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The importance of engaging students with complex societal challenges has led to the adoption of various interdisciplinary teaching and learning practices in both K-12 and higher education. However, interdisciplinary learning is one of the most complex domains of contemporary educational practice, and, despite its significance, remains significantly undertheorized and under-researched. This Special Issue highlights empirical research efforts toward understanding interdisciplinary learning in its complexity. It simultaneously aims to (1) advance ecological perspectives that encompass concepts and methodologies for studying complex heterogeneous learning practices and (2) apply these perspectives to the research of interdisciplinary learning - of how people learn across and beyond disciplines. This introduction provides a historical context for interdisciplinary learning, introduces an ecological stance toward researching learning across and beyond disciplines, and reviews critical theoretical and methodological challenges within interdisciplinary learning, arguing that the field of the learning sciences is well-positioned to address these challenges. It discusses how the contributions presented in this special issue shed light on theoretical, methodological, empirical, and design aspects of interdisciplinary learning and offer a basis for further design work and research.

This paper explores critical cosmopolitan literacies as a framework to engage teacher preparation program candidates in re-conceptualizing about their work as active thinkers, ethical decision makers, and agentive global actors. The purpose of the study is to elucidate how preservice teachers, in a secondary literacy teacher education program, respond to ethics-oriented education in addressing complex and controversial sociopolitical issues, such as the dialectics of freedom, human rights, and growing racism in the neoliberal globalized context. The third space theory of ethics is used to interpret participant student teachers' intellectual epistemology based on their engagement with literary and nonliterary works, as well as multicultural media products. Data consist of observations, discussions, focus-group interviews, reflective journals, and course evaluations. This study contributes to our understanding of how critical cosmopolitan literacies is situated in the intercultural dialogue pertaining to ethical and equitable decision-making as a promising professional enterprise in the preparation of literacy educators as global advocates for equity and social justice.

Background: Unhealthy alcohol use is one of the leading preventable causes of mortality in the U.S. Despite evidence of the growing burden of alcohol-associated mortality and disease, treatment is severely underutilized. Prior literature has often focused on assessing treatment among patients with severe alcohol use. Objectives: Assess factors associated with uptake of treatment for alcohol use among a broad population of those regularly exceeding U.S. guidelines for alcohol use. Design: Cross-sectional study. Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions – Wave III (NESARC-III) collected April 2012 to June 2013, weighted descriptive statistics were used to describe the U.S. population who self-reported regularly exceeding U.S. guidelines for moderate alcohol use at least monthly. Weighted multivariable regression was used to assess the association of individual-level factors with receipt of help for unhealthy alcohol use. Results: In weighted analyses of 6467 NESARC-III participants, 17% of the U.S. population reported regular engagement in unhealthy alcohol use (76% use exceeding guidelines, 14% binge drinking, 11% heavy drinking) and were predominantly male (62%), below age 65 (93%), non-Hispanic White (65%), and had lower levels of education and income. Half (53%) met criteria for alcohol use disorder. Only 5% reported receipt of help for their alcohol use. Compared to non-Hispanic White individuals, non-Hispanic Asian/Native Hawaiian or Other Pacific Islander (odds ratio [OR] 0.40, 95% confidence interval [CI] 0.18-0.90) and non-Hispanic Black (OR 0.68, 95% CI 0.48-0.96) individuals were less likely to receive help for alcohol use. Factors associated with greater receipt of help included being older, educational attainment, Medicaid insurance, concomitant drug use, liver disease, acute healthcare utilization, and greater alcohol-related problems. Conclusion: Identification of the factors associated with receipt of alcohol-related treatment, including race and ethnicity, age, education, insurance, and drug use can inform interventions to increase treatment receipt. [ABSTRACT FROM AUTHOR]

Since its inception nine years ago, CPED members have re-envisioned and implemented a new purpose for the professional practice doctorate in education, or Ed.D. This new purpose is grounded in the goal of preparing doctoral students to serve as scholarly practitioners, those who engage community as stakeholders in the process of improving problems of practice. Forming practitioners to be leaders in their communities under the CPED framework requires faculty who look beyond traditional roles by embEd.D.ing themselves in communities to work alongside practitioners working to transform their communities. Unfortunately, at many institutions, community-engagement is considered counter-normative to the traditional interpretation of research, teaching, and service, though it need not be. This paper will discuss the implications of CPED's community-engagement principle for Ed.D. programs, institutional policies, and academic environments in which community-engaged faculty do their work and the importance of these faculty members in the design of the Education Doctorate.

Aim/Purpose: The purpose is a bibliographic review that seeks to offer a clearer vision of the impact of technological tools on the implementation of the flipped classroom model. Background: This document reviews the flipped classroom and secondary education literature to analyze what technological tools are used to implement this model in secondary education settings and their impact on students. Methodology: For the review, an analysis of 61 articles found in SCOPUS and WOS was carried out, processed with a scientometric tool, where the implementation of the inverted classroom model in high school is evident, and, according to these, an in-depth analysis was carried out on which tools are most used and in which contexts they are applied. Contribution: This document offers new researchers a more unobstructed view of what type of technological tools have been implemented in the flipped classroom model in the context of high school and how students perceive them. Findings: This review analyzes the following aspects: (1) Analysis of the leading countries where the flipped classroom model is applied in secondary education; (2) Analysis of the subjects where the flipped classroom model has been implemented; and (3) It offers an analysis of the most used technological tools and in which contexts they are applied (online or offline). Impact on Society: This document helps new researchers make a conscious decision about the type of tool to implement to support the flipped classroom model and shows the importance of developing technological tools that are not limited by the use of the internet so that they can reach a more significant number of people. Future Research: Carry out research that focuses on applications that support low connectivity contexts, in order to improve the implementation of the flipped classroom model.

Work values, which describe what employees seek from their jobs and which parts of their jobs are important to them, have been linked to employees' response to work situations, organizational commitment, and job satisfaction. One work value that has not received adequate attention when exploring the link between work values and employees' work-related outcomes is creativity. This paper reports the results of a study that sought to fill this gap by assessing the relationships between employees' attitudes and values toward creativity, work environment, and job satisfaction in human service employees in the United States and Lithuania. The results differed for the two countries. While in the Lithuanian sample, creativity as a work value was significantly positively related to job satisfaction, this relationship was negative and non-significant in the US sample. Work environment was a significant predictor of job satisfaction in both countries. The interaction effect of creativity as work value and work environment on job satisfaction was not significant. Based on the results of the study, the authors discuss the practice implications of how to redesign jobs and make changes in work environments to create more complementarity between the two factors.

Introduction: Pharmaceutical regulation on a global scale is a complex process, with regulatory bodies overseeing various aspects, including licensing, registration, manufacturing, marketing, and labeling. Among these, the USFDA plays a crucial role in upholding public health. The pharmaceutical industry contributes significantly to well-being by developing and distributing therapeutic agents. The journey of evaluating new pharmaceuticals involves meticulous examination through several phases, from safety and efficacy assessments to toxicity evaluation. Drug approval involves submitting New Drug Applications (NDAs) to regulatory agencies like the USFDA and EMA. However, disparities in durations contribute to the phenomenon known as "drug lag." This lag refers to delays in a pharmaceutical product's availability in one market compared to another. Addressing this issue is crucial, given its impact on patient access to treatments. Method: This study aims to analyze the extent of drug lag, focusing on newly approved oncology targeted therapies in Saudi Arabia, the United States, and the European Union. Data for cancer treatments authorized by the USFDA, EMA, and SFDA from January 1, 1997, to December 31, 2022, were collected from regulatory agency websites. The data sources included authorization letters, prescription information, and evaluation documents. We conducted a comparative assessment of drug lag for approved oncology targeted therapies between Saudi Arabia, the US, and the EU. Result: Our analysis identified 135 newly approved oncology-targeted drugs within the specified timeframe. Of these, 71 received approval in all three regions, while disparities were evident in others. The USFDA consistently had the highest number of approved drugs, with 98.5% of drugs initially approved there. In contrast, Saudi Arabia had the lowest number of approved drugs and a significantly longer median drug lag, indicating substantial delays in drug availability. Conclusion: This study highlights the significance of mitigating drug lag to enhance global healthcare outcomes and patient access to innovative therapies. Further research and collaborative efforts are essential to bridging these disparities and promoting equitable healthcare worldwide. [ABSTRACT FROM AUTHOR]

Instrumental-variables estimation is an approach commonly used to evaluate the effect of a program in case of noncompliance. However, when the binary treatment status is misreported, standard techniques are not sufficient to point identify and consistently estimate the effect of interest. We present a new command, ivbounds, that implements three partial identification strategies developed by Tommasi and Zhang (2024, Journal of Econometrics 238: 105556) to bound the heterogeneous treatment effect when both noncompliance and misreporting of treatment status are present. We illustrate the use of the command by reassessing the benefits of participating in the 401(k) pension plan on savings in the United States. [ABSTRACT FROM AUTHOR]

COVID-19 vaccinations protect against severe illness and death, but associations with post-COVID conditions (PCC) are less clear. We aimed to evaluate the association between prior COVID-19 vaccination and new-onset PCC among individuals with SARS-CoV-2 infection across eight large healthcare systems in the United States. This retrospective matched cohort study used electronic health records (EHR) from patients with SARS-CoV-2 positive tests during March 2021-February 2022. Vaccinated and unvaccinated COVID-19 cases were matched on location, test date, severity of acute infection, age, and sex. Vaccination status was ascertained using EHR and integrated data on externally administered vaccines. Adjusted relative risks (RRs) were obtained from Poisson regression. PCC was defined as a new diagnosis in one of 13 PCC categories 30 days to 6 months following a positive SARS-CoV-2 test. The study included 161,531 vaccinated COVID-19 cases and 161,531 matched unvaccinated cases. Compared to unvaccinated cases, vaccinated cases had a similar or lower risk of all PCC categories except mental health disorders (RR: 1.06, 95% CI: 1.02–1.10). Vaccination was associated with ≥10% lower risk of sensory (RR: 0.90, 0.86–0.95), circulatory (RR: 0.88, 0.83–0.94), blood and hematologic (RR: 0.79, 0.71–0.89), skin and subcutaneous (RR: 0.69, 0.66–0.72), and non-specific COVID-19 related disorders (RR: 0.53, 0.51–0.56). In general, associations were stronger at younger ages but mostly persisted regardless of SARS-CoV-2 variant period, receipt of ≥3 vs. 1–2 vaccine doses, or time since vaccination. Pre-infection vaccination was associated with reduced risk of several PCC outcomes and hence may decrease the long-term consequences of COVID-19. The impact of COVID-19 vaccination on post-COVID conditions is not well understood. Here, the authors use electronic health record data from a network of eight integrated healthcare systems in the United States to compare rates of post-COVID conditions in those with and without vaccination. [ABSTRACT FROM AUTHOR]

Background: Clinicians need thresholds for the Patient Acceptable Symptom State (PASS) and Treatment Failure to interpret group-based patient-reported outcome measures after anterior cruciate ligament (ACL) injury. Validated thresholds that are crucial for accurately discerning patient symptom state and facilitating effective interpretation have not been determined for long-term follow-up after ACL injury. Purpose: To calculate and validate thresholds for PASS and Treatment Failure for the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales at the 10-year follow-up after ACL injury. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 163 participants with unilateral ACL injury (treated with reconstruction or rehabilitation alone) from the Delaware-Oslo ACL Cohort were included. Thresholds for PASS were calculated for IKDC-SKF and KOOS subscales using anchor-based predictive modeling and receiver operating characteristic (ROC) analysis. Too few participants had self-reported Treatment Failure to calculate thresholds for that outcome. Nonparametric bootstrapping was used to derive 95% CIs. The criterion validity of the predictive modeling and ROC-derived thresholds were assessed by comparing actual patient-reported PASS outcome with the calculated PASS outcome for each method of calculation and calculating their positive and negative predictive values with respect to the anchor questions. Results: A total of 127 (78%) participants reported satisfactory symptom state. Predictive modeling PASS thresholds (95% CIs) were 76.2 points (72.1-79.4 points) for IKDC-SKF, 85.4 points (80.9-89.2 points) for KOOS Pain, 76.5 points (67.8-84.7 points) for KOOS Symptoms, 93.8 points (90.1-96.9 points) for KOOS activities of daily living, 71.6 points (63.4-77.7 points) for KOOS Sports, and 59.0 points (53.7-63.9 points) for KOOS quality of life (QoL). Predictive modeling thresholds classified 81% to 93% of the participants as having satisfactory symptom state, whereas ROC-derived thresholds classified >50% as unsatisfied. The thresholds for IKDC-SKF, KOOS Sports, and KOOS QoL resulted in the most accurate percentages of PASS among all identified thresholds and therefore demonstrate the highest validity. Conclusion: Predictive modeling provided valid PASS thresholds for IKDC-SKF and KOOS at the 10-year follow-up after ACL injury. The thresholds for IKDC-SKF, KOOS Sports, and KOOS QoL should be used when determining satisfactory outcomes. ROC-derived thresholds result in substantial misclassification rates of the participants who reported satisfactory symptom state. [ABSTRACT FROM AUTHOR]

Female-specific reproductive factors might contribute to increased risk of cardiovascular disease, and the American Heart Association (AHA) recently proposed Life's Essential 8 (LE8) score to quantify cardiovascular health (CVH). The study aimed to examine the relationships between reproductive factors and the LE8 score among post-menopause women in the United States. We enrolled 3223 post-menopause women from National Health and Nutrition Examination Survey (NHANES). CVH groups based on LE8 score were low (0–49), moderate (50–79), and high good CVH levels (80–100). Multivariate ordinal logistic regressions were applied to estimate the associations between reproductive factors and the LE8 score. In multivariate model, early menarche (OR: 0.69, 95 percent CI: 0.51–0.93) and early menopause (OR: 0.57, 95 percent CI: 0.43–0.77) were associated with LE8 score compared with normal menarche and menopause; Meanwhile, ages at menarche and menopause were positively correlated with LE8 score. The number of pregnancies and full-term pregnancies were negatively associated with LE8 (OR for per pregnancy increase and 95 percent CI, 0.93 (0.88, 0.98), 0.93 (0.87, 0.99), separately). Overall, natural menopausal women with early age at menarche and menopause, and a higher number of pregnancies may have a high risk of lower CVH, and need to focus on their CVH. [ABSTRACT FROM AUTHOR]

The landscape of medical specialty choice is dynamic, undergoing significant changes as students' progress through undergraduate and graduate medical training. These shifts are influenced by various factors, with financial considerations becoming increasingly relevant among medical students’ preferences. This study conducts a retrospective analysis of specialty match rates and physician compensation, suggesting a potential trend where primary care fields, though fundamental to healthcare, appear less competitive and often associated with less financial reward compared to other specialties. The existence of this disparity is not without consequences. It contributes significantly to the ongoing and anticipated primary care physician shortages. This situation requires a comprehensive approach to tackle the complex factors influencing medical students’ career choices. Understanding these dynamics is critical for healthcare policy and planning. This paper investigates how financial considerations sway medical students’ specialty choices, emphasizing the economic disparities between primary care and other specialties. [ABSTRACT FROM AUTHOR]

Episodes of direct violence against healthcare workers and social workers represent a worrying and widespread phenomenon in Western countries. These violent attacks, whether verbal or physical, occur in various work environments, targeting professionals working in private facilities, medical practices, or those employed within the National Health System facilities. We conducted a search using a single search engine (PubMed) using the terms "violence against healthcare workers AND Western" for the period 2003–2023, identifying 45 results to which we added to the literature through hand searching. Our review thus analyzed the sector literature to highlight the phenomenon of violence against healthcare workers, particularly in Western countries. We began with an analysis of the problem and then focused on the true purpose of the study, which is to propose new solutions to protect healthcare workers in all work settings. Consequently, we aim to improve both the working environment for healthcare professionals and to enhance the overall healthcare and public health outcomes. [ABSTRACT FROM AUTHOR]

Chronic wounds are a common and costly health issue affecting millions of individuals in the United States, particularly those with underlying conditions such as diabetes, venous insufficiency, and peripheral artery disease. When standard treatments fail, advanced wound care therapies, such as skin substitutes, are often applied. However, the clinical effectiveness, indications, and comparative benefits of these therapies have not been well established. In this study, we report on the usage of both acellular and cellular, single and bilayer, natural and synthetic, dermal, and epidermal skin substitutes in a VA hospital system. We performed a retrospective chart review to understand the ordering and usage patterns of advanced wound therapies for patients with chronic wounds at the VA Northern California Health Care System. We examined types of products being recommended, categories of users recommending the products, indications for orders, and rate of repeated orders. Neuropathic, venous, or pressure ulcers were the main indications for using advanced wound matrices. Only 15.6% of patients for whom the matrices were ordered had supporting laboratory tests. Exactly 34.3% of the ordered matrices were not applied. And the use of wound matrices resulted in increased costs per patient visit of $1018–$3450. Our study sheds light on the usage patterns of these therapies in a VA healthcare facility and highlights the need for more robust evidence‐based studies to determine the true benefits, efficacy, and cost‐effectiveness of these innovative treatment options. [ABSTRACT FROM AUTHOR]

Spinal fusions are performed to treat congenital skeletal malformations, spondylosis, degenerative disk diseases, and other pathologies of the vertebrae that can be resolved by reducing motion between neighboring vertebrae. Unfortunately, up to 100,000 fusion procedures fail per year in the United States, suggesting that efforts to develop new approaches to improve spinal fusions are justified. We have explored whether the use of an osteotropic oligopeptide to target an attached bone anabolic agent to the fusion site might be exploited to both accelerate the mineralization process and improve the overall success rate of spinal fusions. The data presented below demonstrate that subcutaneous administration of a modified abaloparatide conjugated to 20 mer of D-glutamic acid not only localizes at the spinal fusion site but also outperforms the standard of care (topically applied BMP2) in both speed of mineralization (p < 0.05) and overall fusion success rate (p < 0.05) in a posterior lateral spinal fusion model in male and female rats, with no accompanying ectopic mineralization. Because the bone-localizing conjugate can be administered ad libitum post-surgery, and since the procedure appears to improve on standard of care, we conclude that administration of a bone-homing anabolic agent for improvement of spinal fusion surgeries warrants further exploration. [ABSTRACT FROM AUTHOR]

Introduction: The Supplemental Nutrition Assistance Programme (SNAP) is a federal programme aimed to alleviate hunger and improve food insecurity. The impact of SNAP participation on overall health has been studied. However, little is known about the effects of SNAP participation on oral health. We aimed to investigate the association between participating in SNAP and dental caries and to explore the role of food insecurity as a moderator in this relationship. Methods: We obtained data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011–2012 and 2013–2014.The primary outcome was untreated dental caries (none vs. one or more). Self‐reported SNAP participation status in the past 12 months was the predictor, and food security was the moderator. Food security was measured as overall food security status (full food secure/ food insecure) and household‐level food security (full, marginal, low and very low). Bivariate and multiple logistic regression analyses were conducted to evaluate the relationship between SNAP and dental caries, and whether food insecurity moderates this relationship. Statistical analysis was carried out in September 2020. Results: Our results suggested that after adjusting for potential confounders, SNAP participants were more likely to have untreated dental caries than non‐SNAP participants (odds ratio: 1.6; 95% CI: 1.2–2.0). Food security status did not alter the relationship between SNAP participation and untreated dental caries. Conclusions: Food security status did not alter the relationship between SNAP participation and untreated dental caries. SNAP participation was associated with untreated dental caries among U.S. adults, and this was not affected by their food security status. [ABSTRACT FROM AUTHOR]

The fungus Colletotrichum orbiculare causes watermelon anthracnose and is an important pathogen of watermelon in the United States, causing a significant impact on yield and quality of the produce. The application of fungicides as preventative and post-occurrence control measures is currently being deployed by growers. Further study of the genetic and molecular basis of anthracnose resistance will help in guiding future watermelon breeding strategies. Several conserved virulence factors (effectors) in C. orbiculare have been reported to interact with the host, at times impairing the host immune machinery. A single dominant gene conferring race 1 anthracnose resistance was reported independently on two watermelon germplasm. The recent advances in genomics, transcriptomics, proteomics, and metabolomics could facilitate a better understanding of the interaction between C. orbiculare effectors and host resistance genes in the already sequenced watermelon genome. In this review, we encompass and discuss (i) the history of watermelon anthracnose, taxonomy, morphology, and diversity in races of C. orbiculare; (ii) the epidemiology of the anthracnose disease and host resistance; (iii) the genetics behind the pathogenesis; and (iv) the current advances in breeding and molecular efforts to elucidate anthracnose resistance. [ABSTRACT FROM AUTHOR]

This paper reports a Spanish-American telecollaborative project through which students used "Twitter," blogs and podcasts for intercultural exchange over the course of one semester. The paper outlines the methodology for the project including pedagogical objectives, task design, selection of web tools and implementation. Using qualitative and quantitative data collection, the study explored how the application of Web 2.0 facilitated cross-cultural communication. How the use of digital technology affected the way in which the students viewed intercultural learning and peer feedback was examined. The findings showed that students viewed the online exchange as a superb venue for intercultural communication with native speakers. Through social engagements, students not only gained cultural knowledge but also became more aware of their own beliefs and attitudes toward their own culture. In addition, discussions on topics of tangible and intangible cultures afforded the opportunity to raise students' awareness of cultural norms and practices. Peer feedback helped learners increase lexical knowledge, prevent language fossilization, and acquire native-sounding discourse. The study suggests that allocating sufficient time to complete each task and making personal commitment to online contributions are essential to successful intercultural exchanges.

The bivalent (original and Omicron BA.4/BA.5) mRNA-1273 COVID-19 vaccine was authorized to offer broader protection against COVID-19. We conducted a matched cohort study to evaluate the effectiveness of the bivalent vaccine in preventing hospitalization for COVID-19 (primary outcome) and medically attended SARS-CoV-2 infection and hospital death (secondary outcomes). Compared to individuals who did not receive bivalent mRNA vaccination but received ≥2 doses of any monovalent mRNA vaccine, the relative vaccine effectiveness (rVE) against hospitalization for COVID-19 was 70.3% (95% confidence interval, 64.0%–75.4%). rVE was consistent across subgroups and not modified by time since last monovalent dose or number of monovalent doses received. Protection was durable ≥3 months after the bivalent booster. rVE against SARS-CoV-2 infection requiring emergency department/urgent care and against COVID-19 hospital death was 55.0% (50.8%–58.8%) and 82.7% (63.7%–91.7%), respectively. The mRNA-1273 bivalent booster provides additional protection against hospitalization for COVID-19, medically attended SARS-CoV-2 infection, and COVID-19 hospital death. Bivalent mRNA COVID-19 vaccines have been developed to provide broader protection against SARS-CoV-2 variants. In this cohort study based on electronic health records from the United States, the authors estimate the effectiveness of bivalent, compared to monovalent, vaccines and no vaccination against a range of COVID-19-related outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Aflatoxin (AFL), a secondary metabolite produced from filamentous fungi, contaminates corn, posing significant health and safety hazards for humans and livestock through toxigenic and carcinogenic effects. Corn is widely used as an essential commodity for food, feed, fuel, and export markets; therefore, AFL mitigation is necessary to ensure food and feed safety within the United States (US) and elsewhere in the world. In this case study, an Iowa-centric model was developed to predict AFL contamination using historical corn contamination, meteorological, satellite, and soil property data in the largest corn-producing state in the US. Methods: We evaluated the performance of AFL prediction with gradient boosting machine (GBM) learning and feature engineering in Iowa corn for two AFL risk thresholds for high contamination events: 20-ppb and 5-ppb. A 90%--10% training-to-testing ratio was utilized in 2010, 2011, 2012, and 2021 (n = 630), with independent validation using the year 2020 (n = 376). Results: The GBM model had an overall accuracy of 96.77% for AFL with a balanced accuracy of 50.00% for a 20-ppb risk threshold, whereas GBM had an overall accuracy of 90.32% with a balanced accuracy of 64.88% for a 5-ppb threshold. The GBM model had a low power to detect high AFL contamination events, resulting in a low sensitivity rate. Analyses for AFL showed satelliteacquired vegetative index during August significantly improved the prediction of corn contamination at the end of the growing season for both risk thresholds. Prediction of high AFL contamination levels was linked to aflatoxin risk indices (ARI) in May. However, ARI in July was an influential factor for the 5-ppb threshold but not for the 20-ppb threshold. Similarly, latitude was an influential factor for the 20-ppb threshold but not the 5-ppb threshold. Furthermore, soil-saturated hydraulic conductivity (Ksat) influenced both risk thresholds. Discussion: Developing these AFL prediction models is practical and implementable in commodity grain handling environments to achieve the goal of preventative rather than reactive mitigations. Finding predictors that influence AFL risk annually is an important cost-effective risk tool and, therefore, is a high priority to ensure hazard management and optimal grain utilization to maximize the utility of the nation's corn crop. [ABSTRACT FROM AUTHOR]

Objectives: Despite recommendations to increase the uptake of colorectal cancer (CRC) screening, trends in CRC screening vary with sociodemographic status. We aimed to evaluate trends in CRC screening in the US population and subpopulations. Methods: A total of 1,082,924 participants aged 50 to 75 from five cycles (2012, 2014, 2016, 2018, and 2020) of the Behavioral Risk Factor Surveillance System were involved. Multivariable logistic regression models were performed to evaluate linear trends in CRC screening utilization from 2012 to 2018. Rao-Scott chi-square tests were used to assess the differences in CRC screening utilization between 2018 and 2020. Results: The estimated percentage reporting up-to-date with CRC screening increased significantly (P for trend <0.001), from 62.8% (95% CI, 62.4%−63.2%) in 2012 to 66.7% (95% CI, 66.3%−67.2%) in 2018 and 70.4% (95% CI, 69.8%−71.0%) in 2020, in accordance with 2008 US Preventive Services Task Force recommendations. Trends followed similar patterns in most subgroups, although with different magnitudes in several subgroups, primarily those underweight showed a stable percentage over time (P for trend = 0.170). In 2020, 72.4% of participants reported they were up to date with CRC screening, including the utilization of stool DNA tests and virtual colonoscopy. Colonoscopy was the most commonly used test in 2020 (64.5%), followed by FOBT (12.6%), stool DNA test (5.8%), sigmoidoscopy (3.8%), and virtual colonoscopy (2.7%). Conclusions: In this nationally representative survey of the US population from 2012 through 2020, the percentage reporting up to date with CRC screening has increased, but not equally among all subgroups. [ABSTRACT FROM AUTHOR]

The pediatric provider of record has a significant role in newborn screening and maintaining infant health after birth. Procedural errors and delays in communication can hinder the identification of infants with critical illnesses or follow up of unsatisfactory NBS samples. For this study, key stakeholders, including nurses, physicians, and midwives were interviewed to understand how the pediatric provider of record is selected by parents and examine factors affecting the newborn screening education and processes in the perinatal period. Provider responsibilities, timing of parent education, and social determinants of health played a role in parents' choices of the pediatric provider. Investment in future intervention programs is needed for reducing the number of infants without a designated pediatric provider of record. Research is needed to understand social complexities and healthcare systems which affect parents' choices of pediatric providers and newborn screening processes to optimize clinical outcomes for infants. [ABSTRACT FROM AUTHOR]

Using a reactive approach to focus-on-form, this study explored the types of feedback and strategies that L2 learners used to draw attention to linguistic problems in a Spanish-American telecollaborative exchange. Data from the readily available transcripts of online postings were utilised and analysed to report the findings. The results showed that the American students produced a much higher rate of lexical and morphosyntactic feedback than did the students from Spain, while the latter used a much greater percentage of affective feedback than their US partners. The Spanish students tended to use reformulations as a quick way to provide target-like forms, whereas the US students offered metalinguistic explanations to help their partners understand sophisticated lexical items and grammatical structures. Despite the fact that both groups received valuable linguistic feedback from their native speaker partners, most of the students did not make error corrections. The study concludes that error correction in a message board might not be a good format for meaningful feedback. Furthermore, specific instructions of how to effectively attend to feedback in conjunction with appropriate training should have been made available for L2 learners. (Contains 6 tables and 5 notes.)

Blogs and podcasts open new ways for global communication and development of intercultural awareness. This article reports a Spanish-American telecollaborative project through which students created blogs and podcasts for intercultural exchanges in light of the sociocultural perspectives. The article outlines the methodology for the project including pedagogical objectives, task design, selection of web tools and implementation. Using qualitative data collection, the study explored how students collaboratively created blogs and podcasts using task-based activities and how blogs and podcasts facilitated cross-cultural exchanges. How the use of Web 2.0 tools affected the way in which the students viewed intercultural communication was examined. The findings showed that effective use of task-based instruction created a dynamic climate for interactive collaboration and afforded unique opportunities for both American and Spanish students to explore the target language and culture. The study suggests that building interpersonal relationships and making personal commitment to online contributions are vital to successful intercultural exchanges. (Contains 4 tables and 12 notes.)

Background: Primary malignant melanomas of the Gastrointestinal mucosa are uncommon. Most cases of gastrointestinal (GI) melanomas are secondary, arising from metastasis at distant sites. The purpose of this study is to assess to what extent the interaction between independent prognostic factors (age and tumor site) of primary GI melanoma influence survival. Furthermore, we also aimed to investigate the clinical characteristics, survival outcomes, and independent prognostic factors of patients with primary GI melanoma in the past decade. Methods: A total of 399 patients diagnosed with primary GI melanoma, between 2008 and 2017, were enrolled in our study by retrieving data from the Surveillance, Epidemiology, and End Results (SEER) database. We analyzed demographics, clinical characteristics, and overall mortality (OM) as well as cancer-specific mortality (CSM) of primary GI melanoma. Variables with a p value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox model (model 1) to determine the independent prognostic factors, with a hazard ratio (HR) of greater than 1 representing adverse prognostic factors. Furthermore, we analyzed the effect of the interaction between age and primary location on mortality (model 2). Results: Multivariate cox proportional hazard regression analyses revealed higher OM in age group 80+ (HR = 5.653, 95% CI 2.212–14.445, p = 0), stomach location of the tumor (HR = 2.821, 95% CI 1.265–6.292, p = 0.011), regional lymph node involvement only (HR = 1.664, 95% CI 1.051–2.635, p < 0.05), regional involvement by both direct extension and lymph node involvement (HR = 1.755, 95% CI 1.047–2.943, p < 0.05) and distant metastases (HR = 4.491, 95% CI 3.115–6.476, p = 0), whereas the lowest OM was observed in patients with small intestine melanoma (HR = 0.383, 95% CI 0.173–0.846, p < 0.05). Multivariate cox proportional hazard regression analyses of CSM also revealed higher mortality of the same groups and lower CSM in small intestine and colon melanoma excluding the rectum. For model 2, considering the interaction between age and primary site on mortality, higher OM was found in age group 80+, followed by age group 40–59 then age group 60–79, regional lymph node involvement only, regional involvement by both direct extension and lymph node involvement and distant metastases. The small intestine had a lower OM. The rectum as primary location and the age range 40–59 interacted to lower the OM (HR = 0.14, 95% CI 0.02–0.89, p = 0.038). Age and primary gastric location did not interact to affect the OM. For the CSM, taking into account the interaction between age and the primary location, higher mortality was found in the same groups and the colon location. The primary colon location also interacted with the age group 40–59 to increase the CSM (HR = 1.38 × 109, 95% CI 7.80 × 107–2.45 × 1010, p = 0). Conclusions: In this United States population-based retrospective cohort study using the SEER database, we found that only the age range 40–59 interacted with the rectum and colon to lower and increase mortality respectively. Primary gastric location, which was the single most important location to affect mortality, did not interact with any age range to influence mortality. With those results, we hope to shed some light on this rare pathology with a very dismal prognosis. [ABSTRACT FROM AUTHOR]

Although biological evidence suggests that tea consumption may protect against non-Hodgkin lymphoma (NHL), epidemiological evidence has been unclear. The aim of this study was to examine the association between tea-drinking habits and the risk of NHL in a large nationwide prospective cohort of postmenopausal US women. 68 854 women who were enrolled from 1993 through 1998 in the Women's Health Initiative Observational Study and responded to year 3 annual follow-up questionnaire comprised the analytic cohort. Newly diagnosed NHL cases after the year 3 visit were confirmed by medical and pathology reports. Multivariable-adjusted Cox proportional hazards models were performed to assess the associations of tea-drinking habits (specifically, the amounts of caffeinated/herbal/decaffeinated tea intake) with the overall risk of NHL and three major subtypes (diffuse large B-cell lymphoma (n 195, 0·3 %), follicular lymphoma (n 128, 0·2 %) and chronic lymphocytic leukaemia/small lymphocytic lymphoma (n 51, 0·1 %)). Among 62 622 participants, a total of 663 (1·1 %) women developed NHL during a median follow-up of 16·51 (sd 6·20) years. Overall, different amounts of type-specific tea intake were not associated with the risk of NHL regardless of its histologic subtypes after adjustment for confounders. Our findings suggest that tea intake at the current consumption level does not influence the risk of NHL, regardless of its histologic types. [ABSTRACT FROM AUTHOR]

Introduction The etiology of congenital diaphragmatic hernia (CDH) remains unknown and only 10 to 30% of patients have a genetic cause. Seasonal variation is known to contribute to the development of some congenital anomalies. Our aim was to investigate whether CDH births have seasonal variation. Materials and Methods A literature review was conducted for CDH and seasonality. Moreover, data from the CDH International Patient Registry Database were collected for infants with due dates between 2008 and 2014. Due dates were used to determine seasonal distribution of births. Birth rates per month in the United States and Canada were extracted from publicly available databases. Data were analyzed using analysis of variance and contingency tables. Results First, the literature review revealed 11 articles, of which 3 were eligible for inclusion. These studies reported conflicting results on seasonality of CDH. Second, we extracted due dates from the CDH International Patient Registry Database (1,259 patients) and found that there were fewer due dates in winter months (12.1 ± 4 patients/month) than in summer (16.7 ± 6 patients/month; p = 0.011) and fall months (16.3 ± 5 patients/month; p = 0.022). Although this trend was similar to that of all births in the United States and Canada, a lower incidence was observed in winter for CDH infants (20.2%) than for the general population (24.1%, p = 0.0012). CDH survival rate did not vary by season. Conclusion This study provides evidence for a seasonal variation of CDH births. No causative link was established between CDH development and seasonality. Population-based studies with a focus on exposome data are needed to explain seasonal variation in CDH. [ABSTRACT FROM AUTHOR]

Purpose: Best practices recommend promoting the use of the home language and allowing caregivers to choose the language(s) that they want to use with their child who is deaf or hard of hearing (DHH). We examined whether Spanishspeaking caregivers of children who are DHH receive professional recommendations on oral bilingualism that follow best practices. We also assessed whether professional recommendations, caregiver beliefs, and language practices had an impact on child language(s) proficiency. Method: Sixty caregivers completed a questionnaire on demographic questions, language(s) use and recommendations, beliefs on bilingualism, and child language proficiency measures in English, Spanish, and American Sign Language (ASL). Professional recommendations on oral bilingualism were reported descriptively, and linear regression was used to identify the predictors of child language(s) proficiency. Results: We found that only 23.3% of the caregivers were actively encouraged to raise their child orally bilingual. Language practices predicted child proficiency in each language (English, Spanish, and ASL), but professional recommendations and caregiver beliefs did not. Conclusions: Our results revealed that most caregivers received recommendations that do not follow current best practices. Professional training is still needed to promote bilingualism and increase cultural competence when providing services to caregivers who speak languages different from English. [ABSTRACT FROM AUTHOR]

Background: The delivery of prompt and appropriate antimicrobial therapy for life-threatening infections is an important antimicrobial stewardship measure and a priority for hospitals.Objectives: To better understand U.S. hospital pharmacy stocking processes and acquisition of nonstocked antimicrobials and to identify strategies for improving this process.Methods: This mixed-methods study recruited infectious diseases and antimicrobial stewardship pharmacists. Semistructured interviews with pharmacists in Minnesota were conducted via video conferencing software from January 21, 2021, to March 17, 2021. Audio recordings of the interviews guided survey development and were also transcribed, coded, and qualitatively analyzed. Surveys were distributed throughout the United States via an e-mail listserv, and responses were collected between August 5, 2021, and September 15, 2021.Results: Ten interviews and 78 surveys were included in the analysis. Formulary and stocking practices varied based on institution. Stocking decisions were most frequently based on the frequency of use, clinical utility, and cost of antimicrobials. Nonstocked antimicrobials were often ordered from the wholesale distributor but, if needed urgently, acquired from another local institution. Antibacterial agents were the most frequently needed nonstocked antimicrobials, especially those targeting multidrug-resistant gram-negative bacteria. When acquiring nonstocked antimicrobials, barriers include process inefficiencies, cost, availability, and safety concerns. Improved information sharing between local institutions may help improve this process.Conclusion: In this exploratory study, antimicrobial stocking practices varied within U.S. hospitals. Acquisition of nonstocked, urgently needed antimicrobials from neighboring hospitals may be common; however, this process lacks guidance and is often inefficient. Establishing better mechanisms for information sharing may improve this process and should be explored. [ABSTRACT FROM AUTHOR]

Abstract: Antibody-drug conjugates (ADCs) have joined the armamentarium against urothelial cancer (UC) as an effective therapy option. Since 2019, the US Food and Drug Administration has approved 2 ADCs for advanced previously treated UC: enfortumab vedotin, which targets nectin-4 and sacituzumab govitecan, which targets trophoblast cell-surface antigen 2. These ADCs are now being tested in earlier disease settings and in previously untreated patients. Furthermore, novel ADCs (e.g., anti-HER-2) are being tested in the clinic and show promising clinical benefit. The next frontier is to understand the mechanisms of resistance and response, gaining experience with ADC-related adverse events and learning the best strategy to sequence and combine these agents with existing therapies. Here, we highlight the recent advances in the development of ADCs for treating localized and metastatic UC. [ABSTRACT FROM AUTHOR]

Field courses provide transformative learning experiences that support success and improve persistence for science, technology, engineering, and mathematics majors. But field courses have not increased proportionally with the number of students in the natural sciences. We conducted a scoping review to investigate the factors influencing undergraduate participation in and the outcomes from field courses in the United States. Our search yielded 61 articles, from which we classified the knowledge, affect, behavior, and skill-based outcomes resulting from field course participation. We found consistent reporting on course design but little reporting on demographics, which limits our understanding of who takes field courses. Cost was the most commonly reported barrier to student participation, and knowledge gains were the most commonly reported outcome. This scoping review underscores the need for more rigorous and evidence-based investigations of student outcomes in field courses. Understanding how field courses support or hinder student engagement is necessary to make them more accessible to all students. [ABSTRACT FROM AUTHOR]

We examine changes in population level incidence and survival of patients diagnosed with myelodysplastic syndrome (MDS) in the United States in 2001–2016. Data were extracted from the Surveillance, Epidemiology, and End Results (SEER)-18 database. Period analysis was used to calculate one-, two-, and five-year survival. The incidence peaked at 5.6 per 100,000 in 2010 then decreased to 3.9 by 2016, with a decrease in the diagnoses of refractory anemia (RA) and RA with ringed sideroblasts (RARS) and a relative increase in RA with excess blasts (RAEB). Overall, one-, two-, and five-year relative survival decreased over time, going from 74.3%, 60.9%, and 42.3%, respectively, in 2008–2010 to 70.9%, 55.9%, and 37.6%, respectively, in 2014–2016. When survival was examined by histology, patients with RA/RARS and RAEB had similar survival expectations in 2008–2010 versus 2014–2016 and a decrease was observed for 5q-MDS. Our results highlight the need for new treatment options in MDS. [ABSTRACT FROM AUTHOR]

Patent and regulatory exclusivity shall constitute incentives for pharmaceutical companies to develop new drugs. This study aims to investigate the differences in the patent term extension (PTE) and regulatory exclusivity between China and the United States, and to evaluate their potential impact on the market exclusivity period of novel drugs. Small‐molecule novel drugs with their first indication approved in China and the United States between 2018 and 2021 were evaluated regarding their PTE and regulatory exclusivity. The PTE length of the China‐approved drugs was calculated by simulation, whereas that of the US‐approved drugs was extracted from the United States Patent and Trademark Office. Thirty‐two and 107 novel drugs approved in China and the United States, respectively, were included in the study. The PTE length of the US‐approved drugs calculated by the China‐PTE method was significantly longer than that calculated by the US‐PTE method. Patent extensions should be granted for 91% of new drugs in China and 82% in the United States. The simulated median PTE length of novel drugs approved in China was significantly higher than that of the United States (5.0 vs. 2.9 years, P < 0.05). It can be expected that the implementation of the PTE policy in China would significantly extend the period of market exclusivity for novel drugs similar to that of the United States. China should fully evaluate the potential impact of the PTE policy on the market exclusivity of novel drugs and provide better incentives to the development of novel drugs in addressing unmet clinical needs when developing its regulatory exclusivity policy. [ABSTRACT FROM AUTHOR]

The purpose of this articles is to identify errors related to management information systems through a Scientometric analysis to divulge the dynamics of the research topic to the academic community. The study was carried out, between 1971 and January 30, 2021, using the Scopus database and VOSviewer software. As a result of the search string "management information system" and "error*" or "mistakes" were obtained 826 published scientific articles. The highest percentage of documents published are conference paper (53.3%), and Article (39.7%). The most productive countries are the United States and Austria (60% articles) and citations are focused on United States (65%). The chronological analysis revealed that the scientific production in the area showed a particular increase from 2006 to 2009. The Lecture Notes in Computer Science. Lecture notes in Artificial Intelligence and Lecture Notes in Bioinformatics was the most productive journal. The 32.7% of the literature was published in the Computer Science field. 6 clusters were identified, and 19 keywords related with errors or mistakes were recognized. The Scientometric analysis accomplished allowed a descriptive analysis and identification of the countries, journals, keywords, sponsors, most cited articles, clustering the results facilitating the visual representation of the study. [ABSTRACT FROM AUTHOR]

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

Metal exposure and depression have each been associated with adverse metabolic diseases, but no study has examined the potential interaction between them. We examined the interaction of depression on the association between metals and metabolic diseases among adults. The interaction of depression in the relationship between metal and metabolic disease in adults was investigated using NHANES, a cross-sectional survey design. By employing data from the NHANES database spanning the years 2007–2018, regression models were employed to investigate the independent impacts of heavy metals (cadmium, lead, and mercury) and depression on metabolic diseases (type 2 diabetes, hypertension, hyperlipidemia, metabolic syndrome). Subsequently, the association between metals and metabolic diseases was explored stratified by depression, and the interaction between heavy metals and depression was explored. Because of the complex NHANES design, statistical evaluations were adjusted through weighting to represent the populace of the United States. We found log transformed-urinary lead was significantly associated with type 2 diabetes (OR: 2.33; 95 % CI: 1.23, 4.41) in adults with depression. Log transformed-urinary lead was not associated with type 2 diabetes (OR: 0.84; 95 % CI: 0.56, 1.27) in adults without depression. The interaction between Pb and depression in type 2 diabetes was significant (P for interaction = 0.033). Log transformed-urinary lead * depression was significantly associated with type 2 diabetes (OR: 1.82; 95 % CI: 1.01, 3.34) in adults. There was no significant interaction between cadmium and mercury exposure and depression in patients with type 2 diabetes, hypertension, hyperlipidemia, and metabolic syndrome (P for interaction > 0.05). The presence of depression positively modified the adverse associations between urinary lead and type 2 diabetes. • Cd was independently associated with metabolic diseases. • Pb was independently associated with hypertension and hyperlipidemia. • Hg was independently associated with hyperlipidemia and metabolic syndrome. • Depression was independently associated with T2DM, hypertension, and hyperlipidemia. • The interaction between urinary Pb and depression in T2DM was significant. [ABSTRACT FROM AUTHOR]

Faith-based organizations (FBOs) can play an important role in improving health outcomes. Lay community health advisors (CHAs) are integral to these efforts. This paper assesses the sustainability of a CHA training program for congregants in African-American and Latino FBOs and subsequent implementation of educational workshops. The program is unique in that a health care chaplain in an academic medical center was central to the program's development and implementation. Forty-eight CHAs in 11 FBOs were trained to teach workshops on cardiovascular health, mental health, diabetes, and smoking cessation. Two thousand four hundred and forty-four participants attended 70 workshops. This program has the potential to be a model to educate individuals and to address health inequities in underserved communities. Health care chaplains in other medical centers may use this as a model for enhancing community engagement and education. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the relationship between red blood cell (RBC) polyunsaturated fatty acid (PUFA) levels, and dietary PUFA and fish intake, with prevalent and incident age-related macular degeneration (AMD) in a US cohort of postmenopausal women. Methods: This analysis included 1456 postmenopausal women from the Women's Health Initiative (WHI) Clinical Trials. RBC PUFAs were measured from fasting serum samples collected at WHI baseline. Dietary PUFAs and fish intake were assessed via food frequency questionnaires at baseline. There were 240 women who had prevalent AMD and 138 who self-reported AMD development over 9.5 years. Adjusted odds ratios and 95% confidence intervals were estimated for prevalent AMD by RBC PUFA levels, dietary PUFA intake, and frequency of fish consumption. Adjusted hazard ratios and 95% confidence intervals were estimated for incident AMD. A p-for-trend was estimated for continuous measures of dietary PUFA and fish intake. Results: No significant association was found between prevalent or incident AMD and RBC docosahexaenoic acid (DHA) + eicosapentaenoic acid (EPA), EPA, DHA, alpha-linolenic acid (ALA), linoleic acid (LA), or arachidonic acid (AA). A positive association was found between dietary intake of AA and odds of prevalent AMD (p-for-trend for continuous AA intake = 0.02) and between intake of LA/ALA and incident AMD (p-for-trend for continuous ratio of LA/ALA intake = 0.03). No statistically significant associations were found between AMD and dietary intake of PUFAs or fish. Conclusions: RBC PUFAs were not associated with AMD in this cohort. Overall, dietary analyses of PUFAs supported this, excepting dietary AA intake and intake of LA in proportion to ALA of which there were trends of increased risk. [ABSTRACT FROM AUTHOR]

Machine learning (ML) has demonstrated promise in predicting mortality; however, understanding spatial variation in risk factor contributions to mortality rate requires explainability. We applied explainable artificial intelligence (XAI) on a stack-ensemble machine learning model framework to explore and visualize the spatial distribution of the contributions of known risk factors to lung and bronchus cancer (LBC) mortality rates in the conterminous United States. We used five base-learners—generalized linear model (GLM), random forest (RF), Gradient boosting machine (GBM), extreme Gradient boosting machine (XGBoost), and Deep Neural Network (DNN) for developing stack-ensemble models. Then we applied several model-agnostic approaches to interpret and visualize the stack ensemble model's output in global and local scales (at the county level). The stack ensemble generally performs better than all the base learners and three spatial regression models. A permutation-based feature importance technique ranked smoking prevalence as the most important predictor, followed by poverty and elevation. However, the impact of these risk factors on LBC mortality rates varies spatially. This is the first study to use ensemble machine learning with explainable algorithms to explore and visualize the spatial heterogeneity of the relationships between LBC mortality and risk factors in the contiguous USA. [ABSTRACT FROM AUTHOR]

Objective: Gynecologic Sarcomas are rare, aggressive tumors. The aim of this study was to explore the incidence and outcomes of gynecologic sarcomas in a large national data registry and to compare them with reports from other countries.Study Design: Records of gynecologic sarcomas diagnosed in Israel (1980-2014) were extracted from the National Cancer Registry and classified according to International Classification of Diseases for Oncology-3 and characterized according to anatomical site, morphology and demographics. Age-standardized incidence rates and 1, 3, 5 and 10-year relative survival rates were calculated for 3 time periods (1980-1994, 1995-2001 and 2005-2014) according to patient age, stage and years of diagnosis.Results: During 1980-2014, 1271 new gynecologic sarcomas were diagnosed in Israel, with incidence slightly increasing in 1980-2004, to an age-standardized incidence rate of 13 per million women. The most common histologic diagnosis was leiomyosarcoma (48%) and the most common anatomical site was the uterus (89%). The age-standardized incidence rate for uterine sarcoma is higher in Israel (10.55 per million) than in England (7.4 per million) and Germany (5.8 per million) respectively. The 5-year overall survival was significantly poorer in patients >70-years, as compared to younger patients (p<0.001) and in those with leiomyosarcoma compared to endometrial stromal sarcoma (p<0.001). The survival rate of patients with leiomyosarcoma in Israel are comparable to survival rates reported by other studies, although substantially lower regarding endometrial stromal sarcoma.Conclusions: Uterine leiomyosarcoma was the most common gynecologic sarcoma found in the Israeli, European and American registries. Older patients and those with leiomyosarcoma have the worst prognoses. Histological and anatomical variations in Israel are comparable with global statistics, but the incidence in Israel seems higher than in Europe. [ABSTRACT FROM AUTHOR]

Objectives. To test whether fruit drink countermarketing messages alone or combined with water promotion messages reduce Latinx parents' purchases of fruit drinks for children aged 0 to 5 years. Methods. We performed a 3-arm randomized controlled online trial enrolling 1628 Latinx parents in the United States during October and November 2019. We assessed the effect of culturally tailored fruit drink countermarketing messages (fruit drink‒only group), countermarketing and water promotion messages combined (combination group), or car-seat safety messages (control) delivered via Facebook groups for 6 weeks on parental beverage choices from a simulated online store. Results. The proportion of parents choosing fruit drinks decreased by 13.7 percentage points in the fruit drink‒only group (95% confidence interval [CI] = −20.0, −7.4; P <.001) and by 19.2 percentage points in the combination group (95% CI = −25.0, −13.4; P <.001) relative to control. Water selection increased in both groups. Conclusions. Fruit drink countermarketing messages, alone or combined with water promotion messages, significantly decreased parental selection of fruit drinks and increased water selection for their children. Public Health Implications. Countermarketing social media messages may be an effective and low-cost intervention for reducing parents' fruit drink purchases for their children. (Am J Public Health. 2021;111(11):1997–2007. https://doi.org/10.2105/AJPH.2021.306488) [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to examine the association between food insecurity and untreated dental caries using a nationally representative sample of US adults. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011‐2012 and 2013‐2014 on adults aged 18 years and older were analysed (n = 10 723). Primary predictors were overall food security (food‐secure/ food‐insecure) and household food security (full, marginal, low and very low). The main outcome was any untreated dental caries (none/ ≥ one). Multiple logistic regression analyses were done to estimate the adjusted odds ratio after controlling for confounders. Results: Food‐insecure adults were more likely to have untreated dental caries than food‐secure adults after adjusting for potential confounders (OR: 1.2; 95% CI: 0.9‐1.5). Adults from households with marginal (OR:1.4; 95% CI:1.5‐2.2), low (OR:1.3, 95% CI:1.3‐2.0) and very low food security (OR:1.3; 95% CI:0.9‐1.5) had higher odds of untreated caries than adults from households with full food security. Following age stratification, marginal, low and very low food‐secure adults had higher prevalence of untreated dental caries than full food‐secure adults across all age groups. Conclusions: Our findings suggest that food‐insecure adults had higher odds of untreated dental caries than food‐secure adults. These findings highlight the importance of assessing food insecurity as a risk factor for dental caries. Longitudinal cohort studies are recommended to determine causal mechanisms. [ABSTRACT FROM AUTHOR]

Although tremendous efforts have been made to ensure fresh produce safety, various foodborne outbreaks and recalls occur annually. Most of the current intervention strategies are evaluated within a short timeframe (less than 1 h), leaving the behavior of the remaining pathogens unknown during subsequent storages. This review summarized outbreak and recall surveillance data from 2009 to 2018 obtained from government agencies in the United States to identify major safety concerns associated with fresh produce, discussed the postharvest handling of fresh produce and the limitations of current antimicrobial interventions, and reviewed the intervention strategies that have the potential to be applied in each storage stage at the commercial scale. One long‐term (up to 12 months) prepacking storage (apples, pears, citrus among others) and three short‐term (up to 3 months) postpacking storages were identified. During the prepacking storage, continuous application of gaseous ozone at low doses (≤1 ppm) is a feasible option. Proper concentration, adequate circulation, as well as excess gas destruction and ventilation systems are essential to commercial application. At the postpacking storage stages, continuous inhibition can be achieved through controlled release of gaseous chlorine dioxide in packaging, antimicrobial edible coatings, and biocontrol agents. During commercialization, factors that need to be taken into consideration include physicochemical properties of antimicrobials, impacts on fresh produce quality and sensory attributes, recontamination and cross‐contamination, cost, and feasibility of large‐scale production. To improve fresh produce safety and quality during storage, the collaboration between researchers and the fresh produce industry needs to be improved. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship. The authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach. Food-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries. Food insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries. Social factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health. [ABSTRACT FROM AUTHOR]

Plant structural traits can act as barriers for herbivore attachment, feeding, and oviposition. In particular, epicuticular waxes (EWs) on the aerial surfaces of many land plants offer protection from biotic and abiotic stresses. In rice (Oryza sativa L.), mutations that reduce EWs have been previously reported. However, whether such mutations affect rice water weevil (Lissorhoptrus oryzophilus Kuschel) and fall armyworm (Spodoptera frugiperda Smith) performance has not been investigated yet. These pests cause significant economic problems in important rice-producing areas of the United States. The aim of our study was to characterize the EWs of EW mutants and wild-type rice plants by gas chromatography–mass spectrometry and compare the resistance of mutant and wild-type plants against rice water weevil and fall armyworm. We hypothesized that mutants with reduced EWs would have weaker resistance to pests than wild-type plants. Three mutant lines (6-1A, 7-17A, and 11-39A) and their wild-type parent (cv. 'Sabine') were used to test this hypothesis. Levels of EWs were significantly lower in mutant lines than in the wild-type, and qualitative differences in EW composition were also observed. Reduction in EWs significantly affected performance of insects in experiments conducted under greenhouse conditions. Experiments with rice water weevils were conducted in arenas in which females were given a choice of the mutants and the wild-type for oviposition. Number of first instars emerging from the three EW mutants (an indication of oviposition preference) was higher on the three EW mutants than on wild-type plants with normal wax levels. Similarly, in no-choice experiments using whole plants or detached leaves, weight gains of armyworms on leaves were higher on the mutant lines than on the wild-type. These results indicate that EW traits are involved in rice resistance to weevils and armyworms. Understanding the plant traits that contribute to resistance to rice pests will be helpful for the development of resistant varieties for reducing pest insect damage. [ABSTRACT FROM AUTHOR]

Background: Complex medication regimens, often present in heart failure with preserved ejection fraction, may increase the risk of adverse drug effects and harm. We sought to characterize this complexity by determining the prevalence of polypharmacy, potentially inappropriate medications, and therapeutic competition (where a medication for 1 condition may worsen another condition) in 1 of the few dedicated heart failure with preserved ejection fraction programs in the United States.Methods: We conducted chart review on 231 patients with heart failure with preserved ejection fraction seen in the University of Michigan's Heart Failure with Preserved Ejection Fraction Clinic between July 2016 and September 2019. We recorded: 1) standing medications to determine the presence of polypharmacy, defined as ≥10 medications; 2) potentially inappropriate medications based on the 2016 American Heart Association Scientific Statement on drugs that pose a major risk of causing or exacerbating heart failure, the 2019 Beers Criteria update, or a previously described list of medications associated with geriatric syndromes; and 3) competing conditions and subsequent medications that could create therapeutic competition.Results: The prevalence of polypharmacy was 74%, and the prevalence of potentially inappropriate medications was 100%. Competing conditions were present in 81% of patients, of whom 49% took a medication that created therapeutic competition.Conclusion: In addition to confirming that polypharmacy was highly prevalent, we found that potentially inappropriate medications and therapeutic competition were also frequently present. This supports the urgent need to develop patient-centered approaches to mitigate the negative effects of complex medication regimens endemic to adults with heart failure with preserved ejection fraction. [ABSTRACT FROM AUTHOR]