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Since 1994, the U.S. Vaccines for Children (VFC) program has covered the cost of vaccines for children whose families might not otherwise be able to afford vaccines. This report assessed and quantified the health benefits and economic impact of routine U.S. childhood immunizations among both VFC-eligible and non--VFC-eligible children born during 1994-2023. Diphtheria and tetanus toxoids and acellular pertussis vaccine; Haemophilus influenzae type b conjugate vaccine; oral and inactivated poliovirus vaccines; measles, mumps, and rubella vaccine; hepatitis B vaccine; varicella vaccine; pneumococcal conjugate vaccine; hepatitis A vaccine; and rotavirus vaccine were included. Averted illnesses and deaths and associated costs over the lifetimes of 30 annual cohorts of children born during 1994--2023 were estimated using established economic models. Net savings were calculated from the payer and societal perspectives. Among approximately 117 million children born during 1994--2023, routine childhood vaccinations will have prevented approximately 508 million lifetime cases of illness, 32 million hospitalizations, and 1,129,000 deaths, at a net savings of $540 billion in direct costs and $2.7 trillion in societal costs. From both payer and societal perspectives, routine childhood vaccinations among children born during 1994--2023 resulted in substantial cost savings. Childhood immunizations continue to provide substantial health and economic benefits, while promoting health equity. [ABSTRACT FROM AUTHOR]

Background: Balance disorders can give rise to sensations of instability, lightheadedness, vertigo, disequilibrium, or syncope, ultimately leading to grave medical, physical, emotional, and societal ramifications. These conditions are highly prevalent among individuals aged 40 and above. Screen time encompasses activities associated with television viewing, video game playing, and non-work-related computer usage. Prolonged screen exposure may engender a spectrum of health issues and even elevate overall mortality rates. However, the available evidence on the potential link between excessive screen time and balance dysfunction remains limited. Aims: The primary aim of this study was to explore the possible association between prolonged screen exposure and impaired balance function. Methods: This cross-sectional study utilized data from participants who completed a comprehensive questionnaire in the NHANES database between 1999 and 2002, all of whom were aged over 40 and under 85 years. Participants' screen time was categorized into two groups (< 4 h/d and ≥4 h/d) for subsequent data analysis. Logistic regression, combined with propensity score matching (PSM), was employed to investigate the correlation between screen time and balance disorders. Results: A total of 5176 participants were enrolled in this study, comprising 2,586 men and 2,590 women, with a prevalence rate of balance disorders at 25.7% (1331/5176). The incidence of balance disorders was found to be significantly higher among individuals who spent 4 hours or more per day on screen time compared to those with less screen time (P<0.001). Multivariate logistic analysis conducted on the unmatched cohort revealed a significant association between screen time and balance disorders, with an odds ratio (OR) 1.8 (95%CI 1.57 ∼ 2.05). These findings remained consistent even after adjusting for confounding factors, yielding an OR 1.43 (95%CI 1.24 ∼ 1.66). Moreover, the association persisted when employing various multivariate analyses such as propensity score matching adjusted model, standardized mortality ratio weighting model and pairwise algorithmic model; all resulting in ORs ranging from 1.38 to 1.43 and p-values < 0.001. Conclusions: After controlling for all covariates, screen time (watching TV, playing video games, and using computers outside of work) was associated with balance dysfunction among middle-aged and older adults. This finding may offer a possible idea for the prevention of dizziness and balance disorders. Nevertheless, additional research is imperative to further validate these results. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate whether the combination of abnormal systemic immune-inflammation index (SII) levels and hyperglycemia increased the risk of cognitive function decline and reduced survival rate in the United States. Methods: This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) database from 2011–2014 and enrolled 1,447 participants aged 60 years or older. Restricted cubic splines (RCS), linear regression and kaplan-meier(KM) curve were employed to explore the combined effects of abnormal SII and hyperglycemia on cognitive function and survival rate, and subgroup analysis was also conducted. Results: The RCS analysis revealed an inverted U-shaped relationship between lgSII levels and cognitive function. Linear regression analysis indicated that neither abnormal SII nor diabetes alone significantly contributed to the decline in cognitive function compared to participants with normal SII levels and blood glucose. However, when abnormal SII coexisted with diabetes (but not prediabetes), it resulted to a significant decline in cognitive function. After adjusting for various confounding factors, these results remained significant in Delayed Word Recall (β:-0.76, P<0.05) and Digit Symbol Substitution tests (β:-5.02, P<0.05). Nevertheless, these results showed marginal significance in Total Word Recall test as well as Animal Fluency test. Among all subgroup analyses performed, participants with both abnormal SII levels and diabetes exhibited the greatest decline in cognitive function compared to those with only diabetes. Furthermore, KM curve demonstrated that the combination of abnormal SII levels and diabetes decreased survival rate among participants. Conclusion: The findings suggest that the impact of diabetes on cognitive function/survival rate is correlated with SII levels, indicating that their combination enhances predictive power. [ABSTRACT FROM AUTHOR]

Aim: Human immunodeficiency virus (HIV) nursing has become more prominent with the increase in chronic HIV infections. This study examined articles related to HIV nursing to determine how the profession has developed and its future direction. Design: A bibliometric analysis was conducted. Methods: HIV nursing‐related articles published in the Web of Science core collection between 1999 and 2022 were searched. VOSviewer was used to identify the contributions of countries, institutions and authors in HIV‐related care. Collaborative maps, hot topics and keywords trends were analysed using VOSviewer and CiteSpace. Results: A total of 1513 publications were extracted. An increase in articles published between 1999 and 2012 was observed. After 2012, the increase in the number of publications was relatively stable. Since 2016, a downward trend in the number of publications has occurred. The USA, South Africa and the UK were the leading contributors to publications related to HIV nursing. The focus of the HIV nursing research has gradually shifted from "HIV infection", "risk factors", and "transmission routes" to "social support", "depression", and "public health". The result shows that increased collaboration among countries/regions can improve the development of HIV nursing and effectively reduce the global HIV infection rate. The mental health of patients has become a research centre in the field of HIV nursing. This study provides direction in clinical practice and future research areas in this field. [ABSTRACT FROM AUTHOR]

Objectives: The systemic immune-inflammation index (SII), a novel and systematic inflammatory biomarker that is associated with chronic kidney disease (CKD), has not received much attention. This study aimed to investigate the relationship between SII and CKD in the United States (U.S.) population. Methods: Our study ultimately included a nationally representative sample of 10,787 adults who participated in the 2007-2018 National Health and Nutrition Examination Survey. Weighted multivariate logistic regression was used to assess the correlation between SII and CKD, and a restricted cubic spline (RCS) model was subsequently used to explore the non-linear relationship between SII and CKD. Subgroup analyses were performed to further the effects of other covariates on the relationship between SII and CKD. Results: Following confounder adjustment, a higher SII was related to the incidence of CKD (OR =1.36; 95% CI, 1.07-1.73; p =0.01), as validated by multivariable logistic regression. The RCS curve revealed a non-linear positive correlation between SII/1000 and CKD incidence (p for non-linear =0.0206). Additionally, subgroup analysis confirmed a stronger correlation for male participants (OR =2.628; 95% CI, 1.829-3.776) than for female participants (OR =1.733; 95% CI, 1.379-2.178) (p for interaction =0.046). Conclusions: SII is positively associated with the incidence of CKD among U.S. adults, especially in males. However, further studies are needed to confirm our findings and explore the causal factors that can contribute to the prevention and treatment of CKD. [ABSTRACT FROM AUTHOR]

Gun ranges in the United States are underinvestigated regarding indoor air quality (IAQ) and energy efficiency. Navy Environmental Health Center (NEHC), National Guard Bureau (NGB), and Air Force Civil Engineer Support Agency (AFCESA) recommend using 100% outdoor air, but this measure will cause prohibitive energy costs since indoor gun ranges must maintain a low air velocity ranging from 0.25 to 0.36 m/s and a supply temperature close to the range target temperature. Hence, typical commercial firing ranges use a fixed outdoor air ratio (OAR) ranging from 25% to 30% together with high-efficiency particulate air filtration to save energy. This OAR is arbitrary and not supported by any standards or guidelines. To obtain reliable control of contaminant levels and better energy efficiency, we propose a model-based demand control ventilation feedback control strategy in which carbon monoxide is monitored and controlled as a proper IAQ indicator around the clock. Our 52-day field study demonstrates that our demand control ventilation control strategy can ensure proper IAQ, reduce the OAR from 30% to as low as 2.5%, and cut up to 85% cooling load and 70% heating load introduced by ventilation. Indoor gun ranges in the United States often struggle with keeping the air clean and energy costs down. Existing recommendations suggest using a lot of outdoor air for ventilation, but this can be expensive because gun ranges need to maintain specific air conditions. Most gun ranges use a fixed amount of outdoor air and special filters to save energy, even though there are no clear guidelines for this. To tackle these issues, we have come up with a smart ventilation system. It constantly checks the air for carbon monoxide, a sign of bad air quality. Our 52-day study showed that this system works considerably well. It keeps the air clean, reduces the need for outdoor air substantially, and cuts down on heating and cooling costs. This means that indoor gun ranges can have clean air and save energy at the same time. It is a practical and efficient solution for making indoor shooting ranges safer and more cost-effective. [ABSTRACT FROM AUTHOR]

Introduction: Many patients with human epidermal growth factor receptor-2-positive metastatic breast cancer (HER2+ mBC) require subsequent lines of therapy (LOTs) after being treated with pertuzumab and trastuzumab-based regimens in the first line (1L). Although the efficacy of the second-line (2L) therapies has been demonstrated in clinical trials, the real-world effectiveness of these treatments is understudied. This retrospective cohort study assessed the real-world treatment patterns and outcomes for patients with HER2+ mBC following 1L therapy with pertuzumab and trastuzumab-based regimens in the United States (US) during 2015–2019. Methods: Adults with HER2+ mBC in the US who initiated 1L pertuzumab and trastuzumab-based regimens between 01/01/2015 and 09/30/2019 and had ≥ 60 days of follow-up after 1L initiation were identified from the IQVIA Oncology Electronic Medical Records database. The regimens utilized in 2L following 1L pertuzumab and trastuzumab-based regimens were described. Median treatment duration and time to treatment failure were reported for 2L based on Kaplan–Meier analyses. Results: Of the 710 eligible patients who received pertuzumab and trastuzumab-based regimens in 1L (median age: 57.0 years [interquartile range: 48.0–65.0]; median follow-up: 20.3 months; median 1L duration: 15.3 months), 222 (31.3%) initiated 2L. The most common regimens in 2L were ado-trastuzumab emtansine (T-DM1)-based regimens (n = 159 [71.6%]), followed by lapatinib-based (n = 21 [9.5%]) and neratinib-based (n = 18 [8.1%]) regimens. The median treatment duration and time to treatment failure were 5.9 (95% CI: 5.0, 8.7) and 8.6 (7.3, 11.5) months, respectively, among patients initiating 2L, and 5.7 (4.7, 7.8) and 7.9 (6.5, 10.0) months among those receiving 2L T-DM1. Conclusions: Most patients with HER2+ mBC requiring additional treatments after 1L pertuzumab and trastuzumab-based regimens utilized T-DM1 in 2L during 2015–2019. The short median treatment duration and time to treatment failure highlight an unmet need that can potentially be fulfilled by recently approved treatment options. [ABSTRACT FROM AUTHOR]

Background: The growing interest suggests that the widespread application of radiomics has facilitated the development of neurological disease diagnosis, prognosis, and classification. The application of artificial intelligence methods in radiomics has increasingly achieved outstanding prediction results in recent years. However, there are few studies that have systematically analyzed this field through bibliometrics. Our destination is to study the visual relationships of publications to identify the trends and hotspots in radiomics research and encourage more researchers to participate in radiomics studies. Methods: Publications in radiomics in the field of neurological disease research can be retrieved from the Web of Science Core Collection. Analysis of relevant countries, institutions, journals, authors, keywords, and references is conducted using Microsoft Excel 2019, VOSviewer, and CiteSpace V. We analyze the research status and hot trends through burst detection. Results: On October 23, 2022, 746 records of studies on the application of radiomics in the diagnosis of neurological disorders were retrieved and published from 2011 to 2023. Approximately half of them were written by scholars in the United States, and most were published in Frontiers in Oncology, European Radiology, Cancer, and SCIENTIFIC REPORTS. Although China ranks first in the number of publications, the United States is the driving force in the field and enjoys a good academic reputation. NORBERT GALLDIKS and JIE TIAN published the most relevant articles, while GILLIES RJ was cited the most. RADIOLOGY is a representative and influential journal in the field. "Glioma" is a current attractive research hotspot. Keywords such as "machine learning," "brain metastasis," and "gene mutations" have recently appeared at the research frontier. Conclusion: Most of the studies focus on clinical trial outcomes, such as the diagnosis, prediction, and prognosis of neurological disorders. The radiomics biomarkers and multi-omics studies of neurological disorders may soon become a hot topic and should be closely monitored, particularly the relationship between tumor-related non-invasive imaging biomarkers and the intrinsic micro- environment of tumors. [ABSTRACT FROM AUTHOR]

Objective: Alzheimer's disease (AD) is a major disease that affects the elderly worldwide. Several studies have revealed that vitamins may influence the risk of developing AD. However, information in this field remains ambiguous. Therefore, this study aimed to examine the relationship between AD and vitamins, identify journal publications and collaborators, and analyze keywords and research trends using a bibliometric method. Methods: We systematically searched the Web of Science (WOS) Core Collection for papers published on AD and vitamins. Retrieved data regarding institutions, journals, countries, authors, journal distribution, keywords, and so on. SPSS 25 software was used for the statistical analysis, and CiteSpace V.6.1.R6 was used to visualize the information through collaborative networks. Results: A total of 2,838 publications were ultimately included in accordance with the specified inclusion criteria. The number of publications gradually increased from 1996 to 2023, with papers published in 87 countries/regions and 329 institutions. China (centrality: 0.02) and the University of Kentucky (centrality: 0.09) were the major research countries and institutions, respectively. NEUROLOGY was cited most frequently, reaching 1,573, and had the greatest impact. The cited keywords show that "Alzheimer's disease," "oxidative stress," "vitamin E," and "dementia" have been research hotspots in recent years. Beta-carotene emerged in 2023 and was identified as a developmental trend in this field. Conclusion: This is the first bibliometric analysis of vitamins associated with AD. We identified 2,838 articles in the field of vitamins and AD, analyzed the information of major countries/regions, institutions, and core journals in this field, and summarized the research hotspots and frontiers. These findings provide useful information for researchers to explore the role of vitamins in AD further. [ABSTRACT FROM AUTHOR]

Background: In patients with advanced non-small cell lung cancer (aNSCLC), cemiplimab plus chemotherapy prolonged overall survival (OS) and progressionfree survival (PFS) significantly compared to chemotherapy alone. The costeffectiveness of these drugs is still uncertain. The aim of this study is to assess the cost-effectiveness of cemiplimab plus chemotherapy compared with chemotherapy for the treatment of aNSCLC from the third-party payer perspective in the United States. Materials and methods: The cost-effectiveness of cemiplimab with chemotherapy versus chemotherapy for the treatment of aNSCLC was evaluated using a partitioned survival model containing three mutually incompatible health states. The clinical characteristics and outcomes used in the model were gathered from EMPOWER-Lung 3 trial. We have conducted deterministic one-way sensitivity analysis and probabilistic sensitivity analysis in order to evaluate the robustness of the model. The primary outcomes considered were the costs, life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefits (INHB), and incremental net monetary benefits (INMB). Results: Treatment of aNSCLC with cemiplimab plus chemotherapy increased efficacy by 0.237 QALYs and was associated with an increased total cost of $50,796 compared to chemotherapy alone, resulting in an ICER of $214,256/QALY gained. At a WTP threshold of $150,000/QALY, the INHB of cemiplimab plus chemotherapy was 0.203 QALYs and the INMB was $304,704 compared to chemotherapy alone. The probabilistic sensitivity analysis revealed that there was only a 0.04% chance that cemiplimab with chemotherapy would be costeffective at a WTP threshold of $150,000/QALY. The performance of model was mainly determined by the price of cemiplimab, according to a one-way sensitivity analysis. Conclusions: From the third-party payer perspective, cemiplimab combined chemotherapy is unlikely to be a cost-effective option for the treatment of aNSCLC at the WTP threshold of $150,000/QALY in the United States. [ABSTRACT FROM AUTHOR]

Background: Increasing attention has been paid to the survival of endometrial cancer (EC) patients, but the non‐cancer causes of death from EC are rarely reported. This study primarily aimed to investigate the non‐cancer causes of death in patients with EC. Methods: The study collected relevant data, including age, tumour stage and treatment mode, on patients diagnosed with endometrial malignancies from 2000 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) Programme. We analysed the standardised mortality ratio (SMR) to determine the cause of death. Results: The study included 135,831 patients with EC. During the follow‐up, 46,604 (34.3%) patients died, of whom 42.9%, 15.6% and 41.5% died of EC, other cancers and non‐cancer causes, respectively. As the diagnosis time increased, the number of EC‐associated mortalities gradually decreased. The most common non‐cancer causes of death were heart disease, cerebrovascular disease and diabetes. Regarding the general population of the United States, patients with EC died of heart disease (SMR: 1.06; 95% confidence interval [CI]: 1.03–1.09), diabetes (SMR: 1.56; 95% CI: 1.47–1.65) and septicaemia (SMR: 1.40; 95% CI: 1.28–1.52), which were statistically significant. Conclusions: For patients with EC, the number of deaths from non‐cancer causes (mainly heart disease, cerebrovascular disease and diabetes mellitus) is equivalent to that of EC. In addition, compared with the general population, EC survivors have a higher risk of death from sepsis and diabetes. These discoveries support how survivors can avoid future‐related health risks. By doing this, clinicians can improve the quality of life and chances of the survival of patients with EC. [ABSTRACT FROM AUTHOR]

Maslinic acid (MA) is a pentacyclic triterpene obtained from the peel of olives that exhibits anti-inflammatory and antioxidant properties in several conditions. Our previous study revealed that MA exerted a cardioprotective effect by repressing inflammation and apoptosis during myocardial ischemia-reperfusion injury (MIRI). However, data regarding the antioxidative effects of MA on MIRI remains limited. This study aims to elucidate the antioxidative roles and underlying mechanisms of MA on MIRI. The left anterior descending coronary artery of rats was subjected to ligate for the induction of the ischemia/reperfusion (I/R) model and the H9c2 cells were exposed to hydrogen peroxide (H2O2) to mimic oxidative stress. The results showed that MA reduced the I/R-induced myocardial injury and H2O2-induced cardiomyocyte death in a dose-dependent manner. Meanwhile, MA increased the activities of glutathione and superoxide dismutase both in vitro and in vivo while lowering the levels of reactive oxygen species and malondialdehyde. Mechanistically, MA could facilitate Nrf2 nuclear translocation, activate the Nrf2/HO-1 signaling pathway, and repress the NF- κ B signaling pathway both in I/R- and H2O2-induced oxidative stress. Besides, MA promoted the intranuclear Nrf2 and HO-1 expression, which could in part be improved by QNZ (NF- κ B inhibitor) in H2O2-insulted cells. Conversely, MA markedly reduced the intranuclear NF- κ B p65 and TNF- α expression, which could be partially abolished by ML385 (Nrf2 inhibitor). Overall, our results indicate that MA, in a dose-dependent manner, mitigated I/R-induced myocardial injury and oxidative stress via activating the Nrf2/HO-1 pathway and inhibiting NF- κ B activation. Furthermore, MA exerts its cardioprotective effect through regulating the crosstalk between the Nrf2 and NF- κ B pathways. [ABSTRACT FROM AUTHOR]

Objective: To determine the coalitions and impact of authors, countries, institutions, and journals, evaluate the knowledge base, find the hotspot trends, and identify the emerging topics in lumbar disc herniation (LDH). Method: The articles related to LDH were obtained from the Web of Science Core Collection on August 21, 2021. Two scientometric software (CiteSpace 5.8.R.1 and VOSviewer 1.6.17) were used to perform bibliometric and knowledge-map analysis. Results: From the set parameters, 4642 articles were included in the literature. Although the total number of publications fluctuated between 2001 and 2020, a general trend toward increase was observed. Respectively, the most productive country and institution in the field were the United States and Wooridul Spine Hospital. The most active and cited authors were Lee and Weinstein. Spine was the most impactful and cited journal. Weinstein (JAMA 296:2441–2450, 2006) had the highest number of co-citations and Weinstein(N Engl J Med 358:794-810, 2008) had the highest number of citations. The keyword "low back pain" was ranked first for frequency and total link strength, whereas "risk factor" was ranked first for centrality. Topics including pathogenesis (disc herniation), examination methods (MRI), treatment methods (non-surgical treatment, surgical treatment), surgical options (laminectomy, discectomy), clinical observations (double-blind, efficacy, outcome, learning curve), and evaluation of efficacy (meta-analysis) of LDH have been the focus of leading-edge research in 2001–2020. Conclusion: Using bibliometric methods, this study mapped the knowledge map of LDH research in the past 20 years. The study identifies existing trends to provide a framework for further research. [ABSTRACT FROM AUTHOR]

Objectives: Diet is an important factor in gestational health. Many pregnant women have suboptimal diets and dairy foods are an excellent source of key nutrients. The aim of this work was to investigate the relationships between dairy consumption (cup equivalents/day) or diet quality assessed using the Healthy Eating Index-2015 and gestational diabetes mellitus (GDM) or gestational weight gain (GWG) among pregnant women in the United States (US). Methods: Study populations were subsets of pregnant, non-lactating women (20–44 years) in the National Health and Nutrition Examination Surveys 2003–2016, which was approved by the National Center for Health Statistics Research Ethics Review Board. GDM and GWG were classified according to national guidelines. General characteristics were compared across categories of dietary variables. Adjusted regression models estimated associations between diet and GDM and GWG. Results: No statistically significant linear associations between dairy consumption or diet quality and GDM or GWG were observed. Conclusions for Practice: Future research should aim to address the limitations of the current cross-sectional analyses and further elucidate the underlying relationships between diet and gestational health. [ABSTRACT FROM AUTHOR]

Introduction: Comparisons of healthcare utilization and expenditure among multiple sclerosis (MS) disease-modifying therapies (DMTs) are limited. Methods: In this retrospective cohort study using commercial insurance claims data of a US population (2010–2019), we compared healthcare utilization and costs in MS across different DMTs. We assigned patients to different treatment arms: no DMT (ND), high-efficacy (HE) DMT (alemtuzumab, B cell depletion, cladribine, and natalizumab), and standard-efficacy (SE) DMT (dimethyl fumarate, glatiramer acetate, interferon beta, sphingosine-1-phosphate receptor modulator, and teriflunomide). We obtained healthcare costs and occurrences of healthcare services: outpatient visits, emergency room visits, hospitalizations, MS-related magnetic resonance imaging (MRI). We quantified relapses (based on MS-related hospitalizations, as well as outpatient visits with prescription of high-dose steroids) and medical complexity (based on unique drug classes of prescriptions). We calculated covariate-adjusted incidence rate ratio of healthcare services using negative binomial regression with ND as reference and covariate-adjusted mean cumulative healthcare costs using a generalized linear model with log-link function and gamma distribution. Results: Among the 25,932 patients with MS (mean age 52.8 years, 75.2% women), both HE (mean age 54.0 years, 76.2% women) and SE (mean age 43.9 years, 75.6% women) groups had more non-pharmacy healthcare utilization than ND (mean age 57.6 years, 75.4% women), including overall outpatient doctor visits, neurology visits, and MS-related MRIs as well as relapses and medical complexities. Relative to ND, both HE and SE groups had higher pharmacy costs and overall healthcare costs 12 months after treatment initiation, despite having lower or equivalent non-pharmacy medical costs. In patients on DMT, pharmacy costs accounted for up to 65% of overall healthcare costs with over 85% of pharmacy costs attributable to DMT costs. Conclusion: DMT cost is a key driver of the overall healthcare expenditure in MS. Future comparative and cost-effectiveness studies integrating claims and electronic health records data with better balancing of patient characteristics are warranted. [ABSTRACT FROM AUTHOR]

Background: Stem cells (SCs) therapy for intervertebral disc degeneration (IDD) has been studied for nearly 20 years and it is an important part of regenerative medicine and tissue engineering research, as well as a current research hotspot and challenge. Although the volume of literature has shown an annual growth trend, there is no literature available for bibliometric and clinical analysis of the content of multiple databases in this field. Methods: The articles were obtained from the WOSCC, Scopus, Pubmed, and ClinicalTrials on 27 December 2021. Three scientometric software (VOSviewer 1.6.17, CiteSpace 5.8.R.1 and Scimago Graphica) were used to perform bibliometric and knowledge-map analysis. Results: We included 867 articles from WOSCC, 716 articles from Scopus and 6 clinical studies from ClinicalTrials for literature analysis. Our results showed that China was the country with the highest number of publications, with the United States (US) being the leader in terms of international collaborations and the number of citations. Sakai D, Grad S and Hoyland JA had made outstanding contributions for their high productivity and the quality articles. Spine was the most published and most cited journal, in addition to Spine Journal and Biomaterials, which were also more authoritative journals and had received high citations. All of them had received high citations. Keyword co-occurrence studies suggested that the current hotspots were in mechanistic studies, including inflammation, apoptosis, exosome, autophagy, and others. Some studies had also investigated tissue-engineered scaffolds of SCs to better repair degenerated discs. Clinical studies were relatively scarce. Direct injection of Mesenchymal Stem Cells (MSCs) into degenerated discs for the treatment of Degenerative disc disease (DDD) was the current direction of research. Conclusion: This study demonstrates the global research hotspots, trends and clinical use of SCs in the treatment of IDD. It can help scholars to quickly understand the current status and hotspots of research in this field, and also provide some guidance and reference for those who are currently researching in this area. [ABSTRACT FROM AUTHOR]

Objectives: Using individual patient-level data from the phase 3 VIALE-A trial, this study assessed the cost-effectiveness of venetoclax in combination with azacitidine compared with azacitidine monotherapy for patients newly diagnosed with acute myeloid leukemia (AML) who are ineligible for intensive chemotherapy, from a United States (US) third-party payer perspective. Methods: A partitioned survival model with a 28-day cycle and three health states (event-free survival (EFS), progressive/relapsed disease, and death) was developed to estimate costs and effectiveness of venetoclax + azacitidine versus azacitidine over a lifetime (25-year) horizon. Efficacy inputs (overall survival (OS), EFS, and complete remission (CR)/CR with incomplete marrow recovery (CRi) rate) were estimated using VIALE-A data. Best-fit parametric models per Akaike Information Criterion were used to extrapolate OS until reaching EFS and extrapolate EFS until Year 5. Within EFS, the time spent in CR/CRi was estimated by applying the CR/CRi rate to the EFS curve. Past Year 5, patients still in EFS were considered cured and to have the same mortality as the US general population. Mean time on treatment (ToT) for both regimens was based on the time observed in VIALE-A. Costs of drug acquisition, drug administration (initial and subsequent treatments), subsequent stem cell transplant procedures, adverse events (AEs), and healthcare resource utilization (HRU) associated with health states were obtained from the literature/public data and inflated to 2021 US dollars. Health state utilities were estimated using EuroQol-5 dimension-5 level data from VIALE-A; AE disutilities were obtained from the literature. Incremental cost-effectiveness ratios (ICERs) per life-year (LY) and quality-adjusted life-year (QALY) gained were estimated. Deterministic sensitivity analyses (DSA), scenario analyses, and probabilistic sensitivity analyses (PSA) were also performed. Results: Over a lifetime horizon, venetoclax + azacitidine versus azacitidine led to gains of 1.89 LYs (2.99 vs. 1.10, respectively) and 1.45 QALYs (2.30 vs. 0.84, respectively). Patients receiving venetoclax + azacitidine incurred higher total lifetime costs ($250,486 vs. $110,034 (azacitidine)). The ICERs for venetoclax + azacitidine versus azacitidine were estimated at $74,141 per LY and $96,579 per QALY gained. Results from the DSA and scenario analyses supported the base-case findings, with ICERs ranging from $60,718 to $138,554 per QALY gained. The results were most sensitive to varying the parameters for the venetoclax + azacitidine base-case EFS parametric function (Gompertz), followed by alternative approaches for ToT estimation, treatment costs of venetoclax + azacitidine, standard mortality rate value and ToT estimation, alternative sources to inform HRU, different cure modeling assumptions, and the parameters for the venetoclax + azacitidine base-case OS parametric function (log-normal). Results from the PSA showed that, compared with azacitidine, venetoclax + azacitidine was cost-effective in 99.9% of cases at a willingness-to-pay threshold of $150,000 per QALY. Conclusions: This analysis suggests that venetoclax + azacitidine offers a cost-effective strategy in the treatment of patients with newly diagnosed AML who are ineligible for intensive chemotherapy from a US third-party payer perspective. Trial Registration: ClinicalTrials.gov, NCT02993523. Date of registration: 15 December 2016. [ABSTRACT FROM AUTHOR]

Objective: Nivolumab improves overall survival (OS) and is associated with fewer adverse events than sorafenib for the treatment of advanced hepatocellular carcinoma (aHCC). However, the cost-effectiveness of nivolumab compared with sorafenib treatment for aHCC remains unclear. This study evaluated the cost-effectiveness of nivolumab and sorafenib in the treatment of aHCC. Materials and methods: A partitioned survival model that included three mutually exclusive health states was used to evaluate the cost-effectiveness of nivolumab and sorafenib for treating aHCC. The clinical characteristics and outcomes of the patients in the model were obtained from the CheckMate 459. We performed deterministic one-way sensitivity and probabilistic sensitivity analyses to evaluate the robustness of the model. Subgroup analyses were also performed. Costs, life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefits (INHB), and incremental net monetary benefits (INMB) were measured. Results: The base case analysis showed that compared with sorafenib, treatment with nivolumab was associated with an increment of 0.50 (2.45 vs. 1.95) life-years and an increment of 0.32 (1.59 vs. 1.27) QALYs, as well as a $69,762 increase in cost per patient. The ICER was $220,864/QALY. The INHB and INMB were -0.15 QALYs and -$22,362 at a willingness-to-pay (WTP) threshold of $150,000/QALY, respectively. The probabilistic sensitivity analysis demonstrated that the probability of nivolumab being cost-effective was only 10.38% at a WTP threshold of $150,000/QALY. The model was most sensitive to the costs of sorafenib and nivolumab according to the one-way sensitivity analysis. When the price of sorafenib exceeded $0.93/mg or nivolumab was less than $24.23/mg, nivolumab was more cost-effective. The subgroup analysis illustrated that the probability of costeffectiveness was >50% in the Barcelona Clinic Liver Cancer Stage B subgroups for nivolumab at a WTP threshold of $150,000/QALY. This study also showed that the probability of cost-effectiveness was <50% in most subgroups. Conclusion: Nivolumab was not cost-effective, although it was associated with better clinical benefit and a favorable safety profile for the treatment of aHCC compared with sorafenib from the third-party payer perspective in the United States. If the price of nivolumab is substantially reduced, favorable cost-effectiveness can be achieved among patients with aHCC. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 is a newly discovered beta coronavirus at the end of 2019, which is highly pathogenic and poses a serious threat to human health. In this paper, 1875 SARS-CoV-2 whole genome sequences and the sequence coding spike protein (S gene) sampled from the United States were used for bioinformatics analysis to study the molecular evolutionary characteristics of its genome and spike protein. The MCMC method was used to calculate the evolution rate of the whole genome sequence and the nucleotide mutation rate of the S gene. The results showed that the nucleotide mutation rate of the whole genome was 6.677 × 10-4 substitution per site per year, and the nucleotide mutation rate of the S gene was 8.066 × 10-4 substitution per site per year, which was at a medium level compared with other RNA viruses. Our findings confirmed the scientific hypothesis that the rate of evolution of the virus gradually decreases over time. We also found 13 statistically significant positive selection sites in the SARS-CoV-2 genome. In addition, the results showed that there were 101 nonsynonymous mutation sites in the amino acid sequence of S protein, including seven putative harmful mutation sites. This paper has preliminarily clarified the evolutionary characteristics of SARS-CoV-2 in the United States, providing a scientific basis for future surveillance and prevention of virus variants. [ABSTRACT FROM AUTHOR]

Abstract Economic theory suggests that a binding minimum wage increase may reduce the generosity of employer-sponsored insurance (ESI) or other fringe benefits, yet previous empirical studies reach conflicting conclusions about the existence of a trade-off between minimum wages and ESI. We study whether recent state and federal minimum wage increases affect the level or the source of health insurance coverage for low-income families using the 2005–16 Current Population Survey. Our research design uses state and year fixed effects to isolate within-state minimum wage changes while controlling for Medicaid eligibility and other changes in health policy related to implementation of the Affordable Care Act. Because dependent coverage might also be affected by minimum wage hikes, we examine ESI coverage for both low-wage workers and their dependents. We find robust evidence that minimum wage increases lead to reductions in ESI coverage in families below 300 percent of the federal poverty level, with a nominal $1 increase in the minimum wage reducing the probability of ESI coverage by 0.99 percentage points. Reductions in coverage were observed both for workers and for their dependents. [ABSTRACT FROM AUTHOR]

In the wake of COVID-19, mental health providers and treatment programs are adapting rapidly to the challenges in engaging people and delivering treatment with limited guidance. This paper will explore the challenges associated with delivering treatment within coordinated specialty care (CSC) programs for people with first episode psychosis. Suggestions for treatment will take into consideration experiences with stress, changes to the pursuit of work and school, and increased time spent with families. Drawing on the experience of several CSC programs in the United States, Israel, and China, we describe the impact and modifications to the core treatment elements in CSC including medication, family interactions, supported employment and education, individual therapy, peer support and the way they are delivered. The paper includes recommendations based on experiences from CSC programs to help staff members, participants, and family members better identify, prepare, cope and respond to the unique new challenges and suggests modifications that can be made during various stages of the coronavirus pandemic. [ABSTRACT FROM AUTHOR]

Background Sodium intake in the USA exceeds recommendations. The replacement of added sodium chloride (NaCl) with potassium chloride (KCl) provides a potential strategy to reduce sodium intake. Objective The purpose of this study was to quantitatively estimate changes in intakes of sodium and potassium by the US population assuming use of potassium-based NaCl replacers in top dietary sodium sources. Methods Data collected in the What We Eat in America (WWEIA) component of the 2015–2016 and 2009–2010 NHANES were used to identify top-ranking sources of dietary sodium among the population aged 2 y and older based on contributions from food categories aligning with the FDA draft guidance for voluntary sodium reduction. Predicted nutrient intakes were estimated in models assuming total and feasible and practical (F&P) replacement of added NaCl with KCl in foods and ingredients within the top food sources of sodium. An expert elicitation was conducted to collect information on the F&P KCl replacement of added NaCl. Results Using 2015–2016 consumption data, the total replacement of added NaCl with KCl in the 18 top-ranking sources of dietary sodium results in a predicted sodium intake of 2004 mg/d from the replacement of 1406 mg/d sodium with 1870 mg/d potassium as KCl. Modeled F&P replacement predicted sodium intakes of 3117 mg/d (range of 2953 to 3255 mg/d) from the replacement of 294 mg/d sodium (155 to 457 mg/d) with 390 mg/d potassium (206 to 608 mg/d). Similar results are seen with 2009–2010 data. Conclusions The F&P replacement of NaCl with KCl in top-ranking sources of dietary sodium modeled in this study can result in decreased sodium to a level consistent with the short-term intake goal targeted by the FDA of 3000 mg/d, with the mean potassium intake remaining in the range recommended for the apparently healthy population. [ABSTRACT FROM AUTHOR]

Background: Individuals with OSA have elevated levels of inflammatory markers, but no prospective study has examined the role of inflammation in the development of OSA.Research Question: Is C-reactive protein (CRP) prospectively associated with risk of developing OSA?Study Design and Methods: We followed 1,882 women from the Nurses' Health Study (NHS) (2002-2012), 3,854 women from Nurses' Health Study II (NHSII) (1995-2013), 3,075 men from the Health Professionals Follow-up Study (HPFS) (1996-2012), and 1,919 women and men from the Multi-Ethnic Study of Atherosclerosis (MESA) (2000-2012) who did not have diagnosed OSA at baseline and for whom CRP levels were available. In NHS/NHSII/HPFS, physician-diagnosed OSA was self-reported. In MESA, at-home polysomnography was performed and OSA was identified as an apnea-hypopnea index ≥ 30. Logistic regression was used to estimate the OR for OSA risk according to baseline CRP level, adjusted for multiple inflammation-related factors.Results: After multivariable adjustment not including BMI, the pooled OR for OSA risk per doubling of baseline CRP level was 1.24 (95% CI, 1.18-1.30). Additional adjustment for BMI substantially attenuated the association (pooled OR, 1.07; 95% CI, 1.01-1.12). The fully adjusted association was consistently stronger in individuals < 55 vs ≥ 55 years of age (P interaction = .01), in individuals with BMI < 25 vs ≥ 25 kg/m2 (P interaction = .02), and in pre- vs postmenopausal women (P interaction = .002). CRP was more strongly associated with risk of OSA associated with excessive daytime sleepiness, high airway collapsibility, and low arousal threshold (P heterogeneity < .05).Interpretation: Higher CRP was prospectively associated with increased OSA risk, particularly among younger individuals, underweight/normal-weight individuals, or premenopausal women. The differential associations by OSA phenotype/endotype suggest possible mechanisms through which inflammation operates to modulate OSA risk. Given our reliance on a single CRP level measured a decade before OSA assessment, future studies with repeated CRP measurements are warranted to confirm these prospective associations. [ABSTRACT FROM AUTHOR]

Cancer patients have a higher risk of depression and are associated with severe adverse prognosis. The relationship between leisure-time physical activity (LTPA) and depressive symptoms in cancer patients is currently unclear. Therefore, our study mainly explores the potential association between LTPA and the weekly cumulative time of LTPA with depressive symptoms in cancer patients. We included and analyzed 3368 cancer patients (aged >20 years) from the National Health and Nutrition Examination Survey (NHANES) of the United States from 1999 to 2018. The LTPA score was evaluated through a self-report questionnaire, while depressive symptoms were evaluated through the Health Questionnaire-9 (PHQ-9). Multiple logistic regression analysis was used to explore the relationship between LTPA duration and the occurrence of cancer-related depressiive symptoms. Linear correlation was studied using the restricted cubic spline method. According to a fully adjusted multivariate logistic regression model with confounding variables, the odds ratio (OR) between LTPA and depressive symptoms in cancer patients in this study was 0.59 (95 % confidence interval = 0.39, 0.92; P = 0.02). When the LTPA level was ≥300 min/week, the incidence of depressive symptoms was reduced by 59 % (OR = 0.41, 95 % CI = 0.21, 0.83). In addition, the cubic spline method was used to obtain a linear negative correlation between LTPA duration and tumor depressive symptoms. LTPA was negatively correlated with cancer-related depressive symptoms, and the cumulative time of LTPA/week was linearly correlated with depressive symptoms. The slope of the benefit curve changed significantly when the cumulative time of LTPA reached 600 min per week, suggesting that appropriately increasing LTPA had significant benefits on mental health of cancer patients. • This study had several key strengths. • Firstly, multi-stage probability sampling of the data improves the validity and generalizability of the results. • Secondly, adjustments were made for confounders such as basic status, dietary status and chronic disease. • Thirdly, stratified analyses to understand the relationship between the factors make the results more relevant. • Finally, the association between leisure-time physical activity and cancer-related depressive symptoms is novel. [ABSTRACT FROM AUTHOR]

This study investigates and compares the impact of information cascades on online shopping behaviors in China and the United States. In particular, the role of information cascades in moderating the effect of price discounts has been examined and cross-culturally compared. To do so, two 122-day panel data sets were collected from two separate online flagship stores selling a same brand of sports shoes on Tmall.com and eBay.com. The results show that product ranking positively influences the product sales in the online shopping market, which follows the predicted results achieved in information cascades studies. Moreover, information cascades are more prominent for Chinese consumers than for American consumers. The findings also suggest that information cascades have moderated the impact of price discounts on online purchase behavior. However, this moderating effect is also influenced by cultural orientation of online customers. The findings are important from not only a theoretical perspective but also a managerial one. [ABSTRACT FROM AUTHOR]

Background: Given the rapid growth of the global aging population, pain has become an unneglectable concern amongst the elderly. The quantity of scientific research outputs on pain in the elderly has increased over time, but only a small number of studies have used bibliometric methods to analyze scientific research in this field. This paper aimed to analyze scientific research on pain in the elderly published from 2000 to 2019 in a systematic manner using bibliometric methods. Methods: Articles on pain in the elderly published from 2000 to 2019 were retrieved from the Web of Science (WoS). Abstracts were coded on the basis of predetermined items (eg, type of article, topic, type of subjects, pain characteristics), and relevant information on the first author, citation scores, and article keywords were collected. Results: A total of 2105 articles were included in this study. Statistical analysis revealed that the publication of articles on pain in the elderly increased in frequency over time (P< 0.001). Most of the publications were original articles. Amongst the countries identified, the United States published the largest number of papers on this topic. Pain characteristics (50.21%), pain intervention (35.68%), and pain assessment (9.69%) were the main topics of research on geriatric pain. Back pain (12.30%) appeared to be the most popular pain type described in the included papers. Conclusion: This work provides researchers with an in-depth understanding of pain in the elderly by evaluating relevant publications in the past two decades. Researchers in this field are warranted to explore future directions on geriatric pain such as the transition from acute pain to chronic pain and the underlying mechanisms of pain in the elderly. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence of hearing impairment in participants with type 1 diabetes enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study and compare with that of a spousal control group without diabetes. Among participants with type 1 diabetes, to evaluate the association of hearing impairment with prior DCCT therapy and overall glycemia.Research Design and Methods: DCCT/EDIC participants (n = 1,150) and 288 spouses without diabetes were recruited for the DCCT/EDIC Hearing Study. All subjects completed a self-administered questionnaire, medical history, and physical measurements. Audiometry was performed by study-certified personnel; audiograms were assessed centrally. Speech-frequency (pure-tone average [PTA] thresholds at 500, 1,000, 2,000, and 4,000 Hz) and high-frequency impairment (PTA thresholds at 3,000, 4,000, 6,000, and 8,000 Hz) were defined as PTA >25 dB hearing loss. Logistic regression models were adjusted for age and sex.Results: DCCT/EDIC participants and spousal control subjects were similar in age, race, education, smoking, and systolic blood pressure. There were no statistically significant differences between groups in the prevalence or adjusted odds of speech- or high-frequency impairment in either ear. Among participants with type 1 diabetes, for every 10% increase in the time-weighted mean HbA1c, there was a 32% (95% CI 1.15-1.50) and 19% (95% CI 1.07-1.33) increase in speech- and high-frequency hearing impairment, respectively.Conclusions: We found no significant difference in the prevalence of hearing impairment between the group with type 1 diabetes and the spousal control group. Among those with type 1 diabetes, higher mean HbA1c over time was associated with hearing impairment. [ABSTRACT FROM AUTHOR]

The Tritium Processing Facility at the Savannah River Site releases effluent containing copper (Cu), zinc (Zn), and lead (Pb) to the H-02 constructed wetland for remediation before the final release. Sediment cores were collected in the wetland cells in both summer and winter. Concentrations of total metals in all sediment layers and acid-volatile sulfide (AVS) and simultaneously extracted metals (SEM) in surface sediments were determined. Total metal concentrations suggested most metals removed from surface water were retained by the organic-rich flocculent in the top sediment layers instead of being transported to the deeper sulfide mineral layers. The seasonal difference of AVS and SEM indicated a season-related sulfur cycle and metal removal process in the wetland cells. SEM-Zn was the major contributor to total SEM. Metals accumulating in surface sediments were mainly sequestered in AVS and SEM extractable phases including metal-sulfides and organic matter complexes. The general SEM/AVS ratio was > 1, demonstrating the metals associated with sediments were potentially mobile and/or bioavailable, which becomes a concern for the long-term sustainability of the constructed wetland. The disturbance event in the sediment triggered the release of total metals, which were mostly in particulate form and were not bioavailable. Due to the high levels of reduced ion (Fe) in the sediment, the released particulate metals were likely to form metal-scavenging particulate Fe3+ oxyhydroxides under oxic conditions. [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]

Objective: Mineral nutrients play an important role in maintaining material and energy metabolism. Reports on mineral nutrient intakes and body mass index (BMI) and waist circumference (WC) are rare in the United States. This study examined the relationship between BMI, WC and dietary mineral intakes. Method: We used the data from National Health and Nutrition Examination Survey 2007–2014. Nutrient intakes were adjusted for energy according to the residual adjustment method. We used the quantile regression model to analyze the relationship between BMI, WC under different distributions and the average daily mineral intakes. Result: A total of 19,952 people were included in the study, including 9,879 men and 10,073 women (≥20 years old). The median BMI was 27.935 kg/m² and the median WC was 97.700 cm. The results of quantile regression showed that calcium, magnesium, potassium, copper, zinc and iron intakes were negatively correlated with BMI and WC, after adjusting for age and gender. Sodium and phosphorus intakes were positively correlated with BMI, sodium intakes were positively correlated with WC. This correlation was enhanced with increasing quantiles of risk levels. In high BMI or high WC populations, mineral intakes had a greater impact on BMI and WC. The quantile regression coefficients of selenium intakes were not statistically significant at each quantile. Conclusion: Our results suggested that the mineral nutrient intakes were associated with BMI and WC in American adults. However, we also need to further study the longitudinal effects of mineral intakes and obesity. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the potential antiobesity benefits of hot tea consumption at the population level.Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006, the association between hot tea consumption and dual-energy x-ray-measured body fat was examined in a large representative sample of US adults (n = 5,681, 51.9% women).Results: Compared with non-tea drinkers, men who consumed 0.25 to 1 cup per day of hot tea had 1.5% (95% CI: 0.4% to 2.6%) and 1.7% (95% CI: 0.4% to 3.0%) less total and trunk body fat, respectively. The associations were stronger among men 45 to 69 years old compared with younger men (20-44 years). For men who consumed 1 or more cups per day of hot tea, lower total (-1.2%, 95% CI: -2.3% to -0.2%) and trunk body fat (-1.3%, 95% CI: -2.6 to -0.1%) was observed among men 45 to 69 years old only. In women, those who drank 1 or more cups per day had 1.5% lower (95% CI: -2.7% to -0.3%) trunk body fat compared with non-tea drinkers.Conclusions: Consumption of hot tea might be considered as part of a healthy diet in order to support parameters associated with metabolic health and may be particularly important in older male age groups in supporting reduced central adiposity. [ABSTRACT FROM AUTHOR]

Background: The number of red blood cell units transfused per capita in China is lower than in western countries and the reason(s) for the difference is unknown.Study Design and Methods: We randomly chose 5050 transfused patients from five Chinese hospitals. We compared transfused cases to nontransfused controls matched for the same underlying diagnosis. We assessed the pretransfusion hemoglobin (Hb) trigger and other clinical characteristics associated with transfusion. After stratifying by underlying disease, we compared pretransfusion Hb level in Chinese hospitals to 12 US hospitals.Results: In 5050 patients who received transfusion, the pretransfusion Hb levels were lower in medical (6.3 g/dL) compared to surgical patients receiving transfusion postoperatively (8.1 g/dL). In patients with nonsurgical diagnoses, the pretransfusion Hb was much lower than that in the United States; the difference in mean Hb level varied by underlying diagnosis from 0.4 to 1.8 g/dL. In case-control analysis of cases (n = 1356) compared to controls (n = 1201), the pretransfusion Hb showed the strongest association with transfusion. Compared to 10 g/dL, the odds ratio (95% confidence interval) for pretransfusion Hb of 7 to 7.9 g/dL was 37.7 (24.8-57.4).Conclusion: Transfusion triggers in five Chinese hospitals appear comparable to those in the United States for surgical patients; however, medical patients have lower pretransfusion Hb levels (approx. 6 g/dL). Of the factors assessed, the pretransfusion Hb was most strongly associated with transfusion. The clinical impact of lower transfusion thresholds used in China is unknown. [ABSTRACT FROM AUTHOR]

• The metal-removing constructed wetland functioned well from 2008 to 2017. • Metal (Cu, Zn) concentrations in the effluent were lower than the discharge limit. • The average metal removal efficiency was 64% for Cu and 70% for Zn. • Metal toxicity was reduced after wastewater being treated by the wetland. • The wetland performed with a three-stage (plateau, trough, recovery) pattern. The H-02 wetland was constructed on the Savannah River Site (SC, USA) in 2007 to remove Cu and Zn from process and storm runoff water. Water samples were routinely collected from 2008 to 2017 in the primary discharge pipes, influent, effluent, and receiving stream. Water quality parameters were measured in situ , total and dissolved metal (Cu and Zn) concentrations were determined, and metal speciation was calculated with the Biotic Ligand Model. Generally, the H-02 wetland system functioned well during the reporting period. Alkaline waters in the pipe became neutral after running through the wetland. Total metal concentrations in the effluent were lower than the regulatory discharge limit with a removal efficiency of 63.8% (95% CI: 60.8–66.8%) for Cu and 70.5% (95% CI: 67.0–73.9%) for Zn. Reduced metal toxicity was inferred from the observed lower concentrations of free Cu2+ and Zn2+ in the effluent than that in the influent and pipe. As suggested by the higher percentage of Cu-organic matter complexes than Zn-organic matter complexes, Cu had a higher affinity for natural organic ligands than Zn. A three-stage performance pattern of a metal-removing constructed wetland was hypothesized, which includes the plateau stage, the trough stage, and the recovery stage. Further studies were needed to test this hypothesis, monitor the treatment efficiency, improve operation strategies, and ensure the long-term sustainability of H-02 wetland system. [ABSTRACT FROM AUTHOR]

Studies have documented the salience of social networks for a range of health outcomes and behaviors among adolescents, but sleep has received far less attention. We examined whether adolescents' network positions relative to cohesive friendship groups and popularity among peers are associated with their sleep behaviors and whether the associations differ by gender. We analyzed friendship data on 2,550 adolescents from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to identify participants' network group positions (member, isolate, liaison) and popularity (number of friendship nominations received). Respondents provided self-reports of sleep duration, insomnia symptoms, and sleep insufficiency. We evaluated the relationships between respondents' group positions and popularity with their sleep behaviors using linear and Poisson regression, adjusting for socio-demographics, self-rated health, smoking and drinking status, integration in non-peer contexts (school, family, and religion), and friends' sleep. Results from the total sample show that liaisons report increased risk of sleep insufficiency compared to group members. Higher popularity status is associated with shorter sleep duration and greater sleep insufficiency. Stratifying by gender, popular girls report shorter sleep duration (β = -2.68 min for each additional friendship nomination; 95% CI [-4.75, -.61]) and greater sleep insufficiency (RR = 1.04; 95% CI [1.01, 1.07]) compared to less popular girls. Girls who are liaisons experience more sleep insufficiency (RR = 1.28; 95% CI [1.07, 1.53]) compared to group member girls. In contrast, isolated boys reported more insomnia symptoms (RR = 2.19; 95% CI [1.20, 3.98]) compared to group members. Popularity may have hidden costs for girls' sleep, while social isolation seems to be detrimental for boys' sleep. These results suggest that a social network perspective is valuable for studying sleep health and might inform targeted interventions to improve adolescents' sleep outcomes. • Positions in peer groups and popularity are related to adolescents' sleep. • There are gender differences in social network attributes related to sleep. • Popularity is associated with shorter sleep and sleep insufficiency in girls. • Liaison status (group-bridging) is associated with sleep insufficiency in girls. • Isolation status is associated with insomnia symptoms in boys. [ABSTRACT FROM AUTHOR]

Abstract Background Many American adults have one or more chronic diseases related to a poor diet, resulting in significant direct and indirect economic impacts. The 2015-2020 Dietary Guidelines for Americans (DGA) recognized that dietary patterns may be more relevant for predicting health outcomes compared with individual diet elements and recommended three healthy patterns based on evidence of favorable associations with many chronic disease risk factors and outcomes. Health economic assessments provide a model to estimate the potential influence on costs associated with changes in chronic disease risk resulting from improved diet quality in the US adult population. Objective To estimate the impact on health care costs associated with increased conformance with the three healthy patterns recommended in the 2015-2020 DGA, including the Healthy US-Style, the Healthy Mediterranean-Style, and the Healthy Vegetarian eating patterns. Methods Recent moderate- to high-quality meta-analyses of health outcomes associated with increased conformance with the Healthy US-Style eating pattern as measured by the Healthy Eating Index (HEI) or the Healthy Mediterranean-Style eating pattern measured by a Mediterranean diet score (MED) were identified. Given the lack of quantification of the association between an increased conformance with a vegetarian pattern and health outcomes, the analysis was limited to studies that evaluated Healthy US-style and Healthy Mediterranean-style eating patterns. The 2013-2014 What We Eat in America data provided estimates of conformance with these two eating patterns using the HEI-2015 and the 9-point MED among the US adult population. Risk estimates quantifying the association between eating patterns and health outcomes were combined with the eating pattern score increase under two conformance scenarios: increasing the average HEI-2015 and MED by 20% and increasing the average HEI-2015 and MED to achieve 80% of complete conformance. The resulting change in risk was combined with published data on annual health care and indirect costs, inflated to 2017 US dollars to estimate cost. To address double counting, costs were adjusted to minimize potential overlap of comorbidities. Results Overall modeled cost savings were $16.7 billion (range=$6.7 billion to $25.4 billion) to $31.5 billion (range=$23.9 billion to $38.9 billion) based on a 20% increase in the MED and HEI-2015, respectively, resulting from reductions in cardiovascular disease, cancer, and type 2 diabetes for both patterns and including Alzheimer's disease and hip fractures for the MED. In the case that diet quality of US adults were to improve to achieve 80% of the maximum MED and HEI-2015, cost savings were estimated at $88.2 billion (range=$35.7 billion to $133 billion) and $55.1 billion (range=$41.8 billion to $68.2 billion), respectively. Conclusions This is the first study quantifying savings from all health outcomes identified to be associated with the HEI and the MED to assess conformance with two eating patterns recommended as part of the 2015-2020 DGA. Findings from this study suggest that increasing conformance with healthy eating patterns among US adults could reduce costs, with billions of dollars in potential savings. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is the third most common malignancy in the United States. Mounting microRNAs (miRNAs) have been identified as oncogenes or tumor suppressors in various cancers including CRC. Materials and methods: The levels of microRNA-143-3p (miR-143-3p) and catenin-δ1 (CTNND1) were determined by RT-qPCR assay. Cell proliferative ability was assessed by Cell Counting Kit-8 assay. Cell migratory and invasive capacities were measured by transwell migration and invasion assay. Luciferase reporter assay was conducted to explore whether miR-143-3p could bind with CTNND1 3'UTR. CTNND1 protein level was determined through Western blot assay. Mouse xenograft models of CRC were established to test the functions and molecular basis of miR-143-3p in the development of CRC in vivo. Results: Low amounts of miR-143-3p were expressed in CRC tissues and cells. Functional analysis revealed that miR-143-3p overexpression suppressed cell proliferation, migration and invasion in CRC. Molecular mechanism exploration indicated that miR-143-3p directly targeted CTNND1. Moreover, enforced expression of CTNND1 contributed to cell proliferation, migration and invasion in CRC, and CTNND1 silencing exerted opposite effects. Restoration experiments disclosed that CTNND1 upregulation weakened the inhibitory effects of miR-143-3p on CRC cell proliferation, migration and invasion. Additionally, miR-143-3p inhibited the growth of HCT116-derived xenograft tumors by targeting CTNND1 in vivo. Conclusion: miR-143-3p hampered the development and progression of CRC by targeting CTNND1 in vitro and in vivo, deepening our understanding of the functions and molecular basis of miR-143-3p in the tumorigenesis of CRC and providing some candidate prognostic markers or therapeutic targets for CRC. [ABSTRACT FROM AUTHOR]

This paper examined the prevalence of depressive symptomotology among women of Mexican ancestry (N = 205), over the age of 18, of diverse incomes and nativity. We examined differences in rates of diagnosis by Spanish/English preference and the sensitivity and specificity of three common measures: the Patient Health Questionnaire (PHQ9), the Kessler Psychological Distress Scale (K-10), and depression questions from the Composite International Diagnostic Interview, Short Form (MDD CIDI-SF); PHQ9 was used as the 'gold standard' measure. Results indicated 18-32 % of participants met criteria for depression with higher rates found among Spanish preference participants. The K-10 had significantly higher sensitivity (0.81) but lower specificity (0.79) than the MDD CIDI-SF items (0.57 and 0.89, respectively). This study suggests that the K-10 and MDD CIDI-SF measures are complementary to each other for screening of depressive symptomatology. Implications for cultural and linguistic assessment of depression are further discussed. [ABSTRACT FROM AUTHOR]

This study's purpose was to identify distinct publishing trajectories among 442 participants in three prominent mentored health services research career development programs (Veterans Affairs, National Institutes of Health, and Agency for Healthcare Research & Quality) in the 10 years after award receipt and to examine awardee characteristics associated with different trajectories. Curricula vitae (CVs) of researchers receiving awards between 1991 and 2010 were coded for publications, grants, and awardee characteristics. We found that awardees published at constant or increasing rates despite flat or decreasing rates of first-author publications. Senior-author publications rose concurrently with rates of overall publications. Higher overall publication trajectories were associated with receiving more grants, more citations as measured by the h-index, and more authors per article. Lower trajectory groups were older and had a greater proportion of female awardees. Career development awards supported researchers who generally published successfully, but trajectories varied across individual researchers. Researchers' collaborative efforts produced an increasing number of articles, whereas first author articles were written at a more consistent rate. Career development awards in health services research supported the careers of researchers who published at a high rate; future research should further examine reasons for variation in publishing among early career researchers. [ABSTRACT FROM AUTHOR]

This study compares public attitudes toward nanotechnology in the United States and Singapore, using large-scale survey data in both countries. Results indicate that Singaporeans tend to be more knowledgeable about and familiar with nanotechnology than the U.S. public. Singaporeans tend to perceive greater benefits and fewer potential risks of nanotechnology, and to indicate greater support for government funding for nanotechnology than the U.S. public. Between the two countries, perceived familiarity with nanotechnology and the benefits and risks of the emerging technology tend to be interpreted differently through the lens of value predispositions (religiosity and deference to scientific authority) and therefore they indirectly affect public support. Specifically, the U.S. public tends to use religiosity to interpret benefits and Singaporeans are inclined to use religiosity to think about risks. Deference to scientific authority also moderates the impact of perceived familiarity with nanotechnology on funding support for the technology among the U.S. public. [ABSTRACT FROM AUTHOR]

The United States consumes 22% of the entire world's energy which is equivalent to all of Europe and the entire continent of Africa combined. Residential homes, accounting for 23% of this consumption, are increasing in size while the average number of occupants is declining. Heating ventilation and air conditioning consume much of the energy in the home. The research team investigated a production homebuilder in the Midwest that builds twenty five models that range from 1041 square foot to nearly 3,000 square foot that was consistently achieving Home Energy Rating System (HERS) below 60. The purpose of this investigation was to determine those features contributing to these low ratings with maintaining competitive production housing pricing. The objectives of the research investigation are as follows: 1. To select a representative energy efficient model for analysis and determine those features that contribute to the energy efficiency; 2. To analyze the cost and energy savings of discrete groupings of features; and 3. To conduct a life cycle analysis on the initial cost and the energy saving of discrete feature. [ABSTRACT FROM AUTHOR]

Global climate change has increased the risks of extreme weather-related disasters, leading to severe public health burdens. In February 2021, Winter Storm Uri brought severe cold to southern United States and caused unprecedented health and safety concerns. Residents in subsidized rental housing were among the most vulnerable to cold stress during such a cold storm. However, existing research on the assessment and mitigation of cold stress in underserved neighborhoods in warmer climate zones is limited, which results in the negligence of cold event preparedness and mitigation policies. Therefore, this study aims to assess the micrometeorological conditions and human cold stress in subsidized housing neighborhoods during the 2021 Winter Storm and determine the extent to which cold mitigation windbreak designs are effective in reducing cold stress. Field measurements, ENVI-met simulations, and biometeorological calculations were conducted to reconstruct the microclimate conditions and cold stress during the storm, and three cold-mitigation windbreak designs with varying foliage densities were evaluated. Results showed that the conditions were categorized as "extreme cold stress" for the majority of the day, but especially during nighttime. Areas close to the buildings were generally warmer, and the wind-blocking effects of a building decreased as the distance to the building increased. A moderately dense-foliage windbreak was the most effective in reducing wind speed and improving thermal comfort. Intentional environmental modifications to alter wind velocity and disaster relief programs that provide emergency clothing supplies during power outage may be beneficial to these underserved communities. • Extreme cold conditions in a hot climate were assessed for effect on residents of subsidized housing. • An innovative approach to identifying effective design interventions was introduced using energy flux comparisons. • Design interventions were simulated and the effect on the thermal experience of residents was identified. [ABSTRACT FROM AUTHOR]

Background: Limited information is available regarding the impact of candy consumption on health. The purpose of this study was to investigate associations between typical frequency of candy consumption and body weight status and select cardiovascular risk factors among adults in the United States. Methods: Using data collected in the 2003-2006 National Health and Nutrition Examination Surveys (NHANES), adults were categorized as infrequent (⩽ 3 eating occasions [EO]/month), moderate (> 3 EO/month and ⩽ 3.5 EO/week), or frequent (> 3.5 EO/week) candy consumers based on the combined frequency of chocolate and other candy consumption over the previous 12 months. Weight and adiposity status were analyzed using logistic regression models, and blood pressure, lipids, and insulin sensitivity were analyzed using linear regression models. Models were adjusted for age, sex and race/ethnicity, and also for additional covariates with potential associations with the outcomes. Appropriate statistical weights were used to yield results generalizable to the US population. Results: Frequency of candy consumption was not associated with the risk of obesity, overweight/obesity, elevated waist circumference, elevated skinfold thickness, blood pressure, low density lipoprotein (LDL) or high density lipoprotein (HDL) cholesterol, triglycerides, or insulin resistance. Increased frequency of candy consumption was associated with higher energy intakes and higher energy adjusted intakes of carbohydrates, total sugars and added sugars, total fat, saturated fatty acids and monounsaturated fatty acids (p < 0.05), and lower adjusted intakes of protein and cholesterol (p < 0.001). Conclusions: Increased frequency of candy consumption among adults in the United States was not associated with objective measures of adiposity or select cardiovascular risk factors, despite associated dietary differences. Given the cross-sectional study design, however, it cannot be concluded that candy consumption does not cause obesity or untoward levels of cardiovascular risk markers. The lack of an association between frequency of candy consumption and cardiovascular risk factors could be due to reduced intake of candy among the overweight due to dieting or a health professional's recommendations. Additionally, it is important to note that the analysis was based on frequency of candy consumption and not amount of candy consumed. Longitudinal studies are needed to confirm the lack of associations between frequency of candy consumption and cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Purpose: To validate measurement scales for rating ocular chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation. Candidate scales were recommended for use in clinical trials by the National Institutes of Health (NIH) Chronic GVHD Consensus Conference or have been previously validated in dry eye syndromes. Design: Prospective follow-up study. Participants: Between August 2007 and June 2010, the study enrolled 387 patients with chronic GVHD in a multicenter, prospective, observational cohort. Methods: Using anchor-based methods, we compared clinician or patient-reported changes in eye symptoms (8-point scale) with calculated changes in 5 candidate scales: The NIH eye score, patient-reported global rating of eye symptoms, Lee eye subscale, Ocular Surface Disease Index, and Schirmer test. Change was examined for 333 follow-up visits where both clinician and patient reported eye involvement at the previous visit. Linear mixed models were used to account for within-patient correlation. Main Outcome Measures: An 8-point scale of clinician or patient-reported symptom change was used as an anchor to measure symptom changes at the follow-up visits. Results: In serial evaluations, agreement regarding improvement, stability, or worsening between the clinician and patient was fair (weighted kappa = 0.34). Despite only fair agreement between evaluators, all scales except the Schirmer test correlated with both clinician-reported and patient-reported changes in ocular GVHD activity. Among all scales, changes in the NIH eye scores showed the greatest sensitivity to symptom change reported by clinicians or patients. Conclusions: Our results support the use of the NIH eye score as a sensitive measure of eye symptom changes in clinical trials assessing treatment of chronic GVHD. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. [ABSTRACT FROM AUTHOR]

Prostate cancer is the most common cancer among men in the United States. For decades, the cornerstone of medical treatment for advanced prostate cancer has been hormonal therapy, intended to lower testosterone levels, known as Androgen Deprivation Therapy (ADT). The development of hormone-resistant prostate cancer (now termed castration-resistant prostate cancer:CRPC) remains the key roadblock in successful long-term management of prostate cancer. New advancements in medical therapy for prostate cancer have added to the hormonal therapy armamentarium. These new therapeutic agents not only provide a survival benefit but also show potential for reversing hormonal resistance in metastatic CRPC, and thus redefining hormonally sensitive disease. [ABSTRACT FROM AUTHOR]

Abstract: One''s place of birth is a major determinant of his or her exposure to environmental toxicants. By understanding biological burdens of long half-life toxicants by race and nativity we can better understand geographic variation in toxicant distribution. We used the National Health and Nutrition Examination Survey (1999–2006) biomonitoring data to examine differences in blood and urine levels of long half-life environmental toxicants of foreign-born relative to US-born people by race/ethnicity. We log transformed blood and urine measures of 51 environmental toxicants. We then used “seemingly unrelated regression,” a robust technique for making multiple comparisons across a group of variables with correlated error terms, to examine differences in blood and urine toxicants by nativity and race. We found that, compared to native-born Americans, the foreign-born are generally more likely to be exposed to metals (p<0.001) and organochlorine pesticides (p<0.001), but less likely to be exposed to dioxin-like compounds (p<0.001) or polyflourinated compounds (p<0.001). While levels of toxicants varied greatly by region of birth, US-born participants had consistently higher levels of dioxin-like compounds and polyflourinated compounds. [Copyright &y& Elsevier]

In light of recent disputes opposing USA and China, this article discusses the validity of measures taken by China, based on the public morals exception, to regulate the importation of publications and audiovisual products. On 19 January 2010, the WTO Dispute Settlement Body (DSB) adopted the Appellate Body's report on China - Measures Affecting Trading Rights and Distribution Services for Certain Publications and Audiovisual Entertainment Products (hereinafter referred to as China -Audiovisual Services). In the report, the Appellate Body ruled against a number of trade restrictions introduced by China related to the importation and distribution of certain products, consisting of reading materials, audiovisual products, sound recordings and films for theatrical release. China, as the importing country, has classified the aforementioned products as "cultural goods" and imposed relatively tougher regulation on the importation of these kinds of goods; the United States, on the other hand, insisted that certain trade control measures of China on "cultural goods" constituted unjustifiable discrimination among countries. Among all the issues raised in this case, the application of "public morals exception" might be one of the most controversial points and thus will be the major concern of this paper. [ABSTRACT FROM AUTHOR]

The article discusses a theoretical transition from unipolarity to multipolarity from the perspective that emerging powers such as China will join the U.S. as poles of influence in the international political system. The theory of hegemonic war, effect of redistributed power on international security issues, and five phases of establishing a new world order are discussed. Topics include balance of global power, legitimacy of and resistance to a hegemonic government, China's ambitions at the international level, law of uneven growth among nations, and outlook for the development of bipolar and nonpolar governance structures.

The relative contributions of proximity to mercury sources and trophic ecology to realized axial muscle mercury concentrations were explored for three deep-water chondrichthyans ( Etmopterus princeps, Centroscymnus coelolepis, and Hydrolagus affinis), two species of which are harvested for human consumption. Samples were taken at three North Atlantic Ocean locations: the Azores, the Charlie Gibbs Fracture Zone, and the Bear Seamount. Despite the long distances between anthropogenic sources and the sampling locations, all species from all locations had muscle mercury concentrations exceeding the United States human health screening value of 0.3 mg/kg wet weight. Proximity to anthropogenic sources was not an obvious determinant of these elevated concentrations. Generally, mercury concentrations appeared to increase with increased dependence on benthic versus pelagic food sources (as indicated by interspecies differences in δC), and with higher position in the trophic web (as indicated by differences in δN). [ABSTRACT FROM AUTHOR]

The dynamic equations of motion of asymmetric offshore platforms under three different environmental conditions: seismic action, wave action and their combination are established in this paper. In establishing these motion equations, three typical eccentricity types including mass eccentricity, rigidity eccentricity and their combination were considered, as are eccentricities that occur uni-directionally and bi-directionally. The effects of the eccentricity type, the dynamic characteristics and the environmental conditions on the torsional coupling response of platforms are investigated and compared. An effort has also been made to analyze the influence of accidental eccentricity on asymmetric platforms with different eccentricity in two horizontally orthogonal directions. The results are given in terms of non-dimensional parameters, accounting for the uncoupled torsional to lateral frequency ratio. Numerical results reveal that the eccentricity type has a great influence on the torsionally coupled response under different environmental conditions. Therefore, it is necessary to consider the combination of earthquake and wave action in the seismic response analysis of some offshore platforms. [ABSTRACT FROM AUTHOR]