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Fetal neurology is a rapidly evolving field. Consultations aim to diagnose, prognosticate, and coordinate prenatal and perinatal management along with other specialists and counsel expectant parents. Practice parameters and guidelines are limited. A 48-question online survey was administered to child neurologists. Questions targeted current care practices and perceived priorities for the field. Representatives from 43 institutions in the United States responded; 83% had prenatal diagnosis centers, and the majority performed on-site neuroimaging. The earliest gestational age for fetal magnetic resonance imaging was variable. Annual consultations ranged from <20 to >100 patients. Fewer than half (n = 17.40%) were subspecialty trained. Most respondents (n = 39.91%) were interested in participating in a collaborative registry and educational initiatives. The survey highlights heterogeneity in clinical practice. Large multisite and multidisciplinary collaborations are essential to gather data that inform outcomes for fetuses evaluated across institutions through registries as well as creation of guidelines and educational material. [ABSTRACT FROM AUTHOR]

The article discusses the specialization of Aedes aegypti mosquitoes in feeding on humans as opposed to other vertebrate animals. It explores how changes in climate, urbanization, and historical events like the African slave trade have influenced the mosquito's preference for humans, increasing the risk of diseases like yellow fever, dengue, chikungunya, and Zika virus in urban areas of Africa and beyond.

Lyme disease is the most common vector-borne infectious disease in the United States. Post-treatment Lyme disease (PTLD) is a condition affecting 10–20% of patients in which symptoms persist despite antibiotic treatment. Cognitive complaints are common among those with PTLD, suggesting that brain changes are associated with the course of the illness. However, there has been a paucity of evidence to explain the cognitive difficulties expressed by patients with PTLD. This study administered a working memory task to a carefully screened group of 12 patients with well-characterized PTLD and 18 healthy controls while undergoing functional MRI (fMRI). A subset of 12 controls and all 12 PTLD participants also received diffusion tensor imaging (DTI) to measure white matter integrity. Clinical variables were also assessed and correlated with these multimodal MRI findings. On the working memory task, the patients with PTLD responded more slowly, but no less accurately, than did controls. FMRI activations were observed in expected regions by the controls, and to a lesser extent, by the PTLD participants. The PTLD group also hypoactivated several regions relevant to the task. Conversely, novel regions were activated by the PTLD group that were not observed in controls, suggesting a compensatory mechanism. Notably, three activations were located in white matter of the frontal lobe. DTI measures applied to these three regions of interest revealed that higher axial diffusivity correlated with fewer cognitive and neurological symptoms. Whole-brain DTI analyses revealed several frontal lobe regions in which higher axial diffusivity in the patients with PTLD correlated with longer duration of illness. Together, these results show that the brain is altered by PTLD, involving changes to white matter within the frontal lobe. Higher axial diffusivity may reflect white matter repair and healing over time, rather than pathology, and cognition appears to be dynamically affected throughout this repair process. [ABSTRACT FROM AUTHOR]

Objectives: Colorectal cancer (CRC) is the third most prevalent type of cancer in the United States. The treatment options for cancer include surgery, chemotherapy, radiation, and/or targeted therapy, which show significant improvement in overall survival. Among the various available treatments, antagonizing VEGF/VEGFR-2 pathways have shown effectiveness in limiting colorectal cancer growth and improving clinical outcomes. In this regard, we hypothesized that F16, a novel VEGFR-2 inhibitor, would control colorectal cancer growth by blocking the VEGFR-2 singling pathway in both in vitro and in vivo conditions. Therefore, the current study was aimed to analyze the efficacy of F16 on the growth of Colo 320DM cells under in vitro and in vivo conditions. Results: Human RT2 profiler PCR array analysis results clearly showed that angiogenesis and anti-apoptosis-related gene expressions were significantly reduced in HUVEC cells after F16 (5 μM) treatment. In addition, Western blot results revealed that F16 attenuated the downstream signaling of the VEGFR-2 pathway in HUVEC cells by up-regulating the p53 and p21 levels and down-regulating the p-AKT and p-FAK levels. Accordingly, F16 confirmed potent cytotoxic effects against the cell viability of Colo 320DM tumors, with an IC50 value of 9.52 ± 1.49 µM. Furthermore, treatment of mice implanted with Colo 320DM xenograft tumors showed a significant reduction in tumor growth and increases in survival rate compared to controls. Immunohistochemistry analysis of tumor tissues showed a reduction in CD31 levels also in F16 treated groups. Conclusions: These results justify further evaluation of F16 as a potential new therapeutic agent for treating colorectal cancers. [ABSTRACT FROM AUTHOR]

In the United States, chronic viral hepatitis B and C (CHB and CHC), nonalcoholic fatty liver disease (NAFLD), and alcohol‐related liver disease (ALD) are the main causes of liver deaths attributable to hepatocellular carcinoma (HCC) and cirrhosis. Our aim was to assess the changes in the rates of mortality and years of potential life lost (YLL) for HCC and cirrhosis due to different liver diseases. We used multiple‐cause mortality data (2007‐2017) from the National Center for Health Statistics. Annual percentage change (APC) in age‐standardized death rate per 100,000 (ASDR) and age‐standardized years of life lost per 100,000 (ASYLLR) were calculated. In the United States in 2017, there were 2,797,265 deaths with 73,424 liver deaths, contributing to 1,467,742 of YLL. Of the liver deaths, HCC was noted in 12,169 (16.6%) and cirrhosis in 60,111 (82.0%). CHC was responsible for 50.4% of HCC deaths; NAFLD, 35.4%; HBV, 6.0%; ALD, 5.4%; and others, 2.8%. NAFLD was responsible for 48.9% of cirrhosis deaths; ALD, 34.7%; CHC, 12.3%; CHB, 0.9%; and others, 3.2%. Between 2007 and 2017, the increase in ASDR for HCC due to ALD and NAFLD accelerated after 2014 (APC, 11.38% and 6.55%, respectively) whereas CHC stabilized (APC, 0.63%; P = 0.272) after 2011. The increase in ASYLLR of HCC escalated after 2014 for ALD and NAFLD (APC, 12.12% and 6.15%, respectively) and leveled out for CHC after 2012 (APC, −1.05%; P = 0.056). Furthermore, the highest annual increase in ASDR and ASYLLR for cirrhosis was due to ALD (APC, 3.24% and 3.34%, respectively) followed by NAFLD (APC, 1.23% and 0.49%, respectively). Conclusion: Over the past decade, ASDR and ASYLLR due to ALD and NAFLD have been increasing in the United States. The rising burden of HCC and cirrhosis are primarily driven by NAFLD and ALD. [ABSTRACT FROM AUTHOR]

The authors assess how and why retailer-customized coupon campaigns affect customer purchases. The conceptual model proposes effects on trip incidence and revenues through the mere exposure to campaigns (exposure effect) and the redemption of coupons (redemption effect). The authors propose monetary savings of the coupons, regularity of the campaigns, and coupon fit with customer preferences as moderators. Analysis of data from a group of regional grocery chains that were part of a quasi experiment demonstrates that retailer-customized coupon campaigns have a positive exposure and redemption effect on customer purchases. Mere exposure to customized coupon campaigns contributes more than coupon redemption to campaign returns. Consistent with theoretical expectations, customized coupon campaigns are more effective if they provide more discounts, are unexpected, and are positioned as specially selected for and customized to consumer preferences. The substantial exposure effects suggest that managers should look beyond redemption rates and also consider sales lift from nonredeemers when measuring the effectiveness of customized coupon campaigns. [ABSTRACT FROM AUTHOR]

Access to near-real time opioid use data is essential to the effective management of the U.S. opioid crisis. Current narcotic data collection methods are limited by time delay and would be complimented by a rapid data acquisition technique. Use of wastewater-based epidemiology (WBE) analysis may offer access to near real-time data on opioid consumption but application in the United States has been limited. From 2015 to 2017, monthly 24-h time-weighted composite samples of municipal raw wastewater from two Midwestern U.S. cities were routinely analyzed using liquid chromatography-tandem mass spectrometry for morphine, codeine, oxycodone, heroin, fentanyl, and select opioid metabolites. Concentrations of opioids (ng/L) in raw wastewater from City 1 and 2, respectively, were: morphine (713 ± 38; 306 ± 29; detection frequency (DF): 100%), oxycodone (17.8 ± 1.1; 78 ± 6; DF: 100%), codeine (332 ± 37; 100 ± 27; DF: 93%), heroin (41 ± 16; 9 ± 11; DF: 81%), and fentanyl (1.7 ± 0.2; 1.0 ± 0.5; DF: 62%). Average opioid consumption rates estimated using WBE ranged between 9 and 2590 mg/day/1000 persons. Anticipated overdoses and overdose-deaths calculated from analyte concentrations in wastewater forecasted 200 opioid-related overdoses/year and 39 opioid related overdose-deaths/year across the two cities during the year 2016, which aligned well with observed coroner-reported opioid deaths. This long-term U.S. screening study of opioids in wastewater was the first to utilize wastewater epidemiological data to estimate the number of expected overdose and overdose-deaths, and to identify detectable levels of the powerful synthetic opioid fentanyl in community wastewater consistently over the course of one whole year. Image 1 • Highlights (85 characters per bullet): • Two-year WBE study of opioid use in the American Midwest. • Analysis of cities with known and identified opioid abuse problems. • First estimation of overdoses and deaths from WBE data. • First routine detection of fentanyl and norfentanyl in U.S. wastewater. [ABSTRACT FROM AUTHOR]

Background: Data on cyclic vomiting syndrome (CVS) are limited to studies from tertiary care centers. There is a paucity of information about CVS on a national scale.Aim: To study the clinical characteristics, comorbidities, and hospital outcomes in patients hospitalized with CVS using a nationwide database.Methods: We identified all hospitalizations associated with a primary diagnosis of CVS in 2010 and 2011 using the Nationwide Inpatient Sample with an age category of 18-55 years. A 1:2 random sample of non-CVS hospitalizations with the same age category was obtained, and comparisons between groups were made. Multivariate logistic regression analysis was used to determine comorbidities independently associated with CVS.Results: Our study included 20,952 CVS and 44,262 non-CVS patients. CVS patients tended to be younger, male, and white compared to non-CVS patients. On multivariate analysis, CVS was significantly associated with comorbidities including dysautonomia, migraine, anxiety, marijuana use, irritable bowel syndrome, gastroparesis, gastroesophageal reflux disease, asthma, cigarette smoking, and hypertension. CVS patients underwent esophagogastroduodenoscopy, colonoscopy, and gastric emptying tests more frequently. They had more favorable hospital outcomes like more routine discharges (discharge to home/self-care), lower mortality, and shorter length of stay but tended to leave against medical advice more frequently. CVS patients incurred total hospital charges of about $400 million over the 2 years.Conclusions: Our study showed that CVS is associated with several comorbidities and incurred substantial health care costs despite benign outcomes. Efforts to optimize therapy of CVS, manage comorbid conditions and reduce healthcare utilization are warranted. [ABSTRACT FROM AUTHOR]

Background and purpose Ethnicity-related differences in the incidence of acute disseminated encephalomyelitis ( ADEM) and other demyelinating diseases including multiple sclerosis and neuromyelitis optica spectrum disorders have been reported. Little is reported on the influence of ethnicity and geographical location in ADEM. Methods Medical records of patients who presented with ADEM ( ICD-9 323.61 and 323.81) at large referral hospitals in China, Singapore and Japan (years 1992-2015) were retrospectively reviewed and data were collected in a centralized database. Presenting features and outcomes of ADEM were compared between this multi-country Asian cohort and a uniformly collected US cohort using risk differences and risk ratios. Both cohorts were standardized to a 35% pediatric population to facilitate the comparison. Results There were 83 Asian patients (48 male, 16 pediatric) followed for a median of 2 (25th-75th percentile 1-10) months. Asian patients exhibited a 26% higher prevalence of spinal cord involvement on magnetic resonance imaging [95% confidence interval (CI) 0-52%; P = 0.05; 63% vs. 37%], a 39% lower prevalence of preceding events (95% CI 12-65%; P < 0.01; 33% vs. 72%) and a 23% lower prevalence of corpus callosum involvement (95% CI 7-39%; P < 0.01; 8% vs. 31%). No difference was observed between the two cohorts in the probability of relapse over the first year after disease onset. Conclusions It is hypothesized that the high proportion of Asian patients with spinal cord lesions relates to genetic vulnerability or the higher incidence of neuromyelitis optica spectrum disorders in Asia or could be a spurious association. ADEM presentations most probably vary across geographical settings or ethnicities. [ABSTRACT FROM AUTHOR]

Background Chronic HCV infection is often considered a contraindication for receiving a heart transplantation. Methods From the Scientific Registry of Transplant Recipients, we selected all adults with and without HCV infection who underwent a single-organ heart transplantation in 1995-2013; the mortality status was updated in September 2015. Results A total of 32 812 heart transplant recipients were included; N=756 (2.30%) HCV positive. Post-transplant patients were discharged alive at similar rates regardless of their HCV status ( P=.10). Despite this, mortality in HCV+ heart transplant recipients was consistently higher throughout post-discharge follow-up ( P<.002). In multivariate survival analysis, being HCV+ was independently associated with a higher post-transplant mortality: adjusted hazard ratio 1.35 (1.16-1.56), P<.0001. Other predictors of lower post-transplant survival included being obese at transplant and pre-transplant history of comorbidities (type 2 diabetes, COPD, hypertension) (all P<.05). No association of HCV infection with graft loss rates or time to graft loss was found (all P>.23). Conclusion Chronic hepatitis C infection is associated with a significantly increased post-transplant mortality in heart transplant recipients. The introduction of new direct-acting antiviral agents may provide a treatment option for HCV pre- or post-heart transplantation which could have a positive impact on patients' survival. [ABSTRACT FROM AUTHOR]

Do consumers boycott in response to international conflict? We showthat during the 2003 U.S.-France dispute over the IraqWar, the market share of French-sounding, U.S. supermarket brands declined. The dispute was a negative shock to U.S. consumers' associations with France. Frenchsounding brands, which consumers perceive to be French imports but are not, allow us to isolate the dispute's effect on economic behavior, as these brands' only link to France is through consumers' associations. Our estimates, derived from a nationwide sample of weekly supermarket sales for over 8,000 brands, are robust to a variety of alternate explanations.We also show that supermarkets with a higher proportion of customers who are U.S. citizens (i.e., who more strongly identify with the U.S. national identity) exhibited sharper boycotts. [ABSTRACT FROM AUTHOR]

Cyclic vomiting syndrome (CVS) is a chronic disorder of gut-brain interaction characterized by recurrent disabling episodes of nausea, vomiting, and abdominal pain. CVS affects both children and adults with a prevalence of approximately 2% in the United States. CVS is more common in female individuals and affects all races. The pathophysiology of CVS is unknown and a combination of genetic, environmental, autonomic, and neurohormonal factors is believed to play a role. CVS is also closely associated with migraine headaches and likely have a shared pathophysiology. The diagnosis of CVS is based on the Rome criteria, andminimal recommended testing includes anupper endoscopy andimaging studies of the abdomen.CVSis frequently associated with anxiety, depression, and autonomic dysfunction. Patients with CVS commonly use cannabis therapeutically for symptom relief. By contrast, cannabinoid hyperemesis syndrome is believed to be a subset of CVS with chronic heavy cannabis use leading to hyperemesis. Due to the recalcitrant nature of the illness, patients often visit the emergency department and are hospitalized for acute CVS flares. Guidelines on themanagement of CVS recommend a biopsychosocial approach. Prophylactic therapy consists of tricyclic antidepressants (amitriptyline), antiepileptics (topiramate), and aprepitant in refractory patients. Abortive therapy consists of triptans, antiemetics (ondansetron), and sedation. Treatment of comorbid conditions is extremely important to improve overall patient outcomes. CVS has a significant negative impact on patients, families, and the healthcare system, and future research to understand its pathophysiology and develop targeted therapies is needed. [ABSTRACT FROM AUTHOR]

Background: Encephalitis rates by etiology and acute-phase outcomes for encephalitis in the 21st century are largely unknown. We sought to evaluate cause-specific rates of encephalitis hospitalizations and predictors of inpatient mortality in the United States. Methods: Using the Nationwide Inpatient Sample (NIS) from 2000 to 2010, a retrospective observational study of 238,567 patients (mean [SD] age, 44.8 [24.0] years) hospitalized within non-federal, acute care hospitals in the U.S. with a diagnosis of encephalitis was conducted. Hospitalization rates were calculated using population-level estimates of disease from the NIS and population estimates from the United States Census Bureau. Adjusted odds of mortality were calculated for patients included in the study. Results: In the U.S. from 2000–2010, there were 7.3±0.2 encephalitis hospitalizations per 100,000 population (95% CI: 7.1–7.6). Encephalitis hospitalization rates were highest among females (7.6±0.2 per 100,000) and those <1 year and >65 years of age with rates of 13.5±0.9 and 14.1±0.4 per 100,000, respectively. Etiology was unknown for approximately 50% of cases. Among patients with identified etiology, viral causes were most common (48.2%), followed by Other Specified causes (32.5%), which included predominantly autoimmune conditions. The most common infectious agents were herpes simplex virus, toxoplasma, and West Nile virus. Comorbid HIV infection was present in 7.7% of hospitalizations. Average length of stay was 11.2 days with mortality of 5.6%. In regression analysis, patients with comorbid HIV/AIDS or cancer had increased odds of mortality (odds ratio [OR]  = 1.70; 95% CI: 1.30–2.22 and OR = 2.26; 95% CI: 1.88–2.71, respectively). Enteroviral, postinfectious, toxic, and Other Specified causes were associated with lower odds vs. herpes simplex encephalitis. Conclusions: While encephalitis and encephalitis-related mortality impose a considerable burden in the U.S. in the 21st Century, the reported demographics of hospitalized encephalitis patients may be changing. [ABSTRACT FROM AUTHOR]

‘Candidatus Liberibacter solanacearum’ (Lso) is a bacterium that infects solanaceous crops and causes plant decline and yield losses, especially in potato and tomato. Lso is transmitted to these hosts by the potato psyllid ( Bactericera cockerelli Sulc) vector. B. cockerelli host plants are not limited to crop plants, but also include many wild, solanaceous weeds. These wild hosts could potentially impact overwintering and breeding of the psyllids and serve as reservoirs for Lso. In the Pacific Northwestern United States, B. cockerelli was recently reported to overwinter on bittersweet nightshade ( Solanum dulcamara L.). The present study utilized high resolution melting analysis of the B. cockerelli mitochondrial cytochrome c oxidase I gene to assess the psyllid populations occurring on S. dulcamara during the summer and winter months in Washington, Oregon, and Idaho. This technique has previously been used to analyze the cytochrome c oxidase I gene of B. cockerelli, and has identified four psyllid haplotypes. Lso infection was also determined for the psyllids collected from S. dulcamara. During both the summer and the winter months in the Pacific Northwest, the Northwestern psyllid haplotype was the predominant population found living on S. dulcamara. However, low levels of the Western psyllid population were also present in Washington and Oregon during the same period. No overwintering psyllids tested were Lso-infected, suggesting that these populations do not pose an imminent threat of Lso transmission to newly emerging potatoes and other solanaceous crops in the region, unless a source of Lso becomes available. [ABSTRACT FROM AUTHOR]

Background Hepatocellular carcinoma ( HCC) is an important complication of cirrhosis. Our aim was to assess the inpatient economic and mortality of HCC in the USA Methods Five cycles of Nationwide Inpatient Sample ( NIS) conducted from 2005 to 2009 were used. Demographics, inpatient mortality, severity of illness, payer type, length of stay (LoS) and charges were available. Changes and associated factors related to inpatient HCC were assessed using simple linear regression. Odds ratios and 95% CIs for hospital mortality were analysed using log-linked regression model. To estimate the sampling variances for complex survey data, we used Taylor series approach. SAS® v.9.3 was used for statistical analysis. Results From 2005 to 2009, 32,697,993 inpatient cases were reported to NIS. During these 5 years, primary diagnosis of HCC increased from 4401 (2005), 4170 (2006), 5065 (2007), 6540 (2008) to 6364 (2009). HCC as any diagnosis increased from 68 per 100 000 discharges (2005) to 99 per 100 000 (2009). However, inpatient mortality associated with HCC decreased from 12% (2005) to 10% (2009) ( P < 0.046) and LoS remained stable. However, median inflation-adjusted charges at the time of discharge increased from $29,466 per case (2005) to $31,656 per case (2009). Total national HCC charges rose from $1.0 billion (2005) to $2.0 billion (2009). In multivariate analysis, hospital characteristic was independently associated with decreasing in-hospital mortality (all P < 0.05). Liver transplantation for HCC was the main contributor to high inpatient charges. Longer LoS and other procedures also contributed to higher inpatient charges. Conclusions There is an increase in the number of inpatient cases of HCC. Although inpatient mortality is decreasing and the LoS is stable, the inpatient charges associated with HCC continue to increase. [ABSTRACT FROM AUTHOR]

Highlights: [•] First study to report nationwide occurrence and concentrations of perfluoroalkyl substances (PFAS) in U.S. biosolids. [•] Ten out of thirteen PFAS analyzed were consistently detected in all biosolids samples. [•] PFOS was the most abundant PFAS in biosolids, followed by PFOA. [•] Mean load of ∑PFASs in U.S. biosolids was estimated at 2749–3450kg/year. [•] PFASs in biosolids show no significant difference between pre- and post-phase out period. [ABSTRACT FROM AUTHOR]

Abstract: We determined the first nationwide inventories of alkylphenol surfactants in U.S. sewage sludges (SS) using samples from the U.S. Environmental Protection Agency''s 2001 national SS survey. Additionally, analysis of archived 3-year outdoor mesocosm samples served to determine chemical fates in SS-amended soil. Nonylphenol (NP) was the most abundant analyte (534 ± 192 mg/kg) in SS composites, followed by its mono- and di-ethoxylates (62.1 ± 28 and 59.5 ± 52 mg/kg, respectively). The mean annual load of NP and its ethoxylates in SS was estimated at 2408–7149 metric tonnes, of which 1204–4289 is applied on U.S. land. NP compounds showed observable loss from SS/soil mixtures (1:2), with mean half-lives ranging from 301 to 495 days. Surfactant levels in U.S. SS ten-times in excess of European regulations, substantial releases to U.S. soils, and prolonged half-lives found under field conditions, all argue for the U.S. to follow Europe''s move from 20 years ago to regulate these chemicals. [Copyright &y& Elsevier]

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This article presents three novel concepts for energy harvesting and scavenging, demonstrating the outcome effectiveness of a program for energy harvesting at New Mexico State University. The design concepts cover a wide range of harvested power outputs from microwatts to kilowatts and illustrate a sampling of the breadth of potential energy harvesting and scavenging capabilities needed to create sustainable environments. The concepts have wide-ranging applications and demonstrate how off-the-shelf components can be integrated into reliable, cost-effective, and environmentally benign implementations for meeting essential energy needs of human society. The outcome clearly demonstrates the value of an experiment-based approach to train graduate and undergraduate students in conceiving, designing, building, testing, validating, and evaluating environmentally benign systems for harvesting and scavenging energy from ambient energy sources that can lead to sustainability. [ABSTRACT FROM AUTHOR]

After introduction, West Nile virus (WNV) spread rapidly across the western United States between the years 2001 and 2004. This westward movement is thought to have been mediated by random dispersive movements of resident birds. Little attention has been placed on the role of mosquito vectors in virus dispersal across North America. The mosquito vector largely responsible for WNV amplification and transmission of WNV in the western USA is Culex tarsalis. Here we present population genetic data that suggest a potential role for C. tarsalis in the dispersal of WNV across the western USA. Population genetic structure across the species range of C. tarsalis in the USA was characterized in 16 states using 12 microsatellite loci.structure andgeneland analyses indicated the presence of three broad population clusters. Barriers to gene flow were resolved near the Sonoran desert in southern Arizona and between the eastern Rocky Mountains and High Plains plateau. Small genetic distances among populations within clusters indicated that gene flow was not obstructed over large portions of the West Coast and within the Great Plains region. Overall, gene flow in C. tarsalis appears to be extensive, potentially mediated by movement of mosquitoes among neighbouring populations and hindered in geographically limited parts of its range. The pattern of genetic clustering in C. tarsalis is congruent with the pattern of invasion of WNV across the western United States, raising the possibility that movement of this important vector may be involved in viral dispersal. [ABSTRACT FROM AUTHOR]

Tako-tsubo cardiomyopathy (TTC) is increasingly diagnosed in the United States, especially in the Caucasian population. To evaluate the clinical features and outcome of patients with TTC, we evaluated 34 patients (32 women and 2 men) 22 to 88 years of age (mean 66 ± 14) who fulfilled the following criteria: (1) akinesia or dyskinesia of the apical and/or midventricular segments of the left ventricle with regional wall motion abnormalities that extended beyond the distribution of a single epicardial vessel and (2) absence of obstructive coronary artery disease. Twenty-five patients (74%) presented with chest pain, 20 patients (59%) presented with dyspnea, and 8 patients (24%) presented with cardiogenic shock. Twenty-two patients (65%) had ST-segment elevation and 14 patients (41%) had T-wave inversion on presentation. Twenty-five patients (74%) reported a preceding stressful event. Cardiac biomarkers were often mildly increased, with a mean troponin I (peak) of 13.9 ± 24. Mean ± SD left ventricular ejection fractions were 28 ± 10% at time of presentation and 51 ± 14 at time of follow-up (p <0.0001). Two patients (6%) died during the hospital stay. Average duration of hospital stay was 6.6 ± 6.2 days. In conclusion, TTC is common in postmenopausal women with preceding physical or emotional stress. It predominantly involves the apical portion of the left ventricle and patients with this condition have a favorable outcome with appropriate medical management. The precise cause remains unclear. [Copyright &y& Elsevier]

The article presents a critical examination of Toni Morrison's novel "Love," and its depiction of the Civil Rights Movement in the U.S. and the problems of its ideology. The protagonist of the story is discussed concerning his family history and the author suggests that the Civil Rights Movement was a detriment to successful African Americans in the years preceding World War II.

INTRODUCTION: Cyclic vomiting syndrome (CVS) imposes a substantial burden, but epidemiological data are scarce. This study aimed to estimate the incidence and prevalence of CVS, comorbid conditions, and treatment patterns, using administrative databases in the United States. METHODS: This cross-sectional study used claims data from Merative MarketScan Commercial/Medicare Supplemental and Medicaid databases in all health care settings. Incidence and prevalence rates for 2019 were calculated and stratified by age, sex, region, and race/ethnicity. Patient characteristics were reported among newly diagnosed patients with CVS (i.e., no documented claims for CVS before 2019). CVS was defined as having 11 inpatient and/or 21 outpatient CVS claims that were 71 days apart. RESULTS: The estimated prevalence of CVS was 16.7 (Commercial/Medicare) and 42.9 (Medicaid) per 100,000 individuals. The incidence of CVS was estimated to be 10.6 (Commercial/Medicare) and 26.6 (Medicaid) per 100,000 individuals. Both prevalence and incidence rates were higher among female individuals (for both Commercial/Medicare and Medicaid). Comorbid conditions were common and included abdominal pain (56%--64%), anxiety (32%--39%), depression (26%--34%), cardiac conditions (39%--42%), and gastroesophageal reflux disease (30%--40%). Despite a diagnosis of CVS, only 32%--35% had prescriptions for prophylactic treatment and 47%--55% for acute treatment within the first 30-day period following diagnosis. DISCUSSION: This study provides the first population-level estimates of CVS incidence and prevalence in the United States. Comorbid conditions are common, and most patients with CVS do not receive adequate treatment. These findings underscore the need for improving disease awareness and developing better screening strategies and effective treatments. [ABSTRACT FROM AUTHOR]

Focuses on the use of the pulsed laser deposition (PLD) technique in the United States. Industrial applications of PLD; Concept behind thin-film deposition; Benefits of PLD.

Antimalarial drug resistance is an evolving global health security threat to malaria control. Early detection of Plasmodium falciparum resistance through therapeutic efficacy studies and associated genetic analyses may facilitate timely implementation of intervention strategies. The US President's Malaria Initiative-supported Antimalarial Resistance Monitoring in Africa Network has assisted numerous laboratories in partner countries in acquiring the knowledge and capability to independently monitor for molecular markers of antimalarial drug resistance. [ABSTRACT FROM AUTHOR]

In the present study, 40 freshwater sediments collected near 14 wastewater treatment plants (WWTPs) across the United States were analyzed for eight N -nitrosamines by liquid chromatography-tandem mass spectrometry (LC–MS/MS). Three N -nitrosamines were detected for the first time in freshwater sediments in units of ng/g dry weight at the specified detection frequency: N -nitrosodibutylamine (NDBA; 0.2–3.3; 58%), N -nitrosodiphenylamine (NDPhA; 0.2–4.7; 50%), and N -nitrosopyrrolidine (NPYR; 3.4–19.6; 18%). At least one N -nitrosamine was detected in 70% (28/40) of sediments analyzed. Non-detect values in units of ng/g dw were obtained for N- nitrosodimethylamine (NDMA; <10.2), N -nitrosomethylethylamine (NMEA; <1.7), N -nitrosodiethylamine (NDEA; <3.9), N -nitroso-di- n -propylamine (NDPA; <1.7), and N -nitrosopiperidine (NPIP; <3.6). Principal component analysis specifically points to two of multiple potential pathways explaining N -nitrosamine occurrences in sediment: NDBA and NDPhA were positively correlated with bulk water ammonia and pH levels, and NPYR with sediment content of organic carbon and iron. Interestingly, N -nitrosamine occurrences up- and downstream of WWTPs were statistically indistinguishable ( p > 0.05). This is the first report on the occurrence of the carcinogenic N -nitrosamines NDBA, NDPhA, and NPYR in U.S. freshwater sediments. Discovery of this phenomenon warrants further research on the compounds’ origin, environmental persistence, aquatic toxicity, and risks posed. [ABSTRACT FROM AUTHOR]

Background & Aims: Hepatic encephalopathy (HE) is a major complication of cirrhosis that causes substantial mortality and utilization of resources. Methods: We analyzed 5 cycles of the Nationwide Inpatient Sample, conducted between 2005 and 2009, to determine national estimates of incidence, prevalence, inpatient mortality, severity of illness, and resource utilization for inpatients with HE. Results: The yearly inpatient incidence of HE ranged from 20,918 (2005) to 22,931 (2009) (P = .2226), comprising approximately 0.33% of all hospitalizations in the United States. Over the 5-year period of analysis, mortality of inpatients with HE remained relatively stable, at 14.13%–15.61% (P = .062); however, the proportion of patients with major and extreme severity of illness increased (P < .0001). The average length of inpatient stay increased from 8.1 to 8.5 days (P = .019). The average total inpatient charges increased from $46,663 to $63,108 per case (P < .0001). Furthermore, total national charges related to HE increased from $4676.7 million (2005) to $7244.7 million (2009). In multivariate analysis, independent predictors of inpatient mortality included the number of diagnoses per admission (odds ratio [OR] = 1.022; 95% confidence interval [CI], 1.016–1.029 per diagnosis), number of procedures per admission (OR = 1.192 per procedure; 95% CI, 1.177–1.208), and major or extreme severity of illness (OR = 3.16; 95% CI, 2.84–3.50). The most important predictors of cost, charge, and length of stay were admission to a large, urban hospital; use of Medicaid or Medicaid as the payer; major or extreme severity of illness; number of diagnoses at discharge; and procedures per admission (P < .05). Conclusions: Resource utilization increased from 2005 to 2009 for patients discharged from US hospitals with the diagnosis of HE. The inpatient mortality rate, however, remained stable, despite a trend toward more severe disease. [ABSTRACT FROM AUTHOR]

Reports that the National Science Foundation awarded funds to C. Robin Buell and Venkatesan Sundaresan to host a workshop on the merits and mission of the U.S. Rice Resource Center. Importance of the establishment of a rice resource center in the U.S.; Emphasis on resolving logistical issues involved in the establishment of a rice resource center; Availability of molecular resources for biologists.

The market for solar energy in the US has grown exponentially due to increased consumer demand resulting from price reduction via economies of scale, technological progress, and a variety of incentives from federal and state governments as well as utility companies. The installation of solar power in Tennessee has more than doubled each year from 2009 to 2011. In this paper, we focus on the behavior of the Tennessee Solar Value Chain (TNSVC) to study the factors that influence growth of solar industry in the state. The impact of existing incentives on the TNSVC is analyzed. The TNSVC is simulated based on inputs from on-site survey to estimate economic impact in terms of the number of jobs added and the tax revenue generated in the state. In addition, a sensitivity analysis for the impact on the TNSVC under different policies those may be adopted by the state of Tennessee in the future is conducted. This paper employs a holistic model which can predict PV installation demand, understand solar value chain capacity, and estimate the revenue generation. It should be noted that the method employed in this study is not unique to the solar energy industry in Tennessee. The data utilized in this study is a combination of public domain information and surveys of suppliers, manufacturers, distributors, and installers. This makes the model in this paper flexible enough to be applied to assess the solar value chain in other state or country. [ABSTRACT FROM AUTHOR]

• Fate of 26 PPCPs in 13 full-scale nitrogen removing biofilters (NRBs) was studied. • The innovative onsite wastewater system, NRB, removed 58 to >99% of PPCPs. • 19 of the PPCPs were removed by 50 to >99% within the oxic layer of the NRBs. • NRBs performed as well as or better than conventional wastewater treatment systems. The presence of pharmaceuticals and personal care products (PPCPs) in the environment is primarily the result of discharge of waste, including from onsite wastewater treatment systems (OWTSs) which are employed by 25% of homes in the United States. However, the occurrence and removal of PPCPs in OWTSs is not well understood, particularly given the large diversity in PPCP compounds as well as in OWTS designs. In this study, we monitored 26 different PPCPs in 13 full-scale nitrogen removing biofilters (NRBs), an innovative/alternative type of OWTS that utilizes an overlying sand layer and an underlying woodchip/sand layer to simultaneously remove nitrogen and other wastewater-derived contaminants. The specific objectives of this study were (i) to measure the occurrence of PPCPs in septic tank effluent (STE) that served as an influent to NRBs, (ii) to quantify PPCP removal in three types of NRB configurations (n = 13), and (iii) to evaluate PPCP removal with depth and environmental conditions in NRBs. Aqueous samples were taken during 42 separate sampling events during 2016 – 2019 and analyzed by liquid chromatography tandem mass spectrometry. Analysis of the STE samples yielded detection of 23 of the 26 PPCPs, with caffeine being the most abundant and frequently detected compound at 52,000 ng/L (range: 190 – 181,000 ng/L), followed by acetaminophen and paraxanthine at 47,500 ng/L (190 – 160,000 ng/L), and 34,300 ng/L (430 – 210,000 ng/L), respectively. Cimetidine, fenofibrate, and warfarin were the only compounds not detected. The average removal of PPCPs by NRBs ranged from 58% to >99% for the various compounds. PPCP removal as a function of depth in the systems showed that 50 to >99% of the observed removal was achieved within the top oxic layer (0 - 46 cm) of the NRBs for 19 analytes. Seven of the compounds had >85% removal by the same depth. These results indicate that NRBs are effective at removing PPCPs and that a large portion of the removal is achieved within the oxic nitrifying layer of the NRBs. Overall, the removal of PPCPs in NRBs was comparable (n = 8) or better (n = 15) than that observed for conventional wastewater treatment plants. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: To identify the burden of hospitalization and common primary admitting diagnoses among MS patients in the United States (US)., Background: The burden of hospitalizations and conditions leading to hospitalizations in MS patients in the US has not been well described., Design/methods: Using the Nationwide Inpatient Sample for 2001-2010, all patients with principal or secondary diagnosis of MS were identified, and the principal admitting diagnoses were compared with that of non-MS patients. Trends in hospitalizations were studied in specific age groups (1-9 yrs, 10-19 yrs, 20-29 yrs, 30-39 yrs, 40-49 yrs, 50-59 yrs, 60-69 yrs,70-79 yrs, 80-84 yrs and ≥85 yrs), and population level rates were obtained and compared with non-MS patients to obtain rate ratios (RR) and odds ratios (OR)., Results: A total of 1,240,410 MS patients were identified representing 4 out of every 1000 US hospital admissions, with an estimated female/male ratio of 2.72/1. The median age for MS hospitalizations was 53 years (Interquartile range=18). The majority of all MS hospitalizations occurred in the 30-69-year age bracket (82.17 %). The average length of in-patient hospital stays for MS patients compared to the non-MS population was 5.8 vs. 4.5 days (p < 0.001), and more MS patients had Medicare insurance (50.36 % vs. 42.24 %, p < 0.001). Overall, conditions such as urinary tract infections (UTI) - (RR11.43, p < 0.001), septicemia (RR8.53, p < 0.001), pneumonia (RR2.84, p < 0.001), chronic skin ulcers (RR20.64, p < 0.001), and lower limb and femoral neck fractures (RR2.86, p < 0.001) were present with increased frequency among MS patients. Patterns of comorbidity varied markedly by age group. The estimated average annual in-hospital charges adjusted to 2010 dollars for all MS inpatient hospitalizations was 3 billion U.S. dollars., Conclusions: Patients with MS are admitted into hospital at a younger age, are hospitalized longer and consume more Medicare resources than the similar patients without MS in the general population. Infections account for a large proportion of MS-associated hospitalizations, from young adulthood onward. These findings are particularly significant in light of the increasing availability of disease modifying therapies with more potent immunosuppressive properties, as well as the accumulating data that systemic infection can drive MS relapses., Competing Interests: Conflict of interest None, (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction: Behçet's disease (BD) is a chronic systemic vasculitis characterized by oral and genital ulcers, uveitis, and skin lesions. Patients with BD may develop gastrointestinal (GI) disease; however, characterization of GI disease in American cohorts is lacking. In this article, we present clinical, endoscopic, and histopathologic GI findings in an American cohort of patients with BD., Methods: Patients with established BD were evaluated prospectively at the National Institutes of Health. Demographic and clinical data were collected including BD manifestations and GI symptoms. Endoscopy with histopathologic sampling was performed for both clinical and research indications with written consent., Results: Eighty-three patients were evaluated. The majority were female (83.1%) and white (75.9%). Mean age was 36 ± 14.8 years. GI symptoms were reported in 75% of cohort with nearly half of reporting abdominal pain (48.2%) and significant numbers reporting acid reflux, diarrhea, and nausea/vomiting. Esophagogastroduodenoscopy was performed in 37 patients; erythema and ulcers were the most common found abnormalities. Colonoscopy was performed in 32 patients with abnormalities including polyps, erythema, and ulcers. Endoscopy was normal in 27% of esophagogastroduodenoscopies and 47% of colonoscopies. Vascular congestion was demonstrated on the majority of random biopsies throughout the GI tract. Inflammation was not highly prevalent on random biopsies except in the stomach. Wireless capsule endoscopy was performed on 18 patients; ulcers and strictures were the most common abnormalities., Discussion: GI symptoms were common in this cohort of American patients with BD. Endoscopic examination was often normal; however, histopathologic examination demonstrated vascular congestion throughout the GI tract., (Copyright © 2023 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Objective: To assess the inpatient hospitalization burden and costs of patients with autoimmune encephalitis (AE) at a tertiary care institution., Methods: Adult inpatients with AE were identified retrospectively from July 1, 2005, to June 30, 2015. Demographic and clinical data were collected and analyzed. Billing data were compared to those of patients with herpes simplex encephalitis (HSE). Charges were adjusted for inflation., Results: Of 244 admissions for encephalitis reviewed, 63 patients met criteria for probable or definite AE. Thirty-one (49%) patients were antibody positive, and 27 (43%) were admitted to the intensive care unit (ICU). Median hospital charges per patient with AE were more than $70,000; median length of stay (LOS) was 15 days; and in-hospital mortality was 6%. Patients admitted to the ICU had substantially higher median hospital charges (ICU $173,000 per admission vs non-ICU $50,000 per admission, p < 0.001). LOS was strongly associated with charges and was driven by delay in diagnosis of AE, prolonged treatment courses, and lack of response to therapy. Compared with HSE, median hospital charges per patient with AE were nearly 4 times higher, median AE LOS was 3 times higher, and total charges over the study period were nearly twice as high., Conclusions: Patients with AE used more inpatient health care resources per patient during a 10-year period than patients with HSE at our institution. ICU-admitted patients with AE were responsible for a substantially higher financial burden than non-ICU-admitted patients with AE. Our data underscore the need for the development of novel diagnostic and therapeutic modalities to improve patient outcomes and to decrease hospital burden in AE., (© 2019 American Academy of Neurology.)

Objective: The study aimed to perform a content validation process by surveying vulvar disorder experts to identify evidence-based competencies appropriate for use in developing vulvar curricula for medical trainees., Materials and Methods: We identified 65 potential vulvar disorder competencies from literature review and expert opinions. Survey participants rated these competencies from 1 (not at all important) to 4 (highly important) in the training of 3 different groups of learners as follows: medical students, obstetrics and gynecology residents, and dermatology residents. We administered the survey to all US-based clinical members of the International Society for the Study of Vulvovaginal Disease as of September 2008 (n = 90). The content validity index and asymmetric CI were calculated for each curricular competency for each group of learners separately and used to identify competencies for use in curricula development., Results: Forty-seven surveys were returned, yielding a response rate of 52.2%. Obstetrician-gynecologists represented 66% of the study sample, followed by dermatologists (15%), and nurse practitioners (9%). Seventy-nine percent of experts received their training by self-teaching, which included mentored experiences (62%) and attending conferences or courses (62%). Only 19% received vulvar training during residency and 11% during fellowship. Four curricular competencies met content validity criteria for medical students, 60 competencies for obstetrics and gynecology residents, and 47 competencies for dermatology residents. The differences between the 2 groups of residents focused on vulvovaginal pain and infection, examination, and procedures of the vagina., Conclusions: The competencies identified in this study can aid in the development of targeted curricula for medical students, obstetrics and gynecology residents, and dermatology residents.