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A novel coronavirus, severe acute respiratory syndrome coronavirus-2, was isolated from patients' lower respiratory tracts in December 2019. As of May 19, 2021, there were over 33 million reported infections and almost 600,000 deaths in the United States. The infection, coronavirus disease-19 (COVID-19), can lead to cytokine storm, with elevations in interleukin-6 (IL-6), IL-10, tumor necrosis factor-α, nuclear factor-kappaB (NF-kappaB), and glutathione reductase. NF-kappaB activation is necessary for further transcription of other pro-inflammatory markers. Glutathione may play a role in modulation of NF-kappaB activation and elevated glutathione reductase may indicate glutathione depletion. Administration of N-acetylcysteine (NAC) may replenish spent glutathione and attenuate over-activation of NF-kappaB. This retrospective case series included 10 patients who were COVID-19 positive and received intravenous NAC in an attempt to attenuate the cytokine storm. Patients' outcomes were graded based on the World Health Organization symptom severity scale from 0, no evidence of infection, to 8, death. Overall, the median WHO Scale prior to NAC was 6.5, and increased by day seven, which indicated clinical worsening. This retrospective case series showed no benefit of NAC; however, further studies are needed to elucidate if differences in drug regimens would lead to positive results. [ABSTRACT FROM AUTHOR]

The purposes of this study were to identify the tourist image of a US state with limited comparative advantages and to suggest using the knowledge of the existing image to develop its competitive advantages. Telephone interviews were conducted with 417 individuals in 12 US states. Both the structured and unstructured queries showed that the state had a fuzzy image among respondents. Visitors and non-visitors held different images. Residents of nearby and far away states also had different perceptions. Practical applications of the findings in developing competitive advantages were suggested. [Copyright &y& Elsevier]

Objectives. This study reports population estimates of Pap smear testing among Korean-American women and evaluates correlates of testing. Methods. Korean Americans in 2 California counties were surveyed by telephone. Frequencies were age-adjusted to the 1990 census to produce population estimates of testing. Logistic regression models were used to evaluate independent correlates of testing. Results. Only 50% of the Korean-American women surveyed had a Pap test in the previous 2 years. The strongest independent correlate was having had a regular check-up in the previous 2 years (odds ratio 7.2, 95% confidence interval 4.2, 12.1). Conclusions. Rates of Pap testing among Korean-American women are well below national objectives. Collaboration and community-sensitive research are essential to collect data and design programs to improve the health of ethnic minority communities. [ABSTRACT FROM AUTHOR]

Along with the trend of a steady utilization decline in the U.S. nursing home beds, post-acute care (PAC) utilization at the skilled nursing facilities has declined. This study was a cross-sectional, retrospective review of hospital discharge-based claim data. We evaluate the factors associated with utilizing post-acute care at rehabilitation facilities among those with extremity fractures in the state of Nevada. All Nevada hospital discharges of aged ≥65 years with extremity fractures between 2018 and 2021 were divided to post-acute care locations by (1) rehabilitation facilities (skilled nursing facility and inpatient rehabilitation facility) and (2) homes (with and without services). PAC utilization at facilities declined from 55.1% in 2018 to 49.7% in 2021 ( P  < .001). In response, PAC utilization at homes continuously upwards, particularly, homes with services from 18.8% in 2018 to 24.5% in 2021 ( P  < .001). Older age, female, lower extremity fractures, comorbidities, and Medicare beneficiaries were associated with higher probabilities of utilizing post-acute rehabilitation facilities. Racial minorities, COVID-19 pandemic, upper extremities, Medicaid beneficiaries, rural hospitals, and prolonged hospital length of stay were associated with lower probabilities of PAC utilization at facilities. Caregiver burdens and workforce training is urgently warranted to respond to this utilization shift. Effective geriatrics workforce training might advance care efficiency of older adults with extremity fractures and guide to the insights of establishing the age-friendly state of Nevada in response to this utilization shift trends., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Capitated Medicaid mental health programs have reduced costs over the short term by lowering the utilization of high-cost inpatient services. This study examined the five-year effects of capitated financing in community mental health centers (CMHCs) by comparing not-for-profit with for-profit programs., Methods: Data were from the Medicaid billing system in Colorado for the precapitation year (1994) and a shadow billing system for the postcapitation years (1995-1999). In a panel design, a random-effect approach estimated the impact of two financing systems on service utilization and cost while adjusting for all the covariates., Results: Consistent with predictions, in both the for-profit and the not-for-profit CMHCs, relative to the precapitation year, there were significant reductions in each postcapitation year in high-cost treatments (inpatient treatment) for all but one comparison (not-for-profit CMHCs in 1999). Also consistent with predictions, the for-profit programs realized significant reductions in cost per user for both outpatient services and total services. In the not-for-profit programs, there were no significant changes in cost per user for total services; a significant reduction in cost per user for outpatient services was found only in the first two years, 1995 and 1996)., Conclusions: The evidence suggests that different strategies were used by the not-for-profit and for-profit programs to control expenditures and utilization and that the for-profit programs were more successful in reducing cost per user.