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A study was performed to evaluate radioactive concentrations in three categories of fertilizers, phosphate (0-46-0); potash (0-0-60); and NPK (13-13-13) using gamma spectroscopic techniques. The experimental analyses indicated mean concentrations of 697 ± 15, 8.9 ± 1.0 and 47 ± 12 Bq kg of Ra, Th, and K, respectively, in phosphate fertilizers. Potash fertilizers had the average levels of 1.1 ± 0.10, 0.40 ± 0.05, and 15,162 ± 1017 Bq kg of Ra, Th, and K, respectively. The NPK fertilizers contained 7.45 ± 2.76, 2.63 ± 0.29, 3581 ± 601 Bq kg of Ra, Th, and K, respectively. Based on the measured activities, the radiological health hazard parameters are assessed and compared with the U.S. acceptable dose limits. [ABSTRACT FROM AUTHOR]

Background: Polycyclic aromatic hydrocarbons (PAHs) can invade and cause harm to the human body through various pathways, but there is currently little research on the relationship between mixed-PAHs exposure and periodontitis. The purpose of this study was to examine the effects of mixed-urinary PAHs exposure on periodontitis in adults in the United States., Methods: The cross-sectional study included 2749 subjects selected from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 cycles. A professional examination of the periodontal status was conducted to distinguish between periodontitis and non-periodontitis based on the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definition. Laboratory testing of urine samples was performed to obtain the levels of urinary PAHs. Pearson correlation coefficients were utilized to determine the degree of correlation between urinary PAHs, while weighted binary logistic regression and Bayesian kernel machine regression (BKMR) were employed to evaluate the relationship between urinary PAHs and periodontitis., Results: In a single-exposure model, 3-hydroxyfluorene (OH-3F), 2-hydroxyfluorene (OH-2F), 1-hydroxyphenanthrene (OH-1Ph), and 2-hydroxyphenanthrene and 3-hydroxyphenanthrene (OH-2,3Ph) were positively associated with periodontitis risk. In the mixed-exposure model, BKMR analysis demonstrated that mixed exposure to urinary PAHs was positively associated with periodontitis, with OH-2F being the most critical factor for the overall mixed effects (posterior inclusion probability [PIP] = 0.98). Univariate exposure-response function and univariate effects analysis revealed a positive correlation between urinary OH-2F levels and periodontitis., Conclusions: The study reveals a significant positive correlation between exposure to mixed PAHs and periodontitis, with a particular emphasis on the pivotal role of OH-2F. Mitigating PAHs in the environment may serve as a preventive measure against periodontitis and alleviate its global public health burden., (© 2023 American Academy of Periodontology.)

Purpose: Cancer survivors have a high risk of mortality, and vitamin D (VD) is associated with the risk of mortality. This study is aim to examine the impact of VD on mortality in cancer survivors., Methods: A prospective study was conducted using data from the National Health and Nutrition Examination Survey. Participants were obtained information on their baseline characteristics, dietary habits, comorbidities, lifestyle, and serum 25-hydroxy VD [25(OH)D] concentrations. The weighted Cox proportional hazard and competing risk regression models were used to estimate the hazard ratio and 95% confidence intervals (HR, 95% CI) of mortality for different serum 25(OH)D concentrations. Restricted cubic spline (RCS) curves were utilized to illustrate the dose-response relationship between serum 25(OH)D concentrations and mortality., Results: The study encompassed 2,495 participants with cancer diagnoses. Multivariate models indicated that, compared to serum 25(OH)D concentrations below 58.5 nmol/L, concentrations exceeding 81.6 nmol/L were associated with reduced HRs for all-cause mortality (HR = 0.70; 95% CI: 0.56-0.87), cardiovascular mortality (HR = 0.53; 95% CI: 0.32-0.86), and cancer-specific mortality (HR = 0.66; 95% CI: 0.45-0.99). RCS curves revealed "L-shaped" associations between serum 25(OH)D concentration and both all-cause and cancer-specific mortality, with threshold effects at 87.9 nmol/L and 84.6 nmol/L, respectively. Conversely, the relationship between serum 25(OH)D concentration and cardiovascular mortality exhibited a more linear pattern, with a threshold at 88.7 nmol/L. Subgroup analyses highlighted a gender-specific interaction that elevated serum 25(OH)D concentrations were significantly more protective against mortality in males than in females, especially regarding cancer-specific mortality (P-interaction = 0.009)., Conclusion: Elevated serum 25(OH)D concentrations were correlated with decreased risks of all-cause, cardiovascular, and cancer-specific mortality in cancer survivors, with benefit thresholds at 87.9, 88.7, and 84.6 nmol/L, respectively. These findings suggested that cancer survivors might benefit from higher vitamin D recommendations than the general population., (© 2024. The Author(s).)

Predictive analytics are used in primary care to efficiently direct health care resources to high-risk patients to prevent unnecessary health care utilization and improve health. Social determinants of health (SDOH) are important features in these models, but they are poorly measured in administrative claims data. Area-level SDOH can be proxies for unavailable individual-level indicators, but the extent to which the granularity of risk factors impacts predictive models is unclear. We examined whether increasing the granularity of area-based SDOH features from ZIP code tabulation area (ZCTA) to Census Tract strengthened an existing clinical prediction model for avoidable hospitalizations (AH events) in Maryland Medicare fee-for-service beneficiaries. We created a person-month dataset for 465,749 beneficiaries (59.4% female; 69.8% White; 22.7% Black) with 144 features indexing medical history and demographics using Medicare claims (September 2018 through July 2021). Claims data were linked with 37 SDOH features associated with AH events from 11 publicly-available sources (e.g., American Community Survey) based on the beneficiaries' ZCTA and Census Tract of residence. Individual AH risk was estimated using six discrete time survival models with different combinations of demographic, condition/utilization, and SDOH features. Each model used stepwise variable selection to retain only meaningful predictors. We compared model fit, predictive performance, and interpretation across models. Results showed that increasing the granularity of area-based risk factors did not dramatically improve model fit or predictive performance. However, it did affect model interpretation by altering which SDOH features were retained during variable selection. Further, the inclusion of SDOH at either granularity level meaningfully reduced the risk that was attributed to demographic predictors (e.g., race, dual-eligibility for Medicaid). Differences in interpretation are critical given that this model is used by primary care staff to inform the allocation of care management resources, including those available to address drivers of health beyond the bounds of traditional health care., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The application of resilience thinking to tourism destination research is a new perspective on sustainable tourism and has gradually become a popular research topic. Some literature has been conducted on tourism destination resilience, but there has not been a comprehensive review and analysis of the whole field. This study was based on the literature from 2000 to 2021 in the Web of Science core collection database. The collaboration analysis, literature co-citation analysis, keyword co-occurrence, burst detection analysis in CiteSpace, and qualitative analysis were adopted to conduct a holistic tourism destination resilience research review. The results indicated that the United States, Australia, China, and the United Kingdom were the primary countries involved in tourism destination resilience research. Five hot research themes were obtained. (1) concept and connotation of tourism destination resilience, (2) drivers of tourism destination resilience, (3) sustainable management framework and practices, (4) perception of tourism destination resilience, and (5) the resilience of the tourism community. Furthermore, four research gaps and future directions were proposed in this study, including the theoretical framework of tourism destination resilience, assessment of tourism destination resilience, sustainable management and resilience, and application of advanced technology in tourism destination resilience. This study assists researchers in understanding the development and future research directions in tourism destination resilience research.

Approved performance quality tests are lacking in the United States Pharmacopeia (USP) for dietary supplements (DSs) containing green tea extracts. We evaluated the applicability of USP <2040 > general chapter protocols for disintegration and dissolution testing of botanicals to GT DSs. Of 28 single-ingredient GT DSs tested in 2 to 4 lots, 9 (32.1%) always passed the disintegration test, 8 (28.6%) always failed, and 11 (39.3%) showed inconsistent results. Of 34 multi-ingredient DSs tested in 2 lots, 21 (61.8%) passed and 8 (23.5%) failed in both lots, and 5 (14.7%) exhibited inconsistent performance. When stronger destructive forces were applied (disk added), all of the capsules that had failed initially, but not the tablets, passed. In dissolution testing, for the release of epigallocatechin-3-gallate (EGCG), only 6 of 20 single-ingredient DSs passed. Unexpectedly, with the addition of pepsin (prescribed by USP), only one additional DS passed. These results raise concerns that EGCG was not released properly from GT DS dosage forms. However, the general USP protocols may be inadequate for this botanical. More biorelevant destructive forces may be needed to break down capsules and tablets strengthened by the EGCG's interaction with shell material and to overcome the inhibition of digestive enzymes by EGCG., (Copyright © 2020 American Pharmacists Association®. All rights reserved.)

Background: The purpose of this study was to analyze the patterns of metastasis and therapeutic approaches in American Joint Committee on Cancer (AJCC) stage IVc nasopharyngeal carcinoma (NPC)., Methods: A retrospective analysis of 263 patients with stage IVc NPC revealed the incidence of bone, liver, and lung metastases was 67.7%, 32.3%, and 16.0%, respectively. All patients received chemotherapy; 160 patients received radiotherapy (RT) to the primary tumor., Results: The factors associated with poor overall survival (OS) were Karnofsky Performance Scale (KPS) ≤70, liver metastasis, multiple-organ metastasis, ≥6 lesions, no RT to the primary tumor, and <4 chemotherapy cycles. Two subgroups of M1 disease were divided into: M1a (oligometastases) = single-organ metastases or 1 to 5 lesions; and M1b = multiple-organ metastases or ≥6 lesions. The 5-year OS rates for M1a and M1b were 38.7% versus 7.0%, respectively., Conclusion: Patients with oligometastases have significantly better OS than patients with widespread metastases. Long-term disease-free survival can be achieved in selected patients with oligometastases after systemic chemotherapy and definitive RT. © 2016 Wiley Periodicals, Inc. Head Neck 38:1152-1157, 2016., (© 2016 Wiley Periodicals, Inc.)

Background: Watchman and Lariat left atrial appendage (LAA) occlusion devices are associated with LAA leaks postdeployment., Objective: The purpose of this study was to compare the incidence, characteristics, and clinical significance of these leaks., Methods: We performed a multicenter prospective observational study of all patients who underwent LAA closure. Baseline, procedural, and imaging variables along with LAA occlusion rates at 30-90 days and 1-year postprocedure were compared., Results: A total of 478 patients (219 with the Watchman device and 259 with the Lariat device) with successful implants were included. Patients in the Lariat group had a higher CHADS2 (congestive heart failure, hypertension, age >74 years, diabetes, stroke) score and a larger left atrium and LAA. A total of 79 patients (17%) had a detectable leak at 1 year. More patients in the Watchman group had a leak compared with those in the Lariat group (46 [21%] vs 33 [14%]; P = .019). All the leaks were eccentric (edge effect) in the Watchman group and concentric (gunny sack effect) in the Lariat group. The size of the leak was larger in the Watchman group than in the Lariat group (3.10 ± 1.5 mm vs 2.15 ± 1.3 mm; P = .001). The Watchman group had 1 device embolization requiring surgery and 2 pericardial effusions requiring pericardiocentesis. In the Lariat group, 4 patients had cardiac tamponade requiring urgent surgical repair. Three patients in each group had a cerebrovascular accident and were not associated with device leaks., Conclusion: The Lariat device is associated with a lower rate of leaks at 1 year as compared with the Watchman device, with no difference in rates of cerebrovascular accident. There was no correlation between the presence of residual leak and the occurrence of cerebrovascular accident., (Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: Sleepiness may account for up to 20% of crashes on monotonous roads, especially highways. Obstructive sleep apnea (OSA) is the most common medical disorder that causes excessive daytime sleepiness, increasing the risk for drowsy driving two to three times. The purpose of these guidelines is to update the 1994 American Thoracic Society Statement that described the relationships among sleepiness, sleep apnea, and driving risk., Methods: A multidisciplinary panel was convened to develop evidence-based clinical practice guidelines for the management of sleepy driving due to OSA. Pragmatic systematic reviews were performed, and the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to formulate and grade the recommendations. Critical outcomes included crash-related mortality and real crashes, whereas important outcomes included near-miss crashes and driving performance., Results: A strong recommendation was made for treatment of confirmed OSA with continuous positive airway pressure to reduce driving risk, rather than no treatment, which was supported by moderate-quality evidence. Weak recommendations were made for expeditious diagnostic evaluation and initiation of treatment and against the use of stimulant medications or empiric continuous positive airway pressure to reduce driving risk. The weak recommendations were supported by very low-quality evidence. Additional suggestions included routinely determining the driving risk, inquiring about additional causes of sleepiness, educating patients about the risks of excessive sleepiness, and encouraging clinicians to become familiar with relevant laws., Discussion: The recommendations presented in this guideline are based on the current evidence, and will require an update as new evidence and/or technologies becomes available.

Aims: Vibrio vulnificus is a major cause of seafood-related deaths in the United States. Several biomarkers, e.g. the virulence-correlated gene (vcg), 16S rRNA, and the capsular polysaccharide operon (CPS) have been used to differentiate virulent- from nonvirulent-type V. vulnificus strains. In this study, we combined the use of these biomarkers with a species-specific V. vulnificus cytolysin/haemolysin gene (vvhA) to develop two pairs of multiplex PCR assays that simultaneously detect and characterize V. vulnificus strains., Methods and Results: The first multiplex PCR pair amplified four genes (vvhA, vcg, 16S rRNA, and CPS), with one for virulent-type and the other one for nonvirulent-type V. vulnificus strains, while the second pair targeted three of those genes excluding CPS. Primer concentration and annealing temperature were optimized for the four multiplex PCR assays. When testing ten V. vulnificus reference strains and 80 field oyster isolates, results from each multiplex PCR matched 100% with known strain characteristics for these target genes., Conclusions: The optimized multiplex PCR assays were capable of simultaneously detecting and characterizing V. vulnificus with high specificity and speed., Significance and Impact of the Study: Multiplex PCR assays designed in this study are valuable tools for microbial ecology and epidemiology studies. They may facilitate better control of V. vulnificus risks in oysters, thereby reducing the number of illnesses and deaths because of V. vulnificus in the long run.