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The aim of this study was to explore the voices of South Asian youth in the United States about gender norms and healthcare decision making. Ten focus group discussions were held with 36 students of South Asian origin at a university on the West Coast of the United States. Thematic analysis was performed on the focus group data. Three main themes emerged from the data: (1) intersectionality of gender with other factors that affect healthcare decision making, (2) impact of gender on health, and (3) coping strategies. Participants reported preferential treatment for boys versus girls, vesting decision-making control among males, worse health among females, and coping strategies. A few responses indicated that power differentials in some families were shifting to a more egalitarian balance between males and females. Aspects such as age, employment, and language barriers intersected with gender to create a complex web of influence on healthcare decision making. The study has implications for social workers to offer culturally responsive support to South Asian youth in the United States, paying attention to the intersectionalities when working with them. Further research is needed to explore the influence of gender on healthcare decision-making processes of South Asian youth in the United States. [ABSTRACT FROM AUTHOR]

Approximately 1,000 out-of-hospital cardiac arrests (OHCAs) are assessed by emergency medical services in the United States every day, and approximately 90% of patients do not survive, leading to substantial years of potential life lost (YPLL). Chicago emergency medical services data were used to assess changes in mean age and YPLL from nontraumatic OHCA in adults in biennial cycles during 2014-2021. Among 21,070 reported nontraumatic OHCAs during 2014-2021, approximately 60% occurred among men and 57% among non-Hispanic Black or African American (Black) persons. YPLL increased from 52,044 during 2014-2015 to 88,788 during 2020-2021 (p = 0.002) and mean age decreased from 64.7 years during 2014-2015, to 62.7 years during 2020-2021. Decrease in mean age occurred among both men (p<0.001) and women (p = 0.002) and was largest among Black men. Mean age decreased among patients without presumed cardiac etiology from 56.3 to 52.5 years (p<0.001) and among patients with nonshockable rhythm from 65.5 to 62.7 years (p<0.001). Further study is needed to assess whether similar trends are occurring elsewhere, and to understand the mechanisms that underlie these trends in Chicago because these mechanisms could help guide prevention efforts. Increased public awareness of the risk of cardiac arrest and knowledge of how to intervene as a bystander could help decrease associated mortality. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) can aid geriatricians in caring for complex, older patients. Currently, there is limited literature on POCUS use by geriatricians. We conducted a national survey to assess current POCUS use, training desired, and barriers among Geriatrics and Extended Care ("geriatric") clinics at Veterans Affairs Medical Centers (VAMCs). Methods: We conducted a prospective observational study of all VAMCs between August 2019 and March 2020 using a web-based survey sent to all VAMC Chiefs of Staff and Chiefs of geriatric clinics. Results: All Chiefs of Staff (n=130) completed the survey (100% response rate). Chiefs of geriatric clinics ("chiefs") at 76 VAMCs were surveyed and 52 completed the survey (68% response rate). Geriatric clinics were located throughout the United States, mostly at high-complexity, urban VAMCs. Only 15% of chiefs responded that there was some POCUS usage in their geriatric clinic, but more than 60% of chiefs would support the implementation of POCUS use. The most common POCUS applications used in geriatric clinics were the evaluation of the bladder and urinary obstruction. Barriers to POCUS use included a lack of trained providers (56%), ultrasound equipment (50%), and funding for training (35%). Additionally, chiefs reported time utilization, clinical indications, and low patient census as barriers. Conclusions: POCUS has several potential applications for clinicians caring for geriatric patients. Though only 15% of geriatric clinics at VAMCs currently use POCUS, most geriatric chiefs would support implementing POCUS use as a diagnostic tool. The greatest barriers to POCUS implementation in geriatric clinics were a lack of training and ultrasound equipment. Addressing these barriers systematically can facilitate implementation of POCUS use into practice and permit assessment of the impact of POCUS on geriatric care in the future. [ABSTRACT FROM AUTHOR]

Despite promising outcomes for >50 years, nonsurgical orthodontic airway plates (OAP) are only infrequently offered for babies with Robin sequence in a few parts of the world. This article demonstrates possibility of providing functional improvement using an OAP to help these babies overcome their functional and structural difficulties on their own. Two consecutively treated cases are presented exemplifying that OAP treatment that had originated from Europe is reproducible and effective in an institution in the United States. [ABSTRACT FROM AUTHOR]

Objective: Preeclampsia is a major obstetric disorder that can lead to severe maternal, fetal and infant outcomes. In women with suspected preeclampsia, measurement of the soluble fms-like tyrosine kinase-1 (sFlt1) and placental growth factor (PlGF) ratio has been shown to have a high negative predictive value (>97%). Our aim was to estimate the value to the US healthcare system of adopting this test into clinical practice.Study Design: An economic model was developed for the evaluation of suspected preeclampsia from a US payer perspective using data from a US observational study of 459 women evaluated between 23 and 34.6 weeks. Test results were not available to clinicians. The model compares two strategies for managing suspected preeclampsia: standard care versus a biomarker-informed pathway utilizing the sFlt1/PlGF ratio.Results: Utilization of the sFlt1/PlGF ratio test reduced the number of women admitted for suspected preeclampsia by 34-49%. Despite fewer admissions, a higher proportion of women admitted to hospital subsequently developed preeclampsia, and the proportion of women not admitted who would subsequently develop preeclampsia remained low (3.2%-6.7%). Cost savings arising from a reduction in admissions are estimated to be $1050 in the base case; varying the hospitalization cost ±25% would lead to savings in the range $771 to $1330 per patient at 2020 prices.Conclusion: Adopting the sFlt1/PlGF ratio test as an adjunct to clinical criteria improves the assessment of risk in women presenting with suspicion of preeclampsia and has the potential to safely reduce unnecessary admissions and save costs. [ABSTRACT FROM AUTHOR]

Objectives Concern has been raised in the rheumatology community regarding recent regulatory warnings that HCQ used in the coronavirus disease 2019 pandemic could cause acute psychiatric events. We aimed to study whether there is risk of incident depression, suicidal ideation or psychosis associated with HCQ as used for RA. Methods We performed a new-user cohort study using claims and electronic medical records from 10 sources and 3 countries (Germany, UK and USA). RA patients ≥18 years of age and initiating HCQ were compared with those initiating SSZ (active comparator) and followed up in the short (30 days) and long term (on treatment). Study outcomes included depression, suicide/suicidal ideation and hospitalization for psychosis. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate database-specific calibrated hazard ratios (HRs), with estimates pooled where I2 <40%. Results A total of 918 144 and 290 383 users of HCQ and SSZ, respectively, were included. No consistent risk of psychiatric events was observed with short-term HCQ (compared with SSZ) use, with meta-analytic HRs of 0.96 (95% CI 0.79, 1.16) for depression, 0.94 (95% CI 0.49, 1.77) for suicide/suicidal ideation and 1.03 (95% CI 0.66, 1.60) for psychosis. No consistent long-term risk was seen, with meta-analytic HRs of 0.94 (95% CI 0.71, 1.26) for depression, 0.77 (95% CI 0.56, 1.07) for suicide/suicidal ideation and 0.99 (95% CI 0.72, 1.35) for psychosis. Conclusion HCQ as used to treat RA does not appear to increase the risk of depression, suicide/suicidal ideation or psychosis compared with SSZ. No effects were seen in the short or long term. Use at a higher dose or for different indications needs further investigation. Trial registration Registered with EU PAS (reference no. EUPAS34497; http://www.encepp.eu/encepp/viewResource.htm? id=34498). The full study protocol and analysis source code can be found at https://github.com/ohdsi-studies/Covid19EstimationHydroxychloroquine2. [ABSTRACT FROM AUTHOR]

Objective: To increase access to high-quality and multiregional databases in global epidemiology of cleft surgeries through partnership with an NGO. Design: The study retrospectively analyzes 34 801 primary palate surgeries in 70+ countries from the 2016 electronic health records of an non-governmental organization (NGO). The study also utilizes the Kids' Inpatient Database to compare the epidemiology of primary cleft palate surgeries in the United States. Participants: Patient records of those undergoing primary cleft palate surgeries only. Main Outcome Measures: Region, age, sex, type of cleft, laterality of cleft. Results: Key findings show that average age of those receiving primary cleft palate surgery in the low- and middle-income countries (LMICs) was 1.95 years. The distribution of males and females receiving surgery corresponds to the US national data. More hard cleft palates were on the left side (66.18%) than the right side (33.82%), independent of gender and region. Conclusions: Databases from an established NGO can be used to enhance our understanding of the disease characteristics in these regions. By increasing the information available regarding cleft surgeries in the LMIC, we hope to increase awareness of the similarities and differences in surgeries across various regions, as part of an effort to inform the goals set by Global Surgery 2030 initiative by the Lancet Commission. [ABSTRACT FROM AUTHOR]

The number of individuals of South Asian origin receiving health care in the United States is rapidly growing, yet little is known about their psychosocial needs. To better inform the provision of culturally competent social work services for this patient population, researchers sought to describe U.S. health care providers' perceptions of the psychosocial needs of seriously ill patients of South Asian origin. To do so, they conducted a multimethod qualitative descriptive study, collecting data during focus groups and individual interviews of health care providers (N = 57) and analyzing them via directed content analysis. Identified patient needs included addressing financial and legal problems, challenges completing activities of daily living, spiritual or existential concerns, psychosocial experiences of unresolved physical symptoms, and psychological distress. Providers also emphasized the importance of supporting patients' family members to aid in their caregiving abilities and to enhance their quality of life. As social workers in U.S. health care settings encounter a growing number of patients of South Asian origin, a more comprehensive understanding of their psychosocial needs is imperative. Study findings suggest that health social workers should provide psychosocial care that encompasses culture-specific needs and psychosocial care that can be provided in a culturally responsive manner. [ABSTRACT FROM AUTHOR]

Rationale Clinician bias contributes to racial disparities in healthcare, but its effects may be indirect and culturally specific. Objective The present work aims to investigate clinicians' perceptions of Black versus White patients' personal responsibility for their health, whether this variable predicts racial bias against Black patients, and whether this effect differs between the U.S. and France. Method American ( N  = 83) and French ( N  = 81) clinicians were randomly assigned to report their impressions of an identical Black or White male patient based on a physician's notes. We measured clinicians' views of the patient's anticipated improvement and adherence to treatment and their perceptions concerning how personally responsible the patient was for his health. Results Whereas French clinicians did not exhibit significant racial bias on the measures of interest, American clinicians rated a hypothetical White patient, compared to an identical Black patient, as significantly more likely to improve, adhere to treatment, and be personally responsible for his health. Moreover, in the U.S., personal responsibility mediated the racial difference in expected improvement, such that as the White patient was seen as more personally responsible for his health, he was also viewed as more likely to improve. Conclusion The present work indicates that American clinicians displayed less optimistic expectations for the medical treatment and health of a Black male patient, relative to a White male patient, and that this racial bias was related to their view of the Black patient as being less personally responsible for his health relative to the White patient. French clinicians did not show this pattern of racial bias, suggesting the importance of considering cultural influences for understanding racial biases in healthcare and health. [ABSTRACT FROM AUTHOR]

Background: While effective communication is important in the care of seriously ill patients, little is known about communication challenges faced by healthcare providers serving U.S. patients of South Asian origin, one of the fastest growing demographic groups in the United States. Objective: Researchers sought to examine communication challenges faced by healthcare providers serving seriously ill South Asian patients and their families and present strategies recommended by providers for effective communication. Design: Researchers conducted a thematic analysis of qualitative data obtained through focus groups and individual interviews with 57 healthcare providers, including physicians, social workers, nurses, chaplains, and others drawn from different healthcare settings in one Midwestern city. Results: While acknowledging the considerable diversity within the U.S. South Asian community, participants discussed three types of communication challenges they often encounter when serving this population: ensuring effective interpretation, identifying a spokesperson, and challenges posed by different cultural norms. Participants shared strategies to address these challenges such as proactively inquiring about patients' and families' preferences and encouraging early appointment of a spokesperson. Conclusions: While providers should avoid stereotyping patients, an awareness of common challenges and adoption of recommended strategies to address these challenges may enhance the provision of culturally responsive person-centered services for seriously ill South Asian patients and their families receiving care in the United States. [ABSTRACT FROM AUTHOR]

Summary: We evaluated the prevalence of osteoporosis using the osteoporosis diagnostic criteria developed by the National Bone Health Alliance (NBHA), which includes qualified fractures, FRAX score in addition to bone mineral density (BMD). The expanded definition increases the prevalence compared to BMD alone definitions; however, it may better identify those at elevated fracture risk. Purpose: The purpose of this paper is to estimate the prevalence of osteoporosis in US adults ≥50 years using the NBHA osteoporosis diagnostic criteria. Methods: Utilizing 2005-2008 data of the National Health and Nutrition Examination Survey (NHANES), we identified participants with osteoporosis with any one of the following: (1) femoral neck or lumbar spine T-score ≤ −2.5; (2) low trauma hip fracture irrespective of BMD or clinical vertebral, proximal humerus, pelvis, or distal forearm fracture with a T-score >−2.5 <−1.0; or (3) FRAX score at the National Osteoporosis Foundation intervention thresholds (≥3% for hip fracture or ≥20% for major osteoporotic fracture). We estimated the prevalence overall and by gender and age. Results: Our sample included 1948 (54.3%) men and 1639 (45.7%) women. Approximately 12% were 80+ years and 21% were from racial/ethnic minority groups. We estimated that 16.0% (0.8) of men and 29.9% (1.0) of women 50+ years have osteoporosis. The prevalence increases with age to 46.3% in men and 77.1% in women 80+ years. The combination of FRAX score and fractures was the largest contributing factor defining osteoporosis in men (70-79, 88.1%; 80+, 80.1%), whereas T-score was the largest contributing factor in women (70-79, 49.2%; 80+, 43.5%). Conclusions: We found that 16% of men and 29.9% of women 50+ have osteoporosis based on the NBHA diagnostic criteria. Although the expanded definition increases the prevalence compared to BMD alone-based definitions, it may better identify those at elevated fracture risk in order to reduce the burden of fractures in older adults. [ABSTRACT FROM AUTHOR]

HIV healthcare services in the USA are made available through a complex funding and delivery system. We present perspectives of HIV agencies on improvements that could lead to an ideal system of HIV prevention, treatment and care. We conducted semi-structured interviews with representatives from 21 HIV agencies offering diverse services in Baltimore, MD. Thematic analysis revealed six key themes: (1) Focusing on HIV prevention, (2) Establishing common entrypoints for services, (3) Improving information availability, (4) Streamlining funding streams, (5) Removing competitiveness and (6) Building trust. We recommend that in addition to addressing operational issues regarding service delivery and patient care, initiatives to improve HIV service systems should address underlying social issues such as building trust. [ABSTRACT FROM AUTHOR]

Advance care planning (ACP) increases the likelihood patients will receive end-of-life care that is congruent with their preferences and lowers stress among both patients and caregivers. Previous efforts to increase ACP have mainly focused on information provision in the very late stage of life. This study examines whether a relationship exists between volunteering and ACP, and whether this relationship is associated with social support. The sample comprises 877 individuals who were aged 55+ in 2008, and were deceased before 2010. The sample is derived from seven waves (1998–2010) of data from the Health and Retirement Study. Logistic regression results showed that overall ACP and durable power of attorney for health care (DPAHC) were both higher (OR = 1.61 and 1.71, respectively) for older adults with volunteering experience in the past 10 years than those without such experience. Available social support (relatives and friends living nearby) was not associated with the relationship between volunteering and ACP. Other factors related to ACP included poorer health, death being expected, death due to cancer, older age, and being a racial minority. Involving older people in volunteer work may help to increase ACP. Future research is encouraged to identify reasons for the association between volunteering and ACP. [ABSTRACT FROM AUTHOR]

Companion animals play important roles in the lives of people managing the many symptoms associated with a chronic illness such as HIV. The authors explored meaningful examples of pets, particularly dogs, and their place in support networks among women living with AIDS/HIV. Data were collected via focus group, as part of a larger Photovoice project. Qualitative analysis discovered three key related themes. Emerging themes included pet as spiritual custodian, pet as unconditional source of support, and pet providing a sense of purpose. The comments these participants made about their dogs allowed us to explore culturally embedded notions about animal companionship; the ability to know when one is sick, frightened, emotionally upset, or facing a spiritual crisis. The women also shared the importance of nonjudgmental support in the wake of a stigmatized diagnosis, and the ways pets provided a sense of purpose. [ABSTRACT FROM AUTHOR]

Background: The introduction of routine measurement of serum calcium levels led to a sharp increase in the incidence of primary hyperparathyroidism in the early 1970s.Objective: To evaluate the trends in the incidence of primary hyperparathyroidism since the mid-1970s.Setting: Rochester and Olmsted County, Minnesota.Design: Population-based descriptive study.Patients: All residents of Rochester, Minnesota, who received an initial diagnosis of primary hyperparathyroidism between 1965 and 1992 were identified through the medical records linkage system of the Rochester Epidemiology Project. Included as persons having definite cases (92% of the total) were patients with pathologically confirmed hyperparathyroidism, hypercalcemia with inappropriately elevated parathyroid hormone levels, or hypercalcemia that had lasted for more than a year and had no cause other than primary hyperparathyroidism.Measurements: Incidence rates were calculated and directly standardized to the population structure of white persons in the United States in 1990.Results: From 1965 to June 1974 (the prescreening era), the age- and sex-adjusted incidence of primary hyperparathyroidism in Rochester was 15 cases per 100,000 person-years. After measurement of calcium levels was added to the automated serum chemistry panel in July 1974, the incidence increased to 112 per 100,000 person-years in 1975 and then decreased somewhat, reflecting a sweeping effect. Despite improved case ascertainment, however, the incidence rate has continued to decrease; in 1992, the incidence was 4 per 100,000 person-years. A few patients had complications that might have been caused by hyperparathyroidism (22% between 1965 and June 1974 and 6% thereafter), and survival was not impaired in either period. The maximum serum calcium levels did not change (P = 0.15).Conclusions: The progressive decrease in the incidence of primary hyperparathyroidism is unexpected and suggests a significant change in the epidemiology of this disease. [ABSTRACT FROM AUTHOR]

Objective: Our study aimed to use national data to assess the perioperative outcomes of craniosynostosis surgical repair. Design: Data were obtained from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Kids inpatient Database from 1997, 2000, 2003, and 2006. Setting: Community hospitals in the United States. Patients: The cohort was identified using the ICD-9-CM procedure codes for craniosynostosis surgical repair (2.01, 2.03, 2.04, 2.06). Main Outcome Measures(s): We determined patient and hospital characteristics. We clustered patients by age group (<7 months, 7 to 12 months, 1 to 3 years) and assessed mortality, comorbidities, mean length of stay (LOS), and total charge. We performed logistic regression with our dependent variable being longer average hospital stay: LOS > 4.2 days. Results: We found 3426 patients. Average age at the time of surgery was 181 days (SD 84). Average length of stay was 4.2 days. The majority of the patients were boys (66%), white (71%), and insured (93%). Nearly all patients underwent surgery in a teaching hospital (98%) in urban centers (99%). Approximately 10% of patients experienced an acute complication, most commonly hemorrhages or hematomas and airway or respiratory failure. Patients ages 1 to 3 years had the highest rates of comorbidities and a longer LOS. Mortality rate was <1%. Conclusions: Craniosynostosis surgery is safe with low rates of mortality and acute complications. LOS >4.2 appears to be associated more with comorbidities than with complications. Higher rates of comorbidities and LOS >4.2 days for patients age 1 to 3 years warrant addition research to assess potential barriers to care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although end-of-life care preferences vary across racial/ethnic groups, little is known about how cultural values affect end-of-life care preferences among South Asian immigrants and their offspring in the US. OBJECTIVE: To examine the perspectives of first- and second-generation South Asians living in the US regarding end-of-life care. DESIGN: Focus group study. Discussions explored participant preferences and experiences with family members facing the end of life. PARTICIPANTS: Twelve first-generation and 11 second-generation self-identified Asian Indians living in the mid-Atlantic region. APPROACH: Content analysis of focus group transcripts. RESULTS: First-generation participants ranged in age from 41 to 76 years and were evenly split by gender. Second-generation participants ranged in age from 23 to 36 years and included seven women and four men. All participants were highly educated, and two thirds were either studying or working in a health care field. All but two subjects were Hindu. Several themes emerged that highlighted cultural differences and challenges for this population in the context of end-of-life care: attitudes toward death and suffering; family duty; and preferences for information disclosure and decision making. Participants described cultural challenges due to the evolution of traditional roles, lack of explicit discussion between patients and family members about preferences and care expectations, and a tension between wanting to meet traditional expectations and the challenges in doing so given US social realities. CONCLUSIONS: Traditional cultural values, such as duty to family, greatly influenced end-of-life care preferences and retained importance across generations. Clinicians caring for Asian Indian patients at the end of life may be better able to assess care preferences after exploring the complex interplay between traditional expectations and specific social realities for each patient. Particular attention should be given to attitudes toward death and suffering, family duty, and preferences for information disclosure and decision making. [ABSTRACT FROM AUTHOR]

The spatial variation of productivity across farm fields can be classified by delineating site-specific management zones. Since productivity is influenced by soil characteristics, the spatial pattern of productivity could be caused by a corresponding variation in certain soil properties. Determining the source of variation in productivity can help achieve more effective site-specific management. The objectives of this study were (i) to characterize the spatial variability of soil physical properties across irrigated corn (Zea Mays L.) production fields and (ii) to determine if soil physical properties could explain the variability in productivity between site-specific management zones. The study was conducted over three study sites in northeastern Colorado. The soil properties measured were bulk density, cone index, surface soil color, organic C, texture, sorptivity, and surface water content. A multi-response permutation procedure was used to test for significant differences among soil properties between management zones. Box plots of soil physical properties were created for each management zone within each study site to determine if trends in soil physical properties corresponded to the productivity potential of the management zones. Overall, this study showed that soil physical properties exhibited significant spatial variability across production fields. The trends observed for the measured soil physical properties corresponded to the productivity potential of the management zones. Utilizing site-specific management zones could help manage the in-field variability of yield-limiting soil physical properties. [ABSTRACT FROM AUTHOR]

Purpose - To describe the function and use of the GreenSeeker[tm] active remote sensor used to detect crop nitrogen status. Design/methodology/approach - In this paper, the GreenSeeker active remote sensor and its use in irrigated maize production systems will be described. A brief discussion of the science of using remote sensing for studying plants is presented. Additionally, a summary of observations collected from field trials is presented. Findings - The GreenSeeker active sensor has tremendous potential for accurately characterizing crop variability for site-specific N rate determinations in the Western Great Plains region of the United States. Originality/value - This paper discusses the GreenSeeker active sensor for detecting crop variability. Data from the GreenSeeker can be used to make site-specific nitrogen fertilizer applications which may lead to improved nitrogen use efficiency. [ABSTRACT FROM AUTHOR]

Precision agriculture is a new and developing discipline that incorporates advanced technologies to enhance the efficiency of farm inputs in a profitable and environmentally sensible manner. Yield monitoring and variable rate application are the most widely used precision technologies. Versatile guidance systems utilizing the global positioning system (GPS) and management zone approaches are also being developed to further increase productivity by reducing error, cost, and time. These technologies provide tools to quantify and manage variability existing in fields across an array of cropping systems. A review of precision farming technologies that are currently being used in the United States and around the world is presented in this article. [ABSTRACT FROM AUTHOR]

Although significant advances have been made in the area of cardiovascular disease, few studies have targeted ethnic groups. There is a large and growing Arab-American (AA) population living in Southeast Michigan, whose risk of cardiovascular disease may be on the increase. The objective of this study was to evaluate the prevalence of cardiovascular disease risk factors and associated behavioral factors in an AA community with a large population of emigrants, subjected to significant lifestyle changes. Three hundred and fifty-two AA living in Southeast Michigan, mostly from the Middle East, were screened to determine their eating and smoking habits, body mass index (BMI) body fat analysis, blood pressure, and complete lipid profiling. Overweight was defined as a BMI greater than or equal to the 85th percentile value for age- and sex-specific reference data from the third National Health and Nutrition Examination Survey (NHANES III). Correlation analysis was used to examine factors associated with being overweight, with adjustment for age and sex. Blood cholesterol concentrations were compared with published data for Arabs from the Middle Eastern countries. The overall prevalence of being overweight in subjects aged 35 and older was significantly higher than NHANES III reference data (Men, 27.7% (95% confidence interval, 21.8-34.5); women, 33.7% (95% confidence interval, 27.9-40.1)). A mean cholesterol concentration of 210 ± 4 mg/dl was observed in those over the age of 40. The mean high-density lipoprotein (HDL)-cholesterol levels for men and women were 38 and 48 mg/dl, respectively. Greater than 54.6% of all subjects had a total cholesterol:HDL ratio >4.5. Although being overweight and obesity were prevalent in this population, the mean BMI for men was 25.7 ± 0.34, compared with 27 ± 0.58 for women. Increased BMI was significantly correlated (P < 0.01) with increased blood pressure, increased glucose levels, increased total cholesterol and decreased HDL-cholesterol levels (P < 0.01). Elevation in risk factors to cardivoascular disease is prevalent in this population and indicates a need for programs targeting primary prevention of obesity in men and women. These results, which could be attributed in part to lifestyle changes typical of most emigrant populations, suggest an increase in the risk for developing cardiovascular disease. In addition, this study provides a basis for future intervention to improve the health of this population. [ABSTRACT FROM AUTHOR]

In response to intense competition from overseas in the last two decades, U.S. companies have instituted a variety of management practices in their quest to improve their competitiveness. Among the many practices that have been adopted by a large number of firms are just-in-time, total quality management, worker empowerment, and design for manufacturability. However, there has been little systematic analysis of the organizational factors that drive the adoption of these practices as well as their successful implementation. This paper posits that the theories and methods from economics can provide a useful aid in such an analysis. Using the basic tenets of economics, a structural framework is proposed to highlight critical issues in operations management that deserve attention. Examples from industry are used to illustrate how the framework may provide answers to questions that have received little attention in the research literature. [ABSTRACT FROM AUTHOR]

The article highlights statistics concerning the use of palm oil in the U.S. Based on global statistics, use of palm oil in the country is at 4.6 percent compared with the soybean oil which accounts for 69 percent of consumption. In terms of global nutrition, 31 percent of global production of vegetable oil is accounted for by palm oil, while soybean oil accounts for 28 percent. Argentina, Malaysia and Indonesia are the leading net exporters of oils and fats.

The article presents information on the increasing number of U.S. Food and Drug Administration (FDA)-approved drugs for osteoporosis prevention and treatment. It highlights a study that appeared in the "New England Journal of Medicine" which involved 7,868 postmenopausal women with osteoporosis who were randomly given with either 60 milligrams (mg) of denosumab or placebo subcutaneously every 6 months for 3 years. It mentions teriparatide as the only currently approved anabolic agent for treating osteoporosis by stimulating new bone formation. The author calls for additional anabolic agents to treat osteoporosis.

Background: Approximately 1000 out-of-hospital cardiac arrest (OHCA) occur each day in the United States. Although sex differences exist for other cardiovascular conditions such as stroke and acute myocardial infarction, they are less well understood for OHCA. Specifically, the extent to which neurological and survival outcomes after OHCA differ between men and women remains poorly characterized in the U.S.Methods and Results: Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 326,138 adults with an OHCA from 2013 to 2019. Using multivariable logistic regression, we evaluated for sex differences in rates of survival to hospital admission, survival to hospital discharge, and favorable neurological survival (i.e., without severe neurological disability), adjusted for demographics, cardiac arrest characteristics and bystander interventions. Overall, 117,281 (36%) patients were women. Median age was 62 and 65 years for men and women, respectively. An initial shockable rhythm (25.1% vs 14.7%, standardized difference of 0.26) and an arrest in a public location (22.2% vs. 11.3%; standardized difference of 0.30) were more common in men, but there were no meaningful sex differences in rates of witnessed arrests, bystander cardiopulmonary resuscitation, intra-venous access, or use of mechanical devices for delivering cardiopulmonary resuscitation. Overall, the unadjusted rates of all survival outcomes were similar between men and women: survival to hospital admission (27.0% for men vs. 27.9% for women, standardized difference of -0.02), survival to hospital discharge (10.5% for men vs. 8.6% for women, standardized difference of 0.07), and favorable neurological survival (9.0% for men vs. 6.6% for women, standardized difference of 0.09). After multivariable adjustment, however, men were less likely to survive to hospital admission (adjusted OR = 0.75, 95% CI: 0.73, 0.77), survive to hospital discharge (adjusted OR = 0.83, 95% CI: 0.80, 0.85), or have favorable neurological survival (adjusted OR = 0.88, 95% CI: 0.85, 0.91).Conclusions: Compared to women, men with OHCA have more favorable cardiac arrest characteristics but were less likely to survive to hospital admission, survive to discharge, nor have favorable neurological survival. [ABSTRACT FROM AUTHOR]

In this article, the author examines the environmental impacts of demand side and renewable energy resources technology. Topics discussed include challenge regarding usage and supply of energy around the world; need for designing systems and technologies in order to minimize bad impacts of renewable energy resources on the environment; and importance of understanding link between demand and supply-side for using energy in developing efficient technologies through through sustainable energy.

The author explores nitroglycerin as a novel and inexpensive treatment for osteoporosis. He notes the current approved medications by the U.S. Food and Drug Administration for prevention and treatment of osteoporosis which fall into 1 of 2 categories. He states that direct evidence for a beneficial effect of nitric oxide donors for preventing bone loss has been conflicting despite various in vitro and animal data, as well as supportive epidemiological data.

Background: Heart failure is the leading cause for 30-day all-cause readmission. We examined the impact of 30-day all-cause readmission on long-term outcomes and cost in a propensity score-matched study of hospitalized patients with heart failure.Methods: Of the 7578 Medicare beneficiaries discharged with a primary diagnosis of heart failure from 106 Alabama hospitals (1998-2001) and alive at 30 days after discharge, 1519 had a 30-day all-cause readmission. Using propensity scores for 30-day all-cause readmission, we assembled a matched cohort of 1516 pairs of patients with and without a 30-day all-cause readmission, balanced on 34 baseline characteristics (mean age 75 years, 56% women, 24% African American).Results: During 2-12 months of follow-up after discharge from index hospitalization, all-cause mortality occurred in 41% and 27% of matched patients with and without a 30-day all-cause readmission, respectively (hazard ratio 1.68; 95% confidence interval 1.48-1.90; P <.001). This harmful association of 30-day all-cause readmission with mortality persisted during an average follow-up of 3.1 (maximum, 8.7) years (hazard ratio 1.33; 95% confidence interval 1.22-1.45; P <.001). Patients with a 30-day all-cause readmission had higher cumulative all-cause readmission (mean, 6.9 vs 5.1; P <.001), a longer cumulative length of stay (mean, 51 vs 43 days; P <.001), and a higher cumulative cost (mean, $38,972 vs $34,025; P = .001) during 8.7 years of follow-up.Conclusions: Among Medicare beneficiaries hospitalized for heart failure, 30-day all-cause readmission was associated with a higher risk of subsequent all-cause mortality, higher number of cumulative all-cause readmission, longer cumulative length of stay, and higher cumulative cost. [ABSTRACT FROM AUTHOR]

Examines the incidence of age related fractures among the residents diagnosed with urolithiasis in Minnesota. Impact of risk factors for fracture on the effects of kidney stones; Causes of bone loss and fractures; Increase in serum calcium levels and reduction of bone demineralization.

Early, accurate outcome prediction after out-of-hospital cardiac arrest (OHCA) is critical for clinical decision-making and resource allocation. We sought to validate the revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) score in a United States cohort and compare its prognostic performance to the Pittsburgh Cardiac Arrest Category (PCAC) and Full Outline of UnResponsiveness (FOUR) scores. This is a single-center, retrospective study of OHCA patients admitted between January 2014-August 2022. Area under the receiver operating curve (AUC) was computed for each score for predicting poor neurologic outcome at discharge and in-hospital mortality. We compared the scores' predictive abilities via Delong's test. Of 505 OHCA patients with all scores available, the medians [IQR] for rCAST, PCAC, and FOUR scores were 9.5 [6.0, 11.5], 4 [3, 4], and 2 [0, 5], respectively. The AUC [95% confidence interval] of the rCAST, PCAC, and FOUR scores for predicting poor neurologic outcome were 0.815 [0.763–0.867], 0.753 [0.697–0.809], and 0.841 [0.796–0.886], respectively. The AUC [95% confidence interval] of the rCAST, PCAC, and FOUR scores for predicting mortality were 0.799 [0.751–0.847], 0.723 [0.673–0.773], and 0.813 [0.770–0.855], respectively. The rCAST score was superior to the PCAC score for predicting mortality (p = 0.017). The FOUR score was superior to the PCAC score for predicting poor neurological outcome (p < 0.001) and mortality (p < 0.001). The rCAST score can reliably predict poor outcome in a United States cohort of OHCA patients regardless of TTM status and outperforms the PCAC score. [ABSTRACT FROM AUTHOR]

Although new technologies such as precision farming will contribute to increasing yields per unit area, similarly soil and water conservation will be instrumental in maintaining these increases in productivity while reducing environmental degradation, off-site transport, and water pollution. Initially, 'precision conservation' was defined as the integration of spatial technologies such as global positioning systems (GPS), remote sensing, and geographic information systems (GIS) and the ability to analyze spatial relationships within and among mapped data. Surface modeling, spatial data mining and map analysis are three broad approaches that can be used to analyze layers of information to help develop and implement management practices that contribute to soil and water conservation in agricultural and natural ecosystems. In this paper, we expand the definition of precision conservation to a developing science that uses the new spatial technologies to link a system from a site specific location, to a field, to a set of fields (farm) to a regional scale. We also expand our discussion based on the status of precision conservation as it was shown by twenty six precision conservation papers presented at the 2004 Soil Science Society of America annual meeting. We propose that precision conservation will be a key science to contribute to the sustainability of our biosphere in this century. [ABSTRACT FROM AUTHOR]

Breast cancer is the second most diagnosed malignancy in American women with a lifetime occurrence of 1 in 8 women in the United States. There has been a dearth of research focusing on regional differences in breast cancer mortality with respect to race in the US. It is crucial to identify regions that are lagging to uplift the outreach of breast cancer care to certain races. Data for this study were obtained from the 2016-2018 Nationwide Inpatient Sample. In-hospital mortality, race and hospital regions for the patients with the primary diagnosis of Malignant Neoplasms of Breast were studied. Baseline characteristics of participants were summarized using descriptive statistics. The patient population was stratified as per race, hospital region, gender, therapy received and family history. Logistic regression was performed to derive the odds ratio while adjusting for different variables. 99, 543 patients with metastatic breast cancer were identified. African Americans (AAs) were found to have the highest reported deaths at 5.54%, followed by Asians and Pacific Islanders at 4.80% and Caucasians 4.09% (p < 0.0001). The odds of dying were significantly higher in the AA population when compared to Caucasian population (OR 1.391 (1.286-1.504)), and the odds were consistently higher across all regions of the US. In terms of regional disparities with respect to race, AA's had highest mortality in the south whereas all other races had the highest mortality in the west. It was seen that races identifying as "others" had significantly higher odds of dying in the Northeast. It is crucial to identify racial differences in the various regions across the US in order to implement appropriate outreach strategies to tackle these disparities., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Heart transplantation is the definitive management for select patients with end-stage heart failure. Owing to an ongoing organ donor shortage, organs are sometimes allocated from distant locales. These organs may be perceived as less desirable because of donor risk factors and ischemic times. We compared survival after heart transplantation by donors originating from British Columbia (BC), other Canadian provinces, and the United States. This retrospective cohort analysis included all patients transplanted in BC between December 1, 1988, and October 21, 2014, and excluded those with missing data or retransplantation. Among 382 patients, 297 (77.7%) recipients and 238 (62.3%) donors were male. The median recipient age was 54.6 years (interquartile range, 46.0-61.0 years) and the median donor age was 33 years (interquartile range, 22-46 years). Overall 10-year survival was 62.1% (95% confidence interval, 56.3-67.4). There was no difference in 10-year survival when comparing donors from BC, other Canadian provinces, and the United States despite significantly lower median ischemic times in donors from BC. Donor location was not predictive of mortality after controlling for recipient age, donor age, and cold ischemic time. Donor origin did not impact 10-year survival after heart transplantation despite increased ischemic time, suggesting that distant donors result in similar outcomes in BC., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: EPIC-CP (Expanded Prostate Cancer Index Composite for Clinical Practice) is a short questionnaire that comprehensively measures patient reported health related quality of life at the point of care. We evaluated the feasibility of using EPIC-CP in the routine clinical care of patients with prostate cancer without research infrastructure. We compared longitudinal patient and practitioner reported prostate cancer outcomes., Materials and Methods: We reviewed health related quality of life outcomes in 482 patients who underwent radical prostatectomy at our institution from 2010 to 2014. EPIC-CP was administered and interpreted in routine clinical practice without research personnel. We compared practitioner documented rates of incontinence pad use and functional erections to patient reported rates using EPIC-CP., Results: A total of 708 EPIC-CP questionnaires were completed. Mean urinary incontinence domain scores were significantly higher (worse) than baseline (mean ± SD 0.6 ± 0.2) 3 and 6 months after treatment (mean 3.1 ± 2.3 and 2.2 ± 2.1, respectively, each p <0.05) but they returned to baseline at 12 months (mean 1.6 ± 1.7, p >0.05). Mean sexual domain scores were significantly worse than baseline (mean 2.4 ± 2.8) at all posttreatment time points (each p <0.05). Practitioners significantly overestimated incontinence pad-free rates at 3 months (48% vs 39%) and functional erection rates at 3 months (18% vs 12%), 6 months (38% vs 23%) and 12 months (45% vs 23%, each p <0.05)., Conclusions: EPIC-CP is feasible to use in the routine clinical care of patients with prostate cancer without requiring a research infrastructure. Using EPIC-CP in clinical practice may help practitioners objectively assess and appropriately manage posttreatment side effects in patients with prostate cancer., (Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)