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Lung cancer ranks as one of the top malignancies and the leading cause of cancer death in both males and females in the US. Using a cancer database covering the entire population, this study was to determine the gender disparities in lung cancer incidence during 2001–2019. Cancer patients were obtained from the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology and End Results (SEER) database. The SEER*Stat software was applied to calculate the age-adjusted incidence rates (AAIR). Temporal changes in lung cancer incidence were analyzed by the Joinpoint software. A total of 4,086,432 patients (53.3% of males) were diagnosed with lung cancer. Among them, 52.1% were 70 years or older, 82.7% non-Hispanic white, 39.7% from the South, and 72.6% non-small cell lung cancer (NSCLC). The AAIR of lung cancer continuously reduced from 91.0 per 100000 to 59.2 in males during the study period, while it increased from 55.0 in 2001 to 56.8 in 2006 in females, then decreased to 48.1 in 2019. The female to male incidence rate ratio of lung cancer continuously increased from 2001 to 2019. Gender disparities were observed among age groups, races, and histological types. In those aged 0–54 years, females had higher overall incidence rates of lung cancer than males in recent years, which was observed in all races (except non-Hispanic black), all regions, and adenocarcinoma and small cell (but not squamous cell). Non-Hispanic black females aged 0–54 years had a faster decline rate than males since 2013. API females demonstrated an increased trend during the study period. Lung cancer incidence continues to decrease with gender disparities among age groups, races, regions, and histological types. Continuous anti-smoking programs plus reduction of related risk factors are necessary to lower lung cancer incidence further. [ABSTRACT FROM AUTHOR]

The prevalence of Autism Spectrum Disorder (ASD) is growing rapidly, affecting 1 in 59 children in the United States in 2018. Individuals with ASD currently receive fragmented care that threatens their health and well-being. Challenges of autism care include disconnections between the medical system and school supports, poor care coordination between primary care and specialists, and saturation of neuropsychiatry-based centers' capacity to care for the ASD population. ASD treatment also lacks of a coordinated system of care for patients' multi-system comorbidities. Families are calling for an ASD care delivery system to meet their needs and the needs of their children. To serve people with ASD and their medical and other providers, we propose a coordinated approach to care grounded in primary care. We call the model the "Systematic Network of Autism Primary Care Services (SYNAPSE)." We develop the model by applying the frameworks of "coproduction" of care and chronic disease management. In this Commentary we discuss the model's rationale, underpinnings, and the implications for clinical practice. We advance these ideas to align with policy makers' recognition of the importance of primary care for ASD, as reflected by the most recent Interagency Autism Coordinating Committee (IACC) meeting at the National Institute of Mental Health. [ABSTRACT FROM AUTHOR]

• This study investigates the latest vehicle ownership patterns among early AFV adopters. • A spatial analysis is performed to leverage the latest national travel survey data. • This study provides new evidence about spatial heterogeneity in consumer preferences for AFVs. • Spatial variations of AFV ownership correlates are identified across the United States. • The impacts of incentives and refueling or charging infrastructures are uneven across the country. Understanding the ownership of alternative fuel vehicles (AFVs) and advanced powertrain vehicle technologies is critical for transitioning to low Carbon. This study explores the choices made by early adopters of AFVs. To identify the ownership behavior of early adopters and their attributes, this study uses the 2017 National Household Travel Survey (NHTS) data. This study contributes by providing new evidence about spatial heterogeneity in consumer preferences for AFVs in space using the most recent travel behavior data. The Geographically Weighted Regression (GWR) is used to explore the spatially varying correlates of AFV ownership. Results reveal significant spatial variations in the associations of AFV ownership and key factors across the United States. For example, high-income households in Southeastern or Northwestern states are more likely to own an AFV. Seniors are with a greater likelihood of owning an AFV relative to young adults, especially in Northeastern and Northwestern states. The effectiveness of incentives is uneven across different states. The incentives are more effective in Florida than in other parts of the country. The number of alternative fuel stations is positively related to AFV ownership. Other spatially varying correlates are related to household size, education, daily trip distance, and online shopping behavior. The spatial modeling applied in this study is a rigorous analytic technique that researchers and practitioners can use to identify local correlates of AFV ownership. The intended outcome of the study is to provide information about consumer preferences regarding owning AFVs, which can potentially impact our transition to a low Carbon economy. [ABSTRACT FROM AUTHOR]

Volatile driving, characterized by hard accelerations and braking, can contribute substantially to higher energy consumption, tailpipe emissions, and crash risks. Drivers’ decisions to maintain speed, accelerate, brake rapidly, or jerk their vehicle are largely constrained by their unique regional and metropolitan contexts. These contexts may be characterized by their geography, roadway structure, traffic management, driving population, etc. This study captures how people generally drive in a region using large-scale vehicle trajectory data, implying how energy is consumed and how emissions are produced in regional transportation systems. Specifically, driving performance in four U.S. metropolitan areas (Los Angeles, San Francisco, Sacramento, and Atlanta) is compared, taking advantage of large-scale behavioral data (78.7 million seconds of speed records), collected by in-vehicle global positioning systems (GPSs) as part of regional surveys. Comparative analysis shows significant regional differences in terms of volatile driving and time spent to accelerate, brake, and jerk the vehicle during daily trips. Correlates of higher volatility are also explored, e.g., battery electric vehicles show low volatility, as expected. This study proposes a novel way to compare regional driving performance by successfully turning GPS driving data into valuable knowledge that can be applied in practice by developing regional driving performance indices. The new indices can also be used to compare regional performance over time and to imply the levels of sustainability of regional transportation systems. This study contributes by proposing a way to extract useful information from large-scale driving data. [ABSTRACT FROM AUTHOR]

ObjectiveThough the median age at diagnosis is 64 years, few studies focus on elderly (≥65 years) patients with chronic myeloid leukemia (CML). This study examines healthcare outcomes among elderly Medicare beneficiaries with CML who started nilotinib or dasatinib after imatinib. Research design and methodsPatients were identified in the Medicare Research Identifiable Files (2006–2012) and had continuous Medicare Parts A, B, and D coverage. Main outcome measuresTreatment patterns, overall survival (OS), monthly healthcare resource utilization and medical costs were measured from the second-line tyrosine kinase inhibitor (TKI) initiation (index date) to end of Medicare coverage. ResultsDespite similar adherence, dasatinib patients (N = 379) were more likely to start on the recommended dose (74% vs. 53%;p < 0.001), and to have dose reductions (21% vs. 11%, adjusted hazard ratio [HR] = 1.94;p = 0.002) or dose increases (9% vs. 7%; adjusted HR = 1.81;p = 0.048) than nilotinib patients (N = 280). Fewer nilotinib patients discontinued (59% vs. 67%; adjusted HR = 0.80;p = 0.026) or switched to another TKI (21% vs. 29%; adjusted HR = 0.72;p = 0.044) than dasatinib patients. Nilotinib patients had longer median OS (>4.9 years vs. 4.0 years;p = 0.032) and 37% lower mortality risk than dasatinib patients (adjusted HR = 0.63;p = 0.008). Nilotinib patients had 23% fewer inpatient admissions, 30% fewer emergency room visits, 13% fewer outpatient visits (allp < 0.05), and lower monthly medical costs (by $513,p = 0.024) than dasatinib patients. LimitationsLack of clinical assessment (disease phase and response to first-line therapy) and retrospective nature of study (unobservable potential confounding factors, non-randomized treatment choice). ConclusionsIn the current study of elderly CML patients, initiation of second-line TKIs frequently occurs at doses lower than the recommended starting doses and, despite this, many patients require dose adjustments. Here, nilotinib patients required fewer dose adjustments than dasatinib patients. Further research focusing on elderly CML patients is warranted in order to help define future best clinical practices. [ABSTRACT FROM PUBLISHER]

Micro-hemorrhages are a common result of traumatic brain injury (TBI), which can be quantified with susceptibility weighted imaging and mapping (SWIM), a quantitative susceptibility mapping approach. A total of 23 TBI patients (five women, 18 men; median age, 41.25 years old; range, 21.69-67.75 years) with an average Glasgow Coma Scale score of 7 (range, 3-15) at admission were recruited at mean 149 d (range, 57-366) after injury. Susceptibility-weighted imaging data were collected and post-processed to create SWIM images. The susceptibility value of small hemorrhages (diameter ≤10 mm) and major deep veins (right septal, left septal, central septal, right thalamostriate, left thalamostriate, internal cerebral, right basal vein of Rosenthal, left basal vein of Rosenthal, and pial veins) were evaluated. Different susceptibility thresholds were tested to determine SWIM's sensitivity and specificity for differentiating hemorrhages from the veins. A total of 253 deep veins and 173 small hemorrhages were identified and evaluated. The mean susceptibility of hemorrhages was 435±206 parts per billion (ppb) and the mean susceptibility of deep veins was 108±56 ppb. Hemorrhages showed a significantly higher susceptibility than all deep veins ( p<0.001). With different thresholds (250, 227 and 200 ppb), the specificity was 97%, 95%, and 92%, and the sensitivity was 84%, 90%, and 92%, respectively. These results show that SWIM could be used to differentiate hemorrhages from veins in TBI patients in a semi-automated manner with reasonable sensitivity and specificity. A larger cohort will be needed to validate these findings. [ABSTRACT FROM AUTHOR]

Explores phases of readers' theater (RT) activities with students from an intermediate L2 writing class of an English as a Second Language (ESL) teaching course in a university in the United States. Positive effects of using RT; Theoretical concerns and issues of cultural appropriacy; Pedagogical implications of RT; Recommendations for future research on RT in language classrooms.

The canopy height model (CHM) derived from LiDAR point cloud data is usually used to accurately identify the position and the canopy dimension of single tree. However, local invalid values (also called data pits) are often encountered during the generation of CHM, which results in low-quality CHM and failure in the detection of treetops. For this reason, this paper proposes an innovative method, called "pixels weighted differential gradient", to filter these data pits accurately and improve the quality of CHM. First, two characteristic parameters, gradient index (GI) and Z-score value (ZV) are extracted from the weighted differential gradient between the pit pixels and their eight neighbors, and then GIs and ZVs are commonly used as criterion for initial identification of data pits. Secondly, CHMs of different resolutions are merged, using the image processing algorithm developed in this paper to distinguish either canopy gaps or data pits. Finally, potential pits were filtered and filled with a reasonable value. The experimental validation and comparative analysis were carried out in a coniferous forest located in Triangle Lake, United States. The experimental results showed that our method could accurately identify potential data pits and retain the canopy structure information in CHM. The root-mean-squared error (RMSE) and mean bias error (MBE) from our method are reduced by between 73% and 26% and 76% and 28%, respectively, when compared with six other methods, including the mean filter, Gaussian filter, median filter, pit-free, spike-free and graph-based progressive morphological filtering (GPMF). The average F1 score from our method could be improved by approximately 4% to 25% when applied in single-tree extraction. [ABSTRACT FROM AUTHOR]

The association between the systemic immune-inflammation index (SII) and the risk of sarcopenia has not yet been revealed. The purpose of this study was to investigate the relationship between the SII and sarcopenia in individuals aged 18–59 years. All data for this study are from the National Health and Nutrition Examination Survey (NHANES) database, including 7258 participants (age range: 18–59 years). We divided SII values by quartiles (quartiles 1–4: 0.3–3.1, 3.2–4.4, 4.4–6.2, and 6.2–58.5). We constructed a multivariate logistic regression model to assess the association between the SII and the risk of sarcopenia, and an interaction test was run to test the stability of the model and identify high-risk individuals with sarcopenia. Compared to nonsarcopenia participants, sarcopenia patients had a significantly higher SII value (weighted average: 6.65 vs. 5.16) (P = 0.002). Multivariate logistic regression results showed a positive linear relationship between the SII and sarcopenia (OR [odds ratio] = 1.12, 95% CI [confidence interval] 1.03–1.21). Compared to the quartile 1 group, the quartile 4 group was associated with a higher risk of sarcopenia (OR = 3.94, 95% CI 1.42–10.94). Compared with the quartile 1 group, the OR value of the quartile 2 to quartile 4 groups showed an upwards trend (Ptrend < 0.001) as the level of SII increased. Subgroup analysis also indicate that the correlation between higher SII values and the risk of sarcopenia was stable. There was a significant positive linear relationship between SII and sarcopenia, indicating that higher SII values can increase the risk of sarcopenia in individuals aged 18–59 in the United States. The findings of this study will be beneficial in promoting the use of SII alone or in combination with other tools for the risk screening of sarcopenia in communities or large populations. [ABSTRACT FROM AUTHOR]

• This study explores the 2017 National Household Travel Survey data. • This study focuses on the correlates of vehicle ownership among young Americans. • Spatial approach is used to reveal the vehicle ownership correlates that vary across the country. • Young adults in the Northeast states have extra-lower likelihoods of owing a vehicle. • Vehicle ownership among young American is less sensitive to household income. This study uses the National Household Travel Survey (NHTS) data to investigate the most recent correlates of vehicle ownership among young Americans. This study performs a spatial analysis to examine the potentially non-stationary relationships between sociodemographic factors and vehicle ownership. Consistent with previous studies, modeling results from this study showed that young Americans are more likely to be carless than older adults. The spatial analysis answers the research question – in which regions(s) young Americans are even less likely to have a car. The results highlighted the Northeast states for the young American's extra-lower vehicle ownership if the influences of all other factors are held constant. The cost of living and availability of transportation alternatives are possible reasons. Further, this study built separate models for young adults (25–34 years old) and three older age groups. The vehicle ownership correlates within the young adults are found to be generally consistent with the correlates among all adults. Among young adults, vehicle ownership is still significantly related to their gender, educational attainment, employment status, household characteristics, and travel demand. However, young adults' vehicle ownership seems to be less sensitive to household income than mid-age adults' (35–44 years old), perhaps because young people may not perceive financial stress such as child support and mortgage. This study contributes by using a spatial analysis approach to reveal the non-stationary correlates of vehicle ownership. This approach is useful for future travel behavior research and transportation policy considering the spatial heterogeneity. [ABSTRACT FROM AUTHOR]

The article reexamines the values of business leaders in light of the financial crisis facing the U.S. and the rest of the world. It states that any consideration of values is hampered by a confusion within the academic literature and researchers have largely avoided directly examining values because of the lack of a precise definition and the difficulties of capturing true values. It also asserts the need for organizations and their leaders to reexamine the importance of values and work to instill the values that will enable them to sustain their causes and ensure the long-lasting prosperity of society.

U.S. government fuel economy tests are used for two primary purposes: 1) to monitor automobile manufacturers’ compliance with fuel economy and greenhouse gas emissions standards and 2) to inform consumers about the fuel economy of passenger cars and light trucks. This study analyzes a unique database of 75,000 fuel economy estimates self-reported by customers of the U.S. government website www.fueleconomy.gov to evaluate the effectiveness of the government's estimates for these two purposes. The analysis shows great variability in individuals’ own fuel economy estimates relative to the official government estimates with a small bias relative to the sample average. For consumers, the primary limitation of government fuel economy estimates is imprecision for a given individual rather than bias relative to the average individual. The analysis also examines correlations between individuals’ fuel economy estimates and specific technologies, vehicle class, driving style, method used to calculate fuel economy, manufacturer, and state. Gasoline, hybrid and diesel vehicles were separately evaluated. There is some evidence that the shortfall between test cycle fuel economy estimates (used to measure compliance with regulations) and in-use fuel economy estimates (such as those provided by customers of www.fueleconomy.gov ) has been increasing since 2005. If this trend continues, it could affect the benefits realized by fuel economy and greenhouse gas emissions standards. A scientifically designed survey of in-use fuel economy is needed to insure that an unbiased sample is collected and that fuel economy is rigorously and consistently measured for all vehicles. The potential for information technology to enable more precise prediction of individual fuel economy should be explored. [ABSTRACT FROM AUTHOR]

In the United States non-alcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people. It occurs in every age group, but predominantly in people with risk factors such as obesity and type 2 diabetes. NAFLD is marked by fat accumulation in the liver leading to liver inflammation, which may lead to scarring and irreversible damage progressing to cirrhosis and liver failure. In animal models, genetic ablation of the protein G0S2 leads to alleviation of liver damage and insulin resistance in high fat diets. The research presented in this paper aims to aid in rational based drug design for the treatment of NAFLD by providing a pathway for a solution state NMR structure of G0S2. Here we describe the expression of G0S2 in an E. coli system from two different constructs, both of which are confirmed to be functionally active based on the ability to inhibit the activity of Adipose Triglyceride Lipase. In one of the constructs, preliminary NMR spectroscopy measurements show dominant alpha-helical characteristics as well as resonance assignments on the N-terminus of G0S2, allowing for further NMR work with this protein. Additionally, the characterization of G0S2 oligomers are outlined for both constructs, suggesting that G0S2 may defensively exist in a multimeric state to protect and potentially stabilize the small 104 amino acid protein within the cell. This information presented on the structure of G0S2 will further guide future development in the therapy for NAFLD. [ABSTRACT FROM AUTHOR]

Background: The efficacy of endoscopic ultrasound (EUS) for determining the T category of gastric cancer is variable. The aim of this study was to evaluate the superiority of EUS by using the 6th edition American Joint Committee on Cancer (AJCC) staging system for stomach cancer compared to the new 7th/8th edition.Methods: A retrospective analysis of clinical and EUS imaging features of 348 gastric carcinoma patients who underwent radical resection were retrospectively analyzed. Differences between the 6th and 7th/8th edition T staging systems for preoperative EUS evaluation were compared.Results: The accuracy of EUS T staging was 72.4% for the 7th/8th edition and 78.4% for the 6th edition. T3 stage accuracy was significantly worse when the T3 group status was changed. The tumor location, echoendoscope type, and histological type were associated with inaccuracy. We further analyzed the EUS image features for each tumor T stage and found that an indistinctly visible muscularis propria (MP) or with obvious thickening was considered an indicator of lesions involved in the MP with a sensitivity of 81.3%; an MP completely disappeared and accompanied with a serosal layer intact may be a marker that the lesion invaded to the subserosa. We also found that irregularities in the outer edge of the gastric wall were markers of gastric serosal layer penetration with a positive predictive value of 92.2%.Conclusions: The increased complexity of the 7th/8th edition T staging system is accompanied by worsening of the predictive accuracy for EUS as compared to the 6th edition. Furthermore, the tumor location, echoendoscope type, histological type, and EUS image features for each tumor T stage should warrant attention. [ABSTRACT FROM AUTHOR]

Objective Systemic lupus erythematosus (SLE) and lupus nephritis (LN) disproportionately affect individuals who are members of racial/ethnic minority groups and individuals of lower socioeconomic status (SES). This study was undertaken to investigate the epidemiology and sociodemographics of SLE and LN in the low-income US Medicaid population. Methods We utilized Medicaid Analytic eXtract data, with billing claims from 47 states and Washington, DC, for 23.9 million individuals ages 18-65 years who were enrolled in Medicaid for >3 months in 2000-2004. Individuals with SLE (≥3 visits >30 days apart with an International Classification of Diseases, Ninth Revision [ICD-9] code of 710.0) and with LN (≥2 visits with an ICD-9 code for glomerulonephritis, proteinuria, or renal failure) were identified. We calculated SLE and LN prevalence and incidence, stratified by sociodemographic category, and adjusted for number of American College of Rheumatology (ACR) member rheumatologists in the state and SES using a validated composite of US Census variables. Results We identified 34,339 individuals with SLE (prevalence 143.7 per 100,000) and 7,388 (21.5%) with LN (prevalence 30.9 per 100,000). SLE prevalence was 6 times higher among women, nearly double in African American compared to white women, and highest in the US South. LN prevalence was higher among all racial/ethnic minority groups compared to whites. The areas with lowest SES had the highest prevalence; areas with the fewest ACR rheumatologists had the lowest prevalence. SLE incidence was 23.2 per 100,000 person-years and LN incidence was 6.9 per 100,000 person-years, with similar sociodemographic trends. Conclusion In this nationwide Medicaid population, there was sociodemographic variation in SLE and LN prevalence and incidence. Understanding the increased burden of SLE and its complications in this low-income population has implications for resource allocation and access to subspecialty care. [ABSTRACT FROM AUTHOR]

Objective To investigate the nationwide prevalence, incidence, and sociodemographics of systemic lupus erythematosus (SLE) and lupus nephritis among children in the US Medicaid beneficiary population. Methods Children ages 3 years to <18 years with a diagnosis of SLE (defined as ≥3 claims with an International Classification of Diseases, Ninth Revision [ICD-9] code of 710.0 for SLE, each >30 days apart) were identified from the US Medicaid Analytic eXtract database from 2000 to 2004. This database contains all inpatient and outpatient Medicaid claims for 47 US states and the District of Columbia. Lupus nephritis was identified from ≥2 ICD-9 billing codes for glomerulonephritis, proteinuria, or renal failure, each recorded >30 days apart. The prevalence and incidence of SLE and lupus nephritis were calculated among Medicaid-enrolled children overall and within sociodemographic groups. Results Of the 30,420,597 Medicaid-enrolled children during these years, 2,959 were identified as having SLE. The prevalence of SLE was 9.73 (95% confidence interval [95% CI] 9.38-10.08) per 100,000 Medicaid-enrolled children. Among the children with SLE, 84% were female, 40% were African American, 25% were Hispanic, 21% were White, and 42% resided in the South region of the US. Moreover, of the children with SLE, 1,106 (37%) had lupus nephritis, representing a prevalence of 3.64 (95% CI 3.43-3.86) per 100,000 children. The average annual incidence of SLE was 2.22 cases (95% CI 2.05-2.40) and that of lupus nephritis was 0.72 cases (95% CI 0.63-0.83) per 100,000 Medicaid enrollees per year. The prevalence and incidence rates of SLE and lupus nephritis increased with age, were higher in girls than in boys, and were higher in all non-White racial/ethnic groups. Conclusion In the current study, the prevalence and incidence rates of SLE among Medicaid-enrolled children in the US are high compared to studies in other populations. In addition, these data represent the first population-based estimates of the prevalence and incidence of lupus nephritis in the US to date. [ABSTRACT FROM AUTHOR]

The key objective of this study is to investigate the interrelationship between fuel economy gaps and to quantify the differential effects of several factors on fuel economy gaps of vehicles operated by the same garage. By using a unique fuel economy database (fueleconomy.gov), users' self-reported fuel economy estimates and government's fuel economy ratings are analyzed for more than 7000 garages across the United States. The empirical analysis, nonetheless, is complicated owing to the presence of important methodological concerns including potential interrelationship between vehicles within the same garage and unobserved heterogeneity. To address these concerns, bivariate seemingly unrelated fixed and random parameter models are presented. With government's test cycle ratings tending to over-estimate the actual on-road fuel economy, a significant variation is observed in the fuel economy gaps for the two vehicles across garages. A wide variety of factors such as driving style, fuel economy calculation method, and several vehicle-specific characteristics are considered. Drivers who drive for maximum gas mileage or drives with the traffic flow have greater on-road fuel economy relative to the government's ratings. Contrarily, volatile drivers have smaller on-road fuel economy relative to the official ratings. Compared to the previous findings, our analysis suggests that the relationship between fuel type and fuel economy gaps is complex and not unidirectional. Regarding several vehicle and manufacturer related variables, the effects do not just significantly vary in magnitude but also in the direction, underscoring the importance of accounting for within-garage correlation and unobserved heterogeneity for making reliable inferences. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel disease (IBD) increases the risk of venous thromboembolism (VTE) by 2 to 3 times. We compared the reduction in risk of incident VTE associated with use of tumour necrosis factor-α (TNF-α) inhibitors versus nonbiologic immunomodulatory agents in patients with IBD.Methods: This observational cohort study used data from public (Medicaid, 2000-2010; Medicare, 2007-2013) and private (Optum Clinformatics, 2004-2013) health insurance programs in the United States. We included a total of 21 671 patients who had IBD without a prior diagnosis of cancer or VTE. The exposure of interest was treatment initiation with TNF-α inhibitor or nonbiologic (azathioprine, mercaptopurine, methotrexate, cyclosporine). The outcome of interest was admission to hospital with VTE as the principal diagnosis. We used Cox proportional hazard regression models to estimate hazard ratios (HRs) separately for each database after risk adjustment for more than 50 covariables using propensity score fine stratification. We used inverse variance meta-analytic methods to pool the adjusted HRs across the 3 databases.Results: We included a total of 5173 patients who started TNF-α inhibitor therapy (1439 in the Medicaid database, 1480 in Medicare and 2254 in Optum Clinformatics) and 16 498 who initiated a nonbiologic agent (5041 in Medicaid, 5166 in Medicare, 6291 in Optum Clinformatics). The adjusted pooled HR for VTE risk with TNF-α inhibitor versus a nonbiologic agent was 0.78 (95% confidence interval [CI] 0.60 to 1.02). The HR was lower in patients with Crohn disease (pooled HR 0.62, 95% CI 0.44 to 0.86) and younger patients (18-44 yr; pooled HR 0.55, 95% CI 0.34 to 0.87).Interpretation: We did not find a statistically significant association between risk of VTE and use of TNF-α inhibitors, relative to nonbiologics, in patients with IBD overall. However, an association was evident for patients younger than 45 years and those with Crohn disease. [ABSTRACT FROM AUTHOR]

Background: Practice guidelines for perioperative pain management recommend that multimodal analgesic therapy should be used for all postsurgical patients. However, the proportion of patients who actually receive this evidence-based approach is unknown. The objective of this study was to describe hospital-level patterns in the utilization of perioperative multimodal analgesia.Methods: Data for the study were obtained from the Premier Research Database. Patients undergoing below-knee amputation, open lobectomy, total knee arthroplasty, and open colectomy between 2007 and 2014 were included in the analysis. Patients were considered to have multimodal therapy if they received one or more nonopioid analgesic therapies. Mixed-effects logistic regression models were used to estimate the hospital-specific frequency of multimodal therapy use while adjusting for the case mix of patients and hospital characteristics and accounting for random variation.Results: The cohort consisted of 799,449 patients who underwent a procedure at 1 of 315 hospitals. The mean probability of receiving multimodal therapy was 90.4%, with 95% of the hospitals having a predicted probability between 42.6 and 99.2%. A secondary analysis examined whether patients received two or more nonopioid analgesics, which gave an average predicted probability of 54.2%, with 95% of the hospitals having a predicted probability between 9.3 and 93.2%.Conclusions: In this large nationwide sample of surgical admissions in the United States, the authors observed tremendous variation in the utilization of multimodal therapy not accounted for by patient or hospital characteristics. Efforts should be made to identify why there are variations in the use of multimodal analgesic therapy and to promote its adoption in appropriate patients. [ABSTRACT FROM AUTHOR]

Background: Opioids play a crucial role in providing analgesia throughout the perioperative period; however, patients may become persistent users of these medications months after surgery. Epidurals have been posited to prevent the development of persistent pain, but there are little data on the effect of epidurals on persistent opioid use.Methods: This study was conducted using a claims database of a large, nationwide commercial health insurer. Opioid-naive patients who underwent open abdominal surgery from January 2004 to December 2013 were included in the study. Propensity scores for epidural placement were calculated accounting for demographic characteristics, resource utilization, and comorbid conditions (including medical, psychiatric, and pain conditions). Time-to-event analysis was used with the primary outcome defined as 30 days without filling an opioid prescription after discharge. In addition, total morphine equivalents dispensed within 90 days of discharge were also calculated for each patient.Results: A total of 6,432 patients were included in the final propensity score-matched cohort. The Cox proportional hazards ratio was 0.96 (95% CI, 0.91 to 1.01; P = 0.0910) for the relation between epidural placement and time till a 30-day gap without filling an opioid prescription. There was no difference in the total morphine equivalents dispensed within 90 days of discharge between the groups (P = 0.7670).Conclusions: Epidural placement was not protective against persistent opioid use in a large cohort of opioid-naive patients undergoing abdominal surgery. This finding does not detract from the other potential benefits of epidural placement. More research is needed to understand the mechanism of persistent opioid use after surgery and its prevention. [ABSTRACT FROM AUTHOR]

This research expands the study of political skill, a construct developed in North America, to other cultures. We examine the psychometric properties of the Political Skill Inventory (PSI) and test the measurement equivalence of the scale in a non-American context. Respondents were 1511 employees from China, Germany, Russia, Turkey, and the United States. The cross-cultural generalizability of the construct is established through consistent evidence of multi-group invariance in an increasingly stringent series of analyses of mean and covariance structures. Overall, the study provides systematic evidence that political skill can be treated as a stable construct among diverse cultural groups. Furthermore, our findings demonstrate that translated PSI measures operationalize the construct similarly. With some exceptions, the item loadings and intercepts are invariant for the US and non-US responses, suggesting partial measurement equivalence. After verifying the accuracy of item translation, we conclude that any differences can be explained by variation in the cultural value of uncertainly avoidance and cultural differences on a low-to-high context continuum. Detected dissimilarities are addressed, and some suggestions regarding the correct use across borders of the instrument by managers and researchers are provided. [ABSTRACT FROM PUBLISHER]

Abstract: Vacuolar protein sorting 35 (VPS35) Asp620Asn mutation has been identified in late-onset familial Parkinson''s disease (PD) patients of Swiss and Austrian descent as well as sporadic PD patients in the United States. In order to determine the contribution of VPS35 mutations in mainland Chinese PD patients and to better understand the association between VPS35 and PD, we sequenced all 17 exons of VPS35 in 32 probands of presumed autosomal-dominant, late-onset familial PD and 35 normal controls. Meanwhile, we analyzed VPS35 Asp620Asn mutation in 512 PD patients. A total of 371 subjects without neurological disorders from the same region in China were set as a control group. We did not find any VPS35 coding region mutation in 32 familial PD patients. VPS35 Asp620Asn mutation was either not found in 480 PD patients. Our results suggested that VPS35 Asp620Asn may be not associated with PD in Chinese population. [Copyright &y& Elsevier]