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Background: Handgrip strength (HGS) and the appendicular lean mass index (ALMI) are important determinants of sarcopenia. Muscle quality (MQ) is a measure of muscle strength relative to muscle mass. We examined trends in handgrip strength, the appendicular lean mass index, and analyzed their relationship with age, anthropometry, and body composition in a sample of participants in the United States (US). Methods: This cross-sectional study analyzed data from 14,741 US males (49.7%) and females (50.3%) 6–80 years old who responded to the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014. Dual X-ray absorptiometry was used to measure appendicular skeletal muscle mass. HGS was evaluated using the Takei Digital Grip Strength Dynamometer. Smoothed normative curves for HGS and the ALMI were constructed using a generalized additive model. Multiple regression analyses were used to examine associations of HGS and the ALMI with age, nutrition-related factors, physical activity, and body composition. Results: Mean HGS and the ALMI declined with advancing age. While mean HGS increased with the ALMI, it decreased with the fat mass index. HGS increased in males with an increase in body mass index, energy intake, the ALMI, and vitamins; however, HGS in females increased with albumin, but it had a negative association with the fat mass index and age, but not with increasing adiposity. Conclusions: HGS and the ALMI change with age: HGS increases with age, then stabilizes and declines; the ALMI increases with age, then stabilizes. In addition, we provide evidence for the effect of anthropometry, nutrition, physical activity, and body composition on HGS and the ALMI in US population. [ABSTRACT FROM AUTHOR]

Background: To meet the growing demand for the science, technology, engineering, and mathematics (STEM) workforce and remain competitive in the fields of science and technology over the next decade, the United States is expected to need more than 1 million additional STEM professionals. This would require an annual increase of 34% in undergraduate STEM degrees over the next decade to meet the projected need. Purpose: This study examined the relationship between Advanced Placement (AP) STEM course‐taking in high school and selection of college STEM majors and whether the relationship differs by gender and race/ethnicity. Design/Method: For controlling student and school factors, a binary logistic regression model with the clustered standard error was utilized to determine the relationship between AP STEM course‐taking and STEM major selection. Multinomial logistic regression was conducted to further understand how AP STEM course‐taking was associated with engineering major selection. The analysis included a series of interaction effects tests, examining the variation of gender and racial/ethnic differences in STEM and, more specifically, engineering major selection as a function of AP STEM course‐taking. Results: Findings indicate gender and AP STEM course exposure are significant in predicting STEM major selection. Interaction effects test results further show that the relationship between AP STEM course‐taking and STEM major selection varies significantly by gender. A similar pattern is found in the relationship between AP STEM course‐taking and engineering major selection. Conclusion: This study provides much‐needed empirical evidence to understand the relationships between AP STEM courses course‐taking in high school and the selection of college STEM majors and how such relationships vary by race/ethnicity and gender. Additional research is encouraged to inform future educators and policymakers in promoting equity for students in pursuing paths to STEM and, more specifically, engineering‐related careers. [ABSTRACT FROM AUTHOR]

While there has been considerable policy discussion about the need to internationalize American higher education, our understanding of the internationalization in American faculty's research remains limited. This study intends to investigate the extent of internationalization in American faculty's scholarly work and what individual and institutional levers shape faculty decisions to engage internationally. The results of a 2007-2008 comparative international survey provide insights into these important issues and suggest implications for enhancing the international engagement of US faculty. [ABSTRACT FROM AUTHOR]

In the past two decades, although access to higher education for American students has improved, student persistence in 4-year institutions is far from assured. There have been a number of research studies on student persistence/dropout in higher education, but most have focused on the characteristics and behavior of students as illustrated by the 'student-centered research tradition'. This study focuses on what institutional characteristics contribute to conditions that reduce student dropout risks. By analyzing longitudinal and hierarchical data, this research proposes and tests a multilevel event history model that identifies the major institutional attributes related to student dropout risk in a longitudinal process. Evidence indicates that institutional expenditure on student services is negatively associated with student dropout behavior. Implications of the results for institutional practices and future research are discussed. [ABSTRACT FROM AUTHOR]

The article presents research regarding ways in which U.S. state policies for funding higher education impact student admissions and enrollment at universities. A brief history of student financial aid programs in the U.S. is provided which includes a description of the federally funded Pell Grant program and the shift in policy to need-based student aid during the 1980s. Particular focus within the research is paid to the relationship between higher education financing policies and the socioeconomic status (SES) and racial characteristics of students.

Background & Aims: Biomarkers are being developed as alternatives to liver biopsy for predicting liver fibrosis in patients with chronic hepatitis C. Hepascore uses noninvasive serum markers and has been validated in Australian and European populations for predicting different degrees of fibrosis. This study validated this test in a U.S. population. Methods: Patients with chronic hepatitis C virus infection were assigned to training (n = 203) or validation (n = 188) sets. Liver fibrosis was staged according to the METAVIR scoring system. The Hepascore algorithm uses data on age, sex, as well as total bilirubin, γ-glutamyl transferase, α2-macroglobulin, and hyaluronic acid levels. Results: The ability of Hepascore to predict significant fibrosis (F2–4) as determined by the area under the receiver operating curve was similar in training (0.83) and validation sets (0.81) and was comparable to results seen in previous studies. A cutoff score of ≥0.55 was best for predicting significant fibrosis, with a sensitivity and specificity of 82% and 65% and positive and negative predictive values of 70% and 78%. When compared with 2 simple indices, FIB-4 (age, platelets, AST, and ALT) and APRI (AST/platelet ratio index), Hepascore performed better at excluding advanced fibrosis by using a low cutoff score but worse at predicting fibrosis by using a high cutoff score. An algorithm with Hepascore followed by FIB-4 or APRI spared 103 of 391 individuals a liver biopsy and missed advanced fibrosis in only 1 patient. Conclusions: Hepascore accurately predicted likelihood of developing fibrosis and could alleviate the need for liver biopsy in a subset of patients. [Copyright &y& Elsevier]

Background and Purpose: Clinical studies have demonstrated that edaravone dexborneol can improve the functional outcomes in patients with acute ischaemic stroke (AIS). The present clinical trial aimed at testing the efficacy and safety of Y-2 sublingual tablet on 90-day functional outcome in patients with AIS., Methods and Design: This is a randomised, double-blind, placebo-controlled, multicentre, parallel-group trial of Y-2 sublingual tablet on patients with AIS.An estimated 914 patients at age of 18-80 years with AIS within 48 hours after symptom onset from 40 hospitals will be randomly assigned to receive Y-2 sublingual tablet or placebo for 14 days. Patients are at score 6-20 points on National Institutes of Health Stroke Scale (NIHSS) and had a modified Rankin Scale (mRS) ≤1 before this stroke, except mechanical thrombectomy and neuroprotective agents treatment., Study Outcomes: The primary outcome is the proportion of patients with mRS ≤1 on day 90 after randomisation. Secondary efficacy outcomes include mRS score on day 90, the proportion of patients with mRS ≤2 on day 90; the change of NIHSS score from baseline to day 14 and the proportion of patients with NIHSS score ≤1 at the days 14, 30 and 90., Discussion: This trial will provide valuable evidence for the efficacy and safety of Y-2 sublingual table for improving 90 days the functional outcomes in patients with AIS., Trial Registration Number: NCT04950920., Competing Interests: Competing interests: RT, JR, SZ and XF are the employees of Simcere Pharmaceutical Group; RC is the employee of Neurodawn Pharmaceutical. Those companies have developed the drug and sponsored the trial. The above-mentioned five authors from companies provided information on the pharmacological mechanism of drugs, gave preclinical experimental data and advised on study design. No other competing interests were reported., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Exposure of biological systems to acute or chronic insults triggers a host of molecular and physiological responses to either tolerate, adapt, or fully restore homeostasis; these responses constitute the hallmarks of resilience. Given the many facets, dimensions, and discipline-specific focus, gaining a shared understanding of "resilience" has been identified as a priority for supporting advances in cardiovascular health. This report is based on the working definition: "Resilience is the ability of living systems to successfully maintain or return to homeostasis in response to physical, molecular, individual, social, societal, or environmental stressors or challenges," developed after considering many factors contributing to cardiovascular resilience through deliberations of multidisciplinary experts convened by the National Heart, Lung, and Blood Institute during a workshop entitled: "Enhancing Resilience for Cardiovascular Health and Wellness." Some of the main emerging themes that support the possibility of enhancing resilience for cardiovascular health include optimal energy management and substrate diversity, a robust immune system that safeguards tissue homeostasis, and social and community support. The report also highlights existing research challenges, along with immediate and long-term opportunities for resilience research. Certain immediate opportunities identified are based on leveraging existing high-dimensional data from longitudinal clinical studies to identify vascular resilience measures, create a 'resilience index,' and adopt a life-course approach. Long-term opportunities include developing quantitative cell/organ/system/community models to identify resilience factors and mechanisms at these various levels, designing experimental and clinical interventions that specifically assess resilience, adopting global sharing of resilience-related data, and cross-domain training of next-generation researchers in this field., (© 2022 The Authors. The FASEB Journal published by Wiley Periodicals LLC on behalf of Federation of American Societies for Experimental Biology.)

Research and data analysis show that there is a shortage of primary care providers throughout the United States. Physician assistants (PAs) play an important role in health care delivery; however, the percentage of PAs practicing in primary care has dramatically decreased in the past 15 years. The purpose of this study was to identify potential factors that influence PA students' first job choice following graduation from a PA program to determine whether they have a relationship to the choosing of primary care. The 2016 End of Program Survey data were analyzed using a multinominal logistic regression to determine what factors influenced PA students' selections of primary care as their first job choice: individual factors, program factors, and external factors. Of the 3038 subjects, 269 (8.9%) accepted a job in primary care, 847 (27.9%) accepted a specialty job, and 1922 (63.3%) did not accept a job. When comparing no job accepted versus primary care job choice, marital status and racial/ethnic differences influenced first job choice. Financial factors were also found to be significant predictors. In the second model, comparing specialty versus primary care job choice, marital status influenced first job choice along with financial factors. In addition, one program variable (moderate clinical rotation experience) was found to be statistically significant in the model of specialty versus primary care job choice. Financial factors were found to be the greatest predictor in first job choice. Focusing on policy to help reduce student debt and increase reimbursement rates could help increase the number of students choosing primary care.

Context: The hypothalamic melanocortin 4 receptor (MC4R) pathway serves a critical role in regulating body weight. Loss of function (LoF) mutations in the MC4R pathway, including mutations in the pro-opiomelanocortin (POMC), prohormone convertase 1 (PCSK1), leptin receptor (LEPR), or MC4R genes, have been shown to cause early-onset severe obesity., Methods: Through a comprehensive epidemiological analysis of known and predicted LoF variants in the POMC, PCSK1, and LEPR genes, we sought to estimate the number of US individuals with biallelic MC4R pathway LoF variants., Results: We predict ~650 α-melanocyte-stimulating hormone (MSH)/POMC, 8500 PCSK1, and 3600 LEPR homozygous and compound heterozygous individuals in the United States, cumulatively enumerating >12,800 MC4R pathway-deficient obese patients. Few of these variants have been genetically diagnosed to date. These estimates increase when we include a small subset of less rare variants: β-MSH/POMC,PCSK1 N221D, and a PCSK1 LoF variant (T640A). To further define the MC4R pathway and its potential impact on obesity, we tested associations between body mass index (BMI) and LoF mutation burden in the POMC, PCSK1, and LEPR genes in various populations. We show that the cumulative allele burden in individuals with two or more LoF alleles in one or more genes in the MC4R pathway are predisposed to a higher BMI than noncarriers or heterozygous LoF carriers with a defect in only one gene., Conclusions: Our analysis represents a genetically rationalized study of the hypothalamic MC4R pathway aimed at genetic patient stratification to determine which obese subpopulations should be studied to elucidate MC4R agonist (e.g., setmelanotide) treatment responsiveness.

Background: The combination of airbag and seat belt is considered to be the most effective vehicle safety system. However, despite the widespread availability of airbags and a belt use rate of more than 85%, US drivers involved in crashes continue to be at risk of serious thoracic injury. The objective of this study was to determine the influence of steering wheel deformation on driver injury risk in frontal automobile crash., Methods: The analysis is based on cases extracted from the National Automotive Sampling System Crashworthiness Data System database for case years 1993 to 2011. The approach was to compare the adjusted odds of frontal crash injury experienced by drivers in vehicles with and without steering wheel deformation., Results: Among frontal crash cases with belted drivers, observable steering wheel deformation occurred in less than 4% of all cases but accounted for 30% of belted drivers with serious (Abbreviated Injury Scale [AIS] score, 3+) thoracic injuries. Similarly, steering wheel deformation occurred in approximately 13% of unbelted drivers but accounted for 60% of unbelted drivers with serious thoracic injuries. Belted drivers in frontal crashes with steering wheel deformation were found to have two times greater odds of serious thoracic injury. Unbelted drivers were found to have four times greater odds of serious thoracic injury in crashes with steering wheel deformation. In frontal crashes, steering wheel deformation was more likely to occur in unbelted drivers than belted drivers, as well as higher severity crashes and with heavier drivers., Conclusion: The results of the present study show that airbag deployment and seat belt restraint do not completely eliminate the possibility of steering wheel contact. Even with the most advanced restraint systems, there remains an opportunity for further reduction in thoracic injury by continued enhancement to the seat belt and airbag systems. Furthermore, the results showed that steering wheel deformation is an indicator of potential serious thoracic injury and can be useful to prehospital personnel in improving the diagnosis of serious injuries., Level of Evidence: Prognostic study, level III.

Diseases such as type 2 diabetes (T2D) result from environmental and genetic factors, and risk varies considerably in the population. T2D-related genetic loci discovered to date explain only a small portion of the T2D heritability. Some heritability may be due to gene-environment interactions. However, documenting these interactions has been difficult due to low availability of concurrent genetic and environmental measures, selection bias, and challenges in controlling for multiple hypothesis testing. Through genome-wide association studies (GWAS), investigators have identified over 90 single nucleotide polymorphisms (SNPs) associated to T2D. Using a method analogous to GWAS [environment-wide association study (EWAS)], we found five environmental factors associated with the disease. By focusing on risk factors that emerge from GWAS and EWAS, it is possible to overcome difficulties in uncovering gene-environment interactions. Using data from the National Health and Nutrition Examination Survey (NHANES), we screened 18 SNPs and 5 serum-based environmental factors for interaction in association to T2D. We controlled for multiple hypotheses using false discovery rate (FDR) and Bonferroni correction and found four interactions with FDR <20 %. The interaction between rs13266634 (SLC30A8) and trans-β-carotene withstood Bonferroni correction (corrected p = 0.006, FDR <1.5 %). The per-risk-allele effect sizes in subjects with low levels of trans-β-carotene were 40 % greater than the marginal effect size [odds ratio (OR) 1.8, 95 % CI 1.3-2.6]. We hypothesize that impaired function driven by rs13266634 increases T2D risk when combined with serum levels of nutrients. Unbiased consideration of environmental and genetic factors may help identify larger and more relevant effect sizes for disease associations.

Background: A family history of prostate cancer (PCa) or breast cancer (BCa) has been associated with the risk of PCa, but the risks were inconsistent in terms of the affected family members, and data in the PSA era are limited., Methods: This study included a subcohort of the Health Professionals Follow-Up Study composed of a highly PSA screened population from 1986 to 2004 with 3,695 PCa cases identified. Questionnaires and a food frequency questionnaire were administered every other and every 4 years, respectively. Family history of PCa and BCa was ascertained in 1990, 1992, and 1996. All statistics were two-sided., Results: A family history of PCa in both a father and brother(s) was associated with a 2.3-fold increased risk of PCa [95% confidence interval (CI) = 1.76-3.12]. Men with a father or brother(s) with a PCa diagnosis at age<60 and >or=60 had 2.16- and 1.95-fold increased risk of PCa, respectively. A family history of PCa was related to early-onset PCa (<65 years: RR = 2.25, 95% CI = 1.95-2.60) and weakly to late-onset PCa (>or=65 years: RR = 1.67, 95% CI = 1.52-1.85). History of BCa in a mother or a sister was associated with a 1.22-fold increased risk of PCa (95% CI = 1.08-1.38)., Conclusion: A family history of PCa or BCa significantly increases PCa risk. These associations are evident in a population with widespread PSA screening.