Search

Employer vaccination requirements have been used to increase vaccination uptake among healthcare personnel (HCP). In summer 2021, HCP were the group most likely to have employer requirements for COVID-19 vaccinations as healthcare facilities led the implementation of such requirements. This study examined the association between employer requirements and HCP's COVID-19 vaccination status and attitudes about the vaccine. Participants were a national representative sample of United States (US) adults who completed the National Immunization Survey Adult COVID Module (NIS-ACM) during August–September 2021. Respondents were asked about COVID-19 vaccination and intent, requirements for vaccination, place of work, attitudes surrounding vaccinations, and sociodemographic variables. This analysis focused on HCP respondents. We first calculated the weighted proportion reporting COVID-19 vaccination for HCP by sociodemographic variables. Then we computed unadjusted and adjusted prevalence ratios for vaccination coverage and key indicators on vaccine attitudes, comparing HCP based on individual self-report of vaccination requirements. Of 12,875 HCP respondents, 41.5% reported COVID-19 vaccination employer requirements. Among HCP with vaccination requirements, 90.5% had been vaccinated against COVID-19, as compared to 73.3% of HCP without vaccination requirements—a pattern consistent across sociodemographic groups. Notably, the greatest differences in uptake between HCP with and without employee requirements were seen in sociodemographic subgroups with the lowest vaccination uptake, e.g., HCP aged 18–29 years, HCP with high school or less education, HCP living below poverty, and uninsured HCP. In every sociodemographic subgroup examined, vaccine uptake was more equitable among HCP with vaccination requirements than in HCP without. Finally, HCP with vaccination requirements were also more likely to express confidence in the vaccine's safety (68.3% vs. 60.1%) and importance (89.6% vs 79.6%). In a large national US sample, employer requirements were associated with higher and more equitable HCP vaccination uptake across all sociodemographic groups examined. Our findings suggest that employer requirements can contribute to improving COVID-19 vaccination coverage, similar to patterns seen for other vaccines. [ABSTRACT FROM AUTHOR]

Introduction: State-level monitoring of changes in tobacco product use can inform tobacco control policy and practice. This study examines the state-specific prevalence of current cigarette smoking, smokeless tobacco use, and E-cigarette use and related cigarette quitting behaviors among E-cigarette users during 2017-2018.Methods: Data from the 2017 and 2018 Behavioral Risk Factor Surveillance System were used to assess state-specific current use of cigarettes, smokeless tobacco, and E-cigarettes among adults aged ≥18 years. Analyzed in 2021, state-specific tobacco product estimates and relative percentage changes between 2017 and 2018 were computed for U.S. states and the District of Columbia. Chi-square tests captured subgroup differences, and logistic regression assessed changes over time.Results: Prevalence of adult current cigarette smoking and smokeless tobacco use varied across states and remained relatively stable during 2017-2018, whereas the prevalence of adult E-cigarette use significantly increased during 2017-2018 among 19 of 36 states that collected Behavioral Risk Factor Surveillance System E-cigarette data in 2018. In all states and the District of Columbia during 2017-2018 combined, the percentage of current cigarette smoking among current E-cigarette users was higher than that of never cigarette smoking; the percentage of attempting to quit cigarette smoking in the past year among dual users of cigarettes and E-cigarettes was >50%.Conclusions: During 2017-2018, the prevalence of adult current cigarette smoking and smokeless tobacco use varied across states and remained relatively stable, whereas adult E-cigarette use prevalence significantly increased. Comprehensive state-based tobacco prevention and control efforts are warranted to reduce the morbidity and mortality attributed to the use of all tobacco products, including E-cigarettes, among U.S. adults. [ABSTRACT FROM AUTHOR]

Tobacco smoking is the leading cause of preventable disease and death in the United States, resulting in approximately 480,000 premature deaths and more than $300 billion in direct health care expenditures and productivity losses each year (1). To assess progress toward achieving the Healthy People 2020 objective of reducing the percentage of U.S. adults who smoke cigarettes to ≤12.0%,* CDC assessed the most recent national estimates of smoking prevalence among adults aged ≥18 years using data from the 2014 National Health Interview Survey (NHIS). The percentage of U.S. adults who smoke cigarettes declined from 20.9% in 2005 to 16.8% in 2014. Among daily cigarette smokers, declines were observed in the percentage who smoked 20–29 cigarettes per day (from 34.9% to 27.4%) or ≥30 cigarettes per day (from 12.7% to 6.9%). In 2014, prevalence of cigarette smoking was higher among males, adults aged 25–44 years, multiracial persons and American Indian/Alaska Natives, persons who have a General Education Development certificate, live below the federal poverty level, live in the Midwest, are insured through Medicaid or are uninsured, have a disability or limitation, or are lesbian, gay, or bisexual. Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, high impact mass media campaigns, and barrier-free access to quitting assistance, are critical to reduce cigarette smoking and smoking-related disease and death among U.S. adults. [ABSTRACT FROM AUTHOR]

While significant declines in cigarette smoking have occurred among U.S. adults during the past 5 decades, the use of emerging tobacco products* has increased in recent years (1-3). To estimate tobacco use among U.S. adults aged ≥18 years, CDC and the Food and Drug Administration (FDA) analyzed data from the 2013-2014 National Adult Tobacco Survey (NATS). During 2013-2014, 21.3% of U.S. adults used a tobacco product every day or some days, and 25.5% of U.S. adults used a tobacco product every day, some days, or rarely. Despite progress in reducing cigarette smoking, during 2013-2014, cigarettes remained the most commonly used tobacco product among adults. Young adults aged 18-24 years reported the highest prevalence of use of emerging tobacco products, including water pipes/hookahs and electronic cigarettes (e-cigarettes). Furthermore, racial/ethnic and sociodemographic differences in the use of any tobacco product were observed, with higher use reported among males; non-Hispanic whites, non-Hispanic blacks, and non-Hispanics of other races(†); persons aged <45 years; persons living in the Midwest or South; persons with a General Educational Development (GED) certificate; persons who were single/never married/not living with a partner or divorced/separated/widowed; persons with annual household income <$20,000; and persons who were lesbian, gay, or bisexual (LGB). Population-level interventions that focus on all forms of tobacco product use, including tobacco price increases, high-impact anti-tobacco mass media campaigns, comprehensive smoke-free laws, and enhanced access to help quitting tobacco use, in conjunction with FDA regulation of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States.(§). [ABSTRACT FROM AUTHOR]

The article reports on the estimated tobacco use among adults in the U.S. from 2012 to 2013 based on data from the 2012-2013 National Adult Tobacco Survey (NATS). It discusses an estimated 21.3% of U.S. adults who used any tobacco product every day or some days during the period, the higher percentage of tobacco use every day or some days among men than women and a proposal by the U.S. Food and Drug Administration (FDA) to extend its authority to additional tobacco products in April 2014.

HCV infections are two-times more prevalent in black Americans than in whites. We previously reported that treatment with peginterferon alfa-2a plus ribavirin produced a sustained virologic response (SVR) rate of 26% in blacks, a lower efficacy compared with the SVR in whites. Here we detail the safety profile of peginterferon alfa-2a plus ribavirin and the relationship between treatment adherence, defined by cumulative drug exposure, and SVR in 78 black patients infected with HCV genotype 1. Sixty-two (79%) patients completed 48 weeks of combination treatment. Peginterferon alfa-2a dose was modified for neutropenia in 36 patients (46%), whereas ribavirin dose was modified due to anemia in 31 patients (40%). The SVR rate was related to medication exposure, based on the percentage of the planned doses of peginterferon and ribavirin that the patients received. The SVR rates were 33, 25 and 0% in patients who received >80, 61–80 and ≤60% of the planned peginterferon, respectively. The SVR rates were 28, 33 and 18% in patients who received >80, 61–80 and ≤60% of the planned ribavirin. The SVR rate was 29% (11 of 38) in patients who received >80% of the total planned doses of both peginterferon and ribavirin and 7% (1 of 14) in patients who received ≤80% of both medicines. The SVR was 30% in patients who received >60% exposure to both, and 0% in patients with ≤60% exposure. In conclusion, peginterferon alfa-2a plus ribavirin demonstrated good safety and tolerability profiles in blacks infected with HCV genotype 1. Adherence to at least >60% of the planned peginterferon alfa-2a and ribavirin doses for 48 weeks was associated with a greater SVR in black patients with HCV genotype 1 infections. [ABSTRACT FROM AUTHOR]

Introduction: Research in gender-affirming chest surgery has primarily compared cisgender versus transgender and gender-diverse (TGD) people, without specifically addressing nonbinary people. This study will assess surgical complications between cisgender, transgender, and nonbinary adults undergoing breast reductions., Methods: The National Surgical Quality Improvement Program databases from 2015 to 2021 were used to identify TGD patients who underwent breast reduction (Current Procedural Terminology code: 19318) and cisgender patients who underwent this procedure for cosmesis or cancer prophylaxis. Analysis of variance tests, chi-squared tests, unpaired t-tests, and regression models compared complications among cisgender, transgender, and nonbinary patients., Results: A total of 1222 patients met the inclusion criteria: 380 (31.1%) were cisgender, 769 (62.9%) were transgender, and 73 (6.0%) were nonbinary. The proportion of TGD patients grew significantly relative to cisgender patients over the study period (P < 0.001). The overall all-cause complication rate was 3.4%, with 4.2% of cisgender, 1.4% of nonbinary, and 3.1% of transgender patients experiencing surgical complications. After adjusting for confounding variables, no statistically significant difference was observed in all-cause complication rates between the cohorts. In the sample, 19 transgender patients (2.5%) underwent reoperation. Transgender patients had a lower likelihood of wound complications (odds ratio: 0.172; 95% confidence interval: 0.035-0.849; P = 0.031) compared to cisgender patients and nonbinary patients. None of the patients experienced a severe systemic complication., Conclusions: The findings emphasize the growing demand and safety of gender-affirming breast reductions. They underscore the importance of continued research and tailored approaches to delivering care to nonbinary and transgender patients, addressing their diverse needs and improving access to gender-affirming surgeries., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: To evaluate the association between surgical modality (RARC vs. ORC) and the risk of 30-day complications., Materials and Methods: We utilized the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Cystectomy-Targeted database from 2019 to 2021. The primary outcome was a composite of major complications including 30-day mortality, reoperation, cardiac events, and stroke. Secondary outcomes included individual major and cystectomy-specific complications. Propensity score matching (PSM) was employed to minimize inherent differences within our cohort. We performed logistic regression to assess the association between outcomes of interest and operative modality., Results: We found no difference between operative modality and the primary outcome, however, RARC was associated with a 70% lower risk of 30-day mortality (OR 0.30, 95% CI 0.13-0.70) and had favorable outcomes with respect to respiratory, deep venous thrombosis, wound complications, and length of stay. Limitations are related to residual confounding given the observational methodology., Conclusions: RARC was associated with reduced risk of multiple 30-day complications, including mortality, as well as organ system and cystectomy-specific outcomes. These data support the clinical benefit of increased adoption of RARC., Competing Interests: Declaration of competing interest We declare that all the authors have no declarations and no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Recruiting participants for clinical trials poses challenges. Major barriers to participation include psychological factors (eg, fear and mistrust) and logistical constraints (eg, transportation, cost, and scheduling). The strategic design of clinical trial messaging can help overcome these barriers. While strategic communication can be done through various channels (eg, recruitment advertisements), health care providers on the internet have been found to be key sources for communicating clinical trial information to US adults in the social media era., Objective: This study aims to examine how communication source (ie, medical doctors and peers) and message framing of TikTok videos (ie, psychological and logistical framing) influence clinical trial-related attitudes, perceptions, and sign-up behaviors under the guidance of the integrated behavioral model., Methods: This study used a 2 (source: doctor vs peer) × 2 (framing: psychological vs logistical) between-participant factorial design web-based experiment targeting adults in the United States who had never participated in clinical trials (ie, newcomers). A Qualtrics panel was used to recruit and compensate the study respondents (n=561). Participants viewed short-form videos with doctors or peers, using psychological or logistical framing. The main outcome measures included perceived source credibility, self-efficacy, attitude toward clinical trial participation, behavioral intention, and sign-up behavior. Structural equation modeling was used to analyze the direct and indirect effects of message factors on the outcome variables. Source (doctor=1; peer=0) and framing (psychological=1; logistical=0) were dummy-coded., Results: Doctor-featured messages led to greater perceived source credibility (β=.31, P<.001), leading to greater self-efficacy (95% CI 0.13-0.30), which in turn enhanced behavioral intention (95% CI 0.12-0.29) and clinical trial sign-up behavior (95% CI 0.02-0.04). Logistical barrier-framed messages led to greater self-efficacy (β=-.09, P=.02), resulting in higher intention to participate in clinical trials (95% CI -0.38 to -0.03) and improved sign-up behavior (95% CI -0.06 to -0.004). Logistical barrier-framed messages were also directly associated with an increased likelihood of signing up for a clinical trial (β=-.08, P=.03). The model accounted for 21% of the variance in clinical trial sign-up behavior. Attitude did not significantly affect behavioral intention in this study (β=.08, P=.14), and psychological and logistical barrier-framed messages did not significantly differ in attitudes toward clinical trial participation (β=-.04, P=.09)., Conclusions: These findings advance our understanding of how people process popular message characteristics in short-form videos and lend practical guidance for communicators. We encourage medical professionals to consider short-form video sites (eg, TikTok and Instagram Reels) as effective tools for discussing clinical trials and participation opportunities. Specifically, featuring doctors discussing efforts to reduce logistical barriers is recommended. Our measuring of actual behavior as an outcome is a rare and noteworthy contribution to this research., (©Sisi Hu, Ciera E Kirkpatrick, Namyeon Lee, Yoorim Hong, Sungkyoung Lee, Amanda Hinnant. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 15.08.2024.)

The large real-world EHR dataset Flatiron has shown that race was not significantly associated with poorer survival in patients with DLBCL. Medicaid insurance status was significantly associated with poorer overall survival and time to second-line therapy or death due to any cause in patients with DLBCL aged <65 years., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Since late 2019, COVID-19 has significantly impacted the world. Understanding the evolution of SARS-CoV-2 is crucial for protecting against future infectious pathogens. In this study, we conducted a comprehensive chronological analysis of SARS-CoV-2 evolution by examining mutation prevalence from the source countries of VOCs: United Kingdom, India, Brazil, South Africa, plus two countries: United States, Russia, utilizing genomic sequences from GISAID. Our methodological approach involved large-scale genomic sequence alignment using MAFFT, Python-based data processing on a high-performance computing platform, and advanced statistical methods the Maximal Information Coefficient (MIC), and also Long Short-Term Memory (LSTM) models for correlation analysis. Our findings elucidate the dynamics of SARS-CoV-2 evolution, highlighting the virus's changing behaviour over various pandemic stages. Key results include the discovery of three temporal mutation patterns-lineage distinct, long-span, and competitive mutations-with varying levels of impact on the virus. Notably, we observed a convergence of advantageous mutations in the spike protein, especially in the later stages of the pandemic, indicating a substantial evolutionary pressure on the virus. One of the most significant revelations is the predominant role of natural immunity over vaccination-induced immunity in driving these evolutionary changes. This emphasizes the critical need for regular vaccine updates to maintain efficacy against evolving strains. In conclusion, our study not only sheds light on the evolutionary trajectory of SARS-CoV-2 but also underscores the urgency for robust, continuous global data collection and sharing. It highlights the necessity for rapid adaptations in medical countermeasures, including vaccine development, to stay ahead of pathogen evolution. This research provides valuable insights for future pandemic preparedness and response strategies., 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. Published by Elsevier B.V.)

Background: The importance of vaccination in combating the COVID-19 pandemic is widely acknowledged. The aim of this study was (1) to understand how one's vaccine conspiracy beliefs would influence their public health news processing, (2) to examine how specific public health news features (i.e., news frame) would influence message processing, and (3) to examine if there were any differences between Black and White participants in their message processing., Methods: A nationwide online experiment (N = 821) with a 3 (vaccine conspiracy beliefs: high vs. moderate vs. low) × 2 (participants' race: Black vs. White) × 2 (news frames: gain vs. loss) mixed-factorial design was conducted in the United States., Results: Participants' level of vaccine conspiracy beliefs was predictive of their responses to outcome measures. Additionally, Black participants reported higher perceived message effectiveness, more favorable attitudes toward the message, and higher vaccination intentions than White participants. Furthermore, health news that emphasized vaccination benefits produced more favorable attitudes than those emphasizing losses associated with non-vaccination, especially for White participants. Lastly, participants reported more favorable attitudes toward gain-framed health news regardless of their vaccine conspiracy beliefs., Conclusion: It is crucial for health officials to work to find effective media message strategies to combat COVID-19 vaccine conspiracy theories and misinformation. Furthermore, this study supports the significance of health organizations' ongoing efforts to tailor public health messaging to specific racial groups, as evidenced by considerable variations in perceptions among Black and White Americans., 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. Published by Elsevier India Pvt Ltd.)

Background: Significant scientific research has been conducted concerning menopausal syndrome(MPS), yet few bibliometric analyses have been performed. Our aim was to recognise the 100 most highly cited published articles on MPS and to analytically evaluate their key features., Methods: To identify the 100 most frequently cited articles, a search was conducted on Web of Science using the term 'menopausal syndrome'. Articles that matched the predetermined criteria were scrutinised to obtain the following data: citation ranking, year of publication, publishing journal, journal impact factor, country of origin, academic institution, authors, study type, and keywords., Results: The publication period is from January 1, 2000, to August 31, 2022. The maximum number of citations was 406 and in 2012. The median citations per year was 39.70. Most of the articles focused on treatment and complications. These articles were published in 36 different journals, with the Journal of MENOPAUSE having published the greatest number (14%). Forty-eight articles (48%) were from the United States, with the University of Pittsburgh being the leading institute (9%). Joann E. Manson was the most frequent first author (n = 6). Observational studies were the most frequently conducted research type (n = 53), followed by experimental studies (n = 33). Keyword analysis identified classic research topics, including genitourinary syndrome of menopause, bone mineral density (BMD), and anti-mullerian hormone (AMH) loci., Conclusion: Using bibliometrics, we conducted an analysis to identify the inadequacies, traditional focal points, and potential prospects in the study of MPS across current scientific areas. Treatment and complications are at the core of MPS research, whereas prediction and biomarkers have less literature of high quality. There is a necessity for innovative analytical metrics to measure the real effect of these papers with a high level of citation on clinical application., (© 2024. The Author(s).)

We employed a Bayesian network meta-analysis for comparison of the efficacy and tolerability of US Food and Drug Administration (FDA)-approved atypical antipsychotics (AAPs) for the treatment of bipolar patients with depressive episodes. Sixteen randomized controlled trials with 7234 patients treated by one of the five AAPs (cariprazine, lumateperone, lurasidone, olanzapine, and quetiapine) were included. For the response rate (defined as an improvement of ≥50% from baseline on the Montgomery-Åsberg Depression Rating Scale [MADRS]), all AAPs were more efficacious than placebo. For the remission rate (defined as the endpoint of MADRS ≤12 or ≤ 10), cariprazine, lurasidone, olanzapine, and quetiapine had higher remission rates than placebo. In terms of tolerability, olanzapine was unexpectedly associated with lower odds of all-cause discontinuation in comparison with placebo, whereas quetiapine was associated with higher odds of discontinuation due to adverse events than placebo. Compared with placebo, lumateperone, olanzapine, and quetiapine showed higher odds of somnolence. Lumateperone had a lower rate of ≥ weight gain of 7% than placebo and other treatments. Olanzapine was associated with a significant increase from baseline in total cholesterol and triglycerides than placebo. These findings inform individualized prescriptions of AAPs for treating bipolar depression in clinical practice.

Ectopic adrenocorticotropic hormone syndrome (EAS) is a rare condition caused by pancreatic neuroendocrine tumors (p-NETs). The severe hypercortisolemia that characterizes EAS is associated with a poor prognosis and survival. Mitotane is the only adrenolytic drug approved by the Food and Drug Administration and is often used to treat adrenocortical carcinoma. Combination therapy with mitotane and other adrenal steroidogenesis inhibitors is common for patients with Cushing's syndrome (CS). Here, we describe three patients who developed EAS secondary to the liver metastasis of p-NETs. All three rapidly developed hypercortisolemia but no typical features of CS. They underwent anti-tumor and mitotane therapy, which rapidly reduced their blood cortisol concentrations and ameliorated their symptoms. Their hypercortisolemia was controlled long term using a low dose of mitotane. The principal adverse effects were a slight loss of appetite and occasional dizziness, and there were no severe adverse effects. Importantly, even when the tumor progressed, the patients' circulating cortisol concentrations remained within the normal range. In summary, the present case series suggests that mitotane could be used to treat hypercortisolemia in patients with EAS caused by advanced p-NETs, in the absence of significant adverse effects., Competing Interests: Declaration of conflicting interestsThe authors declare that there is no conflict of interest.

Rationale: With the advancement of targeted therapies, epidermal growth factor receptor tyrosine kinase inhibitors have become the preferred initial treatment for patients with advanced epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer. Osimertinib, a third-generation epidermal growth factor receptor tyrosine kinase inhibitor, is effective against exon 19 and 21 mutations as well as the T790M mutation. It has been approved by both the food and drug administration and European Medicines Agency for the treatment of non-small cell lung cancer patients with locally advanced or metastatic EGFR-mutated tumors, including those who have acquired T790M mutations., Patient Concerns: To evaluate the effectiveness of osimertinib in treating patients with EGFR-mutated advanced lung adenocarcinoma and bone metastases, we present the treatment outcomes of 3 patients with EGFR 19 deletion-mutated advanced lung adenocarcinoma and bone metastases who received osimertinib treatment in recent years. All 3 cases involved elderly female patients, aged 62, 62, and 54, respectively., Diagnoses: All 3 cases exhibited a diagnosis of pulmonary adenocarcinoma accompanied by osseous metastases, with genetic testing revealing the presence of an EGFR 19del mutation., Interventions: In the first case, following 17 months of gefitinib therapy, disease progression prompted a switch to osimertinib treatment. In the second case, bone metastases were detected after 20 months of pemetrexed-carboplatin chemotherapy, leading to a transition to osimertinib therapy. In the third case, after 11 months of erlotinib treatment, bone metastases were identified. Subsequent interventions, including radiation therapy, pemetrexed-carboplatin chemotherapy, pemetrexed-bevacizumab maintenance therapy, and docetaxel chemotherapy, failed to arrest the progression of bone metastases. As a result, a combination of osimertinib and anlotinib targeted therapy was administered., Outcomes: All 3 patients experienced relatively good and favorable survival outcomes, with a progression-free survival of 22.7 months, 12 months, and 17.7 months, respectively., Lessons: These cases suggest that osimertinib is a promising treatment option for patients with EGFR 19 deletion-mutated lung adenocarcinoma and bone metastases, although further clinical studies are needed to confirm its efficacy., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: To examine whether survey setting was associated with youth reporting of current (past 30-day) use of any tobacco product, e-cigarettes, cigarettes, and cigars., Methods: Data from the 2021 National Youth Tobacco Survey (NYTS) were used to estimate the prevalence of current use of any tobacco product, e-cigarettes, cigarettes, and cigars by survey setting, sociodemographic characteristics, peer tobacco use, and other tobacco product use. Multivariable regression was used to test the impact of survey setting on current tobacco use. Tobacco access sources among current users were compared by survey setting., Results: Among students who participated in the 2021 NYTS, 50.8% reported taking the survey on school campus and 49.2% at home/other place. The prevalence of current use of any tobacco product, e-cigarettes, cigarettes, and cigars was higher among students completing the survey on school campus than at home/other place. After adjusting for covariates, this association persisted only for current use of any tobacco product (adjusted odds ratio = 1.57; 95% confidence interval, 1.28-1.91) and e-cigarettes (adjusted odds ratio = 1.43; 95% confidence interval, 1.20-1.71). Current users reported similar sources of access to tobacco products, regardless of survey setting., Discussion: The likelihood of youth reporting current use of any tobacco product and e-cigarettes differed by survey setting. Such differences could be due to lack of privacy at home, peer influence in school settings, and other unmeasured characteristics. Methodological changes were made due to COVID-19; caution is warranted in comparing results from the 2021 NYTS with those of previous or future NYTS conducted primarily on school campus., (Published by Elsevier Inc.)

Background: Ovarian cancer is the fifth most common female cancer in the United States. There have been very few studies investigating mental health diagnoses among ovarian cancer survivors with long-term follow up. The aim of this study is to examine the incidence of mental illness among ovarian cancer survivors compared to a general population cohort. A secondary aim is to investigate risk factors for mental illnesses among ovarian cancer survivors., Patients and Methods: Cohorts of 1689 ovarian cancer patients diagnosed between 1996 and 2012 and 7038 women without cancer matched by age and birth state from the general population were identified. Mental health diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios (HRs)., Results: Ovarian cancer survivors experienced increased risks of mental illnesses within the first 2 years after cancer diagnosis (HR = 3.55, 95% CI = 3.04-4.14). The risks of depression among ovarian cancer survivors were nearly 3-fold within the first 2 years of cancer diagnosis (HR = 2.59, 95% CI = 1.94-3.47), and 1.69-fold at 2-5 years after cancer diagnosis (HR = 1.69, 95% CI = 1.18-2.42). Ovarian cancer survivors experienced an 80% increased risk of death with a mental illness diagnosis (HR = 1.80, 95% CI = 1.48-2.18) and a 94% increased risk of death with a depression diagnosis (HR = 1.94, 95% CI = 1.56-2.40)., Conclusions: Higher risks of mental illnesses were observed among ovarian cancer survivors throughout the follow-up periods of 0-2 years and 2-5 years after cancer diagnosis. Multidisciplinary care is needed to monitor and treat mental illnesses among ovarian cancer survivors., (© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Vaccine hesitancy has been identified as a major obstacle preventing comprehensive coverage against the COVID-19 pandemic. However, few studies have analyzed the association between ex-ante vaccine hesitancy and ex-post vaccination coverage. This study leveraged one-year county-level data across the contiguous United States to examine whether the prospective vaccine hesitancy eventually translates into differential vaccination rates, and whether vaccine hesitancy can explain socioeconomic, racial, and partisan disparities in vaccine uptake. A set of structural equation modeling was fitted with vaccine hesitancy and vaccination rate as endogenous variables, controlling for various potential confounders. The results demonstrated a significant negative link between vaccine hesitancy and vaccination rate, with the difference between the two continuously widening over time. Counties with higher socioeconomic statuses, more Asian and Hispanic populations, more elderly residents, greater health insurance coverage, and more Democrats presented lower vaccine hesitancy and higher vaccination rates. However, underlying determinants of vaccination coverage and vaccine hesitancy were divergent regarding their different associations with exogenous variables. Mediation analysis further demonstrated that indirect effects from exogenous variables to vaccination coverage via vaccine hesitancy only partially explained corresponding total effects, challenging the popular narrative that portrays vaccine hesitancy as a root cause of disparities in vaccination. Our study highlights the need of well-funded, targeted, and ongoing initiatives to reduce persisting vaccination inequities., 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 © 2022 Elsevier Ltd. All rights reserved.)

To mitigate global warming, China, the world's largest greenhouse gas emitter, has set the goals of achieving carbon peak by 2030 and carbon neutrality by 2060, and financial measures could play an important role. To avoid unnecessary costs, China could learn from the experience of other countries to better understand the potential role of financial measures in achieving carbon emission reduction goals. Hence, this article adopts a SWOT analysis to compare the financial measures taken by Britain, Japan and the United States in the process of carbon emission reduction in the last twenty years. This article finds that government funds and financial innovation have contributed markedly to carbon emission reduction in those three countries. With the help of the SWOT analysis, we recommend that China take financial measures to help achieve carbon peaking and carbon neutrality goals from four aspects: formulating proper policy, regulating carbon trading market, strengthening international cooperation, and promoting innovation.

Introduction: The impact of health insurance status on the survival outcomes of patients with locally advanced gastric cancer (LAGC) receiving gastrectomy have not been addressed in depth. We aim to identify definite associations of health insurance status with cancer-specific survival (CSS) and overall survival (OS) in this population., Methods: We identified LAGC patients aged 18 to 64 years undergoing gastrectomy with complete insurance records, between January 1, 2007, and December 31, 2016, from 18 Surveillance, Epidemiology, and End Results database registries. Relationships between health insurance status and OS/CSS were explored by Kaplan-Meier time-to-event analysis and uni-/multi-variate Cox regression. Probable baseline confounder was adjusted by multiple propensity score (mPS)-adjusted analysis., Results: In total, 5,860 patients met the inclusion criteria. In the multivariate Cox regression, Medicaid coverage was related to poorer OS than private insurance. Non-insurance or Medicaid coverage versus private insurance tended to present poorer OS in the mPS-adjusted model, but this result was insignificant for CSS., Conclusions: Our observational study of exposure-outcome associations suggests that limited or no insurance is moderately linked with OS among LAGC patients undergoing gastrectomy and aged 18-64 years. Healthcare accessibility and broad insurance coverage probably strengthen some disparity outcomes., Competing Interests: Conflict of interest The authors declare that they have no competing interest., (Copyright © 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Introduction: Impacts of health insurance status on survival outcomes among adolescent and young adult (AYA, 15 to 39 years of age) patients with lymphoma in the United States are insufficiently known. This study aimed to clarify associations between health insurance status and overall survival (OS) estimates in this population., Materials and Methods: We examined 18 Surveillance, Epidemiology, and End Results registries in the United States and analyzed American AYA patients with lymphoma diagnosed during January 2007 and December 2016. Health insurance status was categorized, and Kaplan-Meier and multifactor Cox regressions were adopted using hazard ratio and 95% confidence interval. Probable baseline confounding was modulated by multiple propensity score., Results: A total of 21,149 patients were considered; ~28% were 18 to 25 years old, and 63.5% and 7.5% had private and no insurance, respectively. Private insurance rates increased in the 18 to 25 age group (60.1% to 6.1%, P<0.001) following the 2010 Patient Protection and Affordable Care Act (ACA), and lymphoma survival rates improved slightly 1 to 5 years postdiagnosis. Five-year OS rates decreased with age (93.9%, 90.4%, and 87.0% at 15 to 17, 18 to 25, and 26 to 39, respectively) and differed among insurance conditions (81.7%, 79.2%, 89.2%, and 92.0% for uninsured, Medicaid, insured, and insured/no specifics, respectively). Risk of death was significantly higher for those with Medicaid or no insurance than for those with private insurance in multiple propensity score-adjusted models (hazard ratio [95% confidence interval]=1.07 [1.03-1.12]), independent of stage at diagnosis., Conclusions: No or insufficient insurance was linked to poor OS in our sample in exposure-outcome association analysis. Insurance coverage and health care availability may enhance disparate outcomes of AYAs with cancer. The ACA has improved insurance coverage and survival rates for out sample. Nevertheless, strategies are needed to identify causality and eliminate disparities., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Coronavirus disease 2019 (COVID-19) emerged in 2019 and has since caused a global pandemic. Since its emergence, COVID-19 has hugely impacted healthcare, including pediatrics. This study aimed to explore the current status and hotspots of pediatric COVID-19 research using bibliometric analysis., Methods: The Institute for Scientific Information Web of Science core collection database was searched for articles on pediatric COVID-19 to identify original articles that met the criteria. The retrieval period ranged from the creation of the database to September 20, 2021. A total of 3,561 original articles written in English were selected to obtain data, such as author names, titles, source publications, number of citations, author affiliations, and countries where the studies were conducted. Microsoft Excel (Microsoft, Redmond, WA) was used to create charts related to countries, authors, and institutions. VOSviewer (Center for Science and Technology Studies, Leiden, The Netherlands) was used to create visual network diagrams of keyword, author, and country co-occurrence., Results: We screened 3,561 publications with a total citation frequency of 30,528. The United States had the most published articles (1188 articles) and contributed the most with author co-occurrences. The author with the most published articles was Villani from the University of Padua, Italy. He also contributed the most co-authored articles. The most productive institution was Huazhong University of Science and Technology in China. The institution with the most frequently cited published articles was Shanghai Jiao Tong University in China. The United States cooperated most with other countries. Research hotspots were divided into two clusters: social research and clinical research. Besides COVID-19 and children, the most frequent keywords were pandemic (251 times), mental health (187 times), health (172 times), impact (148 times), and multisystem inflammatory syndrome in children (MIS-C) (144 times)., Conclusion: Pediatric COVID-19 has attracted considerable attention worldwide, leading to a considerable number of articles published over the past 2 years. The United States, China, and Italy have leading roles in pediatric COVID-19 research. The new research hotspot is gradually shifting from COVID-19 and its related clinical studies to studies of its psychological and social impacts on children., 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 © 2022 Hu, Wang, Ma and Cheng.)

During the outbreak of the COVID-19 pandemic, Non-Pharmaceutical and Pharmaceutical treatments were alternative strategies for governments to intervene. Though many of these intervention methods proved to be effective to stop the spread of COVID-19, i.e., lockdown and curfew, they also posed risk to the economy; in such a scenario, an analysis on how to strike a balance becomes urgent. Our research leverages the mobility big data from the University of Maryland COVID-19 Impact Analysis Platform and employs the Generalized Additive Model (GAM), to understand how the social demographic variables, NPTs (Non-Pharmaceutical Treatments) and PTs (Pharmaceutical Treatments) affect the New Death Rate (NDR) at county-level. We also portray the mutual and interactive effects of NPTs and PTs on NDR. Our results show that there exists a specific usage rate of PTs where its marginal effect starts to suppress the NDR growth, and this specific rate can be reduced through implementing the NPTs., Competing Interests: The authors have declared that no competing interests exist.

The 21st Century Cures Act passed by the United States (US) Congress in December 2016 requires the US Food and Drug Administration (FDA) shall establish a program to evaluate the potential use of real-world evidence (RWE) which is generated from real-world data (RWD) to (i) support approval of new indication for a drug approved under section 505 (c) and (ii) satisfy post-approval study requirements. RWE offers the opportunities to develop robust evidence using high-quality data and sophisticated methods for producing causal-effect estimates regardless randomization is feasible. In this article, we have demonstrated that the assessment of treatment effect (RWE) based on RWD could be biased due to the potential selection and information biases of RWD. Although fit-for-purpose RWE may meet regulatory standards under certain assumptions, it is not the same as substantial evidence (current regulatory standard in support of approval of regulatory submission). In practice, it is then suggested that when there are gaps between fit-for-purpose RWE and substantial evidence, we should make efforts to fill these gaps based on a comprehensive evaluation of the treatment effect. We also review two RWE examples to show some potential use of RWE in clinical studies., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Universities contribute to economic growth and national competitiveness by equipping students with higher-order thinking and academic skills. Despite large investments in university science, technology, engineering and mathematics (STEM) education, little is known about how the skills of STEM undergraduates compare across countries and by institutional selectivity. Here, we provide direct evidence on these issues by collecting and analysing longitudinal data on tens of thousands of computer science and electrical engineering students in China, India, Russia and the United States. We find stark differences in skill levels and gains among countries and by institutional selectivity. Compared with the United States, students in China, India and Russia do not gain critical thinking skills over four years. Furthermore, while students in India and Russia gain academic skills during the first two years, students in China do not. These gaps in skill levels and gains provide insights into the global competitiveness of STEM university students across nations and institutional types., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

In this paper, we demonstrate the application of MATLAB to develop a pandemic prediction system based on Simulink. The susceptible-exposed-asymptomatic but infectious-symptomatic and infectious (severe infected population + mild infected population)-recovered-deceased (SEAI( I 1 + I 2 )RD) physical model for unsupervised learning and two types of supervised learning, namely, fuzzy proportional-integral-derivative (PID) and wavelet neural-network PID learning, are used to build a predictive-control system model that enables self-learning artificial intelligence (AI)-based control. After parameter setting, the data entering the model are predicted, and the value of the data set at a future moment is calculated. PID controllers are added to ensure that the system does not diverge at the beginning of iterative learning. To adapt to complex system conditions and afford excellent control, a wavelet neural-network PID control strategy is developed that can be adjusted and corrected in real time, according to the output error., (© 2021 IOP Publishing Ltd.)

Background: Visceral pleural invasion (VPI) is considered an adverse prognostic factor in non-small cell lung cancer (NSCLC). However, the prognostic roles of VPI in Ⅲ/N2 NSCLC remain controversial. Therefore, this study aims to evaluate the prognostic value of VPI in patients with postoperative stage pT 1-2 N 2 M 0 NSCLC., Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we screened for patients with stage T1-2N2M0 NSCLC who received surgery from 2010 to 2015. To reduce baseline differences between Non-VPI group and VPI group, two-to-one propensity score matching (PSM) was performed. Cox proportional hazards regression was used to identify factors associated with survival. Overall survival (OS) was between the Non-VPI group and the VPI+ group by the Kaplan-Meier analysis., Results: We identified 1374 postoperative NSCLC patients with stage pT 1-2 N 2 M 0 . The majority of cases (N = 1047, 76.8%) are Non-VPI patients. The factors associated with VPI+ group included white race (P < 0.0001), and adenocarcinoma (P < 0.0001). When analyzed in the total study population, VPI status remained a significant independent predictor of worse OS compared with the Non-VPI group (HR, 1.343; 95% CI, 1.083-1.665 [P=0.007]). Besides, in a subgroup analysis by VPI status, the results showed that patients without treatment exhibited a higher risk level in the Non-VPI group (P<0.0001). However, we did not find statistically significant differences among treatments in the VPI+ group (P=0.199). Mean survival time was 49.5 months (95% CI: 45.7-53.3 months) for chemotherapy alone in the Non-VPI group, compared with 41.2 months (95% CI: 35.8-46.6 months) in VPI+ groups. In both the VPI group and the non-VPI group, there is no statistical difference between adjuvant chemotherapy combined with PORT and chemotherapy alone., Conclusion: This study emphasizes that the presence of VPI is a poor prognostic factor, even in patients with Ⅲ/N2 NSCLC. As the study shows, chemotherapy significantly improved overall survival of patients with postoperative stage pT 1-2 N 2 M 0 NSCLC, especially for Non-VPI patients. However, the significance of PORT is still worth further exploration., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background/aim: The impacts of health insurance status on survival outcomes in multiple myeloma (MM) have not been addressed in depth. The present study was conducted to identify definite relationships of cancer-specific survival (CSS) and overall survival (OS) with health insurance status in MM patients., Methods: MM patients aged 18-64 years and with complete insurance records between January 1, 2007, and December 31, 2016, were identified from 18 Surveillance, Epidemiology, and End Results (SEER) Database registries. Health insurance condition was categorized as uninsured, any Medicaid, insured, and insured (no specifics). Relationships of health insurance condition with OS/CSS were identified through Kaplan-Meier, and uni-/multivariate Cox regressions using the hazard ratio and 95% confidence interval. Potential baseline confounding was adjusted using multiple propensity score (mPS)., Results: Totally 17,981 patients were included, including 68.3% with private insurance and only 4.9% with uninsurance. Log-rank test uncovered significant difference between health insurance status and OS/CSS among MM patients. Patients with non-insurance or Medicaid coverage in comparison with private insurance tended to present poorer OS/CSS both in multivariate Cox regression and in mPS-adjusted model (non-insurance vs. private insurance [OS/CSS]: 1.33 [1.20-1.48]/1.13 [1.00-1.28] and 1.45 [1.25-1.69]/1.18 [1.04-1.33], respectively; Medicaid coverage vs. private insurance [OS/CSS]: 1.67 [1.56-1.78]/1.25 [1.16-1.36] and 1.76 [1.62-1.90]/1.23 [1.13-1.35], respectively)., Conclusions: Our observational study of exposure-outcome associations suggests that insufficient or no insurance is moderately linked with OS among MM patients aged 18-64 years. Wide insurance coverage and health-care availability may strengthen some disparate outcomes. In the future, prospective cohort research is needed to further clarify concrete risks with insurance type, owing to the lack of definite division of insurance data in SEER., (© 2021 S. Karger AG, Basel.)

One approach to delaying the spread of the novel coronavirus (COVID-19) is to reduce human travel by imposing travel restriction policies. Understanding the actual human mobility response to such policies remains a challenge owing to the lack of an observed and large-scale dataset describing human mobility during the pandemic. This study uses an integrated dataset, consisting of anonymized and privacy-protected location data from over 150 million monthly active samples in the USA, COVID-19 case data and census population information, to uncover mobility changes during COVID-19 and under the stay-at-home state orders in the USA. The study successfully quantifies human mobility responses with three important metrics: daily average number of trips per person; daily average person-miles travelled; and daily percentage of residents staying at home. The data analytics reveal a spontaneous mobility reduction that occurred regardless of government actions and a 'floor' phenomenon, where human mobility reached a lower bound and stopped decreasing soon after each state announced the stay-at-home order. A set of longitudinal models is then developed and confirms that the states' stay-at-home policies have only led to about a 5% reduction in average daily human mobility. Lessons learned from the data analytics and longitudinal models offer valuable insights for government actions in preparation for another COVID-19 surge or another virus outbreak in the future.

Accurately estimating human mobility and gauging its relationship with virus transmission is critical for the control of COVID-19 spreading. Using mobile device location data of over 100 million monthly active samples, we compute origin-destination travel demand and aggregate mobility inflow at each US county from March 1 to June 9, 2020. Then, we quantify the change of mobility inflow across the nation and statistically model the time-varying relationship between inflow and the infections. We find that external travel to other counties decreased by 35% soon after the nation entered the emergency situation, but recovered rapidly during the partial reopening phase. Moreover, our simultaneous equations analysis highlights the dynamics in a positive relationship between mobility inflow and the number of infections during the COVID-19 onset. This relationship is found to be increasingly stronger in partially reopened regions. Our study provides a quick reference and timely data availability for researchers and decision makers to understand the national mobility trends before and during the pandemic. The modeling results can be used to predict mobility and transmissions risks and integrated with epidemics models to further assess the public health outcomes., Competing Interests: The authors declare no competing interest., (Copyright © 2020 the Author(s). Published by PNAS.)

Importance: Skin and subcutaneous diseases affect the health of millions of individuals in the US. Data are needed that highlight the geographic trends and variations of skin disease burden across the country to guide health care decision-making., Objective: To characterize trends and variations in the burden of skin and subcutaneous tissue diseases across the US from 1990 to 2017., Design, Setting, and Participants: For this cohort study, data were obtained from the Global Burden of Disease (GBD), a study with an online database that incorporates current and previous epidemiological studies of disease burden, and from GBD 2017, which includes more than 90 000 data sources such as systematic reviews, surveys, population-based disease registries, hospital inpatient and outpatient data, cohort studies, and autopsy data. The GBD separated skin conditions into 15 subcategories according to incidence, prevalence, adequacy of data, and standardized disease definitions. GBD 2017 also estimated the burden from melanoma of the skin and keratinocyte carcinoma. Data analysis for the present study was conducted from September 9, 2019, to March 31, 2020., Main Outcomes and Measures: Primary study outcomes included age-standardized disability-adjusted life-years (DALYs), incidence, and prevalence. The data were stratified by US states with the highest and lowest age-standardized DALY rate per 100 000 people, incidence, and prevalence of each skin condition. The percentage change in DALY rates in each state was calculated from 1990 to 2017., Results: Overall, age-standardized DALY rates for skin and subcutaneous diseases increased from 1990 (821.6; 95% uncertainty interval [UI], 570.3-1124.9) to 2017 (884.2; 95% UI, 614.0-1207.9) in all 50 states and the District of Columbia. The degree of increase varied according to geographic location, with the largest percentage change of 0.12% (95% UI, 0.09%-0.15%) in New York and the smallest percentage change of 0.04% (95% UI, 0.02%-0.07%) in Colorado, 0.04% (95% UI, 0.01%-0.06%) in Nevada, 0.04% (95% UI, 0.02%-0.07%) in New Mexico, and 0.04% (95% UI, 0.02%-0.07%) in Utah. The age-standardized DALY rate, incidence, and prevalence of specific skin conditions differed among the states. New York had the highest age-standardized DALY rate for skin and subcutaneous disease in 2017 (1097.0 [95% UI, 764.9-1496.1]), whereas Wyoming had the lowest age-standardized DALY rate (672.9 [95% UI, 465.6-922.3]). In all 50 states and the District of Columbia, women had higher age-standardized DALY rates for overall skin and subcutaneous diseases than men (women: 971.20 [95% UI, 676.76-1334.59] vs men: 799.23 [95% UI, 559.62-1091.50]). However, men had higher DALY rates than women for malignant melanoma (men: 80.82 [95% UI, 51.68-123.18] vs women: 42.74 [95% UI, 34.05-70.66]) and keratinocyte carcinomas (men: 37.56 [95% UI, 29.35-49.52] vs women: 14.42 [95% UI, 10.01-20.66])., Conclusions and Relevance: Data from the GBD suggest that the burden of skin and subcutaneous disease was large and that DALY rate trends varied across the US; the age-standardized DALY rate for keratinocyte carcinoma appeared greater in men. These findings can be used by states to target interventions and meet the needs of their population.

Allergic contact dermatitis is a delayed type IV hypersensitivity skin reaction to external stimuli. Patterns of dermatitis depend on allergen exposure and patch testing is the gold standard to identify causal agents. The American Contact Dermatitis Society identifies an "Allergen of the Year" in order to highlight facts about particular allergens, which may range from showing increasing prevalence of disease, to documenting low levels of relevant allergic reactions. This article reviews the allergens of the year from 2000 to 2020 with an emphasis on clinical relevance. Categories of allergens include adhesives, dyes, medications, metals, preservatives, rubber accelerators, surfactants, and other skin care product ingredients., Competing Interests: Conflicts of Interest None declared., (Published by Elsevier Inc.)

Study Design: Retrospective database review., Objective: Compare 1-year episode of care costs between single-level decompression and decompression plus fusion for lumbar stenosis., Summary of Background Data: Lumbar stenosis is the most common indication for surgery in patients over 65. Medicare direct hospital costs for lumbar surgery reached $1.65 billion in 2007. Despite stenosis being a common indication for surgery, there is debate as to the preferred surgical treatment. Cost-minimization analysis is a framework that identifies potential cost savings between treatment options that have similar outcomes. We performed a cost-minimization analysis of decompression versus decompression with fusion for lumbar stenosis from the payer perspective., Methods: An administrative claims database of privately insured patients (Humana) identified patients who underwent decompression (n = 5349) or decompression with fusion (n = 8540) for lumbar stenosis with and without spondylolisthesis and compared overall costs. All patients were identified and costs identified for a 1-year period. Complication rates and costs were described using summary statistics., Results: Mean treatment costs at 1 year after surgery were higher for patients who underwent decompression and fusion compared to patients who underwent decompression alone ($20,892 for fusion vs. $6329 for decompression; P < 0.001). Facility costs (P < 0.001), surgeon costs (P < 0.001), and physical therapy costs (P < 0.001) were higher in the fusion group. Cost differences related to infection or durotomy reached significance (P < 0.04). No difference in cost was identified for supplies., Conclusion: Decompression had significantly lower costs for the treatment of lumbar stenosis, including treatment for postoperative complications. If cost minimization is the primary goal, decompression is favored for surgical treatment of lumbar stenosis. Other factors including shared decision-making directed toward patient's values, patient-reported outcomes, and preferences should also be recognized as drivers of healthcare decisions., Level of Evidence: 3.

Introduction: The National Youth Tobacco Survey (NYTS) has successfully monitored tobacco product use patterns and correlates since 1999 among US students in grades 6 through 12 using a scannable paper-and-pencil format. We conducted a study to determine the feasibility and potential benefits of administering an electronic version of the NYTS in school settings., Methods: The pilot survey was administered by using 2 versions. Version 1 mimicked the scannable paper-and-pencil format with respect to design, formatting, and structure, but was administered on a tablet computer. Version 2 used an electronic survey design and formatting capabilities, which included programmed logic skips and tobacco product images. Chi-square and t tests were used to assess subgroup differences. Multivariable-adjusted logistic regression models were used to determine if the odds of ever and current tobacco product use differed between the 2 versions., Results: In total, 2,769 students completed version 1 or version 2. Three-quarters of respondents reported a strong preference for using an electronic device to take the NYTS (74.7%). Compared with version 1, version 2 reduced the mean time to complete the survey by 15% (P < .01), reduced the number of questions students needed to answer by 30% (P < .01), and removed 1.9% of inconsistent survey responses. A significant difference was observed for ever e-cigarette use between versions 1 (22.2%) and 2 (29.5%; P < .0001). No significant differences in ever or current use were observed for other tobacco products., Conclusion: An electronic mode of administration is feasible and valid for conducting surveillance of tobacco product use among US youths.

Introduction: Beginning September 3, 2014, CVS Health stopped selling tobacco products in all of its retail stores nationwide. This study assessed the impact of removing tobacco sales from CVS Health on cigarette smoking behaviors among U.S. adult smokers., Methods: CVS Health retail location data (2012-2016) were linked with data from the Behavioral Risk Factor Surveillance System, a phone-based survey of the non-institutionalized civilian population aged ≥18 years. Using a difference-in-differences regression model, quit attempts and daily versus nondaily smoking were compared between smokers living in counties with CVS stores and counties without CVS stores, before and after CVS's removal of tobacco sales. Control variables included individuals' sociodemographic and health-related variables, state tobacco control variables, and urban status of counties. Analyses were conducted in 2018., Results: During the 2-year period following the removal of tobacco sales from CVS Health, smokers living in counties with high CVS density (≥3.5 CVS stores per 100,000 people) had a 2.21% (95% CI=0.08, 4.33) increase in their quit attempt rates compared with smokers living in counties without CVS stores. This effect was greater in urban areas (marginal effect: 3.03%, 95% CI=0.81, 5.25); however, there was no statistically significant impact in rural areas. Additionally, there was no impact on daily versus nondaily smoking in either urban or rural areas., Conclusions: Removing tobacco sales in retail pharmacies could help support cessation among U.S. adults who are attempting to quit smoking, particularly in urban areas., (Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Bronchodilator responsiveness (BDR) is prevalent in COPD, but its clinical implications remain unclear. We explored the significance of BDR, defined by post-bronchodilator change in FEV 1 (BDR FEV1 ) as a measure reflecting the change in flow and in FVC (BDR FVC ) reflecting the change in volume., Methods: We analyzed 2974 participants from a multicenter observational study designed to identify varying COPD phenotypes (SPIROMICS). We evaluated the association of BDR with baseline clinical characteristics, rate of prospective exacerbations and mortality using negative binomial regression and Cox proportional hazards models., Results: A majority of COPD participants exhibited BDR (52.7%). BDR FEV1 occurred more often in earlier stages of COPD, while BDR FVC occurred more frequently in more advanced disease. When defined by increases in either FEV 1 or FVC, BDR was associated with a self-reported history of asthma, but not with blood eosinophil counts. BDR FVC was more prevalent in subjects with greater emphysema and small airway disease on CT. In a univariate analysis, BDR FVC was associated with increased exacerbations and mortality, although no significance was found in a model adjusted for post-bronchodilator FEV 1 ., Conclusion: With advanced airflow obstruction in COPD, BDR FVC is more prevalent in comparison to BDR FEV1 and correlates with the extent of emphysema and degree of small airway disease. Since these associations appear to be related to the impairment of FEV 1 , BDR FVC itself does not define a distinct phenotype nor can it be more predictive of outcomes, but it can offer additional insights into the pathophysiologic mechanism in advanced COPD., Clinical Trials Registration: ClinicalTrials.gov: NCT01969344T4., Competing Interests: IB has received research grants from AMGEN and GE Healthcare; and reports personal fees from Astra Zeneca, GSK, Boehringer Ingelheim, GE Healthcare, Theravance, Mylan, GRIFOLS, CSL Behring, Verona Pharma and Fisher & Pykel Healthcare. SPB is supported by NIH Grant K23HL133438 and he has served on an advisory board for Sunovion and reports grants from NIH, personal fees from Sunovion, personal fees from GlaxoSmithKline, outside the submitted work. JLC is supported by Merit Review award I01 CX000911 from the Department of Veterans Affairs, and reports grants the Department of Defense, the National Institutes of Health, and from MedImmune Corporation, Ltd., and reports grants from NIH/NHLBI, during the conduct of the study; grants from NIH/NIAID, grants from Department of Veterans Affairs, grants from Department of Defense, outside the submitted work. MKH has consulted for GSK, Boehringer Ingelheim and AstraZeneca, has received research support from Novartis and Sunovion and reports grants from NIH, during the conduct of the study; and Consulting for GSK, BI, Mylan and AstraZeneca, research support from Sunovion and Novartis. FJM reports grants from NHLBI, National Institutes of Health, personal fees from Continuing Education, personal fees from Forest Laboratories, Janssen, GlaxoSmithKline, Nycomed/Takeda, AstraZeneca, Boehringer Ingelheim, Bellerophon (formerly Ikaria), Genentech, Novartis, Pearl, Roche, Sunovion, Theravance, CME Incite, Annenberg Center for Health Sciences at Eisenhower, Integritas, InThought, National Association for Continuing Education, Paradigm Medical Communications, LLC, PeerVoice, UpToDate, Haymarket Communications, Western Society of Allergy and Immunology, Proterixbio (formerly Bioscale), Unity Biotechnology, ConCert Pharmaceuticals, Lucid, Methodist Hospital, Columbia University, Prime Healthcare Ltd, WebMD, PeerView Network, California Society of Allergy and Immunology, Chiesi, Puerto Rico Thoracic Society, outside the submitted work, and reports personal fees from Afferent/Merck, personal fees from American Thoracic Society, grants, personal fees, non-financial support from AstraZeneca, personal fees from Bayer, non-financial support from Boehringer Ingelehim, personal fees from ProTerrix Bio, personal fees from Bridge Biotherapeutics, personal fees, non-financial support from Chiesi, personal fees from Gala, personal fees, non-financial support, personal fees from Genentech, grants, personal fees, non-financial support from GlaxoSmithKline, grants, personal fees from Nitto, personal fees from ProMedior, personal fees from ProMetic, personal fees from Patara/Respivant, personal fees from Biogen, personal fees, non-financial support from Sunovion, personal fees, non-financial support from Teva, personal fees from Veracyte, during the conduct of the study. NH reports grants and personal fees from AstraZeneca, GSK, Boehringer Ingelheim, grants from NIH, COPD Foundation, outside the submitted work. GB has grants from the NIH, Foundation for the NIH, COPD Foundation and Alpha-1 Foundation, and reports grants, personal fees from AstraZeneca, grants from Boehringer Ingelheim, grants from NIH, grants from COPD Foundation, personal fees from Mylan, outside the submitted work. JMW has received grant support from the NIH, contracts to conduct research from GSK, Bayer, MereoBioPharma,Quintiles, and reports grants from NIH/NHLBI, during the conduct of the study; grants from NIH/NCATS, grants from Bayer, grants, personal fees from GSK, personal fees from Boehringer Ingelheim, grants, personal fees from Mereo BioPharma, personal fees from Quintiles, outside the submitted work. EAH a founder and shareholder of VIDA Diagnostics, a company commercializing lung image analysis software developed, and reports personal fees from VIDA Diagnostics, during the conduct of the study. VK has consulted for Boehringer Ingelheim, Gala Therapeutics and AstraZeneca and received personal fees from ABIM, and reports personal fees from Medscape, personal fees from Gala Therapeutics, personal fees from ABIM Critical Care Testwriting Committee, personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, outside the submitted work. MTD reports receiving grants from the NIH, the Department of Defense, and the American Heart Association; consulting fees from Boehringer Ingelheim, GlaxoSmithKline, Novartis, Astra Zeneca, Yungjin, PneumRx/BTG, Pulmonx, Genentech, Boston Scientific, Quark Pharmaceuticals, Mereo and received grants from American Lung Association and NIH, and reports grants from NIH, during the conduct of the study; personal fees from Boehringer Ingelheim, personal fees from AstraZeneca, personal fees from GlaxoSmithKline, personal fees from Boston Scientific, grants from American Lung Association, grants from Department of Defense, grants from Department of Veterans Affairs, personal fees from Mereo, personal fees from Quark, outside the submitted work. MBD has received research grants from the NIH and reports personal fees from Boehringer-Ingelheim, GlaxoSmithKline, AstraZeneca, and Mylan-Theravance, outside the submitted work, and reports grants from NIH-NHLBI, during the conduct of the study; grants, personal fees from Boehringer-Ingelheim, personal fees from GlaxoSmithKline, personal fees from AstraZeneca, personal fees from Mylan-Theravance, grants from Department of Defense, personal fees from Novavax, personal fees from Parion, personal fees from Midmark, personal fees from Philips, outside the submitted work. SAC reports personal fees from AstraZeneca, GSK, Amgen, Glenmark, Sunovion, UpToDate, and received personal fees and non-financial support from Genentech, grants from MedImmune, outside the submitted work, and reports personal fees from AstraZeneca, personal fees from GlaxoSmithKline, personal fees from Amgen, personal fees from Glenmark, personal fees from Sunovion, personal fees from Genentech, non-financial support from Medimmune, outside the submitted work. JAK has received research grants from NIH and the Patient Centered Outcomes Research Institute. DPT reports personal fees from Boehringer-Ingelheim, AstraZeneca, Sunovion, Theravance/Innoviva, Mylan, outside the submitted work, and reports personal fees from AstraZeneca, personal fees from Sunovion, during the conduct of the study; personal fees from AstraZeneca, personal fees from Sunovion, personal fees from Boehringer-Ingelheim, personal fees from Mylan, outside the submitted work. CBC has consulted with PulmonX, has received research funding from Equinox Fitness Clubs, Amgen and is employed part-time by the GlaxoSmithKline Global Respiratory Franchise, and reports personal fees from GlaxoSmithKline, outside the submitted work. DC has grants from the NIH, reports grants from NHLBI, grants from COPD Foundation, during the conduct of the study and no other conflicts. RB served on the advisory boards (GlaxoSmithKline, Boehringer Ingelheim, and Mylan Pharmaceuticals) and received research grants from GlaxoSmithKline and Boehringer Ingelheim, and reports personal fees from GlaxoSmithKline, personal fees from Boehringer Ingelheim, personal fees from Mylan Pharmaceuticals, grants from GlaxoSmithKline, grants from Boehringer Ingelheim, outside the submitted work. RP reports grants from NHLBI, grants from COPD Foundation, NHLBI and Department of Veterans Affairs, outside the submitted work. RGB received personal fees from GlaxoSmithKline, grants from NIH/National Center for Advancing Translational Sciences, grants from NIH/NHLBI, and reports grants from NIH/NCATS, during the conduct of the study; personal fees from GlaxoSmithKline, grants from NIH/NHLBI, outside the submitted work; and Dr. Buhr is employed part-time by the Veterans Health Administration; the content of this manuscript does not necessarily reflect the views of the US Department of Veterans Affairs. RJK received grants and personal fees from Genentech, Boehringer Ingelheim, Medimmune/Astra Zeneca, and Gilead and reports grants from NIH, during the conduct of the study; grants, personal fees from Boehringer Ingelheim, grants, personal fees from Roche/Genentech, outside the submitted work. GC reports grants from Boehringer- Ingelheim, Novartis, Astra Zeneca, Respironics, MedImmune, Actelion, Forest, Pearl, Ikaria, Aeris, PneumRx, Pulmonx, personal fees from HGE Health Care Solutions, Inc, Amirall, Boehringer- Ingelheim, Holaira. NB reports grants from NIH, outside the submitted work. PW reports personal fees from Glenmark Pharmaceuticals, personal fees from GSK, personal fees from NGM Pharma, personal fees from Amgen, nothing from Regeneron, nothing from 23andMe, nothing from Theravance, nothing from AstraZeneca, outside the submitted work. CMD reports grants from NIH, during the conduct of the study. SP reports grants from MIH, HNLBI, during the conduct of the study. The authors report no other conflicts of interest in this work., (© 2019 Barjaktarevic et al.)

Problem/condition: Tobacco use is the leading cause of preventable disease, disability, and death in the United States. Most tobacco product use begins during adolescence. In recent years, tobacco products have evolved to include various smoked, smokeless, and electronic products., Period Covered: 2019., Description of System: The National Youth Tobacco Survey (NYTS) is an annual, cross-sectional, school-based, self-administered survey of U.S. middle school (grades 6-8) and high school (grades 9-12) students. A three-stage cluster sampling procedure is used to generate a nationally representative sample of U.S. students attending public and private schools. NYTS is the only nationally representative survey of U.S. middle and high school students that focuses exclusively on tobacco use patterns and associated factors. NYTS is designed to provide national data on tobacco product use and has been conducted periodically during 1999-2009 and annually since 2011. Data from NYTS are used to support the design, implementation, and evaluation of comprehensive tobacco use prevention and control programs and to inform tobacco regulatory activities. Since its inception in 1999 through 2018, NYTS had been conducted via paper and pencil questionnaires. In 2019, NYTS for the first time was administered in schools using electronic data collection methods. CDC's Office on Smoking and Health, in collaboration with the U.S. Food and Drug Administration's (FDA's) Center for Tobacco Products, analyzed data from the 2019 NYTS to assess tobacco product use patterns and associated factors among U.S. middle and high school students. Overall, 19,018 questionnaires were completed and weighted to represent approximately 27.0 million students. On the basis of self-reported grade level, this included 8,837 middle school questionnaires (11.9 million students) and 10,097 high school questionnaires (15.0 million students); 84 questionnaires with missing information on grade level were excluded from school-level analyses., Results: In 2019, an estimated 53.3% of high school students (8.0 million) and 24.3% of middle school students (2.9 million) reported having ever tried a tobacco product. Current (past 30-day) use of a tobacco product (i.e., electronic cigarettes [e-cigarettes], cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, and bidis [small brown cigarettes wrapped in a leaf]) was reported by 31.2% of high school students (4.7 million) and 12.5% of middle school students (1.5 million). E-cigarettes were the most commonly cited tobacco product currently used by 27.5% of high school students (4.1 million) and 10.5% of middle school students (1.2 million), followed in order by cigars, cigarettes, smokeless tobacco, hookahs, and pipe tobacco. Tobacco product use also varied by sex and race/ethnicity. Among current users of each tobacco product, the prevalence of frequent tobacco product use (on ≥20 days of the preceding 30 days) ranged from 16.8% of cigar smokers to 34.1% of smokeless tobacco product users. Among current users of each individual tobacco product, e-cigarettes were the most commonly used flavored tobacco product (68.8% of current e-cigarette users). Among students who reported ever having tried e-cigarettes, the three most commonly selected reasons for use were "I was curious about them" (55.3%), "friend or family member used them" (30.8%), and "they are available in flavors, such as mint, candy, fruit, or chocolate" (22.4%). Among never users of each individual tobacco product, curiosity and susceptibility (a construct that can help to identify future tobacco product experimentation or use) was highest for e-cigarettes (39.1% and 45.0%, respectively) and cigarettes (37.0% and 45.9%, respectively). Overall, 86.3% of students who reported contact with an assessed potential source of tobacco product advertisements or promotions (going to a convenience store, supermarket, or gas station; using the Internet; watching television or streaming services or going to the movies; or reading newspapers or magazines) reported exposure to marketing for any tobacco product; 69.3% reported exposure to e-cigarette marketing and 81.7% reported exposure to marketing for cigarettes or other tobacco products. Among all students, perceiving no harm or little harm from intermittent tobacco product use (use on some days but not every day) was 28.2% for e-cigarettes, 16.4% for hookahs, 11.5% for smokeless tobacco products, and 9.5% for cigarettes. Among current users of any tobacco product, 24.7% reported experiencing cravings to use tobacco products during the past 30 days and 13.7% reported wanting to use a tobacco product within 30 minutes of waking. Moreover, 57.8% of current tobacco product users reported they were seriously thinking about quitting the use of all tobacco products and 57.5% reported they had stopped using all tobacco products for ≥1 day because they were trying to quit., Interpretation: In 2019, approximately one in four youths (23.0%) had used a tobacco product during the past 30 days. By school level, this represented approximately three in 10 high school students (31.2%) and approximately one in eight middle school students (12.5%). Since 2014, e-cigarettes have been the most commonly used tobacco product among youths. Importantly, more than half of current youth tobacco product users reported seriously thinking about quitting all tobacco products in 2019. However, established factors of use and initiation, including the availability of flavors, exposure to tobacco product marketing, curiosity and susceptibility, and misperceptions about harm from tobacco product use, remained prevalent in 2019 and continue to promote tobacco product use among youths., Public Health Action: The continued monitoring of all forms of youth tobacco product use and associated factors through surveillance efforts including NYTS is important to the development of public health policy and action at national, state, and community levels. Everyone, including public health professionals, health care providers, policymakers, educators, parents, and others who influence youths, can help protect youths from the harms of all tobacco products. In addition, the comprehensive and sustained implementation of evidence-based tobacco control strategies, combined with FDA's regulation of tobacco products, is important for reducing all forms of tobacco product use among U.S. youths., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Background: In 2017, the Food and Drug Administration banned the marketing of triclosan and triclocarban in antibacterial soaps, citing inefficacy and concerns of systemic absorption and antibacterial resistance. As a result, there is an anticipated decrease in the number of triclosan-containing products on the market with an associated increase in antibacterial alternatives (eg, benzalkonium chloride, benzethonium chloride, chloroxylenol, chlorhexidine) and cases of allergic and irritant contact dermatitis., Objectives: The aims of the study were to determine the extent that triclosan and triclocarban are being used in the consumer and medical industries after the Food and Drug Administration marketing ban and to appraise the risk of allergic contact dermatitis to triclosan alternatives., Methods: The National Drug Code Directory (NDCD), Google, Amazon, Target, Walgreens, Walmart, CVS, and Colorado hospitals were surveyed for antibacterial soap use. Antibiotics surveyed include triclosan, triclocarban, benzalkonium chloride, benzethonium chloride, chloroxylenol, and chlorhexidine., Results: The most common antibiotics reported by the NDCD, consumer sites, and Colorado hospitals were benzalkonium chloride, chloroxylenol, and triclosan, respectively. Triclosan accounted for the second most prevalent antibacterial in the NDCD- and consumer site-surveyed products., Conclusions: The triclosan marketing ban may instigate increased exposure to triclosan alternatives. The addition of antibacterial products to hand soaps does not improve soap effectiveness and may cause harm by contributing to antibiotic resistance and the development of allergic conditions. Additional studies are needed to elucidate the benefits and harms of antibacterial soaps.

Purpose: Tobacco 21 (T21) is a population-based strategy to prevent tobacco initiation. A majority of U.S. youths support T21; however, the extent to which individual, interpersonal, and community factors influence T21 support is uncertain. This study explored predictors of T21 support among U.S. youth., Methods: We analyzed data from the 2015 National Youth Tobacco Survey (n = 17,683) to assess the association of peer influence and access to tobacco products on T21 support. We used multivariable logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals for T21 support. For tobacco nonusers, the model included peer influence along with covariates including sex, age, race/ethnicity, household tobacco use, and perceived harm. For tobacco users, the model included tobacco access sources (direct purchase, social sources, and other means), the aforementioned covariates, and tobacco product type., Results: Among nonusers, students least receptive to peer influence (aOR = 2.5), those youngest in age (11-14 years, aOR = 2.3), and those who believe tobacco is dangerous (aOR = 2.5) had higher odds of T21 support. Among users, lower odds of T21 support were observed among those who purchased tobacco (aOR = .3) and accessed tobacco through social sources (aOR = .7) or other means (aOR = .6) in the past 30 days. Younger tobacco users (11-14 years, aOR = 2.2), black, non-Hispanic users (aOR = 3.8), e-cigarette users (aOR = 2.5), and users who believe that tobacco is dangerous (aOR = 2.8) had higher odds of T21 support., Conclusions: Low receptivity to peer influence and lack of access to tobacco products are associated with T21 support. Results underscore that T21 implementation may require a social-ecological approach., (Published by Elsevier Inc.)

From 1965 to 2017, the prevalence of cigarette smoking among U.S. adults aged ≥18 years decreased from 42.4% to 14.0%, in part because of increases in smoking cessation (1,2). Increasing smoking cessation can reduce smoking-related disease, death, and health care expenditures (3). Increases in cessation are driven in large part by increases in quit attempts (4). Healthy People 2020 objective 4.1 calls for increasing the proportion of U.S. adult cigarette smokers who made a past-year quit attempt to ≥80% (5). To assess state-specific trends in the prevalence of past-year quit attempts among adult cigarette smokers, CDC analyzed data from the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys for all 50 states, the District of Columbia (DC), Guam, and Puerto Rico. During 2011-2017, quit attempt prevalence increased in four states (Kansas, Louisiana, Virginia, and West Virginia), declined in two states (New York and Tennessee), and did not significantly change in the remaining 44 states, DC, and two territories. In 2017, the prevalence of past-year quit attempts ranged from 58.6% in Wisconsin to 72.3% in Guam, with a median of 65.4%. In 2017, older smokers were less likely than younger smokers to make a quit attempt in most states. Implementation of comprehensive state tobacco control programs and evidence-based tobacco control interventions, including barrier-free access to cessation treatments, can increase the number of smokers who make quit attempts and succeed in quitting (2,3)., Competing Interests: All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Background: Availability of nursing home care has declined and national efforts have been initiated to improve the quality of nursing home care in the U.S. Yet, data are limited on whether there are geographic variations in declines of availability and quality of nursing home care, and whether variations persist over time. We sought to assess geographic variation in availability and quality of nursing home care., Methods: Retrospective study using Medicaid/Medicare-certified nursing home data from the Centers for Medicare & Medicaid Services, 1996-2016. Outcomes were 1) availability of all nursing home care (1996-2016), measured by the number of Medicaid/Medicare-certified beds for a given county per 100,000 population aged ≥65 years, regardless of nursing home star rating; 2) availability of 5-star nursing home care, measured by the number of Medicaid/Medicare-certified beds provided by 5-star nursing homes; and 3) utilization of nursing home beds, defined as the rate of occupied Medicaid/Medicare-certified beds among the total Medicaid/Medicare-certified beds., Results: From 1999 to 2016, availability of all nursing home care declined from 4882 (standard deviation: 931) to 3480 (912) beds, per 100,000 population aged ≥65 years. Persistent geographic variation in availability of nursing home care was observed; the correlation coefficient of county-specific availabilities from 1996 to 2016 was 0.78 (95% CI 0.77-0.79). From 2011 to 2016, availability of 5-star nursing home beds increased from 658 (303) to 895 (661) per 100,000 population aged ≥65 years. The correlation coefficient for county-specific availabilities from 2011 to 2016 was 0.54 (95% CI 0.51-0.56). Availability and quality of nursing home care were not highly correlated. In 2016, the correlation coefficient for county-specific availabilities between all nursing home and 5-star nursing home beds was 0.33 (95% CI 0.30-0.36). From 1996 to 2016, the utilization of certified beds declined from 78.5 to 72.2%. This decline was consistent across all census divisions, but most pronounced in the Mountain division and less in the South-Atlantic division., Conclusion: We observed persistent geographic variations in availability and quality of nursing home care. Availability of all nursing home care declined but availability of 5-star nursing home care increased. Availability and quality of nursing home care were not highly correlated.

We assess and compare computer science skills among final-year computer science undergraduates (seniors) in four major economic and political powers that produce approximately half of the science, technology, engineering, and mathematics graduates in the world. We find that seniors in the United States substantially outperform seniors in China, India, and Russia by 0.76-0.88 SDs and score comparably with seniors in elite institutions in these countries. Seniors in elite institutions in the United States further outperform seniors in elite institutions in China, India, and Russia by ∼0.85 SDs. The skills advantage of the United States is not because it has a large proportion of high-scoring international students. Finally, males score consistently but only moderately higher (0.16-0.41 SDs) than females within all four countries., Competing Interests: The authors declare no conflict of interest., (Copyright © 2019 the Author(s). Published by PNAS.)

Reactive oxygen species (ROS) play important roles in defence response of host plants versus pathogens. While generation and detoxification of ROS is well understood, how varied ability of different isolates of pathogens to overcome host ROS, or ROS contribution to a particular isolate's pathogenicity, remains largely unexplored. Here, we report that transcriptional regulation of the ROS pathway, in combination with the insulin pathway, increases the pathogenicity of invasive species Bursaphelenchus xylophilus. The results showed a positive correlation between fecundity and pathogenicity of different nematode isolates. The virulent isolates from introduced populations in Japan, China and Europe had significantly higher fecundity than native avirulent isolates from the USA. Increased expression of Mn-SOD and reduced expression of catalase/ GPX-5 and H 2 O 2 accumulation during invasion are associated with virulent strains. Additional H 2 O 2 could improve fecundity of Bu. xylophilus. Furthermore, depletion of Mn-SOD decreased fecundity and virulence of Bu. xylophilus, while the insulin pathway is significantly affected. Thus, we propose that destructive pathogenicity of Bu. xylophilus to pines is partly owing to upregulated fecundity modulated by the insulin pathway in association with the ROS pathway and further enhanced by H 2 O 2 oxidative stress. These findings provide a better understanding of pathogenic mechanisms in plant-pathogen interactions and adaptive evolution of invasive species. This article is part of the theme issue 'Biotic signalling sheds light on smart pest management'.

The American Academy of Dermatology has taken an active stance in addressing the lack of racial and ethnic diversity in the specialty. At the American Academy of Dermatology President's Conference on Diversity in Dermatology, which was held on August 5, 2017, key action items to increase the number of practicing board-certified dermatologists who are under-represented in medicine (UIM) were identified in 3 main areas. The action items include increasing the pipeline of UIM students applying to medical school, increasing UIM medical students' exposure to the field of dermatology and their level of interest in it, and increasing the number of UIM students recruited into dermatology residency programs., (Copyright © 2018. Published by Elsevier Inc.)

Background: Allergic rhinitis, an immunoglobulin E inflammatory condition including nasal congestion, obstruction, sneezing, pruritus, and fatigue symptoms, has significant impact on quality of life and impairs sleep. Sleep-disordered breathing (SDB) patients often have normal all-night apnea-hypopnea (AHI) or respiratory-disturbance (RDI) indices on polysomnography (PSG). We hypothesized that the rapid eye motion-respiratory disturbance index (REM-RDI) may be a novel predictor of allergic status., Methods: A retrospective analysis of 100 patients compared REM-RDI results in 67 allergen-positive patients with 33 nonallergic patients who presented with nasal blockage. Subjects completed STOP-Bang©, 22-item Sino-Nasal Outcome Test (SNOT-22)©, and Epworth Sleepiness Scale© questionnaires and underwent skin-prick testing (SPT) and PSGs including REM-RDI values. Using multivariate logistic regression models, we evaluated relationships between allergic status and sleep parameters while controlling for possible confounders including body mass index (BMI)., Results: Using REM-RDI as the outcome of interest, allergen-positive patients were 3.92 times more likely to have REM-RDI values in a moderate/severe range (≥15 events/hour); and patients with moderate/severe REM-RDI values were more likely to be allergen positive (p < 0.05). Allergic status was not significantly related to all-night AHI, RDI, or REM-AHI. BMI was not significantly related to REM-RDI. STOP-Bang© was related to allergy status (p = 0.02) and REM-RDI (p < 0.01). Allergic patients had increased REM latency and less total amount of REM., Conclusion: We revealed significant bidirectional associations between allergen positivity and increased REM-RDI values independent of BMI, AHI, RDI, and REM-AHI. Allergic inflammation and REM-RDI data may play important roles in diagnosing and treating fatigued SDB patients and as objective perioperative safety and outcomes measures., (© 2018 The Authors International Forum of Allergy & Rhinology, published by ARSAAOA, LLC.)

Background: Coronary artery disease is prevalent in China, with concomitant increases in the volume of coronary artery bypass grafting (CABG). The present study aims to compare CABG-related outcomes between China and the United States among large teaching and urban hospitals., Methods and Results: Observational analysis of patients aged ≥18 years, discharged from acute-care, large teaching and urban hospitals in China and the United States after hospitalization for an isolated CABG surgery. Data were obtained from the Chinese Cardiac Surgery Registry in China and the National Inpatient Sample in the United States. Analysis was stratified by 2 periods: 2007, 2008, and 2010; and 2011 to 2013 periods. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay. The sample included 51 408 patients: 32 040 from 77 hospitals in the China-CABG group and 19 368 from 303 hospitals in the US-CABG group. In the 2007 to 2008, 2010 period and for all-age and aged ≥65 years, the China-CABG group had higher mortality than the US-CABG group (1.91% versus 1.58%, P =0.059; and 3.12% versus 2.20%, P =0.004) and significantly higher age-, sex-, and comorbidity-adjusted odds of death (odds ratio, 1.58; 95% confidential interval, 1.22-2.04; and odds ratio, 1.73; 95% confidential interval, 1.24-2.40). There were no significant mortality differences in the 2011 to 2013 period. For preoperative, postoperative, and total hospital stay, respectively, the median (interquartile range) length of stay across the entire study period between China-CABG and US-CABG groups were 9 (8) versus 1 (3), 9 (6) versus 6 (3), and 20 (12) versus 7 (5) days (all P <0.001). This difference did not change significantly over time., Conclusions: In 2011 to 2013, there was no significant difference in in-hospital mortality among patients who underwent an isolated CABG surgery in large teaching and urban hospitals in China and the United States. The longer length of stay in China may represent an opportunity for improvement., (© 2017 The Authors.)

Objectives: Research indicates that mood-based motivations may be an important predictor of indoor tanning bed use and may be related to indoor tanning dependence. Problematically, little research has been conducted to develop a psychometric measure of mood-based tanning motivations. The current study seeks to develop and validate the moodbased indoor tanning scale (MITS)., Methods: Two studies were conducted to identify and verify the MITS factor structure as well as assess construct validity. Study 1 was conducted at 5 geographically diverse universities in the United States. Study 2 was conducted by using a national online sample in the United States., Results: Results from study 1 specified the factor structure of the MITS. Results from study 2 suggest that a one-point increase in the MITS measure corresponds with using indoor tanning beds 11 more times in the past year., Conclusions: These findings demonstrate that moodbased tanning motivations are a strong predictor of indoor tanning intentions and behavior. Further, they suggest that health behavior researchers and healthcare practitioners can use the MITS to assess the extent to which mood-based motivations impact indoor tanning bed use.