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Introduction: In patients with cardiac sarcoidosis (CS), implantable cardioverter‐defibrillators (ICDs) are important for preventing sudden cardiac death. This study aimed to investigate sex disparities in CS patients undergoing ICD implantation. Methods: The 2016–2020 National Inpatient Sample (NIS) database compared the characteristics and outcomes of males and females with CS receiving ICDs. Results: Among 760 CS patients who underwent inpatient ICD implantation, 66.4% were male. Males were younger (55.0 vs. 56.9 years, p <.01), had higher rates of diabetes (31.7% vs. 21.6%, p <.01) and chronic kidney disease (CKD) (16.8% vs. 7.8%, p <.01) but lower prevalence of atrial fibrillation (AF) (11.9% vs. 23.5%, p <.01), sick sinus syndrome (4.0% vs. 7.8%, p =.024), ventricular fibrillation (VF) (9.9% vs. 15.7%, p =.02), and black ancestry (31.9% vs. 58.0%, p <.01). Unadjusted major adverse cardiovascular events (MACE), defined as a composite of in‐hospital death, myocardial infarction (MI), and ischemic stroke, was higher in females (11.8% vs. 6.9%, p =.024), but when adjusted for age and tCharlson Comorbidity Index (CCI), females demonstrated significantly lower odds of experiencing MACE (aOR: 0.048, 95% CI: 0.006–0.395, p =.005). Incidence of acute kidney injury (AKI) post‐ICD was significantly lower in females (15.7% vs. 23.8%, p =.01) as was the adjusted odds (aOR: 0.282, 95% CI: 0.146–0.546, p <.01). There was comparable mean length of stay and hospital charges. Conclusion: ICD utilization in CS patients is more common among males, who have a higher prevalence of diabetes and CKD but a lower prevalence of AF, sick sinus syndrome, and VF. Adjusted MACE and AKI were significantly lower in females. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, jails were advised to reduce facility census, particularly the growing population of those with medical/behavioral health vulnerabilities that increased susceptibility to adverse outcomes. Although jail census decreased across the nation in the initial days to months following pandemic declaration, there are minimal data regarding the health status of those who remained in jail. The current investigation aspired to describe jail census trends before/since the onset of COVID-19 and offer snapshots of temporal changes and context for prevalence estimates of medical/behavioral health conditions in jail detainees from 2019 to 2023. Using a serial cross-sectional design, prescription information for individuals residing in 18 jails across the United States on June 30 of each respective year was extracted and categorized using MediSpan's ontological system to determine prevalence estimates of prescribed agents/products. Although data evidenced an initial 31% census reduction (followed by gradual return to prepandemic rates), prescribing patterns for all major therapeutic drug classes steadily increased, with 10% more individuals prescribed at least one agent in 2023 than 2019. The largest increases were observed for behavioral health agents (e.g., 32.4% of the sample was prescribed psychotropic agents in 2023 compared with 25.7% in 2019). We provide considerations for future investigations. [ABSTRACT FROM AUTHOR]

Avian metapneumovirus (aMPV) poses a significant threat to the poultry industry worldwide, primarily affecting turkeys and chickens. The recent detection of aMPV-A and -B subtypes in the United States marks a significant shift after a prolonged period free of aMPV following the eradication of the previously circulating subtype C. Hence, the demand for molecular diagnostic tests for aMPV has arisen due to their limited availability in the US market. In this study, we present the molecular characterization based on the complete genome sequence of aMPV subtype A, which was detected in the US for the first time. Four RT-qPCR positive samples were subjected to next-generation sequencing analysis, resulting in the assembly of one complete and one near-complete genome sequences. Phylogenetic analysis revealed that the isolated strains clustered within the aMPV-A subtype and were most closely related to recent Mexican strains. A detailed amino acid analysis identified unique mutations in the G gene of the US isolates compared to Mexican strains. Additionally, we compared the performance, cross-reactivity, and limit of detection of our revised aMPV subtype-specific RT-qPCR test with two commercial kits, demonstrating similar detection and subtyping capabilities. These findings highlight the importance of accurate diagnostic methods for disease management in the poultry industry, provide valuable insights into the epidemiology of aMPV, and underscore the need for continued vigilance and surveillance to mitigate its impact on poultry production. [ABSTRACT FROM AUTHOR]

Infectious hematopoietic necrosis virus (IHNV) and viral hemorrhagic septicemia virus (VHSV) are rhabdoviruses in two different species belonging to the Novirhabdovirus genus. IHNV has a narrow host range restricted to trout and salmon species, and viruses in the M genogroup of IHNV have high virulence in rainbow trout (Oncorhynchus mykiss). In contrast, the VHSV genotype IVb that invaded the Great Lakes in the United States has a broad host range, with high virulence in yellow perch (Perca flavescens), but not in rainbow trout. By using reverse-genetic systems of IHNV-M and VHSV-IVb strains, we generated six IHNV:VHSV chimeric viruses in which the glycoprotein (G), non-virion-protein (NV), or both G and NV genes of IHNV-M were replaced with the analogous genes from VHSV-IVb, and vice versa. These chimeric viruses were used to challenge groups of rainbow trout and yellow perch. The parental recombinants rIHNV-M and rVHSV-IVb were highly virulent in rainbow trout and yellow perch, respectively. Parental rIHNV-M was avirulent in yellow perch, and chimeric rIHNV carrying G, NV, or G and NV genes from VHSV-IVb remained low in virulence in yellow perch. Similarly, the parental rVHSV-IVb exhibited low virulence in rainbow trout, and chimeric rVHSV with substituted G, NV, or G and NV genes from IHNV-M remained avirulent in rainbow trout. Thus, the G and NV genes of either virus were not sufficient to confer high host-specific virulence when exchanged into a heterologous species genome. Some exchanges of G and/or NV genes caused a loss of host-specific virulence, providing insights into possible roles in viral virulence or fitness, and interactions between viral proteins. [ABSTRACT FROM AUTHOR]

Objective Inpatient rehabilitation represents a critical setting for stroke treatment, providing intensive, targeted therapy and task-specific practice to minimize a patient's functional deficits and facilitate their reintegration into the community. However, impairment and recovery vary greatly after stroke, making it difficult to predict a patient's future outcomes or response to treatment. In this study, the authors examined the value of early-stage wearable sensor data to predict 3 functional outcomes (ambulation, independence, and risk of falling) at rehabilitation discharge. Methods Fifty-five individuals undergoing inpatient stroke rehabilitation participated in this study. Supervised machine learning classifiers were retrospectively trained to predict discharge outcomes using data collected at hospital admission, including patient information, functional assessment scores, and inertial sensor data from the lower limbs during gait and/or balance tasks. Model performance was compared across different data combinations and was benchmarked against a traditional model trained without sensor data. Results For patients who were ambulatory at admission, sensor data improved the predictions of ambulation and risk of falling (with weighted F1 scores increasing by 19.6% and 23.4%, respectively) and maintained similar performance for predictions of independence, compared to a benchmark model without sensor data. The best-performing sensor-based models predicted discharge ambulation (community vs household), independence (high vs low), and risk of falling (normal vs high) with accuracies of 84.4%, 68.8%, and 65.9%, respectively. Most misclassifications occurred with admission or discharge scores near the classification boundary. For patients who were nonambulatory at admission, sensor data recorded during simple balance tasks did not offer predictive value over the benchmark models. Conclusion These findings support the continued investigation of wearable sensors as an accessible, easy-to-use tool to predict the functional recovery after stroke. Impact Accurate, early prediction of poststroke rehabilitation outcomes from wearable sensors would improve our ability to deliver personalized, effective care and discharge planning in the inpatient setting and beyond. [ABSTRACT FROM AUTHOR]

Purpose: Early reports of 30-day mortality in COVID-positive patients with hip fracture were often over 30% and were higher than historical rates of 10% in pre-COVID studies. We conducted a multi-institutional retrospective cohort study to determine whether the incidence of 30-day mortality and complications in COVID-positive patients undergoing hip fracture surgery is as high as initially reported. Methods: A retrospective chart review was performed at 11 level I trauma centers from January 1, 2020 to May 1, 2022. Patients 50 years or older undergoing hip fracture surgery with a positive COVID test at the time of surgery were included. The primary outcome measurements were the incidence of 30-day mortality and complications. Post-operative outcomes were reported using proportions with 95% confidence interval (C.I.). Results: Forty patients with a median age of 71.5 years (interquartile range, 50–87 years) met the criteria. Within 30-days, four patients (10%; 95% C.I. 3–24%) died, four developed pneumonia, three developed thromboembolism, and three remained intubated post-operatively. Increased age was a statistically significant predictor of 30-day mortality (p = 0.01), with all deaths occurring in patients over 80 years. Conclusion: In this multi-institutional analysis of COVID-positive patients undergoing hip fracture surgery, 30-day mortality was 10%. The 95% C.I. did not include 30%, suggesting that survival may be better than initially reported. While COVID-positive patients with hip fractures have high short-term mortality, the clinical situation may not be as dire as initially described, which may reflect initial publication bias, selection bias introduced by testing, or other issues. Levels of Evidence: Therapeutic Level III. [ABSTRACT FROM AUTHOR]

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Functional near-infrared spectroscopy (fNIRS) is a neuroimaging tool for studying brain activity in mobile subjects. Open-access fNIRS datasets are limited to simple and/or motion-restricted tasks. Here, we report a fNIRS dataset acquired on mobile subjects performing Fundamentals of Laparoscopic Surgery (FLS) tasks in a laboratory environment. Demonstrating competency in the FLS tasks is a prerequisite for board certification in general surgery in the United States. The ASTaUND data set was acquired over four different studies. We provide the relevant information about the hardware, FLS task execution protocols, and subject demographics to facilitate the use of this open-access data set. We also provide the concurrent FLS scores, a quantitative metric for surgical skill assessment developed by the FLS committee. This data set is expected to support the growing field of assessing surgical skills via neuroimaging data and provide an example of data processing pipeline for use in realistic, non-restrictive environments. [ABSTRACT FROM AUTHOR]

P2Y12 inhibitors (i.e., clopidogrel, prasugrel, or ticagrelor) are effective at reducing adverse cardiovascular outcomes post‐revascularization in coronary artery disease (CAD). However, the choice of a specific P2Y12 inhibitor may vary according to the patient's characteristics, and trends in the use of different P2Y12 inhibitors are not well studied in real‐world settings. The objective of this study is to determine trends in the prescription patterns of P2Y12 inhibitors in patients with CAD. We studied 137,073 patients with CAD cross‐sectionally using the IBM MarketScan database (2013–2018). Patients with CAD prescribed P2Y12 inhibitors within 14 days of index revascularization were included to compare the utilization of P2Y12 inhibitors based on age and clinical characteristics. There were differences in prescription patterns by age. Among patients aged less than or equal to 65 years (N = 92,734), a continuously increased utilization of ticagrelor was observed from 13.7% to 45.6% replacing clopidogrel as the most prescribed medication by 2018. Similarly, ticagrelor was the choice of drug among patients undergoing percutaneous coronary intervention. Among the patients at high bleeding risk, clopidogrel remained the most prescribed medication with use in 50.6% of patients in 2018 in patients aged less than or equal to 65 years. Contrarily, among the older adults with age 65 or above (N = 44,339), although ticagrelor use increased with time, clopidogrel remained the most utilized drug and was used by 66.2% of patients in 2018. Additionally, clopidogrel was the preferred medication among patients with stroke history. With the increasing use of ticagrelor in real‐world practice, further research is needed to observe its impact on cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Individuals with disabilities have lower rates of workforce participation and lower earnings than their nondisabled peers. This article traces the history of the U.S. workforce development policy framework, including the Workforce Investment Act of 1998; the Rehabilitation Act of 1973, as amended; and the impact of the Ticket to Work and Work Incentives Improvement Act of 1999 on both of these policies. Reviewing literature and administrative data, we discuss how these policies have impacted current rehabilitation practice and identify remaining service delivery gaps. We conclude with a set of recommendations for enhancing the current workforce development policy and practice environment. (Contains 6 endnotes and 4 tables.)

Data on outcomes and interventions for children with sickle cell disease (SCD) admitted to a pediatric intensive care units (PICU) are unknown. We provide the first comprehensive multi-center report on PICU interventions associated with death, the need for invasive respiratory support or stroke among critically ill children with SCD. We collected retrospective multi-center cohort data from January 1, 2012 to December 31, 2019 utilizing the Virtual Pediatric Systems, LLC database. We identified 3388 unique children with SCD, accounting for a total of 5264 PICU admissions from 138 PICUs. The overall mortality rate for the PICU admissions cohort was 1.8% (95/5264 PICU admissions, 95/3388 [2.8%] of all unique patients), the rate of needing of needing Invasive Respiratory Support (IRS, a composite category of exposure) was 21.3% (872/4093 PICU admissions with complete data) and the overall rate of stroke (ischemic or hemorrhagic) was 12.5% (657/5264 PICU admissions). In multivariable analysis adjusting for admission age category, sex, race/ethnicity, PRISM-3 score at admission, exposure to IRS, quartile of unit volume of patients with SCD, and patient origin, admitted children who needed invasive respiratory support (IRS) had higher adjusted odds ratios for mortality (adjusted odds ratio [aOR], 19.72; 95% confidence interval [CI] 8.98–43.29; p < 0.001), although admitted children > 2 years old had decreased aOR for needing IRS (aOR 0.25–0.62; 95% CI 0.16–0.94; p < 0.001–0.025). By contrast, admitted children > 2 years old had a strikingly increased aOR for stroke (aOR 7.57–16.32; 95% CI 2.25–52.15; p < 0.001). These groups may represent PICU-specific subsets of patients with SCD who are at higher risk for more serious illness and should deserve early consideration for referral to a pediatric institution providing comprehensive care for patients with SCD. [ABSTRACT FROM AUTHOR]

The pathogenic bacterium Staphylococcus aureus is the most common pathogen isolated in skin-and-soft-tissue infections (SSTIs) in the United States. Most S. aureus SSTIs are caused by the epidemic clone USA300 in the USA. These infections can be serious; in 2019, SSTIs with S. aureus were associated with an all-cause, age-standardized mortality rate of 0.5 globally. Clinical presentations of S. aureus SSTIs vary from superficial infections with local symptoms to monomicrobial necrotizing fasciitis, which can cause systemic manifestations and may lead to serious complications or death. In order to cause skin infections, S. aureus employs a host of virulence factors including cytolytic proteins, superantigenic factors, cell wall-anchored proteins, and molecules used for immune evasion. The immune response to S. aureus SSTIs involves initial responders such as keratinocytes and neutrophils, which are supported by dendritic cells and T-lymphocytes later during infection. Treatment for S. aureus SSTIs is usually oral therapy, with parenteral therapy reserved for severe presentations; it ranges from cephalosporins and penicillin agents such as oxacillin, which is generally used for methicillin-sensitive S. aureus (MSSA), to vancomycin for methicillin-resistant S. aureus (MRSA). Treatment challenges include adverse effects, risk for Clostridioides difficile infection, and potential for antibiotic resistance. [ABSTRACT FROM AUTHOR]

The article discusses the specialization of Aedes aegypti mosquitoes in feeding on humans as opposed to other vertebrate animals. It explores how changes in climate, urbanization, and historical events like the African slave trade have influenced the mosquito's preference for humans, increasing the risk of diseases like yellow fever, dengue, chikungunya, and Zika virus in urban areas of Africa and beyond.

Comparative effectiveness evaluation of newer P2Y12 inhibitors (prasugrel and ticagrelor) compared with clopidogrel after acute coronary syndrome (ACS) is limited in real‐world US populations. The objective of this study was to evaluate cardiovascular events based on ticagrelor, prasugrel, and clopidogrel use in a real‐world patient setting. This retrospective cohort study used the IBM MarketScan database (January 1, 2013, to December 31, 2018) to create three propensity score‐matched pairs: ticagrelor vs. clopidogrel (N = 21,719), prasugrel vs. clopidogrel (N = 11,513), and prasugrel vs. ticagrelor (N = 11,065). The primary outcome was a composite of myocardial ischemia, unstable angina, stroke, and heart failure hospitalization. These groups were compared in a time‐to‐event analysis for the primary outcome at 30, 90, and 180 days following P2Y12 inhibitors initiation after percutaneous coronary intervention. Compared with clopidogrel, ticagrelor use suggested a 10% reduction in the primary outcome at 90 days (hazard ratio (HR): 0.90, 95% confidence interval (CI): 0.82–0.99). There were no differences for all other matched pairs or follow‐up combinations. In the subgroup analysis of females, the results suggested a risk reduction of 27% for prasugrel at 30 days (HR: 0.73, 95% CI: 0.53–1.00) and 17% for ticagrelor at 90 days (HR: 0.83, 95% CI: 0.70–0.98) when compared with clopidogrel. Among patients treated with bare‐metal stents, the results suggested that prasugrel vs. ticagrelor was associated with a 55% and 33% reduced risk for the primary outcome at 30 days and 180 days, respectively. With limited evidence in the United States comparing these drugs, this study helps inform clinicians when choosing P2Y12 inhibitors after ACS. [ABSTRACT FROM AUTHOR]

Background: Despite the benefits of physical activity for healthy physical and cognitive aging, 35% of adults over the age of 75 in the United States are inactive. Robotic exoskeleton-based exercise studies have shown benefits in improving walking function, but most are conducted in clinical settings with a neurologically impaired population. Emerging technology is starting to enable easy-to-use, lightweight, wearable robots, but their impact in the otherwise healthy older adult population remains mostly unknown. For the first time, this study investigates the feasibility and efficacy of using a lightweight, modular hip exoskeleton for in-community gait training in the older adult population to improve walking function. Methods: Twelve adults over the age of 65 were enrolled in a gait training intervention involving twelve 30-min sessions using the Gait Enhancing and Motivating System for Hip in their own senior living community. Results: Performance-based outcome measures suggest clinically significant improvements in balance, gait speed, and endurance following the exoskeleton training, and the device was safe and well tolerated. Gait speed below 1.0 m/s is an indicator of fall risk, and two out of the four participants below this threshold increased their self-selected gait speed over 1.0 m/s after intervention. Time spent in sedentary behavior also decreased significantly. Conclusions: This intervention resulted in greater improvements in speed and endurance than traditional exercise programs, in significantly less time. Together, our results demonstrated that exoskeleton-based gait training is an effective intervention and novel approach to encouraging older adults to exercise and reduce sedentary time, while improving walking function. Future work will focus on whether the device can be used independently long-term by older adults as an everyday exercise and community-use personal mobility device. Trial registration This study was retrospectively registered with ClinicalTrials.gov (ID: NCT05197127). [ABSTRACT FROM AUTHOR]

The skill of NOAA's official monthly U.S. precipitation forecasts (issued in the middle of the prior month) has historically been low, having shown modest skill over the southern United States, but little or no skill over large portions of the central United States. The goal of this study is to explain the seasonal and regional variations of the North American subseasonal (weeks 3–6) precipitation skill, specifically the reasons for its successes and its limitations. The performances of multiple recent-generation model reforecasts over 1999–2015 in predicting precipitation are compared to uninitialized simulation skill using the atmospheric component of the forecast systems. This parallel analysis permits attribution of precipitation skill to two distinct sources: one due to slowly evolving ocean surface boundary states and the other to faster time-scale initial atmospheric weather states. A strong regionality and seasonality in precipitation forecast performance is shown to be analogous to skill patterns dictated by boundary forcing constraints alone. The correspondence is found to be especially high for the North American pattern of the maximum monthly skill that is achieved in the reforecast. The boundary forcing of most importance originates from tropical Pacific SST influences, especially those related to El Niño–Southern Oscillation. We discuss physical constraints that may limit monthly precipitation skill and interpret the performance of existing models in the context of plausible upper limits. Significance Statement: Skillful subseasonal precipitation predictions have societal benefits. Over the United States, however, NOAA's official U.S. monthly precipitation forecast skill has been historically low. Here we explore origins for skill of North American week-3 to week-6 precipitation predictions. Skill arising from initial weather states is compared to that arising from ocean surface boundary states alone. The monthly and seasonally varying pattern of U.S. monthly precipitation skill is appreciably derived from boundary constraints, linked especially with El Niño–Southern Oscillation. Forecasts of opportunity are identified, despite the low skill of monthly precipitation forecasts on average. Potential limits of monthly precipitation skill are explored that provide insight on the juxtaposition of "skill deserts" over the central United States with high skill regions over western North America. [ABSTRACT FROM AUTHOR]

Lyme disease is the most common vector-borne infectious disease in the United States. Post-treatment Lyme disease (PTLD) is a condition affecting 10–20% of patients in which symptoms persist despite antibiotic treatment. Cognitive complaints are common among those with PTLD, suggesting that brain changes are associated with the course of the illness. However, there has been a paucity of evidence to explain the cognitive difficulties expressed by patients with PTLD. This study administered a working memory task to a carefully screened group of 12 patients with well-characterized PTLD and 18 healthy controls while undergoing functional MRI (fMRI). A subset of 12 controls and all 12 PTLD participants also received diffusion tensor imaging (DTI) to measure white matter integrity. Clinical variables were also assessed and correlated with these multimodal MRI findings. On the working memory task, the patients with PTLD responded more slowly, but no less accurately, than did controls. FMRI activations were observed in expected regions by the controls, and to a lesser extent, by the PTLD participants. The PTLD group also hypoactivated several regions relevant to the task. Conversely, novel regions were activated by the PTLD group that were not observed in controls, suggesting a compensatory mechanism. Notably, three activations were located in white matter of the frontal lobe. DTI measures applied to these three regions of interest revealed that higher axial diffusivity correlated with fewer cognitive and neurological symptoms. Whole-brain DTI analyses revealed several frontal lobe regions in which higher axial diffusivity in the patients with PTLD correlated with longer duration of illness. Together, these results show that the brain is altered by PTLD, involving changes to white matter within the frontal lobe. Higher axial diffusivity may reflect white matter repair and healing over time, rather than pathology, and cognition appears to be dynamically affected throughout this repair process. [ABSTRACT FROM AUTHOR]

The low-density lipoprotein receptor (LDLR) controls cellular delivery of cholesterol and clears LDL from the bloodstream, protecting against atherosclerotic heart disease, the leading cause of death in the United States. We therefore sought to identify regulators of the LDLR beyond the targets of current therapies and known causes of familial hypercholesterolemia. We found that cold shock domain–containing protein E1 (CSDE1) enhanced hepatic LDLR messenger RNA (mRNA) decay via its 3′ untranslated region and regulated atherogenic lipoproteins in vivo. Using parallel phenotypic genome-wide CRISPR interference screens in a tissue culture model, we identified 40 specific regulators of the LDLR that were not previously identified by observational human genetic studies. Among these, we demonstrated that, in HepG2 cells, CSDE1 regulated the LDLR at least as strongly as statins and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. In addition, we showed that hepatic gene silencing of Csde1 treated diet-induced dyslipidemia in mice to a similar degree as Pcsk9 silencing. These results suggest the therapeutic potential of targeting CSDE1 to manipulate the posttranscriptional regulation of the LDLR mRNA for the prevention of cardiovascular disease. Our approach of modeling a clinically relevant phenotype in a forward genetic screen, followed by mechanistic pharmacologic dissection and in vivo validation, may serve as a generalizable template for the identification of therapeutic targets in other human disease states. Controlling CSDE1 to contain cholesterol levels: Therapies that up-regulate the hepatic low-density lipoprotein receptor (LDLR) have been shown to reduce cholesterol concentrations and lower the risk of heart attacks. However, further lowering of cholesterol concentrations beyond what statins can achieve may potentially further reduce heart attack risk. Here, Smith and colleagues conducted a genome-wide CRISPR interference screen to identify further factors involved in hepatic LDLR regulation, identifying cold shock domain–containing protein E1 (CSDE1) as a posttranslational regulator of the stability of LDLR mRNA. Knockdown of Csde1 in mice protected the animals from cholesterol accumulation, even on a cholate-rich diet. These findings suggest that CSDE1 may be a therapeutic target to further lower cholesterol in humans. [ABSTRACT FROM AUTHOR]

This practice note reports on the work of the Namaste Community Health Partnership, an academic-community partnership established to address health disparities in a metro-area Bhutanese–Nepali refugee community in the western United States. Partners worked together to develop, implement, and evaluate a culturally-tailored health promotion program where Bhutanese–Nepali individuals led weekly walking groups and shared health promotion information and behavior change tools with community participants. The program was implemented with approximately 70 community members across two metro-area neighborhoods and two adult day care centers serving elders. Evaluation strategies included documenting walk attendance, tracking engagement with health promotion goals, and focus group discussions with program participants. Once enrolled, most participants consistently attended walks and achieved weekly goals—some even increased walking frequency beyond program requirements. Participants provided positive feedback about having a community leader and reported learning new information and enjoying participating with other community members. Challenges and lessons learned included difficulties engaging younger adults from the community, concerns about signing research consent forms, cultural norms discouraging the distribution of individual research participation incentives, variability across groups in preferences for program activities, and barriers to administering survey-based evaluation instruments. This academic–community partnership built capacity in the local Bhutanese–Nepali community, produced culturally relevant health programming, and trained and employed community members as health educators and physical activity leaders. The program resulting from this work has the potential to improve health knowledge and chronic disease prevention practices and ultimately reduce health disparities in an underserved refugee community. [ABSTRACT FROM AUTHOR]

Care coordination involves shaping patient care activities and sharing information among all participants concerned with a patient's care to achieve safe and effective care. The objectives of care coordination are to promote sharing of patients' clinical information, keep patients and families informed, and manage effective referrals and care transitions. Failures in care coordination account for a large amount of waste per year in the United States. Many innovative healthcare organizations have recently recognized the danger of poorly coordinated care and have implemented analytics to improve it. Therefore, more analytics‐based research (especially combining explanatory analytics with predictive analytics) is needed to direct efforts to improve care coordination. This paper focuses on systematically studying the extant literature to understand how analytics play a role in improving care coordination. Our goal is to identify a set of key research questions that would lead to new research areas in the use of analytics for care coordination. Based on these questions, we offer new analytics solution pathways to care coordination problems. [ABSTRACT FROM AUTHOR]

Summary: In pre- and early perimenopausal women, prediabetes (with blood glucose ≥ 110 mg/dL) and greater insulin resistance are associated with worse trabecular bone quality (as assessed by trabecular bone score). Purpose: Diabetes mellitus (DM) is associated with lower trabecular bone score (TBS) and fracture; less certain is whether the precursor states of prediabetes and increased insulin resistance are also related to adverse bone outcomes. We examined, in women who do not have DM, the associations of glycemic status (prediabetes vs. normal) and insulin resistance with TBS. Methods: This was a cross-sectional analysis of baseline data collected from 42- to 52-year-old, pre- and perimenopausal participants in the Study of Women's Health Across the Nation (SWAN) TBS Study. Women with prediabetes were categorized as having either high prediabetes if their fasting glucose was between 110 and 125 mg/dL or low prediabetes if their fasting glucose was between 100 and 109 mg/dL. Normoglycemia was defined as a fasting glucose below 100 mg/dL. Results: In multivariable linear regression, adjusted for age, race/ethnicity, menopause transition stage, cigarette use, calcium and vitamin D supplementation, lumbar spine bone mineral density, and study site, women with high prediabetes had 0.21 (p < 0.0001) standard deviations (SD) lower TBS than those with normoglycemia. Low prediabetes was not associated with lower TBS. When HOMA-IR levels were ≥ 1.62, each doubling of HOMA-IR was associated with a 0.11 SD decrement in TBS (p = 0.0001). Conclusion: Similar to diabetics, high prediabetics have lower TBS than normoglycemic individuals. Women with greater insulin resistance have lower TBS even in the absence of DM. Future studies should examine the associations of high prediabetes and insulin resistance with incident fracture. [ABSTRACT FROM AUTHOR]

The southeastern United States is widely regarded as a leading region for intensively managed, short rotation pine forests. One drawback of this intensive approach is the production of more juvenile wood with lower quality properties that are less desirable for solid end uses. Improved construction sectors (e.g., housing) demand larger diameter sawtimbers. Delaying the final harvest allows for the production of larger diameter higher quality solid wood; however, this approach may incur additional costs to the landowner, which may disincentivize extending the rotation without additional monetary compensation. Sawmills are a primary consumer of pine sawtimber and exert a strong influence on stumpage prices. Therefore, understanding the importance of wood quality to sawmills is important for understanding price dynamics. To explore this aspect, we conducted a mail survey of softwood sawmills in the southeastern United States to determine willingness to pay price premiums for higher quality pine sawtimber. Most sawmills (57%) were willing to pay price premiums. The mean willingness to pay, estimated using a tobit regression, ranged from USD 4.22/ton to USD 12.98/ton. Sawlog size, procurement radius, sawlog grade, and the number of employees positively influenced sawmills' willingness to pay a price premium for higher quality sawtimber, while sawmills' processing capacity and the number of years in business had a negative impact. The results will be useful to landowners considering delaying the final harvest to grow large diameter sawtimber. [ABSTRACT FROM AUTHOR]

Intensive pine silviculture has become the dominant management paradigm in the southeastern United States. Although productivity has been substantially increased by the combination of cultural, silvicultural, and genetic advancements, wood quality is sometimes sacrificed in intensive silviculture. Extending the optimal rotation allows trees to grow more timber, which may result in the production of better quality sawtimber; however, landowners may require incentives to do so. We simulated loblolly, slash, shortleaf, and longleaf pine for growth and yield using the Forest Vegetation Simulator (FVS) to determine sawtimber price premiums landowners would require to offset the costs associated with delaying the final harvest by 10 to 30 years in even-aged systems. Required incentives increased with the length of harvesting delay beyond the financially optimal rotation age. On medium productivity sites, landowners would be willing to delay the final harvest by 10 years for sawtimber price premiums of $5.06/ton (20.47%) for loblolly, $5.34/ton (21.6%) for slash, $4.56/ton (18.45%) for longleaf, and $6.71/ton (27.14%) shortleaf pine, respectively. Harvest delays of 10 to 20 years were financially justifiable, whereas extensions exceeding 30 years were prohibitively costly for all species. Delaying the optimal harvest could benefit landowners by generating a premium price for their sawtimber while providing important ecosystem services. [ABSTRACT FROM AUTHOR]

Background: Organized athletics are undergoing a gradual resumption after a prolonged hiatus in 2020 because of the coronavirus disease 2019 (COVID-19) pandemic. Purpose/Hypothesis: The purpose of this study was to evaluate the effect of the 2020 COVID-19 period on emergency department (ED) visits for sports-related injuries in the United States. It was hypothesized that such visits decreased in response to the pandemic conditions. Study Design: Descriptive epidemiology study. Methods: A selection of sports (baseball, basketball, softball, soccer, American football, weightlifting, track and field, martial arts, boxing, golf, personal fitness, cycling, tennis, and ice hockey) were classified as being an organized team, organized individual, or nonorganized sport. The National Electronic Injury Surveillance System database was then queried for ED visits for sports-related injuries between January 1, 2018, and December 31, 2020, and we compared weighted national injury estimates and injury characteristics from athletes presenting to EDs in 2018 and 2019 versus those from the 2020 COVID-19 pandemic period and between March 1 and May 31, 2020 (government-imposed lockdown period). Bivariate comparisons between variables were conducted using chi-square analysis, with strength of association assessed using odds ratios. Results: The 164,151 unweighted cases obtained from the query resulted in a weighted national estimate of 5,664,795 sports-related injuries during the study period. Overall, there was a 34.6% decrease in sports-related ED visits in 2020 compared with the yearly average between 2018 and 2019 (baseline). The number of ED visits in 2020 decreased by 53.9% versus baseline for injuries incurred by participation in an organized team sport and by 34.9% for injuries incurred by participation in an organized individual sport. The number of ED visits during the 2020 lockdown period decreased by 76.9% versus baseline for injuries incurred by participation in an organized team sport and by 65.8% for injuries incurred by participation in an organized individual sport. Injuries sustained while participating in a nonorganized sport remained relatively unaffected and decreased by only 8.1% in 2020. Conclusion: ED visits in the United States for injuries sustained while participating in an organized team or individual sport underwent a decrease after the beginning of the COVID-19 pandemic in 2020, especially during the lockdown period. [ABSTRACT FROM AUTHOR]

Individuals with autism spectrum disorder and co-occurring intellectual disabilities experience substantial challenges in accessing needed supports. This research aimed to understand the prevalence and factors associated with food insecurity among families of children with autism spectrum disorder and co-occurring intellectual disabilities. Utilizing the National Survey of Children's Health (2016–2018) data, this article illustrated that the households of children with autism spectrum disorder and co-occurring intellectual disabilities were about two times more likely to be food insecure than the households of children without disabilities. Furthermore, the households of children with autism spectrum disorder were 1.5 times more likely, and those with other disabilities were 1.3 times more likely to be food insecure than the households of children without disabilities. Implications of these findings in the context of the COVID-19 pandemic are discussed. Families of children with autism spectrum disorder are more likely to experience financial strain and resulting food insecurity due to additional cost of care, disparate access to needed services, and loss of income resulting from parental job loss. Utilizing nationally representative data, this analysis indicates that the families of children with autism spectrum disorder and co-occurring intellectual disabilities are twice as likely to experience food insecurity than families of children without disabilities after adjusting for various factors. Several factors, ranging from state-level policies such as Medicaid expansion to individual-level factors such as higher utilization of emergency room services, were associated with the higher prevalence of food insecurity in families of children with autism spectrum disorder and co-occurring intellectual disabilities. Implications of these findings on programs and policies supporting families in the COVID-19 pandemic are discussed. [ABSTRACT FROM AUTHOR]

Standard triplicate blood pressure (BP) measurements pose time barriers to hypertension screening, especially in resource-limited settings. We assessed the implications of simplified approaches using fewer measurements with adults (≥18 years old) not using anti-hypertensive medications from the US National Health and Nutrition Examination Survey 1999-2016 (n = 30 614), and two datasets from May Measurement Month 2017-2018 (n = 14 795 for Nepal and n = 6 771 for India). We evaluated the proportion of misclassification of hypertension when employing the following simplified approaches: using only 1st BP, only 2nd BP, 2nd if 1st BP in a given range (otherwise using 1st), and average of 1st and 2nd BP. Hypertension was defined as average of 2nd and 3rd systolic BP ≥140 and/or diastolic BP ≥90 mm Hg. Using only the 1st BP, the proportion of missed hypertension ranged from 8.2%-12.1% and overidentified hypertension from 4.3%-9.1%. Using only 2nd BP reduced the misclassification considerably (corresponding estimates, 4.9%-6.4% for missed hypertension and 2.0%-4.4% for overidentified hypertension) but needed 2nd BP in all participants. Using 2nd BP if 1st BP ≥130/80 demonstrated similar estimates of missed hypertension (3.8%-8.1%) and overidentified hypertension (2.0%-3.9%), but only required a 2nd BP in 33.8%-59.8% of participants. In conclusion, a simplified approach utilizing 1st BP supplemented by 2nd BP in some individuals has low misclassification rates and requires approximately half of the total number of measurements compared to the standard approach, and thus can facilitate screening in resource-constrained settings. [ABSTRACT FROM AUTHOR]

Background: Age-associated inflammation and immune system dysfunction have been implicated as mechanisms that increase risk for adverse long-term procedural outcomes in older adults. The purpose of this study was to investigate relationships between baseline inflammatory and innate antiviral gene expression and outcomes after transcatheter aortic valve replacement (TAVR) in older adults with severe aortic stenosis.Methods: We performed a retrospective case-control study comparing pre-procedural pro-inflammatory and Type 1 interferon (IFN) gene expression in 48 controls with favorable outcomes (alive 1 year after TAVR with improved quality of life [QoL]) versus 48 individuals with unfavorable outcomes (dead by 1 year or alive at 1 year but with reduced QoL). Gene expression was evaluated in whole blood via (1) pre-defined composite scores of 19 inflammation-associated genes and 34 Type I IFN response genes, and (2) pro-inflammatory and antiviral transcription factor activity inferred from promotor based bioinformatics analyses of genes showing > 25% difference in average expression levels across groups. All analyses were adjusted for age, gender, body mass index, diabetes, immunosuppression, cardiovascular disease (CVD), and frailty.Results: Relative to controls, those with unfavorable outcomes demonstrated higher expression of the pro-inflammatory gene composite prior to TAVR (p < 0.01) and bioinformatic indicators of elevated Nuclear Factor kB (p < 0.001) and Activator Protein 1 (p < 0.001) transcription factor activity, but no significant differences in Type I IFN-related gene expression.Conclusions: These results demonstrate that a pro-inflammatory state prior to TAVR, independent of CVD severity and frailty status, is associated with worse long-term procedural outcomes. [ABSTRACT FROM AUTHOR]

Prevailing scholarship on neoliberalism fails to recognise that it generates its own distinctive forms of racial domination. Influential analysts such as Wolfgang Streeck, David Harvey and Wendy Brown assume or argue that racism exists today because neoliberalism's defeat of racial legacies is incomplete. This ignores how racism is reconfigured in ways that are specific to the historical moment of neoliberalism and dependent on a distinctive and substantial intellectual and political hinterland. A consideration of Friedrich Hayek's theory of cultural evolution reveals a contradiction in neoliberal thought between its aspiration to establish a universal market system and its dependence on particularist ideas of western cultural pre-eminence. This ideological contradiction correlates with the fact that globalisation produces masses of surplus populations which are of no market value. A racial idea of culture is the means by which neoliberalism manages and works through its own limitations. Above all, 'race' provides a means of coding and managing the material boundaries between different forms of labour under neoliberalism: citizen and migrant, waged and 'unexploitable', bearers of entitlements and bare life. [ABSTRACT FROM AUTHOR]

Non‐alcoholic steatohepatitis (NASH) is a result of inflammation and hepatocyte injury in the presence of hepatic steatosis which can progress to cirrhosis. NASH is the most rapidly growing aetiology for liver failure and indication for liver transplantation in the United States. Non‐alcoholic fatty liver disease (NAFLD) is associated with obesity, type 2 diabetes, dyslipidaemia and metabolic syndrome. Because of the absence of approved pharmacotherapy, weight loss and lifestyle modifications remain the safest and most effective first‐line treatment. However, this may not be effective in patients with advanced fibrosis or cirrhosis and long‐term adherence is difficult to achieve. Therefore, effective drugs are urgently needed for the treatment of NASH. Drug development targeting pathological pathways in NASH have exploded in the past decade, with numerous new drugs under investigation. This review summarizes the results of pivotal finalized phase 2 studies and provides an outline of key active studies with trial data of drugs under development. [ABSTRACT FROM AUTHOR]

This study presents an experimental model for Seasonal Probabilistic Outlook for Tornadoes (SPOTter) in the contiguous United States for March, April, and May and evaluates its forecast skill. This forecast model uses the leading empirical orthogonal function modes of regional variability in tornadic environmental parameters (i.e., low-level vertical wind shear and convective available potential energy), derived from the NCEP Coupled Forecast System, version 2, as the primary predictors. A multiple linear regression is applied to the predicted modes of tornadic environmental parameters to estimate U.S. tornado activity, which is presented as the probability for above-, near-, and below-normal categories. The initial forecast is carried out in late February for March–April U.S. tornado activity and then is updated in late March for April–May activity. A series of reforecast skill tests, including the jackknife cross-validation test, shows that the probabilistic reforecast is overall skillful for predicting the above- and below-normal area-averaged activity in the contiguous United States for the target months of both March–April and April–May. The forecast model also successfully reforecasts the 2011 super-tornado-outbreak season and the other three most active U.S. tornado seasons in 1982, 1991, and 2008, and thus it may be suitable for an operational use for predicting future active and inactive U.S. tornado seasons. However, additional tests show that the regional reforecast is skillful for March–April activity only in the Ohio Valley and South and for April–May activity only in the Southeast and Upper Midwest. These and other limitations of the current model, along with the future advances needed to improve the U.S. regional-scale tornado forecast, are discussed. [ABSTRACT FROM AUTHOR]

Brown stink bugs, Euschistus servus , are an important early-season pest of field corn in the southeastern United States. Feeding in the early stages of corn development can lead to a number of growth deformities and deficiencies and, ultimately, a reduction in yield. An observational and two experimentally manipulated trials were conducted in 2017 and 2018 to 1) determine optimal timing for assessing brown stink bug damage, 2) assess the level of damage from which yield compensation can occur, and 3) examine the relationship between brown stink bug density and early-season damage and yield. Fields were identified with infestations of brown stink bugs and a damage rating system for early stages of corn was established. Varying rates of brown stink bug densities were introduced using field cages and damage was assessed throughout the season. The density and duration of stink bug infestations were critical factors for damage potential, with each day of active feeding per plant resulting in a loss of ~14 kg/ha in yield. The level of damage in early stages of corn was categorized into easily identifiable groups, with only the most severe damage leading to a reduction in yield. Moderate and minimal feeding damage did not result in yield loss. This study emphasizes the need for early and frequent scouting of corn to determine the risk of damage and yield loss from brown stink bugs. Results from this study can be used to help develop management programs for brown stink bugs in the early vegetative stages of field corn. [ABSTRACT FROM AUTHOR]

In addition to remote SST forcing, realistic representation of land forcing (i.e., soil moisture) over the United States is critical for a prediction of U.S. severe drought events approximately one season in advance. Using "identical twin" experiments with different land initial conditions (ICs) in the 32-yr (1979–2010) CFSv2 reforecasts (NASA GLDAS-2 reanalysis versus NCEP CFSR), sensitivity and skill of U.S. drought predictions to land ICs are evaluated. Although there is no outstanding performer between the two sets of forecasts with different land ICs, each set shows greater skill in some regions, but their locations vary with forecast lead time and season. The 1999 case study demonstrates that although a pattern of below-normal SSTs in the Pacific in the fall and winter is realistically reproduced in both reforecasts, GLDAS-2 land initial states display a stronger east–west gradient of soil moisture, particularly drier in the eastern United States and more consistent with observations, leading to warmer surface temperature anomalies over the United States. Anomalies lasting for one season are accompanied by more persistent barotropic (warm core) anomalous high pressure over CONUS, which results in better prediction skill of this drought case up to 4 months in advance in the reforecasts with GLDAS-2 land ICs. Therefore, it is essential to minimize the uncertainty of land initial states among the current land analyses for improving U.S. drought prediction on seasonal time scales. [ABSTRACT FROM AUTHOR]

Background: Areas within the Appalachian region may have a greater burden of under diagnosed Alzheimer's disease and related disorders (ADRD).Objective: To estimate the prevalence of ADRD in the Appalachian counties of Ohio, and to determine if differences exist by geographic location (Appalachian/non-Appalachian and rural/urban) and across time among Medicare beneficiaries.Methods: Centers for Medicare and Medicaid Services Public Use Files from 2007-2017 were used to estimate county-level ADRD prevalence among all fee-for-service beneficiaries in Ohio. Negative binomial regression was used to estimate prevalence overall, by Appalachian Regional Commission's Appalachian/non-Appalachian designation, and by rural/urban (Rural-Urban Continuum Codes) classification. Models were repeated, adjusting for county-level demographics and comorbidities.Results: The prevalence of ADRD varied by both Appalachian residence and rural status (p = 0.008). Before adjustment by county-level demographics and comorbidities, the prevalence of ADRD in urban Appalachian counties was 1-3% lower than in urban non-Appalachian counties, while rural Appalachian counties had 2-3% higher prevalence compared to rural non-Appalachian counties. After adjustment, the differences between prevalence ratios were accentuated; the prevalence ratio was consistently higher for rural Appalachian counties, yet varied across the study period for urban counties (1.03 in 2007 to 0.97 in 2017).Conclusion: The results suggest a disparate burden of ADRD in Ohio with higher prevalence in rural Appalachian counties. This potential difference by Appalachian region is important to consider for availability of services and subsequent delivery of care. In order to better understand the disparity, further epidemiologic studies are necessary to better estimate the burden of ADRD. [ABSTRACT FROM AUTHOR]

Due to a lack of mechanistic insights, muscle-invasive bladder cancer (MIBC) remains incurable and is one of the most lethal types of cancer in the United States. The present study investigated changes in the molecular signatures of MIBC cells (TCCSUP and HT1376) after treatment with a novel small molecule, ASR488, to gain knowledge of the mechanisms that inhibited MIBC cell growth. ASR488 treatment initiated apoptotic signaling in MIBC cells. Pathway enrichment analysis was used to analyze the changes in function of differentially expressed genes. Gene Ontology analysis, as well as Kyoto Encyclopedia of Genes and Genomes analysis, was also performed. These analyses along with reactome pathway enrichment analyses indicated that the genes upregulated in the ASR488-treated cells are involved in focal adhesion, neurotrophin signaling, p53 signaling, endoplasmic reticulum functioning in terms of protein processing, and pathways related to bladder cancer. The genes downregulated in ASR488-treated MIBC cells were mainly involved in DNA replication, mismatch repair, RNA degradation, nucleotide excision repair and TGFβ signaling (P<0.05). Furthermore, reverse transcription-quantitative PCR analysis revealed an increase in transcripts of the most upregulated genes in ASR 488-treated MIBC cells: CPEB1 (36-fold), IL11 (30-fold), SFN (20.12-fold) and CYP4F11 (15.8-fold). In conclusion, the analysis of biological functions of the most differentially expressed genes revealed possible mechanisms that may be associated with the aggressiveness of MIBC. [ABSTRACT FROM AUTHOR]

Purpose: As the number of cancer survivors in the United States increases, quantifying the risks and burden of second primary cancers (SPCs) among cancer survivors will help develop long-term prevention and surveillance strategies. We describe the risk of developing a SPC among survivors of 10 cancer sites with the highest survival rates in the United States. Methods: Adult patients diagnosed with an index smoking-related (urinary bladder, kidney and renal pelvis, uterine cervix, oral cavity and pharynx, and colon and rectum) and index non-smoking-related (prostate, thyroid, breast, corpus and uterus, and non-Hodgkin lymphoma) cancers were identified from Surveillance, Epidemiology, and End Results (2000–2015). SPC risks were quantified using standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person-years at risk (PYR). Results: A cohort of 2,903,241 patients was identified and 259,685 (8.9%) developed SPC (7.6% of women and 10.3% of men). All index cancer sites (except prostate) were associated with a significant increase in SPC risk for women and men. Patients diagnosed with smoking-related index cancers (SIR range 1.20–2.16 for women and 1.12–1.91 for men) had a higher increased risk of SPC than patients with non-smoking-related index cancers (SIR range 1.08–1.39 for women and 1.23–1.38 for men) relative to the general population. Conclusion: We found that 1-in-11 cancer survivors developed a SPC. Given the increasing number of cancer survivors and the importance of SPC as a cause of cancer death, there is a need for increased screening for and prevention of SPC. [ABSTRACT FROM AUTHOR]

Background: In clinical practice, therapists often rely on clinical outcome measures to quantify a patient's impairment and function. Predicting a patient's discharge outcome using baseline clinical information may help clinicians design more targeted treatment strategies and better anticipate the patient's assistive needs and discharge care plan. The objective of this study was to develop predictive models for four standardized clinical outcome measures (Functional Independence Measure, Ten-Meter Walk Test, Six-Minute Walk Test, Berg Balance Scale) during inpatient rehabilitation.Methods: Fifty stroke survivors admitted to a United States inpatient rehabilitation hospital participated in this study. Predictors chosen for the clinical discharge scores included demographics, stroke characteristics, and scores of clinical tests at admission. We used the Pearson product-moment and Spearman's rank correlation coefficients to calculate correlations among clinical outcome measures and predictors, a cross-validated Lasso regression to develop predictive equations for discharge scores of each clinical outcome measure, and a Random Forest based permutation analysis to compare the relative importance of the predictors.Results: The predictive equations explained 70-77% of the variance in discharge scores and resulted in a normalized error of 13-15% for predicting the outcomes of new patients. The most important predictors were clinical test scores at admission. Additional variables that affected the discharge score of at least one clinical outcome were time from stroke onset to rehabilitation admission, age, sex, body mass index, race, and diagnosis of dysphasia or speech impairment.Conclusions: The models presented in this study could help clinicians and researchers to predict the discharge scores of clinical outcomes for individuals enrolled in an inpatient stroke rehabilitation program that adheres to U.S. Medicare standards. [ABSTRACT FROM AUTHOR]

This editorial describes an effort by 9 consultation-liaison (C-L) psychiatry service leaders in the United States to incorporate routine performance measurement into their service workflows. Although C-L psychiatry is an essential clinical service in general hospitals, performance metrics for this service have not been broadly accepted or implemented. Meanwhile, the performance metrics that have been developed rely on an investment in resources and/or new workflows that C-L psychiatry services may not be prepared to make on a widespread level. Our group sought to determine the feasibility of incorporating routine performance measurement into the workflows of a diverse sample of C-L psychiatry services using only existing resources via three collection methods: timestamp review, chart auditing, and survey administration. No methods were broadly successful across the 9 services. We argue that for routine performance measurement to gain wider traction in the field of C-L psychiatry, the ready availability—or automatability—of performance data must be taken into account. [ABSTRACT FROM AUTHOR]

Background and Aims: Intracranial atherosclerotic disease (ICAD) is common in the Asian population, but less studied in South Asians compared to East Asians. We compared risk factors, treatments, and outcomes among consecutive patients with symptomatic ICAD from India with a mixed-ethnic cohort from Chicago, Illinois. Methods: Consecutive patients with symptomatic ICAD were enrolled at 2 academic medical centers in Kerala, India and Chicago, United States. Data on demographics, risk factors, initial stroke severity (National Institute of Health Stroke Scale score [NIHSS]), recurrent stroke, and 3-month functional outcome (modified Rankin Scale [mRS]) were prospectively collected. Recurrent stroke was defined as symptomatic recurrence of focal neurologic deficits associated with radiographic evidence of new cerebral infarction within 3 months of index admission. Results: 329 patients (117 from Kerala, 212 from Chicago) were included. Indian patients were younger (61 vs. 68, P < 0.001), less frequently had prior stroke history (15.4 vs. 32.5%, P = 0.001) and coronary artery disease (11.1 vs. 22.2%, P = 0.013) but had higher initial NIHSS score (median 6 vs. 3, P < 0.001). Both groups received reperfusion therapy in similar proportions (8.5 vs. 7.1%, P = 0.630) but at discharge, 90.6% of Indian patients compared to 59.0% of Chicago patients were treated with dual antiplatelet therapy. More recurrent strokes occurred in Chicago patients (21.7 vs. 1.9%, P < 0.001) but functional outcome did not differ significantly. Conclusion: Compared to patients in US with symptomatic ICAD, Indian patients were younger and had more severe strokes. However, Indian patients had lower rates of recurrent stroke, perhaps due to greater use of dual antiplatelet therapy. [ABSTRACT FROM AUTHOR]

In light of a warming climate, the complexity of the El Niño/Southern Oscillation (ENSO) makes its prediction a challenge. In addition to various flavors of ENSO, oceanic warming in the central and eastern tropical Pacific is not always accompanied by corresponding atmospheric anomalies; that is, the atmosphere and ocean remain uncoupled. Such uncoupled warm events as happened in 1979, 2004, 2014, and 2018 are rare and represent an unusual form of ENSO diversity. A weaker zonal sea surface temperature anomaly gradient across the tropical Pacific compared to a conventional El Niño may partially account for the decoupling. Also, the uncoupled warm events typically start late in the calendar year, which raises the possible influence of seasonality in background conditions for the lack of coupling. Without coupling, the impact of the warming in the central and eastern tropical Pacific on extratropical climate is different from that of its coupled counterpart. Plain Language Summary: In a warming climate, the features of the El Niño/Southern Oscillation seem to be changing. For example, during the El Niño events in 1979, 2004, 2014, and 2018, oceanic warming in the central and eastern tropical Pacific was not accompanied by corresponding atmospheric anomalies; that is, the atmosphere and ocean remained uncoupled. These uncoupled warming events were associated with a weaker east‐west contrast in sea surface temperature anomaly across the tropical Pacific compared to a conventional El Niño. Also, the uncoupled warm events typically start late in the calendar year, which raises the possible influence of seasonality in the background conditions for the lack of coupling. Without coupling, the impact of the warming in the central and eastern tropical Pacific on extratropical climate is different from that of the coupled counterpart, leading to different predictability of seasonal‐interannual climate in extratropical regions, such as the United States. Key Points: Oceanic warming in the tropical Pacific is not always accompanied by corresponding atmospheric anomaliesA weaker zonal SST anomaly gradient and a late start may partially account for the decouplingThe impact on extratropics is different between the coupled and uncoupled warming [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) and Alzheimer's disease (AD) bear a complex relationship, potentially increasing risk of one another reciprocally. However, recent evidence suggests post-TBI dementia exists as a distinct neurodegenerative syndrome, confounding AD diagnostic accuracy in clinical settings. This investigation sought to evaluate TBI's impact on the accuracy of clinician-diagnosed AD using gold standard neuropathological criteria. In this preliminary analysis, data were acquired from the National Alzheimer's Coordinating Centre (NACC), which aggregates clinical and neuropathologic information from Alzheimer's disease centres across the United States. Modified National Institute on Aging-Reagan criteria were applied to confirm AD by neuropathology. Among participants with clinician-diagnosed AD, TBI history was associated with misdiagnosis (false positives) (OR = 1.351 [95% CI: 1.091–1.674], p = 0.006). Among participants without clinician-diagnosed AD, TBI history was not associated with false negatives. TBI moderates AD diagnostic accuracy. Possible AD misdiagnosis can mislead patients, influence treatment decisions, and confound research study designs. Further work examining the influence of TBI on dementia diagnosis is warranted. [ABSTRACT FROM AUTHOR]

Case: Congenital syphilis (CS) is an infrequently seen condition in the United States; however, rates of CS have been on the rise. We present a case of an infant with a lesion of the radius that was initially diagnosed as a metaphyseal corner fracture and treated as such until maternal syphilis testing was noted to be positive. Ultimately, the child was diagnosed with CS. She is now undergoing treatment with penicillin and recovering well. Conclusion: Although CS is rare, the incidence is on the rise and should remain on the differential of lytic lesions of bone in young children. [ABSTRACT FROM AUTHOR]

Analyzing a set of ensemble seasonal reforecasts for 1958-2017 using CFSv2, we evaluate the predictive skill of the U.S. seasonal mean precipitation and examine its sources of predictability. Our analysis is for each of the three periods of 1958-78, 1979-99, and 2000-17, corresponding to the positive phase of the Pacific decadal oscillation (PDO) during 1979-99 and negative ones before and after. The ensemble reforecasts at two-month lead reproduce the spatial distribution of winter precipitation trends throughout the 60 years and the continental-scale increase of summer precipitation since 2000. The predicted signalto- noise (S/N) ratio also reveals greater predictability in the post-1979 period than during 1958-78. A maximized S/N ratio EOF analysis is applied to the ensemble seasonal precipitation predictions. In winter and spring, the most predictable patterns feature a north--south dipole throughout United States. The summer and fall patterns are dominated by the anomalies in central and southern United States, respectively. In verification with observations, the winter--spring patterns are more skillful. ENSO influences on these predictable patterns are most dominant in winter and spring, but other oceanic factors also play an active role during summer and fall. The multidecadal change of the U.S. precipitation predictability is attributable to the low-frequency modulation of the ENSO predictability and the influences of other major climate modes. PDO can be a dominant factor associated with enhanced prediction skill in 1979-99 and reduced skill in 1958-78. Since the 2000s, the forcing from the SST anomalies in the tropical North Atlantic with opposite sign to those in the tropical Pacific becomes a significant factor for the U.S. summer precipitation prediction. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) has now become a worldwide health issue due to the obesity epidemic, affecting approximately 90% of the obese population and 15–40% of the general population. It is the most common form of chronic liver disease in the United States. NAFLD constitutes a spectrum of diseases ranging in severity from mild, such as fatty liver, progressing into nonalcoholic steatohepatitis (NASH), then fibrosis, and ending with cirrhosis. NASH and increasing fibrosis stage are associated with increased morbidity and mortality; the fibrosis stage is therefore a critical element of risk stratification needed to determine therapeutic approach and also the response to treatment. Liver biopsy is considered the 'gold standard' in the diagnosis of NAFLD. However, it is not practical for widespread clinical use because it is invasive, costly, and associated with complications including occasional death. These limitations have driven the development of noninvasive tests that can accurately predict the fibrosis stage in those with NAFLD. In this review, we provide a concise overview of different non-invasive measurements used for NAFLD/NASH. [ABSTRACT FROM AUTHOR]

Several recent articles have reported conflicting conclusions about educational differences in life expectancy, and this is partly due to the use of unreliable data subject to a numerator-denominator bias previously reported as ranging from 20 % to 40 %. This article presents estimates of life expectancy and lifespan variation by education in the United States using more reliable data from the National Health Interview Survey. Contrary to prior conclusions in the literature, I find that life expectancy increased or stagnated since 1990 among all education-race-sex groups except for non-Hispanic white women with less than a high school education; there has been a robust increase in life expectancy among white high school graduates and a smaller increase among black female high school graduates; lifespan variation did not increase appreciably among high school graduates; and lifespan variation plays a very limited role in explaining educational gradients in mortality. I also discuss the key role that educational expansion may play in driving future changes in mortality gradients. Because of shifting education distributions, within an education-specific synthetic cohort, older age groups are less negatively selected than younger age groups. We could thus expect a greater concentration of mortality at younger ages among people with a high school education or less, which would be reflected in increasing lifespan variability for this group. Future studies of educational gradients in mortality should use more reliable data and should be mindful of the effects of shifting education distributions. [ABSTRACT FROM AUTHOR]