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This qualitative study explores the experiences of 3 generations of Pakistani Americans with an aim to understand the contributing factors to their cultural identity and the meaning of their experiences. The sample consists of 1st-, 1.5-, and 2nd-generation Pakistani Americans. Data were collected via semistructured interviews and a focus group and were analyzed using thematic analysis. Results revealed 5 common themes intertwined across generational groups: awareness of cultural identity differences are situational; sense of loss; positive experience; awareness of 2 cultures; and culture and religion. Implications for counseling Pakistani Americans are discussed.

High-risk acute pulmonary embolism (PE), defined as acute PE associated with hemodynamic instability, remains a significant contributor to cardiovascular morbidity and mortality in the United States and worldwide. Historically, anticoagulant therapy in addition to systemic thrombolysis has been the mainstays of medical therapy for the majority of patients with high-risk PE. In efforts to reduce the morbidity and mortality, a wide array of interventional and surgical therapies has been developed and employed in the management of these patients. However, the most recent guidelines for the management of PE have reserved the use of these advanced therapies in scenarios where thrombolytic therapy plus anticoagulation are unsuccessful. This is due largely to the lack of prospective, randomized studies in this population. Stemming from this, the approach to treatment of these patients varies widely depending on institutional experience and resources. Furthermore, morbidity and mortality remain unacceptably high in this population, with estimated 30-day mortality of at least 30%. As such, development of a standardized approach to treatment of these patients is paramount to improving outcomes. Early and accurate risk stratification in conjunction with a multidisciplinary team approach in the form of a PE response team is crucial. With the advent of novel therapies for the treatment of acute PE, in addition to the growing availability of and familiarity with mechanical circulatory support systems, such a standardized approach may now be within reach. [ABSTRACT FROM AUTHOR]

Stroke in young adults is associated with significant morbidity, and its prevalence is rising in the United States. This is partly attributed to a rise in the prevalence of traditional risk factors including hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease. In addition, there are non-modifiable risk factors comprising migraine, pregnancy and postpartum state, illicit drug use, oral contraceptives and hypercoagulable state. The mechanisms causing stroke in young adults are unique and include cervical dissection, cardioembolic phenomenon, vasculitis and vasculopathy, connective tissue disease, patent foramen ovale and cerebral venous thrombosis. The diagnosis of stroke in the young population can be challenging given its myriad clinical presentations. In this document, we provide an overview of the epidemiology of stroke in young adults, explore mechanisms that may explain increasing rates of stroke in this population, and provide a critical updated overview of the existing literature on the management and prevention of stroke in young adults. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to evaluate how gender, socioeconomic position (SEP), race/ethnicity and nationality intersect to structure social inequalities in adult oral health among American adults. Methods: Data from adults aged 20 years or over who participated in the National Health and Nutrition Examination Survey (NHANES) 2009–2018 were analysed. The outcomes were poor self‐rated oral health and edentulism among all adults (n = 24 541 and 21 446 participants, respectively) and untreated caries and periodontitis among dentate adults (n = 16 483 and 9829 participants, respectively). A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted for each outcome, by nesting individuals within 48 intersectional strata defined as combinations of gender, SEP, race/ethnicity and nationality. Intersectional measures included the variance partition coefficient (VPC), the proportional change in variance (PCV) and predicted excess probability due to interaction. Results: Substantial social inequalities in the prevalence of oral conditions among adults were found, which were characterized by high between‐stratum heterogeneity and outcome specificity. The VPCs of the simple intersectional model showed that 9.4%–12.7% of the total variance in the presentation of oral conditions was attributed to between‐stratum differences. In addition, the PCVs from the simple intersectional model to the intersectional interaction model showed that 84.1%–97.1% of the stratum‐level variance in the presentation of oral conditions was attributed to the additive effects of gender, SEP, race/ethnicity and nationality. The point estimates of the predictions for some intersectional strata were suggestive of an intersectional interaction effect. However, the 95% credible intervals were very wide and the estimations inconclusive. Conclusions: This analysis highlights the value of the intersectionality framework to understand heterogeneity in social inequalities in oral health. These inequalities were mainly due to the additive effect of the social identities defining the intersectional strata, with no evidence of interaction effects. [ABSTRACT FROM AUTHOR]

This study explored the relationship between Perceived Stress and Religious Coping levels among Muslim emerging adults of Pakistani origin living in Pakistan and Muslim emerging adults of Pakistani origin living in the United States (US). Participants (Pakistani Origin Muslims Living in Pakistan, n= 103; and Pakistani Origin Muslims Living in the US, n=50) were between 18-25 years old. The Perceived Stress Scale (PSS-10) and Brief R-Cope scale were administered using an online format. Results indicated that negative religious coping strategies were associated with higher perceived stress in both groups while positive religious coping strategies showed a weaker association with lower perceived stress levels, and this finding appeared only in the US sample. Marital status was also an important predictor of perceived stress. These findings demonstrate that Muslim emerging adults, irrespective of culture, show moderately similar patterns in their perception of stress and their utilization of religious coping strategies. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this research is to describe the use of the social media platform, Instagram, by academic ophthalmology residency programs in the United States over time and consider the impact of the COVID-19 pandemic on ophthalmology's social media presence. Methods and Subjects: This cross-sectional study was conducted online by reviewing the publicly accessible Instagram accounts of all accredited US academic ophthalmology residency programs. Main Outcomes and Measures: Number of US ophthalmology residency programs with an affiliated Instagram account were analyzed by year of creation. The content of the top six accounts with the most followers was analyzed by evaluating amount of engagement within defined post categories. Results: Of the 124 ophthalmology residency programs, 78 (62.9%) were identified as having an affiliated Instagram account, 60 accounts (48.4%) were created during the years 2020 or 2021, and 62 (50.0%) accounts focused specifically on promoting the residency training program. Of the top six accounts with the most followers, post categories that received the most engagement were "Medical" and "Group Photo", while those that received the least engagement were "Department Bulletin" and "Miscellaneous." User engagement on posts as measured by likes and comments increased across multiple post categories after January 2020. Conclusion: Social media presence of ophthalmology residency programs on Instagram increased substantially in 2020 and 2021. As a result of the COVID-19 pandemic restricting in-person interactions, residency programs have used alternative platforms to reach applicants. Given the increasing use of such applications, social media will likely continue to become an important aspect of professional engagement in ophthalmology. [ABSTRACT FROM AUTHOR]

Untreated caries is a prevalent disease that is associated with a substantial health and economic burden. Many past efforts have assessed the epidemiology of untreated caries, and this study provides the most up-to-date figures on the distribution and determinants of the disease in the adult US population for the period 2017 through 2020. Using data from the 2017-2020 National Health and Nutrition Examination Survey, the author derived estimates for untreated caries prevalence in the adult US population. The author conducted subgroup analyses to assess how the epidemiology differed between coronal and root caries and how the disease was distributed among population subgroups. On the basis of a weighted sample representative of 193.5 million adults, the prevalence of untreated caries was found to be 21.3%. Specific prevalence of coronal and root caries were 17.9% and 10.1%, respectively. Caries was most prevalent in those aged 30 through 39 years (25.2%) and 40 through 49 years (22.3%), men (23.5%), those of other (36.5%) or non-Hispanic Black (35.6%) race or ethnicity, those with family income to poverty ratio of 0.5 through 1.0 (46.2%) or less than 0.5 (37.3%), those with educational attainment less than high school graduation (39.6%), those who did not have health insurance (42.1%), and those who were underweight (25.1%) or obese (23.5%). Untreated caries is present in more than 1 in 5 adults within the US population and is disproportionately distributed among those of lower socioeconomic status. There is a substantial unmet health care need in the US adult population for the prevention and management of untreated caries, and public health efforts should aim particularly to address disease within those subgroups who are at a disproportionately high risk. [ABSTRACT FROM AUTHOR]

We investigate the effect of financial access on convergence in the US agricultural sector. We find that financial access allows states with lower real per-capita agricultural production to catch up faster with those with higher real per-capita agricultural production. Our results are robust to various specifications and in the presence of other factors determinant of dynamics in the agricultural sector, such as the level of unemployment and competition. Therefore, this paper unveils higher opportunity costs of lower financial access in terms of welfare improvement, policy dissemination, and technological spillovers across the states. We recommend the implementations and dissemination of strategiesthat will ensure the availability, to all farmers, of innovations developed in agriculture. [ABSTRACT FROM AUTHOR]

Deep vein thrombosis (DVT) is a common disorder affecting approximately 900,000 new patients in the United States each year. Although the mainstay of treatment of DVT patients is therapeutic anticoagulation, some patients remain significantly symptomatic and therefore require more advanced interventions such as catheter-directed thrombolysis (CDT). We describe a case series of 13 patients with acute symptomatic inferior vena cava (IVC) and iliofemoral DVT that were treated with CDT using the Bashir Endovascular Catheter (BEC). We report the first-in-human use of BEC, which is a novel pharmacomechanical thrombolysis device. All the treated patients had complete and rapid resolution of their symptoms with excellent venous outflow. Despite initial promising results, larger studies using this catheter design will be needed to assess the role of BEC-directed therapy on rates of post-thrombotic syndrome and bleeding complications. [ABSTRACT FROM AUTHOR]

Providing culturally competent care for Muslim women poses specific challenges to the mental health provider. The importance of recognizing the strong link of postpartum depression, stigma against mental illness and medications, unique cultural beliefs, effect of discrimination, and emphasis on modesty in this patient population can serve as important tools in understanding the patient and establishing patient--provider alliance. This article will review and analyze illustrative cases related to the mental health treatment of Muslim women as well as the approach that providers can utilize to deliver culturally competent treatment for this patient population. [ABSTRACT FROM AUTHOR]

Objective: Multiple Sclerosis (MS) affects up to 500,000 adults in the United States, with cognitive impairment present in 45%-65% of people. Studies showed hippocampal atrophy in MS, but the underlying mechanisms remain unknown. Inflammation has been proposed to play a significant role, and associations between systemic inflammatory biomarkers and hippocampal atrophy have been shown in other neurological conditions. However, research exploring serum biomarker and volumetric associations in MS are lacking. Given that conventional imaging methods lack resolution for hippocampal internal architecture (HIA), new protocols were developed. We used the High-Resolution Multiple Image Co-Registration and Averaging (HR-MICRA) method to visualize the HIA subfields. We investigated the relationship between subfield volumes generated from HR-MICRA scans and systemic serum biomarkers in MS. Participants and Methods: Patients with MS were recruited (N= 34, mean age= 54.6, 35.3% Black) underwent Magnetic Resonance Imaging (MRI), and serum biomarkers were obtained, specifically chosen for their potential role in MS. Inflammatory biomarkers included; granulocyte colony stimulating factor (G-CSF), interleukin-10 (IL-10), matrix metalloproteinase-9 (MMP-9), tumor necrosis factor- a (TNF- a), and growth factors; vascular endothelial growth factor (VEGF); insulin-like growth factor-1 (IGF-1), and brain derived growth factor (BDNF). Imaging was performed in a Siemens Prisma 3T scanner with a 64-channel head coil using the HR-MICRA method. Hippocampal subfields were calculated using the Automated Segmentation of Hippocampal Subfields (ASHS) package. We used the Magdeburg Young Adult 7T Atlas for sub-hippocampal structures and Penn Temporal Lobe Epilepsy T1-MRI Whole Hippocampus ASHS Atlas for general hippocampal structure and segmentation. Pearson's product-moment analyses provided correlations between biomarkers and hippocampal subfield volumes for each cerebral hemisphere. A statistical significance level of p < 0.05 was used for all analyses. Results: Correlations emerged between left hemisphere Cornu Ammonis (CA) 2 and G-CSF (r = -.384; p =.025); IL-10 (r = -.342; p =.048); VEGF (r = -.371; p=.031); and CA3 with IL-10 (r = -.488, p =.003); G-CSF (r = -.386; p=.024); VEGF (r = -.352; p=.041). Dentate gyrus correlated with MMP-9 (r =.416; p=.014); IL-10 (r = -.365; p =.034). BDNF was correlated with right hemisphere CA1 (r = -.417, p =.014), CA2 (r = -.497; p=.003) and CA3 (r = -.451; p=.007). Conclusions: In our sample of persons with MS, left hemisphere hippocampal subfield volumes were negatively correlated with inflammatory biomarkers, supporting previous reports linking inflammation to reduced brain volumes in other neurological conditions. In the right hemisphere, we found negative correlations between HIA and BDNF, suggesting a neuroprotective function for BDNF in this neurodegenerative disease. These findings in a representative sample of patients with MS highlight the need for further research exploring the relationship between HIA and systemic serum biomarkers in MS. [ABSTRACT FROM AUTHOR]

Purpose: Cigarettes have been demonstrated to be toxic to the pulmonary connective tissue by impairing the lung's ability to clear debris, resulting in infection and acute respiratory distress syndrome (ARDS). Approximately 8% of adolescents are smokers. We hypothesized that adolescent trauma patients who smoke have a higher rate of ARDS and pneumonia when compared to non-smokers.Methods: The Trauma Quality Improvement Program (2014-2016) was queried for adolescent trauma patients aged 13-17 years. Adolescent smokers were 1:2 propensity-score-matched to non-smokers based on age, comorbidities, and injury type. Data were analyzed using chi square for categorical data and Mann-Whitney U test for continuous data.Results: From 32,610 adolescent patients, 997 (3.1%) were smokers. After matching, 459 smokers were compared to 918 non-smokers. There were no differences in matched characteristics. Compared to non-smokers, smokers had an increased rate of pneumonia (3.1% vs. 1.1%, p = 0.01) but not ARDS (0.2% vs. 0%, p = 0.16). Compared to the non-smoking group, the smokers had a longer median total hospital length-of-stay (3 vs. 2 days, p = 0.01) and no difference in overall mortality (1.5% vs. 2.4%, p = 0.29).Conclusion: Smoking is associated with an increased rate of pneumonia in adolescent trauma patients. Future research should target smoking cessation and/or interventions to mitigate the deleterious effects of smoking in this population. [ABSTRACT FROM AUTHOR]

Objective: To characterize the role of clinical and sociodemographic factors in the use of conservative management for localized prostate cancer in the US between 2010 and 2015, and to understand how those factors evolved in light of the recent national increase in conservative management rates.Methods: Data from the Surveillance, Epidemiology, and End Results Program "Prostate with Watchful Waiting Database," where conservative treatment was delineated by a distinct classifier, was used to evaluate factors associated with electing for conservative management at initial diagnosis (2010-2015). Men aged ≥40 years with cT1-T2a and T2NOS with Gleason score 3 + 3 and 3 + 4 were included (n = 118,415). Multivariable logistic regression was used to determine the association between clinical and sociodemographic factors and electing conservative management.Results: Between 2010 and 15, a total of 22,099 (18.6%) men were managed conservatively. Mean age of men managed conservatively decreased from 66.6 to 64.6 years, and median prostate-specific antigen (PSA) increased from 5.7 to 6.0 ng/mL, P <.0001. Men with lower income experienced a greater increase in conservative management rates compared to those with high income (152% vs 72% for third and fifth [richest] income quintiles, respectively). On multivariable analysis, Gleason score 3 + 3, older age, lower PSA, more recent year, treatment in the West, and higher levels of county income were significantly associated with conservative management.Conclusion: Characteristics of men undergoing conservative management are rapidly changing. Younger men, men with higher PSAs, and men of all incomes are increasingly being managed conservatively. Narrowing of income-based disparities with concurrent broadening of patients considered eligible for surveillance is encouraging. [ABSTRACT FROM AUTHOR]

Addressing data breach harms has become a great challenge in the administration of privacy law in the United States. Several data breach cases have been dismissed by US courts because the victims cannot prove cognizable harm. The current US legal system emphasizes that data breach victims must prove that they have suffered an "injury in fact, " which means that the injury suffered must be concrete and particularized. Data breach harms are futuristic and hard-to-quantify, reasons for which they may not fit in the "injury in fact" requirement. Furthermore, victims of data violations have attempted to plead economic loss to prove the harm suffered, but with no success. This article suggests a new approach that aims at addressing privacy harms without necessarily proving economically quantifiable harm. [ABSTRACT FROM AUTHOR]

Background: Diabetes and chronic narcotic use negatively affect the quality of bowel preparation before colonoscopy.Aim: To investigate whether narcotic use and diabetes have an additive negative impact on bowel preparation.Patients and Methods: We performed a retrospective study of 2841 patients (mean age 61 ± 10.2; 94% male) who received outpatient colonoscopies at our Veterans Affairs Medical Center between June 2012 and December 2014. We collected information related to demographics, body mass index, indications, and medical/surgical history (diabetes mellitus, stroke, cirrhosis, dementia, constipation, hypothyroidism, and use of narcotics or antidepressants/anxiolytics for more than three months). Patients were classified into four groups: (1) diabetics on narcotics, (2) diabetics only, (3) on narcotics only, and (4) neither diabetic nor using narcotics. Quality of the bowel preparation was scored using the Boston Bowel Preparation Scale (BBPS) and categorized as either excellent (BBPS ≥7, with no individual segment scoring <2) or not excellent (BBPS <7). Multivariate logistic regression analysis was performed to identify the combined impact of narcotic use and diabetes on bowel preparation.Results: Bowel preparation quality was excellent in 49%. Thirty-eight percent of patients with diabetes who were using narcotics (adjusted OR 0.6, CI [0.4, 0.8]) achieved excellent bowel preparation compared with 44% (adjusted OR 0.7, CI [0.6, 0.9]) of patients on narcotics only, 48% (adjusted OR 0.8, CI [0.7, 0.9]) of diabetics only, and 54% of patients with neither condition.Conclusion: Concomitant narcotic use and diabetes have a compounding effect on the quality of bowel preparation prior to colonoscopy. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic steatohepatitis (NASH) is characterised by hepatic steatosis, inflammation, hepatocellular injury, and progressive liver fibrosis. Resmetirom (MGL-3196) is a liver-directed, orally active, selective thyroid hormone receptor-β agonist designed to improve NASH by increasing hepatic fat metabolism and reducing lipotoxicity. We aimed to assess the safety and efficacy of resmetirom in patients with NASH.Methods: MGL-3196-05 was a 36-week randomised, double-blind, placebo-controlled study at 25 centres in the USA. Adults with biopsy confirmed NASH (fibrosis stages 1-3) and hepatic fat fraction of at least 10% at baseline when assessed by MRI-proton density fat fraction (MRI-PDFF) were eligible. Patients were randomly assigned 2:1 by a computer-based system to receive resmetirom 80 mg or matching placebo, orally once a day. Serial hepatic fat measurements were obtained at weeks 12 and 36, and a second liver biopsy was obtained at week 36. The primary endpoint was relative change in MRI-PDFF assessed hepatic fat compared with placebo at week 12 in patients who had both a baseline and week 12 MRI-PDFF. This trial is registered with ClinicalTrials.gov, number NCT02912260.Findings: 348 patients were screened and 84 were randomly assigned to resmetirom and 41 to placebo at 18 sites in the USA. Resmetirom-treated patients (n=78) showed a relative reduction of hepatic fat compared with placebo (n=38) at week 12 (-32·9% resmetirom vs -10·4% placebo; least squares mean difference -22·5%, 95% CI -32·9 to -12·2; p<0·0001) and week 36 (-37·3% resmetirom [n=74] vs -8·5 placebo [n=34]; -28·8%, -42·0 to -15·7; p<0·0001). Adverse events were mostly mild or moderate and were balanced between groups, except for a higher incidence of transient mild diarrhoea and nausea with resmetirom.Interpretation: Resmetirom treatment resulted in significant reduction in hepatic fat after 12 weeks and 36 weeks of treatment in patients with NASH. Further studies of resmetirom will allow assessment of safety and effectiveness of resmetirom in a larger number of patients with NASH with the possibility of documenting associations between histological effects and changes in non-invasive markers and imaging.Funding: Madrigal Pharmaceuticals. [ABSTRACT FROM AUTHOR]

There has been marked improvement in leukemia survival, particularly among children in recent time. However, the long-term trends in survival among adult leukemia patients and the associated sex and racial survival disparities are not well understood. We, therefore, evaluated the secular trends in survival improvement of leukemia patients from 1973 through 2014, using Surveillance Epidemiology and End-Result Survey Program (SEER) data. ICD-O-3 morphology codes were used to group leukemia into four types: acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML). Survival analysis for each leukemia type stratified by race/ethnicity, age, sex was performed to generate relative survival probability estimates for the baseline time period of 1973 through 1979. Hazard ratios (HR) and respective 95% confidence intervals (CIs) for survival within subsequent 10-year time periods by race, age and sex were calculated using Cox proportional hazard models. Of the 83,255 leukemia patients for the current analysis, the 5-year survival of patients with ALL, AML, CLL, and CML during 1973–1979 were 42.0%, 6.5%, 66.5%, and 20.9%, respectively. Compared to the baseline, there were substantial improvements of leukemia-specific survival in 2010–2014 among African-American (81.0%) and Asian (80.0%) patients with CML and among 20–49 year of age with CLL (96.0%). African-American patients, those with AML and those older than 75 years of age had the lowest survival improvements. Asians experienced some of the largest survival improvements during the study period. Others, including African-American and the elderly, have not benefited as much from advances in leukemia treatment. [ABSTRACT FROM AUTHOR]

Women living in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-eligible households may be pregnant or breastfeeding. Stress during pregnancy and breastfeeding may influence women's mental health making them more vulnerable to higher rates of food insecurity (FI). Determine whether or not FI is associated with moderate-to-severe mental distress among women living in WIC-eligible households, and whether or not the strength of the association differs among WIC participants compared with eligible nonparticipants with low income. Cross-sectional data from the 2011-2018 National Health Interview Survey were utilized. A total of 7,700 women living in WIC-eligible households with at least one child were analyzed. Moderate-to-severe mental distress was measured using the validated K6 nonspecific psychological distress scale. FI was measured using the 10-item, US Adult Food Security Survey Module. Multivariate logistic regression was used to examine the association between FI and mental distress. The conditional effects of WIC participation were examined by including interaction terms for FI and WIC participation as well as by stratifying the sample by WIC participation. Among women in WIC-eligible households, FI was associated with moderate-to-severe mental distress in a dose-response fashion: compared with those who were food secure, the adjusted odds of moderate-to-severe mental distress were 1.8 times higher among those with marginal food security (adjusted odds ratio [AOR] 1.83, 95% CI 1.50 to 2.23), 2.1 times higher among those with low food security (AOR 2.14, 95% CI 1.76 to 2.60), and 3.7 times higher among those with very low food security (AOR 3.73, 95% CI 2.95 to 4.71). The interaction between FI and WIC participation was not significant, with similar associations between FI and mental distress among WIC participants and nonparticipants. Among this nationally representative sample of women in WIC-eligible households, increasing severity of food insecurity was associated with poor mental health among WIC participants and nonparticipants. WIC participation was not observed to moderate the association between FI and mental distress. More research should consider including mental health screening at WIC clinic visits to enable early identification and referral for care. [ABSTRACT FROM AUTHOR]

Fish-paste products, also known as fish cakes or surimi-based products, are worldwide favorites. Surimi, a wet protein concentrate of fish muscle, is used as an intermediate raw material to produce surimi seafood. The flavor, texture, taste, shelf-life, and market value of surimi-based products depend on the source of the fish meat, type of applied heat treatment, and additives used to prepare the surimi. While preparing surimi with chemical additives, several problems have been observed, such as a lack of unique characteristics, inferior acceptability, and poor functionality. Various types of fish-paste products have been developed by using different ingredients (e.g., vegetables, seafood, herbs and oriental medicines, grains and roots including carrots, and functional food materials). However, a systematic review of fish-paste products prepared using natural food additives has not yet been performed. Therefore, the quality characteristics of fish-paste products and their functionalities were elucidated in this study. With the increasing demand for surimi seafood products, the functional properties, physiochemical properties, and shelf-life of surimibased products need to be improved. This review will aid the preparation of new value-added products in the surimi industry. [ABSTRACT FROM AUTHOR]

Background: Women with coronary artery disease are less likely to be revascularized than men based on angiography alone. Recent studies have shown that female patients have higher fractional flow reserve (FFR) values for a given severity of coronary stenosis. However, gender differences in coronary revascularization rates following FFR assessment are unknown. Methods: The nationwide inpatient sample database was used to identify all patients who underwent FFR in the United States between January 2009 and December 2010. We used propensity score matching to compare revascularization rates and in-hospital outcomes among men and women undergoing FFR measurements. Results: Among 3712 patients who underwent FFR during the study period, 1235 matched pairs of men and women were identified. The overall revascularization rates were lower in women than men (40.1% vs. 52.8%, p < 0.01). Women were less likely to undergo either percutaneous (35.2% vs. 45.6%, p < 0.01) or surgical revascularization following FFR than men (5.2% vs. 7.4%, p = 0.03). Women had a nonsignificant trend toward higher in-hospital mortality (0.8% vs. 0.5%, p = 0.32) and significantly higher rates of access site hematoma formation (2.7% vs. 0.8%, p < 0.01) compared to men. Conclusion: In conclusion, this large nationwide study reveals that coronary revascularization rates are significantly lower in women than in men even after functional assessment with FFR. [ABSTRACT FROM AUTHOR]

Background: The massive pandemic of Zika virus (ZIKV) infection is spreading through South America, Central America, the Caribbean, and possibly the USA. It is the most recent of four surprising appearances of imperative arthropod-borne viral illnesses in the Western Hemisphere over the preceding 20 years. Objective: The objective of this narrative review is to summarize the existing knowledge about the epidemiology, transmission, clinical manifestations, complications, replication, pathogenesis, diagnosis, and treatment and prevention of ZIKV infection. Methods: We used electronic databases to identify relevant published data regarding ZIKV in BOOLEAN and MeSH searches. Conclusion: This review concludes that the ZIKV predominantly circulates in arboreal mosquitoes (e.g., Aedes africanus) and wild primates. It rarely causes severe infection in humans, even in extremely enzootic regions. Currently, we do not have any efficacious drugs against ZIKV infection. However, there are virus-specific therapeutic targets, which may lead to the development of targeted anti-ZIKV drugs. [ABSTRACT FROM AUTHOR]

Objective: To examine trends in international medical graduate (IMG) representation within urology and compare these trends to those of other specialties.Methods: Urology match data were obtained from the American Urological Association from 1987 to 2015. IMG representation among residencies was extracted from reports on Graduate Medical Education published in Journal of the American Medical Association from 1978 to 2013. We analyzed trends in the number of IMG urology applicants, match rates in urology for IMGs vs US medical graduates, and the annual percentage of IMGs among all urology residents vs residents of other specialties.Results: Between 1987 and 2015, 6790 applicants matched into urology. The number of positions offered increased by 24% (224 to 295) between 1987 and 2015. However, the number of IMG urology applicants did not increase accordingly (r = -0.55, P = .78). Match rates for US students and IMGs ranged from 68% to 91% and 6% to 33%, respectively. From 1978 to 2013, the proportion of IMGs across all specialties remained relatively stable (25% to 27%), whereas the proportion of IMGs in urology decreased substantially (27% to 5%).Conclusion: The proportion of IMGs in urology training has dramatically decreased over time and remains lower than most other specialties. IMGs are critical to urology as they can assist in meeting workforce demands, contribute diversity to the workplace, and help to propel the field forward through urologic research. Further efforts should be directed toward understanding the unique needs of IMG residents and helping them to navigate the challenges of practicing in a foreign country. [ABSTRACT FROM AUTHOR]

Objective: To investigate recent trends in mesh use for pelvic organ prolapse (POP)-related reconstruction procedures.Materials and Methods: Using the 2001-2011 5% Medicare claims database, we identified POP diagnoses and related procedures. Transvaginal mesh use and sacrocolpopexy were first reported in 2005 and 2004, respectively.Results: A total of 613,160 cases of vaginal and abdominal POP repair procedures were identified. The majority of procedures involved multiple compartments. The rate of mesh use increased dramatically from 2% of repairs in 2005 to 35% by 2008. After the Food and Drug Administration warning in 2008, mesh use plateaued and then decreased in 2011. Mesh was used more commonly in younger (odds ratio [OR] 0.722, P < .001), white (OR 0.712-0.791 for other races, P < .001) women in the South (OR 0.741-0.848 for non-South regions, P < .001). Starting in 2008, the rate of sacrocolpopexy procedures almost doubled yearly until 2011. Sacrocolpopexy was more common in younger patients (49% in women <70 years) and in white women (88%); the majority of sacrocolpopexies were performed in the South (60%) and laparoscopically (83%-98%).Conclusion: The treatment of POP has changed over time. The use of mesh increased significantly until 2008, after which it plateaued following the Food and Drug Administration warning regarding mesh-related complications. Concurrently, the number of sacrocolpopexy procedures increased significantly starting in 2008 as the use of laparoscopic and/or robotic technique and concern regarding transvaginal mesh increased. [ABSTRACT FROM AUTHOR]

Purpose: To determine the rate of agreement between the Organ Procurement and Transplant Network (OPTN) and Liver Imaging Reporting and Data System (LI-RADS) classifications for hypervascular liver nodules at least 1 cm in diameter, and for patient eligibility for hepatocellular/MELD (Model for Endstage Liver Disease) exception points. Materials and Methods: This retrospective study was approved by our Institutional Review Board and was compliant with the Health Insurance Portability and Accountability Act. The requirement for informed consent was waived. This study included 200 hypervascular hepatocellular nodules at least 1 cm in diameter on computed tomography (CT) or magnetic resonance imaging (MRI) examinations in 105 patients with chronic liver disease. Three radiologists blinded to clinical data independently evaluated nodule characteristics, including washout, capsule, size, and size on prior examination. Based on those characteristics, nodules were automatically classified as definite hepatocellular carcinoma (HCC) or not definite HCC using both the OPTN and LI-RADS classifications. Using these classifications and the Milan criteria, each examination was determined to be "below transplant criteria," "within transplant criteria," or "beyond transplant criteria." Agreement was assessed between readers and classification systems, using Fleiss' kappa, intraclass correlation coefficients (ICCs), and simple proportions. Results: Interreader agreement was moderate for nodule features (κ = 0.59-0.69) and nodule classification (0.66-0.69). The two systems were in nearly complete agreement on nodule category assignment (98.7% [592/600]) and patient eligibility for transplant exemption priority (99.4% [313/315]). A few discrepancies occurred for the nodule feature of growth (1.3% [8/600]) and for nodule category assignment (1.3% [8/600]). Conclusion: Agreement between the OPTN and LI-RADS classifications is very strong for categorization of hypervascular liver nodules at least 1 cm in diameter, and for patient eligibility for hepatocellular/MELD exception points. Interreader variability is much higher than intersystem variability. [ABSTRACT FROM AUTHOR]

The application of high-resolution melting (HRM) analysis in the differentiation between Theileria equi and Babesia caballi was evaluated using control samples from the United States Department of Agriculture and field samples collected from horses in Sudan and China. A region of the 18S rRNA gene, with four known nucleotide differences between the two parasites, was selected for primer design. HRM analysis successfully allowed the detection and differentiation of T. equi and B. caballi without the necessity of performing time-consuming and expensive post-PCR procedures such as sequencing or restriction digestion. Our results suggest that HRM could be an ideal method for rapid genotyping, which is required to determine a drug of choice or to administer an appropriate vaccine during an outbreak. [ABSTRACT FROM AUTHOR]

Background: In early 2009, a novel influenza A(H1N1) virus that emerged in Mexico and United States rapidly disseminated worldwide. The spread of this virus caused considerable morbidity with over 18000 recorded deaths. The new virus was found to be a reassortant containing gene segments from human, avian and swine influenza viruses. Methods/Results: The first case of human infection with A(H1N1)pdm09 in Pakistan was detected on 18th June 2009. Since then, 262 laboratory-confirmed cases have been detected during various outbreaks with 29 deaths (as of 31st August 2010). The peak of the epidemic was observed in December with over 51% of total respiratory cases positive for influenza. Representative isolates from Pakistan viruses were sequenced and analyzed antigenically. Sequence analysis of genes coding for surface glycoproteins HA and NA showed high degree of high levels of sequence identity with corresponding genes of regional viruses circulating South East Asia. All tested viruses were sensitive to Oseltamivir in the Neuraminidase Inhibition assays. Conclusions: Influenza A(H1N1)pdm09 viruses from Pakistan form a homogenous group of viruses. Their HA genes belong to clade 7 and show antigenic profile similar to the vaccine strain A/California/07/2009. These isolates do not show any amino acid changes indicative of high pathogenicity and virulence. It is imperative to continue monitoring of these viruses for identification of potential variants of high virulence or drug resistance. [ABSTRACT FROM AUTHOR]

Background The relationship of missed and shortened hemodialysis (HD) to clinical outcomes has not been well characterized in HD patients in the USA. Here we explored the frequency of missed and shortened treatments and their impact on mortality and hospitalization. Methods A retrospective review of data from a cohort of 15 340 HD patients treated in facilities operated by Dialysis Clinics, Inc. We compared the frequency of missed and shortened treatments by gender, race, age and treatment schedules [Mondays, Wednesdays, Fridays (MWF) versus Tuesdays, Thursdays, Saturdays (TTS)]. Results Of the 15 340 patients, 48% were non-Hispanic whites (NHWs), 41% African Americans (AAs), 6% Hispanics, 2% Native American (NA), 2% Asians and 1% other races. The median number of years on HD was 1.8 years and the median follow-up was 12.4 months. The odds of missing at least one treatment in a month were higher in: patients aged <55 years, odds ratio (OR) 1.33 (P<0.0001); in AAs, OR 1.51 (P < 0.0001); in NAs, OR 1.50 (P = 0.0003); and in Hispanics, OR 1.33 (P = 0.0003) compared with NHWs and in patients who dialyzed on TTS compared with MWF, OR 1.33 (P < 0.0001). Similar findings were observed for treatments shortened by at least 10 min per month. Missed and shortened treatments were most prevalent on Saturdays and were also associated with progressive increases in hospitalization and mortality. Conclusion Missed and shortened HD treatments pose a challenge to providers. Improved adherence to prescribed dialysis may decrease the morbidity and mortality. [ABSTRACT FROM AUTHOR]

The role of donor lymphocyte infusion (DLI) in mediating the graft-versus-myeloma (GvM) effect after allogeneic hematopoietic stem cell transplant (allo-HCT) is not clearly defined. We evaluated the safety and utility of DLI in patients with either persistent or recurrent multiple myeloma (MM) after allo-HCT. Twenty-three patients with MM received DLI after allo-HCT at the University of Texas M. D. Anderson Cancer Center between July 1996 and June 2008. Eight patients received preemptive DLI for residual disease (RD) while 15 patients received DLI for the treatment of recurrent or progressive disease (PD). We evaluated the response to DLI and the factors that may predict a response. Median DLI dose was 3.3 × 107 CD3 + cells (range 0.5-14.8 × 107). Grade II-IV acute graft-versus-host disease (GvHD) was seen in five patients (22%). Median follow-up in surviving patients was 24 months. Five of 23 patients (22%) achieved a complete or a very good partial response (two CR, three VGPR), while eight patients (34%) had stable disease (SD) after the DLI. Patients who received DLI for RD had a higher response rate (≥ VGPR 50% vs. 7%, p = 0.03), a longer overall survival (28.3 vs. 7.6 months, p = 0.03) and a trend toward longer progression-free survival (11.9 vs. 5.2 months, p = 0.1). In this largest single institution study, we conclude that the use of preemptive, non-manipulated DLI for RD after reduced-intensity conditioning allo-HCT is encouraging, and it was associated with a higher response rate and a longer overall survival when given preemptively. The role of DLI needs to be further explored in prospective clinical trials. [ABSTRACT FROM AUTHOR]

Generating employment and alleviating poverty are the biggest challenges for regional economic growth in the rural areas of the Northeastern United States. Despite the revival of the economy in much of the nation's heartland, rural areas are still suffering from high poverty and unemployment rates. Self-employment, a measure of entrepreneurship, indicates an opportunity for rural communities to improve the quality of life and accelerate regional economic development. Taking into consideration the problem of unemployment in rural communities, there is a need to focus on generating self-employment opportunities at micro level to enhance economic growth and reduce the per capita income 'gap' between rural and urban areas. The overall objective of the study is to identify and estimate the impacts of self-employment in the economic development of the Northeastern United States. The empirical model of this study is derived from the three-equation simultaneous model of Deller et al. (2001). The study estimated the relationship of employment, population and per capita income to self-employment. Research findings show that employment and population have a positive relationship to self-employment, indicating positive contribution of self-employment to regional economic development. [ABSTRACT FROM AUTHOR]

The overall objective of this study is to provide policy makers identifies and estimates the role and impacts of new firm formation in the Northeast region of the United States. The empirical model of this study is derived from the three-equation simultaneous model of Deller et al. (2001). In this study, Three-Stage Least Squares (3SLS) method is used to estimate the simultaneous equations model. The research findings indicate that population density and per capita income have a positive link with new firm formation. Higher population density and per capita income encourage entrepreneurs to start new firms in the region. This leads to an increase of new jobs, which is a positive contribution to economic development in the Northeast region. [ABSTRACT FROM AUTHOR]

During the 2004-2005 influenza vaccine shortage, the Centers for Disease Control and Prevention (CDC) coordinated distribution of post-October 5th 2004 doses of influenza vaccine to state and local health departments (LHDs), who subsequently distributed vaccine to community providers. The National Association of County and City Health Officials (NACCHO) conducted three Web-based surveys throughout the 2004-2005 influenza season to assess in real-time how LHDs were 1) dealing with the vaccine shortage, 2) implementing the interim recommendations from the Advisory Committee on Immunization Practices (ACIP), and 3) making efforts to reallocate and redistribute doses of influenza vaccine toward high-priority populations within their communities. This paper highlights LHD responses that alleviated adverse impacts during this public health emergency. The first survey asked LHDs to quantify their community's vaccine supply; the second survey asked them to describe their specific responses to the crisis; and the third survey asked them to reflect and evaluate the effectiveness of their efforts to vaccinate high-priority groups during the crisis. Six hundred five (605) of 717 (84%) LHDs in 44 states responded to the three surveys. Results show that LHDs leveraged preparedness plans, formed strategic community partnerships, and practiced vaccination drills to address the problems of vaccinating high-priority and hard-to reach populations that arose out of the vaccine shortage. The practices used by LHDs during this shortage may provide valuable response lessons to minimize the impact of future influenza vaccine shortages and other public health emergencies. [ABSTRACT FROM AUTHOR]

The article analyzes the relations of the U.S. and Israel. The most important aspect of the relations is the cultural and religious exchange. The U.S. imperialism and Israeli colonialism have worked in tandem in order to produce both Israeli and American nationalist outcomes since 1967. It explains how the U.S. interests in the Middle East have become consistent with supporting the Jewish state and defending its colonialist objectives.

The article profiles Mohammad Akhter, executive director of the American Public Health Association. As the executive director of the association, he has been informing the country regarding the need for cohesion and cooperation between public and private agencies, medical and public health communities, professional institutions and the public they exist to serve. An issue that continues to challenge Akhter is that of universal health coverage, which to him is instrumental to the success of any public health objectives. A brief summary of his personal life and career is provided.

The article discusses inadequate housing as a public health crisis in the U.S. The reality is that home often harbors dangers of its own, and the tendency to isolate indoors is shown to have ill effects on family health. The link between inadequate housing and poor health is increasingly well documented. Substandard housing contributes to a variety of ailments, from respiratory disease and neurological disorders to psychological and behavioral dysfunction. These often life-threatening ailments affect children of color and children from low-income families.

Fungal peritonitis in children receiving peritoneal dialysis: A report of the NAPRTCS. Background. The rarity of fungal peritonitis (FP) in children receiving chronic peritoneal dialysis (PD) has limited the amount of information available regarding the risk factors and management associated with this infection. Methods. We reviewed all cases of FP occurring in patients entered into the dialysis registry of the NAPRTCS between January 1992 and May 1996 in an attempt to identify risk factors for infection, treatment strategies, and patient outcome data. A total of 1592 patients who were less than 21 years of age were enrolled in the dialysis registry and received maintenance PD during the period of observation. Results. Of the total 1729 episodes of peritonitis in these patients occurring over 1732 patient-years of follow-up, FP accounted for 51 (2.9%) of the episodes. The patients on PD who developed FP were similar to those who did not develop FP with regard to race, gender, dialysis modality, and dialysis access characteristics. The overall peritonitis rate in patients who developed FP was 2.2 episodes per patient-year compared with 0.96 episodes per patient-year in the patients who did not develop this infection (P < 0.0001). In 25 (49%) cases, the FP was the patient's initial episode of peritonitis. Whereas recent antibiotic usage was present in 23 (56%) of 41 patients with FP, there was no statistically significant relationship (P = 0.26) noted between the presence of a gastrostomy and the development of FP. Candida species caused 33 of 42 (78.6%) FP episodes. Therapy consisted of PD catheter removal and Amphotericin B in the majority of patients. Six months after diagnosis, 27 patients remained on PD, twelve patients were receiving hemodialysis, and only three patients had died, in each case for reasons unrelated to their FP episode. Conclusion. FP is an infrequent cause of peritonitis in children receiving chronic PD. The presence of a gastrostomy does... [ABSTRACT FROM AUTHOR]

Examines the role of executive functions and self-regulation on performance of students with language-learning disorders in the United States. Importance of metacognition for child's academic performance; Role of language in executive function and self-regulatory process; Relationship between executive function, self-regulation and language.

Examines the demographic analysis of the population growth in the U.S. Differences in historical growth trends; Result of population momentum; Variation net migration.

Studies the frequency of pleural thickening shown by computed tomography in Georgia-based workers with mild kaolin pneumoconiosis or simply known as parenchymal changes. Brief clinical description of the disease; Data used in the research; Conclusions.

The article discusses the study which seeks to determine the use of a path analysis model in determining the complex relationships of all factors concerning science activities with the application of new science curricula in the U.S. In order to hypothesize a model, a study was conducted with the participation of randomly selected secondary schools. The study implied that inservice science education programs should be made available to secondary school teachers and principals to promote their awareness about new curricula, as well as consultation services for them to get acquainted with the use of new curricula.

Discusses the educational experiences of Muslim girls and women in the U.S. Information on the marginalization of Muslim girls; Implications of the diversity of the Muslim religion and culture; Roles of teachers in improving the quality and experiences of Muslim girls in education.