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Background: As a new obesity-related index, the weight-adjusted-waist index (WWI) appears to be a good predictor of cardiovascular disease (CVD) in East Asian populations. This study aimed to validate the association between WWI and CVD in United States (US) adults and also evaluate its relationships with the prevalence of specific CVDs. Methods: The data were obtained from the 2009–2016 National Health and Nutrition Examination Survey. WWI was calculated as waist circumference divided by the square root of weight, and CVD was ascertained based on self-reported physician diagnoses. Multivariable logistic regression models and subgroup analyses were performed to evaluate the association between WWI and CVD. Results: A total of 21,040 participants were included. There was a positive linear relationship between WWI and the odds of CVD (P = 0.310). After adjusting for all covariates, each unit of increased WWI was associated with 48% increased risk of CVD (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.25–1.74). Moreover, compared with the lowest quintile (< 10.3 cm/√kg), the multivariable-adjusted OR was 3.18 (95% CI: 1.80–5.59) in the highest quintile (≥ 11.8 cm/√kg). Besides, positive associations were also found between WWI and increased prevalence of congestive heart failure (OR: 1.47, 95% CI: 1.11–1.96), coronary heart disease (OR: 1.27, 95% CI: 1.01–1.60), angina (OR: 1.44, 95% CI: 1.06–1.96), heart attack (OR: 1.66, 95% CI: 1.29–2.12), and stroke (OR: 1.32, 95% CI: 1.02–1.70). Subgroup analyses showed that stronger associations between WWI and CVD were detected in participants younger than 50 years of age (P < 0.001). Conclusions: High levels of WWI were significantly associated with an increased risk of CVD in US adults, particularly in people under 50 years of age. These findings indicate that WWI may be an intervention indicator to reduce the risk of CVD in the general adult population. [ABSTRACT FROM AUTHOR]

Multi‐physics ensembles have emerged as a promising approach to hydrological simulations. As multi‐physics ensembles are constructed by perturbing the model physics, the ensemble members share a substantial portion of the same physics and hence are not independent of each other. It is unknown whether and to what extent this nonindependence affects the skill gain of the ensemble method, especially compared with the multi‐model ensemble approach. This study compares a multi‐physics ensemble configured from the Noah land surface model with multi‐parameterization options (Noah‐MP) with the North American Land Data Assimilation System (NLDAS) multi‐model ensemble. The two ensembles are evaluated in terms of the annual cycle and interannual anomaly at 12 River Forecast Centers over the conterminous United States. The ensemble skill gain is measured by the difference between the performance of the ensemble mean and the average of the ensemble members' performance, and the inter‐member independence is measured by error correlations. Results show that, due to the improved model physics, the Noah‐MP configurations outperform, on average, the NLDAS models, especially in the snow‐dominated areas. The Noah‐MP ensemble almost always obtains an outstanding member that performs the best among the two ensembles, reflecting its dense sampling of the feasible model physics space. However, these two performance superiorities do not lead to a superiority of the ensemble mean. The Noah‐MP ensemble has a lower ensemble skill gain, which corresponds to the lower inter‐member independence. These results highlight the importance of inter‐member independence, particularly when most hydrological ensemble methods have overlooked it. Key Points: Multi‐physics ensembles can sophisticatedly treat the regional difference in dominant processes with a dense sampling of model physics spaceThe overlap in the physics among the multi‐physics ensemble members leads to a lower inter‐member independence and ensemble skill gainThere is a need for advancing ensemble methods to account for both performance and independence, especially for a multi‐physics ensemble [ABSTRACT FROM AUTHOR]

Purpose: This study aims to analyze patient demographics, hospital characteristics, and clinical risk factors which predict penile prosthesis removal. We also examine costs of penile prosthesis removal and trends in inflatable versus non-inflatable penile prostheses implantation in the USA from 2003 to 2015. Methods: Cross-sectional analysis from Premier Perspective Database was completed using data from 2003 to 2015. We compared the relative proportion of inflatable versus non-inflatable penile prostheses implanted. We separated the prosthesis removal group based on indication for removal—Group 1 (infection), Group 2 (mechanical complication), and Group 3 (all explants). All groups were compared to a control group of patients with penile implants who were never subsequently explanted. Multivariate analysis was performed to analyze patient and hospital factors which predicted removal. Cost comparison was performed between the explant groups. Results: There were 5085 penile prostheses implanted with a stable relative proportion of inflatable versus non-inflatable prosthesis over the 13-year study period. There were 3317 explantations. Patient factors associated with prosthesis removal were non-black race, Charlson Comorbidity Index, diabetes, and HIV status. Hospital factors associated with removal included non-teaching status, hospital region, year of removal, and annual surgeon volume. Median hospitalization costs of all explantations were $10,878. Explantations due to infection cost $11,252 versus $8602 for mechanical complications. Conclusions: This large population-based study demonstrates a stable trend in inflatable versus non-inflatable prosthesis implantation. We also identify patient and hospital factors that predict penile prosthesis removal which has clinical utility for patient risk stratification and counseling. [ABSTRACT FROM AUTHOR]

Polychlorinated biphenyl (PCB) congeners were analyzed in eight deep, dated sediment cores collected from the immediate upstream and downstream of DePere dam in Fox River, Wisconsin. The average time span of the cores is about 100 yr, except for one core (FR-9) which is influenced by mixing or covers a short time period (2 yr). The total PCB concentrations have a range of 0.2-6.8 ppm for the upstream and 0.3-17.6 ppm for the downstream cores. The PCB data obtained from the sampling were analyzed as upstream and downstream data, using a factor analysis (FA) model with nonnegative constraints to identify PCB sources and congener patterns. The factor loadings obtained from the FA model were interpreted in terms of the presence of possible environmental degradation mechanisms. In addition, a recently developed model, which is used to identify and quantify possible pathways of anaerobic dechlorination of PCBs in the sediments, was validated on the basis of in situ data from the literature, and then applied to the congener patterns obtained from the FA model. The major PCB source to the Fox River sediments is identified as Aroclor 1242, for both the upstream and the downstream sediments. Loss of di- and trichlorobiphenyls (e.g., 2-4, 25-2) from the sediments suggests desorption from the sediments. On the other hand, observation of elevated amounts of certain congeners such as 24-3 and 25-3 indicates the presence of anaerobic dechlorination activity. The anaerobic dechlorination model demonstrates significant similarities between the Aroclor 1242 profile altered according to dechlorination processes U (upstream) and H' (downstream) and the dominant congener patterns obtained from the FA model. [ABSTRACT FROM AUTHOR]

Examines a possible explanation for the existence of restrictions on stock trading in foreign markets that reduce or negate the benefits of diversification for U.S. investors. Alternative investment for portfolio managers; Details of short sales in investment; Analysis of stock returns in several countries from 1976 to 1999.

Analyzes the effects of short-sale constraints using two measures of diversification benefits in the U.S.

Objective: F-18-fluorothymidine (FLT) is a positron emission tomography (PET) tracer for imaging cell proliferation in vivo. We aimed to assess FLT uptake as a marker for cerebral cell proliferation in a rat model of ischemic stroke and patients with cerebral infarct, correlating with disease severity and outcomes., Methods: Cerebral FLT PET was performed in rats subjected to transient middle cerebral artery occlusion (MCAO) and patients with cerebral infarct. PET data were analyzed and expressed as average standardized uptake value ratios (SUVRs) using cerebellar cortex as reference. Infarct volume was analyzed by 2,3,5-triphenyltetrazolium chloride staining in rats and by magnetic resonance imaging in patients. Neurological function was assessed using modified Neurological Severity Score (mNSS) for rats and National Institutes of Health Stroke Scale (NIHSS) for patients., Results: Seven days post-MCAO, rats' FLT PET displayed higher SUVRs in the infarcted brain, declining gradually until Day 28. FLT-binding ratio (SUVR in the infarcted brain divided by that in contralateral side) correlated positively with stroke severity (p < 0.001), and to early mNSS decline in rats with mild to moderate stroke severity (p = 0.031). In 13 patients with cerebral infarct, FLT PET showed high SUVR in the infarcted regions. FLT-binding ratio correlated positively with infarct volume (p = 0.006). Age-adjusted initial NIHSS (p = 0.035) and early NIHSS decline (p = 0.076) showed significance or a trend toward positive correlation with the FLT-binding ratio., Interpretation: In vivo FLT PET detects poststroke cerebral cell proliferation, which is associated with stroke severity and/or outcomes in MCAO rats and patients with cerebral infarct., (© 2023 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

Background: Most studies have explored the relationship between serum total folate and nonalcoholic fatty liver disease (NAFLD) in adults, but there has been no study on the relationship between different folate forms and hepatic steatosis or liver stiffness in adolescents., Objective: To investigate the association of different folate forms with hepatic steatosis or liver stiffness in adolescents, and further explore the intermediary role of BMI in this relationship., Methods: The cross-sectional study included 549 participants from the 2017-2018 National Health and Nutrition Inspection Survey (NHANES) survey cycle who had complete data. Four folate data (red blood cell folate, serum total folate, 5-methyl-tetrahydrofolate and folic acid) were included in our study. Controlled attenuation parameters (CAP) and liver stiffness came from the results of liver ultrasound transient elastography. We used linear regression to analyze the relationship between different forms of folate and CAP or liver stiffness, and logistic regression to analyze the relationship between different forms of folate and NAFLD or significant fibrosis. We also used restricted cubic splines to analyze the nonlinear relationship between different forms of folate and NAFLD or significant fibrosis. Finally, we used regression-based intermediary analysis to distinguish the direct and BMI-mediated effects of folate on CAP or liver stiffness. All the analyses adjusted the relevant covariates., Results: The means of CAP and liver hardness in this study were 223.02dB/m and 5.03kPa, respectively. We found that in model 2, there was a negative correlation between serum total folate (β: -18.53; 95%CI: -29.32 to -7.73) or 5-methyltetrahydrofolate (β: -14.13; 95%CI: -28.98 to -7.86) and CAP. However, when the BMI was further adjusted in model 3, this negative correlation no longer existed (serum total folate: β: -8.36; 95%CI: -17.69 to 0.97; 5-methyltetrahydrofolate: β: -8.05; 95%CI: -17.19 to 1.09). Similarly, we found a negative correlation between serum total folate or 5-Methyl-tetrahydrofolate and liver stiffness in model 2. There was no significant correlation between red blood cell folate or folic acid and CAP or liver stiffness in either model 2 or model 3. The nonlinear relationship between different folate forms and NAFLD or significant fibrosis was not significant. It is estimated that 76% of the total association between serum total folate and CAP is mediated by BMI. The mediating proportion of BMI in the total correlation between serum total folate and liver stiffness was 50%. Similarly, we found that BMI significantly mediated the relationship between 5-Methyl-tetrahydrofolate and CAP or liver stiffness, with a mediating ratio of 77% and 49%, respectively., Conclusion: Our results show that serum total folate or 5-Methyl-tetrahydrofolate are negatively correlated with hepatic steatosis or liver stiffness in adolescents, and BMI plays major mediating role in this relationship. Our findings emphasize the importance of monitoring the concentration of serum folate, not just the serum total folate concentration., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wen, Fei, Yuan, Li, Xu, Cao, Su, Zhu and Zhang.)

Porcine pegiviruses (PPgV) have been first discovered in serum samples from domestic pigs in Germany in 2016 and then in the USA in 2018. To date, there is no documentation with respect to the presence of PPgVs in domestic pigs in China. Herein, we attempted to determine the presence and prevalence of PPgV in China and its genetic characterization. In this study, 469 sera were tested and 34 (7.25%) were positive for PPgV. An ascending trend of the positive rate for PPgV was observed from suckling piglets (1.61%) to nursing piglets (1.85%), finishing pigs (6.56%), and sows (11.34%). The complete genome sequence of a representative strain of PPgV, PPgV&#95;GDCH2017, and the complete E2 gene of 17 PPgV isolates discovered in this study was determined. Sequence analysis indicated that PPgV&#95;GDCH2017 was highly related to other PPgVs with nucleotide and amino acid identities ranging from 87.3 to 97.4% and 94.6-99.3%, respectively, in the complete coding region. Phylogenetic analyses demonstrated that the PPgV&#95;GDCH2017 discovered in this study was closely related to the PPgVs from the USA and clustered in the same genus with pegiviruses from other hosts. The topology of the phylogenetic tree based on the complete E2 gene was consistent with that based on the complete genome of PPgV. Further studies on pathogenicity and pathogenesis of PPgVs are needed.

Introduction: The epidemiology of penile fractures in the emergency setting is not well described., Aim: Examine the incidence, evaluation, management, risk factors predicting surgical repair or hospital transfer, and use of financial resources in patients presenting with penile fractures to the emergency departments (ED) nationwide in the Unites States., Methods: ED visits with a primary diagnosis of penile fractures (International Classification of Diseases, Ninth Edition codes) between 2010-2014 were abstracted from the Nationwide Emergency Department Sample., Main Outcome Measure: Penile fracture incidence, disposition, hospital, and clinical factors which were associated with immediate surgical repair or transfer to another institution, and cost were investigated., Results: 8,029 ED visits for penile fracture in the United States were observed, which represents a national incidence of 1.02 per 100,000 male subjects per year. No meaningful trends in incidence were observed over the 5-year period. 63.9% were treated non-surgically or discharged from the ED, 25.7% underwent surgical repair, and 10.3% were transferred to other institutions. Hospital factors which predicted surgical repair included Northeast region, teaching hospital status, trauma hospital status, high volume ED, and urban location. Clinical risk factors which predicted surgical repair included hypertension, smoking, alcohol dependence, drug abuse, erectile dysfunction, hematuria, urethral injury, and urinary retention. Factors leading to patient transfers included non-academic, rural and non-trauma hospitals, low economic income and low emergency department volume. In addition, weekend and spring presentation were associated with higher transfer rates, while summer presentation was associated with surgical repair., Clinical Implications: A large proportion of penile fractures are discharged from the ED, indicating possible health care access disparity., Strengths & Limitations: This is one of the first population-based study of penile fracture incidence, disposition, risk factors which predict surgery or transfer, and cost in the US ED setting. The unexpected high number of discharges may be a result of misdiagnosis; alternatively these data may reveal previously under-reported management patterns in the community., Conclusion: This large retrospective study of penile fractures in the US ED setting demonstrates a stable incidence of penile fractures presenting to the US emergency departments. A quarter of patients undergo immediate surgical repair, 10% are transferred to other institutions and 63.9% of patients are discharged home. The high proportion of ED discharges may be due to access to health care disparities. Rodriguez D, Li K, Apoj M, et al. Epidemiology of Penile Fractures in United States Emergency Departments: Access to Care Disparities May Lead to Suboptimal Outcomes. J Sex Med 2019;16:248-256., (Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: The objective of the study was to identify trends in incidence of adult diffuse gliomas in the United States and evaluate the contribution of age, period, and cohort effects to the trends., Methods: Using the Surveillance, Epidemiology, and End Results 9 database, primary diffuse glioma patients (≥20 years old) diagnosed from 1973 to 2014 were identified. Incidence trends were analyzed using joinpoint regression and age-period-cohort modeling., Results: Overall, the incidence for adult glioma decreased slowly from 1985 to 2014 (annual percent change [APC] = 0.5%, 95% confidence intervals [CI], 0.3%-0.6%). In histology subtype-stratified analysis, glioblastoma and nonglioblastoma exhibited opposite trends. The incidence for glioblastoma increased from 1978 to 2014 (APC for year 1978-1992 = 2.7%, 95% CI, 1.8%-3.6%; APC for 1992-2014 = 0.3%, 95% CI, 0%-0.6%), while the incidence for nonglioblastoma decreased significantly from 1982 to 2014 (APC = 2.2%, 95% CI, 2.0%-2.5%). Age-period-cohort modeling revealed significant period and cohort effects, with the patterns for glioblastoma and nonglioblastoma distinctive from each other. Compared with adults born 1890s, those born 1920s had approximately 4-fold the risk of glioblastoma after adjustment of age and period effects, while the risk of nonglioblastoma was reduced by half in individuals in the 1939 cohort as compared with those in the 1909 cohort., Conclusions: The results support the hypothesis of etiological heterogeneity of diffuse gliomas by histology subtypes. The established risk factors cannot fully explain the distinct patterns by histology subtypes, which necessitate further epidemiological studies., (© 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Psoriasis, a chronic inflammatory skin condition, is a complex disease in terms of its significant comorbidities and impact on patients' quality of life. The objective of this article is to elucidate the health outcomes of the disease, including its economic and psychosocial burden on the patient. Current treatments options and the economic considerations of treatment costs are reviewed. Psoriasis is a multidimensional disease, so patients benefit from having a multidisciplinary team of dermatologists and other physicians for management of it and of associated comorbid conditions., (Published by Elsevier Inc.)

Friction variation has been related to employees' perception of slipperiness in a field study conducted in fast-food restaurants. However, details of friction variation in actual workplaces have not been reported in the literature. This field study investigated friction variations in 10 fast-food restaurants in the USA. The results indicated that friction reductions in a step exceeding 10% were proportional to the ages of the floor tiles in most restaurants. There were more friction reductions exceeding 10% in the sink areas than the other five areas measured, but all the areas had more than 10% friction reductions in at least one of the restaurants. As expected, significant relative friction reductions are common on older floors. A small portion of the newer tiles had significant relative friction reductions, despite their overall higher friction levels. Therefore, slip and fall preventions should not be overlooked in restaurants with newer floors. Friction variation is speculated to be a significant contributor to slip and fall incidents. However, friction variation has not been quantified in the literature. Understanding of potential friction variations in field environments helps identify potential issues for interventions. This field study investigated friction variations in fast-food restaurants in the USA.

Although friction variation is speculated to be a significant contributor to slip and fall incidents, it has not been related to a measurement of slipperiness in the literature. This field study investigated the relationship among multiple friction variations, friction levels and the perception ratings of slipperiness in six major working areas of 10 fast-food restaurants in the USA. The mean perception rating score for each working area was correlated with various friction reduction variables across all the restaurants in comparison with its correlation with the mean friction coefficient of each working area. The results indicated that the absolute and relative reductions in friction over the whole working area, among 12 friction reduction variables evaluated, could have a slightly better correlation with the perception rating score (r=0.34 and 0.37, respectively) than the mean friction coefficient of each working area (0.33). However, in friction measurements, more effort and time are needed to quantify friction variations than to obtain the mean friction coefficient. The results of the multiple regression model on the perception rating indicated that adding friction reduction variables into the regression model, in addition to the mean friction coefficient, did not make a significant impact on the outcomes. The results further indicated a statistically significant correlation between the mean friction coefficient and the maximum relative friction reduction over the whole area in each working area across all the restaurants evaluated (r=0.80). Despite a slightly lower correlation with perception rating than the friction variation, the mean friction coefficient of an area is still a reasonably good indicator of slipperiness.

Falls are responsible for a substantial injury burden in the global workplace. Restaurant environments are particularly challenged by slips, trips, and falls. This study explored those factors that could influence workers' self-reports of slipperiness in U.S. fast-food restaurants. One hundred and twenty-six workers employed in 10 fast-food restaurants in the northeastern United States participated in the study representing a study-wide response rate of 87.5%. Participants' ratings of floor slipperiness and occupational slip history within the past 4 weeks were collected through written questionnaire. Additional factors collected by questionnaire included age, gender, shift length, and shoe type. Shoe condition (wear) and shoe contamination were visually assessed by the investigators. Floor friction was also measured. Lower restaurant mean coefficient of friction and the presence of contamination on workers' shoe soles were environmental factors significantly associated with workers reporting more slippery conditions. A recent workplace history of slipping with or without a subsequent fall was also significantly associated with workers reporting more slippery conditions. Workers over the age of 45 reported conditions to be significantly less slippery than younger workers. The results suggest that worker ratings of slipperiness are influenced not only by the actual level of friction but also by the other individual and environmental factors noted above. Recommendations for future studies would include a longitudinal design to better capture the temporal sequence between these variables. More field research is needed to better understand the association between workplace conditions, worker perception of slipperiness, and slipping at work.