acid levels and AD-related pathology were assessed in these mice. Results: Our findings show that intracerebroventricular injection of streptozotocin accelerated cognitive dysfunction associated with increasing levels of glycogen synthase kinase 3 beta (GSK3β) activity, tau protein phosphorylation at the T231 site (pT231), amyloid-β (Aβ) deposition, amyloid-β protein precursor (AβPP), β-site AβPP-cleaving enzyme (BACE1), gliosis, fecal propionic acid (PPA) levels and cognition-related neuronal loss and decreasing postsynaptic density protein 95 (PSD95) levels in 3 × Tg-AD mice. PS128 supplementation effectively prevented the damage induced by intracerebroventricular injection of streptozotocin in 3 × Tg-AD mice. Conclusions: Based on the experimental results, intracerebroventricular injection of streptozotocin accelerates the progression of AD in the 3 × Tg-AD mice, primarily by increasing the levels of gliosis, which were mediated by the propionic acid and glycogen synthase kinase 3 beta pathways. PS128 supplementation prevents damage induced by intracerebroventricular injection of streptozotocin by regulating the propionic acid levels, glycogen synthase kinase 3 beta activity, and gliosis in 3 × Tg-AD mice. Therefore, we suggest that PS128 supplementation is a potential strategy to prevent and/or delay the progression of AD. [ABSTRACT FROM AUTHOR]

Background: Nutritional status has been recognized as an important factor influencing cognitive function-related diseases, but few comprehensive nutrition indicators are available to assess the risk of cognitive decline.Objective: This study aimed to investigate the relationship between the prognostic nutritional index (PNI) and cognitive function in an elderly population, and the differences in nutrient intake between different levels of nutritional risk.Methods: Based on cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014, we included 2,564 older participants. The lower quartile of each of the four cognitive tests was considered to have cognitive function impairment (CFI). Binary and multivariate logistic regression models were used to estimate the relationship between the PNI and the odds ratio of CFI.Results: After adjustment for confounding variables, we found that the odds of CFI were significantly lower for participants with normal PNI levels than for those with low PNI levels. In a comparison of global cognitive impairment scores, participants with a normal PNI had lower ratios of poor cognitive performance than those with a low PNI. By comparing the nutrient intake at different PNI levels, we found a reduction in the intake of protein, dietary fiber, total saturated fatty acids, and multiple micronutrients in the low PNI group.Conclusion: Our study shows that the PNI can be a good predictor of the odds of CFI in the elderly population and that it is a convenient indicator of reduced intake of nutrients which may be important to brain health. [ABSTRACT FROM AUTHOR]

Since the 1960s the immigrant population in the United States has increased fourfold, reaching 44.7 million, or 13.7 percent of the US population, in 2018. The shifting immigrant demography presents several challenges for US health policy makers. We examine recent trends in immigrant health and health care after the Great Recession and the nationwide implementation of the Affordable Care Act. Recent immigrants are more likely to have lower incidence of chronic health conditions than other groups in the US, although these differences vary along the citizenship and documentation status continuum. Health care inequities among immigrants and US-born residents increased after the Great Recession and later diminished after the Affordable Care Act took effect. Unremitting inequities remain, however, particularly among noncitizen immigrants. The number of aging immigrants is growing, which will present a challenge to the expansion of coverage to this population. Health care and immigration policy changes are needed to integrate immigrants successfully into the US health care system. [ABSTRACT FROM AUTHOR]

Using survey data from the American National Election Study (ANES) and aggregate data on Congressional districts, this article assesses the roles that economic and social factors played in Donald J. Trump's 2016 "populist" presidential candidacy. It shows the hollowness of claims that economic issues played little or no role. While agreeing that racial resentment and sexism were important factors, the article shows how various economic considerations helped Trump win the Republican nomination and then led significant blocs of voters to shift from supporting Democrats or abstaining in 2012 to vote for him. It also presents striking evidence of the importance of political money and Senators' "reverse coattails" in the final result. [ABSTRACT FROM AUTHOR]

Background: The health and financial burden of the opioid epidemic has been disproportionately hard on reproductive-aged parenting women. This crisis not only impacts the well-being of the mothers but is also spilling over to their children and families. Objectives: Given the alarming rise of opioid use disorder (OUD) among mothers, this study seeks to examine the primary motivations and sources for the most recent prescription opioids misused among this population. Methods: Using data from 2015 to 2016 National Survey of Drug Use and Health (NSDUH), this study analyzes data on reproductive-aged parenting women who have misused any prescription opioids in the previous 12 months. All estimates were weighted to account for NSDUH's complex survey design and to make the estimates nationally representative (weighted N ≈ 14.4 million). Results: Results show that physicians (43%) are the most commonly reported source for obtaining prescription opioids among parenting women with OUD, whereas social sources (57%) are the most common source for parenting women who have misused opioids without OUD. A significant proportion of parenting women with OUD reported drug-related reasons (57%) and relief from physical pain (25%) as the two primary motivations for opioid misuse, while parenting women without OUD reported relief from physical pain (45%) and help with emotions or feelings (32%) as primary motivations. Conclusions: Opioid misuse and use disorder among parenting women are a significant health risk. Policy initiatives that encompasses a comprehensive approach toward the crisis are warranted. [ABSTRACT FROM AUTHOR]

We examine changes in health insurance coverage and access to and utilization of health care before and after the national implementation of the Patient Protection and Affordable Care Act (ACA) among the U.S. adult immigrant population. Data from the 2011–2016 National Health Interview Survey are used to compare adult respondents in 2011–2013 (before the ACA implementation) and 2014–2016 (after the ACA implementation). Multivariable logistic regression analyses are used to compare changes over time. This study shows that the ACA has closed the coverage gap that previously existed between U.S. citizens and non-citizen immigrants. We find that naturalized citizens, non-citizens with more than 5 years of U.S. residency, and non-citizens with 5 years or less of U.S. residency reduced their probability of being uninsured by 5.81, 9.13, and 8.23%, respectively, in the first 3 years of the ACA. Improvements in other measures of access and utilization were also observed. [ABSTRACT FROM AUTHOR]

Preventive services can help reduce costs associated with chronic conditions. Medicaid beneficiaries have high rates of chronic conditions, but state Medicaid coverage and cost-sharing of preventive services varies widely. States that chose to expand Medicaid under the ACA were incentivized to cover recommended preventive services at no cost-sharing. This study evaluates whether state Medicaid policy and Medicaid expansion were associated with overall utilization, and disparities in utilization of preventive services among vulnerable populations. We used Medicaid policy data from Kaiser Family Foundation and MEPS data (2009-2014, n = 15,610), collected and analyzed in 2017. We used multivariable logistic regression, difference-in-differences, and difference-in-difference-in-differences models to examine the association between state Medicaid preventive service policy and Medicaid expansion on overall utilization, and disparities in utilization among race/ethnicity and income groups for blood pressure check, cholesterol screening, and flu shot. Medicaid coverage of flu shot was significantly associated with utilization (p < 0.001). Medicaid expansion significantly increased flu shot utilization among near-poor individuals (p < 0.01), Asians, and Latinos and blood pressure screening among African Americans (p < 0.05). For flu shot, the ACA is reaching its target audience: those in the coverage gap between Medicaid and private insurance. Increasing access to preventive services may not be enough to increase utilization, especially for vulnerable populations and/or the previously uninsured. Focusing on provider adherence to preventive service guidelines and education around who is eligible for what service and when could help increase utilization of preventive services in the future. [ABSTRACT FROM AUTHOR]

Research has shown a significant increase in overdose deaths among reproductive-aged parenting women in the United States. Given the alarming rise of opioid use disorder, this study analyzes polysubstance use among reproductive-aged parenting women. Using data from 2015 to 2016 National Survey of Drug Use and Health (NSDUH), this study examines data on prevalence and patterns of polysubstance use among US reproductive-aged parenting women who misused prescription opioids in the past 30 days. Results show that 87% of parenting women who misused prescription opioids reported using other substances concurrently in the past 30 days. [ABSTRACT FROM AUTHOR]

Objective: To estimate health care expenditure trends among young adults ages 19-25 before and after the 2010 implementation of the Affordable Care Act (ACA) provision that extended eligibility for dependent private health insurance coverage.Data Sources: Nationally representative Medical Expenditure Panel Survey data from 2008 to 2012.Study Design: We conducted repeated cross-sectional analyses and employed a difference-in-differences quantile regression model to estimate health care expenditure trends among young adults ages 19-25 (the treatment group) and ages 27-29 (the control group).Principal Findings: Our results show that the treatment group had 14 percent lower overall health care expenditures and 21 percent lower out-of-pocket payments compared with the control group in 2011-2012. The overall reduction in health care expenditures among young adults ages 19-25 in years 2011-2012 was more significant at the higher end of the health care expenditure distribution. Young adults ages 19-25 had significantly higher emergency department costs at the 10th percentile in 2011-2012. Differences in the trends of costs of private health insurance and doctor visits are not statistically significant.Conclusions: Increased health insurance enrollment as a consequence of the ACA provision for dependent coverage has successfully reduced spending and catastrophic expenditures, providing financial protections for young adults. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the associations of two measures of vision impairment (i.e., a clinical measure of visual acuity and self-reported vision status) and social isolation in a nationally representative sample of Americans aged 60 and older. Method: Five cycles of the National Health and Nutrition Examination Survey (NHANES IV; 1999-2008) were used to estimate successive logistic regression models, holding constant demographic characteristics, chronic illness, functional limitations, and disability. Results: Effects of both measures of vision impairment in predicting social isolation were substantially reduced or eliminated in adjusted models. Where significant effects of vision impairment on social isolation remained, a strong effect was found for self-reported poor vision (odds ratio = 1.53; 95% confidence interval = [1.08, 2.16]). Discussion: As one of the better vision-related predictors of social isolation, self-reported vision is among the easiest and inexpensive to assess. The use of self-reported vision as a screening criterion for social isolation is discussed. [ABSTRACT FROM AUTHOR]

Objective: Young adults with behavioral health conditions (mental or substance use disorders) often lack access to care. In 2010, the Affordable Care Act (ACA) extended eligibility for dependent coverage under private health insurance, allowing young adults to continue on family plans until age 26. The objective of this study was to analyze out-of-pocket (OOP) spending as a share of total health care expenditures for young adults with behavioral health conditions before and after the implementation of the ACA dependent care provision. The study examined the population of young adults with behavioral health conditions overall and by race and ethnicity.Methods: The study analyzed 2008-2009 and 2011-2012 nationally representative data from the Medical Expenditure Panel Survey with zero-or-one inflated beta regression models in a difference-in-differences framework to estimate the impact of the ACA's dependent coverage expansion. OOP spending was examined as a share of total health care expenditures among young adults with behavioral health disorders. The study compared the treatment group of individuals ages 19-25 (unweighted N=1,158) with a group ages 27-29 (unweighted N=668).Results: Young adults ages 19-25 with behavioral health disorders were significantly less likely than the older group to have high levels of OOP spending after the implementation of the ACA's dependent coverage expansion. The reduction was pronounced among young adults from racial-ethnic minority groups.Conclusions: The extension of health insurance coverage to young adults with behavioral health disorders has provided them with additional financial protection, which can be important given the low incomes and high debt burden that characterize the age group. [ABSTRACT FROM AUTHOR]

Background: To determine the health care and labor productivity costs associated with major depressive disorder in high-risk, low-income mothers.Methods: This study was conducted using the 1996-2011 Medical Expenditure Panel Survey (MEPS). The MEPS is a nationally-representative database that includes information on health care utilization and expenditures for the civilian, non-institutionalized population in the United States. High-risk mothers were between the ages of 18-35 years, and either unmarried, receiving Medicaid, or with incomes less than 300% of the Federal Poverty Level. Mothers were categorized as being depressed if they had an ICD-9 diagnosis code of 296 or 311 (N=2310) or not depressed (N=18,221). Insurer expenditures, out-of-pocket (OOP) expenses, and lost wage earnings were calculated.Results: After controlling for comorbidities, demographics, region, and year, high-risk depressed mothers were more likely to incur insurer (0.84 vs. 0.79) and OOP expenses (0.84 vs. 0.81) and to have higher insurer ($4448 vs. $3072) and OOP expenses ($794 vs. $523). Depression significantly increased the likelihood of missing work days (OR=1.40; p<0.01). Depression increased overall direct health care expenditures by $1.89 billion (range=$1.28-$2.60 billion) and indirect costs by $523 million annually, with a range of $353-$719 million.Conclusions: In this high-risk population, the direct and indirect aggregate costs of depression-related to health care expenditures and lost work productivity were substantial. These findings establish a quantifiable cost for policy makers and highlight the need to target this population for prevention and treatment efforts. [ABSTRACT FROM AUTHOR]

Eight Chinese counselors were interviewed about their use of directives in counseling. They typically believed that directives can be beneficial in counseling Chinese clients. They used directives to extend the influence of counseling beyond sessions, meet client needs and expectations, and fit their own personality and orientation. In terms of conditions that need to be met for directives to be helpful, they identified client factors such as readiness, communication styles, past experience, and insight; the counselor factor of ability to communicate directives; and the therapeutic relationship. They emphasized the importance of clients acquiring a new perspective as a result of directives. Cultural factors in using directives are discussed. [ABSTRACT FROM AUTHOR]

Objective We study the association between the timing of the Great Recession ( GR) and health spending among uninsured adults distinguishing by citizenship/nativity status and time of U.S. residence. Data Source Uninsured U.S. citizens and noncitizens from the 2005-2006 and 2008-2009 Medical Expenditure Panel Survey. Study Design The probability of reporting any health spending and the natural logarithm of health spending are our main dependent variables. We compare health spending across population categories before/during the GR. Subsequently, we implement two-part regression analyses of total and specific health-spending measures. We predict average health spending before/during the GR with a smearing estimation. Principal Findings The probability of reporting any spending diminished for recent immigrants compared to citizens during the GR. For those with any spending, recent immigrants reported higher spending during the GR (27 percent). Average reductions in total spending were driven by the decline in the share of the population reporting any spending among citizens and noncitizens. Conclusions Our study findings suggest that recent immigrants could be forgoing essential care, which later translates into higher spending. It portrays the vulnerability of a population that would remain exposed to income shocks, even after the Affordable Care Act ( ACA) implementation. [ABSTRACT FROM AUTHOR]

This study reports on results from the Early Mathematics Beliefs and Confidence Survey, administered to 346 preschool teachers in a large public school system in the Midwest. Survey results depict a much more positive view of teachers' beliefs and confidence in early math teaching than previously reported. Results also suggest that teacher confidence varies with specific types of math knowledge and teaching abilities, and assessing math learning is a specific area where teachers lack confidence. Examining confidence in their math abilities and in teaching early math, results indicate that teachers are more confident teaching math and remain confident in teaching even when confidence in their abilities is low. Implications of results for early math professional development are discussed. [ABSTRACT FROM AUTHOR]

Aim The study investigated the status of acute fatigue, chronic fatigue and inter-shift recovery among 12-hour shift nurses and how they differed by organisational and individual factors. Background While the 12-hour shift has been a widely accepted staffing solution in hospitals, the fatigue-recovery process in nurses working 12-hour shifts remains unclear. Methods A cross-sectional survey was completed by 130 full-time nurses working 12-hour dayshifts in three hospitals to assess the perceived levels of acute fatigue, chronic fatigue and inter-shift recovery, as well as their associations with selected organisational and individual factors. Results Nurses experienced a moderate to high level of acute fatigue and moderate levels of chronic fatigue and inter-shift recovery. Fatigue and recovery levels differed by the interaction between hospital and unit after controlling for individual factors. Lack of regular exercise and older age were associated with higher acute fatigue. Conclusions An unhealthy fatigue-recovery process was found for nurses working a 12-hour shift during the day. Implications for nursing management There appears to be a need to establish fatigue intervention programmes for 12-hour shift nurses in hospitals. Hospital administration, unit managers and staff nurses need to collaborate to achieve a healthy fatigue-recovery balance when implementing 12-hour shifts. [ABSTRACT FROM AUTHOR]

Objective. To examine the association between the Great Recession of 2007-2009 and health care expenditures along the health care spending distribution, with a focus on racial/ethnic disparities. Data Sources/Study Setting. Secondary data analyses of the Medical Expenditure Panel Survey (2005-2006 and 2008-2009). Study Design. Quantile multivariate regressions are employed to measure the different associations between the economic recession of 2007-2009 and health care spending. Race/ethnicity and interaction terms between race/ethnicity and a recession indicator are controlled to examine whether minorities encountered disproportionately lower health spending during the economic recession. Principal Findings. The Great Recession was significantly associated with reductions in health care expenditures at the 10th-50th percentiles of the distribution, but not at the 75th-90th percentiles. Racial and ethnic disparities were more substantial at the lower end of the health expenditure distribution; however, on average the reduction in expenditures was similar for all race/ethnic groups. The Great Recession was also positively associated with spending on emergency department visits. Conclusion. This study shows that the relationship between the Great Recession and health care spending varied along the health expenditure distribution. More variability was observed in the lower end of the health spending distribution compared to the higher end. [ABSTRACT FROM AUTHOR]

Objective Given the substantial growth rate of the immigrant population, it is critical to examine immigrants' prescription drug expenditure patterns to encourage medication adherence. The aim was to examine and compare prescription drug expenditures and out-of-pocket ( OOP) payment by respondents' US citizenship/nativity status and years spent in the USA, and identify factors associated with these expenditure differences. Methods This study examined total prescription drug expenditures and the proportion of OOP payment to the total drug expenditures for US-born citizens, naturalized US citizens (≤10 and >10 years of US residence) and non- US citizens (≤10 and >10 years of US residence) aged 18-64 years. Two-part multivariate models were used to estimate the effect of citizenship/nativity status and years in the USA on drug expenditures and OOP shares. The Blinder- Oaxaca decomposition techniques were used to identify the most important factors associated with these disparities. Key findings Non- US citizens and naturalized US citizens had lower drug expenditures and higher OOP shares than US-born citizens, and these disparities decreased with more years of US residence. Decomposition results showed that approximately 80% of the disparities in total drug expenditures could be explained by the observed population characteristics. The major variables associated with these disparities were indicators for cultural background, English proficiency, immigrants' self-selections and educational attainment, followed by healthcare access and insurance. Approximately 75% of the differences in OOP shares could be explained by the observed characteristics. Inadequate health insurance coverage and limited healthcare access were major factors associated with these disparities. Conclusions The results suggested that immigrants' higher drug OOP shares could be reduced by improving their health insurance coverage and access. However, to reduce the disparities in total drug expenditures, providing English-assistance and culturally designed programmes to the immigrants would be more effective than improving their healthcare access directly. [ABSTRACT FROM AUTHOR]

This paper analyzes patterns of industrial structure and party competition in the 2012 presidential election. The analysis rests on a new and more comprehensive database that catches more of the myriad ways in which businesses and major investors make political contributions than previous studies do. By drawing on this unified database, the paper is able to show that both major parties depend on very large donors to a greater extent than past studies have estimated. The paper outlines the firm and sectoral bases of support for the major party nominees, as well as for Republican candidates who competed for their party's presidential nomination. The paper shows that President Barack Obama's support by big business was broader than hitherto recognized. A central conclusion is that the sectors most involved in the recent controversies over surveillance were among the president's strongest supporters. The paper also analyzes patterns of business support for the Tea Party in Congress, showing that certain parts of the business community are more supportive of Tea Party candidates than others. The role of climate change, financial regulation, and other issues in the election is discussed at length. [ABSTRACT FROM AUTHOR]

Background: Crohn's disease (CD) and ulcerative colitis (UC) are chronic, debilitating conditions that can have important economic and clinical implications. Aim: To quantify individual and national estimates of the health care and patient out-of-pocket (OOP) costs of CD and UC. Methods: In a retrospective study using 1996 to 2009 data from the Medical Expenditure Panel Survey, individuals' self-reported health conditions were mapped to International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Individuals with a code of 555.x (CD) or 556.x (UC) were identified. Health care services and costs included prescriptions and inpatient, outpatient, emergency room, office, and home health services. OOP costs were the portion of individuals' total payments for health care services. Results: There were 358 individuals with CD (mean age 49.0 years; 55 % female), 198 individuals with UC (mean age 47.1 years; 64 % female), and 206,993 individuals without inflammatory bowel disease (IBD) (mean age 48.2 years; 58 % female). Annual per capita health insurer and OOP costs for individuals with CD were greater than those without IBD ($9,526 versus $3,781, p < 0.001 and $1,603 versus $866, p < 0.001, respectively). Health insurer and OOP costs were greater for UC compared with those without IBD ($6,443 versus $3,781, p < 0.001 and $1,263 versus $866, p < 0.001, respectively). US national aggregate annual estimates of health insurer, OOP, and total direct costs secondary to CD are $2.04 billion, $0.26 billion, and $2.29 billion, respectively. Aggregate health insurer, OOP, and total direct costs attributable to UC are $0.53 billion, $0.07 billion, and $0.61 billion, respectively. Conclusions: The direct costs associated with CD and UC are substantial. The extent to which appropriate diagnosis and treatment reduces the total health care costs for individuals with CD or UC should be examined. [ABSTRACT FROM AUTHOR]

Objectives. We examined the associations of local public health system organization and local health department resources with county-level sexually transmitted disease (STD) incidence rates in large US health jurisdictions. Methods. We linked annual county STD incidence data (2005-2008) to local health department director responses (n = 211) to the 2006 wave of the National Longitudinal Study of Local Public Health Systems, the 2005 national Local Health Department Profile Survey, and the Area Resource File. We used nested mixed effects regression models to assess the relative contribution of local public health system organization, local health department financial and resource factors, and sociodemographic factors known to be associated with STD incidence to county-level (n = 307) STD incidence. Results. Jurisdictions with local governing boards had significantly lower county-level STD incidence. Local public health systems with comprehensive services where local health departments shoulder much of the effort had higher county-level STD rates than did conventional systems. Conclusions. More integration of system partners in local public health system activities, through governance and interorganizational arrangements, may reduce the incidence and burden of STDs. [ABSTRACT FROM AUTHOR]

Objective: To quantify individual and national estimates of direct medical costs of psoriasis and similar disorders using national survey data. Methods: This was a retrospective study using 1996-2006 data from the Medical Expenditure Panel Survey (MEPS). Individuals' self-reported current health conditions were mapped to International Classification of Diseases, 9th Revision, Clinical Modification ( ICD-9-CM) diagnostic codes, whereby individuals with code 696 were categorized as having psoriasis. Healthcare services, for which healthcare costs were collected, included prescriptions and inpatient, outpatient, emergency room, office, and home health services. Out-of-pocket (OOP) costs were the portion of individuals' total payments for healthcare services. Results: There were 873 individuals with psoriasis (mean age = 51 years; 52% female) and 160 617 individuals without psoriasis (mean age = 48 years; 58% female). Annual per capita healthcare and OOP costs for individuals with psoriasis exceeded those for individuals without psoriasis ($4547 vs $3793, p < 0.001; $1255 vs $913, p < 0.001, respectively). United States national annual estimates of healthcare, OOP, and total direct medical expenses for psoriasis were $3.67 billion, $1.49 billion, and $5.17 billion, respectively. Conclusions: Direct medical costs associated with psoriasis are substantial to healthcare payers and patients. The extent to which appropriate and early diagnosis and treatment reduce total healthcare costs for individuals with psoriasis should be examined. [ABSTRACT FROM AUTHOR]

This study examines the construct validity of a new teacher interview designed to assess teachers' pedagogical content knowledge (PCK) for preschool mathematics. PCK describes the subject matter knowledge a teacher needs for effective teaching. Data from 22 teachers and 113 Head Start children in a large midwestern city in the United States were used to test predictive relationships between the PCK interview and two dependent variables: good preschool math teaching practices and improved child learning outcomes. Using a method from previous published work, frequency of math-related language is assessed as a proxy for good preschool math teaching. Changes in children's mathematical achievement were measured from fall to spring within a single school year using the Test of Early Mathematics Ability (3rd ed.). Analysis by hierarchical linear modeling found significant positive relationships between scores on the new measure and both variables, suggesting that the PCK interview adequately represents the knowledge needed for effective teaching of preschool mathematics. A theoretical framework for the interview's construction is provided. [ABSTRACT FROM AUTHOR]

Objective. We investigate health expenditure disparities between Latinos and non-Latino whites by years of United States residence and citizenship/nativity status. Data Sources. We link the Medical Expenditure Panel Survey and the National Health Interview Survey from 2000 to 2007. The sample consists of 31,514 Latinos and 76,021 white adults (18-64 years). Study Design. The likelihood of any health spending, total health expenditure, and the out-of-pocket (OOP) share of health expenditure are our main dependent variables. We use two-part multivariate models to adjust for confounding factors. A stratified analysis by insurance status checks for the results' robustness. The decomposition technique is implemented to estimate the share of disparities that can be explained by observed and unobserved variables. Principal Findings. Latinos are much less likely to have any health spending (68 percent), total health expenditure (57 percent), and more likely to pay OOP (6 percent) compared with the white population. Overall, disparities narrow or disappear for naturalized Latinos the longer they stay in the country. Among noncitizen Latinos, disparities remain constant or decline slightly, but they remain large over time. Conclusions. Low-health spending by foreign-born Latinos contributes to health expenditure disparities between Latinos and whites. Our findings provide preliminary evidence on health-spending convergence over time between foreign-born Latinos and that of whites. [ABSTRACT FROM AUTHOR]

Immigration status is a likely deterrent of mental health care utilization in the United States. Using the Medical Expenditure Panel Survey and National Health Interview survey from 2002 to 2006, multivariable logistic regressions were used to estimate the effects of immigration status on mental health care utilization among patients with depression or anxiety disorders. Multivariate regressions showed that immigrants were significantly less likely to take any prescription drugs, but not significantly less likely to have any physician visits compared to US-born citizens. Results also showed that improving immigrants' health care access and health insurance coverage could potentially reduce disparities between US-born citizens and immigrants by 14-29% and 9-28% respectively. Policy makers should focus on expanding the availability of regular sources of health care and immigrant health coverage to reduce disparities on mental health care utilization. Targeted interventions should also focus on addressing immigrants' language barriers, and providing culturally appropriate services. [ABSTRACT FROM AUTHOR]

Background: Previous studies demonstrate a clear gap in access and receipt of preventive care between Latinos and non-Latino whites. Most of this work, however, pools Latinos together when they compare different racial and ethnic groups. There is currently no information about the consistency of preventive care utilization across major Latino subgroups. Purpose: This study tests for three bundles of preventive care services to analyze the main determinants of adult preventive care receipt among the largest subgroups of U.S. Latinos and non-Latino whites. It also examines the contribution of observed and unobserved factors in explaining differences in the provision of preventive care services. Methods: The Medical Expenditure Panel Survey and the National Health Interview Survey from 2000 to 2006 were merged in 2009. The sample consisted of 28,781 Latinos and 78,979 non-Latino whites. This study compared disparities in the receipt of adult preventive care services and separately examined differences in the provision of the most cost-effective preventive services. Multivariate models adjust for confounding factors. The decomposition technique was used to parse out differences into observed and unobserved components. Results: Latinos of Mexican and Central/South American origin are much less likely to receive guideline-recommended preventive care services than non-Latino whites and other Latino subgroups. Larger disparities were observed for the most cost-effective preventive care services: smoking-cessation advice, colorectal cancer screening, and influenza vaccination. Observed factors accounted for a larger share of disparities across measures (33%–100%), with lack of health insurance coverage and not having a usual source of care as the largest and most consistent factors explaining disparities. Conclusions: Health insurance coverage expansion and more integration of Latinos into primary care practices can substantially reduce disparities in the receipt of preventive care services. Preventive care initiatives should prioritize the availability of cost-effective services among Latinos of Mexican and Central/South American heritage. [Copyright &y& Elsevier]

Objective: This study investigated racial and ethnic disparities in psychotherapy use and expenditures in the United States and identified important factors associated with these disparities. Methods: Using the Medical Expenditure Panel Survey from 1996 to 2006, the investigators performed bivariate and multivariable analyses to estimate racial and ethnic disparities in the probability of receiving any psychotherapy, total psychotherapy expenditures, and out-of-pocket-payment share for 7,376 patients with depressive or anxiety disorders. Blinder-Oaxaca decomposition techniques were used to identify the most important factors associated with these disparities. Results: Caucasians were more likely to use psychotherapy than Latinos (57% versus 52%, p<.001), but there was no significant difference between Caucasians and African Americans in the probability of receiving any psychotherapy. Caucasians self-paid 29% of the total cost for each visit, significantly higher than the shares paid by Latinos (19%) and African Americans (14%). Racial-ethnic differences in the propensity to utilize psychotherapy vanished in multivariable regression, but Caucasians still paid a significantly higher out-of-pocket share than others. English proficiency was the most important factor associated with racial-ethnic disparities in psychotherapy use. The extensive Medicaid coverage among Latinos and African Americans was the main reason for their lower out-of-pocket payment for psychotherapy compared with Caucasians. Conclusions: This study found little evidence of racial and ethnic disparities in access to psychotherapy services. Health care reforms affecting mental health coverage under Medicaid would significantly affect psychotherapy expenditure and use among Latinos and African Americans. [ABSTRACT FROM AUTHOR]

Abstract: Background: Sample analysis and data interpretation for urine organic acid analyses (OAA) for metabolic diseases have not evolved significantly over the last two decades. We evaluated a number of potential improvements in the technology in order to increase productivity. Increasing numbers of this very important clinical test are being ordered resulting from expanded newborn screening programs and also due to greater clinical awareness of these metabolic disorders. This has resulted in a need for faster turn around times in order to establish a rapid diagnosis and reporting of OAA findings. Methods: In this study, we introduced a backflush system which removes residual high boiling point compounds quickly and at a lower oven temperature. We have also introduced deconvolution software (DRS), which provides a mathematical technique that separates overlapping mass spectra based upon peak widths of overlapping compounds and absolute mean retention times. The potential advantages of incorporating DRS into the OAA data processing include a higher match factor (MF) for library searching, elimination of incorrect peak identification, faster data review and minimum human interaction for manual peak integration. Results: In this proof of principle investigation, 64 of the most commonly encountered urinary organic acids and acyl glycines that are essential for the diagnosis and clinical follow-up of inborn errors of metabolism were selected and built into a spectral library. DRS with a customized library and quantitation database was able to clearly separate co-eluting compounds including those with very similar mass spectra such as citric acid and isocitric acid. Conclusions: We were able to reduce sample analytical time from 60 to 45 min using the backflush system. Deconvolution allowed us to identify common overlapping organic acids and provide more accurate quantitation. [Copyright &y& Elsevier]

Assesses the application of long-venerated realignment approach to election analysis in the U.S. Provision of the basis for each party's normal vote in subsequent elections; Dominance of the Republican Party in presidential politics; Cause of the transformation of national policy.

Millions of people older than 60 years are affected by arthritis. Unrelieved chronic pain of arthritis is associated with increased healthcare needs and decreased quality of life in older adults. Understanding older adults' perceptions and experiences of living with arthritis pain can benefit healthcare experts in designing and implementing clinical, education, and research programs to better care for this population. This meta-synthesis of qualitative studies aimed to explore older adults' experiences of living with arthritis pain. A narrative meta-synthesis. Journal articles published in English were identified by conducting electronic searches in CINAHL, PubMed, PsycINFO, Scopus, and ISI Web of Science to June 2019. Unpublished studies were searched in Google Scholar, ProQuest Dissertations and Theses Database. Four groups of keywords were combined in the search strategy: (1) research methods/qualitative researches; (2) older adults; (3) arthritis/arthritis pain; (4) experience. Studies were included if they (a) used qualitative research designs, qualitative data collection and analysis; (b) included participants aged 60 years and older regardless of the study context; (c) reported on older adults' experiences of living with arthritis pain; and (d) were published in English. Studies were excluded if: (a) they used mixed methods where qualitative data could not be extracted or (b) the data analysis lacked the necessary qualitative depth. Noblit and Hare's methodology of synthesizing qualitative studies was used. Eleven studies were included. Among the 11 included studies published in 2003–2018, the sample size ranged from 3 to 551 participants. Older adults aged 62 to 95 years, and the majority were female. The ethnicity of the older adults was reported in 7 studies, including Caucasians, African Americans, Hispanics, Korean Americans, Australian, European, and South Korean. Through meta-synthesis, four themes were identified. The lived experiences of pain among older adults with arthritis include the center of daily living, a lonely path, an inevitable and endless process, and surviving through pain management. These themes may reflect older adults' experiences of living with arthritis pain across diverse ethnicities and cultures. Health care providers must be sensitive to older adults' experience of arthritis pain, realize the importance of providers' support on patients' adaptation, and provide comprehensive and individualized patient-centered interventions for managing arthritis pain for older adults. The study protocol had been registered in PROSPERO (International prospective register of systematic reviews). The registration number is CRD42019129716. Link: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019129716. [ABSTRACT FROM AUTHOR]

Introduction: Accountable care organizations have been successful in improving quality of care, but little is known about who is benefiting from accountable care organizations and through what mechanism. This study examined variation of potentially preventable hospitalizations for chronic conditions with coexisting depression in adults by hospital accountable care organization affiliation and care coordination strategies by race/ethnicity.Methods: Data files of 11 states from 2015 State Inpatient Databases were used to identify potentially preventable hospitalizations for chronic conditions with coexisting depression by race/ethnicity; the 2015 American Hospital Association's Annual Survey was used to identify hospital accountable care organization affiliation; and American Hospital Association's Survey of Care Systems and Payment (collected from January to August 2016) was used to identify hospital Accountable care organizations affiliation and hospital-based care coordination strategies, such as telephonic outreach, and chronic care management. In 2019, multiple logistic regressions was used to test the probability of potentially preventable hospitalization by accountable care organization affiliation and race/ethnicity. The test was repeated on a subsample analysis of accountable care organization-affiliated hospitals by care coordination strategy.Results: Preventable hospitalizations were significantly lower among accountable care organization-affiliated hospitals than accountable care organization-unaffiliated hospitals. Lower preventable hospitalization rates were observed among white, African American, Native American, and Hispanic patients. Effective care coordination strategies varied by patients' race. Results also showed variation of the adoption of specific care coordination strategies among accountable care organization-affiliated hospitals. Analysis further indicated effective care coordination strategies varied by patients' race.Conclusions: Accountable care organizations and specifically designed care coordination strategies can potentially improve preventable hospitalization rates and racial disparities among patients with depression. Findings support the integration of mental and physical health services and provide insights for Centers for Medicare and Medicaid Services risk adjustment efforts across race/ethnicity and socioeconomic status. [ABSTRACT FROM AUTHOR]

Introduction: Racial and ethnic minorities experience greater burden of unintended pregnancy in the U.S. This study examined the factors associated with racial and ethnic disparities in unintended pregnancy among women in the U.S. using the social ecological model.Methods: This study utilized the National Survey of Family Growth data from 2006 to 2010. Data were analyzed in Autumn 2014 and Winter 2015. Decomposition analyses examined which intrapersonal, interpersonal, institutional, community, and public policy factors explained racial and ethnic disparities in unintended pregnancy.Results: Unadjusted analyses found that black and Hispanic women had a greater likelihood of unintended pregnancy compared with white women. Decomposition models explained 51% of the disparity in unintended pregnancy between black and white women and 73% of that between Hispanic and white women. Factors contributing to the disparity between black and white women included age, relationship status, respondent's mother's age at first birth, Federal Poverty Level, and insurance status. Between Hispanic and white women, these factors included age, U.S.-born status, education, and relationship status.Conclusions: Given that the results showed factors at different levels of the social ecological model contribute to racial and ethnic disparities in unintended pregnancy, interventions that aim to reduce these disparities should target at-risk groups of women such as younger, unmarried, lower-income, less-educated, non-U.S. born women and uninsured or publicly insured women. [ABSTRACT FROM AUTHOR]

The geographic preferences feature in the Electronic Residency Application Service (ERAS) allows applicants to voluntarily select up to three of the nine United States (US) census divisions as preferred areas for residency training. This feature was previously piloted in select specialties with research suggesting implications on interview invitations. For the 2024 Match, geographic preferences were newly introduced for all specialties participating in ERAS, including Radiation Oncology (RO). However, the current geographic distribution of the RO residency programs is sparsely described, and the use of geographic preferences by RO applicants is unknown. All ACGME-accredited RO residency programs with offerings for the Match 2024 were cataloged by program size and US census division. Preliminary aggregated applicant ERAS 2023 data was retrieved from the American Association of Medical Colleges (AAMC) website. Descriptive statistics are reported. Cohorts were analyzed with Chi-square and Kruskal-Wallis Tests using SPSS 29 software, with a p-value <0.05 set for statistical significance. RO residency programs were identified in all nine US census divisions, with a total of 204 spots offered for the 2024 Match. The highest concentration of programs was found within the Middle Atlantic (n=18, 21%) and the lowest in New England (n = 4, 5%) and Mountain West (n=4, 5%) (p < 0.001). More spots were located within the Middle Atlantic (38, 20%) and South Atlantic (36, 19%) compared to Mountain West (3%) (p < 0.001). Of all the 2024 RO applicants (n=273), 68% provided at least 1 geographic signal, and the use of this feature varied by applicant type (p<0.016). A majority of DO applicants utilized all three available geographical preferences (85%, n=26) while 37% of IMGs (n=87) opted out of geographical preferences. MD applicants were the only applicants to opt for two (n=11, 7%) or a single (n=10, 6%) geographical preference. The regions receiving the most signals were consistent with those with the most RO residency positions. This work explores RO applicant use and possible implications of the new geographic preference feature during residency applications. We identified an unbalanced distribution of RO residencies within the nine geographic divisions. Questions remain regarding possible advantages for applicants with certain geographic ties toward accessing a greater number of programs and spots. More research is needed to determine the impact of this novel feature on interview offers and matching. [ABSTRACT FROM AUTHOR]

The portrayal of oncology-related topics on the National Board of Medical Examiners (NBME) published practice material for undergraduate medical education (UGME) standardized examinations including the United States Medical Licensing Exams (USMLE) Step 1, Step 2 Clinical Knowledge (CK), and NBME Clinical Science Subject Examinations ('Shelf') is largely unknown. The goal of this study is to explore the presence and characterization of radiation oncology topics, including radiation therapy (RT), on these practice examinations. All current and commercially accessible NBME published self-assessments and sample questions for the aforementioned examinations will be queried for content pertaining to oncology and associated treatment modalities of RT, surgery, and systemic therapy. The total volume of oncology-related questions and its distribution across all 3 major practice examination types will be recorded. The questions will be cataloged by selected attributes including context, treatment modality appearing as the correct answer for "next best step" (NBS) prompt, and answers appearing as the incorrect answer for NBS prompt. 1320 USMLE Step 1 practice questions are available for analysis. In preliminary analysis, minimal questions about RT were noted; all appearing to involve concepts of associated toxicity. 920 USMLE Step 2CK practice questions are available for analysis. RT-related questions appeared with higher frequency on the clinical science preparation material (n=10) compared to basic science (n=4), while also notably appearing as a listed answer choice for NBS prompt against other treatment modalities. 1325 practice questions from relevant NBME shelf examinations were available. RT appeared sparingly on the practice NBME shelf examinations of Surgery (n=5), Medicine (n=4), Ob/Gyn (n=2), and Clinical Neurology (n=2). RT questions were absent from Pediatrics, Emergency Medicine, and Family Medicine Shelf practice examination material. In the final analysis of these practice questions from all 3 major examination types, we seek to conduct a comparative analysis to other treatment modalities. This work represents the first attempt, to our knowledge, to characterize RT topic appearance within the NBME published practice questions and their accompanying explanations for the USMLE Step 1, Step 2CK, and select NBME shelf examinations. Our analysis is important in assessing the presence of RT topics on medical student board preparation material, a potential avenue of RT content exposure in UGME. Careful review and comparative analyses of all oncology-related content can provide important insight for UGME-related RT education. Our anticipated analyses and future discussion may identify areas for improvements in the important education of oncology-related topics in UGME. [ABSTRACT FROM AUTHOR]

The impact of the opioid epidemic has been particularly hard on reproductive-aged parenting women. Yet, very little is known about opioid use, opioid misuse and opioid use disorder among parenting women with major depressive episode (MDE). Information on sources of opioids intended for misuse and reasons for opioid misuse among this population is also lacking. Using the 2015-2016 National Survey on Drug Use and Health, the study estimates a multinomial logistic regression model to investigate the association between MDE and opioid misuse as well as use disorder among reproductive-aged parenting women (n = 7750). Among reproductive-aged parenting women with prescription opioid use in the past 12 months, having had a MDE was associated with a higher relative risk of misusing prescription pain relievers without use disorder (RRR = 1.38, p < .001) and having a use disorder (RRR = 1.99, p < .001), relative to using prescription opioid without misuse or use disorder. However, utilization of mental health treatment mitigated the risk for opioid misuse and use disorder. A significant proportion of parenting women regardless of their MDE status identified family or friends and physicians as their main source of opioids. Relief from physical pain and help with feelings or emotions were the two primary motivations for opioid misuse among this population. These findings underscore the importance of maternal depression and mental health treatment in undertaking policy initiatives directed at the opioid crisis and highlights the role of medical providers, family and friends in targeted interventions aimed at this population. [ABSTRACT FROM AUTHOR]

Diversity multi-criteria decision-making methods have been developed to address different complex decision-making problems, and the analytic network process has been found to be one of the most effective techniques. There is an increase in the quality and quantity of publications related to the analytic network process. This detailed overview can provide the research status and development characteristics of analytic network process research and will be useful to researchers for future research directions. To achieve these goals, bibliometric techniques were used. In addition, past and present hotspots of analytic network process research were concluded, and future research trends were determined. The bibliometric analysis was carried out from various aspects including countries and regions, institutions, journals, authors, research areas, articles and author keywords based on data harvested from the Web of Science database. There were 1485 analytic network process-related publications retrieved from the Web of Science. The results show that Expert Systems with Applications was the most productive journal publishing articles in analytic network process research (118); its number of publications has decreased dramatically since 2013, while Journal of Cleaner Production has shown an upward trend in recent years and ranks second with 47 publications. The most collaborative country is the United States. Taiwan takes a leading position in analytic network process research with 436 publications (29.36%), and National Chiao Tung University, which is located in Taiwan, produced the most articles and has gained the highest h -index (28). The major hot topics that employ analytic network process are sustainability, environmental management and supply chain management. These topics may continue to attract more attention in the future. ∙ The development status of analytic network process was analyzed based on bibliometrics. ∙ Past and present hotspots of analytic network process research were concluded. ∙ Future research trends of analytic network process research were figured out. [ABSTRACT FROM AUTHOR]

Air compressor systems are responsible for approximately 10% of the electricity consumed in United States and European Union industry. As many researches have proven the effectiveness of using Artificial Neural Network in air compressor performance prediction, there is still a need to forecast the air compressor electrical load profile. The objective of this study is to predict compressed air systems' electrical load profile, which is valuable to industry practitioners as well as software providers in developing better practice and tools for load management and look-ahead scheduling programs. Two artificial neural networks, Two-Layer Feed-Forward Neural Network and Long Short-Term Memory were used to predict an air compressors electrical load. Compressors with three different control mechanisms are evaluated with a total number of 11,874 observations. The forecasts were validated using out-of-sample datasets with 5-fold cross-validation. Models produced average coefficient of determination values from 0.24 to 0.94, average root-mean-square errors from 0.05 kW - 5.83 kW, and mean absolute scaled errors from 0.20 to 1.33. The results indicate that both artificial neural networks yield good results for compressors using variable speed drive (average R2 = 0.8 and no naïve forecasting), only the long short-term memory model gives acceptable results for compressors using on/off control (average R2 = 0.82 and no naïve forecasting), and no satisfactory results are obtained for load/unload type air compressors (models constituting naïve forecasting). • Prediction of air compressors' electrical load using artificial neural network. • Modeling and prediction of maximum electric load demand. • Energy demand management for short-term electrical load of an air compressor. • Using the predicted energy consumption to reduce air compressor demand charges. [ABSTRACT FROM AUTHOR]

• A HB framework is used to consider similarity of adjacent basins to restrain time-varying parameter. • Four scenarios were developed to explore the spatial coherence between adjacent basins. • The proposed method succeeded in reducing the uncertainty of time-varying parameters. • The seasonality of the catchment storage was more coherent between adjacent basins. Hydrological processes became non-stationary under the influences of climate change and human activities. This non-stationarity highlights the need to adopt time-varying parameters in hydrological models. The majority of existing literature quantifies time-varying parameters by incorporating real observations of single basin into a hydrological model. They are limited in their information on catchment characteristics and climatic factors to constrain time-varying parameters. Thus, models are difficult to apply for hydrological predictions outside the calibration periods. This paper formulated the time-varying parameters for a lumped hydrological model as explicit functions of physically-based covariates that captured the catchment characteristics. Then, it used a hierarchical Bayesian framework to incorporate the similarity of adjacent basins to reduce the uncertainty of the assumed functions for time-varying parameters. Four modeling scenarios were developed to explore the spatial coherence between different characteristics of adjacent basins. Five criteria were adopted to evaluate the performance of assumed functional forms. Four spatially adjacent catchments in the central United States were selected as case studies to examine the validity of the proposed method. Results showed that (1) the proposed method succeeded in reducing the uncertainty of time-varying parameters, and (2) the seasonality of the catchment storage was more coherent between adjacent basins, indicated by the largest increase in model prediction performance (i.e., 9%). This study improved the understanding of the spatial coherence of time-varying parameters, which helps improve hydrological predictions in the future. [ABSTRACT FROM AUTHOR]

Exposure to increased air pollution, noise, and reduced surrounding greenness have been suggested as potential environmental risk factors for hypertension in adults, but limited evidence exists regarding early-life exposure, particularly from prospective studies. We investigated independent and joint associations of childhood exposure to these factors with incident hypertension in early adulthood in a US nationwide cohort. Study participants were from the Growing Up Today Study (GUTS) established in 1996 (GUTSI) and 2004 (GUTSII), who were ages 9-14 (GUTSI) or 10-17 (GUTSII) at enrollment. Incident hypertension was identified by self-report on questionnaires from 2010 to 2021. We estimated residential exposures to air pollution (from spatiotemporal models), noise, and surrounding greenness throughout childhood (10-18y). We applied Cox proportional hazards models adjusted for potential confounders to assess hazard ratios (HRs) and 95% confidence intervals (CIs) associated with each interquartile range (IQR) change in exposure. We performed a quantile g-computation to assess the joint association of simultaneous exposure to the mixture. We considered potential effect modification by sex, maternal history of hypertension, overweight/obese status at age 18, urbanicity, and neighborhood socioeconomic status. Among 17,762 participants, 1530 hypertensive cases occurred during an average follow-up of 12.8 years. HRs for all exposures were small with CIs including unity. A joint HR of 1.03 (95% CI: 0.95, 1.11) was associated with a one-quartile increase across simultaneous exposure to the environmental mixture. The joint associations were stronger among non-obese participants or participants living in less advantaged neighborhoods: HRs of 1.07 (95% CI: 0.97, 1.18) and 1.08 (95% CI: 0.98, 1.18), respectively. In conclusion, we did not identify an independent or joint association between childhood exposure to air pollution, noise, and surrounding greenness and early adulthood hypertension. However, a positive joint association was suggested among non-obese participants or those living in less advantaged neighborhoods., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: This study investigated variations in Medicare payments for Alzheimer's disease and related dementia (ADRD) by race, ethnicity, and neighborhood social vulnerability, together with cost variations by beneficiaries' enrollment in Accountable Care Organizations (ACOs)., Methods: We used merged datasets of longitudinal Medicare Beneficiary Summary File (2016-2020), the Social Vulnerability Index (SVI), and the Medicare Shared Savings Program (MSSP) ACO to measure beneficiary-level ACO enrollment at the diagnosis year of ADRD. We analyzed Medicare payments for patients newly diagnosed with ADRD for the year preceding the diagnosis and for the subsequent 3 years. The dataset included 742,175 Medicare fee-for-service (FFS) beneficiaries aged 65 and older with a new diagnosis of ADRD in 2017 who remained in the Medicare FFS plan from 2016 to 2020., Results: Among those newly diagnosed, Black and Hispanic patients encountered higher total costs compared to White patients, and ADRD patients living in the most vulnerable areas experienced the highest total costs compared to patients living in other regions. These cost differences persisted over 3 years postdiagnosis. Patients enrolled in ACOs incurred lower costs across all racial and ethnic groups and SVI areas. For ADRD patients living in the areas with the highest vulnerability, the cost differences by ACO enrollment of the total Medicare costs ranged from $4,403.1 to $6,922.7, and beneficiaries' savings ranged from $114.5 to $726.6 over three years post-ADRD diagnosis by patient's race and ethnicity., Conclusions: Black and Hispanic ADRD patients and ADRD patients living in areas with higher social vulnerability would gain more from ACO enrollment compared to their counterparts., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Tralokinumab is a fully human IgG4 monoclonal antibody targeting IL-13, used for treating atopic dermatitis. This study analyzed tralokinumab-related adverse drug events by mining the Food and Drug Administration Adverse Event Reporting System (FAERS) database to provide a safety reference for clinical application., Methods: Adverse drug event reports from Q1 2022 to Q2 2024 were extracted from the FAERS database. After standardizing the data, various signal detection methods were used for analysis, including ROR, PRR, BCPNN, and MGPS., Results: A total of 1,820 reports of adverse events (AEs) with tralokinumab as the primary suspected drug were identified. 70 preferred terms (PTs) met the criteria across four signal detection methods, involving 11 system organ classes (SOCs). These included known adverse reactions like conjunctivitis and injection site reactions, and signals not previously reported in clinical trials, such as eye pruritus, dry eye, eye swelling, pneumonia pneumococcal, and cutaneous T-cell lymphoma. Most AEs occurred within one month of initiating tralokinumab treatment., Conclusions: Based on the FAERS database, this study comprehensively and systematically analyzed AE signals in tralokinumab treatment. The results enhance the understanding of tralokinumab's safety and serve as valuable references for reducing the risk of adverse reactions during clinical use.

Introduction: Recent studies have documented the negative impact of the COVID-19 pandemic on low-income families, rural and underserved areas, and racial and ethnic minority populations. However, less is known about immigrants' healthcare access and utilization, including telehealth use. This study investigated disparities in healthcare access and utilization by immigration status among adults aged 18-64 years during the COVID-19 pandemic., Methods: This cross-sectional study pooled data from the 2020 and 2021 National Health Interview Survey (NHIS). Multivariable logistic regression models were used to estimate the variation of healthcare access and utilization by citizenship and nativity status. Immigration status (U.S.-born citizen, naturalized U.S. citizen, and non-citizen) served as the key independent variable. Healthcare access measures were dichotomized indicators of whether individuals had delayed medical care either due to cost or due to COVID-19. Healthcare utilization measures included whether individuals visited a doctor, used the emergency room, or had a telehealth visit during COVID-19., Results: Compared to U.S.-born citizens, non-citizen immigrants were more likely to delay medical care due to cost (adjusted OR = 1.375, [95%CI: 1.137, 1.662]), less likely to visit a doctor (adjusted OR = 0.71, [95%CI: 0.617, 0.817]), or visit an emergency room (adjusted OR = 0.756, [95%CI: 0.635, 0.901]). Non-citizen immigrants were less likely to have a telehealth visit (either video or phone visits) during COVID-19 (adjusted OR = 0.634, [95%CI: 0.557, 0.723])., Discussion: Compared to U.S.-born citizens, lower healthcare and telehealth utilization persisted among non-citizen immigrants during the pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Spencer, Yoon, Lee, Bustamante and Chen.)

Background: Self-reporting is often used in large epidemiologic research to identify hypertensive participants, but its validity in young adults has not been sufficiently assessed. We aimed to validate self-reported hypertension diagnosis from questionnaires by using medical records among a sample of young adults aged 22-39 years in the Growing Up Today Study (GUTS), during a time of transition in national hypertension definitions., Methods: A sample of 1,000 GUTS participants were asked for permission to access their medical records, to confirm their self-reported hypertension status on questionnaires from 2010 to 2019. Paired self-reported and medical record information was available for 318 participants. Medical records were reviewed by a clinical hypertension specialist. We evaluated agreement, kappa statistic, sensitivity and specificity of self-reporting. We assessed the correlations between blood pressure measurements self-reported on the 2019 questionnaire and those from medical records and compared the measurements using paired t-tests., Results: The selected sample was generally representative of the full GUTS cohort. Agreement, kappa coefficient, sensitivity and specificity of self-reported hypertension were 85.5%, 0.72, 100%, and 75.3%. Although the absolute differences in blood pressure measurements between self-report and medical records were small (e.g., the average difference in typical recent blood pressures was 3.5/1.2 mm Hg), these measures were only moderately correlated., Conclusions: Validity of self-reported hypertension was high in GUTS, ensuring use as an endpoint in future studies with confidence. We demonstrated that young adults likely without formal medical training are able to report hypertension status with reasonable accuracy., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Systemic lupus erythematosus (SLE) can adversely affect surgical outcomes, and the impact on revision total knee arthroplasty (TKA) outcomes is unclear. This study aimed to explore the impact of SLE on in-patient outcomes of revision TKA. The Nationwide Inpatient Sample (NIS) database from 2005 to 2018 was searched for patients aged ≥ 18 years old who received revision TKA. Patients with and without SLE were propensity score matched (PSM) at a 1:4 ratio. Associations between SLE and in-hospital outcomes were examined using regression analyses. The study included 133,054 patients, with 794 having SLE. After 1:4 PSM, data of 3,970 patients were analyzed (SLE, 794; non-SLE, 3,176). Multivariate-adjusted analyses revealed that SLE patients had a significantly higher risk of postoperative complications (adjusted odds ratio [aOR] = 1.23, 95% confidence interval [CI]: 1.05-1.44, p = 0.011), non-routine discharge (aOR = 1.22, 95% CI: 1.02-1.46, p = 0.028), major blood loss (aOR = 1.19), respiratory failure/mechanical ventilation (aOR = 1.79), acute kidney injury (AKI) (aOR = 1.47), and wound dehiscence (aOR = 2.09). SLE patients also had a longer length of hospital stay (aBeta = 0.31) and greater total hospital costs (aBeta = 6.35) compared to non-SLE patients. Among those with aseptic failure, SLE patients had a significantly higher risk of postoperative complications (aOR = 1.23) and non-routine discharge (aOR = 1.36). SLE is independently associated with worse in-hospital outcomes in patients undergoing revision TKA. This study highlights the importance of heightened vigilance and tailored perioperative management for patients undergoing major surgeries in the background of SLE. Key Points • SLE significantly increases the risk of non-routine discharge, major blood loss, respiratory failure, acute kidney injury, and wound dehiscence, in patients undergoing aseptic and septic revision TKA. • Patients with SLE experience longer hospital stays and higher hospital costs compared to those without SLE. • The study's findings highlight the necessity for healthcare providers to consider the presence of SLE as a critical factor in preoperative planning and postoperative care to improve outcomes in revision TKA patients., (© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)