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Objective This study aimed to evaluate the "off-hour effect" on maternal and neonatal adverse events in a large cohort representing U.S. population. Study Design A secondary analysis of the Consortium on Safe Labor (CSL) dataset with 208,695 women and 229,385 deliveries was performed. The study included the deliveries of ≥23 gestational weeks from 19 hospitals in the United States from 2002 to 2008. Babies with congenital anomalies were excluded from neonatal outcomes. We compared maternal and neonatal outcomes of patients delivered during weekdays versus off hours (nights and weekends). The primary outcomes of the study were composite maternal and composite neonatal adverse events. The secondary outcomes were delivery type and individual maternal and neonatal adverse events including maternal death and perinatal mortality rate. Associations between off hours and all the outcomes were analyzed in bivariable and multivariable analyses. The same analyses were performed in strata by indication for admission (spontaneous labor or induction of labor). Results Composite maternal adverse events (6.19 vs. 6.06%, p = 0.41) and maternal death (0.01 vs. 0.01%, p = 0.19) were not significantly different between off hours and weekday groups. In contrast, composite neonatal adverse events (6.91 vs. 5.84%, p < 0.001) and perinatal mortality rate (1.03 vs. 0.77%, p < 0.001) were higher in the off-hour group. After adjusting for confounding variables, only the composite neonatal outcome continued to be associated with off hours (adjusted odds ratio [aOR] = 1.10, 95% confidence interval [CI]: 1.04–1.16). Stratified analyses showed that the off-hour effect for the neonatal composite outcome was not present in those presenting in spontaneous labor (6.1 vs. 5.9%, p = 0.40). Conclusion Off-hour delivery was not associated with severe maternal morbidity and was only modestly associated with severe neonatal morbidity. This association was observed in women undergoing induction, not in those presenting in spontaneous labor. These data draw into question the existence of a clinically meaningful and correctable "off-hour effect" in obstetrics. Key Points The presence of a significant off-hour effect in obstetrics is still questionable. If the off-hour effect exists, it seems that not to be related with staffing issues. There is not a big difference for adverse events at off hours in spontaneously laboring patients. [ABSTRACT FROM AUTHOR]

This study synthesizes two different methods for estimating hydraulic conductivity (K) at large scales. We derive analytical approaches that estimate K and apply them to the contiguous United States. We then compare these analytical approaches to three‐dimensional, national gridded K data products and three transmissivity (T) data products developed from publicly available sources. We evaluate these data products using multiple approaches: comparing their statistics qualitatively and quantitatively and with hydrologic model simulations. Some of these datasets were used as inputs for an integrated hydrologic model of the Upper Colorado River Basin and the comparison of the results with observations was used to further evaluate the K data products. Simulated average daily streamflow was compared to daily flow data from 10 USGS stream gages in the domain, and annually averaged simulated groundwater depths are compared to observations from nearly 2000 monitoring wells. We find streamflow predictions from analytically informed simulations to be similar in relative bias and Spearman's rho to the geologically informed simulations. R‐squared values for groundwater depth predictions are close between the best performing analytically and geologically informed simulations at 0.68 and 0.70 respectively, with RMSE values under 10 m. We also show that the analytical approach derived by this study produces estimates of K that are similar in spatial distribution, standard deviation, mean value, and modeling performance to geologically‐informed estimates. The results of this work are used to inform a follow‐on study that tests additional data‐driven approaches in multiple basins within the contiguous United States. [ABSTRACT FROM AUTHOR]

It is established that dams decrease river connectivity; however, previous global scale studies of river fragmentation focused on a small subset of the largest dams. In the United States, mid-sized dams, which are too small for global databases, account for 96% of major anthropogenic structures and 48% of reservoir storage. We conduct a national evaluation of the evolution of anthropogenic river bifurcation over time that includes more than 50,000 nationally inventoried dams. Mid-sized dams account for 73% of anthropogenically created stream fragments nationally. They also contribute disproportionately to short fragments (less than 10 km), which is particularly troubling for aquatic habitats. Here we show that dam construction has essentially reversed natural fragmentation patterns in the United States. Prior to human development, smaller river fragments and less connected networks occurred in arid basins while today we show that humid basins are the most fragmented due to human structures. Dam construction reshaped the river networks of the United States. Arid basins are naturally more fragmented than humid. However, the opposite is true in the US today. Extensive dam building has created highly fragmented basins in the eastern US. [ABSTRACT FROM AUTHOR]

Background: Breast cancer, the most diagnosed cancer, remains the second leading cause of cancer death in the United States, and excessive Progesterone (PRG) or Mifepristone (MIF) exposure may be at an increased risk for developing breast cancer. PRG exerts its cellular responses through signaling cascades involving classic, non-classic, or combined responses by binding to either classic nuclear PRG receptors (nPRs) or non-classic membrane PRG receptors (mPRs). Currently, the intricate balance and switch mechanisms between these two signaling cascades remain elusive. Three genes, CCM1-3, form the CCM signaling complex (CSC) which mediates multiple signaling cascades. Methods: Utilizing molecular, cellular, Omics, and systems biology approaches, we analyzed the relationship among the CSC, PRG, and nPRs/mPRs during breast cancer tumorigenesis. Results: We discovered that the CSC plays an essential role in coupling both classic and non-classic PRG signaling pathways by mediating crosstalk between them, forming the CmPn (CSC-mPRs-PRG-nPRs) signaling network. We found that mPR-specific PRG actions (PRG + MIF) play an essential role in this CmPn network during breast cancer tumorigenesis. Additionally, we have identified 4 categories of candidate biomarkers (9 intrinsic, 2 PRG-inducible, 1 PRG-repressive, 1 mPR-specific PRG-repressive, and 2 mPR-responsive) for Luminal-A breast cancers during tumorigenesis and have confirmed the prognostic application of RPL13 and RPL38 as intrinsic biomarkers using a dual validation method. Conclusions: We have discovered that the CSC plays an essential role in the CmPn signaling network for Luminal-A breast cancers with identification of two intrinsic biomarkers. FPy3ZpQtYHZLtAbQQBYRNb Video Abstract [ABSTRACT FROM AUTHOR]

The western corn rootworm (WCR), Diabrotica virgifera virgifera LeConte, is a major maize pest in the United States causing significant economic loss. The emergence of field-evolved resistant WCR to Bacillus thuringiensis (Bt) traits has prompted the need to discover and deploy new insecticidal proteins in transgenic maize. In the current study we determined the crystal structure and mode of action (MOA) of the Vpb4Da2 protein (formerly known as Vip4Da2) from Bt, the first identified insecticidal Vpb4 protein with commercial level control against WCR. The Vpb4Da2 structure exhibits a six-domain architecture mainly comprised of antiparallel β-sheets organized into β-sandwich layers. The amino-terminal domains 1–3 of the protein share structural homology with the protective antigen (PA) PA14 domain and encompass a long β-pore forming loop as in the clostridial binary-toxB module. Domains 5 and 6 at the carboxyl-terminal half of Vpb4Da2 are unique as this extension is not observed in PA or any other structurally-related protein other than Vpb4 homologs. These unique Vpb4 domains adopt the topologies of carbohydrate-binding modules known to participate in receptor-recognition. Functional assessment of Vpb4Da2 suggests that domains 4–6 comprise the WCR receptor binding region and are key in conferring the observed insecticidal activity against WCR. The current structural analysis was complemented by in vitro and in vivo characterizations, including immuno-histochemistry, demonstrating that Vpb4Da2 follows a MOA that is consistent with well-characterized 3-domain Bt insecticidal proteins despite significant structural differences. [ABSTRACT FROM AUTHOR]

The western corn rootworm (WCR), Diabrotica virgifera virgifera LeConte, is a major corn pest of significant economic importance in the United States. The continuous need to control this corn maize pest and the development of field-evolved resistance toward all existing transgenic maize (Zea mays L.) expressing Bacillus thuringiensis (Bt) insecticidal proteins against WCR has prompted the development of new insect-protected crops expressing distinct structural classes of insecticidal proteins. In this current study, we describe the crystal structure and functional characterization of Mpp75Aa1.1, which represents the first corn rootworm (CRW) active insecticidal protein member of the ETX_MTX2 sub-family of beta-pore forming proteins (β-PFPs), and provides new and effective protection against WCR feeding. The Mpp75Aa1.1 crystal structure was solved at 1.94 Å resolution. The Mpp75Aa1.1 is processed at its carboxyl-terminus by WCR midgut proteases, forms an oligomer, and specifically interacts with putative membrane-associated binding partners on the midgut apical microvilli to cause cellular tissue damage resulting in insect death. Alanine substitution of the surface-exposed amino acids W206, Y212, and G217 within the Mpp75Aa1.1 putative receptor binding domain I demonstrates that at least these three amino acids are required for WCR activity. The distinctive spatial arrangement of these amino acids suggests that they are part of a receptor binding epitope, which may be unique to Mpp75Aa1.1 and not present in other ETX_MTX2 proteins that do not have WCR activity. Overall, this work establishes that Mpp75Aa1.1 shares a mode of action consistent with traditional WCR-active Bt proteins despite significant structural differences. [ABSTRACT FROM AUTHOR]

Topography is a fundamental input to hydrologic models critical for generating realistic streamflow networks as well as infiltration and groundwater flow. Although there exist several national topographic datasets for the United States, they may not be compatible with gridded models that require hydrologically consistent digital elevation models (DEMs). Here, we present a national topographic dataset developed to support gridded hydrologic simulations at 1 km and 250 m spatial resolution over the contiguous United States. The workflow is described step by step in two parts: (a) DEM processing using a Priority Flood algorithm to ensure hydrologically consistent drainage networks and (b) slope calculation and smoothing to improve drainage performance. The accuracy of the derived stream network is evaluated by comparing the derived drainage area to drainage areas reported by the national stream gage network. The slope smoothing steps are evaluated using the runoff simulations with an integrated hydrologic model. Our DEM product started from the National Water Model DEM to ensure our final datasets will be as consistent as possible with this existing national framework. Our analysis shows that the additional processing we provide improves the consistency of simulated drainage areas and the runoff simulations that simulate gridded overland flow (as opposed to a network routing scheme). The workflow uses an open-source R package, and all output datasets and processing scripts are available and fully documented. All of the output datasets and scripts for processing are published through CyVerse at 250 m and 1 km resolution. The DOI link for the dataset is 10.25739/e1ps-qy48 (Zhang and Condon, 2020). [ABSTRACT FROM AUTHOR]

A diagnosis of cancer is associated with increased risks of suicidal ideation and suicide attempts. Genital-system cancer comprises nearly a third of all cancers in males. We used the SEER database to identify the incidence of and risk factors for suicide death in male patients with genital-system cancer in the United States. Patients were selected from the SEER database, and X-tile software was used to find the best cutoffs for stratifying age. Logistic regression was used to identify independent risk factors for suicide death. Only variables that were statistically significant in the univariate logistic regression models were analyzed in multivariate logistic regression models. This study found that age (18–66 vs ≥ 76 years: OR = 3.300, P < 0.001; 67–75 vs ≥ 76 years: OR = 1.832, P < 0.001), being unmarried (OR = 1.332, P = 0.010), being divorced, separated, or widowed (OR = 1.338, P = 0.002), caucasian (OR = 2.074, P = 0.003) and not receiving surgery or having an unknown surgery status (OR = 1.405, P < 0.001) significantly increased the risk of suicide death. A particularly important finding was that a time of <1 year after the diagnosis was related to an increased risk of suicide death (<1 vs ≥ 10 years: OR = 1.761, P = 0.008). We found that a number of factors significantly increased the risk of suicide. Importantly, a time of <1 year after the diagnosis was related to an increased risk of suicide death, which indicates the importance of identifying and treating people at risk of suicide as early as possible. These can help clinicians to understand suicidal patients and provide them with appropriate support. [ABSTRACT FROM AUTHOR]

Mounting evidence has linked postnatal antibiotic use with body mass index (BMI) in children, but the influence of prenatal antibiotic use on offspring obesity risk remains unclear. We aimed to assess the association between fetal exposure to antibiotics and obesity at ages 4 and 7 years among 43,332 children using a multicenter prospective cohort of the US Collaborative Perinatal Project (1959–1976). Antibiotic use was ascertained for mothers during pregnancy. Modified Poisson regression models were used to estimate risk ratios for obesity (BMI >95th percentile), and linear mixed models were applied to assess the association with BMI z score. Repeated prenatal exposure to antibiotics was associated with childhood obesity at age 7 years, and risk of obesity tended to increase with an increasing number of antibiotic exposures (for 2–3 exposures, risk ratio (RR) = 1.22, 95% confidence interval (CI): 1.04, 1.44; for ≥4 exposures, RR = 1.34, 95% CI: 1.03, 1.73). The magnitude of association was strongest for repeated exposures in the second trimester (RR = 1.40, 95% CI: 1.16, 1.71). Prenatal antibiotic use was not associated with obesity or BMI z score at age 4 years. These findings support an increased risk of mid-childhood obesity with repeated use of antibiotics during pregnancy. [ABSTRACT FROM AUTHOR]

Abstract: This paper investigates the information content of options trading prior to dividend change announcements. I find a positive (negative) relation between pre‐announcement abnormal implied volatility (IV) spread (abnormal IV skew) and cumulative abnormal stock returns around dividend change announcements. The predictive power of informed options trading is stronger for announcements of dividend reduction and when the options market is more liquid relative to the stock market and weaker when information has already been incorporated in the stock market. The predictability of informed options trading is robust to a placebo test and alternative measures of informed options trading. Overall results suggest that informed options trading predicts dividend change announcement returns. [ABSTRACT FROM AUTHOR]

This study evaluates the impact of the modification of the vertical eddy diffusivity (Km) in the boundary layer parameterization of the Hurricane Weather Research and Forecasting (HWRF) Model on forecasts of tropical cyclone (TC) rapid intensification (RI). Composites of HWRF forecasts of Hurricanes Earl (2010) and Karl (2010) were compared for two versions of the planetary boundary layer (PBL) scheme in HWRF. The results show that using a smaller value of Km, in better agreement with observations, improves RI forecasts. The composite-mean, inner-core structures for the two sets of runs at the time of RI onset are compared with observational, theoretical, and modeling studies of RI to determine why the runs with reduced Km are more likely to undergo RI. It is found that the forecasts with reduced Km at the RI onset have a shallower boundary layer with stronger inflow, more unstable near-surface air outside the eyewall, stronger and deeper updrafts in regions farther inward from the radius of maximum wind (RMW), and stronger boundary layer convergence closer to the storm center, although the mean storm intensity (as measured by the 10-m winds) is similar for the two groups. Finally, it is found that the departure of the maximumtangential wind from the gradient wind at the eyewall, and the inward advection of angular momentum outside the eyewall, is much larger in the forecasts with reduced Km. This study emphasizes the important role of the boundary layer structure and dynamics in TC intensity change, supporting recent studies emphasizing boundary layer spinup mechanism, and recommends further improvement to the HWRF PBL physics. [ABSTRACT FROM AUTHOR]

This work proposes a multi-objective optimization model to design a sustainable multi-period second generation biomass-to-bioethanol supply chain under multiple uncertainties. The objective is to simultaneously maximize the economic, environmental, and social performance. The strategic decisions such as land allocation for switchgrass cultivation, biorefinery locations and capacities, and the biomass-to-bioethanol conversion pathway are determined for each planning period which are staggered across the entire planning horizon. The augmented ε –constraint method is used to trade-off among the competing objectives and to obtain feasible solutions that achieve desired levels of sustainability. In order to solve the proposed stochastic optimization model efficiently and effectively, this work proposes a solution approach involving sequential application of a modified Sample Average Approximation method and Benders decomposition. A case study is presented to demonstrate the effectiveness of the proposed mathematical model and its impact on land usage and sustainability. [ABSTRACT FROM AUTHOR]

Objective Evidence for optimal timing of delivery for some pregnancy complications at late preterm gestation is limited. The purpose of this study was to identify center variation of indicated late preterm births. Study design We performed an analysis of singleton late preterm and term births from a large U.S. retrospective obstetrical cohort. Births associated with spontaneous preterm labor, major congenital anomalies, chorioamnionitis, and emergency cesarean were excluded. We used modified Poisson fixed effects logistic regression with interaction terms to assess center variation of indicated late preterm births associated with four medical/obstetric comorbidities after adjusting for socio-demographics, comorbidities, and hospital/provider characteristics. Results We identified 150,055 births from 16 hospitals; 9,218 were indicated late preterm births. We found wide variation of indicated late preterm births across hospitals. The extent of center variation was greater for births associated with preterm premature rupture of membranes (risk ratio [RR] across sites: 0.45-3.05), hypertensive disorders of pregnancy (RR across sites: 0.36-1.27), and placenta previa/abruption (RR across sites: 0.48-1.82). We found less center variation for births associated with diabetes (RR across sites: 0.65-1.39). Conclusion Practice variation in the management of indicated late preterm deliveries might be a source of preventable late preterm birth. [ABSTRACT FROM AUTHOR]

The structural evolution of the inner core and near-environment throughout the life cycle of Hurricane Edouard (2014) is examined using a synthesis of airborne and satellite measurements. This study specifically focuses on differences in the distribution of deep convection during two periods: when Edouard intensified toward hurricane status, and when Edouard peaked in intensity and began to weaken. While both periods saw precipitation maximized in the downshear-left and upshear-left quadrants, deep convection was only seen from the aircraft during the intensifying period. Deep convection was located farther inside the radius of maximum winds (RMW) during the intensifying period than the weakening period. This convection is traced to strong updrafts inside the RMW in the downshear-right quadrant, tied to strong low-level convergence and high convective available potential energy (CAPE) as the storm remained over warm water in a moist environment. Strong updrafts persisted upshear left and were collocated with high inertial stability in the inner core. During weakening, no deep convection was present, and the precipitation that was observed was associated with weaker convergence downshear right at larger radii, as CAPE was reduced from lower sea surface temperatures, reduced humidity from subsidence, and a stronger warm core. Weak updrafts were seen upshear left, with little coincidence with the high inertial stability of the inner core. These results highlight the importance of the azimuthal coverage of precipitation and the radial location of deep convection for intensification. A more symmetrical coverage can occur despite the presence of shear-driven azimuthal asymmetries in both the forcing and the local environment of the precipitation. [ABSTRACT FROM AUTHOR]

The structural evolution of the inner core and near environment throughout the life cycle of Hurricane Edouard (2014) is examined using a synthesis of airborne and satellite measurements. This study specifically focuses on the precipitation evolution and thermodynamic changes that occur on the vortex scale during four periods: when Edouard was a slowly intensifying tropical storm, another while a rapidly intensifying hurricane, during the initial stages of weakening after reaching peak intensity, and later while experiencing moderate weakening in the midlatitudes. Results suggest that, in a shear-relative framework, a wavenumber-1 asymmetry exists whereby the downshear quadrants consistently exhibit the greatest precipitation coverage and highest relative humidity, while the upshear quadrants (especially upshear right) exhibit relatively less precipitation coverage and lower humidity, particularly in the midtroposphere. Whether dynamically or precipitation driven, the relatively dry layers upshear appear to be ubiquitously caused by subsidence. The precipitation and thermodynamic asymmetry is observed throughout the intensification and later weakening stages, while a consistently more symmetric distribution is only observed when Edouard reaches peak intensity. The precipitation distribution, which is also discussed in the context of the boundary layer thermodynamic properties, is intimately linked to the thermodynamic symmetry, which becomes greater as the frequency, areal coverage, and, in particular, rainfall rate increases upshear. Although shear is generally believed to be detrimental to intensification, observations in Edouard also indicate that subsidence warming from mesoscale downdrafts in the low- to midtroposphere very near the center may have contributed favorably to organization early in the intensification stage. [ABSTRACT FROM AUTHOR]

Objective: High prepregnancy body mass index (BMI), excessive gestational weight gain (GWG), and gestational diabetes mellitus (GDM) are associated with the risk of childhood obesity. This study aims to examine the extent to which these effects may be mediated through the placenta.Methods: Data included 33,893 mothers and their singleton infants from birth to 7 years old (total 154,590 visits) in the Collaborative Perinatal Project, a U.S. multicenter prospective cohort study from 1959 to 1976. The placentas were weighed after removing cord and membranes. We performed sequential generalized estimating equation-linear models excluding and including placental weight to evaluate its mediation effect.Results: In this population, 21.7% of mothers had overweight or obesity, 17.3% had excessive GWG, and 350 (1%) had diagnosed GDM; in addition, 7.2% children had obesity. After adjustment for prepregnancy BMI and other covariates, childhood BMI was 0.23 (95% CI: 0.05, 0.40) kg/m(2) higher for children born to mothers with GDM versus those without GDM. Inclusion of placental weight in the model attenuated the association by 52% to 0.11 (95% CI: -0.06, 0.28) and similarly attenuated the associations with childhood BMI for GWG by 25% and maternal prepregnancy BMI by 17%.Conclusions: Placental weight partly mediates the effects of prepregnancy BMI, excessive GWG, and GDM on childhood BMI. [ABSTRACT FROM AUTHOR]

Background: Inflammation, slow gait, and depression individually are associated with mortality, yet little is known about the trajectories of these measures, their interrelationships, or their collective impact on mortality.Methods: Longitudinal latent class analysis was used to evaluate trajectories of depression (Center for Epidemiologic Studies Depression ≥ 10), slow gait (<1.0 m/s), and elevated inflammation (interleukin 6 > 3.2 pg/mL) using data from the Health Aging and Body Composition Study. Logistic regression was used to identify their associations with mortality.Results: For each outcome, low-probability (n inflammation = 1,656, n slow gait = 1,471, n depression = 1,458), increasing-probability (n inflammation = 847, n slow gait = 880, n depression = 1,062), and consistently high-probability (n inflammation = 572, n slow gait = 724, n depression = 555) trajectories were identified, with 22% of all participants classified as having increasing or consistently high-probability trajectories on inflammation, slow gait, and depression (meaning probability of impairment on each outcome increased from low to moderate/high or remained high over 10 years). Trajectories of slow gait were associated with inflammation (r = .40, p < .001) and depression (r = .49, p < .001). Although worsening trajectories of inflammation were independently associated with mortality (p < .001), the association between worsening trajectories of slow gait and mortality was only present in participants with worsening depression trajectories (p < .01). Participants with increasing/consistently high trajectories of depression and consistently high trajectories of inflammation and slow gait (n = 247) have an adjusted-morality rate of 85.2%, greater than all other classification permutations.Conclusions: Comprehensive assessment of older adults is warranted for the development of treatment strategies targeting a high-mortality risk phenotype consisting of inflammation, depression, and slow gait speed. [ABSTRACT FROM AUTHOR]

Objective: To assess HIV testing and factors associated with receipt of testing among persons with Medicaid and commercial insurance during 2012. Methods: Outpatient and laboratory claims were analyzed from two databases: all Medicaid claims from six states and all claims from Medicaid health plans from four other states and a large national convenience sample of patients with commercial insurance in the United States. We excluded those aged <13 years and >64 years, enrolled <9 of the 12 months, pregnant females, and previously diagnosed with HIV. We identified patients with new HIV diagnoses that followed (did not precede) the HIV test, using HIV ICD-9 codes. HIV testing percentages were assessed by patient demographics and other tests or diagnoses that occurred during the same visit. Results: During 2012, 89,242 of 2,069,536 patients (4.3%) with Medicaid had at least one HIV test, and 850 (1.0%) of those tested received a new HIV diagnosis. Among 27,206,804 patients with commercial insurance, 757,646 (2.8%) had at least one HIV test, and 5,884 (0.8%) of those tested received a new HIV diagnosis. During visits that included an HIV test, 80.2% of Medicaid and 83.0% of commercial insurance claims also included a test or diagnosis for a sexually transmitted infection (STI), and/or Hepatitis B or C virus at the same visit. Conclusions: HIV testing primarily took place concurrently with screening or diagnoses for STIs or Hepatitis B or C. We found little evidence to suggest routine screening for HIV infection was widespread. [ABSTRACT FROM AUTHOR]

Intrauterine growth restriction (IUGR) is associated with various prenatal risks and postnatal adverse outcomes. The aim of this study is to choose the most sensitive newborn anthropometric measure, which is closely associated with IUGR-related risks and outcomes, to substitute IUGR after delivery. Data were obtained from the Collaborative Perinatal Project, a multicenter prospective cohort study in the United States from 1959 to 1976. Maternal heavy smoking and severe hypertensive disorders during pregnancy, neonatal polycythemia and hypothermia, low intelligence quotient (<70) at age 7 years were chosen as IUGR-related risks and outcomes. Eight anthropometric measures at birth were tested by logistic regression model. Birth weight-to-head circumference (W/HC) had the largest odds ratio (OR) for neonatal polycythemia (OR = 1.8, 95% confidence interval [CI] = 1.5-2.0), severe hypertensive disorders (OR = 1.9, 95% CI = 1.5-2.2), and maternal heavy smoking (OR = 1.9, 95% CI = 1.7-2.1) during pregnancy. It also had the highest summary OR (9.3). Thus, W/HC may be a good measure for IUGR. [ABSTRACT FROM AUTHOR]

Objective: To investigate the roles of physical activity (exercise) and sociodemographic factors in depressive symptoms among men and women in the United States.Data Source: 2011 U.S. Behavioral Risk Factor Surveillance System (BRFSS).Study Design: Patient Health Questionnaire Depression Scale (PHQ-8) scores are aggregated and divided into five categories. An ordered switching probability model with binary endogenous physical activity is developed to accommodate ordinality of depression categories and ameliorate statistical biases due to endogeneity of physical activity.Principal Findings: Average treatment effects suggest physical activity ameliorates depressive symptoms among mildly and moderately depressed individuals, most notably among mildly depressed women. Gender differences exist in the roles of sociodemographic factors, with age, income, race, education, employment status, and recent mental health condition playing differentiated roles in affecting depressive symptoms.Conclusions: Regular physical activity reduces depressive symptoms among both men and women with mild to moderate depression, notably among women. [ABSTRACT FROM AUTHOR]

Evidence shows that asthma originates in early life. Studies have found that phototherapy and/or neonatal jaundice may be associated with asthma. We investigated the association between neonatal bilirubin levels and childhood asthma without phototherapy intervention in the Collaborative Perinatal Project, a multicenter prospective cohort study conducted in the United States from 1959 to 1965. A total of 54,795 livebirths were included, and 40,063 children were followed up until 7 years of age or older. Total serum bilirubin (TSB) levels were examined at 48 hours postpartum in newborns with birthweights of 2,250 g or more. Information on asthma and other diseases through age 7 years was summarized and confirmed by a group of pediatricians and child neurologists. Among 28,807 term infants, the overall prevalence of asthma was 5.26%. Risks of asthma increased with both maximum TSB levels and TSB levels at 48 hours postpartum (P for trend < 0.01). Neonatal maximum TSB levels greater than 15 mg/dL were associated with a 61% increase in the risk of childhood asthma (odds ratio = 1.61, 95% confidence interval: 1.04, 2.08) after adjustment for confounders. In this prospective cohort study of infants born at a time when phototherapy was unavailable, neonatal hyperbilirubinemia was associated with an increased risk of childhood asthma. [ABSTRACT FROM PUBLISHER]

This article discusses the findings of an online survey conducted by the U.S. Centers for Disease Control and Prevention (CDC) to determine influenza vaccination coverage among health-care personnel (HCP) during the 2012-2013 season. Overall, 72% of HCP reported having vaccination for the said season, an increase during the 2011-2012 season. By occupation, coverage was 92.3% among physicians, 89.1% among pharmacists, 88.5% among nurse practitioners/physician assistants and 84.8% among nurses.

Abstract: In order to secure the energy future and protect the environment, the U.S. is looking for renewable resources to meet the increasing energy demands for its electricity sector (which accounts for ≈ 40% of total U.S. energy consumption in 2011). The overall aim of this article is to summarize the possible approaches that can be used to improve and optimize the utilization of renewables for electricity generation in the United States. First, an overview is presented about the resource potential, current usage, and technical status of electricity generation from renewables (in the United States). Second, a number of economic, operational, regulatory, sustainability, and technical challenges that are likely to be encountered are identified. Third, strategies are outlined that can be used to minimize costs, deal with the spatial nature of renewables, smooth temporal variations associated with intermittency, and achieve successful integration of electricity generated from renewable resources into the U.S. power grid. Fourth, a sustainability assessment framework for renewable resource deployment (for electricity generation in the U.S.) is discussed. The framework considers multiple criteria (including cost, environmental and social impacts), thus giving a comprehensive assessment of each renewable energy resource (for electricity generation in the United States). Fifth, the current U.S. renewable energy policy is analyzed, and rigorous recommendations are made for optimizing future U.S. renewable energy policy that can permanently induce a long-term sustainable shift towards electricity generation from renewables. Finally, directions for future research are highlighted. [Copyright &y& Elsevier]

Regulatoryagencies require testing of chemicals and products toprotect workers and consumers from potential eye injury hazards. Animalscreening, such as the rabbit Draize test, for potential environmentaltoxicants is time-consuming and costly. Therefore, virtual screeningusing computational models to tag potential ocular toxicants is attractiveto toxicologists and policy makers. We have developed quantitativestructure–activity relationship (QSAR) models for a set ofsmall molecules with animal ocular toxicity data compiled by the NationalToxicology Program Interagency Center for the Evaluation of AlternativeToxicological Methods. The data set was initially curated by removingduplicates, mixtures, and inorganics. The remaining 75 compounds wereused to develop QSAR models. We applied both knearestneighbor and random forest statistical approaches in combination withDragon and Molecular Operating Environment descriptors. Developedmodels were validated on an external set of 34 compounds collectedfrom additional sources. The external correct classification rates(CCR) of all individual models were between 72 and 87%. Furthermore,the consensus model, based on the prediction average of individualmodels, showed additional improvement (CCR = 0.93). The validatedmodels could be used to screen external chemical libraries and prioritizechemicals for in vivo screening as potential ocular toxicants. [ABSTRACT FROM AUTHOR]

In this paper, the authors present a Bayes factor model for detecting undocumented artificial discontinuities in a network of temperature series. First, they generate multiple difference series for each station with the pairwise comparison approach. Next, they treat the detection problem as a Bayesian model selection problem and use Bayes factors to calculate the posterior probabilities of the discontinuities and estimate their locations in time and space. The model can be applied to large climate networks and realistic temperature series with missing data. The effectiveness of the model is illustrated with two realistic large-scale simulations and four sensitivity analyses. Results from applying the algorithm to observed monthly temperature data from the conterminous United States are also briefly discussed in the context of what is currently known about the nature of biases in the U.S. surface temperature record. [ABSTRACT FROM AUTHOR]

The article discusses the influenza vaccination of health-care personnel (HCP) in the U.S. during the 2011-2012 influenza season. The Advisory Committee on Immunization has recommended their vaccination. Data showed that vaccination was effective in minimizing the risk for medical care-acquired influenza illnesses among physicians and nurses. The Centers for Medicare & Medicaid Services (CMS) plans to require hospitals to report HCP influenza vaccination levels beginning in January 2013.

Abstract: Retention index (RI) is useful for metabolite identification. However, when RI is integrated with mass spectral similarity for metabolite identification, many controversial RI threshold setup are reported in literatures. In this study, a large scale test dataset of 5844 compounds with both mass spectra and RI information were created from National Institute of Standards and Technology (NIST) repetitive mass spectra (MS) and RI library. Three MS similarity measures: NIST composite measure, the real part of Discrete Fourier Transform (DFT.R) and the detail of Discrete Wavelet Transform (DWT.D) were used to investigate the accuracy of compound identification using the test dataset. To imitate real identification experiments, NIST MS main library was employed as reference library and the test dataset was used as search data. Our study shows that the optimal RI thresholds are 22, 15, and 15i.u. for the NIST composite, DFT.R and DWT.D measures, respectively, when the RI and mass spectral similarity are integrated for compound identification. Compared to the mass spectrum matching, using both RI and mass spectral matching can improve the identification accuracy by 1.7%, 3.5%, and 3.5% for the three mass spectral similarity measures, respectively. It is concluded that the improvement of RI matching for compound identification heavily depends on the method of MS spectral similarity measure and the accuracy of RI data. [Copyright &y& Elsevier]

Abstract: A method was developed to employ National Institute of Standards and Technology (NIST) 2008 retention index database information for molecular retention matching via constructing a set of empirical distribution functions (DFs) of the absolute retention index deviation to its mean value. The effects of different experimental parameters on the molecules’ retention indices were first assessed. The column class, the column type, and the data type have significant effects on the retention index values acquired on capillary columns. However, the normal alkane retention index (I norm) with the ramp condition is similar to the linear retention index (I T ), while the I norm with the isothermal condition is similar to the Kováts retention index (I). As for the I norm with the complex condition, these data should be treated as an additional group, because the mean I norm value of the polar column is significantly different from the I T . Based on this analysis, nine DFs were generated from the grouped retention index data. The DF information was further implemented into a software program called iMatch. The performance of iMatch was evaluated using experimental data of a mixture of standards and metabolite extract of rat plasma with spiked-in standards. About 19% of the molecules identified by ChromaTOF were filtered out by iMatch from the identification list of electron ionization (EI) mass spectral matching, while all of the spiked-in standards were preserved. The analysis results demonstrate that using the retention index values, via constructing a set of DFs, can improve the spectral matching-based identifications by reducing a significant portion of false-positives. [Copyright &y& Elsevier]

Objectives. We examined the relationship between obstetrical intervention and preterm birth in the United States between 1991 and 2006. Methods. We assessed changes in preterm birth, cesarean delivery, labor induction, and associated risks. Logistic regression modeled the odds of preterm obstetrical intervention after risk adjustment. Results. From 1991 to 2006, the percentage of singleton preterm births increased 13%. The cesarean delivery rate for singleton preterm births increased 47%, and the rate of induced labor doubled. In 2006, 51% of singleton preterm births were spontaneous vaginal deliveries, compared with 69% in 1991. After adjustment for demographic and medical risks, the mother of a preterm infant was 88% (95% confidence interval [CI]=1.87, 1.90) more likely to have an obstetrical intervention in 2006 than in 1991. Using new birth certificate data from 19 states, we estimated that 42% of singleton preterm infants were delivered via induction or cesarean birth without spontaneous onset of labor. Conclusions. Obstetrical interventions were related to the increase in the US preterm birth rate between 1991 and 2006. The public health community can play a central role in reducing medically unnecessary interventions. [ABSTRACT FROM AUTHOR]

Data collected in the low-level atmospheric boundary layer in five hurricanes by NOAA research aircraft are analyzed to measure turbulence with scales small enough to retrieve the rate of dissipation. A total of 49 flux runs suitable for analysis are identified in the atmospheric boundary layer within 200 m above the sea surface. Momentum fluxes are directly determined using the eddy correlation method, and drag coefficients are also calculated. The dissipative heating is estimated using two different methods: 1) integrating the rate of dissipation in the surface layer and 2) multiplying the drag coefficient by the cube of surface wind speed. While the latter method has been widely used in theoretical models as well as several numerical models simulating hurricanes, these analyses show that using this method would significantly overestimate the magnitude of dissipative heating. Although the dataset used in this study is limited by the surface wind speed range <30 m s−1, this work highlights that it is crucial to understand the physical processes related to dissipative heating in the hurricane boundary layer for implementing it into hurricane models. [ABSTRACT FROM AUTHOR]

Abstract: Vehicle fuel efficiency has taken on more economic and environmental significance due to the rise in gasoline prices in 2007/2008. We examine adoption of fuel efficiency technologies by the US automobile industry between 1985 and 2002 and consider the environmental implications. The technology efficient frontier between vehicle weight and fuel efficiency of the US automobile fleet did not move outward significantly for an extended period in the 1980s and 1990s indicating a lack of company- or industry-wide adoption of new fuel efficiency technologies. While the firm with inferior technology capability did push its efficient frontier outward to close the technology gap, the two leading firms’ efficient frontiers first showed signs of possible regression in the early 1990s, and did not move outward significantly until the mid 1990s. Several managerial and policy options are examined for improving vehicle fuel efficiency. [Copyright &y& Elsevier]

In the 1950s, Emanuel Friedman described the first comprehensive method of evaluating labour in clinical practice. In this landmark work, Friedman described the relationship between the duration of labour and cervical dilation as a sigmoid curve and outlined a tool for following labour progression and for identifying abnormal labour. His definitions of labour protraction and arrest continue to be applied in contemporary obstetric practice, although there have been considerable changes since in the clinical management of labour and delivery. This paper provides an overview of Friedman's work, addresses various methodological challenges in studying labour progression, and describes the utility of more advanced statistical methods for studying labour progression, such as survival analysis, compared with other approaches. Additional research that utilises and refines such methods will provide greater insight into labour progression and may assist in updating the diagnostic criteria for labour protraction and arrest disorders in contemporary obstetric practice. Moreover, such detailed information could have important clinical implications towards reducing the rate of primary caesarean delivery in the United States. [ABSTRACT FROM AUTHOR]

This study examined the incidence of and risk factors for recurrent and newly developed hypertensive disorders in the second pregnancy. We analysed data on 1641 women who had both the first and second pregnancies in the Collaborative Perinatal Project, a large prospective cohort study at 12 hospitals in the US. Nineteen per cent [95% CI 14%, 24%] of women who had gestational hypertension in the first pregnancy, 32% [95% CI 17%, 48%] of those with pre-eclampsia and 46% [95% CI 32%, 60%] of patients with gestational hypertension or pre-eclampsia superimposed on chronic hypertension, had recurrent hypertensive disorders in the second pregnancy. Risk factors for recurrence included history of chronic hypertension and thromboembolism, early onset of hypertension in the first pregnancy or persistent hypertension after 5 weeks postpartum and high baseline blood pressure in the second pregnancy. Women with a normotensive first pregnancy but a severe small-for-gestational-age birth had twice the risk of developing hypertension in the second pregnancy (RR = 2.1, 95% CI, 1.1, 4.0). In summary, hypertensive disorders have a 20--50% recurrence rate in the second pregnancy. The earlier the onset of hypertension in the first pregnancy, the higher the overall recurrence rate. Intrauterine growth restriction of the first birth is an independent risk factor for hypertension in the second pregnancy. [ABSTRACT FROM AUTHOR]

Low blood pressure during pregnancy has been associated with poor perinatal outcomes. However, whether this association is causal or is due to confounding has never been carefully assessed. The authors used data from the Collaborative Perinatal Project, a large prospective cohort study in 12 hospitals in the United States from 1959 to 1966. A total of 28,095 subjects were included. At first glance, it appeared that the lower the baseline blood pressure during pregnancy, the higher the incidence of very premature birth (<34 weeks) and severe small for gestational age (<5th percentile) in a consistent dose-response pattern. However, women with low blood pressure were generally younger, shorter, lighter, leaner, poorer, and more often a minority, and they gained less weight. After the authors controlled for these factors, low blood pressure was not associated with preterm birth (adjusted relative risks ranging from 0.86 to 0.93, p > 0.05) or small for gestational age (relative risks ranging from 0.45 to 2.0). Therefore, the association between low blood pressure during pregnancy and poor perinatal outcomes is largely due to confounding by other risk factors. Low blood pressure by itself does not increase risk of poor perinatal outcomes at a population level. However, this conclusion may not apply to individual patients who also have a compromised plasma volume expansion or pathologic homeostasis. Am J Epidemiol 2001;153:642-6. [ABSTRACT FROM AUTHOR]

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Abstract Metastatic melanoma therapies have proliferated over the last ten years. Prior to this, decades passed with only very few drugs available to offer our patients, and even then, those few drugs had minimal survival benefits. Many treatment options emerged over the last ten years with diverse mechanisms of action. Further, combination regimens have demonstrated superiority over monotherapy, especially for targeted agents. Each therapeutic combination possesses different advantages and side effect profiles. In this review, we outline the United States Food and Drug Administration–approved melanoma treatment agents and therapies currently in clinical development, focusing on combination approaches. [ABSTRACT FROM AUTHOR]

Objective: We sought to characterize complications of pregnancy, labor, and delivery associated with maternal asthma in a contemporary US cohort. Study Design: We studied a retrospective cohort based on electronic medical record data from 223,512 singleton deliveries from 12 clinical centers across the United States from 2002 through 2008. Results: Women with asthma had higher odds of preeclampsia (adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 1.06−1.22), superimposed preeclampsia (aOR, 1.34; 95% CI, 1.15−1.56), gestational diabetes (aOR, 1.11; 95% CI, 1.03−1.19), placental abruption (aOR, 1.22; 95% CI, 1.09−1.36), and placenta previa (aOR, 1.30; 95% CI, 1.08−1.56). Asthmatic women had a higher odds of preterm birth overall (aOR, 1.17; 95% CI, 1.12−1.23) and of medically indicated preterm delivery (aOR, 1.14; 95% CI, 1.01−1.29). Asthmatics were less likely to have spontaneous labor (aOR, 0.87; 95% CI, 0.84−0.90) and vaginal delivery (aOR, 0.84; 95% CI, 0.80−0.87). Risks were higher for breech presentation (aOR, 1.13; 95% CI, 1.05−1.22), hemorrhage (aOR, 1.09; 95% CI, 1.03−1.16), pulmonary embolism (aOR, 1.71; 95% CI, 1.05−2.79), and maternal intensive care unit admission (aOR, 1.34; 95% CI, 1.04−1.72). Conclusion: Maternal asthma increased risk for nearly all outcomes studied in a general obstetric population. [ABSTRACT FROM AUTHOR]

Objective: We sought to describe details of labor induction, including precursors and methods, and associated vaginal delivery rates. Study Design: This was a retrospective cohort study of 208,695 electronic medical records from 19 hospitals across the United States, 2002 through 2008. Results: Induction occurred in 42.9% of nulliparas and 31.8% of multiparas and elective or no recorded indication for induction at term occurred in 35.5% and 44.1%, respectively. Elective induction at term in multiparas was highly successful (vaginal delivery 97%) compared to nulliparas (76.2%). For all precursors, cesarean delivery was more common in nulliparas in the latent compared to active phase of labor. Regardless of method, vaginal delivery rates were higher with a ripe vs unripe cervix, particularly for multiparas (86.6-100%). Conclusion: Induction of labor was a common obstetric intervention. Selecting appropriate candidates and waiting longer for labor to progress into the active phase would make an impact on decreasing the national cesarean delivery rate. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to examine differences in labor patterns in a modern cohort compared with the 1960s in the United States. Study Design: Data from pregnancies at term, in spontaneous labor, with cephalic, singleton fetuses were compared between the Collaborative Perinatal Project (CPP, n = 39,491 delivering 1959-1966) and the Consortium on Safe Labor (CSL; n = 98,359 delivering 2002-2008). Results: Compared with the CPP, women in the CSL were older (26.8 ± 6.0 vs 24.1 ± 6.0 years), heavier (body mass index 29.9 ± 5.0 vs 26.3 ± 4.1 kg/m2), had higher epidural (55% vs 4%) and oxytocin use (31% vs 12%), and cesarean delivery (12% vs 3%). First stage of labor in the CSL was longer by a median of 2.6 hours in nulliparas and 2.0 hours in multiparas, even after adjusting for maternal and pregnancy characteristics, suggesting that the prolonged labor is mostly due to changes in practice patterns. Conclusion: Labor is longer in the modern obstetrical cohort. The benefit of extensive interventions needs further evaluation. [ABSTRACT FROM AUTHOR]

Objective: To describe contemporary cesarean delivery practice in the United States. Study Design: Consortium on Safe Labor collected detailed labor and delivery information from 228,668 electronic medical records from 19 hospitals across the United States, 2002-2008. Results: The overall cesarean delivery rate was 30.5%. The 31.2% of nulliparous women were delivered by cesarean section. Prelabor repeat cesarean delivery due to a previous uterine scar contributed 30.9% of all cesarean sections. The 28.8% of women with a uterine scar had a trial of labor and the success rate was 57.1%. The 43.8% women attempting vaginal delivery had induction. Half of cesarean for dystocia in induced labor were performed before 6 cm of cervical dilation. Conclusion: To decrease cesarean delivery rate in the United States, reducing primary cesarean delivery is the key. Increasing vaginal birth after previous cesarean rate is urgently needed. Cesarean section for dystocia should be avoided before the active phase is established, particularly in nulliparous women and in induced labor. [ABSTRACT FROM AUTHOR]

Objective: We sought to determine maternal and neonatal outcomes by labor onset type and gestational age. Study Design: We used electronic medical records data from 10 US institutions in the Consortium on Safe Labor on 115,528 deliveries from 2002 through 2008. Deliveries were divided by labor onset type (spontaneous, elective induction, indicated induction, unlabored cesarean). Neonatal and maternal outcomes were calculated by labor onset type and gestational age. Results: Neonatal intensive care unit admissions and sepsis improved with each week of gestational age until 39 weeks (P < .001). After adjusting for complications, elective induction of labor was associated with a lower risk of ventilator use (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.28–0.53), sepsis (OR, 0.36; 95% CI, 0.26–0.49), and neonatal intensive care unit admissions (OR, 0.52; 95% CI, 0.48–0.57) compared to spontaneous labor. The relative risk of hysterectomy at term was 3.21 (95% CI, 1.08–9.54) with elective induction, 1.16 (95% CI, 0.24–5.58) with indicated induction, and 6.57 (95% CI, 1.78–24.30) with cesarean without labor compared to spontaneous labor. Conclusion: Some neonatal outcomes improved until 39 weeks. Babies born with elective induction are associated with better neonatal outcomes compared to spontaneous labor. Elective induction may be associated with an increased hysterectomy risk. [Copyright &y& Elsevier]

Objective: To compare the ability of the INTERGROWTH-21st, National Institute of Child Health and Human Development, and WHO fetal growth standards to identify fetuses at risk of adverse perinatal outcomes.Methods: A retrospective analysis was performed among women enrolled in a multicenter randomized controlled trial (Routine Antenatal Diagnostic Imaging with Ultrasound) that was conducted in six states in the USA between November 1987 and May 1991. The predictive capability of various biometric indicators (biparietal diameter, femur length, abdominal circumference, head circumference, estimated fetal weight, and birthweight) was evaluated. Adverse outcomes included severe morbidity and perinatal death.Results: There were 9409 women included. Biometric indicators measured at a gestational age of 18-24 weeks had insufficient predictive sensitivity (range, 4%-47%). By contrast, measurements taken at 28-34 weeks predicted statistically significant relative risk (range 1.5-10.2; P<0.05 for 27/30 relative risk values) and area under the receiver operating characteristic curve (range, 0.50-0.59; P<0.05 for 8/15 curves). Nonetheless, differences in accuracy between standards for predicting adverse perinatal outcomes were subtle (P>0.05 for differences in area under the curve values).Conclusion: Although useful to monitor fetal growth trajectory and the level of risk, all three fetal growth standards provided limited accuracy for identifying fetuses at risk of adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Previous studies reported conflicting results on the relationship between oxytocin use for labor augmentation and the risk of postpartum hemorrhage, probably because it is rather challenging to disentangle oxytocin use from labor dystocia., Objective: This study aimed to investigate the independent association between oxytocin use for augmentation and the risk of postpartum hemorrhage by using advanced statistical modeling to control for labor patterns and other covariates., Study Design: We used data from 20,899 term, cephalic, singleton pregnancies of patients with spontaneous onset of labor and no previous cesarean delivery from Intermountain Healthcare in Utah in the Consortium on Safe Labor. Presence of postpartum hemorrhage was identified on the basis of a clinical diagnosis. Propensity scores were calculated using a generalized linear mixed model for oxytocin use for augmentation, and covariate balancing generalized propensity score was applied to obtain propensity scores for the duration and total dosage of oxytocin augmentation. A weighted generalized additive mixed model was used to depict dose-response curves between the duration and total dosage of oxytocin augmentation and the outcomes. The average treatment effects of oxytocin use for augmentation on postpartum hemorrhage and estimated blood loss (mL) were assessed by inverse probability weighting of propensity scores., Results: The odds of both postpartum hemorrhage and estimated blood loss increased modestly when the duration and/or total dosage of oxytocin used for augmentation increased. However, in comparison with women for whom oxytocin was not used, oxytocin augmentation was not clinically or statistically significantly associated with estimated blood loss (6.5 mL; 95% confidence interval, 2.5-10.3) or postpartum hemorrhage (adjusted odds ratio, 1.02; 95% confidence interval, 0.82-1.24) when rigorously controlling for labor pattern and potential confounders. The results remained consistent regardless of inclusion of women with an intrapartum cesarean delivery., Conclusion: The odds of postpartum hemorrhage and estimated blood loss increased modestly with increasing duration and total dosage of oxytocin augmentation. However, in comparison with women for whom oxytocin was not used and after controlling for potential confounders, there was no clinically significant association between oxytocin use for augmentation and estimated blood loss or the risk of postpartum hemorrhage., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This study aimed to investigate the concordance rate between the 2022 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria and the 1990 criteria for eosinophilic granulomatosis with polyangiitis (EGPA) in Chinese patients. 68 patients were diagnosed with EGPA according to the 1990 ACR criteria in the Department of Respiratory and Critical Care Medicine, Beijing Chao-yang Hospital Department, from May 2005 to December 2022, and those patients were reclassified using the 2022 ACR/EULAR criteria for EGPA. Among the 68 patients, 88.2% (60 cases) met the 2022 ACR/EULAR criteria for EGPA, and 11.8% (8 cases) patients failed to meet the new criteria. Only 66.2% of the patients were detected blood eosinophil count ≥ 1 × 109/L, while more patients (77.9%) met the item blood eosinophil count > 10% in the 1990 criteria. The report rate of nasal polyps was 13.2% in these patients. The concordance rate between the 2022 ACR/EULAR criteria and the 1990 criteria for EGPA was 88.2%. Compared with the 1990 criteria, the 2022 ACR/EULAR put more weighting on the blood eosinophil count and nasal polyps, while the diagnostic rate of them is low in Chinese patients. Thus improving the positive rate is important and routinely screening for nasal polyps should be performed in the future., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: To assess advanced practitioners' scope of practice laws (i.e., legal authority providers can prescribe regulated medications) as potential barriers to HIV pre-exposure prophylaxis (PrEP), we conducted an analysis using IQVIA Real World Data in association with scope of practice law classifications supplied by the American Association of Nurse Practitioners and scopeofpracticepolicy.org. Nurse practitioners in states that allowed independent scope of practice were 1.4 times more likely to have prescribed PrEP compared with nurse practitioners in states where their prescribing authority is determined by a supervising medical doctor (MD). Physician assistants in states where the law or a state board defined their prescribing authority were more than twice as likely to prescribe PrEP compared with those in states where a supervising MD oversaw prescribing rights. Our findings suggest that restricting scope of prescribing practice by requiring MD oversight limits PrEP access and poses a barrier to scaling up PrEP., (Copyright © 2021 Association of Nurses in AIDS Care.)

Study Design: Observational study., Objectives: The objectives of this study are (1) to quantify social media use among active American Cervical Spine Research Society (CSRS) members; (2) to determine if there is an association between practice setting, region, or years of active membership and social media use., Summary of Background Data: Many patients now seek health and physician information online, including on social media. Indeed, social media use by orthopedic surgeons has been shown to be associated with more and improved ratings on physician review websites. Further, social media can provide a means for improved doctor-patient relationships, educational endeavors, and professional networking. However, there is a paucity of literature examining social media use among spine surgeons., Materials and Methods: In January 2019, the CSRS membership directory was used to identify all active American spine surgeon members. Through a Google search, social media use of each spine surgeon on the following platforms was identified: provider page/official website; Facebook; Twitter; Instagram; LinkedIn; and YouTube. In addition, surgeon characteristics were recorded. The percentage of spine surgeons using each social media platform was reported. Bivariate analysis was used to compare social media use by practice setting, region, and years of active CSRS membership., Results: Nearly all spine surgeons have a provider page/official website (98%) and over half (56%) have a LinkedIn presence. Less than one third of spine surgeons are on any of the remaining social media platforms analyzed. The least frequently used social media platform was Instagram (3.2%). There was no difference in any social media platform use by practice setting, region, and years of active CSRS membership., Conclusions: As social media becomes even more common place and the role of it in medical care continues to be better defined, there is notable room for increased social media use among active American members of the CSRS., Level of Evidence: Level IV-observational study., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The Supplemental Nutrition Assistance Program (SNAP) is designed to improve household diet and food security-a pressing problem confronting low-income families in the United States. Previous studies on the issue often ignored the methodological issue of endogenous program participation. We revisit this important issue by estimating a simultaneous equation system with ordinal household food insecurity. Data are drawn from the 2009-2011 Current Population Survey Food Security Supplement (CPS-FSS), restricted to SNAP-eligible households with children. Our results add to the stocks of empirical findings that SNAP participation ameliorates food insecurity among adults only, but increases the probabilities of low and very low food security among children. These contradictory results indicate that our selection approach with a single cross section is only partially successful, and that additional efforts are needed in further analyses of this complicated issue, perhaps with longitudinal data. Socio-demographic variables are found to affect food-secure households and food-insecure households differently, but affect SNAP nonparticipants and participants in the same direction. The state policy tools, such as broad-based categorical eligibility (BBCE) and simplified reporting, can encourage SNAP participation and thus ameliorate food insecurity. Our findings can inform policy deliberations.

Study Design: Observational study., Objective: To evaluate the online ratings of spine deformity surgeons and variables that may affect online ratings Physician review websites (PRW) continue to be an emerging trend in the US across all specialties. Previous literature with smaller sample sizes revealed that most spine surgeons are rated on at least on PRW. To date, the online ratings of spinal deformity surgeons have not been evaluated., Materials and Methods: A review of the 2017 Scoliosis Research Society (SRS) Fellowship directory for active fellows and candidate members yielded 634 active members. Online ratings from five PRWs were recorded and scaled from 0 to 100. Using SPSS, one-way analysis of variance was used to compare differences between multiple groups. A t test was used to compare differences between two groups. Significance was set at p < 0.05., Results: Most surgeons (98.7%) were rated on at least one PRW. Surgeons in academic or hospital practice had higher ratings than those in private practice (83.4 vs. 78.8, and 83.7 vs. 78.8, p < 0.001). Surgeons with 0-5-year experience had higher ratings than more experienced surgeons (p < 0.001). However, surgeons in practice for 0-5 years also had fewer reviews than their more experienced colleagues (p < 0.05). We found no differences in ratings based on sex, specialty, or region. The largest differences in ratings between high and poorly rated spine surgeons was in areas pertaining to the doctor-patient relationship (answering questions, time spent with the patient)., Conclusion: The majority (98.7%) of SRS surgeons are rated on at least one PRW. SRS surgeons in practice between 0 and 5 years have higher ratings than more experienced surgeons, but were rated by fewer patients than their more experienced counterparts. Higher ratings were associated with variables pertaining to the patient-doctor relationship., Level of Evidence: IV.

Objective: The benefit of adjuvant therapy (AT) remains controversial in stage IB gastric cancer (GC). This study aimed to offer a reference for the rational indications of AT. Methods: We retrospectively included 1216 stage IB GC who experienced curative surgery from the SEER database between 2004 and 2015. These patients were allocated into two groups: Group AT and Group surgery alone (Group SA). We established a nomogram to predict OS and then divided whole cohort into low-risk and high-risk groups based on the OS predicted by the nomogram. Results: Six variables, which were significantly related with OS of entire patients after matched, were incorporated in the nomogram. These variables were age, examined lymph nodes, tumor site, marital, family income and stage IB. The C -index of the model was 0.637 and the calibration curve showed that the anticipated values were in accordance with the actual values. The decision curve demonstrated that the optimal clinical impact was achieved when the threshold possibility was 0-56%. Then, the entire cohort was separated into low-risk (≤159 points) as well as high-risk (>159 points) groups based on the projected 5-year OS of recursive partitioning analysis. Group SA revealed a significantly poorer OS than Group AT for high-risk patients ( p < .001); on the other hand, there was a comparable OS for low-risk patients ( p = .361). Conclusions: We have developed an effective, intuitional and applied prognostic tool to clinical decision-making. For stage IB GC after surgical resection, AT was only recommended for high-risk patients. However, AT may be dispensable for low-risk patients.