States Population Research Articles

Accuracy of Contrast-Enhanced Ultrasound for Hepatocellular Carcinoma Post-Transcatheter Arterial Embolization

Background/Objectives: Contrast-enhanced ultrasound (CEUS) is a non-invasive imaging technique with similar accuracy to CT and MRI for the diagnosis of hepatocellular carcinoma (HCC). CEUS offers several advantages in patient populations who have contraindications for CT or MRI. There are limited prospective studies in the United States evaluating the diagnostic equivalence of CEUS following transcatheter arterial chemoembolization (TACE) with same-day CT/MRI. This prospective pilot study compared CEUS and CT/MRI in patients with HCC following TACE in a United States population using Lumason® contrast agent and the Liver Reporting and Data System (LI-RADS). Methods: Following institutional review board protocols, adult patients with a diagnosis of HCC were included. Follow-up CT/MRI was directed by referring clinicians, and CEUS was performed on the same day. CEUS was used to evaluate for treated lesion(s), new lesion(s), and portal vein thrombus before and after Lumason®. Any subsequent follow-up imaging was reviewed. Results: In 26 enrolled patients, 33 target lesions were identified (size range 0.9–16.8 cm), and 26 were LI-RADS-5 or -M. CEUS identified 19 cases of residual tumor, 12 with no viable disease; CT/MRI identified 17 cases of residual tumor, 16 with no viable disease (p = 0.617). Both CEUS and CT/MRI identified five portal vein thrombi. Two lesions were missed or miscategorized on CEUS, while six were missed or miscategorized on CT/MRI (p = 0.289). Six new lesions were identified on both CEUS and CT/MRI. Of these new lesions, four were identified only by CT/MRI and three only by CEUS. Conclusions: CEUS is comparable to CT/MRI performed at identical follow-up intervals in evaluating for residual versus treated HCC following first-time TACE.

Assessment of detoxification enzymes in pyrethroid‐resistant Listronotus maculicollis Kirby suggests additional mechanisms

AbstractInsecticide resistance is a pressing issue in urban pest management. The annual bluegrass weevil (ABW), Listronotus maculicollis Kirby, is a highly destructive turfgrass pest in northeastern North America. The overuse of pyrethroids has led to resistance in some ABW populations in the northeastern United States. Understanding ABW resistance mechanisms is pivotal for sustaining turf quality and minimizing environmental impact. This study investigated the potential for enzymatic detoxification, a common resistance mechanism in insects, to be the mechanism behind ABW tolerance to pyrethroids. Different ABW populations’ resistance levels to bifenthrin were determined through dose–response Petri dish assays. Cytochrome P450 activity and protein concentrations were measured following bifenthrin exposure. Results indicated golf course‐specific effects on enzyme and protein levels but found no direct correlation between these levels and bifenthrin dosage. P450 activity varied among different golf course populations, showing no dependence on bifenthrin dosage. These findings question prior studies suggesting P450 involvement in bifenthrin detoxification in populations of all resistance levels. This study establishes a foundation for comprehending ABW resistance mechanisms and devising effective management strategies. However, further research is needed to investigate additional detoxification enzymes and other resistance mechanisms.

Disparities in Vision-Related Functional Impairments Among Adults in the United States

ABSTRACT Purpose To investigate the relationships between vision-related functional impairment (VFI) with sociodemographic and healthcare access factors in a representative sample of the United States population. Methods Data from the 2017 National Health Interview Survey (NHIS) were used. The NHIS involves responses from the U.S. civilian, non-institutionalized population aged 18 years or older. It provides self-reported data on demographic characteristics, socioeconomic factors, health status, and healthcare access. NHIS participants who responded to at least one of our target questions about VFI were included in the study. VFI was defined for participants based on their ‘yes’ or ‘no’ responses to target questions about experiencing a VFI. Data analysis was performed through univariable and multivariable logistic regression. Results Overall, 26,711 participants were included, of which 6926 (25.9%) participants reported experiencing a VFI. In univariable analysis, there were greater odds of VFI among females (OR: 1.16, 95% CI: 1.07–1.26, p < 0.001), and participants with less than a high school degree compared to those with an advanced degree (OR: 1.17, 95% CI: 1.02–1.33, p = 0.02). Among economic and healthcare access factors, greater odds of VFI was associated with public health insurance versus private coverage (OR: 1.19, 95% CI: 1.07–1.32, p = 0.001), having delayed medical care due to costs (OR: 1.86, 95% CI: 1.86–2.10, p < 0.001), and being unemployed (OR: 1.39, 95% CI: 1.26–1.53, p < 0.001). Participants whose incomes were lower than the poverty threshold (OR: 1.54, 95% CI: 1.32–1.80, p < 0.001) had higher odds of VFI than those with income >5× poverty threshold. Conclusions Several demographic and economic factors are associated with VFI in a representative sample of the U.S. population. These results highlight the importance of addressing social and economic factors that are associated with the development of VFI.

Floquet dynamics of ultracold atoms in optical lattices with a parametrically modulated trapping potential

Abstract Experiments with ultracold atoms in optical lattices usually involve a&amp;#xD;weak parabolic trapping potential which merely serves to confine the atoms, but&amp;#xD;otherwise remains negligible. In contrast, we suggest a different class of experiments&amp;#xD;in which the presence of a stronger trap is an essential part of the set-up. Because&amp;#xD;the trap-modified on-site energies exhibit a slowly varying level spacing, similar to&amp;#xD;that of an anharmonic oscillator, an additional time-periodic trap modulation with&amp;#xD;judiciously chosen parameters creates nonlinear resonances which enable efficient&amp;#xD;Floquet engineering. We employ a Mathieu approximation for constructing the nearresonant&amp;#xD;Floquet states in an accurate manner and demonstrate the emergence of&amp;#xD;effective ground states from the resonant trap eigenstates. Moreover, we show that the&amp;#xD;population of the Floquet states is strongly affected by the phase of a sudden turn-on&amp;#xD;of the trap modulation, which leads to significantly modified and rich dynamics. As&amp;#xD;a guideline for further studies, we argue that the deliberate population of only the&amp;#xD;resonance-induced effective ground states will allow one to realize Floquet condensates&amp;#xD;which follow classical periodic orbits, thus providing challenging future perspectives&amp;#xD;for the investigation of the quantum-classical correspondence.

The Appropriate Translation of the Nurse Practitioner Will Foster Health Equity.

Background: In September 2020, Governor Gavin Newsom of California signed Assembly Bill 890 (AB 890) into law, which changed Title 16 of the Nurse Practice Act, granting California nurse practitioners (NPs) a stepwise approach to full practice authority. Written within the law, NPs are required to verbally identify themselves specifically to all Spanish-speaking patients, as enfermera(o) especializada (o). Local Problem: AB 890 requires NPs to identify themselves using inappropriate Spanish terminology. There are concerns regarding the translational accuracy of nurse practitioners under AB 890. To avoid confusion, it is essential to ensure the translation of the NP role is precise and unambiguous to ensure health equity. Context: This law has a significant impact on approximately 37,000 NPs in the state of California who provide essential healthcare services to the Spanish-speaking community. Critically, the Hispanic/Latino community accounts for almost 40% of California state's population, and Intervention: This literature review will delve into the current literature for the accurate Spanish terminology of the "Advanced Practice Nurse," "Advanced Practice Registered Nurse," and Nurse Practitioner." Outcome Measures: To accurately translate "Advanced Practice Nurse," "Advanced Practice Registered Nurse," and "Nurse Practitioner."

Asian flushing, ADH1B, aldehyde dehydrogenase 2 genotypic status among the unique ethnic population of the Himalayan state of Sikkim, India

Background: Alcohol induced flushing a phenotypic instrument variable also known as “Asian flush” was first reported by Wolff (1972), commonly seen among East Asians. This phenotype is indicative of inactive aldehyde dehydrogenase 2 (ALDH2) and high activity of alcohol dehydrogenase (ADH1B). Aims and Objectives: This study aimed to examine the sensitivity and specificity of the simple flushing questionnaire for identifying inactive ALDH2 and to examine the flushing, ADH1B and ALDH2 status across the three unique ethnic groups in Sikkim, India. Materials and Methods: Two hundred and fifty consenting adults (age, ≥18 years) visiting the referral hospitals in East Sikkim were enrolled. Flushing questionnaire was assessed among the 201 alcohol users, who were categorized as “non-flusher,” “current flusher,” and “former flusher.” ALDH2 and ADH1B genotyping were done on the all 250 subjects by polymerase chain reaction - restriction fragment length polymorphism blinded from flushing response status. Results: In the study, 201 were alcohol users and 49 were non-alcohol users. The sensitivity and specificity of the flushing questionnaire against inactive ALDH2 genotypes were 84.6% and 93%, and the positive predictive value was 45.8%. 19.5% Bhutia/Sherpa, 8.3% Nepalese and 11.1% Lepcha reported current flushing. Only two Bhutia reported former flushing while remaining were “non-flushers.” ALDH2 (6%) and ADH1B (4.4%) genotypes, respectively, were seen with allele frequency of 0.06 for ALDH2*1/2*2, and 0.004 for ADH1B*2/*2, 0.044 for ADH1B*1/*2. ALDH2*2/*2 were not observed in this study. Conclusion: Alcohol induced flushing, ALDH2 and ADH1B genotype is reported across the ethnicity, among Sikkimese people, and this flushing is the first report from India.

Spatiotemporal patterns of youth isolation and loneliness in the US: a geospatial analysis of Crisis Text Line data (2016–2022)

In 2021, the US Surgeon General issued a national advisory citing an epidemic of isolation and loneliness. Even before the onset of the COVID-19 pandemic, approximately half of people in the US reported experiencing measurable levels of loneliness. Despite localized and select cross-sectional studies highlighting even higher increases in isolation/loneliness during the COVID-19 pandemic, additional research is needed, particularly for youth and young adults. This work examines patterns of isolation/loneliness across the US from 2016 to 2022 among individuals aged 24 and younger. Our study leverages a unique dataset, Crisis Text Line, which provides complete spatiotemporal coverage of crisis conversations in the US. We conducted a geospatial analysis using Kuldroff’s Space–Time SatScan to identify statistically significant clustering of elevated isolation/loneliness-related conversations. The statistical significance of spatiotemporal clusters was determined using Monte Carlo simulations (n = 9999). Results demonstrated local relative risk as high as 1.47 in high-risk populations in Southern, Midwest, and Atlantic states, indicating areas where the actual case count is 147% of the expected cases (p value < 0.01) from May to July 2020. Results also identified co-occurrence of isolation/loneliness and other crises concerns, including depression/sadness, anxiety, and multiple suicidality indicators, with higher rates among racial/ethnic minority, transgender and gender diverse, and younger individuals. This work makes a unique contribution to the literature by elucidating spatiotemporal disparities in isolation/loneliness among young people, providing much-needed knowledge as to where future public health interventions are immediately needed.

Factors Affecting the Population of Excited Charge Transfer States in Adenine/Guanine Dinucleotides: A Joint Computational and Transient Absorption Study

There is compelling evidence that the absorption of low-energy UV radiation directly by DNA in solution generates guanine radicals with quantum yields that are strongly dependent on the secondary structure. Key players in this unexpected phenomenon are the photo-induced charge transfer (CT) states, in which an electric charge has been transferred from one nucleobase to another. The present work examines the factors affecting the population of these states during electronic relaxation. It focuses on two dinucleotides with opposite orientation: 5′-dApdG-3′ (AG) and 5′-dGpdA-3′ (GA). Quantum chemistry calculations determine their ground state geometry and the associated Franck–Condon states, map their relaxation pathways leading to excited state minima, and compute their absorption spectra. It has been shown that the most stable conformer is anti-syn for AG and anti-anti for GA. The ground state geometry governs both the excited states populated upon UV photon absorption and the type of excited state minima reached during their relaxation. Their fingerprints are detected in the transient absorption spectra recorded with excitation at 266 nm and a time resolution of 30 fs. Our measurements reveal that in the large majority of dinucleotides, chromophore coupling is already operative in the ground state and that the charge transfer process occurs within ~120 fs. The competition among various relaxation pathways affects the quantum yields of the CT state formation in each dinucleotide, which are estimated to be 0.18 and 0.32 for AG and GA, respectively.

Lipoprotein(a) levels in a population with clinical atherosclerotic cardiovascular disease in the United States: A subanalysis from the Lp(a)HERITAGE study

BackgroundElevated lipoprotein(a) (Lp[a]) is the most common inherited dyslipidemia that is independently and causally associated with increased atherosclerotic cardiovascular disease (ASCVD) risk. However, data from diverse populations with ASCVD are lacking. ObjectiveTo evaluate Lp(a) levels in a diverse, contemporary United States (US) population with ASCVD, stratified by race, ethnicity, and sex. MethodsLp(a)HERITAGE (NCT03887520) was a multicenter study that estimated the prevalence of elevated Lp(a) in adults (18–80 years) with ASCVD. US participants with Lp(a) measured in nmol/L pre- or post-enrollment were included in this subanalysis. This study was descriptive; therefore, no statistical comparisons were made. ResultsOf all US participants, 14% had an Lp(a) measurement pre-enrollment. This subanalysis included 7,679 US participants with Lp(a) measurements in nmol/L (80.5% White; 66.4% male; mean age 63.8 years [standard deviation ± 9.7]). Median Lp(a) was >2.5-fold higher in Black participants (132.0 nmol/L; interquartile range [IQR],57.1–239.6) vs the overall population (52.1 nmol/L; IQR, 15.7–167.8), and higher in females compared with males (69.4 nmol/L; IQR, 20.1–194.7 vs 45.6 nmol/L; IQR,14.0–152.6, respectively). Lp(a) levels ≥125 nmol/L were more prevalent among Black (52.0%) and female (38.9%) participants vs the overall population (33.3%). ConclusionsIn US Lp(a)HERITAGE participants, only 14% had an Lp(a) measurement pre-enrollment, despite having ASCVD. One-third of participants demonstrated Lp(a) levels ≥125 nmol/L, the threshold for high ASCVD risk, which was higher among Black (1/2) and female (2/5) participants, suggesting a greater need for Lp(a) testing in these groups to inform ASCVD risk mitigation.

Clinical burden, treatment, and disease control in patients with chronic spontaneous urticaria: Real-world evidence.

Chronic spontaneous urticaria (CSU) is an unpredictable inflammatory skin condition with substantial clinical burden that affects 0.23-0.78% of the United States population. To describe the incidence and prevalence of patients with a record of CSU diagnosis, treatment patterns, disease control, and clinical and economic burden in a United States (US) cohort of patients with CSU. Adults with a record of CSU diagnosis within the US HealthVerity claims database were eligible. Age- and sex-adjusted prevalence/incidence rates were calculated for January 2017 to December 2022. Clinical characteristics were described during the 1 year prior to CSU diagnosis (baseline) and the time after (follow-up). Proxy events representing uncontrolled CSU (any record of prescriptions for corticosteroids, biologics, or immunosuppressants [excluding all antihistamines and over-the-counter medication] or any CSU-related inpatient admissions or emergency room or urgent care visits) were used to identify patients with uncontrolled CSU. Health care resource utilization (HCRU) and health care costs were described. Overall, 200,298 patients were followed-up for a median of 2.3 years after diagnosis. Estimated cumulative prevalence of diagnosed CSU was 0.57% (women: 0.80%; men: 0.32%). The average annual incidence rate was 0.08%. Corticosteroids were the most prescribed treatment during follow-up among the 166,195 patients prescribed ≥1 treatment (94.3%). Proxy events were observed in 59.1% of patients. HCRU and health care costs increased from baseline in patients with uncontrolled CSU during follow-up. Of patients with CSU who were prescribed treatment, >50% experienced uncontrolled CSU, which was associated with increased HCRU and health care costs.

Optimizing Gout Treatment: A Comprehensive Review of Current and Emerging Uricosurics

Gout is the most common inflammatory arthritis, affecting approximately 5.1% of adults in the United States (US) population. Gout is a metabolic and autoinflammatory disease. Elevated uric acid pools lead to the precipitation of monosodium urate (MSU) crystals in and around joints, as well as other tissues, and the subsequent autoinflammatory response. Since elevated serum urate (SU) levels (hyperuricemia) correspond with gout severity, urate-lowering therapies (ULTs) are the cornerstone of gout treatment.ULTs include xanthine oxidoreductase inhibitors, uricosurics, less commonly used in the US but widely used in Europe and Asia, including benzbromarone, dotinurad, and probenecid (the only US Food and Drug Administration (FDA) approved uricosuric in the US), and uricases, including rasburicase and pegloticase (available only in the US).Over 90% of the daily load of uric acid filtered by the kidneys is reabsorbed through renal transporters. These urate transporters include uric acid transporter 1 (URAT1), glucose transporter 9, and organic anion transporters 1, 3, and 4 (OAT1, OAT3, OAT4). They are the target of approved and in-the-pipeline uricosurics.Any drug that increases renal excretion of uric acid, independently of the mechanism through which it exerts its effect, may be considered a uricosuric drug. This review discusses drugs that increase renal excretion of uric acid, either approved or in development, as well as off-label drugs with uricosuric properties.

Prevalence trends of type 2 diabetes treatment, dyslipidemia and hepatic steatosis in Northeast Germany.

The investigation of prevalence trends of metabolic cardiovascular risk factors is important for appropriate planning of future health programs aiming to prevent cardiovascular morbidity and mortality. In a previous study, we demonstrated an increase in the prevalence of type 2 diabetes (T2D) between 2000 and 2010 in Northeast Germany. The purpose of this study is to investigate prevalence trends of T2D treatment, dyslipidemia and hepatic steatosis in Northeast Germany. The baseline examinations of the first Study of Health in Pomerania (SHIP) project were carried out from 1997 to 2001 (SHIP-START-0, 4308 subjects). A second, independent random sample of the same region was enrolled between 2008 and 2012 (SHIP-TREND-0, 4420 subjects). All data were standardized with post-stratification weighting derived from the adult population of the German federal state of Mecklenburg-West Pomerania. The prevalence of metformin intake increased from 2.1% to 4.1% and insulin use from 2.0% to 2.8%. While the prevalence of statin intake increased from 6.8% to 12.2%, the prevalence of dyslipidemia decreased slightly from 49.0% in SHIP-START-0 to 45.5% in SHIP-TREND-0. The prevalence of hepatic steatosis increased from 29.7% to 37.3%. This increase was most prominently observed in women and younger age groups. T2D, dyslipidemia and hepatic steatosis are common and increasing health problems among adults in Northeast Germany. Reassuring healthy diet and controlling obesity may result in prevention of above-mentioned health problems.

Nanosecond resolved vibrational kinetics of CO2 in CO2/N2 mixtures measured in a pulsed discharge jet

Abstract This work studies the vibrational kinetics of CO2/N2 mixtures in a nanosecond pulsed near atmospheric pressure plasma jet. Quantum-cascade laser absorption spectroscopy is used to measure the populations of rovibrationally excited states of CO2 without any assumption on a particular vibrational distribution function and with a variable time resolution of as high as 8 ns. These studies are complemented by measurements using electric field induced second harmonic generation and electrical measurements to characterize the discharge. The nanosecond pulsing, combined with fast diagnostics, allows for a temporal separation of processes on different timescales, namely, electron impact excitation (e-V) during the discharge and vibrational-vibrational (V-V) and vibrational-translational (V-T) transfer in the afterglow. During the discharge, the Fermi resonant 10 0 01 state is excited at a higher rate than the energetically close 02 2 01 state of the bending mode, leading to different effective vibrational temperatures. In the afterglow, the two vibrational temperatures converge to a combined vibrational temperature T 12 within 200 ns . This equilibration process is observed here for the first time. In the afterglow, the populations of all vibrational states increase for several 10 μ s . This can be attributed to the V-V transfer from N2 to the asymmetric stretch mode of CO2 and from the latter to the other vibrational modes of CO2. An increase of the N2 admixture, which acts as an energy reservoir for the CO2, enhances the increase of the vibrational populations of CO2 in the afterglow and slows down the decay of the asymmetric mode in the late afterglow through continuous replenishment via V-V transfer. The combined data of all diagnostics allow for a detailed comparison with kinetic models.

Burden of Digestive Diseases in the United States Population: Rates and Trends.

Digestive diseases are common in the United States (U.S.) and lead to significant morbidity, mortality, and health care utilization. We used national survey and claims databases to expand on earlier findings and investigate rates and trends in the digestive disease burden in the U.S. The Nationwide Emergency Department Sample, National Inpatient Sample, Vital Statistics of the U.S.: Multiple Cause-of-Death Data, Optum Clinformatics® Data Mart, and Centers for Medicare and Medicaid Services Medicare 5% Sample and Medicaid files were used to estimate claims-based prevalence, medical care, and mortality with a digestive disease diagnosis. Digestive disease prevalence (claims-based, 2019) was 24.2% among Medicaid beneficiaries, 33.2% among private insurance enrollees, and 51.5% among Medicare beneficiaries and rose over the previous decade. Digestive diseases contributed to 42 million emergency department visits, 17 million hospital stays, and 472,000 deaths in 2019. Women had higher medical care rates with a digestive disease diagnosis, but mortality rates were higher among men. Blacks had higher medical care use and mortality rates compared with Whites, and Hispanics had lower rates. During the study period, ambulatory care and emergency department visit rates with a digestive disease diagnosis rose, while hospitalization and mortality rates declined. Among private insurance enrollees, rates were higher compared with national data for hospitalizations, but lower for emergency department visits. The digestive disease burden in the U.S. is substantial, particularly among Blacks and older adults. Further research is needed to better understand reasons for disparities and trends in health care use and mortality reported in this paper.

Wild yeast isolation by middle school students reveals features of populations residing on North American oaks.

Features of the natural life cycle of the budding yeast Saccharomyces cerevisiae were crucial to its domestication as a laboratory experimental model, especially the ability to maintain stable haploid clones and cross them at will to combine alleles via meiosis. Stable haploidy results from mutations in HO, which encodes an endonuclease required for haploid-specific mating-type switching. Previous studies found an unexpected diversity of HO alleles among natural isolates within a small geographic area. We developed a hands-on field and laboratory activity for middle school students in Denver, Colorado, USA to isolate wild yeast from oak bark, identify species via DNA sequencing, and sequence HO from S. cerevisiae isolates. We find limited HO diversity in North American oak isolates, pointing to efficient, continuous dispersal across the continent. By contrast, we isolated the "dairy yeast", Kluyveromyces lactis, from a tree <10 m away and found that it represents a new population distinct from an oak population in an adjacent state. The outreach activity partnered middle school, high school, and university students in making scientific discoveries and can be adapted to other locations and natural yeast habitats. Indeed, a pilot sampling activity in southeast Texas yielded S. cerevisiae oak isolates with a new allele of HO and, from a nearby prickly pear cactus, a heat-tolerant isolate of Saccharomyces paradoxus.

Intersystem Crossing, Photo-Induced Charge Separation and Regioisomer-Specific Excited State Dynamics in Fully Rigid Spiro Rhodammine-Naphthalene/Anthraquinone Electron Donor-Acceptor Dyads.

We prepared a series fully rigid spiro electron donor-acceptor orthogonal dyads, with closed form of rhodamine (Rho) as electron donor and naphthalene (Np)/anthraquinone (AQ) as electron acceptor, to access the long-lived triplet charge separation (3CS) state, via the electron spin control method. We found strong dependency of the photophysical property of the dyads on the amino substitution positions of the Np chromophores in the dyads 1,8-DaNp-Rho and 2,3-DaNp-Rho. Nanosecond transient absorption (ns-TA) spectra show the population of the 3LE state (lifetime: 47 μs) for 2,3-DaNp-Rho, however, long-lived 3CS state was observed (τCS = 0.62 μs) for AQ-Rho, with a CS quantum yield of ΦCS = 58%. Based on femtosecond transient absorption (fs-TA) spectra, spin orbit charge transfer ISC (SOCT-ISC) is proposed to be responsible for the formation of the triplet states. Time-resolved electron paramagnetic resonance (TREPR) spectra of AQ-Rho indicate the presence of two states, a 3LE state with zero field splitting (ZFS) D parameter of 1400 MHz and E parameter of -410 MHz, formed via radical pair ISC (RP-ISC) and SOCT-ISC mechanism; and a 3CS state with the electron spin-spin interaction in the regime of spin-correlated radical pair (SCRP).

Cost-effectiveness analysis of tislelizumab plus chemotherapy versus placebo plus chemotherapy as first-line treatment for advanced gastric or gastroesophageal junction adenocarcinoma: perspectives from the United States and China.

The efficacy of tislelizumab plus chemotherapy in improving progression-free survival (PFS) and overall survival (OS) in unresectable gastric or gastroesophageal junction cancer (GC/GEJC) has recently been emphasized. This study compared the cost-effectiveness of tislelizumab plus chemotherapy versus placebo plus chemotherapy for the United States (US) and Chinese populations. Using data from the RATIONALE-305 phase 3 trial, a Markov model was developed to analyze quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), incremental net health benefits (INHBs), and incremental net monetary benefits (INMBs). The health state utilities and direct medical costs were obtained from the relevant literature and local cost databases. The model uncertainty was evaluated using sensitivity analyses. In the base-case analysis, the addition of tislelizumab to chemotherapy yielded an ICER of $37,768.48 per QALY in China, slightly below the willingness-to-pay (WTP) threshold of $38,042.49 per QALY, showing marginal cost-effectiveness with an INHB of 0.05 QALYs and an INMB of $1,852.49. Subgroup analyses revealed ICERs of $23,853.52 for patients with a PD-L1 TAP score ≥ 5% (TAP ≥ 5%). In the US, the ICER was $502,786.22 per QALY in the intent-to-treat (ITT) and $321,395.28 per QALY in the TAP ≥ 5% subgroup, exceeding the US WTP threshold of $150,000.00. In China, tislelizumab plus chemotherapy is a cost-effective first-line therapy for unresectable GC/GEJC in both ITT and TAP ≥ 5% subgroups. In the US, tislelizumab plus chemotherapy is not cost-effective.

Comparative efficacy of raw and modified magnesite in the defluoridation of aqueous solutions

Groundwater contamination with fluoride poses a significant global health challenge, critically affecting over one-third of the population in the north western state of Rajasthan, India. This study investigates the possibility of using magnesite, a readily available mineral in the area, as a cost-effective and locally producible option for removing fluoride. We investigated the fluoride adsorption capabilities of magnesite samples, subjected to various treatments including heat treatment at 600 °C, cold-plasma treatment, and coating with aluminium hydroxide to enhance their adsorption efficiency. The results showed that both heat-treated and cold-plasma treated magnesite had excellent abilities to remove fluoride. The cold-plasma treated samples had the highest adsorbent capacity, reaching a maximum of 9.92 mg/g at pH 9. The adsorption effectiveness of both untreated and modified magnesite was continuously high within the pH range of 5–10. It is discovered that at pH values lower than or equivalent to the point of zero charge, the capacity to remove fluoride remains mostly unchanged. This implies that the primary aspect contributing to fluoride removal is mainly due to non-specific adsorption mechanisms including columbic forces. These favorable results suggest that, while the modified magnesite demonstrates marginally improved performance, the raw magnesite powder may offer greater cost-effectiveness.

Association of soft drusen with risk of all-cause and specific-cause mortality in the National Health and Nutrition Examination Survey, 2005 to 2008.

The aim of this study is to investigate the correlation between soft drusen and the likelihood of mortality from all causes and specific ailments within a representative United States population. This cohort study encompassed 4497 individuals from the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES) cycles, and followed for survival to December 31, 2019. Data on soft drusen were obtained from fundus images. Survey-weighted Cox regression models were utilized to evaluate the hazard of soft drusen incidence and mortality. After a median follow-up of 12.33 (11.33, 12.58) years, 1014 (22.5%) patients died from all causes. Overall, individuals with soft drusen exhibited an increased risk for all-cause mortality (HR 1.41; 95% CI 1.22 to 1.64), cardiovascular disease (CVD)-related death (HR 1.53; 95% CI 1.15 to 2.04), and mortality from other causes (HR 1.48; 95% CI 1.20 to 1.83). Further stratified analysis revealed that the mortality rates were heightened in participants who had distinct soft drusen or both types of soft drusen, as well as those with soft drusen measuring 500μm or more in diameter. The investigation revealed that soft drusen was linked to all-cause mortality, CVD mortality, and mortality resulting from non-cardiovascular and non-cancerous conditions, indicating that soft drusen may symbolize frailty and aging processes.

Taking Attendance: Estimating Homeschooling Populations in States without Official Homeschool Data – a Pilot Analysis in Missouri

ABSTRACT There are over one million school-age children in Missouri, and we estimate 61,000 (6% of all school-age children) are homeschooled. Missouri is one of 29 states that does not require homeschooling to be reported. Using methods that can be replicated elsewhere with publicly available data, we test three approaches to estimating homeschool participation: using American Community Survey (ACS) data; subtracting public and estimated private school counts from ACS school-age totals; and polling parents. We comment on the usefulness and limitations of each approach and provide a model for researchers seeking to estimate homeschooling trends in states that lack administrative data.