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Cardiovascular disease remains a leading cause of morbidity and mortality in the United States (US). Although high-quality data are accessible in the US for cardiovascular research, digital literacy (DL) has not been explored as a potential factor influencing cardiovascular mortality, although the Social Vulnerability Index (SVI) has been used previously as a variable in predictive modeling. Utilizing a large language model, ChatGPT4, we investigated the variability in CVD-specific mortality that could be explained by DL and SVI using regression modeling. We fitted two models to calculate the crude and adjusted CVD mortality rates. Mortality data using ICD-10 codes were retrieved from CDC WONDER, and the geographic level data was retrieved from the US Department of Agriculture. Both datasets were merged using the Federal Information Processing Standards code. The initial exploration involved data from 1999 through 2020 (n = 65,791; 99.98% complete for all US Counties) for crude cardiovascular mortality (CCM). Age-adjusted cardiovascular mortality (ACM) had data for 2020 (n = 3118 rows; 99% complete for all US Counties), with the inclusion of SVI and DL in the model (a composite of literacy and internet access). By leveraging on the advanced capabilities of ChatGPT4 and linear regression, we successfully highlighted the importance of incorporating the SVI and DL in predicting adjusted cardiovascular mortality. Our findings imply that just incorporating internet availability in the regression model may not be sufficient without incorporating significant variables, such as DL and SVI, to predict ACM. Further, our approach could enable future researchers to consider DL and SVI as key variables to study other health outcomes of public-health importance, which could inform future clinical practices and policies. [ABSTRACT FROM AUTHOR]

Simple Summary: Imported fire ants are significant pests of urban, agricultural, and medical importance, causing USD billions of annual losses in the United States. Synthetic insecticides are commonly used in their management. The potential adverse effects of synthetic insecticides highlight the need to develop natural-product-based alternatives for fire ant control. Repellants are useful in managing fire ants; for example, repellants can be used to prevent fire ants from invading sensitive areas, such as electrical equipment, nursing homes, and hospitals. In particular, plant-derived natural repellants may provide a safer and more environmentally friendly alternative. This study demonstrates the repellent effects of the plant-essential-oil-derived compounds carvacrol, thymol, and their acetate derivatives against imported fire ants. Carvacrol, a GRAS compound (Generally Recognized As Safe) was the most potent repellent against red, black, and imported fire ants with minimum repellent effective doses of 0.98 µg/g, 7.80 µg/g, and 0.98 µg/g, respectively, followed by thymol, carvacrol acetate, and thymol acetate. Thymol red essential oil containing carvacrol and thymol also showed repellency. These results indicated that carvacrol and thymol as well as essential oils with high contents of carvacrol and/or thymol are potentially useful in managing imported fire ants. In the United States, imported fire ants are commonly referred to as red imported fire ants (Solenopsis invicta Buren), black imported fire ants (S. richteri Forel), and hybrid imported fire ants (S. invicta × S. richteri). They are significant pests, and their control heavily relies on synthetic insecticides. The extensive use of insecticides has led to public concern about their potential negative effects on human health and the well-being of wildlife and the environment. As an alternative, plant-derived natural compounds, particularly essential oils (EOs) and their main constituents, show promise as safe and environmentally friendly products for controlling fire ants. Repellants are useful in managing fire ants, and plant-derived natural repellants may serve as a safer and more environmentally friendly option. This study investigates the repellency of EO-derived compounds carvacrol, thymol, and their acetates against imported fire ant workers. The results revealed that carvacrol, a GRAS compound (Generally Recognized As Safe), was the most potent repellent against S. invicta, S. richteri, and their hybrid, with minimum repellent effective doses (MREDs) of 0.98 µg/g, 7.80 µg/g, and 0.98 µg/g, respectively. Thymol also exhibited strong repellency, with MREDs of 31.25 µg/g, 31.25 µg/g, and 7.8 µg/g, respectively. Furthermore, thyme-red essential oil, characterized by a thymol chemotype containing 48.8% thymol and 5.1% carvacrol, was found to effectively repel the hybrid ants with an MRED of 15.6 µg/g. In contrast, thyme essential oil, characterized by a linalool chemotype lacking thymol and carvacrol, did not exhibit any repellent effect, even at the highest tested dose of 125 µg/g. This study provides the first evidence of the potent repellency of carvacrol and thymol against imported fire ant workers, indicating their potential as promising repellents for fire ant control. [ABSTRACT FROM AUTHOR]

A mental health treatment gap exists in which individuals who would benefit from evidence-based psychotherapies (EBPs) do not receive them. It is critical to take effective actions so that individuals with unmet mental health needs feel empowered to seek treatment. Direct-to-consumer (DTC) marketing meets this objective. DTC marketing is an effective, patient-centered approach that creates patient demand for a product or service by influencing patient behaviors, attitudes, and preferences. While primarily used in the United States and New Zealand to promote prescription drugs, uses and practices for DTC marketing with nonpharmaceutical EBPs are less established. This article highlights the value of leveraging this marketing approach to increase awareness and use of EBPs. Additionally, an illustrative example is presented that describes the use of social marketing and marketing mix principles to develop effective DTC marketing campaigns in psychotherapy practice. [ABSTRACT FROM AUTHOR]

Objective: The primary goal of our retrospective case-control study was to evaluate the ability of cardiopulmonary exercise testing to screen for underlying exercise-induced pulmonary hypertension (EIPH) in symptomatic patients who had a negative stress test and elevated right ventricular systolic pressure on echocardiogram. We also evaluated long-acting nitrates and ranolazine as medication challenges. Setting: Performed at a single, tertiary-care medical center in the United States. Participants: Based on the inclusion and exclusion criteria, 81 patients were included in this study. The primary outcome of the study was to measure mean pulmonary arterial pressure at rest and exertion, as well as Wasserman curves. We also recorded patient demographics and risk factors, left ventricular ejection fraction, and mean oxygen consumption. Additionally, patients were monitored symptomatically after receiving long-acting nitrates and ranolazine. Results: A total of 61 patients had resting pulmonary arterial hypertension, and 27 had EIPH. The EIPH group had a significantly higher mean age of 71.67 years. Wasserman curves calculated from the cardiopulmonary exercise testing data revealed 3 subgroups of EIPH patients: cardiac restriction, chronotropic incompetence, and combination of both patterns. The EIPH group showed significant improvement in symptoms after receiving long-acting nitrate therapy. Conclusions: Many patients with symptoms of angina, dyspnea, and/or fatigue on exertion with negative cardiac stress testing may have underlying pulmonary arterial hypertension, including EIPH. Therefore, these patients require adequate treatment and follow-up to prevent worsening of symptoms and pathology. [ABSTRACT FROM AUTHOR]

Individualism leading to more consumerism seems to be a bit of truism nowadays in the media. The USA is particularly indicted for being too individualistic and consumerist. Past research has mostly indicated a positive relationship between the two. However, past research has not suggested a negative association between individualism and consumerism. This paper offers support for such a negative relationship by showing that an individual’s ethical values can temper the consumerist nature of individualists. Data were collected in the USA and Taiwan. Structural equation models demonstrate that our hypothesized model fits our data well. A key result over the global sample is the stability of the linear path from individualism to work ethic to consumer ethic to consumerism. The two-nation comparison also supports differences in how Taiwanese and Americans differ in their belief that consumption benefits society. [ABSTRACT FROM AUTHOR]

The author talks about the importance of responsibility in business and the economy. He notes that the view of business practices and the economic system has been altered by scandals, frauds and economic meltdowns. He examines the major financial and economic crises faced by the sector during the 20th century which include the debt crisis in the 1920s and the ongoing global financial crisis that started in the U.S. in 2007. In the author's opinion, the current crisis has been caused by a lack of responsibility toward organization and society.

Individualism-collectivism measures, along with decision styles, were examined between two cultural groups of participants: Americans and Arabs. The American group participated in MBA executive programs, while the Arab group participated in international management development programs. American participants scored higher than their Arab counterparts on individualism, but less on collectivism measures. Participants in both groups displayed a strong preference for consultative and participative styles and determined that these two styles were the most effective in practice and that their immediate supervisors were consultative and participative. Similar constructs in each category were significantly and positively correlated, but negatively related to opposite measures. [ABSTRACT FROM PUBLISHER]

Focuses on the need to expose weaknesses in corporate governance and supervision in the United States and the urgency to fix them. Introduction of reforms that revolved around integrity and ethical behavior by U.S. President George W. Bush; Possible restoration of confidence in business and reduction in business irregularities by decent action and commitment to market integrity.

U.S. competitiveness in the global economy is inextricably linked to the participation of small and medium- sized firms. This article examines four hypotheses regarding the relationship of firm size and export experience to exporting attitudes and behaviors. Data from 195 midwestern firms provide only limited support for the effect of size and experience on attitudes toward exporting. Size and experience, however, were found to have a modest impact on the skills and attitudes perceived to be necessary for successful international business. ^ [ABSTRACT FROM AUTHOR]

Presents a study that highlights the importance of work ethic in organizational and cross-cultural studies. Comparison of work ethic and beliefs in the United States and Canada; Relationship between various work-related measures; Conclusion.

The author comments on an article published in the May 19, 2009 issue of the "New York Times" in which the conclusion represents a misunderstanding of the role of U.S. chief executive officers (CEOs). He says the paper claimed that being flexible, team-oriented and empathetic are unnecessary traits for effective CEOs. He cites that the conclusion is based on the study "Which CEO Characteristics and Abilities Matter?," by S. N. Kaplan et al. He notes the apparent suggestion of the periodical that politicians cannot be successful CEOs and vice versa.

The author offers his views on national competitiveness in today's global market and amidst the impending recession in the U.S. He argues that issues of global growth and customer welfare are vital elements of competitiveness. He believes that improving the welfare of the people constitutes the primary outcome of competitiveness and that the output of competitiveness is more likely to erode in an environment of war, instability and hostility.

Discusses issues on job outsourcing in the U.S. Estimated total number of new jobs by 2008 in the information technology services and software market; Policies imposed by Europe on immigration; Number of additional jobs in the country in 2003, according to the Information Technology Association of America.

Heart failure (HF) hospitalizations remains a significant burden on the health care system. Stimulants including cocaine, amphetamine and its derivatives are amongst the most used illegal substances in the United States. The information regarding stimulant-related HF hospitalizations is scarce. We sought to evaluate the characteristics and trends of stimulant-related HF hospitalizations in the United States and their associated outcomes and resource utilization. Using the National Inpatient Sample (NIS), we identified patients with a primary diagnosis of HF hospitalization. These hospitalizations were further divided into those with and without a concomitant diagnosis of stimulant (cocaine or amphetamine) dependence or abuse. Survey specific techniques were employed to compare trends in baseline characteristics, complications, procedures, outcomes and resource utilization between the two cohorts. We identified 9,932,753 hospitalizations (weighted) with a primary diagnosis of heart failure, of those 138,438 (1.39%) had a diagnosis of active stimulant use. The proportion of stimulant-related HF hospitalization is on the rise (1.1% to 1.9%). Stimulant-related HF hospitalization was highest amongst age group 30–39 years and 7.9% of HF hospitalizations in this age group were due to stimulant use. The proportion of stimulant-related HF hospitalization for the White and Hispanic race has doubled from 2008 to 2017. Stimulant-related HF hospitalization is associated with increased incidence of in-hospital complications like cardiogenic shock, acute kidney injury and ventricular tachycardia. These patients have more than 7-fold higher discharge against medical advice. Stimulant-related HF hospitalizations have been increasing. It is associate with significant morbidity burden and health care utilization. • Stimulant related acute congestive heart failure hospitalization (ACHF) is currently on the rise in the United States. • Stimulant related ACHF hospitalization peaks at age 30–39 years and accounts for 8% of heart failure hospitalization from all cause. • Stimulant related ACHF hospitalization mostly affects African Americans, however there is a steady yet gradual trend of increased hospitalization in other race groups. • The proportion of stimulant related hospitalization for Whites and Hispanics has doubled between 2008 and 17. • Stimulant related ACHF hospitalizations had a > 7-fold higher discharge AMA. [ABSTRACT FROM AUTHOR]

• The incidence of Acute kidney injury (AKI) in patients primarily hospitalized for Acute heart failure (AHF) in 24.3%. • AKI in AHF hospitalization is associated with significantly higher in-hospital mortality, longer duration of hospital stay and an increased cost of hospitalization. • Patients presenting with AKI in AHF have higher rates of in-hospital complications including cardiac arrest, cardiogenic shock, transfusion of blood and blood products, and vascular complications. • Patients presenting with AKI in AHF undergo more invasive procedures including permanent pacemaker implantation, implantable cardioverter defibrillation, cardiac resynchronization and mechanical ventilation. • There has been a steady increase in the incidence of AKI among patients hospitalized with AHF between the year 2012-2014 in the United States. We sought to determine the impact of acute kidney injury (AKI) on in-hospital outcomes in patients presenting with acute heart failure (AHF). Data from National Inpatient Sample (2012- 14) were used to identify patients with the principal diagnosis of AHF and the concomitant secondary diagnosis of AKI. Propensity score matching was performed on 30 baseline variables to identify a matched cohort. The outcome of interest was in-hospital mortality. We further evaluated in-hospital procedures and complications. Of 1,470,450 patients admitted with AHF, 24.3% had AKI. After propensity matching a matched cohort of 356,940 patients was identified. In this matched group, the AKI group had significantly higher in-hospital mortality (3.8% vs 1.7%, p<0.001). Complications such as sepsis, transfusions and cardiac arrest were also higher in the AKI group (p<0.01). Similarly, in-hospital procedures including pacemaker, coronary artery bypass graft, mechanical ventilation and intra-aortic balloon pump were performed more in the AKI group compared to the non-AKI group. The rate of AKI in patients with AHF has gradually increased from 29 % in the year 2012 to 35% in 2014. AHF patients with AKI had longer in-hospital stay of ~1.7 days. In this propensity score-matched cohort of AHF with and without AKI, the risk of in-hospital mortality was >2-fold in the AKI group. Healthcare utilization and burden of complications were higher in the AKI group. [ABSTRACT FROM AUTHOR]

Discusses the monopoly charges filed by the United States Department of Justice and Microsoft competitors against Microsoft Corp. How Microsoft captured a high share of the browser market at the expense of Netscape company; Nature of business competition; Comments from Janet Reno, the Attorney General of United States.

Older adults in the United States have lower rates of mental health care utilization than young adults. To understand these lower rates of mental health care, we performed a systematic review, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of barriers that prevent older adults from seeking and accessing treatment. We searched PubMed, PsycINFO, and Clinical Key to identify studies of barriers to mental health treatment in the older adult population (in individuals 50 y of age and older). Thirty-two articles met inclusion criteria (English language and focused on barriers to care in older adults) and exclusion criteria (focus on non-United States populations, focus on younger adults, or no focus on barriers to care). We identified 5 categories of barriers to mental health care in older adults: (1) attitudes and knowledge among older adults; (2) comorbid medical conditions; (3) provider-related factors; (4) other extrinsic barriers (eg, cost, transportation, reliance on caregivers); and (5) unique factors that affect older adults in minority populations. Large studies have primarily identified intrinsic barriers, including negative attitudes toward mental health care and lack of perceived need for treatment, as preventing older adults from seeking mental health care. Minority populations have also been found to face cultural barriers and increased levels of stigma compared with non-Hispanic whites, although several of the identified articles concerning barriers among minority older adults involved qualitative studies with small samples. Larger quantitative studies may help clarify the relative importance of barriers affecting this population. Interventions that have been shown to increase access to mental health services for older adults include community-based care and integrated primary and psychiatric care, but these strategies can be difficult to implement in low-resource settings. More research is needed to determine which interventions and policies are most effective in targeting particular barriers.

Objectives: Despite the growing number of individuals with dementia, clinicians skilled in caring for people with dementia, especially in rural areas, are lacking. The Program for Advancing Cognitive Disorders Education for Rural Staff (PACERS) was designed to improve clinician competency and comfort when caring for individuals with dementia. Based on an interprofessional needs assessment, six 1-hour training modules were created: (1) Dementia and Delirium, (2) Identifying and Assessing for Dementia, (3) Treating Dementia: Case Studies, (4) Normal Cognitive Aging and Dementia Caregiving, (5) Addressing Decision Making and Safety in Dementia, and (6) Dementia and Driving. Each module is available for free on the Department of Veterans Affairs Talent Management System (TMS) for employees and the free TrainingFinder Real-time Affiliate Integrated Network (TRAIN) platform for clinicians in the community. One continuing education unit is earned upon completion of each module., Design: Posttest., Setting: Online training at VA TMS and TRAIN., Participants: To date, more than 3000 modules have been completed by interprofessional healthcare learners (eg, nurses, physicians, psychologists, and social workers)., Measurements: Satisfaction, perceived utility of training, knowledge, skills, and attitudes were assessed., Results: The learners reported high satisfaction (mean [M] > 4) and ability to apply the knowledge and skills learned from the module to their job (M > 4) on a Likert scale (1 = Strongly disagree to 5 = Strongly agree)., Conclusion: Learners also reported perceived impact on both direct patient care (eg, ability to provide education and support to individuals with dementia and their caregivers) and system-level care (eg, more appropriate referrals). Given the number of users and their evaluation data, PACERS can serve as a model curriculum for online interprofessional dementia training. J Am Geriatr Soc 68:192-197, 2019., (© 2019 The American Geriatrics Society.)