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Background: Certain types of cancer and treatment increase the risk of falls among cancer patients, particularly patients with hematologic cancer undergoing bone marrow transplant (BMT). Nurses are integral to preventing falls and maintaining patient safety. Understanding patients undergoing BMT fall risk factors may help nurses identify high fall risk patients and develop fall prevention interventions. Purpose: This systematic review aims to identify risk factors for falls among hospitalized adult patients receiving BMT treatment. Methods: Guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses, a systematic review of the literature was conducted by searching databases PubMed and CINAHL. Study quality was evaluated using the Crowe Critical Appraisal Tool form (v1.4). Findings: An initial search yielded 829 articles; six were included for final review after removing duplicates and screening for inclusion criteria: specific to patients undergoing BMT, measure fall outcome, in hospital, and original research. The identified risk factors include age of 65 and older, leukemia diagnosis, days of diarrhea, incontinence of urine or stool, increased pulse rate, muscle weakness, hypnotic, anxiolytic medication, recent steroid use, allogenic transplant, and post‐engraftment period. Conclusions: Risk factors for falls among patients undergoing BMT are multifactorial and are related to muscle weakness, medication administration, pulse rate, type of transplant, age, engraftment period, and bathroom use. Implications for nursing: Nurses providing care to patients undergoing BMT need to assess and increase nurse surveillance on allogeneic transplant patients, specifically those on anxiolytic, hypnotic, and steroid medications. Nurses providing care to patients undergoing BMT should implement more fall prevention strategies in patients undergoing BMT who develop diarrhea and urine or stool incontinence. Identifying specific patients undergoing BMT fall risk factors and applying multifaceted individualized fall prevention strategies has the potential to improve allogeneic transplant patient care and prevent fall‐related complications. [ABSTRACT FROM AUTHOR]

The trace element selenium, which is found in selenoproteins, plays an antioxidant role in preventing muscle tissue injury. A positive association between selenium concentrations and hand grip strength has been reported in older adults; however, the evidence of this association is scarce in general adults. In this study, we aimed to evaluate the association between blood selenium concentrations and low hand grip strength using the data from the National Health and Nutrition Examination Survey 2011–2012 and 2013–2014 in the United States (US). Logistic regression was used to calculate the odds ratio (OR) of low hand grip strength, with blood selenium level adjusted for potential confounders. Among 8158 adults (women: 51.59%) with a mean age of 47 (range: 18–80) years, women and non-Hispanic Blacks tended to have low blood selenium concentrations. Notably, participants with high blood selenium concentrations (range, 178.1–192.5 µg/L) were more likely to have a low risk of low hand grip strength after adjusting for the potential covariates (OR: 0.60, 95% confidence interval (CI): 0.38–0.95) than those with low blood selenium concentrations. After excluding participants with chronic diseases, high blood selenium concentrations were found to be associated with a low risk of low hand grip strength (OR: 0.30, 95% CI: 0.14–0.65). A J-shaped relationship was found between selenium concentrations and low hand grip strength (P for nonlinear trend <0.0001). Subgroup analyses revealed a significantly consistent relationship among women, non-Hispanic Whites and others, and individuals with overweight or obesity (P < 0.05). Our study suggests that blood selenium concentrations are inversely associated with hand grip strength in general US adults. However, further prospective studies are required to confirm the causality between selenium concentrations and hand grip strength. [ABSTRACT FROM AUTHOR]

Purpose: Chronic low-grade systemic inflammation affects muscle protein metabolism. The dietary inflammatory index (DII®) is a tool designed to assess the inflammatory potential of the diet. The available data on the association between DII and sarcopenia are limited. We aimed to investigate the association of the DII with components of sarcopenia in individuals over 50 years of age. Methods: This cross-sectional study used the National Health and Nutrition Examination Survey (NHANES) 1999–2002 dataset. Body composition was measured, and isokinetic strength of the knee extensors (peak force) was evaluated. Low muscle mass and strength were defined using sex-specific thresholds. Energy-adjusted DII (E-DII™) scores were calculated using 24-h dietary recall data. Regression models were fit to evaluate the association between E-DII scores and low muscle mass and low muscle strength, alone and combined. Results: Mean age of study participants was 62.1 ± 9.5 years, and 138 participants (7.4%) belonged to the combination group of low muscle mass and low muscle strength. In multivariable-adjusted regression models, higher E-DII score was associated with lower appendicular skeletal muscle index (ASMI) (β = − 0.03, P < 0.001, P trend <0.001), and lower peak force (β = −2.15, P = 0.04, P trend = 0.01) and higher likelihood for these components combined (OR = 1.12, 95% CI 1.01–1.25, P = 0.03). Conclusion: Higher E-DII score is associated with lower muscle mass and muscle strength, and increased likelihood for the combination of low muscle mass and low muscle strength in older adults. This has important implications for healthy aging. [ABSTRACT FROM AUTHOR]

Background: Pertuzumab is a humanized monoclonal antibody for the treatment of breast cancer. HLX11 is a biosimilar of pertuzumab developed by Shanghai Henlius Biotech, Inc. We conducted a bioequivalence study for HLX11 and pertuzumab (United States [US]-, European Union [EU]-, and China [CN]-approved products). Objectives: This study compared the biosimilarity in pharmacokinetics (PK), safety, and immunogenicity between HLX11 and reference pertuzumab (approved in the US, the EU, and CN) in healthy Chinese male participants after a single infusion and further characterized the PK profile of HLX11. Methods: Eligible individuals were randomized 1:1:1:1 to receive a single dose of 420 mg HLX11, US-, EU-, or CN-pertuzumab via intravenous infusion over 60 min. The primary endpoints were maximum serum drug concentration (Cmax), area under the serum concentration–time curve (AUC) from time 0 to time of the last quantifiable concentration (AUC0–t), and AUC from time 0 to infinity (AUC0–∞). PK bioequivalence was established if the 90% confidence intervals (CIs) of the geometric mean ratios of the primary endpoints were between 80.0 and 125.0%. Secondary endpoints included other PK parameters, safety, and immunogenicity. Results: A total of 160 participants were enrolled and randomly assigned to each group (n = 40 per group). The 90% CIs of the geometric mean ratios of the primary endpoints were all within the prespecified equivalence margins (HLX11 vs. pertuzumab [US-, EU-, CN-approved products]: Cmax 97.03–115.06%, 91.39–109.80%, 94.53–110.65%; AUC0–t 87.65–99.68%, 87.07–100.79%, 86.29–101.09%; AUC0–∞ 87.66–99.90%, 87.54–101.05%, 89.23–103.20%). The incidence of adverse drug reactions was comparable across the four groups. The presence of anti-drug antibodies or neutralizing antibodies had no obvious effect on PK. Conclusion: The PK, safety, and immunogenicity of HLX11 were highly similar to those of reference pertuzumab (US-, EU-, CN-approved products). The established bioequivalence supports further clinical trials of HLX11 in cancer treatment. Trial Registration: This study was registered with ClinicalTrials.gov (NCT04411550) and Chinadrugtrials.org.cn (CTR20200618). [ABSTRACT FROM AUTHOR]

Background: Levels of inflammatory markers are elevated in patients with psychological disorders. However, anti-psychological drugs have an effect on proinflammatory cytokine production and disturb their relationship. Limited evidence focuses on the inflammatory marker profile of psychological status before treatment. This study aimed to investigate the inflammatory biomarker profiles of psychological treatment-naive individuals.Methods: We included 790 psychological treatment-naive individuals from a longitudinal cohort study of Midlife in the United States (MIDUS). Symptoms of depression, anxiety, and stress were assessed by the Center for Epidemiologic Studies Depression Scale (CES-D) subscales, the Social Anxiety Scale (STAI), and Liebowitz Social Anxiety Scale (LSAS), the Perceived Stress Scale (PSS), respectively.Results: Spearman correlation analysis showed that a higher CESD total score was correlated with higher CRP (p=0.009), IL-6 (p=0.007), fibrinogen (p=0.036), E-selectin (p=0.018), ICAM-1 (p=0.013), and IL-8 (p=0.05) levels. Multivariate linear regression analysis showed that the CESD total score was positively associated with the levels of IL-6 (p=0.024) after adjustments. Moreover, the perceived stress score (PSS) was negatively associated with the levels of IL-8 (p=0.025). However, these associations were not significant after multiple testing (p=0.088, 0.091, respectively).Limitations: The casual relationship cannot be drawn due to the cross-sectional design CONCLUSION: Overall, our results suggested IL-6 and IL-8 might play a important role in the pathogenesis of psychological disorder. Larger and longitude studies are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Displaying partial trust in exchanges between strangers is a common practice, but it does not effectively promote reciprocation. This is an intriguing phenomenon that warrants investigations regarding social mechanisms that can promote reciprocation without changing the level of trust. We seek to examine, given a partial-trust act, whether framing the motive underlying the act as prosocial (mutually beneficial) can promote reciprocation in an exchange between strangers. Across three experiments in the United States, we found that trustor prosocial (vs. no-motive) framing can promote trustee reciprocation through trustee felt obligation and that this effect is particularly strong among trustees with a strong rather than weak exchange orientation. Concurrently, this prosocial framing effect can operate serially through trustee perceived invitation for exchange and felt obligation. Our findings help address the conundrum of promoting reciprocation without introducing deleterious uncertainty about social motives given a partial-trust act that is prevalent in exchanges at zero acquaintance. [ABSTRACT FROM AUTHOR]

In the United States, home health agencies (HHAs) provide essential services for patients recovering from post-acute care and older adults who are aging in place. During the COVID-19 pandemic, HHAs may face additional challenges caring for these vulnerable patients. Our objective was to explore COVID-19 preparedness of US HHAs and compare results by urban/rural location. Cross-sectional study. Using a stratified random sample of 978 HHAs, we conducted a 22-item online survey from April 10 to 17, 2020. Summary statistics were computed; open-ended narrative responses were synthesized using qualitative methods. Similar to national data, most responding HHAs (n = 121, 12% response rate) were for-profit and located in the South. Most HHAs had infectious disease outbreaks included in their emergency preparedness plan (76%), a staff member in charge of outbreak/disaster preparedness (84%), and had provided their staff with COVID-19 education and training (97%). More urban HHAs had cared for confirmed and recovered COVID-19 patients than rural HHAs, but urban HHAs had less capacity to test for COVID-19 than rural HHAs (9% vs 21%). Most (69%) experienced patient census declines and had a current and/or anticipated supply shortage. Rural agencies were affected less than urban agencies. HHAs have already rationed (69%) or implemented extended use (55%) or limited reuse (61%) of personal protective equipment (PPE). Many HHAs reported accessing supplemental PPE from state/local resources, donations, and do-it-yourself efforts; more rural HHAs had accessed these additional resources compared with urban HHAs. This survey reveals challenges that HHAs are having in responding to the COVID-19 pandemic, particularly among urban agencies. Of greatest concern are the declines in patient census, which drastically affect agency revenue, and the shortages of PPE and disinfectants. Without proper protection, HHA clinicians are at risk of self-exposure and viral transmission to patients and vulnerable family members. [ABSTRACT FROM AUTHOR]

This study takes stock of business and economics research on Artificial Intelligence (AI) and provides a dynamic panorama of the overall knowledge structure of this ever-growing body of work ever since its inception in 1966. Our bibliometric analysis based on the full archive of 1024 studies identifies the main trends of and the major intellectual contributors to the extant knowledge of AI in business and economics research. Specifically, our results show that (1) AI-focused business and economics research wintnessed growth over three stages, particularly with a sharp increase after 2017. (2) While this body of research has gained tremendous momentum across the globe, the United States is by far the center of knowledge generation. (3) Research collaborations are still limited in this area. (4) Research topics flourished, ranging from early decision support systems, neural networks, and scheduling methods to more recent machine learning, automation, and big data. This study also identifies fruitful avenues for further business and economics research with an AI focus. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine whether healthcare-associated infections (HAIs) and nurse staffing are associated using unit-level staffing data. BACKGROUND: Previous studies of the association between HAIs and nurse staffing are inconsistent and limited by methodological weaknesses. METHODS: Cross-sectional data between 2007 and 2012 from a large urban hospital system were analyzed. HAIs were diagnosed using the Centers for Disease Control and Prevention's National Healthcare Safety Network definitions. We used Cox proportional-hazards regression model to examine the association of nurse staffing (2 days before HAI onset) with HAIs after adjusting for individual risks. RESULTS: Fifteen percent of patient-days had 1 shift understaffed, defined as staffing below 80% of the unit median for a shift, and 6.2% had both day and night shifts understaffed. Patients on units with both shifts understaffed were significantly more likely to develop HAIs 2 days later. CONCLUSIONS: Understaffing is associated with increased risk of HAIs. [ABSTRACT FROM AUTHOR]

Buildings consume large amounts of energy and resources and have a significant impact on environment. In 2010 buildings accounted for 32% of total global final energy use and 19% of energy-related GHG emissions. This energy use and related emissions may double or potentially even triple by mid-century. China is the world's largest energy consumer and CO 2 emitter. With the process of urbanization, China has been entering into a period of great prosperity for construction, about 1.6–2.0 billion m 2 buildings are constructed each year, which accounts for about 40% of the world's total new buildings. It is predicted that China’s building energy use and related emissions will continue to increase over the next 15 years. Therefore, promoting green building development has become an urgent issue in China. However, green building is a highly complicated system engineering, its promotion needs evaluation standards as technical support. Many countries had issued a series of green building evaluation standards since 1990. Currently, there are some representative green building assessment schemes. Code for Sustainable Homes (CSH) has been fully implemented as the national authoritative standard of the UK since 2010. Leadership in Energy and Environmental Design (LEED) developed by the USA, was revised and updated regularly with the latest version issued in 2013. China enacted its national evaluation standard for green building in 2006, and revised the standard in 2014. Based on introducing the latest evaluation standards for green buildings in China, Britain and United States, the paper compared these standards from 5 aspects including energy-saving, water-saving, material-saving, site selection and the outdoor and indoor environmental quality. The comparison mainly focuses on evaluation methods and evaluation indicators in the three standard systems. Besides, the characteristics of each standard system were summarized and some suggestions for improving China’s evaluation standard for green building were proposed. [ABSTRACT FROM AUTHOR]

The Central Hardwood Region (CHR) of the United States constitutes one of the most diverse ecoregions in North America and the most extensive temperate deciduous forest in the world. Despite the economic and ecological significance of the CHR, the long-term effects of changes in climate and fire regime on forest structure remain largely unknown. In this study, we developed an integrated Climate-Sensitive Matrix framework to synchronously couple (1) forest dynamics, (2) mean fire interval, (3) population density, and (4) future climate scenarios to study the community and population structure of CHR forests under climate change and associated changes of fire regimes. Using Monte Carlo simulations and coupled forest dynamics-disturbance models, we projected that the CHR would undergo a major shift in forest community structure from the present to year 2100. The fundamental changes would consist of a transition of dominant species from oak and hickory to maple species, reduced species diversity (9.6–11.5%), and substantial declines in stand basal area (55.1–62.0%) and stand volume (56.3–62.4%). These projected changes will have profound ecological and economic implications. Ecologically, changes in tree species diversity favoring maples would alter ecosystem processing of nutrients and subsequent nutrient flows to drainage waters within the region. Habitat change would alter the broad spectrum of organisms relying on the forest, leading to a redistribution of wildlife species, further heightening the risks for endangered species. Economically, the total stumpage value throughout the CHR would be reduced by 54.5–59.8% from approximately $1317 billion to $529–599 billion. On the brink of these fundamental shifts, our study calls for ecologically- and economically-informed conservation and mitigation strategies to better prepare society for the associated changes in ecosystem services and economic benefits derived from CHR forests. [ABSTRACT FROM AUTHOR]

There is now an increasing appreciation of how psychological health can contribute to cardiovascular disease, called the mind-heart connection. A blunted cardiovascular reactivity to depression and anxiety may be responsible for the potential mechanism, however, with inconsistent results. Anti-psychological drugs have an effect on the cardiovascular system and, thus, may disturb their relationship. However, in treatment-naive individuals with psychological symptoms, no research has specifically evaluated the relationship between psychological state and cardiovascular reactivity. We included 883 treatment-naive individuals who came from a longitudinal cohort study of Midlife in the United States. Symptoms of depression, anxiety, and stress were assessed by the Center for Epidemiologic Studies Depression Scale (CES-D), Spielberger Trait Anxiety Inventory (STAI), the Liebowitz Social Anxiety scale (LSAS) and the Perceived Stress Scale (PSS), respectively. Cardiovascular reactivity was measured using standardized, laboratory-based stressful tasks. Treatment-naive individuals with depressive symptoms (CES-D ≥ 16), anxiety symptoms (STAI ≥ 54), and higher stress levels (PSS ≥ 27) had lower cardiovascular reactivity as assessed by systolic blood pressure (SBP) reactivity, diastolic blood pressure (DBP) reactivity and heart rate (HR) reactivity (P < 0.05). Pearson analyses showed that psychological symptoms were correlated with lower SBP reactivity, DBP reactivity, and heart rate reactivity (P < 0.05). Multivariate linear regression showed that depression and anxiety were negatively related to lower cardiovascular reactivity (SBP, DBP and HR reactivity) after full adjustments (P < 0.05). Stress was associated with reduced SBP and DBP reactivity but with a nonsignificant association with HR reactivity (P = 0.056). Depression, anxiety, and stress symptoms are associated with blunted cardiovascular reactivity in treatment-naive adult Americans. These findings suggest that blunted cardiovascular reactivity is an underlying mechanism linking psychological health and cardiovascular diseases. [Display omitted] • This is the first study to evaluate the association between psychological status and cardiovascular reactivity in psychological treatment-naive individuals. • We found that treatment-naïve individuals with depressive symptoms, anxiety symptoms, higher stress level were associated with decreased risk of cardiovascular reactivity. • These findings indicate that blunted cardiovascular reactivity may be one of the underlying mechanisms of "mind-heart connection" in cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Purpose: Antihypertensive drugs are prescribed to patients with chronic kidney disease (CKD) for their cardioprotective and renoprotective effects. Nationally representative information on the use of antihypertensive drugs among CKD patients is limited. The purpose of this study was to assess the utilization patterns of antihypertensive drugs among the CKD population (stages I-IV) in the United States. Methods: We conducted a retrospective crosssectional analysis of the National Health and Nutrition Examination Survey (NHANES) panels from 2005-2006, 2007-2008, and 2009-2010. The estimated glomerular filtration rate was calculated and kidney damage was assessed to identify participants with CKD. The demographic and clinical characteristics of the participants with CKD were reported, as were the antihypertensive drugs they used. Findings: A total weighted sample of 116,231,361 participants representative of the CKD population in the United States (stages I-IV) was identified. Less than one half of the participants with CKD in the NHANES were using antihypertensive drugs. β- blockers were the most commonly used and angiotensin II receptor blockers were the least used antihypertensive agents among participants with CKD. Age (Z70 years), awareness of hypertension or diabetes, and higher stage of CKD were associated with an increased likelihood of antihypertensive drug use among participants with CKD. Implications: The results of our analyses suggest that antihypertensive drugs are underused in the CKD population, and the use of preferred agents (ie, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers) is low. Efforts should be directed toward emphasizing the importance of using antihypertensive drugs in the CKD population. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To determine nationally representative estimates of the prevalence of depressive symptoms and factors associated with treatment among those with moderate to severe symptoms. Methods: A cross-sectional, retrospective analysis of adults age≥18 years in the 2005–2010 National Health and Nutrition Examination Survey data who responded to the Patient Health Questionnaire (PHQ-9) was conducted (n=13,320). Depressive symptoms and severity were defined by PHQ-9 scores. Depression treatment was defined as either receiving antidepressants or seeing a mental health professional. Multivariable logistic regression analyses using population weights identified factors associated with having depressive symptoms and receipt of any treatment. Results: The prevalence of depressive symptoms increased from 20.92% to 25.66% over 6 years. Among patients with moderate to severe depression, 38.66% received treatment. Multivariable analyses found that being female, other Hispanic, younger age, having certain chronic comorbidities or previous hospitalization, no health insurance and in poverty status were associated with having depressive symptoms (P<.05). Among patients with moderate to severe depression, being female, white, younger age, having comorbidities (arthritis and hypertension) or previous hospitalization were associated with receipt of treatment (P<.05). Conclusions: The prevalence of depressive symptoms is high, and only a small portion of patients with moderate to severe depression received treatments. Treatment disparities exist and need improvement. [Copyright &y& Elsevier]

A density-dependent matrix model was developed for Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) – western hemlock (Tsuga heterophylla (Raf.) Sarg.) forest stands in the Pacific Northwest of the United States. The model predicted the number and volume of trees for 4 species groups and 19 diameter classes. The parameters were based on species-dependent equations linking individual tree growth, mortality, and stand recruitment to tree and stand characteristics, including stand diversity in terms of tree species and size. The equations were estimated with individual tree and stand data from 2706 permanent plots in western Washington and Oregon, largely from private and state lands, measured twice at an average interval of 10 years. Other things being equal, diameter growth increased slightly with species diversity and decreased with size diversity. Recruitment increased with species diversity and decreased with size diversity. Mortality was independent of species diversity and tended to increase with size diversity. There was practically no relationship between individual tree volume and species or size diversity. The number of trees predicted by the model over the interval between successive inventories was generally unbiased. Long-term predictions with different initial conditions were consistent with standard yield tables and compared favorably with those of the Forest Vegetation Simulator. The model also implied that, independently of its initial condition, an undisturbed stand would eventually reach a steady state dominated by western hemlock more than 1 m in diameter, with few trees of other species and size. [ABSTRACT FROM AUTHOR]

Home health care is a rapidly growing healthcare sector worldwide. Home health professionals face unique challenges related to preventing and controlling infections, which are likely to amplify during an infectious disease outbreak (e.g. SARS-CoV-2). Little is known about the current state of infection prevention and control-related policies and outbreak preparedness at U.S. home health agencies. In this study, we conducted a national survey to assess infection prevention and control-related policies, infrastructure, and procedures prior to the SARS-CoV-2 pandemic. Cross-sectional study. Using a stratified random sample of 1506 U.S. home health agencies, we conducted a 61-item survey (paper and online) from November 9, 2018 to December 31, 2019. Survey data were linked to publicly-available data on the quality of patient care, patient satisfaction, and other agency characteristics. Probability weights were developed to account for sample design and nonresponse; Pearson's χ2, Fisher's exact, t-tests or linear regression were used to compare the universe of agencies/respondents and urban/rural agencies. 35.6% of agencies responded (n = 536). Most home health personnel in charge of infection prevention and control have other responsibilities; one-third have no formal infection prevention and control training. Rural agencies are more likely to not have anyone in charge of infection prevention and control compared to those in urban areas. About 22% of agencies implement recommended guidelines when administering antibiotics. Less than a third (26.4%) report that their staff vaccination rates were higher than 95% during the last flu season. Only 48.1% of agencies accept patients requiring ventilation, and of those, 40.9% located in rural areas do not have specific infection prevention and control policies for ventilated patients, compared to 20.8% in urban areas (p < 0.001). Only 39.7% of agencies provide N95 respirators to their clinical staff; rural agencies are significantly more likely to provide those supplies than urban agencies (50.7% vs. 37.7%, p = 0.004). Lastly, agencies report their greatest challenges with infection prevention and control are collecting/reporting infection data and adherence to/monitoring of nursing bag technique. Prior to the SARS-CoV-2 pandemic, we found that infection prevention and control was suboptimal among U.S. home health care agencies. Consequently, most agencies have limited capacity to respond to infectious disease outbreaks. Staff and personal protective equipment shortages remain major concerns, and agencies will need to quickly adjust their existing infection prevention and control policies and potentially create new ones. In the long-term, agencies also need to improve influenza vaccination coverage among their staff. Tweetable abstract: Infection prevention and control infrastructure, policies and procedures and outbreak preparedness at U.S. home health agencies was found to be suboptimal in nationally-representative survey conducted just prior to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Understanding the evolution of wildfire regimes throughout the United States (US) is crucial in the preparation, mitigation, and planning for national wildfires. Recent wildfire trajectories demonstrating an increase in both frequency and size across the US have made documenting the changes in wildfire regimes a topic of growing importance. While previous studies have examined wildfire regimes using ecoregions, this study analyzes wildfire regimes through the Geographic Area Coordination Center (GACC) regions across the Contiguous US over 34 years, 1984–2017. GACCs are geopolitical boundaries designed by wildfire agencies to promote an efficient way to distribute resources during emergencies such as wildfires. Wildfire observations originate from the Monitoring Trends in Burn Severity (MTBS) database which records large fire events that are 1000(500) acres or greater in the Western (Eastern) US. Using GACCs and MTBS data, this study examines wildfire regimes across the Contiguous US through the following three parameters: total burned area, frequency, and average burned area. This study characterizes the trend direction of the wildfire parameters and which are statistically significant. Results demonstrate that most GACC regions display statistically significant trends, including wildfire regimes that are beyond the Western US (e.g., Southern GACC). The Northwest and Southwest GACCs demonstrate statistically significant positive trends in every parameter observed. The California and Great Basin GACCs demonstrate statistically significant positive trends in the average burned area. The Eastern GACC is the only region to not display any significant trends. Determining significant wildfire regimes and their trend direction can help wildfire agencies to minimize the negative impacts on the environment, society, and economy. [ABSTRACT FROM AUTHOR]

Background: Intersectionality theory focuses on how one's human experiences are constituted by mutually reinforcing interactions between different aspects of one's identities, such as race, class, gender, and sexual orientation. In this study, we asked: 1) Do associations between intersecting identities (race and sexual orientation) and mental health (depressive symptoms) and substance use (alcohol, tobacco, and marijuana) differ between men and women? and 2) How do single or intersecting self-reports of perceived racial and/or sexual orientation discrimination influence mental health and substance use outcomes for men and women? We compared results of assessing identities versus experiences of discrimination.Methods: Multivariable regressions were conducted on cross-sectional data from 2315 Black and White college students. Predictors included measures of sociodemographic characteristics and experiences of discrimination. Outcomes included past 2-week depressive symptoms (PHQ-9), past 30-day alcohol use, past 30-day tobacco use, and past 30-day marijuana use.Results: Intersecting identities and experience of discrimination had different associations with outcomes. Among women, self-reporting both forms of discrimination was associated with higher depressive symptoms and substance use. For example, compared to women experiencing no discrimination, women experiencing both forms of discrimination had higher depressive symptoms (B = 3.63, CI = [2.22-5.03]), alcohol use (B = 1.65, CI = [0.56-2.73]), tobacco use (OR = 3.45, CI = [1.97-6.05]), and marijuana use (OR = 3.38, CI = [1.80-6.31]). However, compared to White heterosexual women, White sexual minority women had higher risks for all outcomes (B = 3.16 and CI = [2.03-4.29] for depressive symptoms, B = 1.45 and CI = [0.58-2.32] for alcohol use, OR = 2.21 and CI = [1.32-3.70] for tobacco use, and OR = 3.01 and CI = [1.77-5.12] for marijuana use); while Black sexual minority women had higher tobacco (OR = 2.64, CI = [1.39-5.02]) and marijuana use (OR = 2.81, CI = [1.33-5.92]) only. Compared to White heterosexual men, White sexual minority men had higher depressive symptoms (B = 1.90, CI = [0.52-3.28]) and marijuana use (OR = 2.37, CI = [1.24-4.49]).Conclusions: Our results highlight the deleterious impacts of racial discrimination and sexual orientation discrimination on health, in particular for women. Future studies should distinguish between and jointly assess intersecting social positions (e.g., identities) and processes (e.g., interpersonal experience of discrimination or forms of structural oppression). [ABSTRACT FROM AUTHOR]

Correspondence bias (CB) refers to individuals' tendency to make trait inferences regarding the constrained behavior of others. To investigate the influences of the attitude diagnosticity of behavior and situational constraints on CB in a cross-cultural context, a sample of 357 Chinese undergraduates (140 males, 39.2%) aged 17-27 years old (Mage = 21.13, SD = 1.94) and 252 American undergraduates (111 males, 44%) aged 16 to 24 years old (Mage = 20.39, SD = 1.70) took part in a modified attitude attribution task. The results of analysis of covariance showed that (a) Americans and Chinese undergraduates produced similar patterns in which CB decreased with the attitude diagnosticity of behavior, while (b) only Chinese undergraduates' CB decreased as situational constraints increased. These results indicated that the initial trait attributions were similar for individuals in America and China, but there were cultural differences in the stage with situational constraints. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections are a significant reason for readmission to hospital post-discharge to the community. In this paper, the authors describe some of the key findings from a programme of work conducted in a home care agency (community care organisation) in the US. A survey was conducted to explore home care nurses' knowledge, attitudes and beliefs around infection control (n=415); 400 nurse-patient visits were observed, and 50 nurses were interviewed about their infection control practices. Nurses reported high compliance with infection control practices. However, the overall average adherence rate to observed hand hygiene practices was 45.6%. Interview data provided valuable insights into specific challenges faced by nurses in a home care setting. This study provides insights that can be used to enhance infection control practice in community care in the UK. [ABSTRACT FROM AUTHOR]

Background: This study aimed to establish a novel nomogram prognostic model to predict death probability for non-small cell lung cancer (NSCLC) patients who received surgery..Methods: We collected data from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute in the United States. A nomogram prognostic model was constructed to predict mortality of NSCLC patients who received surgery.Results: A total of 44,880 NSCLC patients who received surgery from 2004 to 2014 were included in this study. Gender, ethnicity, tumor anatomic sites, histologic subtype, tumor differentiation, clinical stage, tumor size, tumor extent, lymph node stage, examined lymph node, positive lymph node, type of surgery showed significant associations with lung cancer related death rate (P < 0.001). Patients who received chemotherapy and radiotherapy had significant higher lung cancer related death rate but were associated with significant lower non-cancer related mortality (P<0.001). A nomogram model was established based on multivariate models of training data set. In the validation cohort, the unadjusted C-index was 0.73 (95% CI, 0.72-0.74), 0.71 (95% CI, 0.66-0.75) and 0.69 (95% CI, 0.68-0.70) for lung cancer related death, other cancer related death and non-cancer related death.Conclusions: A prognostic nomogram model was constructed to give information about the risk of death for NSCLC patients who received surgery. [ABSTRACT FROM AUTHOR]

The underlying reasons behind the unprecedented increase of the mortality rates due to the opioid epidemics in the United States are still not fully uncovered. Most efforts have been focused on targeting opioids, but there is little information about vulnerable populations at high risk of opioid abuse and death. In this study, we used data from the Ohio Department of Health for deaths caused by prescription opioids from 2010–2017 to analyze the spatiotemporal dynamics of the opioid overdose epidemic. Our results showed a rapid increase in prescription opioid death rates among the white male population aged 30–39 but also a considerable increase among the black male population with an exponential growth trend. Our geospatial analysis suggests that the increasing rates of the opioid overdose epidemic in Ohio were driven by the epidemic hotspot areas. Our findings highlight the relevance of prioritizing public health measures targeting specific locations and vulnerable populations to mitigate the current opioids crisis. [ABSTRACT FROM AUTHOR]

Heart failure with preserved ejection fraction (HFpEF) is now the most common form of HF, affecting over 3 million adults in the United States alone. HFpEF is a heterogenous syndrome. One important phenotype may be related to comorbid conditions, including diabetes mellitus (DM). DM has a prevalence of approximately 45% in HFpEF, but characteristics and outcomes of this population are poorly understood. In this review, the authors summarize data from several clinical trials of HFpEF therapeutics and provide original data from a large cohort using the Get With The Guidelines-HF registry, which together suggest that DM is associated with increased morbidity and long-term mortality in HFpEF. The authors then discuss several common pathological mechanisms in HFpEF and DM, including sodium retention, metabolic derangements, impaired skeletal muscle function, and potential therapeutic targets. As the understanding of comorbid HFpEF and DM improves, it is hoped clinicians will be better equipped to offer effective, patient-centered treatments. [ABSTRACT FROM AUTHOR]

Abstract Background Collaboration among healthcare providers has been considered a promising strategy for improving care quality and patient outcomes. Despite mounting evidence demonstrating the impact of collaboration on outcomes of healthcare providers, there is little empirical evidence on the relationship between collaboration and patient safety outcomes, particularly at the patient care unit level. Objectives The purpose of this study is to identify the extent to which interdisciplinary collaboration between nurses and physicians and intradisciplinary collaboration among nurses on patient care units are associated with patient safety outcomes. Methods This is a cross-sectional study using nurse survey data and patient safety indicators data from U.S. acute care hospital units. Collaboration at the unit level was measured by two 6-item scales: nurse-nurse interaction scale and nurse-physician interaction scale. Patient outcome measures included hospital-acquired pressure ulcers (HAPUs) and patient falls. The unit of analysis was the patient care unit, and the final sample included 900 units of 5 adult unit types in 160 hospitals in the U.S. Multilevel logistic and Poisson regressions were used to estimate the relationship between collaboration and patient outcomes. All models were controlled for hospital and unit characteristics, and clustering of units within hospitals was considered. Results On average, units had 26 patients with HAPUs per 1000 patients and 3 patient falls per 1000 patient days. Critical care units had the highest HAPU rate (50/1000 patients) and the lowest fall rate (1/1000 patient days). A one-unit increase in the nurse-nurse interaction scale score led to 31% decrease in the odds of having a HAPU (OR, 0.69; 95% CI, 0.56–0.82) and 8% lower patient fall rate (IRR, 0.92; 95% CI, 0.87–0.98) on a nursing unit. A one-unit increase in the nurse-physician interaction scale score was associated with 19% decrease in the odds of having a HAPU (OR, 0.81; 95% CI, 0.68–0.97) and 13% lower fall rates (IRR, 0.87; 95% CI, 0.82–0.93) on a unit. Conclusions Both nurse-physician collaboration and nurse-nurse collaboration were significantly associated with patient safety outcomes. Findings from this study suggest that improving collaboration among healthcare providers should be considered as an important strategy for promoting patient safety and both interdisciplinary and intradisciplinary collaboration are critical for achieving better patient outcomes. [ABSTRACT FROM AUTHOR]

Exposure to chemical contaminants is considered as one of risk factors to the current epidemic of obesity. Acrylamide (AA) is a ubiquitous chemical contaminant in environmental waste, mainstream cigarette smoke and carbohydrate-rich foods, and widely used in industrial manufacturers and cosmetics. Few studies have highlighted the association of daily exposure to AA with obesity-related outcomes. We analyzed data from 8364 participants who aged 20–85 years and were recruited in National Health and Nutrition Examination Surveys (NHANES) 2003–2006. We established the model of PROC Survey Logistic regressions via using AA biomarkers in blood, hemoglobin adducts of acrylamide and glycidamide (HbAA and HbGA), as the measure of internal exposure to AA, and assessing obesity, abdominal obesity and overweight with body mass index (BMI) or waist circumference (WC). After the adjustment of sociodemographic variables, lifestyle behaviors, and health-related factors, the ratio of HbGA to HbAA (HbGA/HbAA) was significantly associated with obesity ( p for trend < 0.0001). The odd ratios (ORs) with 95% confidence intervals (CIs) of HbGA/HbAA across increasing quartiles were 1.740 (1.413–2.144), 2.604 (2.157–3.144), and 2.863 (2.425–3.380) compared with the lowest quartile. HbGA was positively associated with obesity [OR (95% CI): 1.226 (1.041–1.443), 1.283 (1.121–1.468), and 1.398 (1.165–1.679); p for trend = 0.0004], while HbAA was inversely associated with obesity [OR (95% CI): 0.839 (0.718–0.980), 0.713 (0.600–0.848), and 0.671 (0.554–0.811); p for trend < 0.0001]. Negative associations were found between the sum of HbAA and HbGA (HbAA + HbGA) and the body weight outcomes. Similar associations were also observed between the hemoglobin biomarkers of AA and abdominal obesity as well as overweight. Thus, the hemoglobin adducts of AA as long-term internal exposure biomarkers are strongly associated with obesity-related outcomes in a population of US adults. [ABSTRACT FROM AUTHOR]

Energy use in buildings has great variability. In order to design and operate low energy buildings as well as to establish building energy codes and standards and effective energy policy, it is crucial to understand and quantify key factors influencing building energy performance. This study investigates air-conditioning (AC) energy use of four office buildings in four locations: Beijing, Taiwan, Hong Kong, and Berkeley. Building simulation was employed to quantify the influences of key factors, including climate, building envelope and occupant behavior. Through simulation of various combinations of the three influencing elements, it is found that climate can lead to AC cooling consumption differences by almost two times, while occupant behavior resulted in the greatest differences (of up to three times) in AC cooling consumption. The influence of occupant behavior on AC energy consumption is not homogeneous. Under similar climates, when the occupant behavior in the building differed, the optimized building envelope design also differed. Overall, the optimal building envelope should be determined according to the climate as well as the occupants who use the building. [ABSTRACT FROM AUTHOR]

Introduction: Antiretroviral medication coverage remains sub-optimal in much of the United States, particularly the Sothern region, and Non-Hispanic Black or African American persons (NHB) continue to be disproportionately impacted by the HIV epidemic. The "Ending the HIV Epidemic in the U.S." (EHE) initiative seeks to reduce HIV incidence nationally by focusing resources towards the most highly impacted localities and populations. This study evaluates the impact of hypothetical improvements in ART and PrEP coverage to estimate the levels of coverage needed to achieve EHE goals in the South. Methods: We developed a stochastic, agent-based network model of 500,000 individuals to simulate the HIV epidemic and hypothetical improvements in ART and PrEP coverage. Results: New infections declined by 78.6% at 90%/40% ART/PrEP and 94.3% at 100%/50% ART/PrEP. Declines in annual incidence rates surpassed 75% by 2025 with 90%/40% ART/PrEP and 90% by 2030 with 100%/50% ART/PrEP coverage. Increased ART coverage among NHB MSM was associated with a linear decline in incidence among all MSM. Declines in incidence among Hispanic/Latino and White/Other MSM were similar regardless of which MSM race group increased their ART coverage, while the benefit to NHB MSM was greatest when their own ART coverage increased. The incidence rate among NHB women declined by over a third when either NHB heterosexual men or NHB MSM increased their ART use respectively. Increased use of PrEP was associated with a decline in incidence for the groups using PrEP. MSM experienced the largest absolute declines in incidence with increasing PrEP coverage, followed by NHB women. Conclusions: Our analysis indicates that it is possible to reach EHE goals. The largest reductions in HIV incidence can be achieved by increasing ART coverage among MSM and all race groups benefit regardless of differences in ART initiation by race. Improving ART coverage to > 90% should be prioritized with a particular emphasis on reaching NHB MSM. Such a focus will reduce the largest number of incident cases, reduce racial HIV incidence disparities among both MSM and women, and reduce racial health disparities among persons with HIV. NHB women should also be prioritized for PrEP outreach. [ABSTRACT FROM AUTHOR]

This study explores participant experiences at two contrasting high schools in a large, urban school district in crisis who implemented mandatory community-based learning (CBL) (e.g. community service, work-based internships) as a policy of reform. Rawls’ theory of justice as fairness is used to examine capacity of the district formal policy to achieve fair equality of opportunity central to its democratic aims and purposes. Researchers found disparities in equity and access was associated with critical agencies exercised on the part of key school personnel (e.g. internship coordinator) who navigated and resisted contextual structural barriers (i.e. transportation limitations, employer inflexibility, neighborhood economic conditions, cultural and religious norms) differently. Findings suggest implications for U.S. urban school districts with formal policies of mandatory CBL including consideration of local context and exercise of critical agency at multiple district levels prior to implementation in order to build capacity for formal equality of opportunity. [ABSTRACT FROM PUBLISHER]

Technology including social media and other technology applications enabled by different technology devices offer many possibilities for second language learners to improve their learning, if they are interested in doing so. We investigated purposes for using technology among urban adolescents, including both English language learners (ELLs) and native English speakers (NESs). Data were collected through a survey of 531 students in an urban public middle school in the USA. The results showed that students used technology for diverse purposes regardless of their first language background. Although overall technology students' access was comparable to national averages, the use of technology for many specific purposes was markedly lower, lending support to the notion of a new digital divide between students from high- and low-income families based on technology knowledge and meaningful application of such knowledge rather than mere access. Student reports of their own English skills were related to various specific uses of technology, e.g., blogging and email. These relationships were stronger for ELLs, particularly those in grade 6, than for NESs. The results suggest that younger ELL adolescents may be more aware of their language constraints and prone to use technology in certain ways than their NES peers. These findings provide some preliminary insights into the complex relationships between language skills and student preferences for technology use and can ultimately provide guidance for the integration of technology into language and literacy instruction for linguistically diverse urban adolescents. [ABSTRACT FROM AUTHOR]

The prevalence of patients who are Incapacitated with No Evident Advance Directives or Surrogates (INEADS) remains unknown because such data are not routinely captured in structured electronic health records. This study sought to develop and validate a natural language processing (NLP) algorithm to identify information related to being INEADS from clinical notes. We used a publicly available dataset of critical care patients from 2001 through 2012 at a United States academic medical center, which contained 418,393 relevant clinical notes for 23,904 adult admissions. We developed 17 subcategories indicating reduced or elevated potential for being INEADS, and created a vocabulary of terms and expressions within each. We used an NLP application to create a language model and expand these vocabularies. The NLP algorithm was validated against gold standard manual review of 300 notes and showed good performance overall (F-score = 0.83). More than 80% of admissions had notes containing information in at least one subcategory. Thirty percent (n = 7,134) contained at least one of five social subcategories indicating elevated potential for being INEADS, and <1% (n = 81) contained at least four, which we classified as high likelihood of being INEADS. Among these, n = 8 admissions had no subcategory indicating reduced likelihood of being INEADS, and appeared to meet the definition of INEADS following manual review. Among the remaining n = 73 who had at least one subcategory indicating reduced likelihood of being INEADS, manual review of a 10% sample showed that most did not appear to be INEADS. Compared with the full cohort, the high likelihood group was significantly more likely to die during hospitalization and within four years, to have Medicaid, to have an emergency admission, and to be male. This investigation demonstrates potential for NLP to identify INEADS patients, and may inform interventions to enhance advance care planning for patients who lack social support. [ABSTRACT FROM AUTHOR]

Online retailers use product ratings to signal quality and help consumers identify products for purchase. These ratings commonly take the form of either non-personalized, aggregate product ratings (i.e., the average rating a product received from a number of consumers such as "the average rating is 4.5/5 based on 100 reviews"), or personalized predicted preference ratings for a product (i.e., recommender-system-generated predictions for a consumer's rating of a product such as "we think you'd rate this product 4.5/5"). Ratings in either format can provide decision aid to the consumer, but the two formats convey different types of product quality information and operate with different psychological mechanisms. Prior research has indicated that each recommendation type can significantly affect consumer's post-experience preference ratings, constituting a judgmental bias, but has not compared the effects of these two common product-rating formats. Using a laboratory experiment, we show that aggregate ratings and personalized recommendations create similar biases on post-experience preference ratings when shown separately. Shown together, there is no cumulative increase in the effect. Instead, personalized recommendations tend to dominate. Our findings can help retailers determine how to use these different types of product ratings to most effectively serve their customers. Additionally, these results help to educate the consumer on how product-rating displays influence their stated preferences. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic presented enormous data challenges in the United States. Policy makers, epidemiological modelers, and health researchers all require up-to-date data on the pandemic and relevant public behavior, ideally at fine spatial and temporal resolution. The COVIDcast API is our attempt to fill this need: Operational since April 2020, it provides open access to both traditional public health surveillance signals (cases, deaths, and hospitalizations) and many auxiliary indicators of COVID-19 activity, such as signals extracted from deidentified medical claims data, massive online surveys, cell phone mobility data, and internet search trends. These are available at a fine geographic resolution (mostly at the county level) and are updated daily. The COVIDcast API also tracks all revisions to historical data, allowing modelers to account for the frequent revisions and backfill that are common for many public health data sources. All of the data are available in a common format through the API and accompanying R and Python software packages. This paper describes the data sources and signals, and provides examples demonstrating that the auxiliary signals in the COVIDcast API present information relevant to tracking COVID activity, augmenting traditional public health reporting and empowering research and decision-making. [ABSTRACT FROM AUTHOR]

In recent years, more and more attention has been paid to international education in schools in the USA. Education professionals, business leaders, and politicians realize that schools and school leaders must identify multiple opportunities for students to interact with and experience a global society. Nationally, there has been a considerable investment of funds by several key foundations and much political talk about the need to push American education towards a model of schooling that expressly responds to the need for internationally competent citizens. Using mixed methodology design, this study is fueled by a desire to better understand several overarching elements in international education. In short, the authors of this paper posit that no further research, policy formation, or program development within the realm of international education for public schools can be undertaken until an understanding of the current state of international education and the capacity for internationalization is empirically explored. [ABSTRACT FROM AUTHOR]

Background: Progression trajectories of patients with mild cognitive impairment (MCI) are currently not well understood.Objective: To classify patients with incident MCI into different latent classes of progression and identify predictors of progression class.Methods: Participants with incident MCI were identified from the US National Alzheimer's Coordinating Center Uniform Data Set (09/2005-02/2019). Clinical Dementia Rating (CDR®) Dementia Staging Instrument-Sum of Boxes (CDR-SB), Functional Activities Questionnaire (FAQ), and Mini-Mental State Examination (MMSE) score longitudinal trajectories from MCI diagnosis were fitted using growth mixture models. Predictors of progression class were identified using multivariate multinomial logistic regression models; odds ratios (ORs) and 95% confidence intervals (CIs) were reported.Results: In total, 21%, 22%, and 57% of participants (N = 830) experienced fast, slow, and no progression on CDR-SB, respectively; for FAQ, these figures were 14%, 23%, and 64%, respectively. CDR-SB and FAQ class membership was concordant for most participants (77%). Older age (≥86 versus≤70 years, OR [95% CI] = 5.26 [1.78-15.54]), one copy of APOE ɛ4 (1.94 [1.08-3.47]), higher baseline CDR-SB (2.46 [1.56-3.88]), lower baseline MMSE (0.85 [0.75-0.97]), and higher baseline FAQ (1.13 [1.02-1.26]) scores were significant predictors of fast progression versus no progression based on CDR-SB (all p < 0.05). Predictors of FAQ class membership were largely similar.Conclusion: Approximately a third of participants experienced progression based on CDR-SB or FAQ during the  4-year follow-up period. CDR-SB and FAQ class assignment were concordant for the vast majority of participants. Identified predictors may help the selection of patients at higher risk of progression in future trials. [ABSTRACT FROM AUTHOR]

• A simple bioanalytical method was first established and validated for CBMIDA. • Direct determination of the chelator itself instead of metal complex. • Improved peek shape was achieved by pulse gradient method. • Poor accuracy and linearity were overcome by addition of EDTA in the mobile phase. • Successful application to pharmacokinetic study. It is usually somewhat difficult to analyze the metal chelators, especially in complex biological matrix, because of the interference of metal ions in both the matrix and analyzing system. In this study, an innovative and simple bioanalytical method was established and validated for the quantification of a newly developed uranium chelator catechol-3, 6-bis (methyleiminodiacetic acid) (CBMIDA) in beagle dog plasma. Different analytical columns and mobile phase were tested for effective chromatography resolution and sensitive and reproducible response of CBMIDA and the internal standard. An Agilent Zorbax SB AQ column was chosen. Excessive peak tailing, peak asymmetry, low recovery, and poor reproducibility, which are generally observed in chromatographic analysis of metal chelators, were overcome by the use of a pulse gradient method and addition of ethylene diamine tetraacetic acid (EDTA) to the mobile phase at 8 μg mL−1, enabling good peak shape, low matrix interference, high precision and good linearity for CBMIDA quantification in beagle dog plasma. Plasma sample pretreatment was performed by a simple, high throughput protein precipitation step with 2.5 mM EDTA methanol solution in a 96-well protein precipitation plate without complexing with the metal ions, and the sample was directly analyzed by electrospray ionization mass spectrometry. By shifting the analysis target from the metal complex to metal chelator itself, the method has an advantage over the existing method for determination of EDTA and diethylenetriaminepentaacetic acid owing to increased sample throughput and apparent simplicity. The assay was validated in accordance with the United States Food and Drug Administration guidelines and successfully applied to the pharmacokinetic study of CBMIDA in beagles after intramuscular injection of CBMIDA at different doses. The method was sensitive enough for the detection of CBMIDA concentration at 4 elimination half-times. The experimental strategies presented herein may be helpful for the measurement of other radionuclide chelators in biological matrices. [ABSTRACT FROM AUTHOR]

Background: Increasing generic drug use, due to potential for cost savings and drug access, is a viable consideration for Medicare prescription drug plans to achieve high star ratings and improve quality of plan offerings for Medicare beneficiaries.Objective: To examine the association between contract-level proportion of generic drugs dispensed (pGDD) and Medicare Part D star ratings.Methods: This was a retrospective study of linked 2011 Medicare Part D star rating data with contract-level pGDD data. A total of 477 individual Medicare prescription contracts were included, representing 75% of total Prescription Drug Plans and more than 65% of total Medicare Advantage Prescription Drug Plans available by the end of 2010. Primary outcomes were Medicare Part D summary and domain star ratings (1-5 indicating lowest to highest performance), incorporating a range of quality measures for access, cost, beneficiary satisfaction, and health services outcomes and processes. Ordinal logistic regression models were used to examine associations between pGDD and Medicare Part D summary and domain star ratings, controlling for contract type and number of beneficiary enrollment.Results: Higher pGDD was associated with higher summary star ratings (adjusted odds ratio 1.08 with 95% confidence interval 1.04-1.12) and higher "member experience with drug plan" domain ratings (adjusted odds ratio 1.07 with 95% confidence interval 1.03-1.11).Conclusions: Prescription formulary benefit design targeting increasing generic drug use appears to be associated with improved member experience and higher plan star ratings. Consideration may be given to incorporating pGDD into Medicare Part D star rating measures to improve quality of prescription plans. [ABSTRACT FROM AUTHOR]

1. Discuss various steps of developing questionnaires, along with advantages and disadvantages of adapting existing scales/questions for use in different audiences. 2. Define content and construct validity and test-retest reliability as related to questionnaire pilot testing. In the United States, home health care (HHC) utilization is increasing due to a patient population with serious illnesses and substantial care needs. For those patients, palliative care can provide relief from symptoms and stress of illness. Yet, it is unknown whether US HHC clinicians are equipped to deliver quality palliative care and how palliative care is viewed by HHC patients and informal caregivers. Several questionnaires exist that measure palliative care–related knowledge, attitudes, and confidence (PC-KAC). However, none have been developed for and tested in the HHC setting. Here, we describe the development of our PC-KAC questionnaires for US HHC clinicians, patients, and caregivers. First, we conducted a comprehensive literature review and identified and adapted existing PC-KAC scales/questions to the US HHC setting. Second, we developed new questions so that our questionnaires (one for clinicians and one for patients/informal caregivers) captured all eight domains from the 2018 National Consensus Project Clinical Practice Guidelines for Quality Palliative Care. Third, we refined our questionnaires through expert input and cognitive interviews with 10 HHC clinicians (nurses, physical therapists, social workers) and 10 patients/caregivers. Lastly, we pilot tested with 30 clinicians and 30 patients/caregivers from a large, urban HHC agency. Our PC-KAC in HHC questions are categorized by (1) knowledge, (2) attitudes, and (3) confidence. There are core questions, clinician role–specific and caregiver-specific items (total number: 56 questions for patients/caregivers, 95 for clinicians). During cognitive interviews, we received feedback about questionnaire length, questions/topics included, and response choices. Pilot testing results indicated the questionnaires are reliable and valid. Through a rigorous process, we developed the first HHC setting-specific PC-KAC questionnaires for a US audience; they can also be adapted for use in other countries. Broader dissemination of the questionnaires will help identify gaps in PC-KAC, thus revealing areas for education and training. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking escalates most in early to middle young adulthood. However, little research has examined a range of multilevel factors in relation to smoking trajectories during this time.Methods: We examined: 1) trajectories of cigarette smoking among 2967 US college students (aged 18-25) in a two-year, six-wave longitudinal study (using growth mixture modeling); and 2) intrapersonal- (i.e., other substance use, depressive symptoms, ADHD symptoms,); interpersonal- (i.e., adverse childhood events, social support, parental tobacco and marijuana use), and community-level (i.e., type of college, rural vs. urban setting) predictors of differing trajectories (using multinomial logistic regression).Results: We identified three trajectory classes: 1) Dabblers, who used cigarettes at one point in their life or not at all (85.6%); 2) College Onset Smokers, who began smoking regularly during the college years (6.2%); and 3) Later Onset Smokers, who began smoking during the mid- to late-20 s (8.2%). Multinomial regression (with Dabblers as the reference group) showed that predictors of being College Onset Smokers included being male (p = .031); Asian (p = .001) but not Black (p = .008; Ref: White); early onset smokers (i.e., initiation before age 15; p = .006); past 30-day users of little cigars/cigarillos (p = .024), alcohol (p < .001), and marijuana (p = .008); children of tobacco users (p = .050); and public (p = .031) or a technical college students (p < .001; Ref: private college); predictors of being Later Onset Smokers were being male (p = .019) and technical college students (p = .005).Conclusions: Despite some young adults' smoking initiating/escalating in middle young adulthood, few risk factors were documented. This understudied period warrants greater examination to inform intervention. [ABSTRACT FROM AUTHOR]

Background: Patients with cancer may use botanical dietary supplements (BDS) in an attempt to manage the side effects of chemotherapy, yet evidence about BDS use among patients with cancer is limited. The authors examined trends in BDS use among US adults according to cancer status and patient characteristics.Methods: A serial, cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey from 1999 through 2014 (n = 43,644). Self-reported cancer diagnosis history and any BDS use in the preceding 30 days were determined. The prevalence of BDS use was calculated in each cycle for respondents with and without cancer, both overall and by patient characteristics. Simple linear regression models were applied to test for trends in BDS use at a 2-sided P value < .05. Multiple logistic regression models were performed to identify the patient factors associated with BDS use. The results were weighted to represent national estimates.Results: The prevalence of BDS use was greater among participants who had cancer compared with participants who did not have cancer, but trends remained stable during 1999 through 2014 for both groups. Trends in BDS use declined in patients with cancer who were older (Ptrend  = .047), had a low annual family income (Ptrend  = .028), and had a lower education level (Ptrend  = .004). Among the respondents without cancer, trends in BDS use declined in those who were middle-aged (Ptrend  = .025), non-Hispanic whites (Ptrend  = .025), those with a lower education level (Ptrend  = .011), and those who were not receiving prescription medication (Ptrend  = .036). Patient age, sex, race/ethnicity, income, education, and health conditions were associated with BDS use.Conclusions: The overall use of BDS remained stable during 1999 through 2014 for US adults with and without cancer, but it varied by individual characteristics. Cancer 2018;124:1207-15. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

The goal of this study was to evaluate instructional influences on the storytelling of English Language Learners (ELLs). Participants were 210 fifth-grade Spanish-speaking ELLs (mean age = 10.8) from schools serving low-income neighborhoods in the Midwest of the United States. They received a six-week socio-scientific unit involving collaborative group work or direct instruction, or were in control classes that continued regular instruction. In an essay to evaluate mastery of the instructional unit, students from collaborative groups produced significantly longer chains of reasoning (more chains with 5–8 links) than direct instruction students (more chains with 3 or 4 links), while control students were unable to display any extended reasoning. Following the unit, students individually told a story prompted by a wordless picture book to evaluate their oral English proficiency. The stories were coded for several features of basic language production, story completeness, and multi-link causal reasoning. The results indicated that students who received the socio-scientific unit told stories with more complicated syntax than the control students, while no difference in complexity of syntax was observed between students from the two instructional conditions. Stories told by students who had participated in collaborative groups contained significantly more elaboration of essential story elements than the stories produced by direct instruction students or control students. Students who had interacted in collaborative groups also generated significantly longer chains of reasoning (many 5–7 link chains) connecting story events than students in the other two conditions (mostly 1 or 2 link chains). The results suggest collaborative group work may be an effective instructional approach to foster ELLs' communicative competence and causal reasoning. [ABSTRACT FROM AUTHOR]

Acute coronary syndrome (ACS) is a life-threatening disease that affects more than half a million people in United States. We currently lack molecular biomarkers to distinguish the unstable angina (UA) and acute myocardial infarction (AMI), which are the two subtypes of ACS. MicroRNAs play significant roles in biological processes and serve as good candidates for biomarkers. In this work, we collected microRNA datasets from the Gene Expression Omnibus database and identified specific microRNAs in different subtypes and universal microRNAs in all subtypes based on our novel network-based bioinformatics approach. These microRNAs were studied for ACS association by pathway enrichment analysis of their target genes. AMI and UA were associated with 27 and 26 microRNAs, respectively, nine of them were detected for both AMI and UA, and five from each subtype had been reported previously. The remaining 22 and 21 microRNAs are novel microRNA biomarkers for AMI and UA, respectively. The findings are then supported by pathway enrichment analysis of the targets of these microRNAs. These novel microRNAs deserve further validation and will be helpful for personalized ACS diagnosis. [ABSTRACT FROM AUTHOR]

Home health care agencies (HHAs) are skilled care providers for Medicare home health beneficiaries in the United States. Rural HHAs face different challenges from their urban counterparts in delivering care (eg, longer distances to travel to patient homes leading to higher fuel/travel costs and fewer number of visits in a day, impacting the quality of home health care for rural beneficiaries). We review evidence on differences in care outcomes provided by urban and rural HHAs. Systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using the Newcastle-Ottawa Scale (NOS) for quality appraisal. Care provided by urban and rural HHAs. We conducted a systematic search for English-language peer-reviewed articles after 2010 on differences in urban and rural care provided by U.S. HHAs. We screened 876 studies, conducted full-text abstraction and NOS quality review on 36 articles and excluded 2 for poor study quality. Twelve studies were included; 7 focused on patient-level analyses and 5 were HHA-level. Nine studies were cross-sectional and 3 used cohorts. Urban and rural differences were measured primarily using a binary variable. All studies controlled for agency-level characteristics, and two-thirds also controlled for patient characteristics. Rural beneficiaries, compared with urban, had lower home health care utilization (4 of 5 studies) and fewer visits for physical therapy and/or rehabilitation (3 of 5 studies). Rural agencies had lower quality of HHA services (3 of 4 studies). Rural patients, compared with urban, visited the emergency room more often (2 of 2 studies) and were more likely to be hospitalized (2 of 2 studies), whereas urban patients with heart failure were more likely to have 30-day preventable hospitalizations (1 study). This review highlights similar urban/rural disparities in home health care quality and utilization as identified in previous decades. Variables used to measure the access to and quality of care by HHAs varied, so consensus was limited. Articles that used more granular measures of rurality (rather than binary measures) revealed additional differences. These findings point to the need for consistent and refined measures of rurality in studies examining urban and rural differences in care from HHAs. [ABSTRACT FROM AUTHOR]

Background: Current evidence on mental health disorders (MHDs) in the U.S. elderly home care population is highly varied and limited to the local level. Aim: The objective of this study was to examine the prevalence and characteristics of U.S. elders with MHDs on the national level. Methods: This is a primary analysis of secondary use data from a 5% random sample of the 2010 National Outcome and Assessment Information Set (OASIS) data spanning a 60-day home care session. MHDs included depression, anxiety, substance abuse, psychotic disorders, aggression, and socially inappropriate behaviors and were identified by diagnosis, symptoms, or mental health service order in the plan of care. Logistic regression was used to identify correlates of MHD. Results: The final analysis was conducted on records from 28,475 elderly patients with an average age of 79 (range 65-110). Patients were primarily female, White, Medicare beneficiaries, referred from short-stay acute hospitals, and living with others at home. Prevalence of MHDs was approximately 40%; depression (28.0%) and anxiety (18.9%) were common. Factors associated with MHDs were younger age, female, smokers, frail, living alone, referred from psychiatric hospitals, cognitively or sensory impaired, poorer health status, recent history of falls or multiple hospitalizations, and insufficient social support. Only about one third of patients identified with MHD received mental health services during the 60-day home care episode, including psychiatric nursing services and depression interventions. Discussion: MHDs are a national health concern in the older U.S. home care population and are common but largely undermanaged. Future research in the home care sector should be aimed at developing targeted MHD screening and interventional protocols and training the current workforce, as well as expanding the future workforce to improve psychiatric care for the homebound elderly. [ABSTRACT FROM AUTHOR]

Estimation of chlorophyll content and the leaf area index (LAI) using remote sensing technology is of particular use in precision agriculture. Wavelengths at the red edge of the vegetation spectrum (705 and 750 nm) were selected to test vegetation indices (VIs) using spaceborne hyperspectral Hyperion data for the estimation of chlorophyll content and LAI in different canopy structures. Thirty sites were selected for the ground data collection. The results show that chlorophyll content and LAI can be successfully estimated by VIs derived from Hyperion data with a root mean square error (RMSE) of 7.20-10.49 μg cm-2 for chlorophyll content and 0.55-0.77 m2 m-2 for LAI. The special index derived from three bands provided the best estimation of the chlorophyll content (RMSE of 7.19 μg cm-2 for the Modified Chlorophyll Absorption Ratio Index/Optimized Soil-Adjusted Vegetation Index (MCARI/OSAVI705)) and LAI (RMSE of 0.55 m2 m-2 for a second form of the MCARI (MCARI2705)). These results demonstrate the possibilities for analysing the variation in chlorophyll content and LAI using hyperspectral Hyperion data with bands from the red edge of the vegetation spectrum. [ABSTRACT FROM AUTHOR]

The article provides information on the climate change mitigation and energy security efforts of China and the U.S. It mentions that the two countries are considered as the biggest contributors of greenhouse gases across the planet due to massive quantity of carbon dioxide emission. It cites their discussion during the Strategic Economic Dialogue regarding energy security and environmental protection. Moreover, the policy recommendations for the two countries are also discussed.

Urinary tract infection (UTI) is common in home care but not easily captured with standard assessment. This study aimed to examine the value of nursing notes in detecting UTI signs and symptoms in home care. The study developed a natural language processing (NLP) algorithm to automatically identify UTI-related information in nursing notes. Home care visit notes (n = 1,149,586) and care coordination notes (n = 1,461,171) for 89,459 patients treated in the largest nonprofit home care agency in the United States during 2014. We generated 6 categories of UTI-related information from literature and used the Unified Medical Language System (UMLS) to identify a preliminary list of terms. The NLP algorithm was tested on a gold standard set of 300 clinical notes annotated by clinical experts. We used structured Outcome and Assessment Information Set data to extract the frequency of UTI-related emergency department (ED) visits or hospitalizations and explored time-patterns in documentation of UTI-related information. The NLP system achieved very good overall performance (F measure = 0.9, 95% CI: 0.87-0.93) based on the test results obtained by using the notes for patients admitted to the ED or hospital due to UTI. UTI-related information was significantly more prevalent (P <.01 for all the tests) in home care episodes with UTI-related ED admission or hospitalization vs the general patient population; 81% of home care episodes with UTI-related hospitalization or ED admission had at least 1 category of UTI-related information vs 21.6% among episodes without UTI-related hospitalization or ED admission. Frequency of UTI-related information documentation increased in advance of UTI-related hospitalization or ED admission, peaking within a few days before the event. Information in nursing notes is often overlooked by stakeholders and not integrated into predictive modeling for decision-making support, but our findings highlight their value in early risk identification and care guidance. Health care administrators should consider using NLP to extract clinical data from nursing notes to improve early detection and treatment, which may lead to quality improvement and cost reduction. [ABSTRACT FROM AUTHOR]

Background Infection prevention and control (IPC) is becoming a national priority in home healthcare (HHC) industry. However, little is known about the impact of agency-level policies and priorities upon IPC practices in the home environment. This qualitative study aimed to explore: 1) how home health agencies (HHA) are implementing IPC policies, and 2) perspectives of HHC staff on agency-level IPC policies and priorities and how they impact patient care. Methods From March to November 2018, we recruited staff from HHAs across the United States to participate in in-depth, telephone interviews. HHAs were purposively sampled based on high or low Quality of Patient Care star rating and other agency characteristics from 2016 Provider of Services and Home Health Compare data. Interviews were conducted with 41 staff from 13 HHAs, including administrators, IPC and quality improvement personnel, registered nurses and home health aides. Interview guides were tailored toward the role of the interviewee. Interview transcripts were coded and themes were identified using content analysis. Results Themes included: 1) "Handwashing is our priority"; 2) Innovative approaches to care coordination and IPC; (3) Monitoring staff compliance; and, (4) Opportunities for improvement. Almost all HHC staff described that handwashing was a primary focus of IPC policies and staff education at their agencies. Some staff depicted creative ways that their agency was coordinating patient care among staff who were not always in the office, and also unique approaches to educating staff about IPC policies and practices. Administrators and managers explained the ways that they monitored staff compliance around IPC policies, while nurses and aides described how the monitoring reminded them about proper procedures. Finally, HHC staff mentioned various ways in which care coordination, staff education and compliance could be improved at their agencies; for example, more frequent supervisory visits were perceived as a way to improve compliance with agency policies and practices. Conclusion This study increases our understanding of the impact that agency-level IPC policies and practices have upon HHC staff and patient care, in addition to specific approaches to care coordination, staff education and compliance monitoring. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]