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This case study explores the first decade (2002-2012) of the California Senior Leaders Program (CSLP), including participants' creation of a formal advocacy group, the California Senior Leaders Alliance. Grounded in concerns with ageism and invisibility, the CSLP provides recognition and support for diverse California elders engaged in community building and social justice work. This study employs qualitative analysis of data from participant interviews, event evaluations, program documents, video footage, and participant observation. Findings show emotional, learning, and networking benefits for participants, intergenerational influences, collective capacity and coalition building, and contributions to policy. Program challenges are described, and future directions discussed. © 2013 Copyright Taylor and Francis Group, LLC.

Discusses fiscal support for special education personnel preparation programs in terms of factors which have altered and will alter service eligibility and service delivery patterns for the handicapped or developmentally disabled, current and future determinants of fiscal support for specialized personnel preparation programs, and ways in which professionals design intricate systems to manage or mismanage fiscal resources. (SBH)

The author summarizes developments affecting current efforts in developing collaborative service systems for the handicapped; identifies basic processes essential to current efforts; summarizes interorganizational models relevant to interagency planning; provides an illustrative planning model; suggests basic problems associated with interagency negotiations; and proposes priorities for research, demonstration, and development. (Author/SB)

We describe a spectral x-ray transmission method to provide images of independent material components of an object using a synchrotron x-ray source. The imaging system and process is similar to K-edge subtraction (KES) imaging where two imaging energies are prepared above and below the K-absorption edge of a contrast element and a quantifiable image of the contrast element and a water equivalent image are obtained. The spectral method, termed ‘spectral-KES’ employs a continuous spectrum encompassing an absorption edge of an element within the object. The spectrum is prepared by a bent Laue monochromator with good focal and energy dispersive properties. The monochromator focuses the spectral beam at the object location, which then diverges onto an area detector such that one dimension in the detector is an energy axis. A least-squares method is used to interpret the transmitted spectral data with fits to either measured and/or calculated absorption of the contrast and matrix material-water. The spectral-KES system is very simple to implement and is comprised of a bent Laue monochromator, a stage for sample manipulation for projection and computed tomography imaging, and a pixelated area detector. The imaging system and examples of its applications to biological imaging are presented. The system is particularly well suited for a synchrotron bend magnet beamline with white beam access. [ABSTRACT FROM AUTHOR]

Larry E Miller,1 Melissa S Martinson,2 Joseph S Gondusky,3 Atul F Kamath,4 Friedrich Boettner,5 Samir K Bhattacharyya6 1Miller Scientific Consulting, Inc., Asheville, NC 28803, USA; 2Technomics Research, LLC, Long Lake, MN 55356, USA; 3Department of Orthopaedic Surgery, Jordan-Young Institute, Virginia Beach, VA 23462, USA; 4Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; 5Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; 6DePuy Synthes, Raynham, MA 02767, USA Background: While primary total hip arthroplasty (THA) is a safe and effective procedure, it is unclear whether choice of surgical approach influences health care cost. Methods: We developed an economic model in which patients receiving THA via the anterior approach (AA) by high volume anterior hip surgeons were compared to a propensity-score matched cohort of primary THA cases performed by high volume surgeons that were identified from Medicare claims (Control). Cost elements included the procedure and hospital stay, postacute care, readmission, and outpatient care through 90 days postoperatively. Costs were derived from Medicare claims and adjusted to account for nationwide payer mix. Results: Health care costs over 90 days postoperative were $17,763 with AA and $23,969 with Control, a difference of $6,206 (95% CI: $5,210–$7,204) per patient. The cost savings with AA were mainly attributable to lower per-patient costs of the index hospitalization ($13,578 vs $16,017), postacute care ($3,123 vs $6,037), and hospital readmissions ($700 vs $1,584). Conclusion: The AA for primary THA was found to lower 90-day health care costs when compared to a matched sample of THA cases. These study findings may be used to inform hospitals and health care payers regarding the cost implications associated with selection of different surgical approaches to primary THA. Keywords: anterior approach, bundle, cost, hip, Medicare, reimbursement, total hip arthroplasty

James C Ulchaker,1 Melissa S Martinson2 1Department of Urology, Cleveland Clinic, Cleveland, OH, 2Technomics Research, LLC, Minneapolis, MN, USA Objective: To conduct a cost-effectiveness analysis from payers’ perspectives of six treatments for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and to examine positioning of these modalities in the marketplace for the best use of health care funds and quality-of-life benefits for patients.Methods: The economic analysis was conducted with a Markov model to compare combination prescription drug therapy (ComboRx), minimally invasive therapies (MITs) including convective radiofrequency (RF) water vapor thermal therapy (Rezūm®), conductive RF thermal therapy (Prostiva®), and prostatic urethral lift (UroLift®), and invasive surgical procedures including photovaporization of the prostate (Greenlight® PVP) and transurethral resection of the prostate (TURP). Effects assessed with International Prostate Symptom Score, adverse events, and re-treatment rates were estimated from medical literature; treatments effects were modeled using a common baseline score. Starting with each therapy, patients’ transitions to more intensive therapies when symptoms returned were simulated in 6-month cycles over 2 years. Incremental cost-effectiveness ratios (ICERs) were calculated for pairs of treatments; uncertainty in ICERs was estimated with probabilistic sensitivity analyses.Results: ComboRx was least effective and provided one-third of the symptom relief achieved with MITs. UroLift was similar in effectiveness to Prostiva and Rezūm but costs more than twice as much. The cheaper MITs were ~$900 more expensive than the cost of ComboRx generic drugs over 2 years. TURP and PVP provided slightly greater relief of LUTS than MITs at approximately twice the cost over 2 years; typically, they are reserved for treatment of more severe LUTS.Conclusion: The analysis evaluated the costs and symptom relief of six treatment options in the continuum of care from a common baseline of LUTS severity. Identification of treatments for LUTS/BPH that demonstrate cost-effectiveness and provide appreciable symptom relief is paramount as reimbursement for patient care moves from volume-based services to value-based services. Keywords: prostate, benign prostatic hyperplasia, lower urinary tract symptoms, cost-­effectiveness analysis, minimally invasive therapy

We conducted an 8-year, prospective, longitudinal study of athletic injuries occurring to students in grades 7 to 12 at a private school in Honolulu. All injuries were evaluated by the same personnel. A total of 14,318 athletes participated in 32 sports; multisport athletes were counted once per sport. Every time an athlete sought medical help it was considered a reportable injury. The five injury classifications were 1) minor, no time lost; 2) mild, 1 to 7 days lost; 3) moderate, 8 to 21 days lost; 4) severe, 22 or more days lost; and 5) catastrophic, permanent disability or death. Athletes reported 11,184 injuries, with 3965 (35%) day-lost injuries (a minimum of 1 day lost from activity). Football resulted in the highest injury rate for male athletes. Soccer resulted in the highest injury rate for female athletes. With the football and wrestling data removed, there was no significant difference between the rate of injury for boys (0.58 injuries per athlete and 0.21 day-lost injuries per athlete) and girls (0.64 injuries per athlete and 0.21 day-lost injuries per athlete). [ABSTRACT FROM AUTHOR]

Agricultural productivity remains pivotal to the sustenance of the economies and livelihoods of Sub-Saharan African (SSA) countries. However, the emerging threat of climate change poses a significant challenge to these agricultural-dependent economies. Sub-Saharan African countries are at risk of experiencing the severe effects of climate change on their agricultural productivity. This paper examines the impact of climate change, as proxied by CO2 emissions, on the agricultural production index in Sub-Saharan Africa. The agricultural production index consists of the Crop and Livestock Production Index. Data for the study were extracted from the World Development Indicator, covering the period 1996-2021. The analysis utilized the Panel GMM estimation technique. The study revealed that the effects of climate change vary on crop production and livestock production indices. While climate change has a positive and significant effect on the crop production index, it exhibits a negative and significant impact on the livestock production index. Factors such as technological development, arable land size, and renewable energy use play a significant role in enhancing agricultural productivity in Sub-Saharan Africa. Conversely, government effectiveness and labor force exhibit a negative influence on the crop production index. In contrast to the crop production index, climate change has a detrimental effect on livestock productivity. Additionally, technological progress, renewable energy use, and arable land size have a negative impact on livestock productivity. The study recommends that African governments implement policies to promote technological progress, improve institutional quality, and increase renewable energy use in the agricultural sector to achieve sustainable agricultural growth. Policymakers and governments are also encouraged to address the challenges of communal land ownership and unclear property rights., Competing Interests: Declarations. Ethics approval: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Longstanding research has shown strong inequalities in low birthweight by household income. However, most such research has focused on Anglophone countries, while evidence emerging from other developed countries suggest a stronger role of education rather than incomes in creating inequalities at birth. This paper compares gradients in low birthweight by maternal education, as well as explores underlying mechanisms contributing to these gradients, in France, the United States, and the United Kingdom., Methods: Analyses are based on harmonized data from large, nationally-representative samples from France, UK and US. We use regression models and decomposition methods to explore the relative role of several possible mechanisms in producing birthweight inequalities., Results: Inequalities in low birth weight across maternal education groups were relatively similar in the United States, the United Kingdom and France. However, the individual-level mechanisms producing such inequalities varied substantially across the three countries, with income being most important in the US, pregnancy smoking being most evident in France, and the UK occupying an intermediate position. Differences in the mechanisms producing birth health inequalities mirror differences in the policy environment in the three countries., Conclusion: While inequalities in health appear from the earliest moments in many countries, our results suggest research on birth health inequalities, and therefore policies, is not easily generalizable across national contexts, and call for more scholarship in uncovering the "whys" of health inequalities in a variety of contexts., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

This paper examines the relative role of financial inclusion in enhancing households' ability to spend on energy consumption across rural and urban locations. It uses comprehensive household data from Ghana and employs the ordinary least square (OLS) as well as an instrumental variable estimation technique. Endogeneity of financial inclusion is instrumented using distance to the nearest bank. Our findings suggest that a standard deviation increase in financial inclusion contributes to an improvement in residential energy expenditure by 1.2835 standard deviations. This finding is robust to different methods for resolving endogeneity and alternative weighting schemes in the financial inclusion construct. Among the different sources of energy for lighting and cooking, financial inclusion increases expenditure on LPG and electricity more than the others. Financial inclusion increases the ability to spend more on residential energy in urban, poorest, and female-headed dual-parent households. Household net income is a key pathway through which financial inclusion affects residential energy expenditure., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: Lower-limb amputation rates in patients with chronic limb-threatening ischemia vary across the United States, with marked disparities in amputation rates by gender, race, and income status. We evaluated the association of patient, hospital, and geographic characteristics with the intensity of vascular care received the year before a major lower-limb amputation and how intensity of care associates with outcomes after amputation., Methods: Using Medicare claims data (2016-2019), beneficiaries diagnosed with chronic limb-threatening ischemia who underwent a major lower-limb amputation were identified. We examined patient, hospital, and geographic characteristics associated with the intensity of vascular care received the year before amputation. Secondary objectives evaluated all-cause mortality and adverse events following amputation., Results: Of 33 036 total Medicare beneficiaries undergoing major amputation, 7885 (23.9%) were due to chronic limb-threatening ischemia; of these, 4988 (63.3%) received low-intensity and 2897 (36.7%) received high-intensity vascular care. Mean age, 76.6 years; women, 38.9%; Black adults, 24.5%; and of low income, 35.2%. After multivariable adjustment, those of low income (odds ratio, 0.65 [95% CI, 0.58-0.72]; P <0.001), and to a lesser extent, men (odds ratio, 0.89 [95% CI, 0.81-0.98]; P =0.019), and those who received care at a safety-net hospital (odds ratio, 0.87 [95% CI, 0.78-0.97]; P =0.012) were most likely to receive low intensity of care before amputation. High-intensity care was associated with a lower risk of all-cause mortality 2 years following amputation (hazard ratio, 0.79 [95% CI, 0.74-0.85]; P <0.001)., Conclusions: Patients who were of low-income status, and to a lesser extent, men, or those cared for at safety-net hospitals were most likely to receive low-intensity vascular care. Low-intensity care was associated with worse long-term event-free survival. These data emphasize the continued disparities that exist in contemporary vascular practice., Competing Interests: Disclosures Dr Quiroga receives personal fees from Boston Scientific and W.L. Gore. Dr Wadhera receives research support from the National Heart, Lung, Blood Institute (NHLBI)/National Institutes of Health (NIH) K23HL148525 and also receives personal fees from CVS Health and Abbott. Dr Secemsky receives research support from NIH/NHLBI K23HL150290, Food and Drug Administration, Harvard Medical School Shore Faculty Development Award, Becton, Dickinson and Company, Boston Scientific, Cook, Cardiovascular Systems, Inc, Laminate Medical, Medtronic, and Philips and receives personal fees from Abbott, Bayer, Becton, Dickinson and Company, Boston Scientific, Cook, Cordis-X, Cardiovascular Systems, Inc, Janssen, Medtronic, Philips, and VentureMed. Dr West, C.M. King, and J.T. Hasegawa are employees of Abbott Vascular. Dr Martinson is a consultant to Abbott Vascular. The other author reports no conflicts.

Green governance and high-quality green development are crucial to the growth of enterprises; therefore, this paper examines how environmental, social, and corporate governance (ESG) disclosure policies affect the value of heavily polluting companies. The study's data is from the new version of the Governance Guidelines for Public Companies promulgated by the China Securities Regulatory Commission in 2018. Thus, the data of China's public companies from 2011 to 2021 is used for the study's analysis. The methods applied for our estimation analysis are the differences-in-differences (DID) and the mediation effect model. The findings depict that ESG information disclosure policies can significantly inhibit the corporate value of heavily polluting enterprises (HPE). Enterprise technological innovation plays a mediating effect in this mechanism; that is, after introducing the policy, it effectively alleviates the information asymmetry and promotes enterprise technological innovation, but it also damages the enterprise value. Further analysis shows that the inhibition effect of ESG information disclosure policy on the value of HPE is heterogeneous, and for non-state-owned enterprises, ESG information disclosure policies have a stronger inhibitory effect. Also, there is little difference between the central and western regions and the eastern region in terms of the inhibitory effect of ESG disclosure policies on the value of HPE. The conclusion of this paper is conducive to improving the information disclosure policy of listed companies and promoting the green development of enterprises., (© 2023 The Authors.)

This study investigates the relationship between rural Ghanaian household food and nutrition security and financial literacy. We used the endogenous treatment regression (ETR) technique to address the analysis's potential selection bias problem. The findings of our study demonstrated a beneficial relationship between food and nutrition security and financial literacy. According to further studies, the relationship between food security and financial literacy is heterogeneous. Our findings may have some ramifications for promoting food and nutritional security while preserving rural development methods., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Agricultural mechanization is an important component of agricultural modernization, as it contributes to the improvement of agricultural technology and the rapid transformation of agricultural development. However, research on the connection between agricultural mechanization and farmers' health status is scarce. Thus, using the 2018 China Health and Retirement Longitudinal Survey (CHARLS) data, this study explored how agricultural mechanization can affect farmers' health. OLS and 2SLS models were used for the study's analysis. Furthermore, we used a PSM model to check the robustness of our analysis. The findings showed that: (1) the current state of agricultural mechanization in western China harms the health of rural residents; (2) agricultural mechanization can mitigate the adverse effects on health by increasing farmers' living expenditure and improving their living environment; and (3) agricultural mechanization's effects on farmers' health are regionally and income-heterogeneous. Agricultural mechanization has a more significant impact on health in Tibetan areas and high-income regions. It has an almost minimal effect in non-Tibetan and low-income areas. This paper suggests approaches that can be used to encourage the rational development of agricultural mechanization and improve rural populations' health.

Prior studies explored the production and technical efficiency of fish farms and farmers from the perspectives of factors such as credit access and cooperative membership. We focused on the chronic non-communicable diseases (NCDs) of household members and their quantitative impacts on fish farm production efficiency, based on data of earthen pond fish farms from two regions (Bono East and Ashanti) in Ghana. A data envelopment analysis (DEA) and the IV Tobit technique were employed for the study's analysis. From the study's observations, we draw the following conclusions. We found that the NCDs of household members indeed reduce farm production efficiency, and the heterogeneous impact of the NCDs of female members on farm production efficiency was more prominent than that of male members. Insights from this study suggest that the national government should provide farmers with the necessary medical care through the provision of subsidized health insurance, which can facilitate access to healthcare services. Moreover, NGOs and governments should encourage health literacy, i.e., organizing programs aimed at educating farmers on NCDs and their impact on agriculture.

Nutritional status plays an indispensable role in enhancing human capital and preventing the return to poverty. In the context of the three-child policy and the aging society in China, intergenerational care will inevitably become a core component of family support. Thus, this paper evaluates the impacts of intergenerational care behavior on nutritional intake in Chinese rural residents from the perspective of household consumption. The study's data is from the China Family Panel Studies (CFPS) (2010-2014), and, the fixed effect model and analyses are applied to achieve the study's objective. The results reveal that rural residents with intergenerational family care behavior have significantly higher food diversity. Thus, Chinese rural residents with intergenerational care consumed 22.4% more food. A possible mechanism is that intergenerational care improves young mothers' labor participation and income, thus optimizing their dietary structure. Moreover, there was heterogeneity concerning the nutrition intake among rural residents in different geographic and family net income groups. Finally, the robust check is consistent with the baseline regression results. In summary, governments should fully affirm the elderly contribution to families to give full play to the elderly family benefit maximization.

Recent progress in targeting KRAS G12C has provided both insight and inspiration for targeting alternative KRAS mutants. In this study, we evaluated the mechanism of action and anti-tumor efficacy of MRTX1133, a potent, selective and non-covalent KRAS G12D inhibitor. MRTX1133 demonstrated a high-affinity interaction with GDP-loaded KRAS G12D with K D and IC 50 values of ~0.2 pM and <2 nM, respectively, and ~700-fold selectivity for binding to KRAS G12D as compared to KRAS WT . MRTX1133 also demonstrated potent inhibition of activated KRAS G12D based on biochemical and co-crystal structural analyses. MRTX1133 inhibited ERK1/2 phosphorylation and cell viability in KRAS G12D -mutant cell lines, with median IC 50 values of ~5 nM, and demonstrated >1,000-fold selectivity compared to KRAS WT cell lines. MRTX1133 exhibited dose-dependent inhibition of KRAS-mediated signal transduction and marked tumor regression (≥30%) in a subset of KRAS G12D -mutant cell-line-derived and patient-derived xenograft models, including eight of 11 (73%) pancreatic ductal adenocarcinoma (PDAC) models. Pharmacological and CRISPR-based screens demonstrated that co-targeting KRAS G12D with putative feedback or bypass pathways, including EGFR or PI3Kα, led to enhanced anti-tumor activity. Together, these data indicate the feasibility of selectively targeting KRAS mutants with non-covalent, high-affinity small molecules and illustrate the therapeutic susceptibility and broad dependence of KRAS G12D mutation-positive tumors on mutant KRAS for tumor cell growth and survival., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

The current study examines the long-run effects of climatic factors on wheat production in China's top three wheat-producing provinces (Hebei, Henan, and Shandong). The data set consists of observations from 1992 to 2020 on which several techniques, namely, fully modified OLS (FMOLS), dynamic OLS (DOLS), and canonical co-integrating regression (CCR) estimators, and Granger causality, are applied. The results reveal that climatic factors, such as temperature and rainfall, negatively influenced wheat production in Henan Province. This means that Henan Province is more vulnerable to climate change. In contrast, it is observed that climatic conditions (via temperature and rainfall) positively contributed to wheat production in Hebei Province. Moreover, temperature negatively influenced wheat production in Shandong Province, while rainfall contributed positively to wheat production. Further, the results of Granger causality reveal that climatic factors and other determinants significantly influenced wheat production in the selected provinces.

In recent years, the changing climate has become a major global concern, and it poses a higher threat to the agricultural sector around the world. Consequently, this study examines the impact of changing climate and technological progress on soybean yield in the 13 major provinces of China, and considers the role of agricultural credit, farming size, public investment, and power of agricultural machinery from 2000 to 2020. Fully modified ordinary least squares (FMOLS) and dynamic ordinary least squares (DOLS) are applied to assess the long-run effect, while Dumitrescu and Hurlin's (2012) causality test is used to explore the short-run causalities among the studied variables. The results revealed that an increase in the annual mean temperature negatively and significantly affects soybean yield, while precipitation expressively helps augment soybean yield. Furthermore, technological factors such as chemical fertilizers accelerate soybean yield significantly, whereas pesticides negatively influence soybean yield. In addition, farming size, public investment, and power of agricultural machinery contribute remarkably to soybean yield. The causality results endorse that chemical fertilizers, pesticides used, agricultural credit, public investment, and power of agricultural machinery have bidirectional causality links with soybean yield. This study suggests several fruitful policy implications for sustainable soybean production in China.

The present article overviews the current state-of-the-art and future prospects for the use of diatomaceous earth (DE) in the continuously expanding sector of energy science and technology. An eco-friendly direct source of silica and the production of silicon, diatomaceous earth possesses a desirable nano- to micro-structure that offers inherent advantages for optimum performance in existing and new applications in electrochemistry, catalysis, optoelectronics, and biomedical engineering. Silica, silicon and silicon-based materials have proven useful for energy harvesting and storage applications. However, they often encounter setbacks to their commercialization due to the limited capability for the production of materials possessing fascinating microstructures to deliver optimum performance. Despite many current research trends focusing on the means to create the required nano- to micro-structures, the high cost and complex, potentially environmentally harmful chemical synthesis techniques remain a considerable challenge. The present review examines the advances made using diatomaceous earth as a source of silica, silicon-based materials and templates for energy related applications. The main synthesis routes aimed at preserving the highly desirable naturally formed neat nanostructure of diatomaceous earth are assessed in this review that culminates with the discussion of recently developed pathways to achieving the best properties. The trend analysis establishes a clear roadmap for diatomaceous earth as a source material of choice for current and future energy applications., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)