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Seldom have comparative studies of educational assessment systems been undertaken, especially regarding their standard setting procedures. This study examines the effects of governance structures on the power relations in standard setting in the dominant school-leaving or university-entrance examinations. We present acritical analysis of the published research and policy documents, including sense-checking with senior assessment practitioners from 22 jurisdictions. The nature of standard setting systems in three cases of Ireland, the USA and India are described in detail to showcase the differences between the following three models of governance systems: nationalised, commercial market and quasi-market. The contribution of this article, then, is to describe the three models of governance systems, to classify the 22 jurisdictions using the three models, and to generate propositions inductively. Thus, the article provides aconceptual basis for extension of this work to other cases to advance the literature cumulatively by theory-building.

In recent years, the ubiquitous occurrence of plastic debris has become a significant environmental concern, posing considerable harm to our ecosystems. Microplastics (MPs) (1 μm–5 mm) and nanoplastics (NPs) (<1 μm) are noticeable in diverse forms, spreading throughout the environment. Notably, wastewater treatment plants (WWTPs) emerge as major contributors to the generation of MP and NP. Within these treatment plants, water influx from domestic and commercial sources carries a considerable load of MPs derived from items like fiber clothing, personal care products, and toothpaste. Lacking dedicated removal mechanisms, these MPs persist through the wastewater treatment process, ultimately entering natural water bodies and the soil environment. The novelty of this review lies in its detailed examination of contemporary methodologies for sampling, detecting, and eliminating MPs specifically from WWTPs. By critically assessing the efficacy of current removal techniques at various treatment stages, the review offers targeted insights into practical aspects of MP management in these facilities. As the study of micro/nano plastics is still in its early stages, this article aims to contribute by offering a comprehensive review of the methods utilized for plastic debris removal in both WWTPs and drinking water treatment plants (DWTPs). Furthermore, the article provides a comprehensive overview of the existing rules, regulations, and policies concerning MPs in the United States. This inclusion not only broadens the scope of the review but also establishes it as a valuable reference for understanding the regulatory framework related to MPs. This review uniquely combines a focused evaluation of WWTPs/DWTPs, an exploration of removal methods, and an examination of regulatory framework, making a different contribution to the review article. Through this review, we aim to enhance understanding and awareness of the multi-layered challenges posed by MPs, offering insights that can inform future research directions and policy initiatives. [ABSTRACT FROM AUTHOR]

Although current guidelines recommend that nearly all patients with chronic hepatitis C virus (HCV) infection receive treatment, a substantial proportion remain untreated. We conducted an administrative claims analysis to provide real‐world data on treatment patterns and characteristics of treated versus untreated patients among individuals with HCV in the United States. Adults with an HCV diagnosis from 01 July 2016 through 30 September 2020 and continuous health plan enrolment for 12 months before and ≥1 month after the diagnosis date were identified in the Optum Research Database. Descriptive and multivariable analyses were conducted to evaluate the association between patient characteristics and the rate of treatment. Of 24,374 patients identified with HCV, only 30% initiated treatment during follow‐up. Factors associated with increased rate of treatment included younger age versus age 75+ (hazard ratio [HR] 1.50–1.83 depending on age group), commercial versus Medicare insurance (HR 1.32), and diagnosis by a specialist versus a primary care physician (HR 2.56 and 2.62 for gastroenterology and infectious disease or hepatology, respectively) (p <.01 for all). Several baseline comorbidities were associated with decreased rate of treatment, including psychiatric disorders (HR 0.87), drug use disorders (HR 0.85) and cirrhosis (HR 0.42) (p <.01 for all). These findings highlight existing HCV treatment inequities, particularly among older patients and those with psychiatric disorders, substance use disorders or chronic comorbidities. Targeted efforts to increase treatment uptake in these populations could mitigate a considerable future burden of HCV‐related morbidity, mortality and healthcare costs. [ABSTRACT FROM AUTHOR]

Nowadays, data science is emerging as an integral concept of nearly every discipline. Thus, the library and information science professionals have also become interested in data science and as a result have started to contribute the scholarly literature on this topic of significance. This article discussed a study dedicated towards mapping the published literature on data science and library and information science through EBSCO library and information science source till December 2021. The results of this study show that the majority of the literature was produced in the year 2020, single authors, sole universities, United States of America (USA) country, in the Journal of Medical Internet Research and Proceedings of the Association for Information Science & Technology journals and on theme of 'data science concept'. [ABSTRACT FROM AUTHOR]

Transplant centers and physicians in the United States have limited guidance on the information which they can and cannot provide to transplant candidates regarding donors of potential organs. Patients may refuse organs for a variety of reasons ranging from pernicious requests including racism to misinformation about emerging medicine as with the COVID-19 vaccine and infection. Patient autonomy, organ stewardship, and equity are often at odds in these cases, but precedent indeed exists to help address these challenges. This work uses such cases to highlight the urgent need for uniform, national policy prohibiting informational requests unrelated to well-established risks. [ABSTRACT FROM AUTHOR]

In the United States, there are laws and standards guiding how people should be informed about the use of their private data. However, the challenge of communicating these guidelines to the naïve user is still at its peak. Research has shown that the willingness to read privacy statements is influenced by attitudes toward privacy risks and privacy benefits. Many websites publish privacy policies somewhere on their web pages, and it can be difficult to navigate to them. In the healthcare field, research has found that health information websites' key information is presented poorly and inconsistently. For the policies to be legally binding, a person must be able to find them. In the healthcare industry, where sensitive data are being collected, research on how a user navigates to privacy policies for different size hospital websites is limited. Studies exist about privacy policies or website design and not both. This descriptive study involved ascertaining commonalities and differences among different-sized hospitals' website designs for supporting privacy policies. A foundation framework was created using Web Content Accessibility Guidelines (WGAC) principles and the literature review findings for evaluating practices for website publishing of privacy policies. The results demonstrated a very low variance in the website design concepts employed by hospitals to publish their privacy policy. [ABSTRACT FROM AUTHOR]

Increasing market demand for sustainable, environmentally friendly edible film materials has called for the development of new customizable production methods utilizing emerging technologies such as 3D printing. We hereby report a new method to generate functional edible soy protein isolate films prepared from three types of soybeans (AR‐R11‐7999, MO‐S17‐17168, and MO‐S17‐19874R) using an innovative 3D printing technology. The protein contents in AR‐R11‐7999, MO‐S17‐17168, and MO‐S17‐19874R soybean meals and their corresponding protein isolates were 40.0, 39.1, and 39.9; and 84.5, 84.7, and 87.3 % (w/w, dry basis), respectively. Response surface methodology was used to maximize the tensile and puncture strength and minimize the thickness of the 3D‐printed edible films using protein concentration, plasticizer concentration (glycerol), and drying time as the independent variables. The optimized film production conditions were determined as soy protein concentration: 8.91%, plasticizer concentration: 3.00%, and drying time: 3.98 h with a desirability value of 0.7428. The optimized conditions were then successfully verified with the original soybean lot with a nonsignificant difference in physical properties. At the optimized conditions, the 3D‐printed edible films using three soybean lots revealed: 0.108–0.114 mm thickness; 14.79–16.07 MPa tensile strength; 6.97–8.20 N puncture strength; 90.81–91.53, −1.89 to −1.31, and 14.85–17.25 were color parameters L*, a*, and b*, respectively; 1.22–1.36 g/cm3 density; and 104.4–105.7% elongation at break ratio (%). Practical Application: Edible soy protein films produced by an extrusion‐based 3D printing approach are highly customizable and precise, and could be produced at an industrial scale. This newly produced environment‐friendly soy protein‐based edible film can serve as an alternate packaging to synthetic plastics and reduce the environmental landfill problem while adding value to soybean produced in the mid‐south United States. [ABSTRACT FROM AUTHOR]

We report our experience of COVID-19 disease with hypoxemic respiratory failure among patients aged 12-21 years admitted to the intensive care unit at two tertiary care institutions in Northeastern and Midwestern United States. Our results showed that during the main study period that spanned the initial surge at both geographic locations, adolescents with SARS-COV-2 infection admitted to the ICU with respiratory failure were more likely to be male, black, and morbidly obese and with two or more comorbidities. The majority (79%) were admitted with COVID-19-related pneumonia and 15 developed respiratory failure; two-thirds of patients with respiratory failure (9/15, 60%) required mechanical ventilation (MV). More than two-thirds of patients (11/15, 75%) with respiratory failure were obese with BMI > 30 compared to those without respiratory failure (p < 0.0001), and those with BMI > 40 were 4.3 times more likely to develop respiratory failure than those with normal BMI; 40% of patients with respiratory failure had two or more pre-existing medical comorbidities. Inflammatory markers were 2-20 times higher in patients with respiratory failure (p < 0.05). The majority of patients on MV (7/9) developed complications, including ARDS (acute respiratory distress syndrome), acute renal injury, and cerebral anoxic encephalopathy. Patients with respiratory failure had a significantly longer length of hospital stay than patients without respiratory failure (p < 0.05). The majority of the admitted adolescents in the ICU received steroid treatment. None of the patients died. An additional review of a 6-month postvaccination approval period indicated that the majority of ICU admissions were unvaccinated, obese, black patients and all patients who developed respiratory failure were unvaccinated. Our study highlights and supports the need for maximizing opportunities to address vaccination and healthcare gaps in adolescents as well as promoting public health measures including correct use of masks, effective vaccination campaigns for this age group, and additional passive preventive interventions for COVID-19 disease in adolescents especially with comorbid conditions, and in minority populations. [ABSTRACT FROM AUTHOR]

Prostate cancer (PCa) is the second most diagnosed cancer in the United States and is associated with metabolic reprogramming and significant disparities in clinical outcomes among African American (AA) men. While the cause is likely multi-factorial, the precise reasons for this are unknown. Here, we identified a higher expression of the metabolic enzyme UGT2B28 in localized PCa and metastatic disease compared to benign adjacent tissue, in AA PCa compared to benign adjacent tissue, and in AA PCa compared to European American (EA) PCa. UGT2B28 was found to be regulated by both full-length androgen receptor (AR) and its splice variant, AR-v7. Genetic knockdown of UGT2B28 across multiple PCa cell lines (LNCaP, LAPC-4, and VCaP), both in androgen-replete and androgen-depleted states resulted in impaired 3D organoid formation and a significant delay in tumor take and growth rate of xenograft tumors, all of which were rescued by re-expression of UGT2B28. Taken together, our findings demonstrate a key role for the UGT2B28 gene in promoting prostate tumor growth. [ABSTRACT FROM AUTHOR]

Amongst different mediums of information dissemination sources, a website is generally treated as the most important medium to impart and fetch the diverse types of information, resources, updates, and services. Therefore, today libraries are keen to develop their own library websites with diverse contents to provide latest information, updates, services, and resources to their targeted audiences. The study discussed in this article analyses the contents of the top 50 engineering and technology universities library websites, based on Quacquarelli Symonds World University Ranking 2021, using a checklist. The results of the study discovered that none of the considered libraries, situated in United States, scored 100%. The results also revealed that general information, services, resources, navigation and search tools, copyright information, design, social networking site, and so on were present on the majority of library websites. However, some important indicators such as job opportunities, Boolean search, person with disabilities service, mobile apps, e-newsletter, website update date, and Web 2.0 Tools were available on limited library websites. This study may be helpful in upgrading not only the library websites of engineering and technology universities but also websites of institutional libraries. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has exacerbated disparities in access to healthcare and mental health, often forcing healthcare social workers into ethical and moral dilemmas as they endeavor to provide equitable, humanistic care to their patients and caregivers. The purpose of this mixed method study was to explore how COVID-19-related personal and professional grief and losses impacted healthcare social worker's distress and resilience. Participants were recruited through healthcare social work professional organizations from September-November 2020. Participants (N = 246) completed an online survey capturing sociodemographic variables, as well as mental distress, pandemic-related meaning-making, and resilience. Data analysis included correlations and regressions pertaining to meaning-making, emotional distress, and resilience, as well as thematic analysis of participants' open-ended survey responses. Approximately one-third of participants reported emotional distress and difficulty in finding meaning from their pandemic-related losses. Participants reported a lower level of resilience when compared with the United States general population. Three themes emerged from social workers' qualitative responses: the hardest year of my career; the collective loss of our normal; and we were built for this. Pandemic-related grief permeates social workers' daily lives; yet their training and resilience foster hope to positively impact their clients, communities, and families. [ABSTRACT FROM AUTHOR]

This paper develops a satellite account for the US health sector and measures productivity growth in health care for the elderly population between 1999 and 2012. We measure the change in medical spending and health outcomes for a comprehensive set of 80 conditions. Medical care has positive productivity growth over the time period, with aggregate productivity growth of 1.5 percent per year. However, there is significant heterogeneity in productivity growth. Care for cardiovascular disease has had very high productivity growth. In contrast, care for people with musculoskeletal conditions has been costly but has not led to improved outcomes. (JEL E01, H51, I10) [ABSTRACT FROM AUTHOR]

Islamophobia and related incidents of hate-crimes, religious discrimination and profiling are increasingly being researched to have adverse effects on Muslim adults and children alike. Rising episodes of anti-Muslim religious bullying are being reported from schools, classrooms and playgrounds across the globe and, hence, need to be accounted for, recognized and mitigated. This study uses child-participatory research methodology to understand experiences of American Muslim children regarding Islamophobia. It was conducted with 26 children participants (N = 26) studying in Grades 5-8, at an Islamic School in the United States. Drawings and semi-structured focus group discussions were used for data collection. Findings revealed that Islamophobia should be characterized through a unique child-centric lens, to recognize how it affects the lives of Muslim children. Narratives and silences of female participants highlighted how gendered Islamophobia has become so common for young Muslim girls that it has become 'invisible.' It was seen that children's perception of Islamophobia often becomes a projection of parental influences. Participants put forward resilience techniques, which pave ways for social work interventions with Muslim children. The study ends with a school social work model directed towards prevention and reduction of Islamophobia, which educators, schools and social workers can implement. [ABSTRACT FROM AUTHOR]

Chronic pain is highly prevalent in the United States, impacting 28.4% of the adult population, or 69.6 million people, as of 2016. Chronic pain is often associated with anxiety, depression, and restrictions in mobility and daily activities, substantially reducing quality of life. Analgesics, especially opioids, are one of the primary pharmaceutical treatment methods for chronic pain. However, prescription opioid misuse and abuse has become increasingly prevalent and concerning, prompting the need for research into alternative treatment methods which avoid the side effects of traditional treatments. Chronic pain is, in part, thought to be the result of oxidative stress and inflammation, and clinical research has indicated links between these conditions and diet. Thus, dietary interventions are a particularly promising therapeutic treatment for chronic pain, with numerous studies suggesting that diet has a noticeable effect on pain as far down as the cellular level. In this review article, data from a number of clinical trials assessing the effect of three diets—antioxidant-rich, low-carbohydrate, and Mediterranean—on oxidative stress and inflammation is compiled and discussed in the context of chronic pain. Clinical data suggests that low-carbohydrate diets and Mediterranean diets both are especially promising dietary interventions. [ABSTRACT FROM AUTHOR]

Deflazacort (Emflaza) was approved in the United States in 2017 for the treatment of the Duchenne muscular dystrophy in patients aged 2 years and older. Several deflazacort metabolites were isolated and identified from rats, dogs, monkeys, and humans. Among them, 1β,2β-epoxy-3β-hydroxy-21-desacetyl deflazacort, referred to as Metabolite V, was reported to be one of the major circulating metabolites in humans. However, its quantitative distribution in plasma was not fully characterized. The objective of this study was to determine deflazacort plasma pharmacokinetics, metabolite profiles and their quantitative exposures in humans following a single oral dose. Six healthy male subjects were each administered a single oral dose of 60 mg [14C]-deflazacort. Plasma and urine were collected and deflazacort metabolites in plasma were quantified by high performance liquid chromatography radio-profiling followed by liquid chromatography-mass spectrometry characterization. Metabolite V was isolated from urine and its structure was further confirmed by nuclear magnetic resonance analysis. These analyses demonstrated that deflazacort was not detectable in plasma; of the eight circulating deflazacort metabolites identified or characterized, the pharmacologically active metabolite 21-desacetyl deflazacort and inactive metabolite 6β-hydroxy-21-desacetyl deflazacort accounted for 25.0% and 32.9% of the 0-24 hours plasma total radioactivity, respectively, while Metabolite V, an epoxide species, was a minor circulating metabolite, representing only about 4.7% of the total plasma radioactivity. [ABSTRACT FROM AUTHOR]

Background  Patients undergoing head and neck (H&N) microvascular reconstruction comprise a population at high risk for venous thromboembolism (VTE). Free flap and VTE thromboprophylaxis may coincide but tend to vary from surgeon to surgeon. This study identifies VTE prophylaxis patterns and perceptions among H&N microsurgeons in the United States. Methods  An online survey on VTE prophylaxis practice patterns and perceptions was emailed to 172 H&N microsurgeons in the United States using an anonymous link. Results  There were 74 respondents (43% response rate). These surgeons completed residencies in otolaryngology (59%), plastic surgery (31%), and oral maxillofacial surgery (7%). Most underwent fellowship training (95%) and have practiced at an academic center (97%) for at least 6 years (58%), performing an average of 42 ± 31 H&N free flap cases per year (range = 1–190). Most adhered to general VTE prophylaxis guidelines (69%) while 11% did not and 20% were unsure. Nearly all surgeons (99%) would provide prophylactic anticoagulation, mostly in the form of subcutaneous heparin (51%) or enoxaparin (44%); 64% additionally used aspirin, while 4% used aspirin alone. The majority of surgeons (68%) reported having postoperative VTE complications, with six surgeons (8%) reporting patient deaths due to pulmonary embolism. A third of the surgeons have encountered VTE prophylaxis-related adverse bleeding events, but most still believe that chemoprophylaxis is important for VTE prevention (92%). While 35% of surgeons were satisfied with their current practice, most would find it helpful to have official prophylactic anticoagulation guidelines specific to H&N free flap cases. Conclusion  The majority of microsurgeons experienced postoperative VTE complications after H&N free flap reconstruction despite the routine use of prophylactic anticoagulation. Though bleeding events are a concern, most surgeons believe chemoprophylaxis is important for VTE prevention and would welcome official guidelines specific to this high-risk population. [ABSTRACT FROM AUTHOR]

The contribution of this research lies in the use of real-world data to test several hypotheses about the role of two signals--sequels and advertising expenditures--in the motion picture industry. The authors analyze the data with a dynamic simultaneous-equations model of the drivers and the interrelationships of the behaviors of movie audiences, studios, and exhibitors. Specifically, the authors test for the attenuating role of third-party information sources, such as critics' review consensus and cumulative word of mouth, on the strength of the two aforementioned signals. The authors find evidence of such an effect both at the release phase across movies and over the postrelease phase for any movie. Notably, they hypothesize and show that sequels and advertising expenditures have a positive interaction effect on box office revenues. This is an important finding because though most firms use multiple signals for their products, empirical work on the interaction of two or more signals is rare. This study offers several new and interesting empirical insights into the market dynamics of the motion picture industry. [ABSTRACT FROM AUTHOR]

The emerging changes in healthcare significantly impact structure of surgical training. To achieve parity in surgical training globally significant work needs to be done in developing nations. The aims of this study are to identify and evaluate the current surgical training system in India and also examine the surgical training system of residents from India and compare the results against the US training system, to suggest changes for parity. On-site observations and cross-sectional survey of residents and staff from 22 institutions in India were done. Results were compared with the current US training system. Difference in pattern of surgical training and lack of coordination in curriculum was noted. Contradictory responses were noted for didactic teaching. No guidelines were mentioned for minimum number of surgical case required or certification courses. No work hour restrictions were followed, and supervision was ill defined. Residents were highly interested for fellowships and experience from the US medical system. Results revealed discordance in surgical training within the evaluated country. However, the two training systems studied have their own pros and cons. We strongly feel that incorporation of certain aspects of the American residency can aid in progression of the Indian training system. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to evaluate demographic/clinical characteristics and treatment/transportation decisions by emergency medical services (EMS) for patients with hypoglycemia and link EMS activations to patient disposition, outcomes, and costs to the emergency medical system. This evaluation was to identify potential areas where improvements in prehospital healthcare could be made. Methods: This was a retrospective analysis of the National Emergency Medical Services Information System (NEMSIS) registry and three national surveys: Nationwide Emergency Department Sample (NEDS), National Hospital Ambulatory Medical Care Survey (NHAMCS), and Medical Expenditure Panel Survey (MEPS) from 2013, to examine care of hypoglycemia from the prehospital and the emergency department (ED) perspectives. Results: The study estimated 270,945 hypoglycemia EMS incidents from the NEMSIS registry. Treatments were consistent with national guidelines (i.e., oral glucose, intravenous [IV] dextrose, or glucagon), and patients were more likely to be transported to the ED if the incident was in a rural setting or they had other chief concerns related to the pulmonary or cardiovascular system. Use of IV dextrose decreased the likelihood of transportation. Approximately 43% of patients were not transported from the scene. Data from the NEDS survey estimated 258,831 ED admissions for hypoglycemia, and 41% arrived by ambulance. The median ambulance expenditure was $664 ± 98. From the ED, 74% were released. The average ED charge that did not lead to hospital admission was $3106 ± 86. Increased odds of overnight admission included infection and acute renal failure. Conclusions: EMS activations for hypoglycemia are sizeable and yet a considerable proportion of patients are not transported to or are discharged from the ED. Seemingly, these events resolved and were not medically complex. It is possible that implementation and appropriate use of EMS treat-and-release protocols along with utilizing programs to educate patients on hypoglycemia risk factors and emergency preparedness could partially reduce the burden of hypoglycemia to the healthcare system. [ABSTRACT FROM AUTHOR]

We examined trends in per capita spending for Medicare beneficiaries ages sixty-five and older in the United States in the period 1999-2012 to determine why spending growth has been declining since around 2005. Decomposing spending by condition, we found that half of the spending slowdown was attributable to slower growth in spending for cardiovascular diseases. Spending growth also slowed for dementia, renal and genitourinary diseases, and aftercare for people with acute illnesses. Using estimates from the medical literature of the impact of pharmaceuticals on acute disease, we found that roughly half of the reduction in major cardiovascular events was attributable to medications controlling cardiovascular risk factors. Despite this substantial cost-saving improvement in cardiovascular health, additional opportunities remain to lower spending through disease prevention and control. [ABSTRACT FROM AUTHOR]

We develop a class of discrete, path-independent models to compute prices of American options within the Black-Scholes (1973) framework, including models in which state variables have time-varying volatility functions and models with multiple state variables. Time-varying volatility functions are illustrated with applications to term structure models developed by Vasicek (1977) and Heath, Jarrow, and Morton (1988), (1990). Distinct from previous work in the literature, the multivariate models suggested in this paper are consistent with arbitrarily large, though constant, covariance functions. Finally, we compare and contrast the numerical accuracy of a large number of models with simulation results. [ABSTRACT FROM AUTHOR]

Enteritis as the only manifestation of novel coronavirus disease 2019 (COVID-19) in adolescents without features of multisystem inflammatory syndrome in children (MIS-C) or a prior history of inflammatory bowel disease (IBD) has not been described. We report two adolescent patients (a 14-year-old male and a 20-year-old pregnant female) presenting to tertiary-care centers in the United States with severe enteritis as the only manifestation of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patients were hospitalized with acute abdominal pain and gastrointestinal (GI) bleeding, with no evidence of MIS-C, and were previously healthy with no history of IBD. The patients' nasopharyngeal swabs were positive for SARS-CoV-2 infection by reverse transcription polymerase chain reaction (RT-PCR), and testing for other infectious etiologies was negative. Both patients received intravenous corticosteroids and recovered without short-term complications. None of the patients died. This report highlights the need for keeping a high index of suspicion for SARS-CoV-2 infection in adolescents presenting solely with gastrointestinal manifestations, in the absence of respiratory symptoms or multisystem involvement, for prompt recognition and timely management. [ABSTRACT FROM AUTHOR]

Chagas cardiomyopathy (CCM) is traditionally considered a disease restricted to areas of endemicity. However, an estimated 300,000 people living in the United States today have CCM, of which its majority is undiagnosed. We present a case of CCM acquired in an endemic area and detected in its early stage. A 42-year-old El Salvadoran woman presented with recurrent chest pain and syncopal episodes. Significant family history includes a sister in El Salvador who also began suffering similar episodes. Physical exam and ancillary studies were only remarkable for sinus bradycardia. The patient was diagnosed with symptomatic sinus bradycardia and a pacemaker was placed. During her hospital course, Chagas serology was ordered given the epidemiological context from which she came. With no other identifiable cause, CCM was the suspected etiology. This case highlights the underrecognized presence of Chagas in the United States and the economic and public health importance of its consideration in the etiological differential diagnosis of electrocardiographic changes among Latin American immigrants. While the United States is not considered an endemic area for Chagas disease, the influx of Latin American immigrants has created a new challenge to identify at-risk populations, diagnose suspected cases, and provide adequate treatment for this disease. [ABSTRACT FROM AUTHOR]

The article discusses the effects of a structured educational wellness program in obese patients with acute mental illness in the U.S. The program incorporates a psycho-educational small-group curricula. Results showed that there are decreases in the mean weight of obese patients, as well as in the glucose and triglyceride levels in patients with diabetes, indicating that the program can be successfully carried out in unselected chronically mentally ill patients.

Background: We sought to determine the incidence of and risk factors for late-onset atrial fibrillation (LOAF) in patients with preserved ejection fractions undergoing mitral valve repairMethods: We included patients undergoing isolated mitral valve repair (MVR) for degenerative disease between 1997-2014 at our institution with EF ≥60%. Patients who had AF preoperatively were excluded from the final analysis. Our primary outcome, LOAF, was defined as AF occurring after discharge following MVR (≥9 days).Results: 223 patients were included in the study with a mean follow-up of 4.8 ± 4.6 years. A total of 25 patients developed LOAF, and freedom from LOAF was 93.9% at one year, and 87.3% at five years. Patients developing LOAF were of similar mean age (58 vs. 63 years in controls, p = 0.08) and had similar preoperative comorbidities, but did show a trend toward larger left atrial diameter (5.1 vs. 4.7 cm, p = 0.11). After risk adjustment with Cox regression analysis, only increasing left atrial size was associated with LOAF (HR 1.63, p = 0.04). On follow-up, 29 patients (10.8%) developed moderate or greater mitral regurgitation at a mean of 2.2 years. Using a mixed-effects model, we were unable to detect an association between recurrent mitral regurgitation following MVR and LOAF (OR 1.36, p = 0.42).Conclusions: LOAF occurs in about 13% of preserved ejection fraction patients undergoing MVR by five years. Increasing left atrial diameter is an independent predictor of LOAF. Concomitant anti-arrhythmic procedures may warrant further investigation in patients with preserved ejection fraction and enlarged left atria undergoing MVR. doi: 10.1111/jocs.12774 (J Card Surg 2016;31:486-492). [ABSTRACT FROM AUTHOR]

In the United States, commercial buildings accounted for about 19% of the total primary energy consumption in 2012. Further, 29% of the ‘site’ energy in commercial buildings was consumed for space heating and cooling. Applying insulation materials to building envelopes is an effective way of reducing energy consumption for heating and cooling, and limiting the negative environmental impacts from the buildings sector. While insulation materials have a net positive impact on the environment due to reduced energy consumption, they also have some negative impacts associated with their ‘embodied energy’. The total lifetime environmental impacts of insulation materials are a summation of: (1) direct impacts due to their embodied energy, and (2) indirect or impacts avoided due to the reduced building energy consumption. Here, assessments of the lifetime environmental impacts of selected insulation materials for commercial buildings in North America are presented. Direct and indirect environmental impact factors were estimated for the cradle-to-grave insulation life cycle stages. Impact factors were calculated for two categories: primary energy consumption and global warming potential. The direct impact factors were calculated using data from existing literature and a life cycle assessment software. The indirect impact factors were calculated through simulations of a set of standard whole-building models. [ABSTRACT FROM AUTHOR]

Objectives. We investigated the development of and service utilization at Supporting Positive Opportunities with Teens (SPOT)--a community-based health and social service facility in St. Louis, Missouri, for youths that focuses on increasing HIV and sexually transmitted infection (STI) testing. Methods. We identified the US-based, co-located youth health and social service models that guided the establishment of the SPOT. We analyzed the first 5 years (2008-2013) of service delivery and utilization data. Results. During the study period, the SPOT provided services for 8233 youths in 37 480 visits. The 5 most utilized services included HIV and STI screening, food, transportation, contraception, and case management. A total of 9812 gonorrhea and chlamydia screenings revealed 1379 (14.1%) cases of chlamydia and 437 (4.5%) cases of gonorrhea, and 5703 HIV tests revealed 59 HIV infections (1.0%); 93.0% of patients found to have an STI were treated within a 5-day window. Conclusions. Co-locating health and social services in informal community settings attracts high-risk youths to utilize services and can prove instrumental in reducing STI burden in this population. [ABSTRACT FROM AUTHOR]

In the United States, forty-eight (48) percent of the residential end-use energy consumption is spent on space heating and air conditioning. Reducing envelope-generated heating and cooling loads through application of phase change materials (PCMs) in building envelopes can enhance the energy efficiency of buildings and reduce energy consumption. Experimental testing and numerical modeling of PCM-enhanced envelope components are two important aspects of the evaluation of their energy benefits. An innovative phase change material (nano-PCM) was developed with PCM supported by expanded graphite (interconnected) nanosheets, which are highly conductive and allow enhanced thermal storage and energy distribution. The nano-PCM is shape-stable for convenient incorporation into lightweight building components. A wall with cellulose cavity insulation and a prototype PCM-enhanced interior wallboard was built and tested in a natural exposure test (NET) facility in a hot-humid climate location. The test wall contained the PCM wallboard and a regular gypsum wallboard, for a side-by-side annual comparison study. Further, numerical modeling of the wall containing the nano-PCM wallboard was performed to determine its actual impact on wall-generated heating and cooling loads. The model was first validated using experimental data, and then used for annual simulations using typical meteorological year (TMY3) weather data. This article presents the measured performance and numerical analysis evaluating the energy-saving potential of the nano-PCM-enhanced wallboard. [ABSTRACT FROM AUTHOR]

Since the 1980s, developed countries, led by the United States and the countries of the European Union, have sought to incorporate intellectual property rights provisions into global trade agreements. These countries successfully negotiated the World Trade Organization's 1994 Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which required developing countries to adopt intellectual property provisions comparable to developed countries. In this manuscript, we review the policy controversy surrounding TRIPS and examine the two main ethical arguments articulated in its support - a theory of natural rights and a utilitarian argument. We contend that these theories provide insufficient bases for an intellectual property rights regime that compromises access to essential medicines in the developing world. While the policy community has engaged in active debate around the policy effects of TRIPS, scholars have not thoroughly considered the full ethical underpinnings of those policy arguments. We believe that a more robust understanding of the ethical implications of the agreement should inform policy discussions in the future. [ABSTRACT FROM AUTHOR]

Knowledge of treatment regimens and outcomes for novel coronavirus disease 2019 (COVID-19) is evolving. Recent studies have reported mortality rates ranging from 39-50% among hospitalized patients with COVID-19. We report our experience of management and outcomes of hospitalized patients with COVID-19 at a large tertiary- care center in Midwestern United States. Of 658 patients presenting to our tertiary care center, 217 needed hospitalization, majority (77%) of whom were severely sick requiring admission to the intensive care unit (ICU). All received corticosteroids, and 78% of the patients received tocilizumab. More than two-thirds of the patients received anticoagulation and 80% of patients in the ICU had prone-positioning. The median duration of hospitalization was 12 days (interquartile range, 8 to16), median duration of intensive care unit stay was 7 days (interquartile range, 5 to 9) and requirement of mechanical ventilation was 6 days (interquartile range, 5 to 8) in our cohort. Of the 217 patients, 27 died (12% mortality). The majority of our patients received corticosteroids, tocilizumab, anticoagulation and prone positioning. While higher mortality rates of >30% have been reported in various studies among hospitalized patients with COVID-19, the majority of hospitalized patients in our cohort survived with a low mortality rate. [ABSTRACT FROM AUTHOR]

Today medical device sector is evolving to find the new horizons. Medical device approval is a time-consuming process that requires submission of safety, efficacy and quality documentation to national regulatory bodies in various countries. While there are some similarities among the countries regarding medical device regulations, some differences also exist that significantly affect the regulatory scrutiny. This presents a great problem for manufacturers marketing their products in multiple countries. Competent authorities worldwide have begun to realize the problem and collaborate to harmonize the regulations. In the present article regulatory approval procedure is discussed in different jurisdictions such as United States, European Union, Japan, China and India along with comparisons in terms of classification of devices, competent authorities, rules and regulations and quality management systems involved in these countries. [ABSTRACT FROM AUTHOR]

Background: Primary care provision is important in the delivery of health care but many countries face primary care workforce challenges. Increasing demand, enlarged workloads, and current and anticipated physician shortages in many countries have led to the introduction of mid-level professionals, such as Physician Assistants (PAs). Objective: This systematic review aimed to appraise the evidence of the contribution of PAs within primary care, defined for this study as general practice, relevant to the UK or similar systems. Methods: Medline, CINAHL, PsycINFO, BNI, SSCI and SCOPUS databases were searched from 1950 to 2010. Eligibility criteria: PAs with a recognised PA qualification, general practice/family medicine included and the findings relevant to it presented separately and an English language journal publication. Two reviewers independently identified relevant publications, assessed quality using Critical Appraisal Skills Programme tools and extracted findings. Findings were classified and synthesised narratively as factors related to structure, process or outcome of care. Results: 2167 publications were identified, of which 49 met our inclusion criteria, with 46 from the United States of America (USA). Structure: approximately half of PAs are reported to work in primary care in the USA with good support and a willingness to employ amongst doctors. Process: the majority of PAs' workload is the management of patients with acute presentations. PAs tend to see younger patients and a different caseload to doctors, and require supervision. Studies of costs provide mixed results. Outcomes: acceptability to patients and potential patients is consistently found to be high, and studies of appropriateness report positively. Overall the evidence was appraised as of weak to moderate quality, with little comparative data presented and little change in research questions over time. Limitations: identification of a broad range of studies examining 'contribution' made meta analysis or meta synthesis untenable. Conclusions: The research evidence of the contribution of PAs to primary care was mixed and limited. However, the continued growth in employment of PAs in American primary care suggests that this professional group is judged to be of value by increasing numbers of employers. Further specific studies are needed to fill in the gaps in our knowledge about the effectiveness of PAs' contribution to the international primary care workforce. [ABSTRACT FROM AUTHOR]

The article focuses on the performance of international equity funds and how fund managers and investors can decide asset allocation strategies based on the research of the author. It states that there has been an increase in U.S. investors investing in international equity funds as they realize that they cannot have diversification by investing only in funds of the U.S. It highlights that investors can earn double returns by investing in funds which performed poor in a previous year.

BACKGROUND. The current study was undertaken to evaluate the spatiotemporal projection models applied by the American Cancer Society to predict the number of new cancer cases. METHODS. Adaptations of a model that has been used since 2007 were evaluated. Modeling is conducted in 3 steps. In step I, ecologic predictors of spatiotemporal variation are used to estimate age-specific incidence counts for every county in the country, providing an estimate even in those areas that are missing data for specific years. Step II adjusts the step I estimates for reporting delays. In step III, the delay-adjusted predictions are projected 4 years ahead to the current calendar year. Adaptations of the original model include updating covariates and evaluating alternative projection methods. Residual analysis and evaluation of 5 temporal projection methods were conducted. RESULTS. The differences between the spatiotemporal model-estimated case counts and the observed case counts for 2007 were < 1%. After delays in reporting of cases were considered, the difference was 2.5% for women and 3.3% for men. Residual analysis indicated no significant pattern that suggested the need for additional covariates. The vector autoregressive model was identified as the best temporal projection method. CONCLUSIONS. The current spatiotemporal prediction model is adequate to provide reasonable estimates of case counts. To project the estimated case counts ahead 4 years, the vector autoregressive model is recommended to be the best temporal projection method for producing estimates closest to the observed case counts. Cancer 2012;. © 2012 American Cancer Society. [ABSTRACT FROM AUTHOR]

BACKGROUND: A study was undertaken to evaluate the temporal projection methods that are applied by the American Cancer Society to predict 4-year-ahead projections. METHODS: Cancer mortality data recorded in each year from 1969 through 2007 for the United States overall and for each state from the National Center for Health Statistics was obtained. Based on the mortality data through 2000, 2001, 2002, and 2003, Projections were made 4 years ahead to estimate the expected number of cancer deaths in 2004, 2005, 2006, 2007, respectively, in the United States and in each state, using 5 projection methods. These predictive estimates were compared to the observed number of deaths that occurred for all cancers combined and 47 cancer sites at the national level, and 21 cancer sites at the state level. RESULTS: Among the models that were compared, the joinpoint regression model with modified Bayesian information criterion selection produced estimates that are closest to the actual number of deaths. Overall, results show the 4-year-ahead projection has larger error than 3-year-ahead projection of death counts when the same method is used. However, 4-year-ahead projection from the new method performed better than the 3-year-ahead projection from the current state-space method. CONCLUSIONS: The Joinpoint method with modified Bayesian information criterion model has the smallest error of all the models considered for 4-year-ahead projection of cancer deaths to the current year for the United States overall and for each state. This method will be used by the American Cancer Society to project the number of cancer deaths starting in 2012. Cancer 2012; © 2012 American Cancer Society. [ABSTRACT FROM AUTHOR]

Abstract: Ceftaroline is a novel broad-spectrum cephalosporin antibiotic currently under US Food and Drug Administration (FDA) review for a new drug application (NDA), filed by Cerexa, Inc. (a wholly owned subsidiary of Forest Laboratories), for the treatment of complicated skin and skin-structure infections (cSSSIs) and community-associated pneumonia (CAP). The antibiotic acts by binding to penicillin-binding proteins in bacteria, consistent with other β-lactams. The antimicrobial spectrum of ceftaroline ranges from aerobic and anaerobic Gram-positive bacteria, including drug-resistant isolates of staphylococci, i.e. heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA), vancomycin-intermediate S. aureus (VISA) and vancomycin-resistant S. aureus (VRSA), to anaerobic Gram-negative pathogens such as Moraxella catarrhalis and Haemophilus influenzae (including β-lactamase-positive strains), as well as bacteria with multiple resistance phenotypes. Ceftaroline fosamil is the prodrug that is rapidly dephosphorylated by in vivo plasma phosphatases to the active drug ceftaroline, which follows a two-compartmental pharmacokinetic model and is eliminated primarily by renal excretion, with a plasma half-life of ca. 2.5h. Ceftaroline is well tolerated, which is consistent with its good safety profile similar to other cephalosporins in clinical trials. Thus, it would be a promising drug to fight multidrug-resistant superbugs such as S. aureus and Streptococcus pneumoniae for the treatment of cSSSIs and CAP. [Copyright &y& Elsevier]

The research presented in this series of articles is a summary of inclusion characterisation techniques in routine to support the process improvement needs of internal customers of ArcelorMittal Global R&D, East Chicago. This paper highlights the use of characterisation techniques including total oxygen analysis, cathodoluminescence microscope on remelt buttons and clogging materials, and pulse discrimination analysis to study steelmaking and casting issues that affect productivity and quality of steel at ArcelorMittal USA. Use of cathodoluminescence microscope for examination of remelt buttons to correlate the nature of inclusions to castability for Ca treated steel grades is explained. Example results of application of total oxygen analysis and pulse discrimination analysis on Ti stabilised ultra low carbon, advanced high strength steels and transformation induced plasticity steels are shown. Formation of spinel inclusions and their impact on castability for desulphurised non-Ca treated versus Ca treated grades is also discussed. [ABSTRACT FROM AUTHOR]

We obtained recommendations for a graphical user interface (GUI) design for a new medical monitoring system. Data were obtained from 26 combat-experienced medics. Volunteers were briefed on the medical monitoring system. They then completed a questionnaire on background medical treatment experience, provided drawings on how and what information should be displayed on the GUI screens for use on a personal digital assistant, and participated in focus group sessions with four to seven medics per group to obtain group consensus on what information the GUI screens should contain. Detailed displays on seven screens provide the medical and situational awareness information medics need for triage decisions and for early processing of a casualty. The created GUI screens are a combination of object-based and text-based information using a color-coded system. Medics believed the information displayed with these GUI designs would improve treatment of casualties on the battlefield. [ABSTRACT FROM AUTHOR]

Abstract: Giant cell arteritis (GCA) is probably the commonest type of large-vessel vasculitis seen in the United States (with a possible involvement of medium-sized vessels as well). The exact etiopathogenesis of GCA is still not fully understood. Clinical manifestations of GCA can be vast and confusing. Up to 22.5% patients may have a ‘normal’ erythrocyte sedimentation rate (ESR) before treatment. Early detection (with a high index of suspicion) with early initiation of treatment can be ‘sight as well as life saving’. Treatment should not be delayed until the results of a temporal artery biopsy are obtained. Newer radiographic techniques including color-Doppler ultrasonography and contrast enhanced 3T MRA may facilitate/increase the yield; and may even obviate the need for a temporal artery biopsy (especially because temporal artery biopsy can be ‘read as negative’ in a significant proportion of cases). Some recent advances in genetics, pathophysiology, treatment and outcome are also reviewed in this article. [Copyright &y& Elsevier]

Air traffic flow control during adverse weather conditions is managed by the Federal Aviation Administration in today's air traffic system, although it is the individual airlines that are in the best position to assess the costs of disruptions to scheduled operations. TO improve the efficiency of resource allocation, a market mechanism is proposed that enables airlines to participate directly in the flow control decision-making process. Since airlines can be expected to behave strategically, a lump-sum market mechanism is used for which existence of a Nash equilibrium and a bound on the worst case efficiency loss have been shown for agents that anticipate the effects of their own bids on resource prices. The convergence properties of this mechanism are studied for a two-player game with linear utilities, which reveals that restricting the airline bid update step-size can result in a wider range of stable bidding processes. The mechanism is then applied to an air traffic flow control scenario for multiple airports in the northeastern United States, which demonstrates the feasibility of performing market-based resource allocation within the time horizon for reliable weather predictions. [ABSTRACT FROM AUTHOR]

The article presents a case study of the significance of prototype adaptive reminder system for home-based medical tasks in the U.S. The system comprises of a mobile device for reminder presentation and ambient sensors to determine opportune moments for reminder delivery. Researchers found that poor adherence to medication and lifestyle guidance is a major challenge in healthcare community in industrialized countries where the cost of nonadherence is estimated to be over $177 billion.

Background and aims: Impaired physical performance in older adults has been shown to vary by ethnic groups. The objective of this study is to examine ethnic differences in physical performance in older Americans. Methods. We conducted a cross-sectional analysis using a sample of 4456 non-institutionalized Americans aged 60 and above (2712 non- Hispanic Whites, 861 non-Hispanic Blacks and 883 Mexican Americans)from a large national representative survey (The Third National Health and Nutrition Examination Survey (NHANES III) conducted in 1988- 1994). Measurements included socio-dernographic variables; self-reported physician diagnosed medical conditions, body mass index (BMI) and physical performance examination (tandem stand balance, timed chair stand, and timed 8-foot walk). Results: Of 4456 study participants, 60.9% (n=2712) subjects were non-Hispanic white, 19.3% (n=861) were non-Hispanic black, and 19.8% (n=883) were Mexican American. About 35% (n=1573) of subjects could not hold the tandem balance test for 10 seconds. Older age, diabetes, stroke and arthritis were significantly associated with decreased performance on the balance test. Older age, female gender, being Mexican American or non-Hispanic black, hip fracture and high BMI were significantly associated with decreased performance on 8- foot walking test, while older age, female gender, being non-Hispanic black, low education, stroke, cancer, arthritis and high BMI were significantly associated with decreased performance on the chair stand test. Conclusions: With some ethnic variation, older age, female gender, being non-Hispanic black, being Mexican American, low education, high BMI, diabetes, stroke, cancer and arthritis were associated with decreased physical performance in elderly Americans. [ABSTRACT FROM AUTHOR]

Objective To examine the relation between the quality of physicians and migration among alumni of All India Institute of Medical Sciences (AIIMS), New Delhi, India over the period 1989-2000. Methods In a retrospective cohort study, data on graduates of AIIMS were collected from entrance exam qualifier lists, the AIIMS alumni directory, convocation records, the American Medical Association and informal alumni networks. The data were analysed by use of 2x2 contingency tables and logistic regression models. Findings Nearly 54% of AIIMS graduates during 1989-2000 now reside outside India. Students admitted under the general category are twice as likely to reside abroad (95% confidence interval: 1.53-2.99) as students admitted under the affirmative-action category. Recipients of multiple academic awards were 35% more likely to emigrate than non-recipients of awards (95% confidence interval: 1.04-1.76). Multivariate analyses do not change these basic conclusions. Conclusion Graduates from higher quality institutions account for a disproportionately large share of emigrating physicians. Even within high-end institutions, such as AIIMS, better physicians are more likely to emigrate. Interventions should focus on the highly trained individuals in the top institutions that contribute disproportionately to the loss of human resources for health. Our findings suggest that affirmative-action programmes may have an unintended benefit in that they may help retain a subset of such personnel. [ABSTRACT FROM AUTHOR]

We present two models for the short-term prediction of the number of deaths arising from common cancers in the United States. The first is a local linear model, in which the slope of the segment joining the number of deaths for any two consecutive time period is assumed to be random with a nonparametric distribution, which has a Dirichlet process prior. For slightly longer prediction periods, we present a local quadratic model. This extension of the local linear model includes an additional "acceleration" term that allows it to quickly adjust to sudden changes in the time series. The proposed models can be used to obtain the predictive distributions of the future number of deaths. as well their meals and variances through Markov chain Monte Carlo techniques. We illustrate our methods by runs on data from selected cancer sites. [ABSTRACT FROM AUTHOR]

To identify the current literature regarding healthcare resource use and cost burden of asthma in the US. The total cost of asthma in 2013 (inflated to 2015; data from Medical Expenditure Panel Survey) was $81.9 billion including costs due to absenteeism ($50.3 billion), losses due to missed work/school days ($3 billion), and mortality ($29 billion). [Extracted from the article]

This article traces systems of exchange concerning the life sciences and capital and how they configure subjectivity in the United States and India. This is done through case studies concerning the emergence of personalized medicine in the two locales. In the U.S. case, I argue for the configuration of the subjects of personalized medicine as sovereign consumers; in the Indian case, I argue for their configuration as experimental subjects. I situate these arguments in the context of epistemologies of genomics and the consolidation of systems of speculative capitalism. [ABSTRACT FROM AUTHOR]