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Advancing age is a risk factor for developing non-valvular atrial fibrillation (NVAF) or acute venous thromboembolism (VTE). We assessed the comparative effectiveness, safety, costs, and healthcare utilization associated with rivaroxaban versus warfarin in patients of advanced age managed in the United States (US). We conducted a systematic review of Medline and Embase through April 2023 to identify real-world evidence (RWE) studies of older adults (at least 65+ years of age) with either NVAF or VTE who received either rivaroxaban or warfarin in the US and reported an outcome of stroke or systemic embolism (SSE), ischemic stroke (IS), recurrent VTE, major bleeding, intracranial hemorrhage, costs, or healthcare resource utilization. We classified each outcome of interest per study as "positive" (lower risk), "negative" (higher risk), or "neutral" based upon the summary effect size of rivaroxaban versus warfarin. Twenty-nine RWE studies met inclusion criteria, mostly (83%) in NVAF populations. For SSE with rivaroxaban versus warfarin, 68.8% of studies showed positive effects and 31.2% showed neutral outcome. For major bleeding, 57.7% showed neutral effects, 38.5% showed negative effects, and 3.8% of studies showed positive effects with rivaroxaban versus warfarin. Of the two studies reporting cost data, both were positive, showing lower costs for SSE for rivaroxaban versus warfarin and neutral cost for major bleeding costs. This systematic review supports findings from subgroup analyses of randomized controlled trials that, compared with warfarin, rivaroxaban is associated with generally neutral or positive effects on thrombosis and a mixed picture on bleeding outcomes in older adults with either NVAF or VTE treated in the United States. [ABSTRACT FROM AUTHOR]

Objectives. Yersiniosis, a foodborne infection of zoonotic origin caused by the bacteria Yersinia enterocolitica and Yersinia pseudotuberculosis, is a reportable disease in 38 states. Both sporadic and foodborne outbreaks of yersiniosis have been reported in the U.S., with annual occurrence of an estimated 98,000 episodes of illness, 533 hospitalizations, and 29 deaths. We analyzed surveillance data from nine non-FoodNet-participating U.S. states during the period 2005-2011 to describe the epidemiology of this disease. Methods. As part of a passive surveillance system, laboratory-confirmed cases of yersiniosis were reported to state health departments in Arizona, Illinois, Michigan, Missouri, Nebraska, North Carolina, South Carolina, Washington, and Wisconsin. We calculated overall, age-, and race-specific annual incidence rates per 100,000 population using 2010 Census data as the denominator. We used Poisson regression to examine seasonal variation and annual incidence trends by race, age group, and overall. Results. The average annual incidence of yersiniosis was 0.16 cases per 100,000 population during 2005-2011. We observed a statistically significant decreasing annual trend of yersiniosis incidence among African Americans <5 years of age (p<0.01), whereas white people aged 19-64 years (p=0.08) and Hispanic people (p=0.05) had an overall increasing annual incidence of yersiniosis. We observed higher incidence during October-December (p<0.01) and January-March (p=0.03) quarters among African Americans, whereas white people had a higher incidence during April-June (p=0.05). Conclusion. This multistate analysis revealed differences in the epidemiology of yersiniosis by race/ethnicity that may be useful for future research and prevention efforts. While this study was consistent with the FoodNet report in recognizing the high and declining incidence among African American children and winter seasonality among African Americans, our study also identified April-June seasonality among the white population. [ABSTRACT FROM AUTHOR]

This study was conducted to estimate the indirect costs and health-related quality of life (HRQoL) (utilities) of multiple sclerosis (MS) patients in the United States (US), and to determine the impact of worsening mobility on these parameters. In collaboration with the North American Research Committee on Multiple Sclerosis (NARCOMS) registry we conducted a cross-sectional study of participants who completed the biannual update and supplemental spring 2010 survey. Demographic, employment status, income, mobility impairment, and health utility data were collected from a sample of registry participants who met the study criteria and agreed to participate in the supplemental Mobility Study. Mean annual indirect costs per participant in 2011 US$ and mean utilities for the population and for cohorts reporting different levels of mobility impairment were estimated. Analyses included 3,484 to 3,611 participants, based on survey completeness. Thirty- seven percent of registrants were not working or attending school and 46.7% of these reported retiring early. Indirect costs per participant per year, not including informal caregiver cost, were estimated at $30,601±31,184. The largest relative increase in indirect costs occurred at earlier mobility impairment stages, regardless of the measure used. Participants' mean utility score (0.73±0.18) was lower than that of a similarly aged sample from the general US population (0.87). As with indirect costs, larger decrements in utility were seen at earlier mobility impairment stages. These results suggest that mobility impairment may contribute to increases in indirect costs and declines in HRQoL in MS patients. [ABSTRACT FROM AUTHOR]

The article provides information on the U.S. comparative advantage in bioenergy. It draws some concepts coming from the studies conducted by the Organization for Economic Co-Operation and Development (OECD) in which several policy instruments, trade in biofuels, tax credits, import tariffs, agriculture, production technologies, crude oil prices, crop yields, and production technologies are analyzed. It is stated that technological innovation maybe accounted for the comparative advantage of the United States when it comes to biofuel and ethanol production. A stylized trade model that employs a Heckscher-Ohlin-Ricardo approach could become a predicting factor for the economic advantage of the United States.

Abstract: This paper specifies and estimates state-level models of short- and long-term electricity demand in the United States. The short-term model predicts hourly load based on weather and calendar inputs. The long-term model estimates interannual demand, and includes population, prices, and gross state product as predictors. These models are combined to incorporate the short- and long-term trends in electricity consumption when generating forecasts of diurnal patterns into the future. Finally, the authors investigate the effects of short-run price elasticities of demand. The short-term model is shown to be within 95% accuracy of actual levels in out-of-sample tests. [Copyright &y& Elsevier]

Aim: To describe national surgical patterns of prostate cancer (PCa) care considering radical prostatectomy with or without pelvic lymphadenectomy and consideration of robotic-assisted techniques., Methods: Retrospective analysis of publicly accessible Medicare claims data was performed for the period 2001-2016 and included patients undergoing radical prostatectomy with or without pelvic lymphadenectomy relative to total and PCa-specific populations among men aged 45-84 years. Proportion of cases performed robotically was considered., Results: Total procedures performed increased from 2001, peaked in 2009 and subsequently decreased until 2016. Since 2009, the age-specific rate of surgery in men aged 75-84 increased by 2.3-fold, whereas the rates for men aged 55-64 and 45-54 reduced by 44% and 55%, respectively. Rates of concurrent pelvic lymphadenectomy fell until 2009 with subsequent stabilization (ratio 1.05-1.14) through to 2016. Significant regional practice patterns were observed, as was an increasing trend toward a robotic-assisted laparoscopic approach, comprising more than 80% of radical prostatectomies in 2016., Conclusion: Since the peak in 2009, radical prostatectomy is performed less in men <65 years and more in men ≥65 years. An increasing proportion of cases omit concurrent pelvic lymphadenectomy and are performed robotically., (© 2019 John Wiley & Sons Australia, Ltd.)

Introduction: Safety research in the U.S. motor carrier context remains important, as the trucking industry employs approximately 1.7 million large truck drivers. Drivers face many competing pressures in this unique high risk, high regulation, and low direct supervision context. They represent the cornerstone of safe carrier operations., Methods: Using a multi-theoretical approach, this study investigates how drivers' perceptions of carrier safety climate influence their safety-related attitudes and intentions., Results: Responses from nearly 1500 over the road drivers provide evidence that safety climate directly influences drivers' attitudes toward safety, safety norms, and driver risk avoidance, and indirectly influences drivers' intentions to commit unsafe acts. These findings replicate previous findings and also extend the nomological network of theory in this context, adding driver risk avoidance as a central factor to the driver safety theoretical framework. Additionally, carrier managers are encouraged to reflect on the study's evidence and pursue a better understanding of their drivers' risk perceptions and tolerance, while minimizing avoidable risk through prudent safety and operational policies, procedures, and processes. Future research in this area is highly encouraged., (Copyright © 2019 Elsevier Ltd and National Safety Council. All rights reserved.)

Background: Few studies have examined how changes in BMI [body mass index] over time associate with risk of adverse outcomes in children receiving renal replacement therapy [RRT]. The objective of this study was to examine the association between annualized changes in BMI and the risk of death in children treated with RRT., Methods: We performed a retrospective cohort study of 1182 pediatric dialysis and transplant patients in the Pediatric Growth and Development Special Study of the United States Renal Data System. Quintiles of annualized change in BMI z-score (with cutoffs of - 0.50, - 0.13, 0.09, 0.57) were used as the primary predictor, with the middle quintile (- 0.13 to 0.09) serving as the reference category. Cox models were used to examine the association between exposure and death, with time of analysis starting from the second BMI measurement., Results: Median follow-up time to death or censoring was 6 years. Median age was 14.6 years, and 61% of children had a functional graft at cohort entry. There was a U-shaped association between BMI change and mortality risk: a large decline in annualized BMI z-score change (> - 0.50) was associated with an increased risk of death (adjusted hazard ratio [aHR] 1.54 (95% CI 1.17-2.03), p = 0.002). A large increase in annualized BMI z-score change (> 0.57) was also associated with an increased risk of death (aHR 1.44 (95% CI 1.07-1.92), p = 0.02). No interaction was noted between annualized BMI change and initial treatment modality (dialysis or transplant, p = 0.15)., Conclusions: Maintenance of a stable BMI in pediatric patients receiving RRT may be associated with improved survival.

Objective: Fingolimod has been shown to be more efficacious than interferon (IFN) beta-1a, but at a higher drug acquisition cost. The aim of this study was to assess the cost-effectiveness of fingolimod compared to IFN beta-1a in patients diagnosed with relapsing-remitting multiple sclerosis (RRMS) in the US., Methods: A Markov model comparing fingolimod to intramuscular IFN beta-1a using a US societal perspective and a 10-year time horizon was developed. A cohort of 37-year-old patients with RRMS and a Kurtzke Expanded Disability Status Scale score of 0-2.5 were assumed. Data sources included the Trial Assessing Injectable Interferon vs FTY720 Oral in Relapsing-Remitting Multiple Sclerosis (TRANSFORMS) and other published studies of MS. Outcomes included costs in 2011 US dollars, quality-adjusted life years (QALYs), number of relapses avoided, and incremental cost-effectiveness ratios (ICERs)., Results: Compared to IFN beta-1a, fingolimod was associated with fewer relapses (0.41 vs 0.73 per patient per year) and more QALYs gained (6.7663 vs 5.9503), but at a higher cost ($565,598 vs $505,234). This resulted in an ICER of $73,975 per QALY. Results were most sensitive to changes in drug costs and the disutility of receiving IFN beta-1a. Monte Carlo simulation demonstrated fingolimod was cost-effective in 35% and 70% of 10,000 iterations, assuming willingness-to-pay thresholds of $50,000 and $100,000 per QALY, respectively., Limitations: Event rates were primarily derived from a single randomized clinical trial with 1-year duration of follow-up and extrapolated to a 10-year time horizon. Comparison was made to only one disease-modifying drug-intramuscular IFN beta-1a., Conclusion: Fingolimod use is not likely to be cost-effective compared to IFN beta-1a unless fingolimod cost falls below $3476 per month or a higher than normal willingness-to-pay threshold is accepted by decision-makers.

Background: In 2003, a limited survey regarding the number of dedicated foot and ankle faculty and foot and ankle rotations at orthopaedic surgery residency programs was published. The purpose of this paper was to update the results of that previous survey and provide additional, more in-depth information., Materials and Methods: A survey questionnaire was emailed to the program directors and chairpersons of the 150 ACGME-accredited orthopaedic residency training programs in the United States., Results: Responses were obtained from all programs. One hundred thirty-seven (91.3%) programs had one or more orthopaedic surgeon faculty members with a predominantly foot and ankle practice (at least 50%), an increase of 5.5 percentage points from the survey performed 6 years previously. One hundred forty three (95.3%) programs had one or more orthopaedic surgeon faculty members with a practice consisting of at least 25% foot and ankle. One hundred twenty programs (80%) had one or more dedicated foot and ankle rotations, an increase of 15.1% from 6 years prior. Orthopaedic surgery residents were felt to spend a mean of 30.4% and a median of 20% of their time with board-certified/ board-eligible orthopaedic surgeons in rotations that include treatment of foot and ankle pathology but were not considered ;;dedicated'' foot and ankle rotations., Conclusions: The number of orthopaedic surgery residency programs with rotations and faculty members dedicated to foot and ankle education has increased over the 6 years between surveys. Orthopaedic surgery residents' experience and skill development in foot and ankle surgery during their 5 years of residency training are not limited to their time spent in dedicated foot and ankle rotations.