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Introduction: The number and characteristics of pregnant patients presenting to the emergency department (ED) has not been well described. Our objective in this study was to determine the prevalence and characteristics of pregnant patients presenting to EDs in the US between 2010-2020. Methods: We completed a retrospective, cross-sectional study of patient encounters at hospital-based EDs in the US from 2010-2020. Using the ED subsample of the National Hospital Ambulatory Medical Care Survey (NHAMCS) we identified ED visits for female patients aged 15-44 years. We defined a subsample of these as visits for pregnant patients using discharge diagnosis codes specific to pregnancy. We compared this population of pregnant patient visits to those for non-pregnant patients and computed point estimates for nationally weighted values. Multivariable linear regression was used to determine factors independently associated with pregnant patient visits. Results: The 2010-2020 NHAMCS dataset included 255,963 ED visits. Of these visits 59,080 were for female patients 15-44 years old, and 6,068 of those visits were for pregnant patients. Pregnant patients accounted for 3% (95% confidence interval [CI] 2.7-3.2) of all ED visits and 8.6% (95% CI 8-9.3) of all visits among female patients 15-44 years. Weighting to a national sample, this equates to 2.77 million pregnant patients presenting for ED visits annually. Pregnant patients were more likely to be Black, Hispanic, or to use public insurance. Conclusion: Pregnant patients make up a significant number of ED visits annually and are more likely to be people of color or publicly insured. Interventions to address the effects of changing abortion legislation on emergency medicine practice may benefit from consideration that certain populations of pregnant people are more likely to present to the ED for care. [ABSTRACT FROM AUTHOR]

Background Many different risk stratification systems have been formulated for thyroid nodules, differing in their fine-needle aspiration cytology (FNAC) indication, suggesting a lack of consensus around the world. Purpose This prospective study was conducted to find the best guideline for risk stratification, for a better malignancy yield, and with reduced rates of negative FNACs among three Thyroid Imaging, Reporting, and Data System (TIRADS) guidelines. Materials and Methods A total of 625 thyroid nodules with conclusive FNAC or histopathological diagnosis were included in the study. Various sonographic parameters were recorded. They were classified into categories as per the three guidelines and compared with FNAC diagnosis. The guidelines were evaluated in terms of sensitivity, specificity, predictive values, and diagnostic accuracy. Sensitivity and specificity were compared by McNemar's test. Results American College of Radiology (ACR) TIRADS had the highest diagnostic accuracy (56.8%), specificity (50.75%), positive predictive value (23.92%), lowest rates of negative FNACs (76.08%), and high negative predictive value (97.84 %). Korean (K) TIRADS had the maximum sensitivity (97.75%), highest negative predictive value (98.44%), and gross malignancy yield. European TIRADS was between the two other guidelines in most parameters with specificity like K TIRADS. Conclusion All the three guidelines are very good screening tools, with comparable high sensitivity. ACR TIRADS is better in terms of specificity and reduced rates of negative FNACs. Including the presence of a suspicious cervical lymph node as a criterion and more frequent follow-up might further improve the diagnostic performance of the guideline. [ABSTRACT FROM AUTHOR]

Urban living is a growing worldwide phenomenon with more than two-thirds of people expected to live in cities by 2050. Although there are many benefits to living in an urban environment, urbanicity has also been associated with deleterious health outcomes, including increased risk for psychotic outcomes particularly when the urban exposure occurs in pre-adolescence. However, the mechanisms underlying this association is unclear. Here, we utilize one-year follow-up data from a large (N=7,979), nationwide study of pre-adolescence in the United States to clarify why urbanicity (i.e., census-tract population density) might impact psychotic-like experiences (PLE) by looking at the indirect effect of eight candidate urbanicity-related physical (e.g., pollution) and social (e.g., poverty) exposures. Consistent with other work, we found that of the evaluated exposures related to urbanicity, several were also related to increased number of PLE: PM2.5, proximity to roads, census-level homes at-risk for exposure to lead paint, census-level poverty, and census-level income-disparity. These same urban-related exposures were also related to the persistence of PLE after 1 year, but not new onset of PLE. Mediation analysis revealed that a substantial proportion the urbanicity-PLE association (number and persistence) could be explained by PM2.5 (23-44%), families in poverty (68-93%), and income disparity (67-80%). Together, these findings suggest that specific urban-related exposures contribute to the existence and maintenance, but not onset of PLE, which might help to explain why those in urban environments are disproportionately at-risk for psychosis and point toward areas for public health intervention. [ABSTRACT FROM AUTHOR]

Objectives: This study examined how frailty in traditional risk-adjusted models could improve the predictability of unplanned 30-day readmission and mortality among heart failure patients. Methods: This study was a retrospective analysis of Nationwide Readmissions Database data collected during the years 2010–2018. All patients ≥65 years who had a principal diagnosis of heart failure were included in the analysis. The Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator was used to identify frail patients. Results: There was a total of 819,854 patients admitted for heart failure during the study period. Among them, 63,302 (7.7%) were frail. In the regression analysis, the risk of all-cause 30-day readmission (OR, 1.18; 95% CI, 1.14–1.22) and in-hospital mortality (OR, 1.52; 95% CI, 1.40–1.66) were higher in patients with frailty. Discussion: Inclusion of frailty in comorbidity-based risk-prediction models significantly improved the predictability of unplanned 30-day readmission and in-hospital mortality. [ABSTRACT FROM AUTHOR]

Objective: To discover novel serum biomarkers that have diagnostic or predictive value in lupus nephritis (LN). Methods: Using a quantitative protein microarray, we screened for high‐abundant proteome expression in the serum of patients with LN compared to healthy controls. Top candidates from this screening were validated using a larger cohort of patients with LN compared to a disease control cohort (subjects with other chronic kidney diseases) and a healthy control cohort. Promising markers were then selected using a machine‐learning model and further validated with a larger patient cohort. The corresponding autoantibodies and immune complexes containing these proteins were also examined. Results: In total, 13 proteins were found to be significantly elevated in LN patient serum in the screening, among which 8 proteins were validated by enzyme‐linked immunosorbent assay using 81 serum samples from LN patients and control subjects. Three serum markers with LN diagnostic potential were identified using feature importance analysis and further validated using 155 serum samples from LN patients and control subjects. V‐set immunoglobulin domain–containing protein 4 (VSIG4) appeared to be the most promising marker in distinguishing LN from healthy controls, with an area under the curve of 0.93. VSIG4 could also discriminate active LN from inactive LN. Furthermore, serum VSIG4 levels were positively correlated with all of the following clinical parameters: the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score (Spearman's rank correlation rs = 0.42, P < 0.001), the renal domain score of the SLEDAI (rs = 0.46, P < 0.001), the urinary protein‐to‐creatinine ratio (rs = 0.56, P < 0.001), and the serum creatinine level (rs = 0.41, P < 0.001). Importantly, we found that serum VSIG4 levels tracked with LN disease activity longitudinally, and that serum VSIG4 levels reflected the renal pathology activity index (AI), particularly the AI components of crescent formation and hyaline deposits. Conclusion: VSIG4 may be a promising novel serum biomarker and therapeutic target in patients with LN. [ABSTRACT FROM AUTHOR]

Objectives: GLOBAL AIM: Increase license portability across state lines for all US medical professionals. SPECIFIC AIM: Increase the ability to provide medical care nationwide for all US sports medicine physicians (who have a CAQ for their specialty) across state lines and set a precedent for other licensed healthcare professionals by 2026. The aim is to extend the portability of medical licensure across state lines to all sports medicine professionals (not just those who care for professional teams) and use this as a precedent eventually for all types of healthcare workers. Currently sports medicine physicians for professional teams are allowed to provide care across state lines which is legislated by "The Sports Medicine Licensure Clarity Act" (SMLCA) in 2018. As July 22, 2022, licensure is allowed for at least telemedicine across state lines for 23 states and has been extended by the HHS as part of Covid healthcare measures that were implemented in 2020. Methods: Review of current policies, barriers and facilitators has been performed using various search strategies and qualitative techniques. Current state and national laws were reviewed and will be presented. California has a large population where there is no reciprocity for other medical professionals, therefore meetings have been set with the Business Professions Committee with a plan to submit a bill sponsored by a state assemblyman to expand access to licensure across state lines in 2023. Results: One barrier is the loss of states' autonomy as well as the individual authority and stature a medical professional may gain from being on a licensing board. Most US states have no reciprocity and not all have the licensure process standardized. Some states have a nontransparent process and others do not wish to participate in regional compacts such as California. Even more concerning, some states are found to more-likely censure doctors of color and perform sham peer review. This is an example of bias in medical credentialing that can impede diversity and inclusion efforts. The European Union allows medical licensure across national borders. Doctors need to pass a language proficiency test for the country they wish to practice in, regardless of which European country they received their medical training. Given that English is the only language of instruction in the US, proficiency can be easily evaluated. Language should not be a barrier to license portability, especially if one is already licensed in one US state even for foreign medical graduates. The Covid pandemic showed licensure is obtainable in a relatively rapid fashion across state lines. In addition, federal health care facilities such as the VA system already allow practitioners licensed in one state to practice in another without a license to that specific state. Portability across state-lines aids practitioners who practice on state borders in both rural and urban areas, such as the NH and VT border(rural), and NY and DC metro areas (urban) as well as telehealth for both an immobile and mobile populations, enhancing equitable healthcare access. This also removes financial barriers of cost for licensing fees for practitioners and staff resources to process licenses. Conclusions: The US has one of the most restrictive medical licensures of all developed countries, making mobilization of healthcare workers extremely difficult. Removing this barrier will be beneficial when medical staff is needed across state lines for pandemics, natural disasters, intake of refugees/immigrants, and global sporting events held in the US such as the World Cup in 2026, and Olympics in 2028. This could also extend access for the general US population to healthcare providersvia "tele-medicine" (virtual/video visits), to essentially all populations (socio-economically disadvantaged, immigrants, those with mobility and transportation barriers, rural locations etc). This will ensure higher quality care, better follow-up along with more timely and equitable healthcare, which are all currently limited by restricting portability and requiring licenses for each individual state. [ABSTRACT FROM AUTHOR]

Intensive care units (ICUs) may disrupt sleep. Quantitative ICU studies of concurrent and continuous sound and light levels and timings remain sparse in part due to the lack of ICU equipment that monitors sound and light. Here, we describe sound and light levels across three adult ICUs in a large urban United States tertiary care hospital using a novel sensor. The novel sound and light sensor is composed of a Gravity Sound Level Meter for sound level measurements and an Adafruit TSL2561 digital luminosity sensor for light levels. Sound and light levels were continuously monitored in the room of 136 patients (mean age = 67.0 (8.7) years, 44.9% female) enrolled in the Investigation of Sleep in the Intensive Care Unit study (ICU-SLEEP; Clinicaltrials.gov: #NCT03355053), at the Massachusetts General Hospital. The hours of available sound and light data ranged from 24.0 to 72.2 hours. Average sound and light levels oscillated throughout the day and night. On average, the loudest hour was 17:00 and the quietest hour was 02:00. Average light levels were brightest at 09:00 and dimmest at 04:00. For all participants, average nightly sound levels exceeded the WHO guideline of < 35 decibels. Similarly, mean nightly light levels varied across participants (minimum: 1.00 lux, maximum: 577.05 lux). Sound and light events were more frequent between 08:00 and 20:00 than between 20:00 and 08:00 and were largely similar on weekdays and weekend days. Peaks in distinct alarm frequencies (Alarm 1) occurred at 01:00, 06:00, and at 20:00. Alarms at other frequencies (Alarm 2) were relatively consistent throughout the day and night, with a small peak at 20:00. In conclusion, we present a sound and light data collection method and results from a cohort of critically ill patients, demonstrating excess sound and light levels across multiple ICUs in a large tertiary care hospital in the United States. ClinicalTrials.gov, #NCT03355053. Registered 28 November 2017, . [ABSTRACT FROM AUTHOR]

A sample of 112 Asian-Indian Immigrant grandchildren, age 10-16 years, from different parts of the United States completed survey questionnaires regarding the quality of relationship with their grandparents in India. The study explored the factors that affected the quality of relationship between two different generations living at considerable geographical distance and in different cultures. Findings indicated that role importance, amount of contact, and health of the grandparent uniquely contributed to the relationship quality. Results also indicated acculturation was not a significant predictor of relationship quality, although it was a significant predictor of role importance. Limitations to the study relative to acculturation scores and sampling are discussed and further research should address these limitations and the grandparent-parent relationship. Implications include adopting a tri-generational perspective in future studies and practice. (Contains 2 tables.)

Background: Prostate cancer (PCa) is a major cause of morbidity and mortality among men in the United States and globally. However, many men with prostate cancer have slow growing tumor and experience an indolent course even without curative therapy. The increasing incidence may be due to increased PSA-measurements and other diagnostic efforts. However, this review does not handle the associated differential diagnosis. Also, the biological heterogeneity that characterizes this disease causes decision issues unique to prostate cancer. Low-grade cancer diagnosed late in life may have no impact on the quality or length of life. Materials and methods: A cross-sectional study was conducted to test the hypothesis of an association of IFN-γ, IL-6 and PSA with obesity parameters for the severity of prostate cancer. Total 90 participants included in study and Anthropometric examination and hormonal test were also performed simultaneously. Among 90 participants; Total 45 participants were grouped in Benign Prostatic Hyperplasia (BPH) and 45 in PCa groups respectively. Serum samples of men with suspicion of prostate cancer based on high prostate specific antigen (PSA) and/or abnormal DRE were withdrawn before biopsy between 8 a.m. and 11 a.m. Serum PSA, IFN-gamma and IL-6 levels were estimated using ELISA on the same day. The serum was separated, aliquoted and kept frozen at -80°C for analysis. Result: Waist hip ratio was significantly (p<0.0001) higher in the patients of PCa (2.9 ± 1.43) as compared to BPH (1.92 ± 1.20). Level of IFN-γ was significantly (p<0.0001) higher in PCa (144.6 ± 49.9) patients as compared to BPH patients (61.8 ± 11.9). Similarly, the Interleukin-6 level was significantly (p<0.0001) higher in PCa patients (36.95±11.37) as compared to BPH patients (13.7±9.47). The age of the patients was almost similar in both Lower (68.59±12.15) and Higher (67.70±12.70) grades. The level of BMI was significantly (p=0.008) higher in the patients of Higher grade (28.35±7.99) as compared to Lower (26.85±5.89) grade. The higher-grade patients had more risk of being overweight than the lower grade patients (Unadjusted OR=1.14, 95%CI=1.03-1.16). Similarly, the waist-hip ratio was also significantly (p=0.03) higher in the patients of Higher grade (2.33±1.53) as compared to Lower grade (2.09±1.38). Conclusion: The introduction of total PSA in clinical practice has resulted in early detection and reduced mortality from PCa. However, PCa screening remains controversial, because of the risk of over diagnosis reduced mortality and overtreatment and the inability to detect a significant proportion of dangerous tumors. A large concerted effort has been made to improve and/or monitoring the activity of PCa and to guide molecular targeted therapy and/or assess therapeutic response. An integrated approach with blood-based measurement of different molecular forms of PSA in combination with genetic and urine biomarkers hold the promise of improving screening for and diagnosis of PCa. Analysis of panels of blood-based biomarkers will be a significant step towards fingerprinting of the tumors biologic behavior. [ABSTRACT FROM AUTHOR]

According to recent census data, Hispanic and Latino populations comprise the largest minority group in the United States. Despite ongoing efforts for improved diversity, equity, and inclusion, Hispanics remain underrepresented in medicine (UIM). In addition to well-established benefits to patient care and health systems, physician diversity and increased representation in academic faculty positively impact the recruitment of trainees from UIM backgrounds. Disproportionate representation (as compared to increases of certain underrepresented groups in the US population) has direct implications for recruitment of UIM trainees to residency programs. To examine the number of full-time US medical school faculty physicians who self-identify as Hispanic in light of the increasing Hispanic population in the United States. We analyzed data from the Association of American Medical Colleges from 1990 to 2021, looking at those academic faculty who were classified as Hispanic, Latino, of Spanish Origin, or of Multiple Race—Hispanic. We used descriptive statistics and visualizations to illustrate the level of representation of Hispanic faculty by sex, rank, and clinical specialty over time. Overall, the proportion of faculty studied who identified as Hispanic increased from 3.1% (1990) to 6.01% (2021). Moreover, while the proportion of female Hispanic academic faculty increased, there remains a lag between females versus males. Our analysis shows that the number of full-time US medical school faculty who self-identify as Hispanic has not increased, though the population of Hispanics in the United States has increased. [ABSTRACT FROM AUTHOR]

In 2019, the United States (US) Advisory Committee on Immunization Practices (ACIP) recommended that healthcare providers engage in shared clinical decision making for adults aged 27–45 who may benefit from HPV vaccination. However, it is difficult to assess these benefits as there is a lack of data on HPV burden on young and mid-adult women. This analysis estimates the incidence of conization and the burden associated with treating pre-cancerous states related to HPV with a loop electrosurgical excision procedure (LEEP) or a cold knife conization (CKC) among commercially insured women aged 18–45. This retrospective cohort study used the IBM MarketScan commercial claims encounter database for women aged 18–45 treated with conization. We assessed the annual incidence of conization (2016–2019) and adjusted the two-year health care costs post-conization using a multivariable Generalized Linear Model (GLM)—accounting for follow-up time and other characteristics—stratified by the age groups, namely 18–26 and 27–45. The inclusion criteria were met by 6735 women, with a mean age of 33.9 years (SD = 6.2). Conization incidence was lowest for women aged 18–26 (41/100,000 to 62/100,000 women-years) and highest for women aged 31–35 (243/100,000 to 269/100,000). The GLM-adjusted, all-cause healthcare costs per patient per year were USD 7279 and USD 9249 in the 18–26 and 27–45 age groups, respectively. The adjusted costs for disease-specific care were USD 3609 and USD 4557 for women ages 18–26 and 27–45, respectively. The burden of conization and the associated costs were significant, indicating a potential healthcare benefit of HPV vaccination among young and middle-aged women. [ABSTRACT FROM AUTHOR]

Rising obesity rates have become a major public health concern within the United States. Understanding the systemic and neural effects of obesity is crucial in designing preventive and therapeutic measures. In previous studies, administration of a high fat diet has induced significant weight gain for mouse models of obesity. Interestingly, sex differences in high-fat diet-induced weight gain have been observed, with female mice gaining significantly less weight compared to male mice on the same high-fat diet. It has also been observed that consumption of a high-fat diet can increase neurogliosis, but the mechanism by which this occurs is still not fully understood. Recent research has suggested that the gut microbiome may mediate diet-induced glial activation. The current study aimed to (1) analyze changes to the gut microbiome following consumption of a high fat (HF) diet as well as antibiotic treatment, (2) evaluate hippocampal microgliosis and astrogliosis, and (3) identify sex differences within these responses. We administered a low fat (Research Diets D12450 K) or high fat diet (Research Diets D12451) to male and female C57Bl/6 mice for sixteen weeks. Mice received an antibiotic cocktail containing 0.5g/L of vancomycin, 1.0 g/L ampicillin, 1.0 g/L neomycin, and 1.0 g/L metronidazole in their drinking water during the last six weeks of the study and were compared to control mice receiving normal drinking water throughout the study. We observed a significant reduction in gut microbiome diversity for groups that received the antibiotic cocktail, as determined by Illumina next-generation sequencing. Male mice fed the HF diet (± antibiotics) had significantly greater body weights compared to all other groups. And, female mice fed the low fat (LF) diet and administered antibiotics revealed significantly decreased microgliosis and astrogliosis in the hippocampus compared to LF-fed females without antibiotics. Interestingly, male mice fed the LF diet and administered antibiotics revealed significantly increased microgliosis, but decreased astrogliosis, compared to LF-fed males without antibiotics. The observed sex differences in LF-fed mice given antibiotics brings forward questions about sex differences in nutrient metabolism, gut microbiome composition, and response to antibiotics. [ABSTRACT FROM AUTHOR]

A multicountry outbreak of the monkeypox virus has gained global attention. As of May 25, 250 confirmed human monkeypox cases have been reported globally. Monkeypox is caused by the Monkeypox virus, which belongs to the Orthopoxvirus genus and Poxviridae family. Monkeypox is often a self‐limiting infection, with symptoms lasting 2–4 weeks with the case fatality ratio around 3%–6%. Monkeypox is transmitted to humans by direct contact with an infected person or animal or contact with virus‐contaminated material. Human monkeypox infections may lead to various medical complications such as fever, rash, and lymphadenopathies. Pneumonitis, encephalitis, sight‐threatening keratitis, and subsequent bacterial infections are all possible complications of monkeypox. An antiviral agent developed to treat smallpox has also been approved for use in the treatment of monkeypox in the United States. Vaccines used in the smallpox eradication program also provided immunity to monkeypox. Newer vaccines have been developed, one of which has been approved for monkeypox prevention. In this study, we provide information about the recent outbreaks of human monkeypox, epidemiology, transmission pattern, possible diagnosis techniques, therapeutics, and available preventive strategies. [ABSTRACT FROM AUTHOR]

This study provides an updated and expanded analysis of the impact of the COVID-19 pandemic on routine vaccinations across the life-course in the United States. Routine wellness visits and vaccination rates were calculated using structured claims data for each month during the impact period (January 2020 to August 2022) and compared to the respective baseline period (January 2018 to December 2019). Monthly rates were aggregated as annual accumulated and cumulative percent changes. The complete monthly rate interactive dataset can be viewed at . The greatest decrease in annual accumulated administration rates in the 0–2 and 4–6 years age groups was for the measles, mumps, and rubella vaccine; for adolescents and older adults, it was for human papillomavirus and pneumococcal vaccines, respectively. Routine in-person wellness visit rates recovered faster and more completely than vaccination rates in all age groups, indicating potential missed opportunities to administer vaccines during visits. This updated analysis reveals that the negative impact of the COVID-19 pandemic on routine vaccination continued through 2021 and into 2022. Proactive efforts to reverse this decline are needed to increase individual- and population-level vaccination coverage and avoid the associated preventable morbidity, mortality, and health care costs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine trends in diabetes-related hospitalizations over the period 2010 to 2019 using Nationwide Inpatient Sample (NIS) to facilitate informed policies regarding diabetes-related prevention and management. Between 2010 and 2019, there were 304 million hospitalizations above 18 years of age, of which 78 million were diabetes-associated hospitalizations. The overall population-adjusted diabetes hospitalizations significantly increased from 3079.0 to 3280.8 per 100,000 US population (relative increase, 6.6%, Ptrend < 0.028). Age-stratified analysis showed that hospitalizations significantly increased for 18–29 years (relative increase, 7.8%, Ptrend < 0.001) while age- and gender-stratified analysis showed that diabetes hospitalization significantly increased for 18–29-year males (relative increase, 18.1%, Ptrend < 0.001). Total hospitalization charge increased from 97.5 billion USD in 2010 to 132.0 billion USD in 2019 (relative increase, 35.4%, Ptrend < 0.001). Our study's findings suggest that diabetes-associated hospitalizations will continue to increase in the future because recent evidence indicates a reappearance of diabetes complications. It is important to screen, prevent, and control diabetes at a younger age based on the trends observed in our study. [ABSTRACT FROM AUTHOR]

Simple Summary: All fields of healthcare were adversely affected by the COVID-19 pandemic. In this study, we sought to understand the effects of COVID-19 on hospitalizations for intracranial meningioma resection using a large database. We compared hospitalization rates as well as hospital outcomes such as Clavien–Dindo grade IV complications, in-hospital mortality, and prolonged length of stay for intracranial meningioma resection during 2019 and 2020. Our findings showed that though hospitalization rates decreased slightly during the COVID-19 pandemic, hospital outcomes were not adversely affected. The findings of our study show that with adequate planning and preparations, better hospital outcomes could be sustained even during healthcare emergencies such as COVID-19 pandemic. Our findings assure that neurosurgery practice in the US ensured the best quality of care to their patients even during COVID-19 pandemic. Purpose: To assess the effects of COVID-19 on hospitalizations for intracranial meningioma resection using a large database. Methods: We conducted a retrospective analysis of the California State Inpatient Database (SID) 2019 and 2020. All adult (18 years or older) hospitalizations were included for the analysis. The primary outcomes were trends in hospitalization for intracranial meningioma resection between 2019 and 2020. Secondary outcomes were Clavien–Dindo grade IV complications, in-hospital mortality, and prolonged length of stay, which was defined as length of stay ≥75 percentile. Results: There were 3,173,333 and 2,866,161 hospitalizations in 2019 and 2020, respectively (relative decrease, 9.7%), of which 921 and 788 underwent intracranial meningioma resection (relative decrease, 14.4%). In 2020, there were 94,114 admissions for COVID-19 treatment. Logistic regression analysis showed that year in which intracranial meningioma resection was performed did not show significant association with Clavien–Dindo grade IV complications and in-hospital mortality (OR, 1.23, 95% CI: 0.78–1.94) and prolonged length of stay (OR, 1.05, 95% CI: 0.84–1.32). Conclusion: Our findings show that neurosurgery practice in the US successfully adapted to the unforeseen challenges posed by COVD-19 and ensured the best quality of care to the patients. [ABSTRACT FROM AUTHOR]

Rapid and reliable identification of the hemagglutinin (HA) and neuraminidase (NA) genetic clades of an influenza A virus (IAV) sequence from swine can inform control measures and multivalent vaccine composition. Current approaches to genetically characterize HA or NA sequences are based on nucleotide similarity or phylogenetic analyses. Public databases exist to acquire IAV genetic sequences for comparison, but personnel at the diagnostic or production level have difficulty in adequately updating and maintaining relevant sequence datasets for IAV in swine. Further, phylogenetic analyses are time intensive, and inference drawn from these methods is impacted by input sequence data and associated metadata. We describe here the use of the IAV multisequence identity tool as an integrated public webpage located on the Iowa State University Veterinary Diagnostic Laboratory (ISU-VDL) FLU ture website: https://influenza.cvm.iastate.edu/. The multisequence identity tool uses sequence data derived from IAV-positive cases sequenced at the ISU-VDL, employs a BLAST algorithm that identifies sequences that are genetically similar to submitted query sequences, and presents a tabulation and visualization of the most genetically similar IAV sequence and associated metadata from the FLU ture database. Our tool removes bioinformatic barriers and allows clients, veterinarians, and researchers to rapidly classify and identify IAV sequences similar to their own sequences to augment interpretation of results. [ABSTRACT FROM AUTHOR]

The United States Constitution grants Americans the "right to a speedy and public trial," with an assumption that the trial is impartial and fair. Recent data suggest a nontrivial number of cases fail to meet this standard. During interrogations, suspects can be presented with false evidence, long interrogations can undermine a suspect's cognitive ability, and minimization tactics often mislead suspects into believing justice is on their side. These dynamics facilitate false confessions and wrongful convictions, which are common in the United States and globally. We argue the current approaches to understand and predict innocence in legal cases are insufficient and interdisciplinary research is required to prevent innocent people from going to jail. In this review, we cover research on wrongful convictions and false confessions, ending with The Truth Project (www.truth-project.io), a new global framework to connect scholars and facilitate research into behavioral patterns of innocence. [ABSTRACT FROM AUTHOR]

Existing studies on pregnancy-related outcomes among cancer survivors are limited by sample size or specificity of the cancer type. This study estimated the burden of adverse maternal and fetal outcomes among pregnant cancer survivors using a national database. This study was a retrospective analysis of National Inpatient Sample collected during 2010–2014. Multivariate regression models were used to calculate odds ratios for maternal and fetal outcomes. The study included a weighted sample of 64,506 pregnant cancer survivors and 18,687,217 pregnant women without cancer. Pregnant cancer survivors had significantly higher odds for death during delivery hospitalization, compared to pregnant women without cancer (58 versus 5 deaths per 100,000 pregnancies). They also had higher odds of severe maternal morbidity (aOR 2.00 [95% CI 1.66–2.41]), cesarean section (aOR 1.27 [95% CI 1.19–1.37]), labor induction (aOR 1.17 [95% CI 1.07–1.29]), pre-eclampsia (aOR 1.18 [95% CI 1.02–1.36]), preterm labor (aOR 1.55 [95% CI 1.36–1.76]), chorioamnionitis (aOR 1.45 [95% CI 1.15–1.82]), postpartum infection (aOR 1.68 [95% CI 1.21–2.33]), venous thromboembolism (aOR 3.62 [95% CI 2.69–4.88]), and decreased fetal movements (aOR 1.67 [95% CI 1.13–2.46]). This study showed that pregnancy among cancer survivors constitutes a high-risk condition requiring advanced care and collective efforts from multiple subspecialties. [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic overwhelmed the world, educational leaders implemented crisis management plans to mitigate its impact on their students, faculty, staff, and their families. We studied five cases in the education sector in the world's largest democracies: the United States of America and India. Through document analysis and semi-structured interviews, we investigated the responses of educational leadership during each stage of the crisis. In the cases we studied, leaders in USA adopted a consultative decision-making approach more often than their Indian counterparts. Moreover, group-based approach was evident only among leaders in USA. Leaders in both countries were creative and diligent in communicating, both to gather information as well as for dissemination. Leaders had to think out of the box to meet the needs of students and faculty, as well as the communities in their immediate areas. Resource identification and distribution, overcoming the digital divide between rural and urban areas, and the acquisition and appropriate allocation of safety equipment are just a few of the challenges addressed by the academic leaders. This study makes an important contribution to crisis leadership by looking at competencies needed to manage a crisis, and the influence of national culture in decision-making behaviours during a crisis. [ABSTRACT FROM AUTHOR]

The rates of both maternal and fetal adverse outcomes increase significantly with higher body mass index. The aim of this study was to calculate national estimates of adverse maternal and fetal outcomes and associated hospitalization cost among obese pregnant women using a national database. This study was a retrospective analysis of data retrieved from Nationwide Inpatient Sample database, collected during 2010–2014. The primary outcomes of this study were adverse maternal and fetal outcomes, hospital length of stay, and hospitalization cost. There was a total of 18,687,217 delivery-related hospitalizations, of which 1,048,323 were among obese women. Obese women were more likely to have cesarean deliveries (aOR 1.70, 95% CI 1.62–1.79) and labor inductions (aOR 1.51, 95% CI 1.42–1.60), greater length of stay after cesarean deliveries (aOR 1.14, 95% CI 1.08–1.36) and vaginal deliveries (aOR 1.48, 95% CI 1.23–1.77). They were also more likely to have pregnancy-related hypertension, preeclampsia, gestational diabetes, premature rupture of membranes, chorioamnionitis, venous thromboembolism, excessive fetal growth, and fetal distress. Obese pregnant women had significantly greater risk for adverse obstetrical outcomes, which substantially increased the hospital and economic burden. Risk stratification of pregnant patients based on obesity could also help obstetricians to make better clinical decisions and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Hospitalizations due to radiotherapy (RT) complications result in significant healthcare expenditures and adversely affect the quality of life of cancer patients. Using a nationally representative dataset, the objective of this study is to identify trends in the incidence of these hospitalizations, their causes, and the resulting financial burden. Data from the National Inpatient Sample was retrospectively analyzed from 2005 to 2016. RT complications were identified using ICD-9 and ICD-10 external cause-of-injury codes. The hospitalization rate was the primary endpoint, with cost and in-hospital death as secondary outcomes. 443,222,223 weighted hospitalizations occurred during the study period, of which 482,525 (0.11%) were attributed to RT. The 3 most common reasons for RT-related hospitalization were cystitis (4.8%, standard error [SE] = 0.09), gastroenteritis/colitis (3.7%, SE = 0.07), and esophagitis (3.5%, SE = 0.07). Aspiration pneumonitis (1.4-fold) and mucositis (1.3-fold) had the highest relative increases among these hospitalizations from 2005 to 2016, while esophagitis (0.58-fold) and disorders of the rectum and anus were the lowest (0.67-fold). The median length of stay of patient for hospitalization for RT complications was 4.1 (IQR, 2.2–7.5) days and the median charge per patient was $10,097 (IQR, 5755–18,891) and the total cost during the study period was $4.9 billion. Hospitalization for RT-related complications is relatively rare, but those that are admitted incur a substantial cost. Use of advanced RT techniques should be employed whenever possible to mitigate the risk of severe toxicity and therefore reduce the need to admit patients. [ABSTRACT FROM AUTHOR]

Urban living is a growing worldwide phenomenon with more than two-thirds of people expected to live in cities by 2050. Although there are many benefits to living in an urban environment, urbanicity has also been associated with deleterious health outcomes, including increased risk for psychotic outcomes particularly when the urban exposure occurs in pre-adolescence. However, the mechanisms underlying this association is unclear. Here, we utilize one-year follow-up data from a large (N =7,979), nationwide study of pre-adolescence in the United States to clarify why urbanicity (i.e., census-tract population density) might impact psychotic-like experiences (PLE) by looking at the indirect effect of eight candidate urbanicity-related physical (e.g., pollution) and social (e.g., poverty) exposures. Consistent with other work, we found that of the evaluated exposures related to urbanicity, several were also related to increased number of PLE: PM2.5, proximity to roads, census-level homes at-risk for exposure to lead paint, census-level poverty, and census-level income-disparity. These same urban-related exposures were also related to the persistence of PLE after 1 year, but not new onset of PLE. Mediation analysis revealed that a substantial proportion the urbanicity-PLE association (number and persistence) could be explained by PM2.5 (23–44%), families in poverty (68–93%), and income disparity (67–80%). Together, these findings suggest that specific urban-related exposures contribute to the existence and maintenance, but not onset of PLE, which might help to explain why those in urban environments are disproportionately at-risk for psychosis and point toward areas for public health intervention. [ABSTRACT FROM AUTHOR]

During the past decade, many reforms were proposed and implemented for improving primary care in the US. This study assessed improvements in quality of primary care, using a nationally representative database. We conducted a retrospective trend analysis of National Inpatient Sample data (2007–2016). The quality of primary care was assessed using Prevention Quality Indicators (PQIs), which consist of 13 sets of preventable hospitalization conditions. PQI hospitalization decreased from 154,565 to 151,168 per million hospitalizations during the study period (relative decrease, 2.2%; P = 0.041). Age-adjusted hospitalization rate increased for diabetes short-term complications (relative increase, 46.9%; P < 0.001) and lower-extremity amputations (relative increase, 15.1%; P = 0.035). Age stratified trends showed that hospitalization rates decreased significantly in all age-groups for diabetes short-term complications. For lower-extremity amputations, hospitalization rates increased significantly in younger age groups and decreased significantly in the older age groups. All other PQIs showed either decreasing or no change in trends. Adults aged 18–64 years should be the focus for future prevention attempts for diabetes complications. Identifying and acting on the factors responsible for these changes could help in reversing the concerning trends observed in this study. Existing strategies should focus on improving access to diabetes care and self-management. [ABSTRACT FROM AUTHOR]

Background: The relationship between insurance status and interhospital transfers has not been adequately researched among cancer patients. Hence this study aimed for understanding this relationship using a nationally representative database.Methods: A retrospective analysis was conducted using National Inpatient Sample (NIS) data collected during 2010-2016 and included all cancer hospitalization between 18 and 64 years of age. Interhospital transfers were compared based on insurance status (Medicare, Medicaid, private, and uninsured). Weighted multivariable logistic regressions were used to calculate the odds of interhospital transfers based on insurance status, after adjusting for many covariates.Results: There were 3,580,908 weighted cancer hospitalizations, of which 72,353 (2.02%) had interhospital transfers. Uninsured patients had significantly higher rates of interhospital transfers, compared to those with Medicare (P = 0.005) and private insurance (P < 0.001). Privately insured patients had significantly lower rates of interhospital transfers, compared to those with Medicare (P < 0.001) and Medicaid (P < 0.001). Logistic regression analyses showed that the odds of having interhospital transfers were significantly higher among uninsured (adjusted odds ratio [aOR], 1.57, 95% CI: 1.45-1.69), Medicare (aOR, 1.38, 95% CI: 1.32-1.45) and Medicaid (aOR, 1.23, 95% CI: 1.16-1.30) patients when compared to those with private insurance coverages.Conclusion: Among cancer patients, uninsured and Medicare and Medicaid beneficiaries were more likely to experience interhospital transfers. In addition to medical reasons, factors such as affordability and socioeconomic status are influencing interhospital transfer decisions, indicating existing healthcare disparities. Further studies should focus on identifying the causal associations between factors explored in this study as well as additional unexplored factors. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of literature regarding injury incidence, mechanism, and return to play in National Football League (NFL) players who have sustained traumatic posterior hip instability. Purpose: To describe the incidence of traumatic posterior hip instability and the rate of return to play in NFL players across 18 seasons. Study Design: Descriptive epidemiology study. Methods: We retrospectively assessed all traumatic posterior hip dislocations/subluxations that occurred during football-related activities in the NFL seasons from 2000 through 2017. Player demographics and injury data (injury mechanism, season of injury, treatment, days missed, and return to play time) were collected from all 32 NFL teams prospectively through a leaguewide electronic health record system. Descriptive statistics are presented. Results: Across the 18 NFL seasons, 16 posterior hip instability injuries in 14 players were reported, with a maximum incidence of 4 (25%) in 2013. Posterior hip instability was predominantly sustained by offensive players (64.3%), with tight ends being the most affected (31.3%). Half of the injuries occurred during the regular season, 43.8% in the preseason, and 6.2% in the offseason. Of all injuries, 37.5% were noncontact, while 56.3% involved contact (direct or indirect), and 6.2% were of unknown mechanism. Among noncontact injuries, 66.7% occurred during cutting and change of direction while sprinting. The time of return to full participation was documented for 11 of the 16 reported injuries (68.8%); among them, the mean time loss was 136.7 ± 83.8 days—143.3 ± 99.6 days if the player underwent surgery (n = 4) and 116.7 ± 76.2 days missed by players without surgery (n = 6)—the treatment modality was unknown in 1 player. Conclusion: Although the incidence of traumatic posterior hip instability during the study period was low, all injured athletes missed time from football activities and competitions. Injuries that required surgery led to more missed time than those that did not. Ongoing research to understand risk factors and mechanisms of this injury, in conjunction with improvements to prevention and rehabilitation protocols, is necessary to ensure the safety of professional American football players. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has led to significant reductions in the administration of routinely recommended vaccines among adolescents in the US including tetanus, diphtheria, and acellular pertussis (Tdap); meningococcal (ACWY); and human papillomavirus (HPV) vaccines. The extent to which these deficits could persist in 2021 and beyond is unclear. To address this knowledge gap, this study estimated the cumulative deficits of routine vaccine doses among US adolescents during the COVID-19 pandemic and estimated the time and effort needed to recover from those deficits. Monthly reductions in Tdap, meningococcal, and HPV doses administered to US adolescents during the COVID-19 pandemic were quantified using MarketScan Commercial Claims and Encounters data. The time and effort required to reverse the vaccination deficit under various catch-up scenarios were estimated. Annual doses administered of Tdap, meningococcus, and HPV vaccines decreased by 21.2%, 20.8%, and 24.0%, respectively, in 2020 compared to 2019. For 2021, the reduction in doses administered is projected to be 6%–21% compared to 2019 under different scenarios. The projected deficit of missed doses is expected to be cleared between winter 2023 and fall 2031. Administration rates of routine vaccines decreased significantly among US adolescents during COVID-19. Reversing these deficits to mitigate long-term health and economic consequences will require a sustained increase in vaccination rates over multiple years. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) cause cancers in a variety of anatomic sites presenting at various stages of disease. Current economic assessments rely on HPV-related cancer cost estimates from data prior to the launch of the nonavalent HPV vaccine (2014). The goal of the present study was to assess and describe the current direct medical care burden of HPV-related cancers in the US. Using Clinformatics Data Mart, patients in the US who were newly diagnosed with cervical, vulvar, vaginal, anal, and oropharyngeal cancers between 2012 and 2015 were compared to non-cancer matched (propensity score) controls. Health care resource utilization and direct medical cost (2020 USD) were assessed over a 2-year follow-up period following index diagnosis from a payer perspective. The cost for censored time was estimated using generalized linear model while adjusting for survival probability using cox-proportional hazard model. Confidence intervals were calculated with bootstrapping technique. The analyses included 4128 cervical, 1580 vulvar, 538 vaginal, 1827 anal, and 6106 oropharyngeal cancers and matched controls. Cases and controls had similar baseline clinical characteristics and length of follow-up. The 2-year incremental direct medical costs were $93,272, $81,676, $141,096, $129,366, and $134,045 for cervical, vulvar, vaginal, anal, and oropharyngeal cancers respectively. Outpatient care costs was the biggest driver of the total incremental medical costs. Most cancer costs were incurred during the first 6 months of follow-up and then stabilized during follow-up. HPV-related cancers are responsible for substantial health care expenditure each year. [ABSTRACT FROM AUTHOR]

Sources of stress responsible for earthquakes occurring in the Central and Eastern United States (CEUS) include not only far-field plate boundary forces but also various local contributions. In this study, we model stress fields due to heterogeneities in the upper mantle beneath the CEUS including a high-velocity feature identified as a lithospheric drip in a recent regional P -wave tomography study. We calculate velocity and stress distributions from numerical models for instantaneous 3-D mantle flow. Our models are driven by the heterogeneous density distribution based on a temperature field converted from the tomography study. The temperature field is utilized in a composite rheology, assumed for the numerical models. We compute several geodynamic quantities with our numerical models: dynamic topography, rate of dynamic topography, gravitational potential energy (GPE), differential stress, and Coulomb stress. We find that the GPE, representative of the density anomalies in the lithosphere, is an important factor for understanding the seismicity of the CEUS. When only the upper mantle heterogeneities are included in a model, differential and Coulomb stress for the observed fault geometries in the CEUS seismic zones acts as a good indicator to predict the seismicity distribution. Our modelling results suggest that the upper mantle heterogeneities and structure below the CEUS have stress concentration effects and are likely to promote earthquake generation at preexisting faults in the region's seismic zones. Our results imply that the mantle flow due to the upper-mantle heterogeneities can cause stress perturbations, which could help explain the intraplate seismicity in this region. [ABSTRACT FROM AUTHOR]

Background: Individuals with OSA have elevated levels of inflammatory markers, but no prospective study has examined the role of inflammation in the development of OSA.Research Question: Is C-reactive protein (CRP) prospectively associated with risk of developing OSA?Study Design and Methods: We followed 1,882 women from the Nurses' Health Study (NHS) (2002-2012), 3,854 women from Nurses' Health Study II (NHSII) (1995-2013), 3,075 men from the Health Professionals Follow-up Study (HPFS) (1996-2012), and 1,919 women and men from the Multi-Ethnic Study of Atherosclerosis (MESA) (2000-2012) who did not have diagnosed OSA at baseline and for whom CRP levels were available. In NHS/NHSII/HPFS, physician-diagnosed OSA was self-reported. In MESA, at-home polysomnography was performed and OSA was identified as an apnea-hypopnea index ≥ 30. Logistic regression was used to estimate the OR for OSA risk according to baseline CRP level, adjusted for multiple inflammation-related factors.Results: After multivariable adjustment not including BMI, the pooled OR for OSA risk per doubling of baseline CRP level was 1.24 (95% CI, 1.18-1.30). Additional adjustment for BMI substantially attenuated the association (pooled OR, 1.07; 95% CI, 1.01-1.12). The fully adjusted association was consistently stronger in individuals < 55 vs ≥ 55 years of age (P interaction = .01), in individuals with BMI < 25 vs ≥ 25 kg/m2 (P interaction = .02), and in pre- vs postmenopausal women (P interaction = .002). CRP was more strongly associated with risk of OSA associated with excessive daytime sleepiness, high airway collapsibility, and low arousal threshold (P heterogeneity < .05).Interpretation: Higher CRP was prospectively associated with increased OSA risk, particularly among younger individuals, underweight/normal-weight individuals, or premenopausal women. The differential associations by OSA phenotype/endotype suggest possible mechanisms through which inflammation operates to modulate OSA risk. Given our reliance on a single CRP level measured a decade before OSA assessment, future studies with repeated CRP measurements are warranted to confirm these prospective associations. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has significantly affected utilization of preventative health care, including vaccines. We aimed to assess HPV vaccination rates during the pandemic, and conduct a simulation model-based analysis to estimate the impact of current coverage and future pandemic recovery scenarios on disease outcomes. The model population included females and males of all ages in the US. The model compares pre-COVID vaccine uptake to 3 reduced coverage scenarios with varying recovery speed. Vaccine coverage was obtained from Truven Marketscan™. Substantially reduced coverage between March-August 2020 was observed compared to 2018–2019. The model predicted that 130,853 to 213,926 additional cases of genital warts; 22,503 to 48,157 cases of CIN1; 48,682 to 110,192 cases of CIN2/3; and 2,882 to 6,487 cases of cervical cancer will occur over the next 100 years, compared to status quo. Providers should plan efforts to recover HPV vaccination and minimize potential long-term consequences. [ABSTRACT FROM AUTHOR]

The aim of this study was to estimate the trends and burdens associated with systemic therapy-related hospitalizations, using nationally representative data. National Inpatient Sample data from 2005 to 2016 was used to identify systemic therapy-related complications using ICD-9 and ICD-10 external causes-of-injury codes. The primary outcome was hospitalization rates, while secondary outcomes were cost and in-hospital mortality. Overall, there were 443,222,223 hospitalizations during the study period, of which 2,419,722 were due to complications of systemic therapy. The average annual percentage change of these hospitalizations was 8.1%, compared to − 0.5% for general hospitalizations. The three most common causes for hospitalization were anemia (12.8%), neutropenia (10.8%), and sepsis (7.8%). Hospitalization rates had the highest relative increases for sepsis (1.9-fold) and acute kidney injury (1.6-fold), and the highest relative decrease for dehydration (0.21-fold) and fever of unknown origin (0.35-fold). Complications with the highest total charges were anemia ($4.6 billion), neutropenia ($3.0 billion), and sepsis ($2.5 billion). The leading causes of in-hospital mortality associated with systemic therapy were sepsis (15.8%), pneumonia (7.6%), and acute kidney injury (7.0%). Promoting initiatives such as rule OP-35, improving access to and providing coordinated care, developing systems leading to early identification and management of symptoms, and expanding urgent care access, can decrease these hospitalizations and the burden they carry on the healthcare system. [ABSTRACT FROM AUTHOR]

Objectives: To examine the trends in hospitalization rates, mortality, and costs for sepsis during the years 2005 to 2014. Methods: This was a retrospective serial cross-sectional analysis of patients ≥18 years admitted for sepsis in National Inpatient Sample. Trends in sepsis hospitalizations were estimated, and age- and sex-adjusted rates were calculated for the years 2005 to 2014. Results: There were 541 694 sepsis admissions in 2005 and increased to 1 338 905 in 2014. Sepsis rates increased significantly from 1.2% to 2.7% during the years 2005 to 2014 (relative increase: 123.8%; Ptrend < .001). However, the relative increase changed by 105.8% (Ptrend < .001) after adjusting for age and sex and maintained significance. Although total cost of hospitalization due to sepsis increased significantly from US$22.2 to US$38.1 billion (Ptrend < .001), the mean hospitalization cost decreased significantly from US$46,470 to US$29,290 (Ptrend < .001). Conclusions: Hospitalizations for sepsis increased during the years 2005 to 2014. Our study paradoxically found declining rates of in-hospital mortality, length of stay, and mean hospitalization cost for sepsis. These findings could be due to biases introduced by International Classification of Diseases, Ninth Revision, Clinical Modification coding rules and increased readmission rates or alternatively due to increased awareness and surveillance and changing disposition status. Standardized epidemiologic registries should be developed to overcome these biases. [ABSTRACT FROM AUTHOR]

Most episodes of peritoneal dialysis (PD)-associated peritonitis are caused by skin-dwelling gram-positive bacteria and gram-negative bacteria colonizing gut and urinary tract. Occasionally, however, uncommon bacteria can cause peritonitis in PD patients. We describe a case of Ewingella americana peritonitis, the first such case reported from the United States. A 68-year-old woman with end-stage kidney disease due to hypertension was initiated on PD 2 years prior to the present event. She presented with abdominal pain associated with nausea and vomiting. She was afebrile and hemodynamically stable. Abdomen was diffusely tender with guarding and rebound. No obvious root cause was apparent. Initial PD fluid white count was 502/mm3 with 87% neutrophils. Gram stain was negative. Culture grew gram-negative rods, which were later identified as Ewingella americana, resistant to ampicillin and cefazolin but sensitive to gentamicin, ceftazidime, and cefepime. After empiric intraperitoneal vancomycin and gentamicin, she was continued on intraperitoneal gentamicin for a total period of 21 days. She responded to the treatment rapidly with complete recovery. PD fluid on day four showed 40 nucleated cells with 12% neutrophils. Patient remained on PD without consequences. Ewingella americana is a gram-negative facultative anaerobic bacillus that can survive in water, including domestic water. Inadequate hand hygiene is a potential root cause of infection. Although rare, Ewingella peritonitis can be observed in PD patients and is treatable. Clinicians should be aware of Ewingella as a potential cause of PD peritonitis. [ABSTRACT FROM AUTHOR]

Evidence on the implementation of health systems strengthening (HSS) interventions is scarce. Donors need this information to prioritise investments and lobby for continued financial support. To develop a deeper understanding of the implementation dynamics of robust HSS interventions, we retrospectively compared five USAID-supported projects in the Dominican Republic, Ethiopia, Kazakhstan, Rwanda, and Zambia. A document review and key informant interviews (n = 44) were conducted, coded, and analysed in each of the five cases using an integrated implementation framework. The framework was organised by four phases of implementation. For the pre-condition phase, data-driven HSS interventions were nested in a range of political contexts and with differing levels of financial support. In pre-implementation, cases relied on diverse teams that created a data-informed, inclusive, and transparent project ethos for implementation. Implementation was located at multiple tiers of the health system, used interventions as catalysts for government initiatives, supported governance/accountability initiatives, and responded nimbly to contextual changes in the implementation climate. There was less evidence of maintenance and evolution but all cases were designed with an eye towards sustainability. This research yields important insights about the dynamics of HSS, identifying ways donors can better support countries to achieve universal health coverage. [ABSTRACT FROM AUTHOR]

Inflammation is implicated in a wide range of disorders, and thought to be involved in most leading causes of death today in the United States with high associated costs. New insights into better understanding its etiology, detection and prevention are thus of major importance in health care. One emerging field providing such insights has been the identification of DAMPs, or damage-associated molecular patterns. We have studied DAMPs within the context of degraded and oxidized mitochondrial DNA and RNA ("DeMP"), most recently demonstrating potent mitochondrial RNA (mtRNA) immunogenic response in mouse macrophages. Here, we extend these studies to assess the proinflammatory role of mitochondrial control (native) and oxidized RNA using human RNA and cells. THP-1 macrophage mtRNA triggered a proinflammatory response (induction of IL-6 and TNFα) when transfected into the same cells. Modestly oxidized mtRNA (DeMP RNA) but not cytoplasmic RNA induced a similar response, in contrast to attenuated immunogenicity previously observed with more oxidized DeMP RNA. This DeMP RNA may also cause a mild prooxidant stress. The proinflammatory effects of mtRNA was significantly reduced following pretreatment with RNases specific for single and double stranded RNA, implicating these forms of mtRNA in proinflammatory response. The natural nucleic acid-encapsulating peptide LL-37 also triggered a proinflammatory effect in the presence of control mtRNA and DeMP RNA. Finally, human blood plasma RNA exhibits proinflammatory activity. These results provide new insights into the immunostimulation of mitochondrial RNA including its activity in human cells; identify human plasma RNA as proinflammatory; and provide further evidence that oxidized DeMP mtRNA acts as a sensitive and broad-spectrum sensor and regulator of mitochondrial oxidative stress. Image 1 • Human control and oxidized mitochondrial RNAs induce IL-6 and TNFα in human cells. • Induction depends upon both single- and double-stranded RNA. • The natural peptide LL-37 delivers a proinflammatory effect with mitochondrial RNAs. • Oxidized mitochondrial RNA appears to be a broad-spectrum sensor of oxidative stress. • Human plasma RNA induces proinflammatory cytokines. [ABSTRACT FROM AUTHOR]

Malignant fungating wounds present in 5–14% of advanced cancer patients in the United States and are a result of cancerous cells infiltrating and proliferating in the skin. Presentation of malignant fungating wounds often occurs in the last 6 months of life and therefore become symbols of impending death for patients and their families. Due to the incurable and severe nature of these wounds, patients require palliative care until death to minimize pain and suffering. Symptoms associated with these chronic wounds include malodor, pain, bleeding, necrosis, large amounts of exudate, increased microbial growth, and more. Limited research using culture-based techniques has been conducted on malignant fungating wounds and therefore no optimal approach to treating these wounds has been established. Despite limited data, associations between the cutaneous microbiome of these wounds and severity of symptoms have been made. The presence of at least one strain of obligate anaerobic bacteria is linked with severe odor and exudate. A concentration of over 105/g bacteria is linked with increased pain and exudate. Bacterial metabolites such as DMTS and putrescine are linked with components of malignant fungating wound odor and degradation of periwound skin. The few but significant associations made between the malignant fungating wound microbiome and severity of symptoms indicate that further study on this topic using 16S rRNA gene sequencing may reveal potential therapeutic targets within the microbiome to significantly improve current methods of treatment used in the palliative care approach. [ABSTRACT FROM AUTHOR]

Introduction: Peptic ulcer disease (PUD) is a rare condition in children. Perforated peptic ulcer (PPU), a complication of PUD has an estimated mortality between 1.3% and 20%. We evaluate incidence and outcomes of PPU in children using an administrative database, perform a review of the literature, and report our technique for laparoscopic omental patch repair for PPU in two pediatric patients.Materials and Methods: Kids' inpatient database (KID's) was analyzed for demographics, incidence, and outcomes. Incidence for each year was calculated based on the reported pediatric population in the United States for 2000, 2003, 2006, 2009, and 2012 by the U.S. Census Bureau. Additionally, we present two PPU cases, accompanied by a comprehensive review of the literature.Results: The annual number of primary discharge diagnosis of PPU in the KID was 178 cases for 2000, 252 for 2003, 255 for 2006, 299 for 2009, and 266 for 2012. An increase trend over time was noted between 2000 and 2009; however, it was not statistically significant (0.05). PPU appears to be more common in Caucasian teenage boys. The mean length of stay was 8.02 days and with a statistically significant increase in healthcare charges ($33,187 versus $78,142, P = .002) when comparing year 2000-2012.Discussion: PPU is a rare cause of abdominal pain in children, but still a PUD complication that requires surgery. PPU should be included in the differential diagnosis in patients presenting with acute abdominal pain of uncertain etiology and pneumoperitoneum. Laparoscopy is both diagnostic and therapeutic. Laparoscopic omental patch repair is a safe and effective treatment for PPUs. [ABSTRACT FROM AUTHOR]

Research concerning psychiatric issues relating to opioid drugs currently focuses primarily on their role in reinforcing addictive behaviors, given the recent proliferation of lethal abuse of illicit opiates in the United States and around the world. In contrast, this article will review the mechanism of action of opioids in affective disorders and the available evidence and potential for their use, especially in the treatment of resistant major depression. Buprenorphine is the opioid derivative of special interest; we review this and other opioid derivatives, highlighting the growing role of opioids in treating depressive illnesses and other related psychopathologies. [ABSTRACT FROM AUTHOR]

Individuals with disabilities increasingly live at home. This study focuses on experiences of adult siblings (aged 18 years and older) in the United States who have a brother or sister with an intellectual/developmental disability. It is based on qualitative survey data (n = 224). We coded narratives of siblings’ experiences and identified themes, correlating themes with demographic characteristics. The major finding was that narratives of the youngest age group (aged 18-25 years) had the highest number of direct care codes. This group of siblings also had the highest number of codes indicating that their lives were enhanced by their brother or sister. To account for this, we utilize the mutual exchange theory of care from sociology and a social model of disability. As a result, we suggest a richer theoretical understanding of care and disability that can capture these nuances, and comment on some of the historical tensions between disability studies and caregiving. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common cancer in women. Disparities in some characteristics of breast cancer patients and their survival data for six randomly selected states in the US were examined.Materials and Methods: A probability random sampling method was used to select the records of 2,000 patients from each of six randomly selected states. Demographic and disease characteristics were extracted from the Surveillance Epidemiology and End Results (SEER) database. To evaluate relationships between variables, we employed a Cox Proportional Regression to compare survival times in the different states.Results: Iowa had the highest mean age of diagnosis at 64.14 years (SE = 0.324) and Georgia had the lowest at 57.97 years (SE = 0.313). New Mexico had the longest mean survival time of 189.09 months (SE = 20.414) and Hawaii the shortest at 119.01 (SE = 5.394) months, a 70.08-month difference (5.84 years). Analysis of stage of diagnosis showed that the highest survival times for Whites and American Indians/Alaska Natives were for stage I cancers. The highest survival times for Blacks varied. Stage IV cancer consistently showed the lowest survival times.Conclusions: Differences in breast cancer characteristics across states highlight the need to understand differences between the states that result in variances in breast cancer survival. [ABSTRACT FROM AUTHOR]

Prior research has not verified the theoretical or practical value of slice-of-life and slice-of-death advertising appeals in relation to advertising and branding constructs like advertising polysemy and consumer-based brand equity. The authors make conceptual, measurement, and managerial contributions to this research issue dealing with slice of life versus death advertising appeals. Across three studies, the authors measure, evaluate, compare, and contrast slice-of-life and slice-of-death (SOL/D) advertising appeals across British and American cultures. The authors demonstrate the interrelationships of SOL/D appeals with advertising polysemy, consumer-based brand equity, cultural differences in advertising attitudes, and purchase intentions. From a measurement perspective, the authors develop and validate parsimonious measures of slice-of-life and slice-of-death (SOL/D) advertising appeals. Furthermore, they test the assumptions that underlie these appeals for United States and British customers, and investigate how the cultural characteristic of uncertainty avoidance moderates the impact of SOL/D advertising attitudes on purchase intentions. Managerially, the research demonstrates that SOL/D appeals offer value in predicting (a) consumer-based brand equity through advertising polysemy, (b) consumers’ advertising attitudes across different cultures, (c) consumers’ intentions to purchase, and (d) advertising differences and varying consumer responses in the United States and Britain. [ABSTRACT FROM PUBLISHER]

Objective: To determine whether European Americans with polycystic ovary syndrome (PCOS) exhibit genetic differences associated with PCOS status and phenotypic features.Design: Case-control association study in European Americans.Setting: Academic center.Subject(s): Women with PCOS diagnosed with the use of the National Institutes of Health criteria (n = 532) and control women with regular menstrual cycles and no evidence of hyperandrogenism (n = 432).Intervention(s): Blood was drawn for measurement of sex steroids, metabolic parameters, and genotyping.Main Outcome Measure(s): Associations among PCOS status, phenotype, and genetic background identified with the use of principal component analysis.Result(s): Principal component analysis identified five principal components (PCs). PC1 captured northwest-to-southeast European genetic variation and was associated with PCOS status. Acanthosis was associated with southern European ancestry, and larger waist:hip ratio was associated with northern European ancestry. PC2 was associated with east-to-west European genetic variation and cholesterol levels.Conclusion(s): These data provide evidence for genetic influence based on European ethnicity in women with PCOS. There is also evidence for a genetic component in the phenotypic features of PCOS within a mixed European population. The data point to the need to control for population stratification in genetic studies in women of mixed European ethnicity. They also emphasize the need for better studies of PCOS prevalence and phenotype as a function of genetic background. [ABSTRACT FROM AUTHOR]

A recent report from the Center for Disease Control identified melanoma as being among the highest causes of cancer-related mortalities in the USA. While interventions such as checkpoint blockade have made substantial impact in terms of improving response rates and overall survival, a significant number of patients fail to respond to treatment or become resistant to therapy. A better understanding of the tumor microenvironment in these patients becomes imperative for identifying immune suppressive mechanisms that impact the development of effective anti-tumor immune responses. We have investigated innate immune cells (dendritic cells, NK cells) in the tumor microenvironment (TME) in order to devise effective targeted anticancer immune therapies. We find that matrix metalloproteinase-2 (MMP-2), secreted from melanoma cells and stromal cells, cleaves IFNAR1 and stimulates TLR-2 on dendritic cells (DC) within the TME. Both these events independently culminate in programing the DCs to promote pro-tumorigenic T2 T cell differentiation. In addition, we have shown that NK cells become functionally exhausted in melanoma patients. We identified the expression of Tim-3 as one of the factors responsible for NK cell exhaustion and showed that anti-Tim3 antibodies partially reversed this exhaustion. We have initiated local intervention strategies such as intra-tumoral administration of DC activating Poly-ICLC and compared the efficacy of different TLR agonists and melanoma antigens for use as combination tumor vaccine in clinical trials. Such approaches will provide a unique insight into tumor biology and will facilitate in development of highly effective and cell type-specific immune therapies. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the second most common cancer among women resulting in nearly 500,000 cases annually. Screening leads to better treatment and survival time. However, human papillomavirus (HPV) exposure, screening, and treatment vary among races and ethnicities in the United States. The purpose of this study is to examine disparities in characteristics of cervical cancer and survival of cases between White Hispanic (WH) and White non-Hispanic (WNH) women in the United States. Methods: We used a stratified random sampling method to select cervical cancer patient records from nine states; a simple random sampling method to extract the demographic and disease characteristics data within states from the Surveillance Epidemiology and End Results (SEER) database. We used statistical probability distribution methods for discrete and continuous data. The chi-square test and independent samples t-test were used to evaluate statistically significant differences. Furthermore, the Cox Proportional Regression and the Kaplan-Meier survival estimators were used to compare WH and WNH population survival times in the United States. Results: The samples of WNH and WH women included 4,000 cervical cancer cases from 1973-2009. There were statistically significant differences between ethnicities: marital status ( p < 0.001); primary site of cancer ( p < 0.001); lymph node involvement ( p < 0.001); grading and differentiation ( p < 0.0001); and tumor behavior ( p < 0.001). The mean age of diagnosis for both groups showed no statistical differences. However, the mean survival time for WNH was 221.7 (standard deviation [SD] = 118.1) months and for WH was 190.3 (SD = 120.3), which differed significantly ( p < 0.001). Conclusions: Clear disparities exist in risk factors, cervical cancer characteristics, and survival time between WH and WNH women. [ABSTRACT FROM AUTHOR]

Background: Higher exposure to certain phthalates is associated with a diabetes and insulin resistance, with sex differences seen. Yet, little is known about the association between phthalates and metabolic syndrome (MetS), particularly with consideration for differences by sex and menopausal status.Methods: We analyzed data from 2719 participants in the National Health and Nutrition Examination Survey (NHANES) 2001-2010 aged 20-80 years. Five urinary phthalate metabolites (MEP, MnBP, MiBP, MBzP, and MCPP) and DEHP metabolites were analyzed by the Centers for Disease Control and Prevention and were evaluated as population-specific quartiles. MetS was defined by National Cholesterol Education Program's Adult Treatment Panel III report criteria. Prevalence odds ratios (POR) and 95 % confidence intervals (CI) were calculated using multivariable logistic regression, adjusting for potential confounders and stratifying by sex and menopausal status.Results: Participants with MetS (32 % of the study population) had higher concentrations for all urinary phthalate metabolites. After full adjustment, higher DEHP metabolite concentrations were associated with an increased odds of MetS in men, but not women (adj. POR for men Q4 versus Q1: 2.20; 95 % CI: 1.32, 3.68 and adj. POR for women Q4 versus Q1: 1.50; 95 % CI: 0.89, 2.52). When evaluating by menopausal status, pre-menopausal women with higher concentrations of MBzP had close to a 4-fold increased odds of MetS compared to pre-menopausal women with the lowest concentrations of MBzP (adj POR: Q4 versus Q1: 3.88; 95 % CI: 1.59, 9.49).Conclusions: Higher concentrations of certain phthalate metabolites were associated with an increased odds of MetS. Higher DEHP metabolite concentrations were associated with an increased odds of MetS for men. In women, the strongest association was between higher concentrations of MBzP and MetS, but only among pre-menopausal women. [ABSTRACT FROM AUTHOR]

Background and Aim: The American Association for the Study of Liver Disease (AASLD) recommends screening for esophageal varices (EV) by esophagoduodenoscopy (EGD) in patients with cirrhosis to guide decisions regarding primary prophylaxis for EV hemorrhage. We aimed to identify patient and facility factors associated with EV screening in veterans with hepatitis C (HCV)-associated cirrhosis.Methods: This was a population-based cohort study. Veterans with HCV and newly diagnosed cirrhosis between 1/1/2004 and 12/31/2005 and followed until 12/31/2011 were included. The primary outcome was receipt of EGD within 1 year of cirrhosis diagnosis. Patient- and facility-level factors associated with EV screening were determined.Results: A total of 4230 patients with HCV cirrhosis were identified. During median follow-up of 6.1 years (IQR: 4.0-8.0), 21.5 % developed a decompensating event, and 38.3 % died. Fifty-four percent received an EGD, and 33.8 % had an EGD within guidelines. Median time from cirrhosis diagnosis to EGD was 72 days (IQR: 12-176). Factors independently associated with receipt of EV screening were a decompensation event (OR 1.16, CI 1.01-1.32) and gastroenterology/hepatology clinic access (OR 2.1, CI 1.73-2.46), whereas cardiovascular (OR 0.81, CI 0.69-0.95), mental health (OR 0.79, CI 0.68-0.91), and respiratory (OR 0.85, CI 0.72-0.99) comorbidities were associated with reduced likelihood of EV screening.Conclusion: EV screening per AASLD guidelines occurs in only one-third of patients. This missed opportunity was strongly associated with access to gastroenterology/hepatology specialty care. Additionally, providers may be relying on clinical cues (i.e., decompensation) to prompt referral for endoscopy suggesting education to improve compliance with guidelines is needed. [ABSTRACT FROM AUTHOR]

Background: Endoscopic therapy is considered first line for management of benign biliary strictures (BBSs). Placement of plastic stents has been effective but limited by their short-term patency and need for repeated procedures. Fully covered self-expandable metallic stents (FCSEMSs) offer longer-lasting biliary drainage without the need for frequent exchanges.Aims: The aim of this study was to assess the efficacy and safety of FCSEMS in patients with BBS.Methods: A retrospective review of all patients who underwent ERCP and FCSEMS placement at five tertiary referral US hospitals was performed. Stricture resolution and adverse events related to ERCP and/or stenting were recorded.Results: A total of 123 patients underwent FCSEMS placement for BBS and 112 underwent a subsequent follow-up ERCP. The mean age was 62 years (±15.6), and 57% were males. Stricture resolution occurred in 81% of patients after a mean of 1.2 stenting procedures (mean stent dwell time 24.4 ± 2.3 weeks), with a mean follow-up of 18.5 months. Stricture recurrence occurred in 5 patients, and 3 patients required surgery for treatment of refractory strictures. Stent migration (9.7%) was the most common complication, followed by stent occlusion (4.9%), cholangitis (4.1%), and pancreatitis (3.3%). There was one case of stent fracture during removal, and one stent could not be removed. There was one death due to cholangitis.Conclusions: Majority of BBS can be successfully managed with 1-2 consecutive FCSEMS with stent dwell time of 6 months. [ABSTRACT FROM AUTHOR]