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This paper examines the striking contrasts and inequalities observation by walking from Manhattan to Harlem in New York City, highlighting the significant social and economic differences that have profound implications for public health and social policy. Through this journey, we explore various aspects including racial segregation, the composition of shops, smoking habits, street cleanliness, police presence, unemployment, real estate disparities, and the pervasive sense of insecurity. The transition from a predominantly White Manhattan to a predominantly Black and Hispanic Harlem underscores the historical and systemic inequalities that continue to shape the city's demographic and economic landscape. These disparities, rooted in discriminatory housing policies, economic disparities, and social exclusion, manifest in poorer health outcomes, higher rates of substance use, and limited economic opportunities for minority populations. By addressing these structural issues through targeted policies and sustained interventions, policymakers may work towards reducing health disparities and promoting racial equity. This paper also highlights the concept of Minorities' Diminished Returns (MDRs), where the benefits of education and income are less pronounced for minority individuals compared to their White counterparts, further perpetuating cycles of disadvantage. Comprehensive efforts to dismantle systemic inequities are essential for fostering a more equitable and healthy society.

Background: Racial discrimination remains a significant issue in the United States, particularly affecting Black individuals. Understanding how beliefs about the persistence of racial discrimination are shaped by race and parental education among college students is crucial for developing strategies to address these inequities., Objectives: This study aims to examine the multiplicative effects of race and parental education on beliefs about the persistence of racial discrimination among Black and White college students. We hypothesize that Black students, particularly those with highly educated parents, will exhibit stronger beliefs in the persistence of racial discrimination as a significant issue compared to their White peers., Methods: Data were drawn from the Higher Education Research Institute (HERI) study, which includes a national sample of Black and White young adults on college campuses across the United States. We conducted statistical analyses to explore the influence of race and parental education on students' beliefs about racial discrimination., Results: Black students demonstrated stronger beliefs in the persistence of racial discrimination compared to White students. Additionally, students with higher parental education levels were more likely to recognize racial discrimination as a significant issue than those with lower parental education. The impact of parental education on these beliefs was more pronounced for Black students compared to White students., Discussion: Black college students, especially those from higher SES backgrounds, exhibit a heightened awareness of racial discrimination due to their lived experiences and educational exposure. High SES Black individuals often face increased visibility and prejudice in predominantly White environments, further reinforcing their beliefs about the persistence of discrimination. These findings highlight the need for targeted interventions to support Black students in higher education and promote awareness of racial discrimination. Policy solutions should include comprehensive anti-discrimination policies, increased diversity and inclusion efforts, and educational curricula that address systemic racism and social justice. The cross-sectional nature of the data limits causality inference, and self-reported measures may be subject to bias. Despite these limitations, the study's large and diverse sample enhances the generalizability of the findings. Race and parental education have multiplicative effects on college students' beliefs about the persistence of racial discrimination. Black students, particularly those from high SES backgrounds, are more likely to perceive racial discrimination as a continuing problem. Addressing these disparities through targeted policies and interventions is essential for creating equitable and inclusive educational environments., Competing Interests: Conflicts of Interest: The authors declare no conflict of interest.

Epigenetic studies have provided new opportunities to better understand the biological effects of poverty and racial/ethnic minority status. However, little is known about sex differences in these processes., Methods: We used 15 years of follow up of 854 racially and ethnically diverse birth cohort who were followed from birth to age 15. Structural equation modeling (SEM) was used to examine the effects of race/ethnicity, maternal education, and family structure on poverty at birth, as well as the effects of poverty at birth on epigenetic changes at age 15. We also explored variations by sex., Results: Our findings indicate that Black and Latino families had lower maternal education and married family structure which in turn predicted poverty at birth. Poverty at birth then was predictive of epigenetic changes 15 years later when the index child was 15. This suggested that poverty at birth partially mediates the effects of race/ethnicity, maternal education, and family structure on epigenetic changes of youth at age 15. There was an effect of poverty status at birth on DNA methylation of male but not female youth at age 15. Thus, poverty at birth may have a more salient effect on long term epigenetic changes of male than female youth., Conclusions: Further studies are needed to understand the mechanisms underlying the observed sex differences in the effects of poverty as a mechanism that connects race/ethnicity, maternal education, and family structure to epigenetic changes later in life., Competing Interests: Conflicts of Interest: “The authors declare no conflict of interest.” “No funders had any role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results”.

The intersection of race and place in shaping health disparities presents complex dynamics, as evidenced by studies in cities like Detroit, Baltimore, and Philadelphia, where predominantly Black and economically disadvantaged populations experience high overall rates of health problems. Surprisingly, these cities do not exhibit the most pronounced racial disparities. In contrast, areas with a higher percentage of White residents, indicative of greater income inequality, show stark differences in health outcomes between Black and White populations. This disparity underscores how conditions diverge more sharply between Black and White individuals in wealthier urban areas. This phenomenon suggests a complex and sometimes counterintuitive relationship among race, place, income, and income inequality in shaping racial health disparities. These dynamics have significant policy implications. Addressing health disparities requires nuanced strategies that recognize the multiplicative effects of race and income inequality on health outcomes. Policies focusing on areas with a high disease burden, such as Detroit, Philadelphia, and Baltimore can effectively mitigate disparities both locally and more broadly. Conversely, interventions targeting regions with lower disease prevalence, but higher racial disparities must be approached carefully to avoid exacerbating inequalities. In conclusion, understanding and addressing the complex drivers of health disparities demand comprehensive approaches that acknowledge the intertwined influences of race, income, and place. By prioritizing interventions that address economic disparities alongside health initiatives, policymakers can foster more equitable health outcomes across diverse communities.

Epigenetic studies, which can reflect biological aging, have shown that measuring DNA methylation (DNAm) levels provides new insights into the biological effects of social environment and socioeconomic position (SEP). This study explores how race, family structure, and SEP (income to poverty ratio) at birth influence youth epigenetic aging at age 15. Data were obtained from the Future of Families and Child Wellbeing Study (FFCWS) cohort, with GrimAge used as a measure of DNAm levels and epigenetic aging. Our analysis included 854 racially and ethnically diverse participants followed from birth to age 15. Structural equation modeling (SEM) examined the relationships among race, SEP at birth, and epigenetic aging at age 15, controlling for sex, ethnicity, and family structure at birth. Findings indicate that race was associated with lower SEP at birth and faster epigenetic aging. Specifically, income to poverty ratio at birth partially mediated the effects of race on accelerated aging by age 15. The effect of income to poverty ratio at birth on DNAm was observed in male but not female youth at age 15. Thus, SEP partially mediated the effect of race on epigenetic aging in male but not female youth. These results suggest that income to poverty ratio at birth partially mediates the effects of race on biological aging into adolescence. These findings highlight the long-term biological impact of early-life poverty in explaining racial disparities in epigenetic aging and underscore the importance of addressing economic inequalities to mitigate these disparities. Policymakers should focus on poverty prevention in Black communities to prevent accelerated biological aging and associated health risks later in life. Interventions aimed at eliminating poverty and addressing racial inequities could have significant long-term benefits for public health. Future research should explore additional factors contributing to epigenetic aging and investigate potential interventions to slow down the aging process. Further studies are needed to understand the mechanisms underlying these associations and to identify effective strategies for mitigating the impact of SEP and racial disparities on biological aging., Competing Interests: Conflicts of Interest: The authors declare no conflict of interest.

Background: Occupational classes play a significant role in influencing both individual and population health, serving as a vital conduit through which higher education can lead to better health outcomes. However, the pathway from education to corresponding occupational classes does not apply uniformly across different racial and ethnic groups, hindered by factors such as social stratification, labor market discrimination, and job segregation., Aims: This study seeks to investigate the relationship between educational attainment and occupational classes among Black, Latino, and White middle-aged and older adults, with a focus on their transition into retirement., Methods: Using cross-sectional data from the Health and Retirement Study (HRS), this research examines the impact of race/ethnicity, educational attainment, occupational classes, and timing of retirement among middle-aged and older adults. The analysis includes a sample of 7,096 individuals identified as White, Black, or Latino. Through logistic regression, we assess the additive and multiplicative effects of race/ethnicity and education on six defined occupational classes: 1. Managerial and specialty operations, 2. Professional Specialty, 3. Sales, 4. Clerical/administrative support, 5. Services, and 6. Manual labor., Results: Participants were Black (n = 1,143) or White (n =5,953). This included Latino (N =459) or non-Latino (n = 6,634). Our analysis reveals a skewed distribution of Black and Latino adults in manual and service occupations, in stark contrast to White adults who were more commonly found in clerical/administrative and managerial positions. Educational attainment did not equate to similar occupational outcomes across racial groups. Key findings include: Firstly, Black individuals with a college degree or higher were less likely to occupy clerical and administrative positions compared to their White counterparts. Secondly, holding a General Educational Development (GED) credential or some college education was generally linked to reduced likelihood of being in managerial roles; however, this inverse relationship was less evident among Black middle-aged and older adults than White ones. Thirdly, having a GED reduced the chances of working in sales roles, while having a college degree increased such chances. An interaction between race and some college education revealed that the impact of some college education on sales roles was more significant for Black adults than for White ones. We did not observe any interaction between ethnicity (Latino) and educational attainment on occupational classes. Given the stability of occupational classes, these findings could also apply to the last occupation held prior to retirement., Conclusion: This study highlights significant racial disparities in occupational classes among individuals with comparable levels of education, underscoring the profound implications for health and wellbeing disparities. Future research should explore strategies to alleviate labor market discrimination and job segregation as ways to close these occupational gaps. Additionally, the influence of social stratification, job segregation, and historical legacies, such as the repercussions of the Jim Crow era, on these disparities merits further investigation. Addressing these issues is crucial for enhancing the health and wellbeing of all populations.

Objective: Previous research has underscored the link between allostatic load-a comprehensive indicator of the cumulative physiological burden of chronic stress-and depression. However, there remains a significant gap in understanding how this relationship may differ across race and sex intersectional groups. This study aimed to investigate variations in the association between elevated allostatic load (AL>4) and depression among different race-sex intersectional groups within the general population., Methods: This cross-sectional secondary analysis utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2018. The analysis included variables such as race, sex, age, socioeconomic status, depression (measured via the Patient Health Questionnaire - PHQ), and allostatic load. Linear regression analyses were conducted to examine the interactions between race and sex with allostatic load, focusing on the likelihood of high depression as the outcome., Results: Across the pooled sample, an allostatic load greater than 4 was significantly associated with increased depression. Notably, an interaction effect was observed between race and AL>4 on depression among women, indicating that non-Hispanic Black women with a high allostatic load exhibited more pronounced depressive symptoms (Beta: 1.09, CI: 0.02-2.61). Conversely, among men, allostatic load greater than 4 neither correlated with nor interacted with race to influence depression levels., Conclusion: The study highlights the critical need to consider allostatic load as a key intervention point for preventing or reducing depression, particularly among Black women. These findings underscore the necessity for customized intervention strategies that address the nuanced race-sex disparities in the impact of allostatic load on mental health across populations., Competing Interests: Conflicts of Interest: The authors declare that they have no known competing financial interest or personal relationship that could have appeared to influence the work reported in this paper.

Objectives: Although educational attainment is a major social determinant of health, according to Marginalization-related Diminished Returns (MDRs), the effect of education tends to be weaker for marginalized groups compared to the privileged groups. While we know more about marginalization due to race and ethnicity, limited information is available on MDRs of educational attainment among US immigrant individuals., Aims: This study compared immigrant and non-immigrant US adults aged 18 and over for the effects of educational attainment on subjective health (self-rated health; SRH)., Methods: Data came from General Social Survey (GSS) that recruited a nationally representative sample of US adults from 1972 to 2022. Overall, GSS has enrolled 45,043 individuals who were either immigrant (4,247; 9.4%) and non-immigrant (40,796; 90.6%). The independent variable was educational attainment, the dependent variable was SRH (measured with a single item), confounders were age, gender, race, employment and marital status, and moderator was immigration (nativity) status., Results: Higher educational attainment was associated with higher odds of good SRH (odds ratio OR = 2.08 for 12 years of education, OR = 2.81 for 13-15 years of education, OR = 4.38 for college graduation, and OR = 4.83 for graduate studies). However, we found significant statistical interaction between immigration status and college graduation on SRH, which was indicative of smaller association between college graduation and SRH for immigrant than non-immigrant US adults., Conclusions: In line with MDRs, the association between educational attainment and SRH was weaker for immigrant than non-immigrant. It is essential to implement two sets of policies to achieve health inequalities among immigrant populations: policies that increase educational attainment of immigrants and those that increase the health returns of educational attainment for immigrants., Competing Interests: Conflicts of Interest The authors declare no conflicts of interest.

Background: High parental education promotes various aspects of offspring well-being including reducing their risk of depression/anxiety, criminal justice involvement, and welfare reliance. However, according to minorities' diminished returns, these benefits are not equal across racial groups, with Black families experiencing diminished returns of parental education compared to White families. This study explores the role of household income and offspring educational attainment as potential serial pathways that operate as mechanisms underlying diminished returns of parental education on offspring outcomes in Black families. Gender differences in these effects were also explored., Methods: Utilizing data from the Future of Families and Child Wellbeing Study (FFCWS) over a 22-year follow-up period (seven waves), we examined the serial mediation by household income and offspring educational attainment in explaining the relationship between parental education and offspring outcomes namely depression, anxiety, criminal justice involvement, and welfare reliance [Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP)]. We used structural equation modeling (SEM) with household income as the first mediator and young adult education as the second mediator. Multi-group models were used to explore gender differences in these paths., Results: The study confirmed the role of our proposed serial mediators for Blacks' weaker effects of parental education on offspring outcomes. We observed weaker effects of first affects household income, with this effect being for Black families compared to White families, which then impacted educational attainment of the offspring. The findings indicate that household income plays a crucial mediating role, but its effect is weaker in Black families. Additionally, the educational attainment of offspring from highly educated Black parents is less effective in improving outcomes compared to their White peers, further contributing to diminished returns. Some gender differences were observed for the effects of educational attainment on economic and health outcomes of young adults., Conclusions: The study underscores the need to reconsider traditional assumptions about the comparability of family conditions and outcomes across racial groups with similar levels of parental education. The findings highlight the importance of targeted policies and interventions aimed at enhancing the economic stability and educational outcomes of Black families to address these disparities. Policies should focus on promoting the economic well-being of highly educated Black parents and improving the educational outcomes of their children., Competing Interests: Conflicts of Interest: The authors declare no conflict of interest. No funders had any role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

This study aimed to examine whether hypertension prevalence varies by race/ethnicity and within age groups in a nationally representative sample of men in the United States. Hypertension was defined as blood pressure (BP) readings of 140 mm Hg and higher for systolic BP, 90 mm Hg and higher for diastolic BP, or self-reports of taking medication for hypertension. Modified Poisson models estimated prevalence ratios (PRs) and 95% confidence intervals (CI) for race and age group associations with hypertension. The prevalence of hypertension was 38% overall and 46% of the men were aged 50 and older. Analyses that focused on older men (50 years of age or older) found that non-Hispanic Black men had a higher prevalence of hypertension (PR  =  1.28, 95% CI: 1.19 - 1.37) compared to non-Hispanic White men. We suggest future research utilize life course perspectives to better identify which cumulative experiences impact hypertension disparities., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: American Indian and Alaska Native (AIAN) communities face pronounced economic and health disparities compared to White Americans, a situation rooted in long-standing historical injustices and segregation. The theory of Minorities' Diminished Returns (MDR) provides insight beyond the traditional focus on socioeconomic status (SES) disparities, such as educational attainment. It suggests that the beneficial outcomes of educational achievements on health and economic status are less substantial for marginalized and racially non-White groups compared to White Americans., Aims: This study investigates the applicability of the MDR theory to AIAN populations by examining whether the positive effects of education on poverty reduction and the decreased risk of disability benefit dependency are weaker for AIAN adults relative to their White counterparts., Methods: Utilizing data from the 2022 National Health Interview Survey (NHIS), this cross-sectional study analyzed a cohort of 20,743 adults, comprising 20,474 White and 269 AIAN individuals. We assessed the relationships between educational attainment, poverty level, and the likelihood of receiving disability benefits. A structural equation model was employed, with receipt of disability benefits as a latent factor influenced by racial background (AIAN) as a potential moderator, education as the main predictor, and poverty level and self-rated health as mediators. Gender, age, employment status, marital status, and Hispanic ethnicity served as additional covariates., Results: Findings indicate that higher educational levels are generally associated with a lower likelihood of receiving disability benefits, mediated by improved health and economic status. Nonetheless, the interaction between race (AIAN) and education significantly influenced economic outcomes, subsequently affecting the risk of receiving disability benefits. This suggests that Whites benefit more economically from education than AIAN individuals do., Conclusion: The study underscores the MDR theory's relevance to the disparities in educational outcomes related to poverty risk and receiving disability benefits among AIAN populations. The challenges AIAN individuals face in leveraging their educational achievements for economic gain relative to Whites may be attributed to pervasive racism and discrimination within various sectors, including employment and education. Addressing these disparities necessitates policy interventions that ensure educational returns are equitable across racial groups, with a focus on equal access to resources and opportunities.

There is a pressing need to develop and evaluate culturally tailored, community-based interventions that address hypertension management among low-income African American women. We employed a randomized controlled trial to test the effectiveness of the Prime Time Sister Circles® Program in reducing blood pressure and body mass index among low-income African American women ages with hypertension. Study participants (N = 339) were African American women aged 40-75 years who were diagnosed with hypertension and received their primary care at government funded health centers in Washington, D.C. Compared to the usual care group, Prime Time Sister Circles® participation was associated with a reduction in systolic BP by - 2.45 (CI - 6.13, 1.23) mmHg, a reduction in diastolic BP by - 3.66 mmHg (CI - 6.32, - 0.99), and a change in BMI by - 0.26 (CI - 2.00, 1.48) from baseline to 15 months. The results suggest that culturally tailored community-based interventions can improve hypertension management in low-income women., (© 2023. The Author(s).)

Introduction: Heart failure (HF) imposes a heavy economic burden on patients, their families, and society as a whole. Therefore, it is crucial to quantify the impact and dimensions of the disease in order to prioritize and allocate resources effectively., Methods: This study utilized a prevalence-based, bottom-up, and incidence-based Markov model to assess the cost of illness. A total of 502 HF patients (classes I-IV) were recruited from Madani Hospital in Tabriz between May and October 2022. Patients were followed up every two months for a minimum of two and a maximum of six months using a person-month measurement approach. The perspective of the study was societal, and both direct and indirect costs were estimated. Indirect costs were calculated using the Human Capital (HC) method. A two-part regression model, consisting of the Generalized Linear Model (GLM) and Probit model, was used to analyze the relationship between HF costs and clinical and demographic variables., Results: The total cost per patient in one year was 261,409,854.9 Tomans (21,967.21 PPP). Of this amount, 207,147,805.8 Tomans (17,407.38 PPP) (79%) were indirect costs, while 54,262,049.09 Tomans (4,559.84 PPP) (21%) were direct costs. The mean lifetime cost was 2,173,961,178 Tomans. Premature death accounted for the highest share of lifetime costs (48%), while class III HF had the lowest share (2%). Gender, having basic insurance, and disease class significantly influenced the costs of HF, while comorbidity and age did not have a significant impact. The predicted amount closely matched the observed amount, indicating good predictive power., Conclusion: This study revealed that HF places a significant economic burden on patients in terms of both direct and indirect costs. The substantial contribution of indirect costs, which reflect the impact of the disease on other sectors of the economy, highlights the importance of unpaid work. Given the significant variation in HF costs among assessed variables, social and financial support systems should consider these variations to provide efficient and fair support to HF patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Mahmoudi, Chenaghlou, Zare, Safaei and Yousefi.)

Obesity prevalence in the United States has increased drastically in the last two decades. Racial differences in obesity have emerged with the increase in obesity, with temporal trends because of individual, socioeconomic, and environmental factors, eating behaviors, lack of exercise, etc., raising questions about understanding the mechanisms driving these racial differences in the prevalence of obesity among non-Hispanic Black (NHB) and non-Hispanic White (NHW) men. Although many studies have measured obesity using body mass index (BMI), little is known about waist circumference (WC). This study examines variations in obesity among NHW and NHB using BMI and WC. We used National Health and Nutrition Examination Surveys (1999-2016) with a sample of 9,000 NHW and 3,913 NHB men aged 20 years or older. To estimate the association between the prevalence of obesity (BMI ≥30) and race, we applied modified Poisson regression; to explore and decompose racial differences, we used Oaxaca-Blinder decomposition (OBD). We found that NHW had higher abdominal obesity (WC ≥102) than NHB, but NHB were more likely to be obese (BMI ≥30) during most years, with some fluctuations. Modified Poisson regression showed that NHB had a higher prevalence of obesity (prevalence ratio [PR]: 1.11, 95% confidence interval [CI] = [1.04, 1.18]) but lower abdominal obesity (PR: 0.845; 95% CI = [0.801, 0.892]) than NHW. OBD showed that age, access to health care, smoking, and drinking contributed to the differences in abdominal obesity. The study identifies a significant increase in obesity among men over the last two decades; generalized obesity (based on BMI) was more problematic for NHB men, but abdominal obesity was more problematic for NHW men., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The Prime Time Sister Circles®, a randomized controlled trial (PTSC-RCT), assessed the impact of a community-based peer support program on hypertension management among African American women 40-75 years of age. While the PTSC-RCT was designed to evaluate changes in blood pressure control, subsequent sub-analyses revealed a high proportion of self-reported depressive symptoms in our sample. Accordingly, we conducted an ancillary investigation of the PTSC intervention on depression to ascertain its impact on reduced depressive symptoms in the study population., Method: Depressive symptoms were measured using an adapted version of the Center for Epidemiologic Studies Depression Scale Revised (CES-D-10). We used unadjusted and adjusted fixed effect models. Data for this study came from the PTSC-RCT. We collected data between 2017 and 2018 in Washington, DC. We used a balanced analytical sample of 172 African American, English-speaking women between 40 to 75 years old with uncontrolled hypertension., Intervention: The intervention group participated in a 2-h, peer-based support group once a week for 13 weeks. A trained PTSC facilitator facilitated sessions with experts who delivered content on various topics, including psychosocial wellness (e.g., stress, depressive symptoms, anxiety management, and self-esteem), physical health (e.g., hypertension, inflammation, and heart disease), physical activity, and healthy nutrition., Results: Results from the fixed-effects models indicated that participants in the PTSC program exhibited a greater reduction in CES-D-10 score at three months (Coeff: -1.99, 95% CI: -3.49, -0.49) and at 15 months (Coeff: -2.38, 95% CI: -3.94, -0.83), as compared to those in the control group., Conclusions: Evidence suggests that the Prime Time Sister Circles® intervention reduced depressive symptoms among African American women with low socioeconomic status and hypertension., Trial Registration: NCT04371614., (© 2023. The Author(s).)

Objectives: Educational attainment is a protective factor against poor health, but high educational attainment has a weaker effect on black people than on white people; this pattern has been called marginalization-related diminished returns (MDRs). Using a national sample of white people and black people 25 years and above, this study estimates the association between high educational attainment and allostatic load between black people and white people, and within each group., Study Design: This cross-sectional study uses data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016, including 2761 black people and 7058 white people. The outcome variable of interest was the Allostatic Load Scale (AL). We created the allostatic load scale by using 8 biomarkers, then created a binary variable (if ALS≥4 as 1 and ALS<4 as 0) to present elevated AL., Methods: We used several weighted modified Poisson regression models controlling for educational attainment (a predictor) and race (a moderator variable), age, sex, and marital status. We also controlled the models for smoking and drinking status as health behavior variables. As a sensitivity analysis, we ran several sets of regression analysis using the AL scale as a continuous outcome variable., Results: We found an inverse association between AL and educational attainment. The interaction between race and education has resulted in an inverse association between AL and educational attainment, with a weaker association in black people than in white people. We found similar findings by running regression models with AL as a continuous variable., Conclusions: We observed a weaker association between educational attainment and AL in black people than in white people, suggesting that educational attainment has more robust protection against allostatic load for white people than black people., Competing Interests: The Author(s) declare(s) that there is no conflict of interest., (© 2023 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health.)

In 2019 more than one-third of US nonprofit hospitals compensated their trustees. These hospitals provided less charity care than nonprofit hospitals that did not compensate their trustees. We found that trustee compensation was negatively associated with hospitals' charity care provision and that it may affect the self-selection of trustees and their fulfillment of their fiduciary duties.

Non-profit hospitals are expected to provide charity care and other community benefits to adjust their tax exemption status. Using the Medicare Hospital Cost Report, American Hospital Association Annual Survey, and the American Community Survey datasets, we examined if church-affiliated hospitals spent more on charity care and community benefit. For this analysis, we defined five main categories of community benefits were measured: total community benefit; charity care; Medicaid shortfall; unreimbursed other means-tested services; and the total of unreimbursed education and unfunded research. Multiple regression was used to examine the effect of church ownership, controlling for other factors, on the level of community benefit in 2644 general acute care non-profit hospitals. Descriptive analyses and multiple regression were used to show the relationship between the provision of community benefits and church affiliation including Catholic (CH), other church-affiliated hospitals (OCAH), and non-church affiliated hospitals (NCAH). The non-profit hospital on average spent 6.5% of its total expenses on community benefits. NCAH spent 6.09%, CH spent 7.5%, and OCAH spent 9.4%. Non-profits spent 2.8% of their total expenses on charity care, with the highest charity care spending for OCAH (5.2%), followed by CH (3.9%), and NCAH (2.4%). Regression results showed that CH and OCAH, on average, spent 1.08% and 2.16% more on community benefits than NCAHs. In addition, CH and OCAH spent more on other categories of community benefits except for education and research. Church-affiliated hospitals spend more on community benefits and charity care than non-church affiliated nonprofit hospitals., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Goal: We examined the variation in community benefit and charity care reporting standards mandated by states to determine whether state-mandated community benefit and charity care reporting is associated with greater provision of these services., Methods: We used 2011-2019 data from IRS Form 990 Schedule H for 1,423 nonprofit hospitals to create a sample of 12,807 total observations. Random effects regression models were used to examine the association between state reporting requirements and community benefit spending by nonprofit hospitals. Specific reporting requirements were analyzed to determine whether certain requirements were associated with increased spending on these services., Principal Findings: Nonprofit hospitals in states that required reports spent a higher percentage of total hospital expenditures on community benefits (9.1%, SD = 6.2%) compared to states without these requirements (7.2%, SD = 5.7%). A similar association between the percentage of charity care and total hospital expenditures (2.3% and 1.5%) was found. The greater number of reporting requirements was associated with lower levels of charity care provision, as hospitals allocated more resources to other community benefits., Practical Applications: Mandating the reporting of specific services is associated with greater provision of certain specific services, but not all. A concern is that when many services must be reported, the provision of charity care might be reduced as hospitals choose to allocate their community benefit dollars to other categories. As a result, policymakers may want to focus their attention on the services they most want to prioritize., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Foundation of the American College of Healthcare Executives.)

Objective: To determine if greater non-profit hospital spending for community benefits is associated with better health outcomes in the county where they are located., Data Sources and Study Setting: Community benefit data from IRS Form 990/Schedule H was linked to health outcome data from Area Health Resource Files, Map the Meal Gap, and Medicare claims from the Center for Medicare and Medicaid Services at the county level. Counties with at least one non-profit hospital in the United States from 2015 to 2019 (N = 5469 across the 5 years) were included., Study Design: We ran multiple regressions on community benefit expenditures linked with the number of health professionals, food insecurity, and adherence to diabetes and hypertension medication for each county., Data Collection: The three outcomes were chosen based on prior studies of community benefit and a recent survey sent to 12 health care executives across four regions of the U.S. Data on community benefit expenditures and health outcomes were aggregated at the county level., Principal Findings: Average hospital community benefit spending in 2019 was $63.6 million per county ($255 per capita). Multivariable regression results did not demonstrate significant associations of total community benefit spending with food insecurity or medication adherence for diabetes. Statistically significant associations with the number of health professionals per 1000 (coefficient, 12.10; SE, 0.32; p < 0.001) and medication adherence for hypertension (marginal effect, 0.27; SE, 0.09; p = 0.003) were identified, but both would require very large increases in community benefit spending to meaningfully improve outcomes., Conclusions: Despite varying levels of non-profit hospital community benefit investment across counties, higher community benefit expenditures are not associated with an improvement in the selected health outcomes at the county level. Hospitals can use this information to reassess community benefit strategies, while federal, state, and local governments can use these findings to redefine the measures of community benefit they use to monitor and grant tax exemption., (© 2022 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)

Background: Multiple studies have been conducted to test the moderating effect of immigration on the positive health results yielded through educational attainment. However, no study has been conducted to examine the role of immigration as a moderator in the association between educational level and perceived discrimination in Europe., Aim: We aimed to study whether an inverse association exists between educational level and perceived discrimination in European countries and whether immigration status moderates the association between educational level and perceived discrimination., Methods: Data from the 10th round of the cross-sectional European Social Survey (ESS) were used in this cross-sectional study. A total of 17,596 participants between 15-90 years old who lived in European countries were included. The independent variable was educational level, a categorical variable, and the dependent variable was perceived discrimination. Immigration status was the moderator, and age and sex were confounders., Results: Of 17,596 participants, 16,632 (94.5%) were native-born and 964 were immigrants (5.5%). We found that higher levels of educational level were protective against perceived discrimination, which was also found in immigrant participants; however, the effect was weaker., Conclusions: This study found that educational level was a protective factor against perceived discrimination. This effect, however, was more robust in the native-born participants than in their immigrant counterparts.

Background: Educational attainment has well established and widely recognized the effects on employment conditions and job demands. However, the way in which educational attainment correlates with perceived job demands may be inconsistent across racial groups as suggested by Minorities' Diminished Returns (MDRs). The aim was to test the moderating effect of race on the association between educational attainment and perceived job demands, particularly for Black and White individuals., Methods: This study was a cross-sectional analysis of MIDUS Refresher 1, including 1,232 Black and White adults over the age of 25 in the United States. Education attainment was the independent variable and perceived job demands was the dependent variable covariates. Linear regression was used for multivariate models., Results: We observed positive association between education and perceived job demands, however, statistical interaction between race and education suggested stronger positive associations for Black than White individuals., Conclusion: Being a highly educated Black professional in the United States equals high demand such increase stress is a risk factor of being a middle class black American. Innovated and bold market policies are required to solve this unfair dilemma.

Background: A growing body of research suggests that financial difficulties could weaken the protective effects of socioeconomic status (SES) indicators, including education and income, on the health status of marginalized communities, such as African Americans., Aim: We investigated the separate and joint effects of education, income, and financial difficulties on mental, physical, and oral self-rated health (SRH) outcomes in African American middle-aged and older adults., Methods: This cross-sectional study enrolled 150 middle-aged and older African Americans residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics (education, income, and financial difficulties), and self-rated health (mental, physical, and oral health) were collected. Three linear regression models were used to analyze the data., Results: Higher education and income were associated with a lower level of financial strain in a bivariate analysis. However, according to multivariable models, only financial difficulties were associated with poor mental, physical, and oral health. As similar patterns emerged for all three health outcomes, the risk associated with financial difficulties seems robust., Conclusions: According to our multivariable models, financial strain is a more salient social determinant of health within African American communities than education and income in economically constrained urban environments such as South Los Angeles. While education and income lose some protective effects, financial strain continues to deteriorate the health of African American communities across domains.

Study Objective: Despite projections of an oversupply of residency-trained emergency medicine physicians by 2030 and amidst intensifying national debate over Nurse Practitioner (NP) qualifications to practice independently and unsupervised, NPs are increasingly staffing Emergency Departments (EDs) as hospitals seek to contain costs while simultaneously expanding services. We sought to characterize NP practice in the ED by examining NP independent billing by level of severity of illness, and relationship to practice authority, State Medicaid expansion status, and rurality., Methods: Medicare provider utilization and payment data between 2015-2018 was used to explore NP billing as compared to five other clinician provider types for common emergency services acuity codes (CPT codes 99281-99285) to determine services billed for levels of severity of illness and trends over time. Number of services billed by clinician provider type related to state policies on NP practice authority, location, and population characteristics was explored., Results: NPs who independently billed for ED CPT codes (99282-99285), increased during this time and decreased for acuity code 99281 (minor and self-limiting). Overall, NPs saw a greater increase than all other providers in both the highest severity CPT codes of 99284 and 99285. The analysis revealed that type of clinician, state practice authority policy, number of NPs, and percent of population 65 years and older (by zipcode) and population size are positive predictors for services billed. The negative predictors were rurality, states which accepted the Medicaid expansion, having a higher number of non-English speaking residents, and non-emergency medicine clinicians., Conclusion: As a proportion of the providers independently billing in the ED, NPs are increasingly managing higher acuity patients as evidenced by billing percentage of the highest acuity CPT codes (99284 and 99285). During the same time period, ED MDs decreased their billing in the same categories. Current employment of NPs in the ED may not be fulfilling its original vision to care for the lower acuity patients in order to allow MDs to care for the more acutely and critically ill patients, and to increase the services for underserved populations in rural areas, those over age 65, and those with limited English language proficiency. Future research should investigate ED policies resulting in NPs as opposed to MDs seeing patients with greater severity codes., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Obesity is a significant public health problem globally and within the United States. It varies by multiple factors, including but not limited to income. The literature indicates little evidence of the association between income and obesity. We examined the association between income and obesity in U.S. adult men ages 20 years and older and tested racial and ethnic differences. We used data from the 1999 to 2016 National Health and Nutrition Examination Surveys for analyses. Obesity was determined using body mass index ≥30 kg/m 2 . We used poverty income ratio (PIR) as a proxy for income and calculated the Gini coefficient (GC) to measure income inequality. We then categorized low-, medium-, and high PIR to examine the relationship between income inequality and obesity. We used Modified Poisson regression in a sample of 17,238 adult men, including 9,511 White Non-Hispanic White (NHW), 4,166 Non-Hispanic Black (NHB), and 3,561 Mexican Americans (MA). We controlled the models for age category, racial and ethnic groups, marital status, education, health behaviors, health insurance coverage, self-reported health, comorbidity, and household structure. Results of our adjusted models suggested a positive and significant association between PIR and obesity among NHWs and NHBs in medium and high PIR; this association was not significant in MAs. Results of our analyses using GC in obese men indicate that compared with NHWs (GC: 0.306, SE: 0.004), MAs (GC: 0.368, SE: 0.005), and NHBs (GC: 0.328, SE: 0.005) had experienced higher-income inequality. In treating obesity, policymakers should consider race/ethnicity strategies to reduce inequality in income.

Aim : To estimate the association between income and depressive symptoms in adult women, ages 20 years and older. Methods : Data for this study came from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). We measured the presence of depressive symptoms by using a 9-item PHQ (Public Health Questionnaire, PHQ-9) and the Poverty to Income Ratio (PIR) as a proxy for income. We employed Negative Binomial Regression (NBRG) and logistic regression models in a sample of 11,420 women. We adjusted models by age, racial/ethnic groups, marital status, education, health insurance, comorbidity, and utilization of mental health professionals. We calculated the Gini Coefficient (GC) as a measure of income inequality, using PIR. Results : Between 2005 and 2016, 20.1% of low-PIR women suffered from depression (PHQ ≥10) compared with 12.0% of women in medium-PIR and 5.0% in high-PIR. The highest probabilities of being depressed were in Black Non-Hispanics (BNH) and Hispanics (12.0%), and then in White NH (WNH; 9.1%). The results of NBRG have shown that women in medium-PIR (0.90 [CI: 0.84-0.97]) and high-PIR 0.76 (CI: 0.70-0.82) had a lower incidence-rate ratio than women in low-PIR. The logistic regression results showed that income is protective in High-PIR groups (OR = 0.56, CI [0.43-0.73]). Conclusion : Policies to treat depression should prioritize the needs of low-income women of all racial groups and women.

Importance: Depression is one of the leading causes of disability in the United States. Depression prevalence varies by income and sex, but more evidence is needed on the role income inequality may play in these associations., Objective: To examine the association between the Poverty to Income Ratio (PIR)-as a proxy for income-and depressive symptoms in adults ages 20 years and older, and to test how depression was concentrated among PIR., Design: Using the 2005-2016 National Health and Nutrition Examination Survey (NHANES), we employed Negative Binomial Regression (NBRG) in a sample of 24,166 adults. We used a 9-item PHQ (Public Health Questionnaire, PHQ-9) to measure the presence of depressive symptoms as an outcome variable. Additionally, we plotted a concentration curve to explain how depression is distributed among PIR., Results: In comparison with high-income, the low-income population in the study suffered more from greater than or equal to ten on the PHQ-9 by 4.5 and 3.5 times, respectively. The results of NBRG have shown that people with low-PIR (IRR: 1.30, 95% CI: 1.23-1.37) and medium-PIR (IRR: 1.55, 95% CI: 1.46-1.65) have experienced a higher relative risk ratio of having depressive symptoms. Women have a higher IRR (IRR: 1.29, 95% CI: 1.24-1.34) than men. We observed that depression was concentrated among low-PIR men and women, with a higher concentration among women., Conclusion and Relevance: Addressing depression should target low-income populations and populations with higher income inequality.

Education continues to be a key factor contributing to increased access to critical life-improving opportunities and has been found to be protective against Allostatic Load (AL). The purpose of this study was to assess AL among Non-Hispanic (NH) White and NH Black men with the same level of education. We used 1999-2016 National Health and Nutrition Examination Surveys (NHANES) data with an analytical sample of 6472 men (1842 NH Black and 4630 NH White), and nine biomarkers to measure AL, controlling for various demographic and health-related factors. NH Black men had a higher AL score than NH White men (39.1%, 842 vs. 37.7%, 1,975). Racial disparities in AL between NH Black and NH White men who have a college degree or above (PR: 1.49, CI: [1.24-1.80]) were observed. Models posited similar AL differences at every other level of education, although these were not statistically significant. The findings reveal that socioeconomic returns to education and the societal protective mechanisms associated with education vary greatly between White and Black men.

Objective: We examined the characteristics of non-profit hospitals providing more community benefits and charity care than value of their tax exemptions and how this relationship changed between 2011 and 2018., Data Sources: Primary dataset was schedule H Form IRS 990 data. This data was merged with the American Hospital Association, Medicare Hospital Cost Report, and the America Community Survey., Study Design: We measured six categories of tax benefits and 17 types of community benefits. Subtracting the average value of community benefits provided by for-profit hospitals, we computed incremental community benefit and charity care provided by each non-profit hospital., Extraction Methods: A nationally representative sample was created of 11 776 non-profit hospital-year observations from 1472 unique hospitals over the 2011 to 2018 period was created. Descriptive analyses and random effect logistic regression were used to show associations between hospital characteristics and difference between incremental net community benefits and the value of tax-exemption., Principal Findings: After adjusting for community benefits provided by for-profits hospitals, on average, non-profit hospitals spent 5.9% (CI: 5.8%-6.0%) of their total expenses on community benefits; 1.3% (CI: 1.2%-1.3%) on charity care; and received 4.3% (CI: 4.2%-4.4%) of total expenses in tax exemptions. A total of 38.5% of non-profit hospitals did not provide more community benefit and 86% did not provide more charity care than the value of their tax exemption. Hospitals with fewer beds, providing residency education and located in high poverty communities were more likely to provide more incremental community benefits and charity care than the value of their tax exemption, while system affiliation had a negative association., Conclusion: The amount of community benefits and charity care provided by non-profits varied substantially across non-profit hospitals. Establishing minimum requirements for non-profit hospitals or publicly ranking hospitals based on their community benefit or charity care contributions, could encourage greater community benefits and charity care., (© 2021 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)

Objective: The present study aimed to determine the effects of mindful breath awareness & muscle relaxation (MBMR) and transcranial electrical stimulation (tCES) techniques on improving the systolic and diastolic blood pressure status in patients with type 2 diabetes., Methods: The research method was randomized controlled trial (RCT) using split-plot ANOVA (SPANOVA). Thirty patients were selected through purposive sampling from Bonab County Diabetes Association (Iran) and were randomly divided into three 10-member groups, namely MBMR, tCES, and MBMR+tCES groups. Participants received their group interventions in 10 individual sessions. All patients were evaluated for systolic and diastolic blood pressure at two stages, before and immediately after each session. SPANOVA and Bonferroni pairwise comparison tests were used for data analysis., Results: The results indicated that the MBMR and tCES techniques, alone and in combination, had significant and equal effects on reducing diastolic blood pressure, but the MBMR treatment was more effective in the systolic blood pressure than the tCES., Conclusions: The MBMR and tCES techniques were effective and safe in treating hypertension in patients with type 2 diabetes., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflicts of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The present study aimed to investigate the effectiveness of a cognitive rehabilitation program in improving the visual and auditory attention performance in stroke patients. The research method was quasi-experimental with a pre-intervention, post-intervention and follow-up design and control group. Twenty ischemic stroke patients with attention disorder were randomly classified into experimental and control groups. Cognitive evaluation of patients, including pre-intervention, immediately and 6 weeks after the intervention, was performed by the IVA + Plus (Integrated Visual and Auditory Continuous Performance Test). The experimental group received a cognitive rehabilitation program as 1-h sessions per week for 8 weeks, but the control group received no intervention. The results indicated significant effects of a cognitive rehabilitation program on the auditory (p = 0.002) and visual (p = 0.009) attention as well as the 6-week follow-up after the intervention, and it improved visual and auditory attention in stroke patients in the experimental group. The effectiveness of a cognitive rehabilitation program improved attention performance in stroke patients and had a positive effect on visual and auditory attention performance in ischemic stroke patients., (© 2020. Belgian Neurological Society.)

CD47, a member of the immunoglobulin superfamily, is an important "Don't Eat-Me" signal in phagocytosis process [clearance of apoptotic cells] as well as a regulator of the adaptive immune response. The lower level of CD47 on the cell surface leads to the clearance of apoptotic cells. Dysregulation of CD47 plays a critical role in the development of disorders, particularly cancers. In cancers, recognition of CD47 overexpression on the surface of cancer cells by its receptor, SIRPα on the phagocytic cells, inhibits phagocytosis of cancer cells. Thus, blocking of CD47-SIRPα signaling axis might be as a promising therapeutic target, which promotes phagocytosis of cancer cells, antigen-presenting cell function as well as adaptive T cell-mediated anti-cancer immunity. In this respect, it has been reported that CD47 expression can be regulated by microRNAs (miRNAs). MiRNAs can regulate phagocytosis of macrophages apoptotic process, drug resistance, relapse of disease, radio-sensitivity, and suppress cell proliferation, migration, and invasion through post-transcriptional regulation of CD47-SIRPα signaling axis. Moreover, the regulation of CD47 expression by miRNAs and combination with conventional cytotoxic drugs together with the help of nano-delivery represent a valuable opportunity for effective cancer treatment. In this review, we review studies that evaluate the role of miRNAs in the regulation of CD47-SIRPα in disorders to achieve a novel preventive, diagnostic, and therapeutic strategy.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Also, kindly confirm the details in the metadata are correct. Confirmed.Journal standard instruction requires a structured abstract; however, none was provided. Please supply an Abstract with subsections..Not confirmed. This is a review article. According to submission guidelines: "The abstract should be presented divided into subheadings (unless it is a mini or full review article)". Kindly check and confirm whether the corresponding authors and mail ID are correctly identified. Confirmed., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

The US government imposed two travel restriction policies to prevent the spread of the COVID-19 but may have funneled asymptomatic air travelers to selected major airports and transportation hubs. Using the most recent JHU COVID-19 database, American Community Survey, Airport and Amtrak data form Bureau of Transportation Statistics from 3132 US counties we ran negative binomial regressions and Cox regression models to explore the associations between COVID-19 cases and death rates and proximity to airports, train stations, and public transportation. Counties within 25 miles of an airport had 1.392 times the rate of COVID-19 cases and 1.545 times the rate of COVID-19 deaths in comparison to counties that are more than 50 miles from an airport. More effective policies to detect and isolate infected travelers are needed. Policymakers and officials in transportation and public health should collaborate to promulgate policies and procedures to protect travelers and transportation workers from COVID-19., Competing Interests: The Author(s) declare(s) that there is no conflict of interest., (© 2020 The Authors.)

Objective: This study decomposes race and ethnic differences in hypertension, waist circumference, obesity and allostatic load between black non-Hispanic (BNH), Mexican American (MA), and white non-Hispanic (WNH) women., Data: This study uses 10,109 observations from The National Health and Nutrition Examination Survey from years 1999-2014 for BNH, MA women, and WNH between 40 and 75 years old., Methodology: We used the Oaxaca-Blinder decomposition to explore how demographic, socioeconomic, healthcare access, and health behavior factors are associated with race and ethnic differences in blood pressure, waist circumference, body mass index (BMI), and allostatic load score (ALS)., Results: We found that demographic factors, socioeconomic status, healthcare access, and health behaviors explained from 0 to 50% of the difference in CVD risk factors between BNH and WNH. However, these factors explain from 39 to 100% of the difference in CVD risk factors between MA and WNH. Differences in demographic, socioeconomic, access to care, and health behavior factor variables explained very little of the differences in CVD risk factors between NHB and MA women., Conclusion: The impact of the determinants on CVD risk factors varies by race and ethnicity. Efforts to address differences in CVD risk factors should promote health equity programs and acknowledge that even race and ethnic groups that have similar demographic, SES, access to care, and health behavior factors can have different outcomes.

Background: While socioeconomic status (SES) indicators such as educational attainment and employment are among the major drivers of health and illness, the health returns of SES indicators may differ across racial groups. Built on Marginalization related Diminished Returns framework (MDRs) that refers to weaker health effects of SES indicators for marginalized and minoritized groups than non-Hispanic White people, we conducted this study with two aims: First to test the association between educational attainment and employment with cardiometabolic diseases (CMDs), and second, to test racial variation in these associations., Methods: This cross-sectional study used the National Health and Nutrition Examination Survey (NHANES 1999-2016) data. Participants included 29,230 adults who were either non-Hispanic White or non-Hispanic Black. Race, demographic factors (age and sex, and marital status), SES (educational attainment and employment), behaviors (smoking, drinking, and exercise), health insurance, and CMDs (diabetes, stroke, hypertension, and congestive heart failure) were measured. Weighted Poisson regression models were used in Stata to adjust for the complex sample design of the NHANES. Models without and with interactions were performed in the pooled sample. We also ran race-stratified models., Results: Overall, high educational attainment and employment showed inverse associations with some CMDs. As documented by statistical interactions between race and our SES indicators, we observed weaker inverse associations between educational attainment and employment with some CMDs. Race-stratified models also confirmed our main analysis. However, the results varied across CMD conditions., Conclusion: We observe that SES indicators such as educational attainment and employment have differential associations for racial groups. Compared to non-Hispanic White people, non-Hispanic Black people remain at CMDs risk across the full SES spectrum. This finding is in line with the MDRs framework and may be due to the structural racism, social stratification, and Marginalization of non-Hispanic Black Americans., Competing Interests: Declaration of conflicting interests: The Author(s) declare(s) no conflict of interest.

Policymakers are using different ways to measure the community benefit provided by non-profit hospitals because different policy makers have different policy objectives. We compare 3 commonly used measures of community benefit; examine the correlation across the 3 measures; examine how the distribution of community benefits varies across non-profit hospitals; and compare the factors associated with the level of community benefit for each definition. The main dataset for this study is the Schedule H of IRS Form 990 data for 2017. We merged this data with the 2017 American Hospital Association (AHA), the 2017 CMS Hospital Cost Report, and the 2018 American Community Survey data. The final sample consists of 1904 non-profit hospitals. We define 3 measures of community benefit: (1) Total community benefits: combining all 17 possible measures in the 990 data; (2) Total community benefits less unreimbursed Medicaid care because it reflects a policy choice made by the state; and (3) only charity care. We also subdivided the community benefits into individual and service-based benefit. Gini Coefficients and descriptive analysis show the distribution of 3 types of community benefit measures. On average, hospitals spent 8.1% of their expenses on all community benefits; 4.3% on community benefits less unreimbursed Medicaid; and 1.7% on charity care. The provision of charity care showed more variation (Gini coefficient) than the other 2 measures. Different hospital and geographic characteristics were associated with each definition, suggesting that different types of hospitals place emphasis on different community benefits. When policy makers choose among different definitions of community benefit, they should consider what incentives they want to instill.

Background: The Hospital Readmission Reduction Program (HRRP) disproportionately penalizes hospitals serving minority communities. The National Academy of Science, Engineering, and Medicine has recommended that the Centers for Medicare and Medicaid Services (CMS) consider adjusting for social risk factors in their risk adjustment methodology. This study examines the association between the racial and ethnic composition of a hospital market and the impact of other social risk factors on the probability of a hospital being penalized under the HRRP., Research Methods and Data: This study analyzes data from CMS, the American Hospital Association, and the American Community Survey for 3168 hospitals from 2013 to 2017. We used logistic regression models to estimate the association between the penalty status under HRRP and the racial and ethnic composition of a hospital market, and explored whether this association was moderated by other social risk factors., Results: Our results indicate that the probability of being penalized increases with the percentage of black and Asian residents in the hospital service area (HSA) and decreased with the percentage of Hispanic residents in the HSA. This association was reduced and became statistically insignificant when we controlled for other social risk factors. The strongest predictors of penalty status were the hospital's share of Medicaid patients and the percent of persons without a high school diploma in the HSA., Conclusions: By incorporating relevant social risk factors in the reimbursement methodology, CMS could mitigate the negative effects of HRRP on hospitals serving minority communities.

The tax-exempt status of nonprofit hospitals has received increased attention from policymakers interested in examining the value they provide instead of paying taxes. We use 2012 data from the Internal Revenue Service (IRS) Form 990, Centers for Medicare and Medicaid Services (CMS) Hospital Cost Reports, and American Hospital Association's (AHA) Annual Survey to compare the value of community benefits with the tax exemption. We contrast nonprofit's total community benefits to what for-profits provide and distinguish between charity and other community benefits. We find that the value of the tax exemption averages 5.9% of total expenses, while total community benefits average 7.6% of expenses, incremental nonprofit community benefits beyond those provided by for-profits average 5.7% of expenses, and incremental charity alone average 1.7% of expenses. The incremental community benefit exceeds the tax exemption for only 62% of nonprofits. Policymakers should be aware that the tax exemption is a rather blunt instrument, with many nonprofits benefiting greatly from it while providing relatively few community benefits.

Advanced nanomaterials such as carbon nano-tubes (CNTs) display unprecedented properties such as strength, electrical conductance, thermal stability, and intriguing optical properties. These properties of CNT allow construction of small microfluidic devices leading to miniaturization of analyses previously conducted on a laboratory bench. With dimensions of only millimeters to a few square centimeters, these devices are called lab-on-a-chip (LOC). A LOC device requires a multidisciplinary contribution from different fields and offers automation, portability, and high-throughput screening along with a significant reduction in reagent consumption. Today, CNT can play a vital role in many parts of a LOC such as membrane channels, sensors and channel walls. This review paper provides an overview of recent trends in the use of CNT in LOC devices and covers challenges and recent advances in the field. CNTs are also reviewed in terms of synthesis, integration techniques, functionalization and superhydrophobicity. In addition, the toxicity of these nanomaterials is reviewed as a major challenge and recent approaches addressing this issue are discussed.

Nanocages (NCs) have emerged as a new class of drug-carriers, with a wide range of possibilities in multi-modality medical treatments and theranostics. Nanocages can overcome such limitations as high toxicity caused by anti-cancer chemotherapy or by the nanocarrier itself, due to their unique characteristics. These properties consist of: (1) a high loading-capacity (spacious interior); (2) a porous structure (analogous to openings between the bars of the cage); (3) enabling smart release (a key to unlock the cage); and (4) a low likelihood of unfavorable immune responses (the outside of the cage is safe). In this review, we cover different classes of NC structures such as virus-like particles (VLPs), protein NCs, DNA NCs, supramolecular nanosystems, hybrid metal-organic NCs, gold NCs, carbon-based NCs and silica NCs. Moreover, NC-assisted drug delivery including modification methods, drug immobilization, active targeting, and stimulus-responsive release mechanisms are discussed, highlighting the advantages, disadvantages and challenges. Finally, translation of NCs into clinical applications, and an up-to-date assessment of the nanotoxicology considerations of NCs are presented.

Histone variants complement and integrate histone post-translational modifications in regulating transcription. The histone variant macroH2A1 (mH2A1) is almost three times the size of its canonical H2A counterpart, due to the presence of an ∼25 kDa evolutionarily conserved non-histone macro domain. Strikingly, mH2A1 can mediate both gene repression and activation. However, the molecular determinants conferring these alternative functions remain elusive. Here, we report that mH2A1.2 is required for the activation of the myogenic gene regulatory network and muscle cell differentiation. H3K27 acetylation at prospective enhancers is exquisitely sensitive to mH2A1.2, indicating a role of mH2A1.2 in imparting enhancer activation. Both H3K27 acetylation and recruitment of the transcription factor Pbx1 at prospective enhancers are regulated by mH2A1.2. Overall, our findings indicate a role of mH2A1.2 in marking regulatory regions for activation., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)