Entire US Research Articles

Return to Play Among Golfers Undergoing Hip Arthroscopy: Short- to Mid-term Follow-up.

There are approximately 25 million amateur golfers in the United States, making up almost 10% of the entire US population. The purpose of this study was to evaluate short-term outcomes and rates of return to sport among recreational golfers who underwent hip arthroscopy for the treatment of labral tears. Data were prospectively collected and retrospectively reviewed for patients who underwent hip arthroscopy by one surgeon between August 2008 and February 2015. Exclusion criteria were previous ipsilateral hip surgeries or conditions, preoperative Tönnis osteoarthritis grade greater than 1, or workers' compensation status. Patients who played golf at a recreational level within 1 year prior to their surgery, attempted to return to golf postoperatively, and had preoperative and minimum 2-year postoperative measures for the modified Harris hip score, Nonarthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale for pain were included in the final cohort. Data on return to sport, surgical complications, and secondary surgeries were recorded. Of the 49 patients eligible for inclusion, 40 (81.6%) had minimum 2-year follow-up at a mean of 51.0 months. Mean age at surgery was 49.1 years. All patient-reported outcomes and visual analog scale scores were significantly improved at latest follow-up. Thirty-six (90%) of the 40 patients returned to golf after surgery. Hip arthroscopy leads to significant improvement in patient-reported outcomes and a high rate of return to sport for recreational golfers presenting with labral tears. Therefore, it is a good treatment option for this patient population. [Orthopedics. 2018; 41(4):e545-e549.].

Estimating the Association of the 2017 and 2014 Hypertension Guidelines With Cardiovascular Events and Deaths in US Adults

The 2017 American College of Cardiology/American Heart Association hypertension guideline recommends lower blood pressure (BP) thresholds for initiating antihypertensive medication and treatment goals than the 2014 evidence-based hypertension guideline. To estimate the potential association of the 2017 and 2014 hypertension guidelines with the proportion of US adults defined as being hypertensive or recommended for antihypertensive treatment and with risk reduction of major cardiovascular disease (CVD) and all-cause mortality. Using data from the National Health and Nutrition Examination Survey 2013 to 2016, we estimated the proportions of US adults with hypertension or recommended for antihypertensive treatment according to the 2017 and 2014 hypertension guidelines. Using data from the National Health and Nutrition Examination Survey, antihypertensive clinical trials, and population-based cohort studies, we estimated risk reductions of CVD and all-cause mortality assuming the entire US adult population achieved guideline-recommended systolic BP (SBP) treatment goals. Data were analyzed between October 2017 and March 2018. Proportions and numbers of individuals with hypertension or recommended for antihypertensive treatment and numbers of CVD and all-cause mortality reduction. According to the 2017 hypertension guideline, the prevalence of hypertension (BP level ≥130/80 mm Hg) was 45.4% (95% CI, 43.9%-46.9%), representing 105.3 (95% CI, 101.9-108.8) million US adults, which was significantly higher than estimates per the 2014 hypertension guideline (BP level ≥140/90 mm Hg): 32.0% (95% CI, 30.3%-33.6%) or 74.1 (95% CI, 70.3-77.9) million individuals, respectively. Additionally, the proportion of individuals recommended for antihypertensive treatment was significantly higher according to the 2017 hypertension guideline (35.9%; 95% CI, 34.2%-37.5%) compared with the 2014 hypertension guideline (31.1%; 95% CI, 29.6%-32.7%). Achieving the 2017 hypertension guideline SBP treatment goals is estimated to reduce 610 000 (95% CI, 496 000-734 000) CVD events and 334 000 (95% CI, 245 000-434 000) total deaths in US adults 40 years and older. Corresponding estimates after achieving the 2014 hypertension guideline SBP treatment goals were 270 000 (95% CI, 202 000-349 000) and 177 000 (95% CI, 123 000-241 000), respectively. Implementing the 2017 hypertension guideline is estimated to increase 62 000 hypotension and 79 000 acute kidney injury or failure events. Compared with the 2014 hypertension guideline, the 2017 hypertension guideline was associated with an increase in the proportion of adults recommended for antihypertensive treatment and a further reduction in major CVD events and all-cause mortality, but a possible increase in the number of adverse events in the United States.

Sometimes they mean what they say: understanding violence among domestic extremists

This project aims at predictors of violence among domestic extremist organizations, which historically have received sparse investigative attention, especially in regard to violent rhetoric. The United States is host to hundreds of such organizations, the majority of which are non-violent, and despite there being designation organizations such as the Southern Poverty Law centre, as well as a rich qualitative literature detailing group operational dynamics, the question of what variables influence the use of violence by these groups as a whole has yet to be taken up in detail. This paper utilizes data gathered on all designated extremist groups currently operating in New York State which is coded using variables drawn from “Minorities at Risk Operational Behavior” (MAROB). While the goal is eventually to gather data on the entire US, exploratory analysis of the New York data indicates that violent rhetoric has the most significant impact on group violence, while the impact of ideological variables highlighted by existing literature are minimal.

Regulating Mismeasured Pollution: Implications of Firm Heterogeneity for Environmental Policy

This paper provides the first estimates of within-industry heterogeneity in energy and CO2 productivity for the entire US manufacturing sector. We measure energy and CO2 productivity as output per dollar energy input or per ton CO2 emitted. Three findings emerge. First, within narrowly defined industries, heterogeneity in energy and CO2 productivity across plants is enormous. Second, heterogeneity in energy and CO2 productivity exceeds heterogeneity in most other productivity measures, like labor or total factor productivity. Third, heterogeneity in energy and CO2 productivity has important implications for environmental policies targeting industries rather than plants, including technology standards and carbon border adjustments.

Kidney Transplantation in HIV-Positive Patients: A Single-Center, 16-Year Experience

Hahnemann University Hospital has performed 120 kidney transplantations in human immunodeficiency virus (HIV)-positive individuals during the last 16 years. Our patient population represents ∼10% of the entire US population of HIV-positive kidney recipients. In our earlier years of HIV transplantation, we noted increased rejection rates, often leading to graft failure. We have established a multidisciplinary team and over the years have made substantial protocol modifications based on lessons learned. These modifications affected our approach to candidate evaluation, donor selection, perioperative immunosuppression, and posttransplantation monitoring and resulted in excellent posttransplantation outcomes, including 100% patient and graft survival at 1 year and patient and graft survival at 3 years of 100% and 96%, respectively. We present key clinical data, including a granular patient-level analysis of the associations of antiretroviral therapy regimens with long-term survival, cellular and antibody-mediated rejection rates, and the causes of allograft failures. In summary, we provide details on the evolution of our approach to HIV transplantation during the last 16 years, including strategies that may improve outcomes among HIV-positive kidney transplantation candidates throughout the United States.

A systematic review of the epidemiology of carbapenem-resistant Enterobacteriaceae in the United States

BackgroundCarbapenem-resistant Enterobacteriaceae (CRE) pose an urgent public health threat in the United States. An important step in planning and monitoring a national response to CRE is understanding its epidemiology and associated outcomes. We conducted a systematic literature review of studies that investigated incidence and outcomes of CRE infection in the US.MethodsWe performed searches in MEDLINE via Ovid, CDSR, DARE, CENTRAL, NHS EED, Scopus, and Web of Science for articles published from 1/1/2000 to 2/1/2016 about the incidence and outcomes of CRE at US sites.ResultsFive studies evaluated incidence, but many used differing definitions for cases. Across the entire US population, the reported incidence of CRE was 0.3–2.93 infections per 100,000 person-years. Infection rates were highest in long-term acute-care (LTAC) hospitals. There was insufficient data to assess trends in infection rates over time. Four studies evaluated outcomes. Mortality was higher in CRE patients in some but not all studies.ConclusionWhile the incidence of CRE infections in the United States remains low on a national level, the incidence is highest in LTACs. Studies assessing outcomes in CRE-infected patients are limited in number, small in size, and have reached conflicting results. Future research should measure a variety of clinical outcomes and adequately adjust for confounders to better assess the full burden of CRE.

Ensuring America's Health: The Public Creation of the Corporate Health Care SystemRemaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers

Ensuring America's Health: The Public Creation of the Corporate Health Care SystemRemaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers

Abnormal mortgage delinquencies as housing crisis early symptoms

PurposeThe purpose of this paper is to analyze the differences between the actual mortgage prompt and late payments and their respective expected measures from 2004 to 2010 to spot early symptoms of housing crisis.Design/methodology/approachThis paper explores these discrepancies across the entire US market and along various delinquency lengths of 30, 60 and 90 days. This paper constructs a Bayesian forecasting model that relies on prior distributional properties of diverse time horizons.FindingsAbnormal mortgage delinquency rates are identified in real time and can be served as early symptoms for housing crisis.Practical implicationsThe statistical scheme proposed in this paper can function as a valuable predictive tool for lending institutions, bank audit companies, regulatory bodies and real estate professional investors who examine changes in economic settings and trends in short sale leads.Social implicationsThe abnormal mortgage delinquencies can serve as indicators of changes in economic fundamentals and early signs of a mounting housing crisis.Originality/valueThis paper presents a unique statistical technique in the context of mortgage delinquencies.

Does Mean-CVaR Outperform Mean-Variance? A Practical Perspective

This paper provides a systematic investigation of the relative performance between the two mainstream portfolio optimisation methods: mean-variance and mean-Conditional Value-at-Risk (CVaR) from both theoretical and practical perspectives. Using portfolios representing the entire US stock market, we confirm the theoretical outperformance of mean-CVaR in the frictionless market. We explain the popularity of mean-variance in a practical investment context by showing that the superiority of mean-CVaR disappears when simple historical sample inputs and transaction costs are incorporated. We further reveal that the relative performance between the two optimisation methods is significantly influenced by the characteristics of the constituent stocks in the portfolio as well as the stock market condition. Our findings have important implications in shaping investment decisions.

Estimates of present and future flood risk in the conterminous United States

Past attempts to estimate rainfall-driven flood risk across the US either have incomplete coverage, coarse resolution or use overly simplified models of the flooding process. In this paper, we use a new 30 m resolution model of the entire conterminous US with a 2D representation of flood physics to produce estimates of flood hazard, which match to within 90% accuracy the skill of local models built with detailed data. These flood depths are combined with exposure datasets of commensurate resolution to calculate current and future flood risk. Our data show that the total US population exposed to serious flooding is 2.6–3.1 times higher than previous estimates, and that nearly 41 million Americans live within the 1% annual exceedance probability floodplain (compared to only 13 million when calculated using FEMA flood maps). We find that population and GDP growth alone are expected to lead to significant future increases in exposure, and this change may be exacerbated in the future by climate change.

Topical Testosterone Therapy Adherence and Outcomes Among Men With Primary or Secondary Hypogonadism

BackgroundMen with primary or secondary hypogonadism (HG) prescribed testosterone therapy (TTh) who terminate treatment early might not obtain the benefit of symptom relief. AimTo estimate adherence to topical TTh and to compare baseline characteristics and follow-up outcomes between adherent and non-adherent patients in a population of commercially insured US men with primary or secondary HG. MethodsA retrospective cohort of adult men with primary or secondary HG and initiating topical TTh from 2007 through 2014, with continuous coverage during 12-month baseline and follow-up periods, was identified from a large US health plan. Clinical conditions were assessed using International Classification of Diseases, 9th Revision, Clinical Modification codes. Adherence to initial topical TTh was defined as proportion of days covered of at least 80%. Characteristics and outcomes were compared across adherent and non-adherent patients. OutcomesAdherence to topical TTh, occurrence of HG-related clinical outcomes, and total health care costs. ResultsWe identified 3,184 topical TTh initiators (mean age = 49 years), of whom 17% (n = 538) were adherent at 12 months. Factors positively associated with adherence included prescribing by specialists, a lower prevalence of certain comorbidities at baseline, residence in the Northeast, and an earlier start year of the topical TTh prescription. Adherence to topical TTh was associated with lower odds of having HG-associated clinical conditions (composite measure) over 12-month follow-up. In the subset of patients with available laboratory results, adherent patients had greater increases in testosterone levels compared with non-adherent patients. Increased pharmacy costs for adherent patients were partly offset by decreases in medical costs. Clinical ImplicationsAdherence to topical testosterone is low but associated with positive outcomes, demonstrating the need for future efforts to focus on improving adherence in this population. Strengths and LimitationsStrengths of this study include the large number of analyzed patients and the routine care (rather than interventional trial) setting, which maximizes generalizability within the source population. Limitations are primarily a result of reliance on medical claims data, which lack clinical context and are subject to potential coding errors. Certain factors of potential importance for adherence, such as patient and provider preferences, were not available in the dataset. The study analyzed commercially insured US patients and our ability to generalize these results to the entire US population or other countries might be limited. ConclusionStudy findings provide further evidence for suboptimal topical TTh adherence among men treated for primary or secondary HG. Adherence is associated with greater improvement in total testosterone laboratory values and might be associated with a lower likelihood of having certain HG-related conditions.Grabner M, Hepp Z, Raval A, et al. Topical Testosterone Therapy Adherence and Outcomes Among Men With Primary or Secondary Hypogonadism. J Sex Med 2018;15:148–158.

Celebrating AACC's 70th Anniversary: 1948 to 2018-A Thank-you Note to the Founders.

Congratulations to the AACC on the 70th Anniversary of its 1948 creation! The Founders left an excellent legacy that continues to benefit health and healthcare. It is hard to believe that in 1948 the baby boomer was only a 3-year-old toddler. Back then, the entire US population consisted of 147 million individuals and was among the very best educated countries in the world. Approximately one-third of Americans had attained a high school diploma and about 6% of the US population had completed a 4-year college degree. Today, at 325 million, the US population is about 220% larger than it was in 1948. The education level of Americans has increased greatly …

A comparison of the US National Fire Danger Rating System (NFDRS) with recorded fire occurrence and final fire size

Most previous research has assessed the ability of the National Fire Danger Rating System (NFDRS) to portray fire activity at either single sites or on small spatial scales, despite it being a nation-wide system. This study seeks to examine the relationships between a set of NFDRS fire danger indices (Fire Danger Ratings, Staffing Level and the Ignition Component) and measures of fire activity (fire occurrence and final fire size) across the entire conterminous US over an 8-year period. We reveal that different regions of the US display different levels of correspondence between each of the fire danger indices and recorded fire activity. Areas in the Southern and Eastern Geographic Area Coordination Centers (GACCs) exhibit weaker correlations than those in the Northwest, Northern Rockies, Great Basin and Northern California GACCs. Peaks in fire occurrence are shown to occur at mid–low values of fire danger whereas final fire sizes increase monotonically with each fire danger index. Our findings appear to align with perceived shifts in management practices currently employed across the US and indicate that the ability of the NFDRS to apportion the resources required to combat large fires is in general well developed.

Exhibiting the West at the Paris Exposition of 1867: Towards a New American Aesthetic Identity?

The Exposition Universelle of 1867 was the second of its kind to be held in Paris and was the largest to date. In 1867 the French Second Empire’s “social” doctrine staged industry and labor not only as economic values but as cultural facts, envisioned in socio-ethnographic terms if not as forms of spectacle. The United States was only a second-tier player; however, for the U.S. organizers the Paris Exposition was a crucial opportunity for the country as it just emerged from the Civil War and entered Reconstruction. This paper seeks to identify aesthetic concerns and, more generally, an ambition to seduce the gaze of French and international viewers through the general organization and specific displays of the American exhibition, concentrating on exhibits offered by the Western states and territories. Images and objects from this region—particularly between the Rocky Mountains and California—played a significant, if perhaps unexpected, role in shaping a new aesthetic identity that potentially extended to the entire US exhibition. The display of Western photographs inaugurated a trend that pushed geographical imageries, especially of so-called new lands, into greater visibility. The Paris Exposition of 1867 seems to have been a pivotal moment in the use of geographical imageries, and their ability to link economic and aesthetic values. In the context of this Exposition western photography, natural specimens and material culture of the post-Civil War era contributed to renovating the French and European view of America—substituting specific objects and pictures for an abstract idea and creating, for the first time perhaps, a strong aesthetic appeal for American pictures that were no longer the cliches understood by the phrase “American images.”

Do Unions Increase Labor Shares? Evidence from US Industry-Level Data

We explore the relationship between union membership rates and labor shares using panel data on 35 industries, spanning the entire US economy, for the years 1983–2005. For the full sample, a standard deviation increase in union membership rates is associated with an increase in an industry’s labor share of about 10%. Starting from the mean labor share in our sample (0.614), this effect amounts to about 6 percentage points. However, the effect is weaker and not statistically significant for manufacturing industries. We control for the capital-to-output ratio in all of our estimations, and the results are consistent with an elasticity of substitution between capital and labor that is less than unity. As such, the positive union effect on labor share is consistent with either the right-to-manage or the efficiency bargaining model of unions.

Coal bursts that occur during development: A rock mechanics enigma

Coal bursts are typically associated with highly stressed coal. Most bursts occur during retreat mining (longwall mining or pillar recovery) in highly stressed locations like the tailgate corner of the longwall panel. Others are associated with multiple seam interactions. However, a small but significant percentage of coal bursts have occurred during development or in outby locations unaffected by active mining. Most development bursts have been relatively small, but some have been highly destructive. No theory of coal bursts can be complete if it does not account for this type of event. This paper focusses on the development mining coal burst experience in the US, putting it into the context of the entire US coal burst database. The first documented development coal burst occurred almost exactly 100 years ago during slope drivage at the Sunnyside Mine in Utah. Sunnyside subsequently had a long history of bursts, mainly during retreat mining but also during development. Several Colorado mines have also experienced multiple development bursts. Many, but by no means all, of the development bursts in these western US coalfields have been associated with known faults. In the Central Appalachian coalfields, most development bursts have occurred in multiple seam situations. In some of these cases, however, there was no retreat mining in either seam. The paper closes with some lessons from this history, with implications for preventing such events in the future.

Migration from Mexico to the United States: A high-speed cancer transition.

Differences and similarities in cancer patterns between the country of Mexico and the United States' Mexican population, 11% of the entire US population, have not been studied. Mortality data from 2008 to 2012 in Mexico and California were analyzed and compared for causes of cancer death among adult and pediatric populations, using standard techniques and negative binomial regression. A total of 380,227 cancer deaths from Mexico and California were included. Mexican Americans had 49% and 13% higher mortality than their counterparts in Mexico among males and females, respectively. For Mexican Immigrants in the US, overall cancer mortality was similar to Mexico, their country of birth, but all-cancers-combined rates mask wide variation by specific cancer site. The most extreme results were recorded when comparing Mexican Americans to Mexicans in Mexico: with mortality rate ratios ranging from 2.72 (95% CI: 2.44-3.03) for colorectal cancer in males to 0.28 (95% CI: 0.24-0.33) for cervical cancer in females. These findings further reinforce the preeminent role that the environment, in its multiple aspects, has on cancer. Overall, mortality from obesity and tobacco-related cancers was higher among Mexican origin populations in the US compared to Mexico, suggesting a higher risk for these cancers, while mortality from prostate, stomach, and especially cervical and pediatric cancers was markedly higher in Mexico. Among children, brain cancer and neuroblastoma patterns suggest an environmental role in the etiology of these malignancies as well. Partnered research between the US and Mexico for cancer studies is warranted.

Application of an Original Wildfire Smoke Health Cost Benefits Transfer Protocol to the Western US, 2005-2015.

Recent growth in the frequency and severity of US wildfires has led to more wildfire smoke and increased public exposure to harmful air pollutants. Populations exposed to wildfire smoke experience a variety of negative health impacts, imposing economic costs on society. However, few estimates of smoke health costs exist and none for the entire Western US, in particular, which experiences some of the largest and most intense wildfires in the US. The lack of cost estimates is troublesome because smoke health impacts are an important consideration of the overall costs of wildfire. To address this gap, this study provides the first time series estimates of PM2.5 smoke costs across mortality and several morbidity measures for the Western US over 2005-2015. This time period includes smoke from several megafires and includes years of record-breaking acres burned. Smoke costs are estimated using a benefits transfer protocol developed for contexts when original health data are not available. The novelty of our protocol is that it synthesizes the literature on choices faced by researchers when conducting a smoke cost benefit transfer. On average, wildfire smoke in the Western US creates $165 million in annual morbidity and mortality health costs.

Temporal Trends in the Incidence, Prevalence, and Survival of Patients With Atrial Fibrillation From 2004 to 2016

A growing epidemic of atrial fibrillation (AF) has been predicted, although no data on the AF burden has been reported for the United States since 2010. The objectives of this study were to (1) describe trends in AF incidence, prevalence, and postdiagnosis survival from 2004 to 2016 within a large health-care system and (2) extrapolate observed prevalence rates to the entire US population to estimate the national AF burden. This retrospective cohort study incorporates the patients and electronic medical record of the Geisinger Health System, an integrated health-care delivery system serving central and northeast Pennsylvania. Standardized incidence rates were calculated per 1,000 person-years by calendar year, and point prevalence rates estimated on July 1st of the respective years from 2004 to 2016. Rate ratios were estimated from Poisson regression as the annual relative change over time. A total of 464,363 patients met study inclusion criteria. Age- and sex-adjusted AF incidence rates increased over the study period: 4.7, 5.0, 5.8, and 6.2 in 2004, 2008, 2012, and 2016, respectively (rate ratio 1.03 per year, 95% confidence interval 1.02, 1.03). Age- and sex-adjusted prevalence rates increased consistently over time from 2.7%, 3.0%, 3.4%, to 4.1% in 2004, 2008, 2012, and 2016, respectively. In 2004, an estimated 6.1 million Americans had diagnosed AF, increasing to 6.7, 7.8, and 9.3 million in 2008, 2012, and 2016, respectively. Postdiagnosis survival has not improved in recent years. In conclusion, AF incidence and prevalence have increased steadily since 2004, whereas postdiagnosis survival has not improved.

Work-related mortality in the US fishing industry during 2000-2014: New findings based on improved workforce exposure estimates.

Commercial fishing is a global industry that has been frequently classified as high-risk. The use of detailed surveillance data is critical in identifying hazards. The purpose of this study was to provide updated statistics for the entire US fishing industry during 2010-2014, generate fleet-specific fatality rates using a revised calculation of full-time equivalent estimates, and examine changes in the patterns of fatalities and in risk over a 15-year period (2000-2014). During 2010-2014, 188 commercial fishing fatalities occurred in the United States. Vessel disasters and falls overboard remain leading contributors to commercial fishing deaths. The Atlantic scallop fleet stands out for achieving substantial declines in the risk of fatalities over the 15-year study period. However, fatality rates ranged from 21 to 147 deaths per 100 000 FTEs, many times higher than the rate for all US workers. Although the number of fatalities among commercial fishermen in the United States has generally declined since 2000, commercial fishing continues to have one of the highest occupational fatality rates in the United States. The sustainable seafood movement could assist in improving the health and safety of fishing industry workers if worker well-being was integrated into the definition of sustainable seafood.