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The article discusses the features and reasons for the development of electric vehicles in the context of intensifying globalization processes and limited resources. It is substantiated that motorization is a key factor in the development of developed countries. Therefore, the presence of a competitive and well-functioning automotive market is an important condition for successful economic growth. The experience of foreign countries in stimulating the production and consumption of electric vehicles has been studied. Current trends in the development of the global electric vehicle market have been analyzed. It has been found that more than a third of the global market (over 36%) of electric vehicles is occupied by three manufacturers: BYD, Tesla and Volkswagen. An analysis of the global electric vehicle market by country shows that three countries are the leaders in electric vehicle sales: China, Europe, and the United States. It has been observed that China is ahead of other leading countries in terms of electric vehicle consumption, and the following companies have the greatest demand for electric vehicles in its market: BYD, SAIC and Tesla. Chinese manufacturers are showing faster growth rates in electric vehicle production than leading American and European companies. The article classifies the problems of development of the global market for electric vehicles: the global energy crisis, shortage of resource components for electric vehicles, the Covid-19 pandemic, uneven development of countries, institutional factors. Taking into account current global development trends, we conclude that the global electric vehicle market will develop at a rapid pace, effectively solving the problems hindering the growth of electric vehicle production. It has been substantiated that Ukraine has the potential to produce electric vehicles. Using the latest Industry 4.0 technologies and research and production potential, Ukraine can produce cars of a new generation, since developments in this area do not stop. Based on the graphic of the Ukrainian alphabet «Ruthenia», a sample trademark for the national electric vehicle has been developed and proposed. It has been established that this graphic most closely matches the functions and requirements of developing a national trademark. The proposed trademark reflects the features of the national manufacturer, indicates the latest technologies and will attract the attention of consumers. [ABSTRACT FROM AUTHOR]

There are two known directions of work on the implementation of inertial thermonuclear fusion using Z-pinches. In the first, to achieve thermonuclear ignition, it is proposed to compress the target by indirect irradiation with Z-pinch X-ray radiation. The other direction is to compress the preheated magnetized plasma with a liner. Preheating reduces compression requirements, while magnetization reduces thermal conductivity losses and provides additional heating by α-particles even at low plasma density. This concept is being developed in the United States at the Z machine (MagLIF project). According to existing concepts, in order to achieve thermonuclear ignition in these schemes, facilities are required that can create a current pulse with an amplitude of ~ 60 MA. The most powerful facilities based on capacitor banks—the Z machine—realizes a current of up to 25 MA. The creation of facilities that are one order of magnitude more powerful than the Z machine is a matter of the future. Along with this, explosive magnetic generators (EMG) today already implement the required energy, although with much longer rise time of current pulse. The paper discusses the possibilities of using the EMG to achieve the ignition, the arising problems and ways to solve them. [ABSTRACT FROM AUTHOR]

Background Free-text directions generated by prescribers in electronic prescriptions can be difficult for patients to understand due to their variability, complexity and ambiguity. Pharmacy staff are responsible for transcribing these directions so that patients can take their medication as prescribed. However, little is known about the quality of these transcribed directions received by patients. Methods A retrospective observational analysis of 529 990 e-prescription directions processed at a mailorder pharmacy in the USA. We measured pharmacy staff editing of directions using string edit distance and execution time using the Keystroke-Level Model. Using the New Dale-Chall (NDC) readability formula, we calculated NDC cloze scores of the patient directions before and after transcription. We also evaluated the quality of directions (eg, included a dose, dose unit, frequency of administration) before and after transcription with a random sample of 966 patient directions. Results Pharmacy staff edited 83.8% of all eprescription directions received with a median edit distance of 18 per e-prescription. We estimated a median of 6.64 s of transcribing each e-prescription. The median NDC score increased by 68.6% after transcription (26.12 vs 44.03, p<0.001), which indicated a significant readability improvement. In our sample, 51.4% of patient directions on e-prescriptions contained at least one predefined direction quality issue. Pharmacy staff corrected 79.5% of the quality issues. Conclusion Pharmacy staff put significant effort into transcribing e-prescription directions. Manual transcription removed the majority of quality issues; however, pharmacy staff still miss or introduce following their manual transcription processes. The development of tools and techniques such as a comprehensive set of structured direction components or machine learning--based natural language processing techniques may help produce clear directions. [ABSTRACT FROM AUTHOR]

The article discusses auditor litigation brought under Section 10(b) of the U.S. Securities Exchange Act 1934 and Rule 10b-5 with consideration given to audit quality under the joint and several liability regime and the proportionate liability regime. The legislation to relieve accountants from the joint and several liability regime is being considered by the U.S. Congress despite expert testimonials that this could lessen audit quality. However, the litigation cost for an auditor under the proportionate liability regime is sensitive to his effort and liability must be apportioned between the auditor and the company.

By demonstrating the superiority of the present-value to the recoupment-period criterion, Peter Lindert [2] has made a major contribution to the analysis of foreign investment controls. In fact, after reading Lindert's analysis, one wonders how the recoupment-period criterion got a foothold in the first place' the assessment of the net impact of a control program is clearly dependent on a comparison of capital inflows and outflows occurring at different points in time; and the accepted and traditional way to make such intertemporal comparisons is by a present value calculation. [ABSTRACT FROM AUTHOR]

The multinational corporation (MNC) has the choice of supplying foreign markets via either exports from the home market (US) or local production by a foreign subsidiary (FS). If the final (as distinguished from intermediate) U.S.-made and FS-produced goods are not identical the firm may do both. Two important questions in the analysis of the balance of payments impact of direct investment then arise. What determines this choice? And what is the impact of an increase in sales of the FS-product on sales of MNC exports? The purpose of this paper is to investigate these issues and especially the latter, the question of export displacement. [ABSTRACT FROM AUTHOR]

The article offers information on the panel discussion on "Regulatory and ethical issues in clinical research in children" held in collaboration with Indian Academy of Pediatrics and the Federation of Obstetrics and Gynecological Societies of India in April 2017 in Mumbai, India. Topics discussed include clinical pharmacology for maternal and child health; new drug development and clinical trials in children; and pediatric clinical research and drug development by pharmaceutical industry.

An introduction is presented in which the editor discusses various reports within the issue on topics including effect of 9/11 attack on the U.S. national security policies, responsibility of government activities on execution of violence against humans and security policies against Muslims.

Texas High Plains agriculture, largely dependent on water from the Ogallala aquifer for irrigation, exemplifies semiarid agricultural regions where irrigation is used at nonsustainable rates of extraction. Integrating crop and livestock systems has been suggested to conserve water and to achieve other environmental and economic goals compared with monoculture systems. From 1998 to 2008, two large-scale systems, with three blocks in a randomized block design, compared irrigation water, productivity, chemical inputs, and specific pests of (i) a cotton (Gossypium hirsutum L.) monoculture, and (ii) an integrated three-paddock system that included cotton in a two-paddock rotation with grazed wheat (Triticum aestivum L.) and rye (Secale cereale L.) and the perennial variety WW-B. Dahl old world bluestem (OWB) [Bothriochloa bladbii (Retz) S.T. Blake] in a third paddock for grazing and seed production. All paddocks were irrigated by subsurface drip. Angus crossbred beef steers (Bos taurus; initial BW 229 kg; SD = 33 kg) grazed 185 d from January to mid-July each year. During the 10 yr following the establishment year, cotton lint yield was similar and averaged 1370 kg ha-1 for both systems. Bluestem seed yield averaged 25 kg pure live seed (PLS) ha-1. Steers gained 139 kg on pasture and 0.79 kg d-1. Per hectare, the integrated system used 25% less (P < 0.001) irrigation water, 36% less N fertilizer, and fewer other chemical inputs than monoculture cotton. Integrated production systems that are less dependent on irrigation and chemical inputs appear possible while achieving goals of sustainability, fiber production, and food security. [ABSTRACT FROM AUTHOR]

Between 2006 and 2010, National Aeronautics and Space Administration (NASA) and the US Forest Service flew 14 unmanned airborne system (UAS) sensor missions, over 57 fires in the western US. The missions demonstrated the capabilities of a UAS platform (NASA Ikhana UAS), a multispectral sensor (autonomous modular sensor (AMS)), onboard processing and data visualization (Wildfire Collaborative Decision Environment (W-CDE)), to provide fire intelligence to management teams. Autonomous, on-board processing of the AMS sensor data allowed real-time fire product delivery to incident management teams on the wildfire events. The fire products included geo-rectified, colour-composite quick-look imagery, fire detection shape files, post-fire real-time normalized burn ratio imagery and burn area emergency response (BAER) imagery. The W-CDE was developed to allow the ingestion and visualization of AMS data and other pertinent fire-related information layers. This article highlights the technologies developed and employed, the UAS wildfire imaging missions performed and the outcomes and findings of the multi-year efforts. [ABSTRACT FROM AUTHOR]

Cotton (Gossypium hirsutum L.) monoculturc under conventional tillage has been the predominant cropping system in the Southern High Plains region of the United States since the 1940s. This study evaluated other cropping systems and land uses for their potential to increase soil quality and enhance soil functioning compared with continuous cotton (Ct-Ct), including a mixture of grasses in the Conservation Reserve Program (CRP), a pasture monoculture [Bothriochloa bladhii (Retz) S.T. Blake] and a cotton-winter wheat ( Triticum aestivum L.)corn (Zea mays L.) rotation (Ct-W-Cr). Soil microbial communities were evaluated according to microbial biomass C (MBC) and N (MBN), fatty acid methyl ester (FAME) profiling, and molecular cloning techniques. Soil MBC was higher under the alternative systems at 0 to 5 cm (CRP > pasture = Ct-W-Cr > Ct-Ct), 5 to 10 cm (CRP = Ct-W-Cr> pasture> Ct-Ct), and 10 to 20cm (CRP = pasture = Ct-W-Cr> Ct-Ct). Soil DNA concentration was correlated with key soil quality parameters such as microbial biomass (r>0.52, P <0.05), total C (r = 0.372, P <0.1), and total N (r = 0.449, P <0.05). The 16S rRNA gene banding patterns (0-5 cm) of undisturbed systems (CRP and pasture) were more similar to each other than to Ct-Ct and Ct-W-Cr. Fungal/bacterial FAME ratios were higher under CRP and pasture than under Ct-Ct at 0 to 5 and 5 to 10 cm. This study found increases in sensitive soil quality parameters under alternative management compared with cotton monoculture. [ABSTRACT FROM AUTHOR]

The authors have recently proposed a model, based on Monte Carlo methods, to simulate light interaction with sand. In this paper, principal component analysis and regression techniques are applied to yield a compact analytical representation of the spectral reflectance signatures produced by the model. This analytical formulation compares well with the original model and is appropriate for applications demanding interactive rates. Examples are provided comparing the original model to the proposed formulation for three hypothetical sand samples. The effect of water content on reflectance is demonstrated for these samples. Additionally, examples are provided comparing the original and proposed models for three sand samples from the U.S. Army Topographic Engineering Center spectral database. [ABSTRACT FROM AUTHOR]

Results of investigating the scattering and propagation effects for the HF radiation from the HAARP heating facility (Alaska, USA) are presented. The latest data were collected during the HAARP measurement campaign that was conducted from February 21 through March 3, 2008. The transmissions from the HAARP HF heater were monitored at geographically dispersed sites in the USA, Europe, and Arctic, using digital Doppler receivers of the Institute of Radio Astronomy (Kharkov, Ukraine) and Digisondes of the University of Massachusetts Lowell (Lowell, USA). A number of characteristics features of the detected scattered signals suggest that the received radiowaves were scattered by ionospheric irregularities produced by the same HF emission. This effect is known as "self-scattering." Average relaxation times for the self-scattered signals were shown to be several tens of seconds (40-60 s), while the observed risetime was much longer, up to a few minutes. These numbers are characteristics of the types of the irregularities responsible for the scattering of the heater signal. A time constant of 50-60 s is usually associated with the relaxation time of small-scale irregularities with spatial scale sizes from a few meters to tens of meters. Several possibilities for explaining the observed longer risetime constant of two to three minutes are discussed. The power and spectral width of the scattered signals depend on the HAARP beam orientation and local ionospheric conditions. The possibility of extracting parameters of the stimulated plasma irregularities is discussed. [ABSTRACT FROM AUTHOR]

Aim To analyse the current geographical structure of chloroplast DNA variation in the Turnera sidoides L. complex in order to establish historical biogeographical hypotheses for the mid-latitude South American lowlands. During the Quaternary, the climate shifted from tropical humid to cold dry, and the vegetation cover has not been stable. The consequences of these processes on the current distribution of the vegetation of this area have received very little attention. Location The mid-latitude South American lowlands extend between c. 20 and 40°S and include Uruguay, northern, central and eastern Argentina, southern Brazil, and parts of southern Paraguay and Bolivia. They are surrounded by higher-elevation systems. Methods Turnera sidoides is a well-studied polyploid complex of perennial rhizomatous herbs occurring throughout the area of interest. We analysed 321 individuals from 79 populations of the five recognized subspecies. We also included progenies from artificial crosses in order to analyse chloroplast inheritance. After screening sequences for four non-coding chloroplast DNA regions, the trnL– trnF spacer was selected to characterize the collection. Results Three haplotypes can be easily identified, with each differing from the others in two independent characters. A clear geographic structure is revealed when haplotypes are plotted for the complex as a whole regardless of subspecies and cytotype. Three distinct regions can be identified. Main conclusions We propose three putative refugial areas for the Turnera sidoides complex, which are associated with the orographical systems of the region. Ravines and slopes in the Haedo Cuchilla system in northern Uruguay, the elevations of the western side of the area in Argentina, and the eastern Serranías system in south-eastern Uruguay may each have served as refugia in which the A, B and C haplotypes became fixed during the drier climatic phases. Biogeographical patterns in the area covered by T. sidoides, particularly east of the Uruguay River, have not previously been analysed from a historical perspective. [ABSTRACT FROM AUTHOR]

Two hundred crossbred cattle (Bos indicus × Bos taurus) were supplemented with 2% Tasco (Ascophyllum nodosum) in a commercial finishing facility to evaluate marbling score, USDA quality grade, sensory traits, and retail display shelf life. Treatment animals (n = 100) received a steam-rolled corn (Zea mays)-based diet containing 2% Tasco meal (DM basis), for 14 d beginning at d 45 of the finishing period and again 14 d before slaughter. Control animals (n = 100) received a steam-rolled corn (Zea mays)-based diet without Tasco at identical feeding periods. Carcasses from Tasco-fed cattle exhibited greater marbling scores (P = 0.003) than controls. There were no treatment effects (P > 0.05) on sensory, shear, or purge attributes of striploin or inside round steaks with the exception of inside round steaks from Tasco animals having a greater initial tenderness (P = 0.03) and lower off-flavor score (P = 0.002) than control steaks. The LM samples from Tasco-fed cattle had a greater percentage of ether extractable fat (P = 0.001) and lower percentage of protein (P = 0.001) than controls. Inside round samples from treated animals exhibited a greater percentage of moisture (P = 0.03) than control steaks. Visual lean color of strip-loin steaks was not affected by Tasco supplementation (P = 0.26); however, steaks from Tasco-treated animals were more uniform and had less discoloration and browning than those from controls (P = 0.005, 0.04, and 0.05, respectively). Inside round visual scores and instrument values reflected similar treatment responses (P < 0.05), with a majority of the effects on muscle redness (CIE a*, hue angle) and measures of discoloration. Tasco steaks were generally more red and less discolored during extended postmortem aging and retail exposure (P < 0.05). The results from this study indicate that short-term supplementation of 2% Tasco meal in feedlot cattle increases carcass quality and prolonged retail shelf life. [ABSTRACT FROM AUTHOR]

Examines the effectiveness of an alternative to antibiotic-based drugs used for enhancing performance of broilers grown on recycled litter infected with eimeria spp. in the U.S. Comparison on the effects of a commercial anticoccidial lasalocid, a growth promoter bacitracin Zn and yeast culture residue (YCR), on the performance of the broilers; Analysis of the body weight of male broiler chicks receiving lasalocid, bacitracin or YCR treatment in the basal diet; Effect of the alternative drugs on the broilers' liver and ceca weights.

An approach is developed to block the effects of lateral nonuniformities in thin-film semiconductor structures. The nonuniformity modulates the surface photovoltage distribution. When exposed to light and immersed in a proper electrolyte, this distribution will generate laterally nonuniform electrochemical reactions. Such treatments result in a nonuniform interfacial layer that balances the original nonuniformity. This approach has been implemented for CdTe/CdS photovoltaic devices, in which it improved the device efficiency from 1%–3% to 11%–12%. © 2004 American Institute of Physics. [ABSTRACT FROM AUTHOR]

The article presents a report form the U.S. Centers for Disease Control and Prevention about rates of hospitalization related to traumatic brain injury (TBI) in the U.S. in 12 states during 2002. TBI is a major cause of death and disability in the U.S. Each year approximately 1.4 million people suffer TBI, and of those, 80 to 90 thousand suffer long-term disability. The study analysed data from 12 states that reported that the leading causes of TBI hospitalizations were unintentional falls, motor vehicle accidents, and assaults. The findings point to the need for states to continue monitoring TBI incidence and to devise and implement injury prevention programs. An editorial note follows the report.

The Journal of the Experimental Analysis of Behavior was founded in 1958 by a group of male psychologists, mainly from the northeastern USA and connected with either Harvard or Columbia. Fifty years later about 20% of both editors and authors reside outside this country and almost the same proportion is women. Other changes in the journal include having its own website for more than a decade and now publishing online as well as on paper. A recent connection with PubMed Central of the National Library of Medicine has made possible the completely free electronic presentation of the entire archive of about 3,800 articles. [ABSTRACT FROM AUTHOR]

The article focuses on an educational film on land reforms. Released in October 1960, "Land--and Space to Grow," is the story of a typical young U.S. couple as they pursue the great adventure of buying land and building the home of their dreams. Within the framework of this warmly human story, some challenging questions are raised. One of these is--Why, in a land where everyone agrees upon the need for adequate housing, is every step taken to provide it taxed so heavily." The public for the sponsored film, at least in the United States, is vast. Clubs, churches, schools and other community groups alone produce 181,000 film-viewing audiences.

Purpose: To describe clinical features and outcomes of enterococcal left-sided native valve endocarditis and to compare it to endocarditis caused by other pathogens. Subjects and Methods: Patients in the International Collaboration on Endocarditis-Merged Database were included if they had left-sided native valve endocarditis. Demographic characteristics, clinical features, and outcomes were analyzed. Multivariable analysis evaluated enterococcus as a predictor of mortality. Results: Of 1285 patients with left-sided native valve endocarditis, 107 had enterococcal endocarditis. Enterococcal endocarditis was most frequently seen in elderly men, frequently involved the aortic valve, tended to produce heart failure rather than embolic events, and had relatively low short-term mortality. Compared to patients with non-enterococcal endocarditis, patients with enterococcal endocarditis had similar rates of nosocomial acquisition, heart failure, embolization, surgery, and mortality. Compared to patients with streptococcal endocarditis, patients with enterococcal endocarditis were more likely to be nosocomially acquired (9 of 59 [15%] vs 2 of 400 [1%]; P <.0001) and have heart failure (49 of 107 [46%] vs 234 of 666 [35%]; P = 0.03). Compared to patients with S. aureus endocarditis, patients with enterococcal endocarditis were less likely to embolize (28 of 107 [26%] vs 155 of 314 [49%]; P <.0001) and less likely to die (12 of 107 [11%] vs 83 of 313 [27%]; P = 0.001). Multivariable analysis of all patients with left-sided native valve endocarditis showed that enterococcal endocarditis was associated with lower mortality (odds ratio [OR] 0.49; 95% confidence interval [CI] 0.24 to 0.97). Conclusions: Enterococcal native valve endocarditis has a distinctive clinical picture with a good prognosis. [ABSTRACT FROM AUTHOR]

Lead (Pb) exposures from soil and dust ingestion contribute to children's blood lead levels (BLLs) in the United States. The U.S. Environmental Protection Agency (EPA)'s Strategy to Reduce Lead Exposures and Disparities in U.S. Communities and the Federal Action Plan to Reduce Childhood Lead Exposure describe multi-pronged collaborative approaches. These include reducing multi-media lead exposures nationally using analytical tools such as EPA's Stochastic Human Exposure and Dose Simulation model for lead [SHEDS-Pb; formerly known as SHEDS-IEUBK (Integrated Exposure Uptake Biokinetic model)], which was initially developed and applied with a focus on children's drinking water exposures. In this study we applied SHEDS-Pb to determine what residential soil Pb and dust Pb concentrations (individually and their sum) can keep BLLs of potentially exposed young children in the general U.S. population below specified values, considering aggregate exposures from water, soil, dust, food, and air. We considered two age groups (1 to <2 years and 2 to <6 years), two BLL values (5 μg/dL and 3.5 μg/dL), and two population percentiles (95 th and 97.5 th ). Sensitivity analyses were conducted using several alternative model inputs and data sets, yielding 15 scenarios summarized in the paper. Of those scenarios, we focused on ones with the most recent science and available data. Modeled soil Pb concentrations by age group, population percentile and reference BLL scenarios for the focus scenarios ranged from 70 ppm to 220 ppm; and modeled dust Pb concentrations ranged from 110 ppm to 240 ppm. These results are consistent with current soil and dust Pb concentrations in the U.S. general population and are lower than most of the current U.S. Federal standards. Estimated BLLs compared well with measured BLLs from CDC's NHANES 2009-2016 (0-27 % relative error for focus scenarios). This analysis can be used to inform EPA and other federal Pb efforts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)

Background: More than 100 million surgeries take place annually in the United States, and more than 90% of surgical patients receive an opioid prescription. A sizable minority of these patients will go on to use opioids long-term, contributing to the national opioid epidemic., Methods: The objective of this study was to develop and validate a model to predict persistent opioid use after surgery. Participants included surgical patients (≥18 years old) enrolled in a cohort study at an academic medical center between 2015 and 2018. Persistent opioid use was defined as filling opioid prescriptions in postdischarge days 4 to 90 and 91 to 180. Predictors included electronic health record data, state prescription drug monitoring data, and patient-reported measures. Three models were developed: a full, a restricted, and a minimal model using a derivation and validation cohort., Results: Of 24,040 patients, 4,879 (20%) experienced persistent opioid use. In the validation cohort, the full, restricted, and minimal model had C-statistics of 0.87 (95% CI 0.86-0.88), 0.86 (0.85-0.88), and 0.85 (0.84-0.87), respectively. All models performed better among patients with preoperative opioid use compared to opioid-naive patients (P < .001). The models slightly overpredicted risk in the validation cohort. The net benefit of using the restricted model to refer patients for preoperative counseling was 0.072 to 0.092, which is superior to evaluating no patients (net benefit of 0) or all patients (net benefit of -0.22 to -0.63)., Conclusion: This study developed and validated a prediction model for persistent opioid use using accessible data resources. The models achieved strong performance, outperforming prior published models., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Embedded pragmatic clinical trials (ePCTs) are embedded in healthcare systems as well as their data environments. For people living with dementia (PLWD), settings of care can be different from the general population and involve additional people whose information is also important. The ePCT designs have the opportunity to leverage data that becomes available through the normal delivery of care. They may be particularly valuable in Alzheimer's disease and Alzheimer's disease-related dementia (AD/ADRD), given the complexity of case identification and the diversity of care settings. Grounded in the objectives of the Data and Technical Core of the newly established National Institute on Aging Imbedded Pragmatic Alzheimer's Disease and AD-Related Dementias Clinical Trials Collaboratory (IMPACT Collaboratory), this article summarizes the state of the art in using existing data sources (eg, Medicare claims, electronic health records) in AD/ADRD ePCTs and approaches to integrating them in real-world settings. J Am Geriatr Soc 68:S49-S54, 2020., (© 2020 The American Geriatrics Society.)

Background: Multiple modern Indian hospitals operate at very low cost while meeting US-equivalent quality accreditation standards. Though US hospitals face intensifying pressure to lower their cost, including proposals to extend Medicare payment rates to all admissions, the transferability of Indian hospitals' cost advantages to US peers remains unclear., Methods: Using time-driven activity-based costing methods, we estimate the average cost of personnel and space for an elective coronary artery bypass graft (CABG) surgery at two American hospitals and one Indian hospital (NH). All three hospitals are Joint Commission accredited and have reputations for use of modern performance management methods. Our case study applies several analytic steps to distinguish transferable from non-transferable sources of NH's cost savings., Results: After removing non-transferable sources of efficiency, NH's residual cost advantage primarily rests on shifting tasks to less-credentialed and/or less-experienced personnel who are supervised by highly-skilled personnel when perceived risk of complications is low. NH's high annual CABG volume facilitates such supervised work "downshifting." The study is subject to limitations inherent in case studies, does not account for the younger age of NH's patients, or capture savings attributable to NH's negligible frequency of re-admission or post-acute care facility placement., Conclusions: Most transferable bases for a modern Indian hospital's cost advantage would require more flexible American states' hospital and health professional licensing regulations, greater family participation in inpatient care, and stronger support by hospital executives and clinicians for substantially lowering the cost of care via regionalization of complex surgeries and weekend use of costly operating rooms., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Initiatives to reduce neighborhood-based health disparities require access to meaningful, timely, and local information regarding health behavior and its determinants. We examined the validity of Twitter as a source of information for neighborhood-level analysis of dietary choices and attitudes., Materials and Methods: We analyzed the "healthiness" quotient and sentiment in food-related tweets at the census tract level, and associated them with neighborhood characteristics and health outcomes. We analyzed keywords driving the differences in food healthiness between the most and least-affluent tracts, and qualitatively analyzed contents of a random sample of tweets., Results: Significant, albeit weak, correlations existed between healthiness and sentiment in food-related tweets and tract-level measures of affluence, disadvantage, race, age, U.S. density, and mortality from conditions associated with obesity. Analyses of keywords driving the differences in food healthiness revealed foods high in saturated fat (eg, pizza, bacon, fries) were mentioned more frequently in less-affluent tracts. Food-related discussion referred to activities (eating, drinking, cooking), locations where food was consumed, and positive (affection, cravings, enjoyment) and negative attitudes (dislike, personal struggles, complaints)., Discussion: Tweet-based healthiness scores largely correlated with offline phenomena in the expected directions. Social media offer less resource-intensive data collection methods than traditional surveys do. Twitter may assist in informing local health programs that focus on drivers of food consumption and could inform interventions focused on attitudes and the food environment., Conclusions: Twitter provided weak but significant signals concerning food-related behavior and attitudes at the neighborhood level, suggesting its potential usefulness for informing local health disparity reduction efforts., (© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Changes in the legislation, the development of the regulatory and legal framework governing relations in the sphere of wage payment for health care workers has caused the transition of medical organizations to the new system of salaries payments (NSWP). This system has given executives and economists significant freedom when determining the size of payments to the employee per hour worked, including stimulating and compensation payments, bonuses and other regular pension benefits. However, given situation has also resulted in the need for studies intended on the formulation of the criteria's for medical workers of different specialties actions evaluation and the quality of medical services that they have provided, as well as on the efficiency of the health care organizations in general.

Objectives: To examine the characteristics of patient experience in community pharmacies through pattern exploration techniques of the unstructured free-text data from an online review website., Design: Retrospective observational study design using structural topic model (STM) and term frequency-inverse document frequency (tf-idf) to categorize free-text data. Tf-idf scores words in terms of importance, and STM extracts latent themes from free-text data based on the co-occurrence of words in a review. Human labels were assigned to STM output, with each topic's prevalence mapped to each level of the 1- to 5-star review ratings., Setting and Participants: Data were obtained from the Yelp Academic data set from April 2006 through December 2017. These data were available for analysis from certain cities in the United States, Canada, and Europe. Included reviews were filtered based on the presence of pharmacy-specific character strings (e.g., "prescri")., Main Outcome Measures: Descriptive statistics of Yelp review characteristics, tf-idf scores, and topics produced from STM were used to characterize the content of Yelp reviews at each star-rating level., Results: The filtered data set contained 4463 reviews from 964 pharmacies in 8 U.S. states. The mean (±SD) review rating was 2.97 ± 0.91. The mean number of words in a review was 135 ± 116. STM revealed 9 topics that influenced patient experiences at community pharmacies, including waiting time, service attitude, and physical store characteristics. Friendly and helpful staff accounted for 28.3% of content in 5-star ratings, whereas waiting time accounted for 19.4% of 1-star ratings., Conclusion: Yelp reviews provide a public look into patient experience at community pharmacies, and the reviews likely influence other patients' decisions to use the pharmacy. Pharmacies should focus their efforts on enabling pharmacy staff to provide high-quality care and minimizing unnecessary waiting times for patients., (Copyright © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Essentials Cognitive disorders are increasing and vascular risk factors play a role in this. We performed a nested case control study of hemostasis biomarkers and cognitive impairment (CI). Higher baseline fibrinogen, factor VIII and D-dimer were related to incident CI over 3.5 years. Adjusted for other risk factors, 2+ abnormal markers (but not single ones) led to higher risk., Summary: Background Vascular risk factors are associated with cognitive impairment, a condition that imposes a substantial public health burden. We hypothesized that hemostasis biomarkers related to vascular disease would be associated with the risk of incident cognitive impairment. Methods We performed a nested case-control study including 1082 participants with 3.5 years of follow-up in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a longitudinal cohort study of 30 239 black and white Americans aged ≥ 45 years. Participants were free of stroke or cognitive impairment at baseline. Baseline D-dimer, fibrinogen, factor VIII and protein C levels were measured in 495 cases who developed cognitive impairment during follow-up (based on abnormal scores on two or more of three cognitive tests) and 587 controls. Results Unadjusted odds ratios (ORs) for incident cognitive impairment were 1.32 (95% confidence interval [CI] 1.02-1.70) for D-dimer > 0.50 μg mL -1 , 1.83 (95% CI 1.24-2.71) for fibrinogen > 90th percentile, 1.63 (95% CI 1.11-2.38) for FVIII > 90th percentile, and 1.10 (95% CI 0.73-1.65) for protein C < 10th percentile. There were no differences in associations by race or region. Adjustment for demographic, vascular and health behavior risk factors attenuated these associations. However, having at least two elevated biomarkers was associated with incident cognitive impairment, with an adjusted OR of 1.73 (95% CI 1.10-2.69). Conclusion Elevated D-dimer, fibrinogen and FVIII levels were not associated with the occurrence of cognitive impairment after multivariable adjustment; however, having at least two abnormal biomarkers was associated with the occurrence of cognitive impairment, suggesting that the burden of these biomarkers is relevant., (© 2018 International Society on Thrombosis and Haemostasis.)

Internal regulatory documents of the medical organization reflecting the calculation of incentive payments and a personalized assessment of the quality of dental care were analyzed. It is found that until now the new system of wage payment has not solved the problem of stimulating dental care professionals depending on the results of their work and needs to be changed. The applied criteria of quality assessment and the intensity of labor must have measurable parameters that exclude subjective appraisal; the integrative coefficient of labor quality must be created. A transparent mechanism of wage payment is also needed in order to motivate staff highly to achieve the qualitative and quantitative indicators of labor that are incorporated in it by the medical organization authority and are related with their work goals. Every criterion outlined in the 'Regulation on Inner Control of the Quality and Safety of Dental Care' should reflect the intensity and quality of dental services and correspond with the criteria of the incentive premiums calculation, that have been prescribed in the 'Wage payment regulations'.

Introduction: Coronary artery bypass graft (CABG) surgery is a well-established, commonly performed treatment for coronary artery disease--a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32, 201 ± $23,059. The same operation reportedly costs less than $2000 to produce in India. The goals of the proposed study are to (1) identify the difference in the costs incurred to perform CABG surgery by three Joint Commission accredited hospitals with reputations for high quality and efficiency and (2) characterise the opportunity to reduce the cost of performing CABG surgery., Methods and Analysis: We use time-driven activity-based costing (TDABC) to quantify the hospitals' costs of producing elective, multivessel CABG. TDABC estimates the costs of a given clinical service by combining information about the process of patient care delivery (specifically, the time and quantity of labour and non-labour resources utilised to perform each activity) with the unit cost of each resource used to provide the care. Resource utilisation was estimated by constructing CABG process maps for each site based on observation of care and staff interviews. Unit costs were calculated as a capacity cost rate, measured as a $/min, for each resource consumed in CABG production. Multiplying together the unit costs and resource quantities and summing across all resources used will produce the average cost of CABG production at each site. We will conclude by conducting a variance analysis of labour costs to reveal opportunities to bend the cost curve for CABG production in the USA., Ethics and Dissemination: All our methods were exempted from review by the Stanford Institutional Review Board. Results will be published in peer-reviewed journals and presented at scientific meetings., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

The paper deals with an approach to the description of the age and temporal dynamics of cancer, based on the model describing the dynamics of the age of cancer as a second order phase transition. This approach is widely used for studying physical systems. This model of cancer development as second order phase transitions is in a good agreement with medical statistics. The cancer incidence dynamics is described only with two free parameters, easily verified according to statistics and well interpreted. The applicability of the second order phase transition model for description of a non-physical system defines the universal nature of the processes occurring during phase transitions.

Currently, Crotalus viridis was divided into two species: Crotalus viridis and Crotalus oreganus. The current classification divides "the old" Crotalus viridis into two new and independent species: Crotalus viridis (subspecies: viridis and nuntius) and Crotalus oreganus (subspecies: abyssus, lutosus, concolor, oreganus, helleri, cerberus, and caliginis). The analysis of a product from cDNA (E6d), derived from the gland of a specie Crotalus viridis viridis, was found to produce an acid phospholipase A2. In this study we isolated and characterized a PLA2 (D49) from Crotalus oreganus abyssus venom. Our studies show that the PLA2 produced from the cDNA of Crotalus viridis viridis (named E6d) is exactly the same PLA2 primary sequence of amino acids isolated from the venom of Crotalus oreganus abyssus. Thus, the PLA2 from E6d cDNA is actually the same PLA2 presented in the venom of Crotalus oreganus abyssus and does not correspond to the venom from Crotalus viridis viridis. These facts highlight the importance of performing more studies on subspecies of Crotalus oreganus and Crotalus viridis, since the old classification may have led to mixed results or mistaken data.

The fundamental basics of contact radiation therapy (brachytherapy) for gynecological cancer are presented. During brachytherapy the principles of conformal radiotherapy should be implemented, the aim of which is to sum the maximum possible dose of radiation to the tumor and decrease the dose load in adjacent organs and tissues, which allows reducing the frequency of radiation damage at treatment of primary tumors. It is really feasible only on modern technological level, thanks to precision topometry preparation, optimal computer dosimetrical and radiobiological planning of each session and radiotherapy in general. Successful local and long-term results of the contact radiation therapy for cancer of cervix and endometrium are due to optimal anatomical and topometrical ratio of the tumor localization, radioactive sources, and also physical and radiobiological laws of distribution and effects of ionizing radiation, the dose load accounting rules.

Food choice is influenced by consumer attitudes towards food attributes. This U.S.-based study (n = 601) simultaneously compares attitudes towards selected food attributes of organic, locally grown, U.S. grown, and GM-free food in relation to other food attributes. Exploratory factor analysis identifies underlying constructs that determine, together and separately, female and male food choice decisions. Gendered analysis of the value of food in life and food behaviours (cooking and shopping) support the investigation of the highlighted food attributes. Respondents generally assigned greater importance to the U.S. grown, followed by GM-free, locally grown, and organically produced food attributes in deciding what to eat. Analysis of the female and male subsamples yielded similar factor results. All four main attributes were captured in a single factor, associated with respondents in both the female and male subsamples who are older, have lower incomes, and who are religiously observant. Additionally, among females, this factor was associated with higher education; and among males, living in households with children and/or with partners. Additional studies should further explore the interaction of food attributes now becoming increasingly important and prevalent in current food products., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: The present study was done to evaluate the serological profile of herpes simplex virus-2 (HSV-2) among patients attending sexually transmitted infections (STI) clinic and to determine the utility of detecting HSV-2 IgM antibodies in such patients. A correlation of HSV-2 infection with other STI including HIV has also been attempted., Materials and Methods: Hundred consecutive patients who attended STI clinic, with one or more of the complaints as enunciated by WHO in syndromic approach for the diagnosis of STI, were included as subjects. All subjects were screened for common STI by standard laboratory procedures/ commercially available kits. HSV-1 and HSV-2 IgM antibody was detected by commercially available enzyme immuno assay kit in all patient's sera. Sera were also tested for other STI, namely HIV, Hepatitis B virus, Hepatitis C virus and Treponema pallidum. Antigen detection for Chlamydia trachomatis was done in genital swabs of all patients by Bio-Rad Chlamydia Microplate EIA 31189 (United States) kit., Results: Thirty patients were found to have genital herpes. In 17/30 (56.6%) patients, HSV-2 serology was found to correlate with the clinical diagnosis. The coexistence of other infection in HSV-2 seropositive patients was detected in 8/30 patients. None of the patients having concomitant infections were clinically diagnosed accurately. Sensitivity, specificity, positive predictive value and negative predictive value of IgM antibodies for the diagnosis of genital herpes was 73.91%, 90.91%, 70.83% and 92.91% respectively., Conclusion: HSV-2 IgM detection could only be used as a supportive test for the diagnosis of genital herpes . It needs to be emphasized that the sensitivity and positive predictive value scores are pointers for further improvement in the commercial assay systems and a large sample size may determine the broader utility of such systems.

The results of proper investigations received under the cytogenetic examination of 225 persons (control groups, Chernobyl liquidators exposed to different radiation doses, oncogematology patients) had been summarized and analyzed. The conclusion concerning possibilities and limitations of FISH technique usage for retrospective biodosimetry of human radiation exposure has been presented.

Our understanding of origins and spread of emerging infectious diseases has increased dramatically because of recent applications of phylogenetic theory. Iridoviruses are emerging pathogens that cause global amphibian epizootics, including tiger salamander (Ambystoma tigrinum) die-offs throughout western North America. To explain phylogeographical relationships and potential causes for emergence of western North American salamander iridovirus strains, we sequenced major capsid protein and DNA methyltransferase genes, as well as two noncoding regions from 18 geographically widespread isolates. Phylogenetic analyses of sequence data from the capsid protein gene showed shallow genetic divergence (< 1%) among salamander iridovirus strains and monophyly relative to available fish, reptile, and other amphibian iridovirus strains from the genus Ranavirus, suggesting a single introduction and radiation. Analysis of capsid protein sequences also provided support for a closer relationship of tiger salamander virus strains to those isolated from sport fish (e.g. rainbow trout) than other amphibian isolates. Despite monophyly based on capsid protein sequences, there was low genetic divergence among all strains (< 1.1%) based on a supergene analysis of the capsid protein and the two noncoding regions. These analyses also showed polyphyly of strains from Arizona and Colorado, suggesting recent spread. Nested clade analyses indicated both range expansion and long-distance colonization in clades containing virus strains isolated from bait salamanders and the Indiana University axolotl (Ambystoma mexicanum) colony. Human enhancement of viral movement is a mechanism consistent with these results. These findings suggest North American salamander ranaviruses cause emerging disease, as evidenced by apparent recent spread over a broad geographical area.

Most companies don't worry about the behavior of their supply chain partners. Instead, they expect the supply chain to work efficiently without interference, as if guided by Adam Smith's famed invisible hand. In their study of more than 50 supply networks, V.G. Narayanan and Ananth Raman found that companies often looked out for their own interests and ignored those of their network partners. Consequently, supply chains performed poorly. Those results aren't shocking when you consider that supply chains extend across several functions and many companies, each with its own priorities and goals. Yet all those functions and firms must pull in the same direction for a chain to deliver goods and services to consumers quickly and cost-effectively. According to the authors, a supply chain works well only if the risks, costs, and rewards of doing business are distributed fairly across the network. In fact, misaligned incentives are often the cause of excess inventory, stock-outs, incorrect forecasts, inadequate sales efforts, and even poor customer service. The fates of all supply chain partners are interlinked: If the firms work together to serve consumers, they will all win. However, they can do that only if incentives are aligned. Companies must acknowledge that the problem of incentive misalignment exists and then determine its root cause and align or redesign incentives. They can improve alignment by, for instance, adopting revenue-sharing contracts, using technology to track previously hidden information, or working with intermediaries to build trust among network partners. It's also important to periodically reassess incentives, because even top-performing networks find that changes in technology or business conditions alter the alignment of incentives.

The authors bring into light several aspects of nuclear radiation risks, i.e. physical safety of nuclear technologies and ecology, place of operator within the nuclear radiation safety system (proficiency, protective culture, safety guides) and consider approaches to the human factor quantification within the system of mitigation of risks from nuclear technologies, and IAEA recommendations on probable risk estimation. Future investigations should be aimed at extension of the radiation sensitivity threshold, personnel selection as by psychological so genetic testing for immunity to ionizing radiation, development of pharmachemical and physical protectors and methods of enhancing nonspecific resistance to extreme, including radiation, environments, and building of radiation event simulators for training.

Motivation: A model for learning potential causes of toxicity from positive and negative examples and predicting toxicity for the dataset used in the Predictive Toxicology Challenge (PTC) is presented. The learning model assumes that the causes of toxicity can be given as substructures common to positive examples that are not substructures of negative examples. This assumption results in the choice of a learning model, called the JSM-method, and a language for representing chemical compounds, called the Fragmentary Code of Substructure Superposition (FCSS). By means of the latter, chemical compounds are represented as sets of substructures which are 'biologically meaningful' from the expert point of view., Results: The chosen learning model and representation language show comparatively good performance for the PTC dataset: for three sex/species groups the predictions were ROC optimal, for one group the prediction was nearly optimal. The predictions tend to be conservative (few predictions and almost no errors), which can be explained by the specific features of the learning model., Availability: by request to finn@viniti.ru; serge@viniti.ru, http://ki-www2.intellektik.informatik.tu-darmstadt.de/~jsm/QDA.

Background: Alcohol-related motor vehicle crashes are a major public health problem, resulting in 15,786 deaths and more than 300,000 injuries in 1999. This report presents the results of systematic reviews of the effectiveness and economic efficiency of selected population-based interventions to reduce alcohol-impaired driving., Methods: The Guide to Community Preventive Services's methods for systematic reviews were used to evaluate the effectiveness of five interventions to decrease alcohol-impaired driving, using changes in alcohol-related crashes as the primary outcome measure., Results: Strong evidence was found for the effectiveness of .08 blood alcohol concentration laws, minimum legal drinking age laws, and sobriety checkpoints. Sufficient evidence was found for the effectiveness of lower blood alcohol concentration laws for young and inexperienced drivers and of intervention training programs for servers of alcoholic beverages. Additional information is provided about the applicability, other effects, and barriers to implementation of these interventions., Conclusion: These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement. They can help decision makers identify and implement effective interventions that fit within an overall strategy to prevent impaired driving.

We report on recommendations from a National Institutes of Health Workshop on methods for evaluating the use of surrogate endpoints in clinical trials, which was attended by experts in biostatistics and clinical trials from a broad array of disease areas. Recent advances in biosciences and technology have increased the ability to understand, measure, and model biological mechanisms; appropriate application of these advances in clinical research settings requires collaboration of quantitative and laboratory scientists. Biomarkers, new examples of which arise rapidly from new technologies, are used frequently in such areas as early detection of disease and identification of patients most likely to benefit from new therapies. There is also scientific interest in exploring whether, and under what conditions, biomarkers may substitute for clinical endpoints of phase III trials, although workshop participants agreed that these considerations apply primarily to situations where trials using clinical endpoints are not feasible. Evaluating candidate biomarkers in the exploratory phases of drug development and investigating surrogate endpoints in confirmatory trials require the establishment of a statistical and inferential framework. As a first step, participants reviewed methods for investigating the degree to which biomarkers can explain or predict the effect of treatments on clinical endpoints measured in clinical trials. They also suggested new approaches appropriate in settings where biomarkers reflect only indirectly the important processes on the causal path to clinical disease and where biomarker measurement errors are of concern. Participants emphasized the need for further research on development of such models, whether they are empirical in nature or attempt to describe mechanisms in mathematical terms. Of special interest were meta-analytic models for combining information from multiple studies involving interventions for the same condition. Recommendations also included considerations for design and conduct of trials and for assemblage of databases needed for such research. Finally, there was a strong recommendation for increased training of quantitative scientists in biologic research as well as in statistical methods and modeling to ensure that there will be an adequate workforce to meet future research needs.