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BackgroundWe examined the association between cannabis use and cardiovascular outcomes among the general population, among never-tobacco smokers, and among younger individuals.Methods and resultsThis is a population-based, cross-sectional study of 2016 to 2020 data from the Behavioral Risk Factor Surveillance Survey from 27 American states and 2 territories. We assessed the association of cannabis use (number of days of cannabis use in the past 30 days) with self-reported cardiovascular outcomes (coronary heart disease, myocardial infarction, stroke, and a composite measure of all 3) in multivariable regression models, adjusting for tobacco use and other characteristics in adults 18 to 74 years old. We repeated this analysis among nontobacco smokers, and among men

OBJECTIVE: Cannabis use disorder diagnoses are increasing among U.S. adults and are more prevalent among people with comorbid psychiatric disorders. Recent changes in cannabis laws, increasing cannabis availability, and higher-potency cannabis may have placed people with cannabis use and psychiatric disorders at disproportionately increasing risk for cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine whether trends in cannabis use disorder prevalence among VHA patients differ by whether they have psychiatric disorders. METHODS: VHA electronic health records from 2005 to 2019 (N range, 4,332,165-5,657,277) were used to identify overall and age-group-specific (

All-cause COVID-19 hospitalization ≤ 30 days of infection is a common outcome for severe illness in observational/surveillance studies. Milder COVID-19 disease and COVID-19-specific measurements calls for an evaluation of this endpoint. This was a descriptive, retrospective cohort study of adults ≥ 18 who were established in primary care at Veteran Health Administration (VHA) facilities. The outcome was hospitalization within 30 days of a laboratory-confirmed, symptomatic SARS-CoV-2 infection. Between December 15, 2021 and May 1, 2022, a simple random sample of all VA facilities, excluding Puerto Rico or Philippines, was drawn to identify these hospitalized cases and determine whether hospitalization was due to COVID-19-specific causes. A chart review was conducted to record the inpatient clinical team's diagnosis and whether the inpatient team classified the diagnosis as COVID-19 related or not. These data were used to classify hospitalizations as either due to COVID-19-specific causes (direct manifestations of SARS-CoV-2 infection) or non-COVID-19-specific hospitalizations (incidental SARS-CoV-2 infection), A simple random sample of 9966 (12.3%) all-cause hospitalizations (95% CI: 12.1%, 12.5%) was used to select 300 representative patients. Of these, 226/300 (75.3%) were determined to be COVID-19-specific. COVID-19 pneumonia was most common (147/226, 65.0%). The highest proportion of COVID-19-specific hospitalizations occurred among unvaccinated (85.0%), followed by vaccinated but not boosted (73.7%) and boosted (59.4%) (p

BackgroundWe aimed to characterize pain and analgesic use in a large contemporary cohort of patients with cirrhosis and to associate pain with unplanned health care utilization and clinical outcomes in this population.MethodsWe included all patients with cirrhosis seen in UCSF hepatology clinics from 2013 to 2020. Pain severity and location were determined using documented pain scores at the initial visit; "significant pain" was defined as moderate or severe using established cutoffs. Demographic, clinical, and medication data were abstracted from electronic medical records. Associations between significant pain and our primary outcome of 1-year unplanned health care utilization (ie, emergency department visit or hospitalization) and our secondary outcomes of mortality and liver transplantation were explored in multivariable models.ResultsAmong 5333 patients with cirrhosis, 32% had a nonzero pain score at their initial visit and 25% had significant (ie moderate/severe) pain. Sixty percent of patients with significant pain used ≥1 analgesic; 34% used opioids. Patients with cirrhosis with significant pain had similar Model for End-Stage Liver Disease-Sodium scores (14 vs. 13), but higher rates of decompensation (65% vs. 55%). The most common pain location was the abdomen (44%). Patients with abdominal pain, compared to pain in other locations, were more likely to have decompensation (72% vs. 56%). Significant pain was independently associated with unplanned health care utilization (adjusted odds ratio: 1.3, 95% CI: 1.1-1.5) and mortality (adjusted hazard ratio: 1.4, 95% CI: 1.2-1.6).ConclusionsPain among patients with cirrhosis is often not well-controlled despite analgesic use, and significant pain is associated with unplanned health care utilization and mortality in this population. Effectively identifying and treating pain are essential in reducing costs and improving quality of life and outcomes among patients with cirrhosis.

BackgroundThe Veterans Health Administration tracks urine drug tests (UDTs) among patients on long-term opioid therapy (LTOT) and recommends discussing the health effects of cannabis use.ObjectiveTo determine the occurrence of cannabis-related discussions between providers and patients on LTOT during six months following UDT positive for cannabis, and examine factors associated with documenting cannabis use.DesignWe identified patients prescribed LTOT with a UDT positive for cannabis in 2019. We developed a text-processing tool to extract discussions around cannabis use from their charts.SubjectsTwelve thousand seventy patients were included. Chart review was conducted on a random sample of 1,946 patients.Main measuresThe presence of a cannabis term in the chart suggesting documented cannabis use or cannabis-related discussions. Content of those discussions was extracted in a subset of patients. Logistic regression was used to examine the association between patient factors, including state of residence legal status, with documentation of cannabis use.Key resultsAmong the 12,070 patients, 65.8% (N = 7,948) had a cannabis term, whereas 34.1% (N = 4,122) of patients lacked a cannabis term, suggesting that no documentation of cannabis use or discussion between provider and patient took place. Among the subset of patients who had a discussion documented, 47% related to cannabis use for medical reasons, 35% related to a discussion of VA policy or legal issues, and 17% related to a discussion specific to medical risks or harm reduction strategies. In adjusted analyses, residents of states with legalized recreational cannabis were less likely to have any cannabis-related discussion compared to patients in non-legal states [OR 0.73, 95% CI 0.64-0.82].ConclusionsOne-third of LTOT patients did not have documentation of cannabis use in the chart in the 6 months following a positive UDT for cannabis. Discussions related to the medical risks of cannabis use or harm reduction strategies were uncommon.

ImportanceEarly detection of atrial fibrillation (AF) may help prevent adverse cardiovascular events such as stroke. Deep learning applied to electrocardiograms (ECGs) has been successfully used for early identification of several cardiovascular diseases.ObjectiveTo determine whether deep learning models applied to outpatient ECGs in sinus rhythm can predict AF in a large and diverse patient population.Design, setting, and participantsThis prognostic study was performed on ECGs acquired from January 1, 1987, to December 31, 2022, at 6 US Veterans Affairs (VA) hospital networks and 1 large non-VA academic medical center. Participants included all outpatients with 12-lead ECGs in sinus rhythm.Main outcomes and measuresA convolutional neural network using 12-lead ECGs from 2 US VA hospital networks was trained to predict the presence of AF within 31 days of sinus rhythm ECGs. The model was tested on ECGs held out from training at the 2 VA networks as well as 4 additional VA networks and 1 large non-VA academic medical center.ResultsA total of 907 858 ECGs from patients across 6 VA sites were included in the analysis. These patients had a mean (SD) age of 62.4 (13.5) years, 6.4% were female, and 93.6% were male, with a mean (SD) CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age, sex category) score of 1.9 (1.6). A total of 0.2% were American Indian or Alaska Native, 2.7% were Asian, 10.7% were Black, 4.6% were Latinx, 0.7% were Native Hawaiian or Other Pacific Islander, 62.4% were White, 0.4% were of other race or ethnicity (which is not broken down into subcategories in the VA data set), and 18.4% were of unknown race or ethnicity. At the non-VA academic medical center (72 483 ECGs), the mean (SD) age was 59.5 (15.4) years and 52.5% were female, with a mean (SD) CHA2DS2-VASc score of 1.6 (1.4). A total of 0.1% were American Indian or Alaska Native, 7.9% were Asian, 9.4% were Black, 2.9% were Latinx, 0.03% were Native Hawaiian or Other Pacific Islander, 74.8% were White, 0.1% were of other race or ethnicity, and 4.7% were of unknown race or ethnicity. A deep learning model predicted the presence of AF within 31 days of a sinus rhythm ECG on held-out test ECGs at VA sites with an area under the receiver operating characteristic curve (AUROC) of 0.86 (95% CI, 0.85-0.86), accuracy of 0.78 (95% CI, 0.77-0.78), and F1 score of 0.30 (95% CI, 0.30-0.31). At the non-VA site, AUROC was 0.93 (95% CI, 0.93-0.94); accuracy, 0.87 (95% CI, 0.86-0.88); and F1 score, 0.46 (95% CI, 0.44-0.48). The model was well calibrated, with a Brier score of 0.02 across all sites. Among individuals deemed high risk by deep learning, the number needed to screen to detect a positive case of AF was 2.47 individuals for a testing sensitivity of 25% and 11.48 for 75%. Model performance was similar in patients who were Black, female, or younger than 65 years or who had CHA2DS2-VASc scores of 2 or greater.Conclusions and relevanceDeep learning of outpatient sinus rhythm ECGs predicted AF within 31 days in populations with diverse demographics and comorbidities. Similar models could be used in future AF screening efforts to reduce adverse complications associated with this disease.

In the United States, cannabis is increasingly used to manage chronic pain. Veterans Health Administration (VHA) patients are disproportionately affected by pain and may use cannabis for symptom management. Because cannabis use increases the risk of cannabis use disorders (CUDs), we examined time trends in CUD among VHA patients with and without chronic pain, and whether these trends differed by age. From VHA electronic health records from 2005 to 2019 (∼4.3-5.6 million patients yearly), we extracted diagnoses of CUD and chronic pain conditions ( International Classification of Diseases [ ICD ]- 9-CM , 2005-2014; ICD-10-CM , 2016-2019). Differential trends in CUD prevalence overall and age-stratified (

One of the most important energy sources is non-renewable sources, including fossil fuels, the release of which causes many harmful consequences, including respiratory diseases, growth disorders, etc. On the other hand, renewable energies, including water, wind, sun, etc., are sustainable energy sources and compared to traditional fossil fuels, they have less adverse environmental effects due to the minimal emission of greenhouse gases. Due to the need to use renewable energy to reduce greenhouse gas emissions and combat climate change, the widespread use of these resources will bring about sustainable development. Therefore, creating the necessary infrastructure to use renewable energy as an important solution plays a key role in preserving natural resources. The purpose of this study is to review green and renewable fuels; Their sources, applications, advantages, and limitations. In this narrative review study, review articles, research articles, and cross-sectional descriptions were published until the beginning of February 2023 in English and Persian related to green and renewable fuels; Sources, applications, advantages, and limitations were investigated. These articles were searched in ScienceDirect, PubMed, Google Scholar, Web of Science, Scopus, and SID databases, using keywords such as renewable energy, fossil fuel, green fuel, and non-renewable energy with the aim of better understanding green fuels; Their sources, application, advantages, and limitations were obtained. After searching the databases with the mentioned keywords, 78 articles were included in the study. After removing duplicate articles, studying the abstract, and finally the full text of the articles, 35 related articles were included in the study. Endnote X7 resource management software was also used to organize, study titles and abstracts, and identify duplicate articles. Gren fuel is a non-toxic fuel that is essentially free of sulfur and aromatic compounds and is produced through various technologies such as biological and thermochemical processes. All the reviewed articles in the direction of producing green fuels such as biodiesel, natural gas, and hydrogen have pointed to the reduction of greenhouse gas emissions, improvement of air quality, stability of combustion in engines with dual fuel performance, and reduction of the negative effects of air pollution on health. Green fuel production is promising, but it faces limitations and challenges such as the need for land, water, and other resources, which can lead to changes in land use patterns, deforestation, and biodiversity loss. Also, the costs of producing biofuels depend on important factors such as raw materials, land, agricultural inputs, subsidies, and production technology. Biofuels are usually more expensive than fossil fuels and their production requires initial investment and maintenance costs. Considering the limitations and challenges of producing or using green fuel, using these renewable energy sources requires environmental planning and policy. Green fuels and renewable energy sources have emerged as promising solutions to deal with the environmental challenges caused by traditional fossil fuels. In general, green fuels offer a glimpse of a more sustainable future. However, their environmental effects need to be carefully investigated. Hence, a comprehensive understanding of diverse green fuel production methods and renewable energy technologies, along with their potential ecological impacts, is necessary to ensure the alignment of these alternative energy sources to achieve sustainable development.

Abstract Background The fall armyworm (FAW), Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae), is an aggressive pest species that causes severe economic losses in outbreak regions. Use of FAW natural enemies, particularly native parasitoids, has been suggested as a promising control strategy. Campoletis chlorideae Uchida (Hymenoptera: Ichneumonidae) is a solitary ichneumonid larval endoparasitoid with a broad host range that includes S. frugiperda. However, its parasitism rate, developmental stages, and population dynamics during parasitization of S. frugiperda remain unclear. A field survey was conducted to determine the emergence rate and sex ratio of C. chlorideae, evaluated the biological control performance, and investigated the production potential of it on the individually reared and group-reared S. frugiperda through age-stage, two-sex life tables, respectively. Results The results showed that C. chlorideae parasitizing individually reared FAW resulted for the parasitoid in a lifetime total fecundity (F) of 301.5 ± 16.4 eggs/female, a net reproduction rate (R 0) of 62.03 ± 9.07 adult females/female, an overall life span of females of 28.3 ± 0.52 days, and an intrinsic rate of increase (r) of 0.1946 ± 0.0076 day−1. In contrast, the parameters of F, R 0, overall life span of females, and r were 87.71 ± 6.32 pupae/female, 6.02 ± 1.61 adult females/female, 25.21 ± 0.79 days, and 0.0918 ± 0.0148 day−1 in group-reared S. frugiperda. Conclusions This study suggests that C. chlorideae has a promising biological control potential against S. frugiperda. Future research should focus on developing methods to increase the production of C. chlorideae.

Fertilizer application plays a crucial role in the decomposition of white poplar leaf litter and cycling of nutrients within forest ecosystems. The impact of various fertilizer additions on white poplar leaf litter and nutrient cycling is poorly understood. In this study, seven treatments were conducted at the following levels: Control (CK), no adding mineral fertilizers, N fertilization (+N), N and P fertilization (+NP), N, P, K fertilization (+NPK), P, K (+PK), manure fertilizer (+MF), and bird fertilizers (+BF) in a white poplar plantation in Qadis district, and used the litterbag techniques to measure litter mass remaining. The main objectives of our study were: (1) to explore the response of white poplar leaf litter decomposition to various fertilizers and accelerate the decomposition process; (2) to examine the relationship between C, N, and P concentration and their stoichiometric characteristic in leaf litter and soil. In this investigation, our results showed that white poplar leaf litter was significantly affected by fertilizers, and the decomposition process was greatly accelerated with + MF, +NPK, and + BF. The decay rate constant k (year −1) shows the decomposition rate of white poplar leaf litter as follows: +MF > +NPK > +BF > +PK > +NP > +N > CK (0.56, 0.53, 0.52, 0.51,0.51,0.5, and 0.46). Soil nutrients N, P and K increased significantly during the decomposition time with + MF, +NPK, and + BF, respectively, while C:N, C:P, and N:P ratios were highest in the white poplar leaf litter, and lowest in soil, we observed significant association between nutrients concentrations in soil and white poplar leaf and their stoichiometric. This current study concluded that adding + MF, +NPK and + BF fertilizers might be the preferred management option as they provided potentially beneficial changes in leaf litter decomposition and increased nutrient concentration. The data obtained will be a valuable reference for fertilization management strategies in forest ecosystems.

Abstract All-cause COVID-19 hospitalization ≤ 30 days of infection is a common outcome for severe illness in observational/surveillance studies. Milder COVID-19 disease and COVID-19-specific measurements calls for an evaluation of this endpoint. This was a descriptive, retrospective cohort study of adults ≥ 18 who were established in primary care at Veteran Health Administration (VHA) facilities. The outcome was hospitalization within 30 days of a laboratory-confirmed, symptomatic SARS-CoV-2 infection. Between December 15, 2021 and May 1, 2022, a simple random sample of all VA facilities, excluding Puerto Rico or Philippines, was drawn to identify these hospitalized cases and determine whether hospitalization was due to COVID-19-specific causes. A chart review was conducted to record the inpatient clinical team’s diagnosis and whether the inpatient team classified the diagnosis as COVID-19 related or not. These data were used to classify hospitalizations as either due to COVID-19-specific causes (direct manifestations of SARS-CoV-2 infection) or non-COVID-19-specific hospitalizations (incidental SARS-CoV-2 infection), A simple random sample of 9966 (12.3%) all-cause hospitalizations (95% CI: 12.1%, 12.5%) was used to select 300 representative patients. Of these, 226/300 (75.3%) were determined to be COVID-19-specific. COVID-19 pneumonia was most common (147/226, 65.0%). The highest proportion of COVID-19-specific hospitalizations occurred among unvaccinated (85.0%), followed by vaccinated but not boosted (73.7%) and boosted (59.4%) (p

Abstract Background This study explored the impact of predicted miRNAs on DNA methyltransferases (DNMTs) and the PODXL gene in Nalm6 cells, revealing the significance of these miRNAs in acute lymphocytic leukemia (ALL). Methods A comprehensive approach was adopted, integrating bioinformatic analyses encompassing protein structure prediction, molecular docking, dynamics, and ADMET profiling, in conjunction with evaluations of gene and miRNA expression patterns. This methodology was employed to elucidate the therapeutic potential of catechin compounds in modulating the activity of DNA methyltransferases (DNMTs) and the PODXL gene. Results The findings from our investigation indicate that catechins possess the capability to inhibit DNMT enzymes. This inhibitory effect is associated with the upregulation of microRNAs miR-200c and miR-548 and a concurrent downregulation of PODXL gene expression. These molecular interactions culminate in an augmented apoptotic response within ALL (Nalm6) cells. Conclusion The study posits that catechins may represent a viable therapeutic avenue for inducing apoptosis in ALL cells. This is achieved through the modulation of epigenetic mechanisms and alterations in gene expression profiles, highlighting the potential of catechins as agents for cancer therapy.

INTRODUCTION: Veterans are at high risk for lung cancer and are an important group for lung cancer screening. Previous research suggests that lung cancer screening may not be reaching healthier and/or non-White individuals, who stand to benefit most from lung cancer screening. We sought to test whether lung cancer screening is associated with poor health and/or race and ethnicity among veterans. METHODS: This cross-sectional, population-based study included veterans eligible for lung cancer screening (aged 55-79 years, ≥30 pack-year smoking history, current smokers or quit within 15 years, no previous lung cancer) in the 2017-2020 Behavioral Risk Factor Surveillance System surveys. Exposures were (1) poor health, defined as fair/poor health status and difficulty walking or climbing stairs, aligning with eligibility criteria for a pivotal lung cancer screening trial, and (2) race/ethnicity. The outcome was a receipt of lung cancer screening. All variables were self-reported. RESULTS: Of 3,376 lung cancer screening-eligible veterans representing an underlying population of 866,000 individuals, 20.3% (95% CI=17.3, 23.6) had poor health, and 13.7% (95% CI=10.6, 17.5) identified as non-White. Poor health was strongly associated with lung cancer screening (adjusted RR=1.64, 95% CI=1.06, 2.27); one third of veterans screened for lung cancer would not qualify for a pivotal lung cancer screening trial in terms of health. Marked racial disparities were observed among veterans: after adjustment, non-White veterans were 67% less likely to report lung cancer screening than White veterans (adjusted RR=0.33, 95% CI=0.11, 0.66). CONCLUSIONS: Lung cancer screening is correlated with poorer health and White race/ethnicity among veterans, which may undermine its population-level effectiveness. These results highlight the need to promote lung cancer screening, especially for healthier and/or non-White veterans, an important group of Americans for lung cancer screening.

The aim of this study was to determine the energy consumption and economic analysis for strawberry production. The data were collected from 60 farmers growing strawberry in the Sanandaj zone of Iran by using a face-to-face questionnaire in August-September 2009. The plowing operation at the study area was done by two methods; manually plow (P1) and machinery plow (P2). Also the irrigation operation was done by two methods; pumping irrigation (P) and non pumping irrigation (NP). Univariate analysis of variance was used for finding the differences among the total energy used for production and profitability of this crop in the different methods at the 5% and 1% level. Total energy used in various farm operations during strawberry production was 53,605 MJ.ha-1. Total energy output was 17,338 MJ.ha-1, and the average annual yield of strawberry farms was 9,125 kg.ha-1. Energy efficiency was 0.32, and energy productivity calculated as 0.17 kg.MJ-1. This means a production of 0.17 kg per unit energy. The difference between total input energy in the different irrigation types (NP and P) is significant at 1% level. There is not any significant difference between different plow types at the 5% level. The interaction of irrigation types and plow types is significant at 5% level. The profit-cost ratio, productivity, and net profit in the strawberry production are 1.2, 0.99, and 1,825 $.ha-1, respectively. The difference between net return in the different irrigation types (NP and P) is significant at 5% level. The difference between net return in the different plow types (P1 and P2) is significant at 1% level.

BACKGROUND: Understanding experiences with private important to improving the quality of health care coverage. OBJECTIVE: To examine the association of health with cost-related access barriers, medical debt, and dissatisfaction with care among privately insured Americans. DESIGN: We classified Americans with private insurance by self-reported health status into five groups (excellent, very good, good, fair, and poor health). We examined self-reported difficulty seeing a doctor due to costs, not taking medications due to costs, medical debt, and dissatisfaction with care among individuals with differing health status. We used logistic regression to examine the association of health status with individuals experiences after accounting for baseline characteristics. The analysis was repeated among individuals with different forms of private insurance. Odds ratios were converted to risk ratios to improve ease of interpretation of the results. SETTING: Behavioral Risk Factor Surveillance System of Americans in 17 states RESULTS: The sample included 82,494 US adults with private insurance. Following adjustment, compared to individuals with excellent health those in very good health, good health, fair health, and poor health reported increasingly higher risks of difficulty seeing a doctor due to costs with risk ratios of 1.02 (95% CI 1.01, 1.03), 1.07 (95% CI 1.06, 1.08), 1.18 (95% CI 1.17, 1.20), and 1.29 (95% CI 1.27, 1.31), respectively. Compared to individuals with excellent health, those in very good health, good health, fair health, and poor health reported increasingly higher risks of not taking medication due to costs, outstanding medical debt, and dissatisfaction with care. Similar relationships were seen across individually purchased and employer-sponsored insurance. CONCLUSION: Cost-related access barriers, medical debt, and dissatisfaction with care were common among individuals with private insurance and most pronounced among those with fair and poor health who likely need and use their health insurance the most.

Abstract Background Response to oxidative stress is universal in almost all organisms and the mitochondrial membrane protein, BbOhmm, negatively affects oxidative stress responses and virulence in the insect fungal pathogen, Beauveria bassiana. Nothing further, however, is known concerning how BbOhmm and this phenomenon is regulated. Results Three oxidative stress response regulating Zn2Cys6 transcription factors (BbOsrR1, 2, and 3) were identified and verified via chromatin immunoprecipitation (ChIP)-qPCR analysis as binding to the BbOhmm promoter region, with BbOsrR2 showing the strongest binding. Targeted gene knockout of BbOsrR1 or BbOsrR3 led to decreased BbOhmm expression and consequently increased tolerances to free radical generating compounds (H2O2 and menadione), whereas the ΔBbOsrR2 strain showed increased BbOhmm expression with concomitant decreased tolerances to these compounds. RNA and ChIP sequencing analysis revealed that BbOsrR1 directly regulated a wide range of antioxidation and transcription-associated genes, negatively affecting the expression of the BbClp1 cyclin and BbOsrR2. BbClp1 was shown to localize to the cell nucleus and negatively mediate oxidative stress responses. BbOsrR2 and BbOsrR3 were shown to feed into the Fus3-MAPK pathway in addition to regulating antioxidation and detoxification genes. Binding motifs for the three transcription factors were found to partially overlap in the promoter region of BbOhmm and other target genes. Whereas BbOsrR1 appeared to function independently, co-immunoprecipitation revealed complex formation between BbClp1, BbOsrR2, and BbOsrR3, with BbClp1 partially regulating BbOsrR2 phosphorylation. Conclusions These findings reveal a regulatory network mediated by BbOsrR1 and the formation of a BbClp1-BbOsrR2-BbOsrR3 complex that orchestrates fungal oxidative stress responses.

Entrepreneurial agency, defined as people's ability to discover and exploit business opportunities and create new value, is a complicated notion that necessitates an interdisciplinary approach and the integration of various views. Adopting this approach in the first step requires understanding the knowledge-based agencies and selecting related fields, which in this article is done through the scientometric analysis method. 18060 English-language items from the WOS database were selected and evaluated. The co-citation analysis of sources indicated five major clusters: Sociology, organization and management, agency theory, neuroscience/cognitive science, and psychology. The authors' co-citation analysis revealed seven theoretical groups. The co-occurrence analysis of key phrases and time trends revealed that concepts such as agency theory, human agency, and structure-agency duality originated in the 1970s and 1980s, but newer concepts such as teacher agency and entrepreneurial agency arose more recently. The findings revealed that the concept of agency evokes diverse interpretations depending on the field researched upon. In economics and law, it refers to representation and the principal-agent relationship. In public administration and political science, it refers to an organization or firm that performs a function for another. In philosophy, sociology, psychology, education, cognitive science, and neuroscience, it refers to the capacity, condition, or state of executing an action or exerting power, as well as the human ability to perform conscious and purposeful activities. Finally, to investigate entrepreneurial agency at the individual level, an integrated study of psychology and the social sciences is proposed.

Abstract Background The Veterans Health Administration tracks urine drug tests (UDTs) among patients on long-term opioid therapy (LTOT) and recommends discussing the health effects of cannabis use. Objective To determine the occurrence of cannabis-related discussions between providers and patients on LTOT during six months following UDT positive for cannabis, and examine factors associated with documenting cannabis use. Design We identified patients prescribed LTOT with a UDT positive for cannabis in 2019. We developed a text-processing tool to extract discussions around cannabis use from their charts. Subjects Twelve thousand seventy patients were included. Chart review was conducted on a random sample of 1,946 patients. Main measures The presence of a cannabis term in the chart suggesting documented cannabis use or cannabis-related discussions. Content of those discussions was extracted in a subset of patients. Logistic regression was used to examine the association between patient factors, including state of residence legal status, with documentation of cannabis use. Key Results Among the 12,070 patients, 65.8% (N = 7,948) had a cannabis term, whereas 34.1% (N = 4,122) of patients lacked a cannabis term, suggesting that no documentation of cannabis use or discussion between provider and patient took place. Among the subset of patients who had a discussion documented, 47% related to cannabis use for medical reasons, 35% related to a discussion of VA policy or legal issues, and 17% related to a discussion specific to medical risks or harm reduction strategies. In adjusted analyses, residents of states with legalized recreational cannabis were less likely to have any cannabis-related discussion compared to patients in non-legal states [OR 0.73, 95% CI 0.64–0.82]. Conclusions One-third of LTOT patients did not have documentation of cannabis use in the chart in the 6 months following a positive UDT for cannabis. Discussions related to the medical risks of cannabis use or harm reduction strategies were uncommon.

Studies of comparative mRNA booster effectiveness among high-risk populations can inform mRNA booster-specific guidelines. The study emulated a target trial of COVID-19 vaccinated U.S. Veterans who received three doses of either mRNA-1273 or BNT162b2 vaccines. Participants were followed for up to 32 weeks between July 1, 2021 to May 30, 2022. Non-overlapping populations were average and high risk; high-risk sub-groups were age ≥65 years, high-risk co-morbid conditions, and immunocompromising conditions. Of 1,703,189 participants, 10.9 per 10,000 persons died or were hospitalized with COVID-19 pneumonia over 32 weeks (95% CI: 10.2, 11.8). Although relative risks of death or hospitalization with COVID-19 pneumonia were similar across at-risk groups, absolute risk varied when comparing three doses of BNT162b2 with mRNA-1273 (BNT162b2 minus mRNA-1273) between average-risk and high-risk populations, confirmed by the presence of additive interaction. The risk difference of death or hospitalization with COVID-19 pneumonia for high-risk populations was 2.2 (0.9, 3.6). Effects were not modified by predominant viral variant. In this work, the risk of death or hospitalization with COVID-19 pneumonia over 32 weeks was lower among high-risk populations who received three doses of mRNA-1273 vaccine instead of BNT162b2 vaccine; no difference was found among the average-risk population and age >65 sub-group.

BackgroundCannabis is marketed as a treatment for pain. There is limited data on the prevalence of cannabis use and its correlates among Veterans prescribed opioids.ObjectiveTo examine the prevalence and correlates of cannabis use among Veterans prescribed opioids.DesignCross-sectional study.ParticipantsVeterans with a urine drug test (UDT) from Primary Care 2014-2018, in 50 states, Washington, D.C., and Puerto Rico. A total of 1,182,779 patients were identified with an opioid prescription within 90 days prior to UDT.Main measuresAnnual prevalence of cannabis positive UDT by state. We used multivariable logistic regression to assess associations of demographic factors, mental health conditions, substance use disorders, and pain diagnoses with cannabis positive UDT.ResultsAnnual prevalence of cannabis positive UDT ranged from 8.5% to 9.7% during the study period, and in 2018 was 18.15% in Washington, D.C. and 10 states with legalized medical and recreational cannabis, 6.1% in Puerto Rico and 25 states with legalized medical cannabis, and 4.5% in non-legal states. Younger age, male sex, being unmarried, and marginal housing were associated with use (p

BackgroundUpcoming alternative payment models Primary Care First (PCF) and Kidney Care Choices (KCC) incorporate capitated payments for chronic disease management. Prior research on the effect of capitated payments on chronic disease management has shown mixed results. We assessed the patient, physician, and practice characteristics of practices with capitation as the majority of revenue, and evaluated the association of capitated reimbursement with quality of chronic disease care.MethodsWe performed a cross-sectional analysis of visits in the United States' National Ambulatory Medical Care Survey (NAMCS) for patients with hypertension, diabetes, or chronic kidney disease (CKD). Our predictor was practice reimbursement type, classified as 1) majority capitation, 2) majority FFS, or 3) other reimbursement mix. Outcomes were quality indicators of hypertension control, diabetes control, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) use, and statin use.ResultsAbout 9% of visits were to practices with majority capitation revenue. Capitated practices, compared with FFS and other practices, had lower visit frequency (3.7 vs. 5.2 vs. 5.2, p = 0.006), were more likely to be located in the West Census Region (55% vs. 18% vs. 17%, p

Background and Objectives: Today, medicinal plants and their derivatives are considered to reduce the prevalence of antibiotic resistance. The aim of this study was to investigate the effect of Mentha longifolia essential oil on oqxA efflux pump gene expression and biofilm formation in ciprofloxacin-resistant Klebsiella pneumoniae strains. Materials and Methods: A total of 50 clinical strains of K. pneumoniae resistant to ciprofloxacin were studied. The minimum inhibitory concentration (MIC) of M. longifolia essential oil and its synergistic effect with ciprofloxacin were determined using the microbroth dilution method and the fractional inhibitory concentration (FIC) method. Minimum biofilm inhibition concentration (MBIC) of M. longifolia essential oil was detected. The effect of essential oils on the expression level of the oqxA gene was detected by Real-time PCR. Results: M. longifolia essential oil showed inhibitory activity against ciprofloxacin-resistant strains of K. pneumoniae. When M. longifolia essential oil was combined with ciprofloxacin, the MIC was reduced 2-4 times. In 28% of the strains, M. longifolia with ciprofloxacin showed a synergistic effect. M. longifolia essential oil reduces the strength of biofilm formation and alters the biofilm phenotype. A significant decrease in oqxA gene expression was observed in all isolates after treatment with M. longifolia essential oil. Conclusion: Based on the results of this study, it was observed that supplementing M. longifolia essential oil can help reduce ciprofloxacin resistance and inhibit biofilm formation in fluoroquinolone-resistant K. pneumoniae strains.

Objective The objective is to examine the test–retest reliability and internal reliability of six self-report questions assessing both current (past 30 days) and lifetime cannabis smoking in an internet survey in the adult US population.Design Cross-sectional national survey.Participants Out of 957 US adults who completed a national 2020 survey administered through Ipsos KnowledgePanel, 557 completed a second survey (‘reliability survey’) aimed at assessing the test–retest and internal reliability of questions asking about current and lifetime cannabis smoking. The sample size used in the analysis for the six self-report questions varied and was dependent on respondents answering the questions in both the 2020 survey and the reliability survey.Primary outcome measure Test–retest and internal reliability of six self-report questions asking about current and lifetime cannabis smoking.Results Among respondents who had smoked cannabis in the past 30 days, 33.8% were aged 18–34, 29.7% were 35–49, 27.7% were 50–64 and 8.8% were 65 or older. Current cannabis smokers were primarily men (59.5%) and white (63.0%). Almost half of current cannabis smokers had a high school diploma or less followed by some college and a bachelor’s degree or higher (45.7%, 30.6%, 23.8%, respectively). The question assessing number of days participants smoked cannabis in the past 30 days demonstrated good test–retest (r=0.87) and excellent internal reliability (α=0.94). The questions assessing the number of years, the most common form of use and the number of times participants smoked cannabis over their lifetime also demonstrated test–retest (r=0.77 (acceptable), r=0.75 (acceptable) and κ=0.65 (substantial), respectively) and excellent-to-good internal reliability (α=0.91, α=0.87 and α=0.88, respectively).Conclusions We found simple questions assessing current and lifetime cannabis use to demonstrate both test–retest reliability and internal reliability. These questions can serve as a simple framework for clinicians to evaluate the frequency of cannabis smoking in their patients. Future work should examine if these simple frequency measures of smoking cannabis are associated with adverse health outcomes.

Reactive carbonyl and oxygen species (RCS/ROS), often generated as metabolic byproducts, particularly under conditions of pathology, can cause direct damage to proteins, lipids, and nucleic acids. Glyoxal oxidases (Gloxs) oxidize aldehydes to carboxylic acids, generating hydrogen peroxide (H2O2). Although best characterized for their roles in lignin degradation, Glox in plant fungal pathogens are known to contribute to virulence, however, the mechanism underlying such effects are unclear. Here, we show that Glox in the insect pathogenic fungus, Metarhizium acridum, is highly expressed in mycelia and during formation of infection structures (appressoria), with the enzyme localizing to the cell membrane. MaGlox targeted gene disruption mutants showed RCS and ROS accumulation, resulting in cell toxicity, induction of apoptosis and increased autophagy, inhibiting normal fungal growth and development. The ability of the MaGlox mutant to scavenge RCS was significantly reduced, and the mutant exhibited increased susceptibility to aldehydes, oxidative and cell wall perturbing agents but not toward osmotic stress, with altered cell wall contents. The ΔMaGlox mutant was impaired in its ability to penetrate the host cuticle and evade host immune defense resulting in attenuated pathogenicity. Overexpression of MaGlox promoted fungal growth and conidial germination, increased tolerance to H2O2, but had little to other phenotypic effects. Transcriptomic analyses revealed downregulation of genes related to cell wall synthesis, conidiation, stress tolerance, and host cuticle penetration in the ΔMaGlox mutant. These findings demonstrate that MaGlox-mediated scavenging of RCS is required for virulence, and contributes to normal fungal growth and development, stress resistance.

Background: We aimed to evaluate the differential expression of nanos and ago genes in the protoscoleces, germinal layer, the neck, and the sucker regions of adult Echinococcus granulosus. Methods: The study was conducted in 2018 at the Research Center for Hydatid Disease in Iran, Kerman University of Medical Sciences, Kerman, Iran. In the present study E. granulosus protoscoleces were cultured in a di-phasic medium to obtain strobilated worms. The strobilated worms were harvested and using a sterile razor blade, the neck region was separated. In the molecular study the neck sections were compared with the tissues derived from the suckers from the same worm. The primers were specifically designed for RT-qPCR on nanos and ago. The germinative cells were isolated from the cyst germinal layer and cultured in DMEM for further molecular studies. The Immunohistochemical profile was designed to explore the nature of nanos protein in the strobilated worms. Differences between and within groups were statistically assessed relative to the protoscoleces. Results: An increasing nanos gene expressions were found in sucker, neck, cells and germinal layer in comparison to the protoscoleces. The expression of ago gene was decreased in sucker, cell and germinal layer, and increased in the neck region in comparison to the protoscoleces. The results showed that both genes were expressed in all developmental stages of E. granulosus. Conclusion: nanos and ago genes were differentially expressed at different developmental stages of E. granulosus and may contribute to differentiation of the parasite.

BackgroundEvidence on the cardiovascular health effects of cannabis use is limited. We designed a prospective cohort study of older Veterans (66 to 68 years) with coronary artery disease (CAD) to understand the cardiovascular consequences of cannabis use. We describe the cohort construction, baseline characteristics, and health behaviors that were associated with smoking cannabis.ObjectiveTo understand the cardiovascular consequences of cannabis use.DesignWe designed a prospective cohort study of older Veterans (66 to 68 years) with CAD.ParticipantsA total of 1,015 current cannabis smokers and 3,270 non-cannabis smokers with CAD.Main measuresUsing logistic regression, we examined the association of baseline variables with smoking cannabis in the past 30 days.ResultsThe current cannabis smokers and non-current smokers were predominantly male (97.2% vs 97.1%, p=0.96). Characteristics associated with recent cannabis use in multivariable analyses included lack of a high school education (odds ratio [OR] 2.15, 95% confidence interval [CI]: 1.10 to 4.19), financial difficulty (OR 1.47, 95% CI: 1.02 to 2.11), tobacco use (OR 3.02, 95% CI: 1.66 to 5.48), current drug use (OR 2.82, 95% CI: 1.06 to 7.46), and prior drug use (OR 2.84, 95% CI: 2.11 to 3.82). In contrast, compared to individuals with 0 to 1 comorbid conditions, those with 5 chronic conditions or more (OR 0.43, 95% CI: 0.27 to 0.70) were less likely to smoke cannabis.ConclusionsIn this older high-risk cohort, smoking cannabis was associated with higher social and behavioral risk, but with fewer chronic health conditions.

ObjectiveIn the United States, adult cannabis use has increased over time, but less information is available on time trends in cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine change over time in cannabis use disorder diagnoses among veterans, an important population subgroup, and whether such trends differ by age group (

Rates of suicide and unintended overdose death are high among midlife and older women, yet there is paucity of data identifying women at greatest risk. Psychoactive medications, commonly prescribed and co-prescribed in this population, may serve as salient indicators of risk for these outcomes. To determine whether long-term psychoactive medications and psychoactive polypharmacy predict risk of suicide and unintended overdose death among midlife and older women Veterans above and beyond other recognized factors. Longitudinal cohort study PARTICIPANTS: Women Veterans aged ≥ 50 with at least one Veterans Health Administration (VHA) clinical encounter in FY2012-2013. Long-term psychoactive medications (opioids, benzodiazepines, sedative-hypnotics, antidepressants, antipsychotics, and antiepileptics, prescribed for ≥ 90/180 days) and psychoactive polypharmacy (overlapping for ≥ 1 day) from VHA pharmacy records; suicide and unintended overdose death through December 31, 2018. In this national sample of 154,558 midlife and older women Veterans (mean age 63.4, SD 9.3 years), 130 died by suicide and 175 died from unintentional overdose over an average of 5.6 years. In fully adjusted models, long-term opioids (hazard ratio (HR) 2.01, 95% CI 1.21-3.35) and benzodiazepines (HR 2.99, 95% CI 1.82-4.91) were associated with death by suicide; opioids (HR 3.62, 95% CI 2.46-5.34), benzodiazepines (HR 2.77, 95% CI 1.73-4.42), sedative-hypnotics (HR 1.87, 95% CI 1.06-3.29), antidepressants (HR 1.47, 95% CI 1.03-2.12), antipsychotics (HR 1.81, 95% CI 1.02-3.22), and antiepileptics (HR 2.17, 95% CI 1.48-3.19) were associated with unintended overdose death. Women who were co-prescribed ≥ 3 psychoactive medications had over 2-fold increased risk of suicide (HR 2.83, 95% CI 1.65-4.84) and unintended overdose death (HR 2.60, 95% CI 1.72-3.94). Long-term psychoactive medications and psychoactive medication polypharmacy were important indicators of risk for death by suicide and death by unintended overdose among midlife and older women Veterans, even after accounting for psychiatric and substance use disorders.

The rice planthopper, Sogatella furcifera, is a piercing-sucking insect pest of rice, Oryza sativa. It is responsible for significant crop yield losses, and has developed moderate to high resistance to several commonly used chemical insecticides. We investigated the effects of the insect fungal pathogen Isaria javanica, alone and in combination with the chemical insecticide dinotefuran, on S. furcifera under both laboratory and field conditions. Our results show that I. javanica displays high infection efficiency and mortality for different stages of S. furcifera, reducing adult survival, female oviposition and ovary development. Laboratory bioassays showed that the combined use of I. javanica with a low dose (4–16 mg L–1) of dinotefuran resulted in higher mortality in S. furcifera than the use of I. javanica or dinotefuran alone. The combined treatment also had more significant effects on several host enzymes, including superoxide dismutase, catalase, peroxidase, and prophenol oxidase activities. In field trials, I. javanica effectively suppressed populations of rice planthoppers to low levels (22–64% of the level in untreated plots). Additional field experiments showed synergistic effects, i.e., enhanced efficiency, for the control of S. furcifera populations using the combination of a low dose of I. javanica (1×104 conidia mL–1) and a low dose of dinotefuran (~4.8–19.2% of normal field use levels), with control effects of >90% and a population level under 50 insects per 100 hills at 3–14 days post-treatment. Our findings indicate that the entomogenous fungus I. javanica offers an attractive biological control addition as part of the integrated pest management (IPM) practices for the control of rice plant pests.

Characterization of fungal spider pathogens lags far behind their insect counterparts. In addition, little to nothing is known concerning the ecological reservoir and/or fungal entomopathogen community surrounding infection sites. Five infected spider cadavers were identified in the neo-tropical climate of north-central Florida, USA, from three of which viable cultures were obtained. Multi-locus molecular phylogenetic and morphological characterization identified one isolate as a new Gibellula species, here named, Gibellula floridensis, and the other isolates highly similar to Parengyodontium album. The fungal entomopathogen community surrounding infected spiders was sampled at different habitats/trophic levels, including soil, leaf litter, leaf, and twig, and analyzed using ITS amplicon sequencing. These data revealed broad but differential distribution of insect-pathogenic fungi between habitats and variation between sites, with members of genera belonging to Metarhizium and Metacordyceps from Clavicipitaceae, Purpureocillium and Polycephalomyces from Ophiocordyceps, and Akanthomyces and Simplicillium from Cordycipitaceae predominating. However, no sequences corresponding to Gibellula or Parengyodontium, even at the genera levels, could be detected. Potential explanations for these findings are discussed. These data highlight novel discovery of fungal spider pathogens and open the broader question regarding the environmental distribution and ecological niches of such host-specific pathogens.

Abstract Purpose: Since ptosis is an early feature of chronic progressive external ophthalmoplegia (CPEO), patients are commonly misdiagnosed with other causes of ptosis. This study aims to report the type and frequency of misdiagnosis and time lag to diagnosis and the palpebral fissure transfer (PFT) procedure in patients with CPEO. Methods: This is a retrospective analysis of consecutive patients with CPEO who underwent PFT between 2006 and 2017. The data on previous diagnoses and treatments, age at definitive diagnosis of CPEO, and clinical manifestations were recorded. While the diagnosis of CPEO was based on clinical examination, 75% (24/32) of patients had undergone a confirmatory muscle biopsy and genetic tests. Results: There were 32 patients (19 females) with a mean age of 24.8 years (range, 13–36) at the final diagnosis and 34.1 years (range, 15–56) at the time of PFT. Also, 78% (25/32) of patients had been initially misdiagnosed with congenital ptosis (60%; 15/25) and ocular myasthenia gravis (OMG) (40%; 10/25). The majority of patients (20/32) had one to three previous eyelid surgical procedures, of which 90% (18/20) were performed before the definitive diagnosis of CPEO. The mean time lag from the first surgical procedure to CPEO diagnosis and PFT was 6.2 and 14.7 years, respectively. Conclusion: In a referral center, 78% of the patients with CPEO were initially misdiagnosed with congenital ptosis and OMG, and 56% of them underwent ptosis repair before the diagnosis. While the onset of the disease was in the first or second decades of life, diagnosis was delayed up to a mean age of 25 years. Reviewing early family photos and paying attention to other signs of CPEO could prevent misdiagnosis.

Cannabis use may confer high COVID-19 risk. This study examined self-reported changes in cannabis use that US adults attributed to the pandemic and factors associated with any changes. We conducted a national, cross-sectional survey among US adults in August 2020. The analytic sample included 957 past-year cannabis users (Mage = 43 years old; 51% male). Weighted multinomial regression examined associations between forms and reasons of cannabis used, perceived addictiveness and safety, co-use of cannabis with tobacco/alcohol, state legalization, and the outcome (self-reported increase/decrease in cannabis use vs. no change). Overall, 14.8% reported decreasing cannabis use due to the pandemic, 16.1% reported increasing, and 65.4% reported not changing. Factors associated with increased cannabis use included past-year use of vaporized (AOR = 1.7, 95% CI = 1.0, 3.0) or edible cannabis (AOR = 2.4, CI = 1.3, 4.3), and simultaneous use of cannabis and tobacco (AOR = 2.6; CI = 1.4, 5.2). Young adults (18-29 years old) had higher odds of self-reporting both increased (AOR = 4.8; CI = 1.8, 13.1) and decreased use (AOR = 3.3; CI = 1.5, 7.5). The pandemic has had a mixed impact on cannabis use, with participants reporting both increased and decreased use. Efforts may target users of vaporized and edible cannabis, co-users of cannabis and tobacco, and young adults to prevent increased cannabis use during the pandemic.

As opioid prescribing has declined, it is unclear how the landscape of prescription pain treatment across the U.S. has changed. We used nationally-representative data from the Medical Expenditure Health Survey, 2014 to 2018 to examine trends in prescriptions for opioid and non-opioid pain medications, including acetaminophen, non-steroidal anti-inflammatory drugs, gabapentinoids, and antidepressants among U.S. adults with self-reported pain. Overall, from 2014 to 2018, the percentage of participants receiving a prescription for opioids declined, (38.8% vs 32.8%), remained stable for non-steroidal anti-inflammatory drugs (26.8% vs 27.7%), and increased for acetaminophen (1.6% vs 2.3%), antidepressants (9.6% vs 12.0%) and gabapentinoids (13.2% vs 19.0%). In this period, the adjusted odds of receiving an opioid prescription decreased (aOR = .93, 95% CI = .90-.96), while the adjusted odds of receiving antidepressant, gabapentinoid and acetaminophen prescriptions increased (antidepressants: aOR = 1.08, 95% CI = 1.03-1.13 gabapentinoids: aOR = 1.11, 95% CI = 1.06-1.17; acetaminophen: aOR = 1.10, 95% CI: 1.02-1.20). Secondary analyses stratifiying within the 2014 to 2016 and 2016 to 2018 periods revealed particular increases in prescriptions for gabapentinoids (aOR = 1.13, 95% CI = 1.05-1.21) and antidepressants (aOR = 1.23, 95% CI = 1.12-1.35) since 2016. PERSPECTIVE: These data demonstrate that physicians are increasingly turning to CDC-recommended non-opioid medications for pain management, particularly antidepressants and gabapentinoids. However, evidence for these medications' efficacy in treating numerous common pain conditions, including low back pain, remains limited.

ImportanceWhile the association between Social Determinants of Health (SDOH) and health outcomes is well known, few studies have explored the impact of SDOH on hospitalization.ObjectiveExamine the independent association and cumulative effect of six SDOH domains on hospitalization.DesignUsing cross-sectional data from the 2016-2018 National Health Interview Surveys (NHIS), we used multivariable logistical regression models controlling for sociodemographics and comorbid conditions to assess the association of each SDOH and SDOH burden (i.e., cumulative number of SDOH) with hospitalization.SettingNational survey of community-dwelling individuals in the US PARTICIPANTS: Adults ≥18 years who responded to the NHIS survey EXPOSURE: Six SDOH domains (economic instability, lack of community, educational deficits, food insecurity, social isolation, and inadequate access to medical care) MEASURES: Hospitalization within 1 year RESULTS: Among all 55,186 respondents, most were ≤50 years old (54.2%), female (51.7%, 95% CI 51.1-52.3), non-Hispanic (83.9%, 95% CI 82.4-84.5), identified as White (77.9%, 95% CI 76.8-79.1), and had health insurance (90%, 95% CI 88.9-91.9). Hospitalized individuals (n=5506; 8.7%) were more likely to be ≥50 years old (61.2%), female (60.7%, 95% CI 58.9-62.4), non-Hispanic (87%, 95% CI 86.2-88.4), and identify as White (78.5%, 95% CI 76.7-80.3), compared to those who were not hospitalized. Hospitalized individuals described poorer overall health, reporting higher incidence of having ≥5 comorbid conditions (38.9%, 95% CI 37.1-40.1) compared to those who did not report a hospitalization (15.9%, 95% CI 15.4-16.5). Hospitalized respondents reported higher rates of economic instability (33%), lack of community (14%), educational deficits (67%), food insecurity (14%), social isolation (34%), and less access to health care (6%) compared to non-hospitalized individuals. In adjusted analysis, food insecurity (OR: 1.36, 95% CI 1.22-1.52), social isolation (OR: 1.17, 95% CI 1.08-1.26), and lower educational attainment (OR: 1.12, 95% CI 1.02-1.25) were associated with hospitalization, while a higher SDOH burden was associated with increased odds of hospitalization (3-4 SDOH [OR: 1.25, 95% CI 1.06-1.49] and ≥5 SDOH [OR: 1.72, 95% CI 1.40-2.06]) compared to those who reported no SDOH.ConclusionsAmong community-dwelling US adults, three SDOH domains: food insecurity, social isolation, and low educational attainment increase an individual's risk of hospitalization. Additionally, risk of hospitalization increases as SDOH burden increases.